Differences in lung cancer symptom severity by tertiary cancer center vs. centers treating underserved patients

Abstract

19577 Background: Understanding how differences in treatment site and ethnic/racial background affect the severity and outcomes of symptoms related to advanced lung cancer is critical to providing optimal symptom management. This analysis investigated the differences in the severity of symptoms among patients receiving treatment for advanced non-small cell lung cancer (NSCLC) at three different treatment centers. Methods: We compared changes in ratings of 139 patients diagnosed with NSCLC over the course of their chemotherapy regimen for symptoms and their interference on daily activities. Eligible patients had to be diagnosed with Stage III or IV NSCLC and treated at Jackson Memorial - Dade County, LBJ - Harris County or The University of Texas M. D. Anderson Cancer Center. Data were collected using telephone and pen-paper versions of the M. D. Anderson Symptom Inventory Lung Chemotherapy Module. Mixed modeling analysis was used to examine the differences in self-reported symptom severity between black, non-Hispanic, Latino/Hispanic and white, non-Hispanic patients. Results: A total of 56 patients from all sites, matched by age and gender, were included in this sub-analysis. Because this was a relatively small sample, we combined the non-Hispanic, black (27%) and Latino/Hispanic (14%) groups to form the minority group vs. the majority group (59%). Median follow-up was 24 weeks. Inclusion of the treatment site in the model resulted in losing the effect for ethnicity for the majority of symptoms. Significant higher ratings were found for fatigue and drowsiness in white, non-Hispanic patients when compared to the minority group. We found that treatment site (tertiary vs. center treating underserved) was a significant predictor for differences in symptom severity scores. Greater symptom severity ratings were found in patients seen at centers treating the underserved for pain, sleep, fatigue, nausea, shortness of breath, appetite, drowsy, dry mouth, and numbness. Conclusions: These findings suggest that receiving treatment at a center caring for the medically underserved is associated with greater symptom burden in patients with advanced lung cancer. These results underscore the need for additional studies. No significant financial relationships to disclose.