Non-small cell lung cancer: Do African Americans really do worse?
K. R. Chan, J. C. Leighton, K. Pincus, W. J. Tester;
Albert Einstein Medical Center, Philadelphia, PA
Abstract: Background: The Surveillance, Epidemiology, and End Results Medicare database (SEER), a population-based study, reported lower resection and survival rates for African-Americans with non-small cell lung cancer (NSCLC).
This study was designed determine if such disparity also exists at Albert Einstein Medical Center (AEMC), a tertiary-care urban hospital.
The study objectives are (1) to compare resection and 5-year survival rates for non-Hispanic whites (W) and African-Americans (AA); (2) to learn why eligible patients did not have surgery; and (3) to compare resection and survival rates with SEER.
Methods: Demographic data was collected from AEMC tumor registry for stage I and II NSCLC from 1997-2001. From retrospective chart review, comorbidity score was determined using the Charlson Index.
Actuarial survival curves were computed using Kaplan-Meier method and compare by log-rank statistic. The comparison population was the SEER data (NEJM 341:1198-1205, 1999).
Results: Of 176 patients, 90 (51% W and 987 (49%) AA, no difference was found in resection rate and 5-year survival (56% W vs. 52% AA; 27%W vs. 28% AA).
Among those not operated, 65% had medical contraindications, 12% refused, 3% had psychiatric contraindications, and the other reasons were unknown.
Reasons given for refusal included: concerns of age, adverse experiences of others, and misconceptions of tumor spread with surgery.
Compared to the SEER data, resection rate and 5-year overall survival was lower at AEMC (76% vs. 54%, p<0.01; 33% vs. 27%).
Conclusions: The AEMC data show no difference in the resection rates or survival for AA, compared to W.
However, our resection rate is lower than that of the SEER. This apparent difference may largely be related to greater medical comorbidity in the AEMC study population when compared with the SEER.
Abstract No: 7293
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