HSR22-166: Patient Demographic and Socioeconomic Differences in Non-Small Cell and Small Cell Lung Cancers: Impact on Outcomes. A National Cancer Database Analysis.

Authors:
Logan Roof Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH

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Wei Wei Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH

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James P Stevenson Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH

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Background: We recently queried the National Cancer Database (NCDB) to study demographic and socioeconomic factors in small cell lung cancer (SCLC) and found many disparities that correspond with access to healthcare resources, including rural communities, distance to an academic center, income, insurer, and education level. The goal of this study was to determine whether the same disparities exist in non-small cell lung cancer (NSCLC), and how the patient demographics and outcomes compare to those observed in SCLC. Methods: We identified all patients with NSCLC and SCLC in the NCDB from 2004 to 2016. Differences in demographic, disease, and treatment characteristics were assessed by year of diagnosis using Chi-square test. The effect of age, race, insurance status, income, distance to treatment center, and education level on overall survival (OS) was assessed by log-rank test. Results: Median OS for NSCLC patients was 17.48 months (95% CI: 17.41-17.54) with a 5-year OS of 27.2% (95% CI: 27.1-27.2). Median OS for SCLC patients was 8.51 months (95% CI: 8.48-8.54) with a 5-year OS of 7.6% (95% CI: 7.5-7.7). Of the total number of lung cancer cases, SCLC made up 14.2% between 2004-2010 and 11.5% between 2011-2016. Patients with NSCLC were noted to be significantly younger, were more frequently male, African American and Hispanic, had less comorbidities, and had a higher mean income than patients with SCLC. More stage I-III disease and less stage IV disease were diagnosed in NSCLC. Patients with NSCLC had significantly higher rates of surgery, and underwent less radiation therapy and chemotherapy as compared to SCLC. OS in general improved in both disease groups over time, despite more stage IV disease diagnosed in the later time period. In both groups, older patients, males, those with more co-morbidities, stage IV disease, government primary payer insurance, and living in rural areas had significantly worse OS (p<0.0001 for all). Patients with higher income, treated at an academic center, higher mean community education level, and who received surgery had significantly better OS (p<0.0001 for all). Conclusions: Despite notable differences in incidence, patient demographics, and treatment modalities between NSCLC and SCLC, the same healthcare disparities exist. These factors were found to have an impact on survival in both groups.

Corresponding Author: Logan Roof, MD
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