Do race and income influence quality of life (QOL) or survival outcomes after lung stereotactic body radiation therapy (SBRT)? a prospective study.
Vance S, Al Feghali KA, Taylor A, Kaur M, Neslund-Dudas C, Chetty IJ, Simoff M, Ajlouni M, and Movsas B. Do race and income influence quality of life (QOL) or survival outcomes after lung stereotactic body radiation therapy (SBRT)? a prospective study. Int J Radiat Oncol Biol Phys 2016; 96(2s):E534.
Int J Radiat Oncol Biol Phys
Few studies have assessed the influence of sociodemographic factors on outcomes after treatment with lung stereotactic body radiotherapy (SBRT). We conducted a prospective clinical study focused on QOL with the hypothesis that there would be no difference in survival or QOL based on race or income when patients were treated in a center with a multidisciplinary approach. Materials/Methods: This prospective study was open to all patients undergoing SBRT directed to the lung within our health system. SBRT was offered only after a multi-disciplinary tumor board discussion. The study was designed to evaluate changes in patient-reported QOL using several previously validated instruments: the EuroQol-5D index (EQ-5D index), EQ-5D Visual Analog Scale (EQ-5D VAS), FACT Lung Cancer Subscale (FACT LCS) and FACT Trial Outcome Index (FACT TOI). Responses are currently available at pre-treatment baseline, immediately post-treatment, and at 3 and 6 months post-treatment. Median household income (MHHI) was estimated at the census tract level. Statistical analysis was performed using R v3.2.3 and survival package v0.4.3. Changes in QOL measures across time points were calculated using paired t-tests. Survival was assessed using Kaplan-Meier analysis. Results: Ninety-four patients (of 113 currently enrolled) had at least 6 month follow-up and were included for analysis. Median follow-up was 1.5 years. African Americans (AA) represented 34% of the study cohort (nZ32), 65% of patients (nZ61) were whites, (<5 patients were non-AA, non-white); 24% of the patients (nZ23) had stage IV/metastatic disease and an additional 10% (nZ9) were recurrent NSCLC. Patients were primarily treated with 4 fractions of 12 Gy each. MHHI of the cohort was $43,211 and was used to stratify high vs low income. The calculated EQ5D index, EQ-5D VAS, FACT LCS, and FACT TOI showed for the entire cohort of patients, there was no difference relative to baseline for each of the QOL scores at any of the measured time points (immediately posttreatment and 3 and 6 months). Similar comparisons after stratifying by race and MHHI, again failed to identify significant differences. KaplanMeier analysis showed no differences in OS when stratified by race (PZ0.31) or by median household income (PZ0.76). There was no difference in 1- and 2-year-OS between white and AA (92% vs 96%, PZ0.58; and 73% vs 89%, PZ0.17, respectively) nor between low and high income (94% vs 94%, PZ0.98; and 80% vs 77%, PZ0.95, respectively). Conclusion: In this multidisciplinary care setting, QOL was not influenced by race or income at any measured time-point in the 6 months following lung SBRT. Further follow up will be presented. Race and income were also not associated with any differences in OS. NOTE: This research was supported in part by a grant from Varian Inc. Author Disclosure: S. Vance: None. K.A. Al Feghali: None. A. Taylor: None. M. Kaur: None. C. Neslund-Dudas: None. I.J. Chetty: Research Grant; Varian Medical Systems, Philips. M. Simoff: None. M. Ajlouni: None. B. Movsas: Research Grant; Varian Medical Systems, Philips. Involved with selection of scientific content of the meeting; ASTRO.