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Brief Report|Articles in Press, 100496

Racial, Ethnic, and Socioeconomic Characteristics Independently Predict for Cachexia Risk and Associated Survival Outcomes in Stage IV Non-Small Cell Lung Cancer: A Brief Report

Open AccessPublished:March 10, 2023DOI:https://doi.org/10.1016/j.jtocrr.2023.100496
Racial, Ethnic, and Socioeconomic Characteristics Independently Predict for Cachexia Risk and Associated Survival Outcomes in Stage IV Non-Small Cell Lung Cancer: A Brief Report
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      Abstract

      Background

      Cancer cachexia, seen in more than a third of patients with non-small cell lung cancer (NSCLC), directly leads to functional and survival detriments. As screening and interventions for cachexia and NSCLC improve, deficits in healthcare access and quality among patients disadvantaged by race and socioeconomic factors must be addressed.

      Methods

      We retrospectively evaluated 957 patients diagnosed with stage IV NSCLC between 2014-2020 in Dallas, Texas. Cachexia was retrospectively assessed by applying criteria for substantial unintentional weight loss in the time leading up to cancer diagnosis. Non-parametric, parametric, multivariate logistic regression, and Kaplan-Meier analyses were conducted to evaluate for variables with significant associations with cachexia incidence and survival.

      Results

      In multivariate analysis including age, sex, comorbidities, BMI, risk behaviors, and tumor histology, Black race and Hispanic ethnicity independently associated with more than a 70% increased risk of presenting with cachexia at the time of NSCLC diagnosis (P<0.05). When private insurance status was included as a covariate, this association was diminished for Hispanic patients only. Black patients presented with stage IV disease at an average of approximately 3 years younger than White patients (Kruskal-Wallis P=0.0012; T-test P=0.0002). Cachexia status at diagnosis consistently predicted for survival detriments, further highlighting the importance of addressing differential cachexia risk across race/ethnicity.

      Conclusions

      Fundamentally, our findings reveal elevated cachexia risk in Black and Hispanic stage IV NSCLC patients with associated survival detriments. These differences are not fully accounted for by traditional determinants of health and suggest novel avenues for addressing oncologic health inequities.

      Keywords

      Article info

      Publication history

      Accepted: March 6, 2023
      Received in revised form: March 2, 2023
      Received: September 26, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      This work was supported by National Institutes of Health [P30 CA142543]; Burroughs Wellcome Fund Career Awards for Medical Scientists [1019692]; American Cancer Society grant [133889-RSG-19-195-01-TBE]; Cancer Prevention and Research Institute of Texas [RP200170]; and the Conquer Cancer Medical Student Rotation for Underrepresented Populations Award. Any opinions, findings, and conclusions expressed in this material are those of the author(s) and do not necessarily reflect those of the American Society of Clinical Oncology® or Conquer Cancer®

      S Olaechea has a research grant from the American Society of Clinical Oncology. R Infante laboratory has received funding from Pfizer unrelated to this work. P Iyengar has worked with AstraZeneca in an advisory capacity unrelated to this work. The remaining authors have no conflicts of interest to declare.

      Santiago Olaechea: Conceptualization, formal analysis, investigation, methodology, visualization, writing - original draft, writing - review & editing

      Alison Liu: Writing - original draft, writing - review & editing

      Brandon Sarver: Writing - review & editing

      Linda Anne Gilmore: Data curation

      Christian Alvarez: Data curation

      Kayvon Yazdanbakhsh: Writing - review & editing

      Rodney Infante: Project administration, supervision

      Puneeth Iyengar: Project administration, supervision, writing - review & editing

      Identification

      DOI: https://doi.org/10.1016/j.jtocrr.2023.100496

      Copyright

      © 2023 Published by Elsevier Inc. on behalf of the International Association for the Study of Lung Cancer.

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