Survival Rates Have Improved, but Disparities Persist in SCLC

Survival rates in small cell lung cancer (SCLC) have improved since 2010 due to advancements in staging precision and therapy, but a new report shows significant demographic disparities in outcomes remain, suggesting that all patients are not benefitting equally from the scientific progress.

The new report, published in JTO Clinical and Research Reports, is based on data from 2004 to 2016; investigators compared the 6 years prior to 2010 to the 6 years following 2010.

The authors said because the cancer type is closely associated with cigarette smoking, the demographics of SCLC have shifted, in large part due to changes in the demographics of the smoking population. It is likely that other factors are at play, too, the investigators said, but there has been insufficient research to know what those factors are.

“Given recent treatment advances, the impact that demographic factors have on patient outcomes for SCLC requires further evaluation,” they wrote.

The investigators turned to the National Cancer Database, pulling 12 years of records. They looked at demographics, disease characteristics, and treatment among patients with SCLC, and then assessed changes in those factors over time. They found significant shifts.

“Patients diagnosed after 2010 were significantly older, more frequently treated at academic centers, had more comorbidities, government payer insurance, more stage IV disease, and lived further from treatment centers,” the investigators wrote.

The proportion of females, African Americans, patients without high school diplomas, and people from rural areas among the SCLC population also increased after 2010, they found.

In terms of overall survival (OS), the investigators found that patients who received their diagnosis between 2004 and 2010 had a 5-year OS rate of 6.8% (95% CI, 6.6%-6.9%), while receiving their diagnosis after 2010 had a 5-year OS rate of 8.7% (95% CI, 8.5%-8.9%). The authors said this was true even though the latter group had a higher percentage of patients with stage IV disease.

In terms of OS, older patients, males, Caucasians, patients with stage IV disease, those with government primary payer insurance, and patients from rural areas tended to have worse survival rates.

“Patients without comorbidities and treated at academic centers had significantly better OS,” the authors wrote.

They said greater use of PET/CT scans at diagnosis is likely one reason for the improvement in survival rates over time, because these tools allow for more accurate staging, which in turn allows better identification of patients who could benefit from combined modality therapy. They said greater utilization of chemotherapy, radiation therapy, and immunotherapy all likely contributed to the improvement in OS. They added that it is likely advances in immunotherapy and wider adoption of the therapy following 2016 have further improved OS rates in recent years.

Still, the authors said many patients’ outcomes appear to be significantly affected by factors that are not directly connected to the state of the science, such as their insurance coverage and their place of residence.

“We believe there is a complex interplay of these factors and that disparities noted in these key demographics may correspond with access to health care resources,” they wrote. “We feel strongly that focused health care outreach programs will lead to improved outcomes in these populations.”

They emphasized that better access to primary care, telemedicine, and outreach programs by academic medical centers could all be used to curtail the disparities identified in the study. They noted that the COVID-19 pandemic showed that telemedicine can be an effective tool for reaching patients who cannot access a health care facility.

“We need these efforts to continue, in order to alleviate the disparities present in these medically underserved demographic groups leading to poorer outcomes in not only SCLC, but other common malignancies as well,” they concluded.

Reference

Roof L, Wei W, Tullio K, Pennell NA, Stevenson JP. Impact of socioeconomic factors on overall survival in small cell lung cancer. JTO Clin Res Rep. Published online June 8, 2022. doi:10.1016/j.jtocrr.2022.100360