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Rajesh Balkrishnan

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    P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.01-09 - Impact of Urban or Rural Residence on Overall Survival for Patients with Metastatic Non-Squamous NSCLC (ID 12735)

      12:00 - 13:30  |  Author(s): Rajesh Balkrishnan

      • Abstract
      • Slides


      Although data suggests that disparities in ethnicity impact survival outcomes in lung cancer, little is known about whether disparities according to primary residence (rural vs urban) impact survival outcomes in metastatic non-squamous, non-small cell lung cancer (ns-NSCLC).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This is a retrospective study of 176 patients with stage IV ns-NSCLC treated at our institution from 2014-2016. Patients were classified as urban or rural residents based on zip codes using the RUCA and SAS zip code databases. Socioeconomic factors were derived from the AHRF database. Risk of death and overall survival (OS) were calculated using COX proportional hazards regression.

      4c3880bb027f159e801041b1021e88e8 Result

      Baseline characteristics are in Table 1. Patients from rural zip codes had worse median OS (12.2 mo, 95% CI 5.1-16.0) compared to patients from urban zip codes (15.7 mo, 95% CI 9.6-27.9), with a hazard ratio (HR) of 1.589 (95% CI 1.052-2.401, p=0.0278). When adjusted for age, gender, smoking status, median income, percent in poverty per county, and EGFR mutational status, these results remained significant (HR 1.670, 95% CI 1.016-2.743, p=0.0376). A secondary analysis based on median household income (MHI) showed that those from regions with MHI less than the median of the cohort were 1.931 times more likely to die than those from regions with greater MHI (95% CI 1.038-3.595, p=0.0378).

      Table 1. Baseline patient characteristics
      Characteristic Rural Urban
      Total (%) 76 (43.2) 100 (56.8)
      Median age in years 65 64
      Male gender (%) 36 (47.4) 50 (50)
      White 66 (86.8) 75 (75.0)
      Black 9 (11.8) 16 (16.0)
      Hispanic 1 (1.3) 2 (2.0)
      Other 0 7 (7.0)
      Ever-smokers (%) 65 (85.5) 80 (80.0)
      Median household income in dollars 52818 63343
      Percent persons in poverty 14.4 14.3
      EGFR mutation present (%) 14 (18.4) 19 (19.0)

      8eea62084ca7e541d918e823422bd82e Conclusion

      Overall survival for rural patients with metastatic ns-NSCLC was inferior to those living in urban areas. This risk was more pronounced after adjusting for potential confounders. Those from regions with MHI below the median also had increased risk of death compared to those from areas above the median, suggesting that rural financial toxicity may influence lung cancer survival in our area. Further efforts to characterize the socioeconomic determinants of poorer outcomes in rural areas are needed and could support the formation of programs aimed at improving access to care.


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