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Nisha Ohri



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    P2.06 - Mesothelioma (ID 170)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Mesothelioma
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.06-16 - Racial Disparities in Treatment Patterns and Survival Among Surgically Treated Malignant Pleural Mesothelioma Patients (ID 1869)

      10:15 - 18:15  |  Author(s): Nisha Ohri

      • Abstract
      • Slides

      Background

      Although surgical intervention improves survival for patients with malignant pleural mesothelioma (MPM), black patients are less likely to receive surgery. It is not known what the treatment patterns in MPM surgical patients are according to race. This study sought to examine treatment patterns and survival between black and white surgical patients using a large nationwide cancer database.

      Method

      This study used the National Cancer Database (NCDB) to examine the subset of black and white MPM patients who received surgery, defined as pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP). Multivariable logistic regressions were used to evaluate the racial differences in the extent of surgery, receipt of additional treatment (chemotherapy and/or radiotherapy), and 30-/90- day mortality, while accounting for clinical and demographic factors. A multivariable Cox proportional hazards model was used to assess the independent associations of race with overall survival. Association between race and survival was also analyzed using a 1:1 propensity score matching with the greedy algorithm.

      Result

      There were 2550 MPM patients in the NCDB who received surgery; 2462 white (96.5%) and 88 black (3.5%). Most patients received P/D (77.8%); 63.8% received additional treatment. Black patients were significantly less likely to receive EPP (ORadj: 0.36, 95% CI: 0.17-0.78). There was no significant difference with race in the receipt of additional treatment (ORadj: 0.79, 95% CI: 0.46-1.34); EPP patients were significantly more likely to receive additional treatment (ORadj: 1.34, 95% CI: 1.02-1.74). Black patients tended to have worse 30- and 90- day mortality than white patients (ORadj: 1.52, 95% CI: 0.58-4.01; ORadj: 1.50, 95% CI: 0.75-3.01, respectively). There was no significant difference in overall survival between black and white patients (HRadj: 0.96, 95% CI: 0.72-1.27); patients who had treatment in addition to surgery had significantly better survival (HRadj: 0.71, 95% CI: 0.64-0.80). Results remained similar after propensity matching.

      Conclusion

      Among MPM patients receiving surgery, black patients received less extensive surgery, and are less likely to receive additional treatment, indicating less aggressive treatment overall. Although overall survival was similar, black patients tended to have worse short term outcomes after surgery. Racial disparities in treatment and short term outcomes need to be better addressed.

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