How Socioeconomic Factors Affect Survival in Patients With SCLC and Brain Metastases

Multiple socioeconomic factors, such as treatment setting and insurance type, are associated with survival outcomes in patients with small cell lung cancer (SCLC) who have brain metastases, according to a recent study.

To examine socioeconomic disparities in SCLC brain metastases, investigators from Florida, Maryland, Michigan, and India conducted a retrospective cohort study using data from the National Cancer Database. Socioeconomic and survival outcomes were analyzed and reported using median overall survival (OS). Their findings were presented at the 2024 American Society of Clinical Oncology Annual Meeting, held May 31-June 4, 2024, in Chicago, Illinois.

It was important to evaluate disparities in SCLC brain metastases because 80% of patients with SCLC may develop brain metastases over the course of their disease. Typically, even patients who respond well to initial treatment will face a high risk of recurrence.

The study, which included 2369 patients with SCLC brain metastases, examined if factors such as race, insurance type, and income affect which patients live longer. Patients were grouped by race: White (85%), Black (11%), American Indian (0.4%), Aleutian or Pacific Islander (0.4%), or Asian (1.8%). All patients received a diagnosis in 2018-2019. More than half of the patients (58%) were on Medicare and 21% earned a salary greater than $74,063 a year. Furthermore, 40% were treated at comprehensive cancer care centers.

“Race did not significantly impact survival based on unadjusted analysis,” the researchers concluded. However, adjusted analysis showed that Asian (hazard ratio [HR], 0.55; P=.014) and Black (HR, 0.82; P=.029) patients with SCLC brain metastases have better survival outcomes than White patients. Patients who had higher salaries were also seen to have greater survival (HR, 0.82; P=.030).

Compared with patients who had private insurance, patients with Medicare had significantly worse median OS (13.77 vs 7.56 months, respectively). In addition, patients who received treatment at comprehensive cancer care centers had worse survival (HR, 1.26; P<0.001) than those who received treatment in academic centers.

“Focused efforts are warranted to bridge this gap and reduce disparities due to socioeconomic factors,” the researchers said.

Reference

Bellur SS, Jayram D, Ahmad S, et al. Socioeconomic disparities in survival outcomes of patients with SCLC with brain metastases: A nationwide analysis. Abstract #e20133. Presented at the 2024 American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2024, Chicago, Illinois.