Ethnic Differences in the Treatment Outcome of Lung Cancer in Florida by Histology and Stage

Objective. Does ethnicity have an impact on the treatment outcome when controlling for stage of cancer and histology? Background. Lung cancer is a common cause of death in the United States. African-Americans have a higher mortality from lung cancer than do people of other races. Previous studies have been equivocal regarding the cause of this disparity. To address this lack of consensus we investigated different possible causes including the fact that people of ethnic minority groups may be more likely than the ethnic majority to have a poorer prognosis at diagnosis due to advanced cancer stage, histological type, and treatment mode, ultimately leading to poorer survival. Methods. We examined the effect of ethnicity, histology, and stage of lung cancer on the relationship between treatment (radiotherapy alone vs. surgery alone) and outcome, vital status (dead or alive) at the end of the study period, in all incident cases of 21,144 patients diagnosed with lung cancer in Florida between January 1st 1995 and December 31st 2002. We used the Mantel-Haenszel stratified analysis for a crosssectional study with incident cases, using relative risks (RR) and their corresponding 95% confidence intervals. Results. The African-Americans were diagnosed at an advanced stage when compared to Caucasians and Hispanics, and received less surgery, and had the poorest overall survival. Ethnic minorities are more likely to die from advanced large cell lung cancer undergoing radiotherapy. Conclusion. Lack of access amongst ethnic minorities can explain, at least in part, the reason why Caucasians far better from radiotherapy treatment as opposed to ethnic minorities. Grants and Acknowledgement. This study was funded in part through the HPD Research Grant for Florida Cancer Registry Analysis, 2004-2007. The views expressed herein are solely those of the authors and do not necessarily reflect those of FCDS, the contractor of FL-DOH