Racial disparities and survival for nonsmall-cell lung cancer in a large cohort of black and white elderly patients

Cancer. 2009 Oct 15;115(20):4807-18. doi: 10.1002/cncr.24521.


Background: This study aimed to examine disparities in survival and associated factors for patients with nonsmall-cell lung cancer (NSCLC) and to determine whether racial disparities varied over time (1991-1995, 1996-1999, and 2000-2002).

Methods: The authors studied 70,901 patients aged>or=65 years with stage I-IV NSCLC identified from Surveillance, Epidemiology, and End Results/Medicare data. Multivariate time-to-event survival analyses were completed using Cox proportional regression modeling.

Results: The 5-year observed lung cancer-specific survival rates were 52.7% for whites and 47.5% for blacks with stage I-II disease, and 17.7% and 19.6% for whites and blacks, respectively at stages III-IV. After controlling for standard treatment, socioeconomic status (SES), and other factors, there were no significant differences in all-cause mortality, or lung cancer-specific mortality between black and white patients with stage I-II or III-IV lung cancer. However, blacks had an increased risk for overall all-cause mortality at stage I-IV (hazard ratio [HR], 1.24; 95% confidence interval, 1.13-1.35), and during 2000-2002 at stage III-IV for all-cause mortality (HR, 1.22; 95% CI, 1.02-1.47) and lung cancer-specific mortality (HR, 1.24; 95% CI,1.01-1.53). Standard treatment was significantly associated with increased survival, whereas poor SES was associated with increased mortality.

Conclusions: There were no significant differences in survival between blacks and whites with NSCLC within stage stratifications after adjusting for covariates, except for black patients at overall stage for all-cause mortality and at stage III-IV diagnosed in 2000-2002. Receiving stage-specific evidence-based standard therapy was associated with significantly increased survival.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • African Americans
  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / ethnology*
  • Carcinoma, Non-Small-Cell Lung / mortality*
  • Carcinoma, Non-Small-Cell Lung / therapy
  • European Continental Ancestry Group
  • Female
  • Health Status Disparities
  • Humans
  • Lung Neoplasms / ethnology*
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / therapy
  • Male
  • Risk Factors
  • Survival Rate
  • Time Factors