Patient education level as a predictor of survival in lung cancer clinical trials.

Full Abstract

PURPOSE:
To investigate the effect of socioeconomic status, as measured by education, on the survival of 1,577 lung cancer patients treated on 11 studies conducted by the Cancer and Leukemia Group B.

PATIENTS AND METHODS:
Sociodemographic data, including education, was reported by the patient at the time of clinical trial accrual. Cox proportional hazards model stratified by treatment arm/study was used to examine the effect of education on survival after adjustment for known prognostic factors.

RESULTS:
The patient population included 1,177 patients diagnosed with non-small-cell lung cancer (NSCLC; stage III or IV) and 400 patients diagnosed with small-cell lung cancer (SCLC; extensive or limited). Patients with less than an eighth grade education (13% of patients) were significantly more likely to be male, nonwhite, and older; have a performance status (PS) of 1 or 2; and have chest pain. Significant predictors of poor survival in the final model included male sex, PS of 1 or 2, dyspnea, weight loss, liver or bone metastases, unmarried, presence of adrenal metastases and high alkaline phosphatase levels among patients with NSCLC, and high WBC levels among patients with advanced disease. Education was not predictive of survival.

CONCLUSION:
The physical condition of patients with low education who enroll onto clinical trials is worse than patients with higher education. Once enrolled onto a clinical trial, education does not affect the survival of patients with SCLC or stage III or IV NSCLC. The standardization of treatment and follow-up within a clinical trial, regardless of education, is one possible explanation for this lack of effect.

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Author information

Author/s: Herndon, James E (JE); Kornblith, Alice B (AB); Holland, Jimmie C (JC); Paskett, Electra D (ED);

Affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA. james.herndon(-atsign-)duke.edu

Grants: CA32291 (Agency:United States NCI) ; CA77651 (Agency:United States NCI) ; CA77658 (Agency:United States NCI)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural

Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol), published in United States. (Language: eng)

Reference: 2008-Sep; vol 26 (issue 25) : pp 4116-23

Dates: Created 2008/09/01; Completed 2008/09/24;

PMID: 18757325, status: MEDLINE (last retrieval date: 11/6/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Aged
Carcinoma, Non-Small-Cell Lung - epidemiology; mortality
Clinical Trials as Topic
Disease Progression
Educational Status
Female
Humans

Humans
Lung Neoplasms - epidemiology; mortality
Male
Middle Aged
Prognosis
Proportional Hazards Models
Social Class
Treatment Outcome

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