Comparison of outcomes for patients diagnosed with small cell lung cancer between a university and safety net hospital.

Abstract

12077 Background: With immunotherapy, the five year overall survival (OS) for small cell lung cancer (SCLC) is 12%. However, real world factors such as social determinants of health (SDH) and enrollment to clinical trials may vary. Here, we compare treatment patterns and outcomes for SCLC between two affiliated hospital settings. Methods: A retrospective analysis was conducted on patients with SCLC seen at university hospital (UH, Indiana University Melvin and Bren Simon Comprehensive Cancer Center) or its affiliate safety net hospital (SNH, Sidney and Lois Eskenazi Hospital) from 1/1/2018 to 8/31/2024. SDH was defined as housing, food, financial, or transportation instability. Chi-square, Fisher’s exact test, t-test, Wilcoxon two-sample test, and Kaplan-Meier were applied accordingly. P value < .05 was considered significant. Results: A total of 189 patients were identified; 50 (26%) at SNH and 139 (74%) at UH. Stage, age, sex, and tobacco use were similar. Variations in race and SDH were noted (Table). Receipt of chemoimmunotherapy was comparable. Chemotherapy-free interval (CTFI) was shorter at UH (3.3 months; 95% CI, 2.7–4.3) vs at SNH (7.8 months; 95% CI, 3.7–11.5; P = .015). Patients at UH were enrolled in more SCLC-related trials, received more second line therapies, GCSF or CDK4/6 inhibitor (Table), and had increased adverse events (UH, 64% vs SNH, 40%, P = .003). At data cut-off, no difference was found between UH and SNH for use of lurbinectedin (15.8% vs 8%, P = .16) or tarlatamab (3.6% vs 2%, P = 1). OS was analogous between UH (16 months; 95% CI, 11.3–18.7) and SNH (12.8 months; 95% CI, 7.6–NE; P = .21). Conclusions: Patient at UH were found to have shorter CTFI with first line chemoimmunotherapy. This difference may reflect the referral patterns for patients with complex SCLC presentations to an academic cancer center. More SDH was identified at UH. Patients at UH were more likely to enroll in SCLC trials and receive supportive care medications. Patients at SNH received more PC referrals. Further studies are needed to evaluate the effect of socioeconomic factors on SCLC outcomes. Outcomes stratified by hospital setting. Variable Stratified by Hospital Setting Overall N=189 Safety Net Hospital N=50 University Hospital N=139 P Value Black race 22 (11.6%) 16 (32%) 6 (4.3%) <.001* White race 160 (84.7%) 33 (66%) 127 (91.4%) <.001* Positive SDH 87 (46%) 15 (30%) 72 (51.8%) .008 Consented to a SCLC clinical trial 47 (24.9%) 1 (2%) 46 (33.1%) <.001 Received second line treatment 87 (46%) 16 (32%) 71 (51.1%) .020 Received supportive care with GCSF or CDK4/6 inhibitor 85 (45%) 8 (16%) 77 (55.4%) <.001 Referred to palliative care (PC) 86 (45.5%) 45 (90%) 41 (29.5%) <.001 Note: Values expressed as n (%). *Indicates Fisher’s exact test.