Racial, Ethnic, Socioeconomic Disparities Identified Among Patients With Cachexia at NSCLC Diagnosis

An analysis of cachexia risk among patients with stage IV non­–small cell lung cancer (NSCLC) revealed a higher risk and associated survival detriments among Black and Hispanic patients. The findings, published in JTO Clinical and Research Reports, were not fully explained by traditional determinants of health and highlight a need for further research to identify the mechanisms behind the disparities.

Most patients with NSCLC present with late-stage disease and treatment options are limited, the authors noted. Cancer cachexia, also known as wasting syndrome, is a multifactorial syndrome characterized by general ill health and a substantial loss of muscle and adipose tissue stores. The condition is common among patients with cancer and negatively affects quality of life, may impair responses to cancer therapies, and is linked to a poor prognosis overall.

While outcome disparities are broadly seen between racial and socioeconomic (SES) groups in NSCLC overall, the study aimed to characterize disparities among patients with NSCLC in the context of cachexia.

“Racial and SES outcome disparities are prevalent in NSCLC, as higher incidence and mortality is consistently observed in marginalized groups,” the authors wrote. “NSCLC patients who are Black, Hispanic, uninsured, or residing in low-income areas have been found to be less likely to receive guideline-concordant care.”

Data from 957 patients with stage IV NSCLC at a tertiary care center in Dallas, Texas, between 2014 and 2020 were included in the study. Of those patients, 411 (42.95%) met the criteria for cachexia at the time of their NSCLC diagnosis.

Black patients showed an odds ratio (OR) of 1.558 (95% CI, 1.051-2.309; P = .0272) for cachexia at diagnosis in a multivariate analysis that included private insurance as a binary covariate. Hispanic patients did not show an elevated risk of cachexia at diagnosis, and patients with private insurance had an OR of .692 (95% CI, 0.496-0.964; P = .0298).

Another analysis excluding private insurance as a covariate showed that Black patients were at a substantially greater risk of cachexia at diagnosis (OR, 1.748; 95% CI, 1.205-2.535; P = .0033), with Hispanic patients also showing increased risk (OR, 1.717; 95% CI, 1.005-2.932; P = 0.0477).

There was no significant difference in survival time between non-Hispanic White patients and Black patients who did not have cachexia at diagnosis. There was also no significant difference between non-Hispanic White patients and Black patients within those who did not present with cachexia at diagnosis. However, there were survival differences between patients with and without cachexia regardless of other demographic characteristics.

“This observation, in conjunction with the differential cachexia incidence we observed, suggests that the decreased survival observed in Black and Hispanic NSCLC patients may depend on cachexia and/or factors contributing to its progression,” the authors wrote. A Cox regression analysis in the study also found no association between Black race and survival outcomes when cachexia at diagnosis was factored into the analysis.

The higher rate of cachexia among Black patients in the study also suggests there may be a delay in cancer detection in Black patients vs non-Hispanic White patients. Delayed detection and inadequate screening have been identified as factors contributing to higher rates of late-stage NSCLC presentation in Black patients in past research, the authors noted. The higher risk of cachexia may also be related to environmental or pathophysiological mechanisms outside of those explored in the study, they added.

“As the field of cancer cachexia sees improvements in diagnostic and interventional strategy, future research must simultaneously expand to further characterize the specific mechanisms behind outcome disparities to substantiate targeted and equitable reform to health policy,” the authors concluded.

Reference

Olaechea S, Liu A, Sarver B, et al. Racial, ethnic, and socioeconomic characteristics independently predict for cachexia risk and associated survival outcomes in stage IV non-small cell lung cancer: a brief report. JTO Clin Res Rep. Published online March 10, 2023. 10.1016/j.jtocrr.2023.100496