Specific Racial, Socioeconomic Factors Associated with Improved Survival Rates for Patients with LS-SCLC


Racial and socioeconomic factors were associated with varying levels of survival for patients with limited-stage small cell lung cancer, with improved survival noted among African American and Asian patients compared with White patients.

According to a recent study, specific racial and socioeconomic factors were associated with better survival rates for patients with limited-stage small cell lung cancer (LS-SCLC), with African American and Asian patients having better survival rates than White patients after adjusting for sociodemographic factors.

The data, published in JAMA Network Open, also highlighted that, among other things, female sex, higher income, higher education, private insurance, and diagnosis at earlier stages of the disease were all associated with better survival rates for patients of this cancer type.

“The findings of this cohort study suggest that race is associated with survival of L[S]-SCLC, because Asian and African American patients had better survival compared with White patients,” wrote the investigators. “In addition, our results confirmed that female sex, higher median annual income, private insurance, diagnosis confirmation by positive cytological analysis, larger increase in number of sampled regional lymph nodes examined, and earlier stage at diagnosis were associated with prolonged survival in L[S]-SCLC.”

Hazard of death for African American patients decreased to 0.92 (95% CI, 0.89-0.95; P <.001) and 0.83 (95% CI, 0.77-0.91; P <.001) for Asian patients compared to White patients. While significant, median survival differences between racial groups were only statistically significant among patients with stage III disease.

A total of 72,409 patients were analyzed in this cohort study, with a median age of 67.0 years (range, 23.0-90.0) and women accounting for 55.6% (n = 40,289) of the total population. The disease stage distribution saw 10,619 patients (14.7%) with stage I disease; 7,689 patients (10.6%) with stage II disease; and 54,101 patients (74.7%) with stage III disease. The median follow-up was 8.2 months (range, 2.4-15.8) for patients.

Demographic data were collected for patients diagnosed with LS-SCLC between 2004 and 2014 from the National Cancer Database, with the data analysis being conducted in October of 2019. The population was divided into 5 exclusive cohorts by race.

“It has been frequently reported that White patients have better outcomes, whereas African American patients are more likely to receive a diagnosis of cancer at an advanced stage and have higher mortality rates than other racial groups,” the investigators wrote. “However, our analysis indicated that African American and Asian patients had significantly decreased mortality rates compared with White patients.”

The investigators acknowledged that the median follow-up of 8.2 months is relatively short, resulting in the potential for selection bias due to the small case numbers. Moreover, the investigators explain that access to screening programs could have impacted the data. Different levels of access for racial groups can lead to disease diagnosis at early stage, impacting the likelihood for a patient’s survival.

Future research is warranted to determine strategies to overcome survival differences between patients of diverse racial and socioeconomic backgrounds, and to also further validate the findings presented by the research team.


Zhou K, Shi H, Chen R, et al. Association of race, socioeconomic factors, and treatment characteristics with overall survival in patients with limited-stage small cell lung cancer. JAMA Network Open. doi:10.1001/jamanetworkopen.2020.32276

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