TY - JOUR
T1 - Racial disparities and survival for nonsmall-cell lung cancer in a large cohort of black and white elderly patients
AU - Hardy, Dale
AU - Xia, Rui
AU - Liu, Chih Chin
AU - Cormier, Janice N.
AU - Nurgalieva, Zhannat
AU - Du, Xianglin L.
PY - 2009/10/15
Y1 - 2009/10/15
N2 - BACKGROUND: This study aimed to examine disparities in survival and associated factors for patients with nonsmall-cell lung cancer (NSCLC) and to determine whether racial disparities varied over time (1991-1995, 1996-1999, and 2000-2002). METHODS: The authors studied 70,901 patients aged ≥65 years with stage I-IV NSCLC identified from Surveillance, Epidemiology, and End Results/Medicare data. Multivariate time-to-event survival analyses were completed using Cox proportional regression modeling. RESULTS: The 5-year observed lung cancer-specific survival rates were 52.7% for whites and 47.5% for blacks with stage I-II disease, and 17.7% and 19.6% for whites and blacks, respectively at stages III-IV. After controlling for standard treatment, socioeconomic status (SES), and other factors, there were no significant differences in all-cause mortality, or lung cancer-specific mortality between black and white patients with stage I-II or III-IV lung cancer. However, blacks had an increased risk for overall all-cause mortality at stage I-IV (hazard ratio [HR], 1.24; 95% confidence interval, 1.13-1.35), and during 2000-2002 at stage III-IV for all-cause mortality (HR, 1.22; 95% CI, 1.02-1.47) and lung cancer-specific mortality (HR, 1.24; 95% CI,1.01-1.53). Standard treatment was significantly associated with increased survival, whereas poor SES was associated with increased mortality. CONCLUSIONS: There were no significant differences in survival between blacks and whites with NSCLC within stage stratifications after adjusting for covariates, except for black patients at overall stage for all-cause mortality and at stage III-IV diagnosed in 2000-2002. Receiving stage-specific evidence-based standard therapy was associated with significantly increased survival.
AB - BACKGROUND: This study aimed to examine disparities in survival and associated factors for patients with nonsmall-cell lung cancer (NSCLC) and to determine whether racial disparities varied over time (1991-1995, 1996-1999, and 2000-2002). METHODS: The authors studied 70,901 patients aged ≥65 years with stage I-IV NSCLC identified from Surveillance, Epidemiology, and End Results/Medicare data. Multivariate time-to-event survival analyses were completed using Cox proportional regression modeling. RESULTS: The 5-year observed lung cancer-specific survival rates were 52.7% for whites and 47.5% for blacks with stage I-II disease, and 17.7% and 19.6% for whites and blacks, respectively at stages III-IV. After controlling for standard treatment, socioeconomic status (SES), and other factors, there were no significant differences in all-cause mortality, or lung cancer-specific mortality between black and white patients with stage I-II or III-IV lung cancer. However, blacks had an increased risk for overall all-cause mortality at stage I-IV (hazard ratio [HR], 1.24; 95% confidence interval, 1.13-1.35), and during 2000-2002 at stage III-IV for all-cause mortality (HR, 1.22; 95% CI, 1.02-1.47) and lung cancer-specific mortality (HR, 1.24; 95% CI,1.01-1.53). Standard treatment was significantly associated with increased survival, whereas poor SES was associated with increased mortality. CONCLUSIONS: There were no significant differences in survival between blacks and whites with NSCLC within stage stratifications after adjusting for covariates, except for black patients at overall stage for all-cause mortality and at stage III-IV diagnosed in 2000-2002. Receiving stage-specific evidence-based standard therapy was associated with significantly increased survival.
KW - Health disparity
KW - Nonsmall-cell lung cancer
KW - Race/ethnicity
KW - Standard treatment
KW - Survival
KW - Survival rates
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U2 - 10.1002/cncr.24521
DO - 10.1002/cncr.24521
M3 - Article
C2 - 19626650
AN - SCOPUS:70350098235
SN - 0008-543X
VL - 115
SP - 4807
EP - 4818
JO - Cancer
JF - Cancer
IS - 20
ER -