Lung cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study

Abstract

Background: Results from the second CONCORD study (CONCORD-2) indicated that 5-year net survival for lung cancer was low (range, 10%-20%) between 1995 and 2009 in most countries, including the United States, which was at the higher end of this range.

Methods: Data from CONCORD-2 were used to analyze net survival among patients with lung cancer (aged 15-99 years) who were diagnosed in 37 states covering 80% of the US population. Survival was corrected for background mortality using state-specific and race-specific life tables and age-standardized using International Cancer Survival Standard weights. Net survival was estimated for patients diagnosed between 2001 and 2003 and between 2004 and 2009 at 1, 3, and 5 years after diagnosis by race (all races, black, and white); Surveillance, Epidemiology, and End Results Summary Stage 2000; and US state.

Results: Five-year net survival increased from 16.4% (95% confidence interval, 16.3%-16.5%) for patients diagnosed 2001-2003 to 19.0% (18.8%-19.1%) for those diagnosed 2004-2009, with increases in most states and among both blacks and whites. Between 2004 and 2009, 5-year survival was lower among blacks (14.9%) than among whites (19.4%) and ranged by state from 14.5% to 25.2%.

Conclusions: Lung cancer survival improved slightly between the periods 2001-2003 and 2004-2009 but was still low, with variation between states, and persistently lower survival among blacks than whites. Efforts to control well established risk factors would be expected to have the greatest impact on reducing the burden of lung cancer, and efforts to ensure that all patients receive timely and appropriate treatment should reduce the differences in survival by race and state. Cancer 2017;123:5079-99. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Keywords: cancer registries; disparities; lung neoplasms; population-based survival; race; stage; survival; trends.

Figure 1

5-year, age-standardized net survival (%) is illustrated for adult patients (men and women aged 15–99 years) diagnosed with lung cancer between 2001 and 2003 and between 2004 and 2009 with the absolute change (%). States are grouped by US Census Region and are ranked within Census Region by the survival estimate for 2004 to 2009. Dark colors indicate states affiliated with the National Program of Cancer Registries; pale colors, states affiliated with the Surveillance, Epidemiology, and End Results program. An asterisk indicates registries affiliated with both federal surveillance programs. Change (%) is not plotted if the survival estimate for 1 or both periods was not age standardized.

Figure 2

Lung cancer 5-year, age-standardized net survival (%) is illustrated for adult patients (men and women aged 15–99 years) by state, race, and calendar period of diagnosis. The pooled US survival for each calendar period is indicated by the horizontal (solid) line.