Impact of clinical and socioeconomic factors on survival outcomes in non-small cell lung cancer: A retrospective analysis.

Abstract

e13548 Background: Lung cancer is the most common cause of cancer-related mortality in the United States. Research suggests that not only clinical factors but also Social Determinants of Health (SDOH) have a significant impact on lung cancer-related deaths. This study evaluates the impact of SDOH on lung cancer outcomes. Methods: We analyzed 500 NSCLC patients diagnosed and treated at St. Luke's University Health Network from January 2013 to December 2021. Data on demographics, co-morbidities, cancer stage, treatments, complications, survival time, and SDOH factors were collected from medical records. Data was analyzed using the median, inter-quartile range, and statistical tests (Wilcoxon, Chi-square, Fisher’s exact, and Cox regression) to assess mortality and identify exposure variables. Kaplan-Meier survival curves were generated, and the analysis was conducted with REDcap and Stata V.18. Results: Among 500 patients, 67.4% were aged 61-80, 56% were males, 92.2% were Caucasian, and 53% had Stage 4 disease at diagnosis. Overall mortality was 60.8% by the end of the study period. In multivariate analysis, advanced age (HR = 1.80, P = 0.005) and higher ECOG scores (HR = 5.72, P = 0.000) were linked to higher mortality. Regular PCP follow-up (HR = 0.74, P = 0.014) emerged as a protective factor against mortality. Access to private transportation showed favorable outcomes in univariate analysis but did not retain significance in multivariate analysis. We found an inverse relationship between no-shows at oncology office and hazard ratio: 1-3 no-shows (0.67, p = 0.004) and > 3 no-shows (0.47, p = 0.001). Conclusions: Physicians should consider age and poor performance status when tailoring therapy plans for each patient. Intuitively nonadherence to treatment is linked to worse outcomes, but our data shows measuring missed appointments as a discrete number may skew results, as patients with more appointments may have more no-shows. A percentage of missed appointments would be a better measure. Furthermore, regular PCP follow-up can be utilized as an important tool in improving survival outcomes in lung cancer patients as this likely contributes to more comprehensive health management, monitoring and addressing a wide range of health issues, including comorbid conditions, preventive care, symptoms of cancer, and side effects of cancer treatment. This is consistent with previous studies that demonstrated improved overall survival in lung cancer patients who were also followed by palliative care. This proactive approach can help in early detection and management of complications that might otherwise impact cancer treatment and survival. PCP and/or palliative care utilization should be a core component of the management of patients with lung cancer and possibly other cancers as well. More studies are needed to continue to improve care and management of lung cancer patients and all cancer patients.