Multifactorial Impact of Age, Race, and Female Sex on Management of Non-small Cell Lung Cancer

The purpose of this study was to evaluate the impact of age and race on female patients with non-small cell lung cancer (NSCLC) and identify factors posing a greater risk to overall survival (OS).

A retrospective analysis of the Southern Community Cohort Study database was conducted of female patients diagnosed with NSCLC from 2004 to 2018. Patients were stratified into Black versus white groups and by age: < 55 years and ≥ 55 years. Fisher's exact test was used to compare categorical variables and Wilcoxon rank sum for numerical variables. Hazard ratios were calculated to assess risk on OS for both races.

Black female patients, more often than white female patients, were diagnosed with pathologic stage IV (43.2% versus 33.9%, p = 0.02), did not receive lymphadenectomy (75.3% versus 64.8%, p = 0.02), and did not undergo surgery of the primary site (80.2% versus 65.4%, p = 0.002). Age-stratified analysis revealed more apparent trends for Black female patients. Compared with their older counterparts, younger Black female patients presented with larger tumor sizes (43.7 mm versus 40.2 mm), were more often diagnosed with clinical metastasis (11.6% versus 8.8%), and had higher rates of death due to their malignancy (74.0% versus 58.1%). Factors protective for OS were private insurance (HR 0.51 Black versus HR 0.34 white), number of persons in household (HR 0.78 Black versus HR 0.80 white). Urban environment was protective for Black female patients (HR 0.75) and rural environment for white female patients (HR 0.60).

Disparities are prevalent in different groups of female patients with NSCLC. Continued work is imperative to improve care for this increasingly vulnerable demographic.