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. 2022 Jun 18;3(7):100360.
doi: 10.1016/j.jtocrr.2022.100360. eCollection 2022 Jul.

Impact of Socioeconomic Factors on Overall Survival in SCLC

Logan Roof  1 , Wei Wei  1 , Katherine Tullio  1 , Nathan A Pennell  1 , James P Stevenson  1
Affiliations

Impact of Socioeconomic Factors on Overall Survival in SCLC

Logan Roof et al. JTO Clin Res Rep. .

Abstract

Objectives: To determine how the incidence and demographics of SCLC have changed over time and to evaluate whether patient demographics, disease presentation, and treatment characteristics affect patient outcomes.

Methods: We identified patients with SCLC in the National Cancer Database from 2004 to 2016. Differences in demographics, 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 evaluated by multivariable Cox proportional hazard model.

Results: Patients diagnosed after 2010 were significantly older, more frequently treated at academic centers, had more comorbidities, had government payer insurance, had more stage IV disease, and lived further from treatment centers. More females, African Americans, patients without high school diplomas, and those from rural areas were diagnosed after 2010. In patients diagnosed between 2004 and 2010, 5-year OS was 6.8% (95% confidence interval: 6.6-6.9), and after 2010, 5-year OS was 8.7% (95% confidence interval: 8.5-8.9), despite an increase in stage IV disease in the latter group. Older patients, males, Caucasians, patients with stage IV disease, those with government primary payer insurance, and those from rural areas had significantly worse OS. Patients without comorbidities and treated at academic centers had significantly better OS. OS significantly increased with community income and education level.

Conclusions: Despite improvement in OS, disparities were noted in demographics which may complicate patient and provider access to health care resources, including rural communities, distance to academic centers, income, insurer, and education level. Efforts to affect these variables will improve outcomes for patients with SCLC.

Keywords: Healthcare disparities; Outcomes; Small cell lung cancer; Socioeconomic factors.

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Figures

Figure 1
Figure 1
OS by stage/surgery status for all patients diagnosed in 2004 to 2016. OS, overall survival.
Figure 2
Figure 2
OS by stage/RT status for all patients diagnosed in 2004 to 2016. OS, overall survival; RT, radiation therapy.
Figure 3
Figure 3
OS by stage/chemo status for all patients diagnosed in 2004 to 2016. Chemo, chemotherapy; OS, overall survival.
See this image and copyright information in PMC

References

    1. Govindan R., Page N., Morgensztern D., et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006;24:4539–4544. - PubMed
    1. Jemal A., Thun M.J., Ries L.A., et al. Annual report to the nation on the status of cancer, 1975–2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst. 2008;100:1672–1694. - PMC - PubMed
    1. Alberg A.J., Samet J.M. Epidemiology of lung cancer. Chest. 2003;123(1 suppl):21S–49S. - PubMed
    1. Travis W.D. Advances in neuroendocrine lung tumors. Ann Oncol. 2010;21(suppl 7):vii65–vii71. - PubMed
    1. Travis W.D., Brambilla E., Nicholson A.G., et al. The 2015 World Health Organization Classification of Lung Tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015;10:1243–1260. - PubMed

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