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A. Jasmine Bullard



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    P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.16-24 - Racial Differences in Treatment and Survival of Stage I NSCLC: A Comparison of Veterans Affairs (VA) and SEER-Medicare Populations (ID 14125)

      16:45 - 18:00  |  Author(s): A. Jasmine Bullard

      • Abstract
      • Slides

      Background

      Disparities in treatment and survival continue to persist in early-stage non-small cell lung cancer (NSCLC), yet they vary among different patient populations. The objective of this study is to compare racial differences in demographic, clinical, treatment, and survival characteristics among veteran and non-veteran patients with stage I NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Patients with stage I NSCLC diagnosed 2001-2009 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and Veterans Affairs (VA) cancer registry. In both cohorts, analyses were restricted to Black and White males aged ≥65 years. Descriptive statistics were used to compare racial differences in demographic and clinical factors. Multivariate logistic regression models estimated odds ratios (OR) and 95% confidence intervals (95% CI) for the association between race and receipt of treatment. Cox proportional hazards models were used to assess 5-year survival.

      4c3880bb027f159e801041b1021e88e8 Result

      Among patients in VA (N=7895) and SEER (N=8744), the proportion of Black patients was 13% and 7%, respectively. In VA, 50% of both Black and White patients were diagnosed at ages 65-74 years (p=0.60); in SEER, Black patients were younger than Whites (60% vs 50%, p<0.0001). The predominant histology was squamous cell in Blacks (47%) and adenocarcinoma in Whites (42%) in SEER; 40% of both Blacks and Whites in VA had squamous cell histology. In SEER, 11% of Whites and 14% of Blacks had a comorbidity score ≥3 (p=0.003); corresponding proportions in VA were 29% and 28% (p=0.10). While 84% of SEER patients and 77% of VA patients received treatment, after adjusting for covariates, Blacks were less likely than Whites to get any treatment (ORadj: 0.66, 95% CI 0.57-0.77 in VA; ORadj: 0.56, 95% CI 0.47-0.68 in SEER), and to receive surgery alone when treated (ORadj: 0.73, 95% CI 0.62-0.86 in VA; ORadj: 0.57, 95% CI 0.47-0.70 in SEER). Among treated patients, there was no significant difference in overall survival for Blacks and Whites, after adjusting for type of treatment (HRadj: 0.99, 95% CI 0.91-1.09 in VA; HRadj: 1.00 95% CI 0.89-1.13 in SEER).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Among older stage I NSCLC patients, the proportion of Blacks in VA was nearly twice that in SEER, and Blacks and Whites were more similar in VA than in SEER. Despite population differences, similar racial differences in receipt of treatment were noted in both veteran and non-veteran cohorts. No significant racial difference in survival was observed in either cohort when type of treatment is accounted for.

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