OA14.02 Social Vulnerability Is an Independent Risk Factor in Patients Undergoing Surgical Treatment of Lung Cancer

Abstract

The social vulnerability has become an object of study linked to cancer. Emerging countries like Brazil have very high levels of social inequality and the problem of vulnerability becomes even more relevant. Lung cancer is one of the most common neoplasms in the country and an understanding of the role of social vulnerability in this disease is essential for the development of specific public policies. The objective is to analyze the influence of social vulnerability on surgical treatment for lung cancer. Retrospective study with analysis of the Hospital Cancer Registry (RHC) database of patients diagnosed with lung cancer in the city of São Paulo, from January 2000 to December 2013. RHC is a record maintained by the Oncocentro Foundation of São Paulo that collects, through trained registrars, data from cancer hospitals in the State of São Paulo. Patients with clinical stage I and who received surgery or a combination of treatments involving surgery were selected from the sample. For the analysis of the social vulnerability, the São Paulo Social Vulnerability Index (IPVS) was used, classified from 1 to 6 (1: little and 6: a lot of social vulnerability) according to the patient's address. We use georeferencing technology to classify the individual IPVS of each patient. The main outcome was mortality at 30 days and we used a logistic regression model to calculate the odds ratio (OR) of the relevant variables. To calculate the measure of association between the independent variables and survival, we used Cox regression analysis. We considered p <0.05 as significant. A total of 7,896 records, 11.2% (881) diagnosed with clinical stage I. Of these, 523 received surgery,t and 48% (251) died by 2019. 53.2% were male (278) the mean age was 64 years (SD 10.4). As for social vulnerability, 49.6% of patients lived in areas with very low vulnerability (IPVS 2). The most prevalent cancer was adenocarcinoma (54%) and the average time between diagnosis and treatment was 28.4 days. Using the independent variables IPVS, age, histological type, and gender, logistic regression showed that IPVS (OR 1.73; p <0.001) and age (OR 2.51; p = 0.012) are risk factors for mortality in 30 days in the population of patients with clinical stage I and who received surgical treatment. Overall survival: median of 87 months (32-0). After adjusting for the independent variables, the Cox regression showed that the IPVS (HR 1.28; 95% CI 1.12 and 1.45; p = 0.000) and age (HR 1.03; CI 95 % 1.01 and 1.04; p = 0.000) are associated with greater risk, while Gender showed an HR of 0.61 (95% CI 0.47 and 0.8; p = 0.000), indicating lower risk when associated with the female. Even when diagnosed at an early stage, the social aspects contribute to the 30-day mortality of patients undergoing surgical treatment of lung cancer. It confirms that social vulnerability, by the IPVS, is an independent risk factor in the population studied.