Socioeconomic Status Impacts Survival Outcomes in Patients With Non-small Cell Lung Cancer

By Rob Dillard - Last Updated: September 26, 2023

Researchers have found a link between social determinants of health (SDH) and survival outcomes in patients with non-small cell lung cancer (NSCLC) undergoing surgery.

“We believe our social determinants of health scoring system is the first to provide a composite perspective on many of the nonmedical factors that affect outcomes in patients receiving treatment for non-small cell lung cancer,” said Dao Nguyen, MD, co-leader of the Sylvester Thoracic Cancers Group, via a press release.

The analysis focused on patients with stage II or III NSCLC who had surgically confirmed metastasis to regional lymph nodes within the chest cavity. Nguyen and colleagues assessed 11,274 patients (average age, 68 years; 57% female; 84% non-Hispanic White) with locally advanced NSCLC from the National Cancer Database, a registry in which patients with locally advanced disease comprise approximately one-third of the NSCLC population.

The investigators analyzed the study subjects’ income, residence, education, and hospital proximity based on residence. They also assessed demographics, types of treatment facilities, surgical volumes at treatment facilities, and comorbidities in addition to NSCLC.

Socioeconomic Disadvantage Lowers NSCLC Survival

According to the results, patients residing in rural areas had a 30% decreased likelihood of overall survival and long-term outcomes, and patients with access to only community hospitals had worse survival. Conversely, patients undergoing surgery in high-volume hospitals had a 31% decreased mortality risk and a 93% increased likelihood of textbook outcomes compared with those undergoing surgery in low-volume hospitals. Furthermore, the researchers observed that Black patients were 31% less likely to achieve optimal, textbook outcomes than White patients.

To ameliorate these disparities, the investigators noted that policymakers should ensure equitable access to surgery and multimodal treatment so that all patients can receive the best care. “In this cohort, we found that socioeconomic status—indicated by SDH score—has an important association with both textbook outcomes and survival,” said Ahmed Alnajar, MD, the paper’s first author.

“Significant socioeconomic disadvantage was associated with a 21% decrease in textbook outcomes and a 32% decrease in overall survival when compared [with] a patient subgroup that was not disadvantaged,” he concluded. “Vulnerable patient population groups living in areas with limited income, limited education, rural locations, and areas with limited access to specialized cancer care settings are at increased risk of poor outcomes and long-term mortality.”

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