Disparities in Treatment and Outcomes for Early-Stage Small Cell Lung Cancer

M. Langille. Collins¹, S. J. Mack², J. Martin³, H. Rshaidat¹, G. Whitehorn³, L. Thomas. Meredith¹, B. Till¹, T. Grenda⁴, N. R. Evans⁵, O. Tokunbo. Okusanya^6
1Thomas Jefferson University Hospital, Philadelphia, Pennsylvania ²Sidney Kimmel Medical College at Thomas Jeffeson.University, Philadelphia, Pennsylvania ³Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania ⁴Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania ⁵Thomas Jefferson University, Philadelphia, Pennsylvania ⁶Thomas Jefferson University, Haverford, Pennsylvania

Purpose: Minimal data exists about the interaction between race and long-term outcomes for patients with early-stage small cell lung cancer (SCLC). Given the identified racial disparities in the receipt of therapy for early-stage non-small cell lung cancer, we set out to determine if these disparities exist for small cell lung cancer.

Methods: We utilized the National Cancer Database from 2004-2018. Patients of Black and white race with clinical stage T1-2, N0, M0 SCLC were included in the study. Basic demographic information was collected, as well as information about treatment courses, available surgical data, and short-term outcomes. Long-term outcomes were assessed via Kaplan-Meier analysis with log-rank tests, and multivariable Cox regression analysis was performed to determine variables associated with 5-year survival.

Results: A total of 13,651 patients met inclusion criteria, 1,072 of whom were Black. Black patients were younger (median age 68 vs 70; p< 0.001), and had fewer comorbidities (Charlson-Deyo comorbidity index [CCI] score 0: 600 [56%] vs. 6601 [52.5%]; p=0.028). Black patients were less likely to receive surgical therapy as a component of treatment (151 [14.1%] vs 1437 [18.5%]; p< 0.001) and were more likely to receive chemotherapy and/or radiotherapy-based treatment (561 [52.3%] vs. 6109 [48.6%]; p=0.018). Overall, individuals who received chemotherapy/radiotherapy-based treatment had lower 5-year survival than those who received surgical therapy (p < 0.001). When compared to white patients, Black patients had improved 5-year survival rates (Figure 1; p=0.018). On multivariable analysis, female sex (hazard ratio [HR] 0.87, 95% confidence interval [CI]0.83,0.90; p< 0.001), was independently associated with improved survival at 5 years, but race was not (HR 0.95; CI 0.88,1.03; p=0.19) .Older age (HR 1.03, CI 1.03,1.04; p< 0.001) and CCI score >1 (HR 1.08, CI 1.04,1.28; p< 0.001) were negatively associated with survival at 5 years.

Conclusion: Race was not independently associated with survival for patients with SCLC. Though disparities exist, with Black patients less likely to receive more favorable surgery-based treatments, Black patients had better outcomes, likely due to their younger age and fewer comorbidities on presentation. Understanding disparities in SCLC is necessary to improve survival.

Identify the source of the funding for this research project: No funding was received for this research project.