SESSION TYPE: Lung Cancer III
PRESENTED ON: Tuesday, October 23, 2012 at 02:45 PM - 04:15 PM
PURPOSE: Smoking is common risk factor for chronic obstructive pulmonary disease (COPD) and lung cancer is more common in adults with lower socioeconomic status (SES). SES and COPD may result in a late diagnosis of lung cancer, less stage-based appropriate treatment, and a reduced survival.
METHODS: Medicare patients diagnosed with lung cancer from 2001-2005 were identified in Surveillance, Epidemiology, and End Results (SEER) registries. Registry data provided information on histology (small cell [SCLC] and non-small cell [NSCLC]), and diagnosis stage (extensive versus limited [SCLC] and Stages 0, I, II, locally advance, and advanced [NSCLC]). Medicare enrollment and claims data provided detailed information on demographic characteristics, diagnostic workup, treatment, vital status and duration of survival. Comorbid conditions at baseline, including COPD, were identified by ICD9-CM diagnoses on claims (1 inpatient or 2 outpatient) during the 12 months prior to lung cancer diagnosis. SES was measured based on census tract level median household income, stratified into tertiles. Bivariate analyses compared patient characteristics, treatments, and outcomes by SES status and presence of comorbid COPD.
RESULTS: Patients with lower SES also have more comorbidities, greater prevalence of poor performance status (13.2% vs. 6.9%), a greater likelihood of late stage diagnosis (51% vs 48.5%), lower probability of surgery or chemotherapy, and shorter survival (median 213 versus 291 days) all p<0.001. Comparisons of patients with and without comorbid COPD stratified by SES indicate that COPD is associated with earlier stage diagnosis, but with reduced rates of surgery, chemotherapy, and shorter survival duration
CONCLUSIONS: Contrary to expectations, patients diagnosed with comorbid COPD were diagnosed at earlier stages, which likely altered stage-appropriate treatment and outcomes. Within SES strata, it is likely that patients with COPD had both better primary care and pulmonologist follow-up, which facilitated early stage diagnosis.
CLINICAL IMPLICATIONS: Patients with lung cancer will benefit from a multidisciplinary approach to their treatment, which should include a pulmonologist.
DISCLOSURE: The following authors have nothing to disclose: Janaki Deepak, Lisa Gardner, Li Mao, Amy Davidoff
No Product/Research Disclosure InformationUniversity of Maryland School of Medicine, Baltimore, MD