A new study suggests that socioeconomic status and other social circumstances could be responsible for decreased physical health at the time of diagnosis among African-American patients with non-small-cell lung cancer, which may explain disparities in survival rates between African-American and non-African-American patients who receive the same treatment for their cancer.
A. William Blackstock, M.D., of the Wake Forest University School of Medicine, Winston-Salem, N.C., and colleagues pooled data from five clinical trials of treatments for non-small-cell lung cancer and found that the one-year survival rate was 22% among African-American patients and 30% among non-African-American patients. The investigators collected information on the patients to determine if the difference was related to innate characteristics of the disease in the two ethnicities or to disparities in health care.
They found that both groups of patients had similar stages of disease when they entered the clinical trials; however, substantially more African-American patients had a worse performance status (the ability to perform physical activity) and had experienced weight loss associated with their disease. (Both of these factors are known to have a negative impact on survival.) After the investigators performed statistical tests to adjust for these factors, there was no difference in outcome between the two ethnic groups.
They also found that African-American patients were more likely to be unmarried, to be uninsured or rely upon Medicaid, and in, general, to have a lower income. The authors note that these factors are associated with decreased overall health, and, by extension, survival outcomes. They conclude that these results lend further support to evidence that “equal treatment of racially diverse patients with equivalent pretreatment prognostic features results in equal outcome.” The study appears in the Feb. 20 issue of the Journal of the National Cancer Institute.
Contact: Jonnie Rohrer, Wake Forest University School of Medicine, (336) 716-6972, fax: (336) 716-6841, jrohrer@wfubmc.edu.
Most Widely Used Regimen for Non-Small-Cell Lung Cancer Is More Expensive Than Previous Standard Treatment
The most widely used chemotherapy regimen for advanced non-small-cell lung cancer in the United States, carboplatin plus paclitaxel, is substantially more expensive than an equally effective treatment that was the previous standard regimen, cisplatin plus vinorelbine.
An economic analysis of the two therapies found that the total health care costs associated with cisplatin plus vinorelbine averaged $40,292 per patient, and the costs associated with treatment with carboplatin plus paclitaxel averaged $48,940 per patient. Scott D. Ramsey, M.D., Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, and colleagues performed their analysis alongside a clinical trial of the two therapies, which yielded similar survival rates and quality of life among patients.
The cost averages include many of the costs associated with cancer care. Ramsey and colleagues did not observe notable differences in costs of blood products, supportive care medications, non-protocol-related inpatient or outpatient care, or nonprotocol chemotherapy between the two groups. The cost of the chemotherapy drugs and medical procedures were substantially higher in the paclitaxel arm; the cost of carboplatin plus paclitaxel alone was nearly $12,000 more than the cost of cisplatin plus vinorelbine. Chemotherapy delivery costs were higher in the vinorelbine arm, but the difference was not enough to offset the higher cost of carboplatin and paclitaxel.
The study, which appears in the Feb. 20 issue of the Journal of the National Cancer Institute, was funded in part by Glaxo Wellcome Inc., which makes vinorelbine (Navelbine), and by Bristol-Myers Squibb Inc., which makes carboplatin (Paraplatin), paclitaxel (Taxol), and cisplatin (Platinol). Additional support was provided by the Southwest Oncology Group and the National Cancer Institute.
Contact: Kristen Woodward, Fred Hutchinson Cancer Research Center, (206) 667-5095, fax: (206) 667-7005; kwoodwar@fhcrc.org.
Absence of Carcinogen-Metabolizing Gene Associated With Increased Risk of Pancreatic Cancer In Smokers
A new study has found that heavy smokers who lack a gene responsible for protecting cells from the damaging effects of tobacco carcinogens may have a higher risk of developing pancreatic cancer.
The gene, GSTT1, is a member of a family of enzymes called glutathione S-transferases, which are responsible for protecting cells from carcinogen-related cell damage. The study, which appears in the Feb. 20 issue of the Journal of the National Cancer Institute, found that, compared with nonsmokers who had both copies of the GSTT1 gene, heavy smokers who were missing both copies of the gene had a higher risk of pancreatic cancer. The relative risk was higher in women than men; women had a fivefold increased relative risk, and men had a 3.2-fold increased relative risk.
Cigarette smoking is estimated to account for 25% to 29% of pancreatic cancers. Eric J. Duell, Ph.D., and Karl T. Kelsey, M.D., of the Harvard School of Public Health, and colleagues hypothesized that mutations in carcinogen-metabolizing genes may play a role in smoking-related pancreatic cancer. For the current study, the investigators analyzed blood samples from 309 pancreatic cancer patients and 964 people who did not have pancreatic cancer.
In addition to the GSTT1 gene, the researchers looked at polymorphisms in the CYP1A1 gene and deletions in the GSTM1 gene; however, there was no strong evidence of a link between polymorphisms in CYP1A1 or deletions in GSTM1 and smoking-related pancreatic cancer.
Contact: Kevin Myron, Harvard School of Public Health, (617) 432-3952, fax: 617-432-5531, kmyron@hsph.harvard.edu.
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JNCI Journal of the National Cancer Institute