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Background: Non-small cell lung carcinoma (NSCLC) is the most common type of lung cancer. According to a Surveillance, Epidemiology, and End Results (SEER) database analysis, the 5-year survival rates for clinical stages IA, IB, IIA, and IIB NSCLC are 50%, 43%, 36%, and 25%, respectively. Even with advances in therapies in both the surgical and medical fields, patient outcomes remain suboptimal. Our aim was to assess the role of various demographic and insurance characteristics on patient survival in early stage (stage I and II) NSCLC.
Methods: This is a retrospective study of patients diagnosed with stage I and stage II NSCLC between 1998 and 2012 utilizing the National Cancer Database (NCDB) participant user file (PUF). The NCDB is a nationwide oncology outcomes database for more than 1,500 American College of Surgeons Commission on Cancer-accredited cancer programs. The impact of various factors on survival was analyzed using the Cox proportional hazards model.
Results: A total of 304,092 patients with early stage NSCLC were analyzed for this study. On multivariate analysis, the factors associated with decreased survival were male (hazard ratio [HR] 1.32, P < .0001) compared with female, increasing age (HR 1.036, P < .0001), African American (HR 1.15, P < .0001) compared with white, and rural residency (HR 1.146, P < .0001) compared with metro areas. Privately insured patients had better survival when compared with uninsured patients (HR 0.674, P < .0001), whereas Medicaid patients had the worst survival (HR 1.076, P < .0001). Also, the patients who were diagnosed between 2008 and 2012 had a higher survival than those diagnosed earlier (HR 0.645, P < .0001).
Discussion: The above data suggest that there is a disparity in outcomes among patients with early stage NSCLC based on various demographic and health system factors. Despite an overall increase in survival due to improved therapies from 1998 to 2012, significant differences exist in terms of patient age, gender, race, residency, and insurance status. This could be secondary to decreased receipt of appropriate treatment in certain subgroups or due to a difference in cancer biology in some of these groups. Nevertheless, this study suggests room for improvement in health care delivery to all patients for optimal outcomes.
Background: Non-small cell lung carcinoma (NSCLC) is the most common type of lung cancer. According to a Surveillance, Epidemiology, and End Results (SEER) database analysis, the 5-year survival rates for clinical stages IA, IB, IIA, and IIB NSCLC are 50%, 43%, 36%, and 25%, respectively. Even with advances in therapies in both the surgical and medical fields, patient outcomes remain suboptimal. Our aim was to assess the role of various demographic and insurance characteristics on patient survival in early stage (stage I and II) NSCLC.
Methods: This is a retrospective study of patients diagnosed with stage I and stage II NSCLC between 1998 and 2012 utilizing the National Cancer Database (NCDB) participant user file (PUF). The NCDB is a nationwide oncology outcomes database for more than 1,500 American College of Surgeons Commission on Cancer-accredited cancer programs. The impact of various factors on survival was analyzed using the Cox proportional hazards model.
Results: A total of 304,092 patients with early stage NSCLC were analyzed for this study. On multivariate analysis, the factors associated with decreased survival were male (hazard ratio [HR] 1.32, P < .0001) compared with female, increasing age (HR 1.036, P < .0001), African American (HR 1.15, P < .0001) compared with white, and rural residency (HR 1.146, P < .0001) compared with metro areas. Privately insured patients had better survival when compared with uninsured patients (HR 0.674, P < .0001), whereas Medicaid patients had the worst survival (HR 1.076, P < .0001). Also, the patients who were diagnosed between 2008 and 2012 had a higher survival than those diagnosed earlier (HR 0.645, P < .0001).
Discussion: The above data suggest that there is a disparity in outcomes among patients with early stage NSCLC based on various demographic and health system factors. Despite an overall increase in survival due to improved therapies from 1998 to 2012, significant differences exist in terms of patient age, gender, race, residency, and insurance status. This could be secondary to decreased receipt of appropriate treatment in certain subgroups or due to a difference in cancer biology in some of these groups. Nevertheless, this study suggests room for improvement in health care delivery to all patients for optimal outcomes.
Background: Non-small cell lung carcinoma (NSCLC) is the most common type of lung cancer. According to a Surveillance, Epidemiology, and End Results (SEER) database analysis, the 5-year survival rates for clinical stages IA, IB, IIA, and IIB NSCLC are 50%, 43%, 36%, and 25%, respectively. Even with advances in therapies in both the surgical and medical fields, patient outcomes remain suboptimal. Our aim was to assess the role of various demographic and insurance characteristics on patient survival in early stage (stage I and II) NSCLC.
Methods: This is a retrospective study of patients diagnosed with stage I and stage II NSCLC between 1998 and 2012 utilizing the National Cancer Database (NCDB) participant user file (PUF). The NCDB is a nationwide oncology outcomes database for more than 1,500 American College of Surgeons Commission on Cancer-accredited cancer programs. The impact of various factors on survival was analyzed using the Cox proportional hazards model.
Results: A total of 304,092 patients with early stage NSCLC were analyzed for this study. On multivariate analysis, the factors associated with decreased survival were male (hazard ratio [HR] 1.32, P < .0001) compared with female, increasing age (HR 1.036, P < .0001), African American (HR 1.15, P < .0001) compared with white, and rural residency (HR 1.146, P < .0001) compared with metro areas. Privately insured patients had better survival when compared with uninsured patients (HR 0.674, P < .0001), whereas Medicaid patients had the worst survival (HR 1.076, P < .0001). Also, the patients who were diagnosed between 2008 and 2012 had a higher survival than those diagnosed earlier (HR 0.645, P < .0001).
Discussion: The above data suggest that there is a disparity in outcomes among patients with early stage NSCLC based on various demographic and health system factors. Despite an overall increase in survival due to improved therapies from 1998 to 2012, significant differences exist in terms of patient age, gender, race, residency, and insurance status. This could be secondary to decreased receipt of appropriate treatment in certain subgroups or due to a difference in cancer biology in some of these groups. Nevertheless, this study suggests room for improvement in health care delivery to all patients for optimal outcomes.