The role of race and economic characteristics in the presentation and survival of patients with surgically resected non-small cell lung cancer

John M. Varlotto*, Kerri McKie, Rickie P. Voland, John C. Flickinger, Malcom McAvoy DeCamp Jr, Debra Maddox, Paul Stephen Rava, Thomas J. Fitzgerald, William Walsh, Paulo Oliveira, Negar Rassaei, Jennifer Baima, Karl Uy

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Little is understood regarding the inter-relation between economic, marital, and racial/ethnic differences in presentation and survival of surgically resected lung cancer patients. Our investigation will assess these differences in addition to known therapeutic, patient, and histopathologic factors. Methods: A retrospective review of the Surveillance Epidemiology and End Reporting database was conducted through the years 2007-2012. The population was split into nine different ethnic groups. Population differences were assessed via chi-square testing. Multivariable analysis (MVA) were used to detect overall survival (OS) differences in the total surgical population (TS, N = 35,689) in an ear (T1-T2 < 4 cm N0) surgical population [early-stage resectable (ESR), N = 17,931]. Lung cancer-specific survival (LCSS) was assessed in the ESR. Results: In the TS population, as compared to Whites, Blacks, and Hispanics presented with younger age, more adenocarcinomas, lower rates of marriage, lower rates of insurance, less stage I tumors, and had less nodes examined, but their type of surgical procedures and OS/LCSS were the same. MVA demonstrated that lower OS and LCSS were associated with males, single/divorced/widowed partnership, lower income (TS only), and Medicaid insurance. MVA also found that Blacks and Hispanics had a similar OS/LCSS to Whites and that all ethnic groups were associated with a similar or better outcomes. The 90-day mortality and positive nodes were correlated with not having insurance and not being married, but they were not associated with ethnicity. Conclusion: In TS and ESR groups, OS was not different in the two largest ethnic groups (Black and Hispanic) as compared to Whites, but was related to single/widowed/divorced status, Medicaid insurance, and income (TS group only). Nodal positivity was associated with patients who did not have a married partner or insurance suggesting that these factors may impact disease biology. Economic and psychosocial variables may play a role in survival of ear lung cancer in addition to standard histopathologic and treatment variables.

Original languageEnglish (US)
Article number146
JournalFrontiers in Oncology
Volume8
Issue numberMAY
DOIs
StatePublished - May 14 2018

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Non-Small Cell Lung Carcinoma
Economics
Survival
Lung Neoplasms
Insurance
Hispanic Americans
Ethnic Groups
Widowhood
Divorce
Population
Medicaid
Ear Neoplasms
Insurance Coverage
Marriage
Ear
Epidemiology
Adenocarcinoma
Databases
Mortality

Keywords

  • Lung cancer
  • Marital status
  • Racial differences
  • Socioeconomic status
  • Surgical resection

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Varlotto, John M. ; McKie, Kerri ; Voland, Rickie P. ; Flickinger, John C. ; DeCamp Jr, Malcom McAvoy ; Maddox, Debra ; Rava, Paul Stephen ; Fitzgerald, Thomas J. ; Walsh, William ; Oliveira, Paulo ; Rassaei, Negar ; Baima, Jennifer ; Uy, Karl. / The role of race and economic characteristics in the presentation and survival of patients with surgically resected non-small cell lung cancer. In: Frontiers in Oncology. 2018 ; Vol. 8, No. MAY.
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abstract = "Background: Little is understood regarding the inter-relation between economic, marital, and racial/ethnic differences in presentation and survival of surgically resected lung cancer patients. Our investigation will assess these differences in addition to known therapeutic, patient, and histopathologic factors. Methods: A retrospective review of the Surveillance Epidemiology and End Reporting database was conducted through the years 2007-2012. The population was split into nine different ethnic groups. Population differences were assessed via chi-square testing. Multivariable analysis (MVA) were used to detect overall survival (OS) differences in the total surgical population (TS, N = 35,689) in an ear (T1-T2 < 4 cm N0) surgical population [early-stage resectable (ESR), N = 17,931]. Lung cancer-specific survival (LCSS) was assessed in the ESR. Results: In the TS population, as compared to Whites, Blacks, and Hispanics presented with younger age, more adenocarcinomas, lower rates of marriage, lower rates of insurance, less stage I tumors, and had less nodes examined, but their type of surgical procedures and OS/LCSS were the same. MVA demonstrated that lower OS and LCSS were associated with males, single/divorced/widowed partnership, lower income (TS only), and Medicaid insurance. MVA also found that Blacks and Hispanics had a similar OS/LCSS to Whites and that all ethnic groups were associated with a similar or better outcomes. The 90-day mortality and positive nodes were correlated with not having insurance and not being married, but they were not associated with ethnicity. Conclusion: In TS and ESR groups, OS was not different in the two largest ethnic groups (Black and Hispanic) as compared to Whites, but was related to single/widowed/divorced status, Medicaid insurance, and income (TS group only). Nodal positivity was associated with patients who did not have a married partner or insurance suggesting that these factors may impact disease biology. Economic and psychosocial variables may play a role in survival of ear lung cancer in addition to standard histopathologic and treatment variables.",
keywords = "Lung cancer, Marital status, Racial differences, Socioeconomic status, Surgical resection",
author = "Varlotto, {John M.} and Kerri McKie and Voland, {Rickie P.} and Flickinger, {John C.} and {DeCamp Jr}, {Malcom McAvoy} and Debra Maddox and Rava, {Paul Stephen} and Fitzgerald, {Thomas J.} and William Walsh and Paulo Oliveira and Negar Rassaei and Jennifer Baima and Karl Uy",
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Varlotto, JM, McKie, K, Voland, RP, Flickinger, JC, DeCamp Jr, MM, Maddox, D, Rava, PS, Fitzgerald, TJ, Walsh, W, Oliveira, P, Rassaei, N, Baima, J & Uy, K 2018, 'The role of race and economic characteristics in the presentation and survival of patients with surgically resected non-small cell lung cancer', Frontiers in Oncology, vol. 8, no. MAY, 146. https://doi.org/10.3389/fonc.2018.00146

The role of race and economic characteristics in the presentation and survival of patients with surgically resected non-small cell lung cancer. / Varlotto, John M.; McKie, Kerri; Voland, Rickie P.; Flickinger, John C.; DeCamp Jr, Malcom McAvoy; Maddox, Debra; Rava, Paul Stephen; Fitzgerald, Thomas J.; Walsh, William; Oliveira, Paulo; Rassaei, Negar; Baima, Jennifer; Uy, Karl.

In: Frontiers in Oncology, Vol. 8, No. MAY, 146, 14.05.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The role of race and economic characteristics in the presentation and survival of patients with surgically resected non-small cell lung cancer

AU - Varlotto, John M.

AU - McKie, Kerri

AU - Voland, Rickie P.

AU - Flickinger, John C.

AU - DeCamp Jr, Malcom McAvoy

AU - Maddox, Debra

AU - Rava, Paul Stephen

AU - Fitzgerald, Thomas J.

AU - Walsh, William

AU - Oliveira, Paulo

AU - Rassaei, Negar

AU - Baima, Jennifer

AU - Uy, Karl

PY - 2018/5/14

Y1 - 2018/5/14

N2 - Background: Little is understood regarding the inter-relation between economic, marital, and racial/ethnic differences in presentation and survival of surgically resected lung cancer patients. Our investigation will assess these differences in addition to known therapeutic, patient, and histopathologic factors. Methods: A retrospective review of the Surveillance Epidemiology and End Reporting database was conducted through the years 2007-2012. The population was split into nine different ethnic groups. Population differences were assessed via chi-square testing. Multivariable analysis (MVA) were used to detect overall survival (OS) differences in the total surgical population (TS, N = 35,689) in an ear (T1-T2 < 4 cm N0) surgical population [early-stage resectable (ESR), N = 17,931]. Lung cancer-specific survival (LCSS) was assessed in the ESR. Results: In the TS population, as compared to Whites, Blacks, and Hispanics presented with younger age, more adenocarcinomas, lower rates of marriage, lower rates of insurance, less stage I tumors, and had less nodes examined, but their type of surgical procedures and OS/LCSS were the same. MVA demonstrated that lower OS and LCSS were associated with males, single/divorced/widowed partnership, lower income (TS only), and Medicaid insurance. MVA also found that Blacks and Hispanics had a similar OS/LCSS to Whites and that all ethnic groups were associated with a similar or better outcomes. The 90-day mortality and positive nodes were correlated with not having insurance and not being married, but they were not associated with ethnicity. Conclusion: In TS and ESR groups, OS was not different in the two largest ethnic groups (Black and Hispanic) as compared to Whites, but was related to single/widowed/divorced status, Medicaid insurance, and income (TS group only). Nodal positivity was associated with patients who did not have a married partner or insurance suggesting that these factors may impact disease biology. Economic and psychosocial variables may play a role in survival of ear lung cancer in addition to standard histopathologic and treatment variables.

AB - Background: Little is understood regarding the inter-relation between economic, marital, and racial/ethnic differences in presentation and survival of surgically resected lung cancer patients. Our investigation will assess these differences in addition to known therapeutic, patient, and histopathologic factors. Methods: A retrospective review of the Surveillance Epidemiology and End Reporting database was conducted through the years 2007-2012. The population was split into nine different ethnic groups. Population differences were assessed via chi-square testing. Multivariable analysis (MVA) were used to detect overall survival (OS) differences in the total surgical population (TS, N = 35,689) in an ear (T1-T2 < 4 cm N0) surgical population [early-stage resectable (ESR), N = 17,931]. Lung cancer-specific survival (LCSS) was assessed in the ESR. Results: In the TS population, as compared to Whites, Blacks, and Hispanics presented with younger age, more adenocarcinomas, lower rates of marriage, lower rates of insurance, less stage I tumors, and had less nodes examined, but their type of surgical procedures and OS/LCSS were the same. MVA demonstrated that lower OS and LCSS were associated with males, single/divorced/widowed partnership, lower income (TS only), and Medicaid insurance. MVA also found that Blacks and Hispanics had a similar OS/LCSS to Whites and that all ethnic groups were associated with a similar or better outcomes. The 90-day mortality and positive nodes were correlated with not having insurance and not being married, but they were not associated with ethnicity. Conclusion: In TS and ESR groups, OS was not different in the two largest ethnic groups (Black and Hispanic) as compared to Whites, but was related to single/widowed/divorced status, Medicaid insurance, and income (TS group only). Nodal positivity was associated with patients who did not have a married partner or insurance suggesting that these factors may impact disease biology. Economic and psychosocial variables may play a role in survival of ear lung cancer in addition to standard histopathologic and treatment variables.

KW - Lung cancer

KW - Marital status

KW - Racial differences

KW - Socioeconomic status

KW - Surgical resection

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