Hispanic/Latino Non-Small Cell Lung Cancer Patients Have Higher Overall Survival Than Non-Hispanic White Patients
Analysis of non-small cell lung cancer (NSCLC) patient records in the California Cancer Registry (CCR) database during the 20-year period of 1988-2008 indicates that Hispanics/Latinos with NSCLC have a higher overall survival compared to non-Hispanic white patients, according to research presented at the 2012 Chicago Multidisciplinary Symposium in Thoracic Oncology. This symposium is sponsored by the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), the International Association for the Study of Lung Cancer (IASLC) and The University of Chicago.
This study evaluated the records of 14,829 Hispanic patients from the CCR from 1988-2008. Foreign-born Hispanics had a 14 percent decreased risk for death compared to U.S.-born Hispanic patients, including individual patient factors and clinical factors. Adjustments for neighborhood factors, specifically socioeconomic status and ethnicity, slightly moderated the significant decrease in death risk among foreign-born Hispanics. The data also indicates that foreign-born Hispanics who lived in the least U.S.-assimilated neighborhoods had the better overall survival.
“The results of this study confirm the ‘Hispanic paradox’ of improved survival rates for Hispanic/Latino NSCLC patients compared to non-Hispanic white patients, despite lower socioeconomic status,” said lead author Manali Patel, MD, a post-doctoral fellow in the hematology/oncology department at Stanford University in Stanford, Calif. “Social and neighborhood factors, in addition to being foreign-born, appear to be positive contributing factors to incidence and survival that need further study.”
The abstract, “How Do Social Factors Explain Outcomes in Non-small Cell Lung Cancer Among Hispanic/Latinos in California?” was presented during the Poster Discussion at 5:30 p.m. Central time on September 6, 2012.
How Do Social Factors Explain Outcomes In Non-small Cell Lung Cancer Among Hispanic/Latinos In California?
M. I. Patel1, E. Chang2, S. Gomez2, H. A. Wakelee1, 1Stanford University, Stanford, Calif., 2Cancer Prevention Institute of California, Fremont, Calif.
Purpose/Objective(s): Hispanics in the United States have a lower age-adjusted incidence and mortality rate from non-small cell lung cancer compared with non-Hispanic whites. The better survival rates of Hispanics as compared with non-Hispanic whites despite lower socioeconomic status is known as the “Hispanic paradox.” Previous studies have demonstrated the influence of birthplace (nativity) on survival among Hispanic patients but no studies to date have evaluated the interplay of nativity, clinical factors, social factors, and neighborhood factors on survival among Hispanic patients with non-small cell lung cancer.
Materials/Methods: All Hispanic patients with non-small cell lung cancer between the years of 1988-2008 were identified in the California Cancer Registry (CCR). Kaplan Meier curves depict survival by nativity status among Hispanics with non-small cell lung cancer. Cox proportional hazard models estimate the hazard of mortality by race with adjustment for individual covariates (age, gender, marital status), clinical factors (histologic grade, surgery, radiation, and chemotherapy), and social and neighborhood factors (neighborhood and ethnic enclave status).
Results: A total of 4,062 Hispanic patients with non small cell lung cancer were included. Overall, there was a 7% decreased risk of disease-specific mortality for foreign-born patients as compared with US-born Hispanic patients (HR 0.93, p=0.08, 95% CI 0.87-1.00) although this result was not-statistically significant. Adjustment for individual patient factors and clinical factors resulted in a statistically significant 16% decreased risk of disease-specific mortality for foreign-born Hispanic patients compared with US-born Hispanic patients (HR 0.84, p<0.0001, 95% CI 0.78-0.91). Adjustment for socioeconomic status, neighborhood socioeconomic status and ethnic enclave status did not explain the differences in survival between the foreign-born and US-born Hispanic patients (HR 0.84, p <0.001, 95% CI 0.78-0.91).
Conclusions: Overall, foreign-born Hispanics with non-small cell lung cancer have a decreased risk of disease-specific mortality compared with US-born Hispanics with non-small cell lung cancer. Social factors do not fully explain this survival advantage. Further investigation is needed to understand the drivers of the survival advantage outcomes in foreign-born populations.
Author Disclosure Block: M.I. Patel: None. E. Chang: None. S. Gomez: None. H.A. Wakelee: E. Research Grant; ECOG. F. Honoraria; Educational Concepts Group, Medical Learning Institute, PER Group, LP.