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Factors Associated with Survival and Epidemiology of Gastrointestinal Neuroendocrine Tumors in the US Department of Veteran Affairs
Introduction
Rectal carcinoid tumors are rare but the second most common carcinoid in the gastrointestinal tract. They are usually found incidentally during endoscopic or rectal examination. They do not often produce carcinoid syndrome like manifestations although they may manifest as rectal bleeding. Rectal carcinoid patients also have a higher morbidity for other cancers such as stomach, small intestine, or secondary lung cancer.
Methods
We retrospectively explored factors associated with survival in Veterans with rectal carcinoid tumors over a ten-year period from 2007-2017 using the National Veterans Affairs Cancer Cube Registry using specific histological ICD-03 coding. We identified 1110 cases of rectal carcinoid. Chi-squared tests were used for statistical analysis.
Results
Regarding age distribution in our cohort, there were 2.61% of patients ages 40-50 group, 14.0% in the 50-60 age group, 41.5% in the 60-70 age group, and 40.7% above ages 70. There was a higher proportion of rectal cancer in stage 1 compared to other stages (86.3%). The majority of diagnoses occur after age 50 (89.8%). A higher proportion of rectal carcinoid was identified in the 60-70 years category compared to <60 and >70 years old. In the general VA population, there are 80.2% White and 12.8% Black patients. We found a higher proportion of rectal carcinoid in Black patients (47.8%) over White patients (42.8%, p=0.02), which differs significantly from the racial makeup of the VA population (12.8% Black vs 80.3% White). Looking at survival time based on diagnosis, it is notable that 82.7% of individuals survive longer than 5 years when the diagnosis is made in ages 50-60 when compared to 68.7% when the diagnosis is made between ages 60-70 (p<0.001).
Conclusions
Our data is consistent with the SEER data in that the incidence and prevalence of rectal carcinoid are higher in Black patients compared to White patients. Further analysis into reasons for this racial disparity may prove beneficial to our understanding of this malignancy in the Veteran population. Further research is needed to determine whether diagnosis at a younger age offers a survival advantage in rectal carcinoid.
Introduction
Rectal carcinoid tumors are rare but the second most common carcinoid in the gastrointestinal tract. They are usually found incidentally during endoscopic or rectal examination. They do not often produce carcinoid syndrome like manifestations although they may manifest as rectal bleeding. Rectal carcinoid patients also have a higher morbidity for other cancers such as stomach, small intestine, or secondary lung cancer.
Methods
We retrospectively explored factors associated with survival in Veterans with rectal carcinoid tumors over a ten-year period from 2007-2017 using the National Veterans Affairs Cancer Cube Registry using specific histological ICD-03 coding. We identified 1110 cases of rectal carcinoid. Chi-squared tests were used for statistical analysis.
Results
Regarding age distribution in our cohort, there were 2.61% of patients ages 40-50 group, 14.0% in the 50-60 age group, 41.5% in the 60-70 age group, and 40.7% above ages 70. There was a higher proportion of rectal cancer in stage 1 compared to other stages (86.3%). The majority of diagnoses occur after age 50 (89.8%). A higher proportion of rectal carcinoid was identified in the 60-70 years category compared to <60 and >70 years old. In the general VA population, there are 80.2% White and 12.8% Black patients. We found a higher proportion of rectal carcinoid in Black patients (47.8%) over White patients (42.8%, p=0.02), which differs significantly from the racial makeup of the VA population (12.8% Black vs 80.3% White). Looking at survival time based on diagnosis, it is notable that 82.7% of individuals survive longer than 5 years when the diagnosis is made in ages 50-60 when compared to 68.7% when the diagnosis is made between ages 60-70 (p<0.001).
Conclusions
Our data is consistent with the SEER data in that the incidence and prevalence of rectal carcinoid are higher in Black patients compared to White patients. Further analysis into reasons for this racial disparity may prove beneficial to our understanding of this malignancy in the Veteran population. Further research is needed to determine whether diagnosis at a younger age offers a survival advantage in rectal carcinoid.
Introduction
Rectal carcinoid tumors are rare but the second most common carcinoid in the gastrointestinal tract. They are usually found incidentally during endoscopic or rectal examination. They do not often produce carcinoid syndrome like manifestations although they may manifest as rectal bleeding. Rectal carcinoid patients also have a higher morbidity for other cancers such as stomach, small intestine, or secondary lung cancer.
Methods
We retrospectively explored factors associated with survival in Veterans with rectal carcinoid tumors over a ten-year period from 2007-2017 using the National Veterans Affairs Cancer Cube Registry using specific histological ICD-03 coding. We identified 1110 cases of rectal carcinoid. Chi-squared tests were used for statistical analysis.
Results
Regarding age distribution in our cohort, there were 2.61% of patients ages 40-50 group, 14.0% in the 50-60 age group, 41.5% in the 60-70 age group, and 40.7% above ages 70. There was a higher proportion of rectal cancer in stage 1 compared to other stages (86.3%). The majority of diagnoses occur after age 50 (89.8%). A higher proportion of rectal carcinoid was identified in the 60-70 years category compared to <60 and >70 years old. In the general VA population, there are 80.2% White and 12.8% Black patients. We found a higher proportion of rectal carcinoid in Black patients (47.8%) over White patients (42.8%, p=0.02), which differs significantly from the racial makeup of the VA population (12.8% Black vs 80.3% White). Looking at survival time based on diagnosis, it is notable that 82.7% of individuals survive longer than 5 years when the diagnosis is made in ages 50-60 when compared to 68.7% when the diagnosis is made between ages 60-70 (p<0.001).
Conclusions
Our data is consistent with the SEER data in that the incidence and prevalence of rectal carcinoid are higher in Black patients compared to White patients. Further analysis into reasons for this racial disparity may prove beneficial to our understanding of this malignancy in the Veteran population. Further research is needed to determine whether diagnosis at a younger age offers a survival advantage in rectal carcinoid.
Racial Disparities in Treatment and Survival for Early-Stage Non-Small Cell Lung Cancer: Is Equal Access Health Care System the Answer?
Background
Survival for early-stage non-small cell lung cancer (NSCLC) has dramatically improved with advancement in surgical and radiation techniques over last two decades but there exists a disparity for African Americans (AA) having worse overall survival (OS) in recent studies on the general US population. We studied this racial disparity in Veteran population.
Methods
Data for 2589 AA and 14184 Caucasian Veterans diagnosed with early-stage (I, II) NSCLC between 2011-2017 was obtained from the Cancer Cube Registry (VACCR). IRB approval was obtained.
Results
The distribution of newly diagnosed cases of Stage I (73.92% AA vs 74.71% Caucasians) and Stage II (26.07% vs 25.29%) between the two races was comparable (p = .41). More Caucasians were diagnosed above the age of 60 compared to AA (92.22% vs 84.51%, p < .05). More AA were diagnosed with adenocarcinoma at diagnosis (56.01% vs 45.88% Caucasians, p < .05) for both Stage I and II disease. For the limited number of Veterans with reported performance status (PS), similar proportion of patients had a good PS defined as ECOG 0-2 among the two races (93.70% AA vs 93.97% Caucasians, p = .73). There was no statistically significant difference between 5-year OS for AA and Caucasians (69.81% vs 70.78%, p = .33) for both Stage I and II NSCLC. Both groups had similar rate of receipt of surgery as first line treatment or in combination with other treatments (58.90% AA vs 59.07% Caucasians, p = .90). Similarly, the rate of receiving radiation therapy was comparable between AA and Caucasians (42.4% vs 42.3%, p = .96). Although both races showed improved 5-year OS after surgery, there was no statistical difference in survival benefit between AA and Caucasians (69.8% vs 70.8%, p = .33).
Conclusion
In contrast to the studies assessing general US population trends, there was no racial disparity for 5-year OS in early-stage NSCLC for the Veteran population. This points to the inequities in access to treatment and preventive healthcare services as a possible contributing cause to the increased mortality in AA in general US population and a more equitable healthcare delivery within the VHA system.
Background
Survival for early-stage non-small cell lung cancer (NSCLC) has dramatically improved with advancement in surgical and radiation techniques over last two decades but there exists a disparity for African Americans (AA) having worse overall survival (OS) in recent studies on the general US population. We studied this racial disparity in Veteran population.
Methods
Data for 2589 AA and 14184 Caucasian Veterans diagnosed with early-stage (I, II) NSCLC between 2011-2017 was obtained from the Cancer Cube Registry (VACCR). IRB approval was obtained.
Results
The distribution of newly diagnosed cases of Stage I (73.92% AA vs 74.71% Caucasians) and Stage II (26.07% vs 25.29%) between the two races was comparable (p = .41). More Caucasians were diagnosed above the age of 60 compared to AA (92.22% vs 84.51%, p < .05). More AA were diagnosed with adenocarcinoma at diagnosis (56.01% vs 45.88% Caucasians, p < .05) for both Stage I and II disease. For the limited number of Veterans with reported performance status (PS), similar proportion of patients had a good PS defined as ECOG 0-2 among the two races (93.70% AA vs 93.97% Caucasians, p = .73). There was no statistically significant difference between 5-year OS for AA and Caucasians (69.81% vs 70.78%, p = .33) for both Stage I and II NSCLC. Both groups had similar rate of receipt of surgery as first line treatment or in combination with other treatments (58.90% AA vs 59.07% Caucasians, p = .90). Similarly, the rate of receiving radiation therapy was comparable between AA and Caucasians (42.4% vs 42.3%, p = .96). Although both races showed improved 5-year OS after surgery, there was no statistical difference in survival benefit between AA and Caucasians (69.8% vs 70.8%, p = .33).
Conclusion
In contrast to the studies assessing general US population trends, there was no racial disparity for 5-year OS in early-stage NSCLC for the Veteran population. This points to the inequities in access to treatment and preventive healthcare services as a possible contributing cause to the increased mortality in AA in general US population and a more equitable healthcare delivery within the VHA system.
Background
Survival for early-stage non-small cell lung cancer (NSCLC) has dramatically improved with advancement in surgical and radiation techniques over last two decades but there exists a disparity for African Americans (AA) having worse overall survival (OS) in recent studies on the general US population. We studied this racial disparity in Veteran population.
Methods
Data for 2589 AA and 14184 Caucasian Veterans diagnosed with early-stage (I, II) NSCLC between 2011-2017 was obtained from the Cancer Cube Registry (VACCR). IRB approval was obtained.
Results
The distribution of newly diagnosed cases of Stage I (73.92% AA vs 74.71% Caucasians) and Stage II (26.07% vs 25.29%) between the two races was comparable (p = .41). More Caucasians were diagnosed above the age of 60 compared to AA (92.22% vs 84.51%, p < .05). More AA were diagnosed with adenocarcinoma at diagnosis (56.01% vs 45.88% Caucasians, p < .05) for both Stage I and II disease. For the limited number of Veterans with reported performance status (PS), similar proportion of patients had a good PS defined as ECOG 0-2 among the two races (93.70% AA vs 93.97% Caucasians, p = .73). There was no statistically significant difference between 5-year OS for AA and Caucasians (69.81% vs 70.78%, p = .33) for both Stage I and II NSCLC. Both groups had similar rate of receipt of surgery as first line treatment or in combination with other treatments (58.90% AA vs 59.07% Caucasians, p = .90). Similarly, the rate of receiving radiation therapy was comparable between AA and Caucasians (42.4% vs 42.3%, p = .96). Although both races showed improved 5-year OS after surgery, there was no statistical difference in survival benefit between AA and Caucasians (69.8% vs 70.8%, p = .33).
Conclusion
In contrast to the studies assessing general US population trends, there was no racial disparity for 5-year OS in early-stage NSCLC for the Veteran population. This points to the inequities in access to treatment and preventive healthcare services as a possible contributing cause to the increased mortality in AA in general US population and a more equitable healthcare delivery within the VHA system.
Survival Analysis of Untreated Early-Stage Non-Small Cell Lung Cancer (NSCLC) in a Veteran Population
Introduction
Veterans with early-stage NSCLC who do not receive any form of treatment have been shown to have a worse overall survival compared to those who receive treatment. Factors that may influence the decision to administer treatment including age, performance status (PS), comorbidities, and racial disparity have not been assessed on a national level in recent years.
Methods
Data for 31,966 veterans diagnosed with early-stage (0, I) NSCLC between 2003-2017 was obtained from the Cancer cube registry (VACCR). IRB approval was obtained.
Results
Patients were divided into treatment (26,833/31,966, 83.16%) and no-treatment group (3096/31966, 9.68%). Of the no-treatment group, 3004 patients were stage I and 92 were stage 0 whereas in the treatment group, the distribution was 26,584 and 249 respectively. Gender, race, and histology distribution were comparable between the two. Patients with poor PS (defined as ECOG III and IV) received less treatment with any modality compared to those with good PS (ECOG I and II) (15.07% in no treatment group vs 4.03% in treatment group, p<0.05). The treatment group had a better 5-year overall survival (OS) as compared to no-treatment group (43.1% vs 14.7%, p<0.05). Regardless of treatment, patients above the age of 60 (41% vs 13.4%, p<0.05) and those with poor PS (19.6% vs 5.8%, p<0.05) had worse 5-year survival, with the effect being greater in the treatment group. Adenocarcinoma had a better 5-year survival compared to squamous cell carcinoma (SCC) in both groups (49.56% vs 39.1% p<0.05). There was no clinically significant OS difference in terms of race (Caucasian or African American) or tumor location (upper, middle, or lower lobe) in between the two groups. Our study was limited by lack of patient- level data including smoking status or reason why no treatment was given.
Conclusion
Patients with early-stage NSCLC who receive no treatment based on poor PS have a worse overall survival compared to the patients that receive treatment. Further investigation is required to assess what other criteria are used to decide treatment eligibility and whether these patients would be candidates for immunotherapy or targeted therapy in the future.
Introduction
Veterans with early-stage NSCLC who do not receive any form of treatment have been shown to have a worse overall survival compared to those who receive treatment. Factors that may influence the decision to administer treatment including age, performance status (PS), comorbidities, and racial disparity have not been assessed on a national level in recent years.
Methods
Data for 31,966 veterans diagnosed with early-stage (0, I) NSCLC between 2003-2017 was obtained from the Cancer cube registry (VACCR). IRB approval was obtained.
Results
Patients were divided into treatment (26,833/31,966, 83.16%) and no-treatment group (3096/31966, 9.68%). Of the no-treatment group, 3004 patients were stage I and 92 were stage 0 whereas in the treatment group, the distribution was 26,584 and 249 respectively. Gender, race, and histology distribution were comparable between the two. Patients with poor PS (defined as ECOG III and IV) received less treatment with any modality compared to those with good PS (ECOG I and II) (15.07% in no treatment group vs 4.03% in treatment group, p<0.05). The treatment group had a better 5-year overall survival (OS) as compared to no-treatment group (43.1% vs 14.7%, p<0.05). Regardless of treatment, patients above the age of 60 (41% vs 13.4%, p<0.05) and those with poor PS (19.6% vs 5.8%, p<0.05) had worse 5-year survival, with the effect being greater in the treatment group. Adenocarcinoma had a better 5-year survival compared to squamous cell carcinoma (SCC) in both groups (49.56% vs 39.1% p<0.05). There was no clinically significant OS difference in terms of race (Caucasian or African American) or tumor location (upper, middle, or lower lobe) in between the two groups. Our study was limited by lack of patient- level data including smoking status or reason why no treatment was given.
Conclusion
Patients with early-stage NSCLC who receive no treatment based on poor PS have a worse overall survival compared to the patients that receive treatment. Further investigation is required to assess what other criteria are used to decide treatment eligibility and whether these patients would be candidates for immunotherapy or targeted therapy in the future.
Introduction
Veterans with early-stage NSCLC who do not receive any form of treatment have been shown to have a worse overall survival compared to those who receive treatment. Factors that may influence the decision to administer treatment including age, performance status (PS), comorbidities, and racial disparity have not been assessed on a national level in recent years.
Methods
Data for 31,966 veterans diagnosed with early-stage (0, I) NSCLC between 2003-2017 was obtained from the Cancer cube registry (VACCR). IRB approval was obtained.
Results
Patients were divided into treatment (26,833/31,966, 83.16%) and no-treatment group (3096/31966, 9.68%). Of the no-treatment group, 3004 patients were stage I and 92 were stage 0 whereas in the treatment group, the distribution was 26,584 and 249 respectively. Gender, race, and histology distribution were comparable between the two. Patients with poor PS (defined as ECOG III and IV) received less treatment with any modality compared to those with good PS (ECOG I and II) (15.07% in no treatment group vs 4.03% in treatment group, p<0.05). The treatment group had a better 5-year overall survival (OS) as compared to no-treatment group (43.1% vs 14.7%, p<0.05). Regardless of treatment, patients above the age of 60 (41% vs 13.4%, p<0.05) and those with poor PS (19.6% vs 5.8%, p<0.05) had worse 5-year survival, with the effect being greater in the treatment group. Adenocarcinoma had a better 5-year survival compared to squamous cell carcinoma (SCC) in both groups (49.56% vs 39.1% p<0.05). There was no clinically significant OS difference in terms of race (Caucasian or African American) or tumor location (upper, middle, or lower lobe) in between the two groups. Our study was limited by lack of patient- level data including smoking status or reason why no treatment was given.
Conclusion
Patients with early-stage NSCLC who receive no treatment based on poor PS have a worse overall survival compared to the patients that receive treatment. Further investigation is required to assess what other criteria are used to decide treatment eligibility and whether these patients would be candidates for immunotherapy or targeted therapy in the future.