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Pranshu Mohindra



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    P1.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 947)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.15-31 - Survival and Patterns of Care Comparing Black and White Patients With All Stages of NSCLC: An NCDB Analysis (ID 14084)

      16:45 - 18:00  |  Author(s): Pranshu Mohindra

      • Abstract
      • Slides

      Background

      Race and other socioeconomic factors continue to influence survival in patients with non-small cell lung cancer (NSCLC). Recent population-based studies have paradoxically shown a survival advantage in the black population compared to white patients with stage III NSCLC. To further investigate this, we analyzed stage-wise overall survival (OS) and patterns of care in black patients as compared to white patients with NSCLC using the National Cancer Database (NCDB).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All black and white patients within the NCDB with biopsy-proven, stages I-IV NSCLC from 2004-2013 were analyzed. Associations between demographics was assessed using c2-tests. Guideline concordant care (GCC) and non-guideline concordant care (NGCC) were defined for each stage as per NCCN guidelines. OS between the races were analyzed using the log-rank test and the multivariable Cox proportional hazards regression.

      4c3880bb027f159e801041b1021e88e8 Result

      When compared to white patients, black patients were younger at presentation (</=60years: 36.2% vs. 22.5%, p<0.001), had a lower household income (<$30,000: 37.9% vs. 11.5%, p<0.001), twice as likely to not have insurance (6.4% vs. 2.9%, p<0.001) and were diagnosed with more advanced disease (stage I: 18% vs. 24.9%, stage II: 6.1% vs. 6.9%, stage III: 25.9% vs. 23.7%, stage IV: 50% vs. 44.5%, p<0.001).

      White patients were more likely to undergo GCC in stages I-III when compared to black patients (stage I: 77% vs. 69.6%; stage II: 68.5% vs. 65.3%; stage III: 52.8% vs. 51.9%) but had a very similar incidence of GCC in stage IV (stage IV: 66.7% vs. 67.3%, p<0.001).

      Black race was associated with a 17%, 5%, and 3% increase risk of NGCC in stage I (OR: 0.835, 95% CI: 0.817-0.852, p<0.001), stage II (OR: 0.947, 95% CI: 0.916-0.978, p=0.001) and stage III (OR: 0.970, 95% CI: 0.954-0.985, p<0.001) disease, respectively, when compared to white patients in multivariate analysis (MVA). While in stage IV, being black predicted for a 4% greater receipt of appropriate treatment (OR: 1.041, 95% CI: 1.028-1.054, p<0.001).

      In the Cox MVA, race was not linked to OS in stage I or II disease, but being black predicted for a 3% lower risk of death in stage III and IV (stage III: HR: 0.973, 95% CI: 0.965-0.982, p<0.001; stage IV: HR: 0.967, 95% CI: 0.961-0.973, p<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Black patients with NSCLC had similar or slightly improved OS when compared to white patients after accounting for socioeconomic demographics, staging and patterns of care. To explain this contradictory finding, further research should investigate biological differences between the two races.

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