Impact of Socioeconomic Factors on Overall Survival in SCLC

Abstract

Objectives: To determine how the incidence and demographics of SCLC have changed over time and to evaluate whether patient demographics, disease presentation, and treatment characteristics affect patient outcomes. Methods: We identified patients with SCLC in the National Cancer Database from 2004 to 2016. Differences in demographics, disease, and treatment characteristics were assessed by year of diagnosis using chi-square test. The effect of age, race, insurance status, income, distance to treatment center, and education level on overall survival (OS) was evaluated by multivariable Cox proportional hazard model. Results: Patients diagnosed after 2010 were significantly older, more frequently treated at academic centers, had more comorbidities, had government payer insurance, had more stage IV disease, and lived further from treatment centers. More females, African Americans, patients without high school diplomas, and those from rural areas were diagnosed after 2010. In patients diagnosed between 2004 and 2010, 5-year OS was 6.8% (95% confidence interval: 6.6–6.9), and after 2010, 5-year OS was 8.7% (95% confidence interval: 8.5–8.9), despite an increase in stage IV disease in the latter group. Older patients, males, Caucasians, patients with stage IV disease, those with government primary payer insurance, and those from rural areas had significantly worse OS. Patients without comorbidities and treated at academic centers had significantly better OS. OS significantly increased with community income and education level. Conclusions: Despite improvement in OS, disparities were noted in demographics which may complicate patient and provider access to health care resources, including rural communities, distance to academic centers, income, insurer, and education level. Efforts to affect these variables will improve outcomes for patients with SCLC.

Keywords

• Small cell lung cancer
• Outcomes
• Socioeconomic factors
• Healthcare disparities