Trends in racial and ethnic disparities in health-related quality of life in older adults with lung cancer

Introduction: We aimed to quantitatively examine differences in health-related quality of life (HRQOL) by race/ ethnicity among older adults with lung cancer. Materials and Methods: Using the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) data set, we identified two cohorts of patients >= 65 years old with lung cancer diagnosed from 2004 to 2015 who completed the health outcomes survey within 36 months pre- and post-diagnosis. The Physical Component Summary (PCS) and Mental Component Summary (MCS) were used to measure HRQOL. Racial/ ethnic groups were White, Black, Asian, and Hispanic. Univariate (UVA) and multivariable (MVA) linear regression analyses with pairwise contrasts assessed disparities among the racial/ethnic groups. MVA models were adjusted for sex, age, marital status, education, income, year diagnosed, comorbidity count, limitations in activities of daily living, national region, histology, and treatment type (post-diagnosis cohort only). Results: We identified 4025 patients in the pre-diagnosis cohort (White = 75.9 %, Asian = 6.3 %, Black = 8.7 %, and Hispanic = 6.1 %; stages I = 28.8 %, II = 8.9 %, III = 21.7 %, IV = 27.8 %, unknown = 12.7 %) and 2465 patients in the post-diagnosis cohort (White = 74.4 %, Asian = 7.8 %, Black = 8.8 %, and Hispanic = 5.8 %; stages I = 40.2 %, II = 14.1 %, III = 17.5 %, IV = 10.7 %, unknown = 17.5 %; treatment type surgery = 0.9 %, radiation = 46.5 %, radiation and surgery = 26.8 %, no radiation or surgery = 25.9 %). Upon pre-diagnosis cohort UVA, White and Asian patients had higher mean MCS scores than Black and Hispanic patients (51.3 and 52.7 vs 47.4 and 47.4, respectively; p < .001 and p < .001), White patients had higher mean PCS scores than Black patients (38.6 vs 36.0; p < .001), and Asian patients had higher mean PCS scores than White, Black, and Hispanic patients (40.7 vs 38.6, 36.0 and 37.5, respectively; p = .008, p < .001, and p = .005). On pre-diagnosis MVA, White and Asian patients had higher mean MCS scores than Hispanic patients (51.2 and 52.0, respectively, vs 47.2; p < .001). On pre-diagnosis MVA, Asian patients had higher mean PCS scores than White patients (52.0 and 51.2; p = .002).On post-diagnosis UVA, White and Asian patients had higher mean MCS scores than Black patients (48.9 and 48.9, respectively, vs 46.3; p = .006 and p = .042), White patients had higher mean MCS scores than Hispanic patients (48.9 vs 46.1; p = .015), White patients had higher mean PCS scores than Black patients (33.8 vs 31.9; p = .018), and Hispanic patients had higher mean PCS scores than Black patients (34.9 vs. 31.9; p = .019). On post-diagnosis MVA, race/ethnicity was no longer associated with differing MCS or PCS. Discussion: Among older patients with lung cancer, those identifying as White or Asian had higher pre-diagnosis mental HRQOL than Hispanic patients. However, HRQOL differences before diagnosis among all racial/ethnic groups were no longer significant after cancer diagnosis and treatment. Understanding these patterns of HRQOL can be used for more pointed initiatives to improve therapeutic strategy, compliance, goals of care, and treatment-related morbidity.