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. 2015 Oct;30(10):1406-12.
doi: 10.1007/s11606-015-3280-z. Epub 2015 Mar 25.

Survival and Racial Differences of Non-Small Cell Lung Cancer in the United States Military

Christina Brzezniak  1 , Sacha Satram-Hoang  2 , Hans-Peter Goertz  3 , Carolina Reyes  3 , Ashok Gunuganti  2 , Christopher Gallagher  4 , Corey A Carter  5
Affiliations

Survival and Racial Differences of Non-Small Cell Lung Cancer in the United States Military

Christina Brzezniak et al. J Gen Intern Med. 2015 Oct.

Abstract

Background: Lung cancer is the leading cause of cancer-related death in the United States (US) Military and worldwide, with non-small cell lung cancer (NSCLC) accounting for 87 % of cases.

Objectives: Using a US military cohort who receives equal and open access to healthcare, we sought to examine demographic, clinical features and outcomes with NSCLC.

Design and participants: We conducted a retrospective cohort analysis of 4,751 patients, aged ≥ 18 years and diagnosed with a first primary NSCLC between 1 January 2003 and 31 December 2013 in the US Department of Defense (DoD) cancer registry.

Main measures: Differences by patient and disease characteristics were compared using Chi-square and t-test. Kaplan Meier curves and Cox proportional hazards regression assessed overall survival.

Results: The mean age at diagnosis was 66 years, 64 % were male, 72 % were Caucasian, 41 % were diagnosed at early stage, 77 % received treatment and 82 % had a history of tobacco use. Mean age at diagnosis was highest among Caucasians (67 years) and lowest among African Americans (AA; 62 years). Asian/Pacific Islanders (PI) were more likely to be female (p < 0.0001), have adenocarcinoma histology (p = 0.0003) and less likely to have a history of tobacco use (p < 0.0001) compared to other racial/ethnic groups. In multivariable survival analysis, older age, male gender, increasing stage, not receiving treatment, and tobacco history were associated with higher mortality risk. Untreated patients exhibited a 39 % higher mortality risk compared to treated patients (HR = 1.39; 95%CI = 1.23-1.57). Compared to Caucasian patients, Asian/PIs demonstrated a 20 % lower risk of death (HR = 0.80; 95%CI = 0.66-0.96). There was no difference in mortality risk between AAs and Hispanics compared to Caucasians.

Conclusion: The lack of significant outcome disparity between AAs and Caucasians and the earlier stage at diagnosis than usually seen in civilian populations suggest that equal access to healthcare may play a role in early detection and survival.

Keywords: lung cancer; military; survival outcomes.

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Figures

Figure 1.
Figure 1.
a. Unadjusted overall survival by stage. b. Unadjusted overall survival by race/ethnicity.
See this image and copyright information in PMC

Comment in

  • Equity in Lung Cancer Care and Outcomes.
    Ibrahim SA. Ibrahim SA. J Gen Intern Med. 2015 Oct;30(10):1385-6. doi: 10.1007/s11606-015-3346-y. J Gen Intern Med. 2015. PMID: 25903994 Free PMC article. No abstract available.

References

    1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11–30. doi: 10.3322/caac.21166. - DOI - PubMed
    1. American Cancer Society. Cancer Facts & Figures 2010. Available at: http://www.cancer.org/acs/groups/content/@nho/documents/document/acspc-0... [accessed February 26, 2015].
    1. Surveillance Epidemiology and End Results (SEER) Stat bite: lung cancer stage at diagnosis in the United States, 1995–2001. J Natl Cancer Inst. 2005;97:1805. doi: 10.1093/jnci/dji454. - DOI - PubMed
    1. Tammemagi CM, Neslund-Dudas C, Simoff M, Kvale P. Lung carcinoma symptoms–an independent predictor of survival and an important mediator of African-American disparity in survival. Cancer. 2004;101:1655–63. doi: 10.1002/cncr.20547. - DOI - PubMed
    1. Tammemagi CM, Neslund-Dudas C, Simoff M, Kvale P. In lung cancer patients, age, race-ethnicity, gender and smoking predict adverse comorbidity, which in turn predicts treatment and survival. J Clin Epidemiol. 2004;57:597–609. doi: 10.1016/j.jclinepi.2003.11.002. - DOI - PubMed

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