2019 STS: How Socioeconomic Status Impacts Outcomes in Non–Small Cell Lung Cancer
Posted: Wednesday, February 13, 2019
Patients appear to be at higher risk of failing to receive guideline-recommended adjuvant chemotherapy for non–small cell lung cancer (NSCLC) if they are less educated, live in a rural area, or are uninsured or have Medicaid, according to a study by Anthony W. Kim, MD, of the Keck School of Medicine, University of Southern California, Los Angeles, and colleagues. Their study insights were presented at the 2019 Society of Thoracic Surgeons (STS) Annual Meeting in San Diego.
“Given the significant survival benefit of adjuvant chemotherapy in this context, physicians must be mindful of these findings and take steps to mitigate perpetuating these disparities,” encouraged the investigators.
The study focused on records from the National Cancer Database of 69,168 patients who underwent lobectomy, bilobectomy, or pneumonectomy for stage I NSCLC between 2004 and 2014. Patients were categorized into three groups: those who underwent surgery alone, those who underwent nonstandard treatments such as chemotherapy with or without radiation therapy, and those who received no therapy. The 5-year survival of all groups was evaluated.
The socioeconomic variables used to compare the groups included race, income, insurance, urban/rural residence, and education. Not only were less-educated patients who resided in rural areas or were uninsured or on Medicaid less likely to receive adjuvant chemotherapy, but less-educated and uninsured patients also had a higher risk of mortality. Additionally, the overall survival was significantly higher for those receiving multiagent adjuvant chemotherapy.
Moreover, for patients who underwent treatment with or without radiation therapy versus those who had surgery, each additional socioeconomic status factor “conferred a nearly constant increase in rise of risk,” the authors noted.
Disclosure: The study authors’ disclosure information can be found at sts.org.
