(ChemotherapyAdvisor) – In California, Hispanics who are foreign-born have a 13% decreased risk for death from non-small cell lung cancer (NSCLC) compared with US-born Hispanics, a survival advantage not fully explained by social factors, results of a study presented at the 2012 Chicago Multidisciplinary Symposium in Thoracic Oncology September 6 has found.
Noting a “Hispanic paradox” exists with respect to Hispanics in the United States having a lower age-adjusted incidence and mortality rate from NSCLC vs non-Hispanic whites despite lower socioeconomic status, Manali Patel, MD, MPH, and colleagues from Stanford University, Stanford, CA, investigated “the interplay of nativity, clinical factors, social factors, and neighborhood factors on survival among Hispanic patients with NSCLC.”
They identified 14,829 Hispanic patients with NSCLC in the California Cancer Registry from 1988-2008; 50.6% were US-born and 49.4%, foreign-born. The majority were male, >60 years of age, and married; more than 50% presented with advanced stage disease and the majority did not receive treatment. Those who were foreign-born vs US-born were more likely to live in the lowest socioeconomic status neighborhood and the highest Hispanic enclaves.
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Hazard ratios of mortality by race were estimated, adjusting for individual factors (age, gender, marital status), clinical factors (histologic grade, surgery, radiation, and chemotherapy), and social and neighborhood factors (neighborhood and ethnic enclave status).
After adjustment for age, gender, year of diagnosis, marital status and treatment, foreign-born Hispanics had a 13% decreased risk of NSCLC mortality compared with US-born Hispanics, Dr. Patel reported. Adjustment for neighborhood factors, specifically socioeconomic status and ethnic enclave, slightly moderated the survival benefit among foreign-born relative to US-born Hispanics.
“There is a better survival among foreign-born than US-born Hispanics with NSCLC despite lower income, education, and access to medical care among foreign-born Hispanics,” she added. “Enclave plays an important, perhaps protective, role for foreign-born Hispanics with NSCLC” and “may serve as a proxy for social capital.”
Dr. Patel concluded that additional studies are needed “to understand the drivers of the survival advantage outcomes in foreign-born populations.”
The symposium is sponsored by the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), the International Association for the Study of Lung Cancer (IASLC), and The University of Chicago.
