Abstract B38: Lung cancer survival among Chinese Americans in California, 2000-2010
Authors: Gomez Scarlett Lin , Clarke Christina , Yang Juan , Sandler Alan , Lin Shih-Wen 
Published: October 2015

Background: Previous reports have examined lung cancer survival patterns and prognostic factors among Asian Americans considered as a single group or as specific ethnic groups in one survival model. No prognostic studies have focused specifically on Chinese Americans, the largest Asian American ethnic group in the U.S. Lung cancer is among the 3 most commonly occurring cancers and the most common cause of cancer deaths among Chinese Americans, and identifying factors associated with poor survival may inform opportunities for targeted interventions.

Methods: Chinese American patients diagnosed with lung cancer during the period 2000-2010 were identified through the population-based California Cancer Registry and followed through December 31, 2012. Median survival was calculated stratified by sociodemographic (gender, age, nativity, marital status, insurance status, neighborhood socioeconomic status (SES), neighborhood ethnic enclave, urbanicity) and clinical (stage, initial treatment, including surgery, radiation, chemotherapy, reporting by NCI designated cancer center) characteristics. Multivariate Cox proportional hazards regression analysis was used to estimate the hazard ratios (HR) and 95% confidence intervals (CI) associated with mortality after diagnosis.

Results: Among males, 46.0% of all lung cancers were diagnosed in stage IV, with a higher percentage among US-born (51.4%) than foreign-born (45.4%). A higher proportion of adenocarcinoma was seen among US-born than foreign-born males (54.3% and 45.7%, respectively). Contrasting patterns by nativity were seen among females, among whom 48.0% of all lung cancers were diagnosed in stage IV, with a slightly higher percentage among foreign-born (48.2%) than US-born (46.7%), and higher proportion of adenocarcinoma in foreign-born (58.3% and 66.4% among US-born and foreign-born females, respectively).

While median survival was higher among US-born than foreign-born females (23.4 versus 18.4 months, respectively), survival was similar between US-born and foreign-born males (12.5 versus 13.0 months, respectively). The better survival among Chinese females compared to Chinese males was seen across all histologic subtypes, with the exception of squamous cell carcinoma.

In multivariate survival models, among males, the following factors were associated with worse survival: older age, never married, advanced stage, and reporting from non cancer center, while adenocarcarcinoma and large cell carcinoma were associated with better survival relative to small cell. Among females, the following factors were associated with worse survival: older age, never married, residence in lower socioeconomic status neighborhoods, advanced stage, reporting from non cancer center, and squamous cell (relative to small cell) histology.

Conclusions: While lung cancer survival is generally poor, considerable variations in survival were seen among Chinese Americans by patient sociodemographic and neighborhood characteristics, in addition to clinical factors. Closer investigation of underlying factors or mechanisms, such as those related to marital status, socioeconomic status, and NCI-designated cancer center, may provide insights for interventions to improve lung cancer survival.

Citation Format: Scarlett Lin Gomez, Christina Clarke, Juan Yang, Alan Sandler, Shih-Wen Lin. Lung cancer survival among Chinese Americans in California, 2000-2010. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B38.