Disparities in lung cancer survival and receipt of surgical treatment

Abstract

Background: Lung cancer accounts for the greatest proportion of cancer deaths in the United States. This study aims to characterize lung cancer survival by racial/ethnic group and ascertain any modifiable determinants of identified disparities in the newly diverse Mountain West by using the state of Nevada.

Materials and methods: 12,964 first primary lung cancer cases diagnosed between 2003 and 2010 were identified for analysis from the Nevada Central Cancer Registry and followed for vital status until December 31, 2011. Standardized age-adjusted five-year survival stratified by race/ethnicity was computed using life table methods. Hazard ratios adjusted for covariates were estimated using Cox proportional hazards regression modeling. Adjusted odds of receiving surgical treatment for localized non-small cell lung cancer by region of Nevada were compared using logistic regression.

Results: By the end of the follow-up period, 86% of lung cancer cases in Nevada were deceased. Five-year overall survival was 12.3% (95%CI: 11.5-13.1) for males and 18.9% (95%CI: 17.9-19.9) for females. Compared to cases in Northwestern Nevada, patients in Southern and Rural Nevada had 9% (HR:1.09; 95% CI:1.04-1.14) and 10% (HR:1.10; 95% CI:1.02-1.19) higher risk of dying from lung cancer, respectively. For localized non-small cell lung cancer (NSCLC), which is potentially curable, Southern Nevadans had 67% higher odds of not receiving surgical treatment than Northwestern Nevadans (OR 1.67; 95%CI: 1.30-2.13).

Conclusions: While the prognosis for lung cancer survival in Nevada is poor for all populations, there is no racial/ethnic disparity. However, there is a considerable survival disparity by geographic region, with Southern Nevadans disproportionately impacted. Potential modifiable factors include treatment differences, particularly in receipt of surgery for potentially curative tumor types such as localized NSCLC. Further studies are required to identify barriers to receipt of surgery in Southern Nevada.

Keywords: Disparity; Lung cancer; Nevada; Surgery; Survival.