Survival disparities in non-small cell lung cancer patients receiving radiation treatment: An investigation of race and gender

Abstract

Multiple studies evaluating non-small cell lung cancer disparities reveal male gender and African American race as independent predictors for poorer outcome. This study aims to evaluate the prognostic factors affecting survival of non-small cell lung cancer patients receiving radiation treatment at the University of Washington and to investigate whether race and gender disparities persist at the level of access to radiation treatment. Race, age, stage at presentation, radiation treatment length, and length of time from initial diagnosis to death or last follow-up were recorded and analyzed in a retrospective review of 372 patients receiving radiation treatment from 1994 - 2008. Of a final 372 patients, 306 were Caucasian, 32 African American, 34 Asian American and 134 female, 238 male patients. Cox regression models showed male gender [hazard ratio (HR, 1.34) p-value 0.027] and stage at presentation [stage III: HR, 1.93, p-value .001, stage IV: HR, 2.46, P value < 0.001] were predictors for shorter survival. In these analyses, race had no significant effect on length of survival. These results suggest disparate origins of race and gender inequity in non-small cell lung cancer outcome, highlighting that race differences in lung cancer survival disappear at the level patients have access to radiation treatment. This supports the notion that gender survival differences are likely the result of biologic differences, while racial survival disparities are an issue of healthcare access- however, additional studies are needed to conclusively discern the etiology of these disparities. Key words: Race, disparity, radiation, lung, cancer.