Project title: Trends in incidence and survival outcomes for lung NETs

Description

Mulvey will quantify sociodemographic and geographic patterns of incidence and overall survival among those diagnosed with lung NETs in California from 1992-2017 to identify potential risk factors.

What question will the researchers try to answer?

What is the incidence of lung NETs (typical and atypical histologies) in the diverse state of California from 1992-2017, and what differences might exist in the incidence rate and survival by race, ethnicity, sex, geographic regions, and year of diagnosis?

Why is this important?

Little is known about the epidemiology of lung NETs. This research will yield a better understanding of the predisposing factors, predictors of survival, and disparities in care.

What will researchers do?

Researchers will evaluate whether the incidence patterns and survival differ by patient race/ethnicity, sex, year of diagnosis, and geographic region classified as rural, suburban, or urban.

How might this improve the treatment of NETs?

The data generated from this proposal will provide insight into who gets lung NETs and why, as well as identify opportunities to improve care and to reduce disparities for all patients with lung NETs.

What is the next step?

The data generated from this study will generate hypotheses to inform future etiologic studies and will identify opportunities to improve care for all patients with lung NETs.

Outcomes:

Typical and atypical lung neuroendocrine tumors (NETs) are a relatively rare, heterogeneous group of cancers with a wide spectrum of clinical behavior. Preliminary analysis suggests that, as for other primary NET sites, the incidence of lung NETs has increased over the last 40 years.

In this research project, I quantified sociodemographic and geographic patterns of incidence and overall survival among people diagnosed with a lung NET in the diverse state of California from 1992-2017. The data source for this project was the California Cancer Registry, a population-based cancer registry that encompasses nearly all cancer diagnoses in the state and is uniquely suited to address epidemiological questions. In my analysis, I found that the incidence of lung NETs in California increased sharply starting in the year 2014.

Women had higher incidence of lung NETs than men, with incidence rates nearly double that of men between 2014 and 2019. There were also differences in incidence of lung NETs by race/ethnicity. The non-Hispanic White population had a higher incidence of lung NETs than other racial/ethnic groups, while Asian/Pacific Islander population had lower incidence rates.
I also found that married individuals had higher incidence rates compared with unmarried individuals, and higher incidence rates in the highest neighborhood socioeconomic status tertile. The reasons for these differences in incidence are unclear, and further research is needed to better understand the mechanisms. These findings may provide clues into the pathogenesis of lung NETs and/or may suggest underlying disparities in who is diagnosed with lung NETs.

In multivariable models, I found that sociodemographic factors were independently associated with survival in lung NETs beyond disease-related and treatment variables. Survival was better for women versus men, married versus unmarried Californians, and residents of high socioeconomic status neighborhoods compared with residents of low socioeconomic status neighborhoods. Compared to patients with private health insurance, survival was worse for patients with Medicare, or Medicaid, military, or other public insurance. These results suggest that future efforts to improve outcomes and reduce disparities should include supporting socially isolated and economically disadvantaged individuals.

Overall, this analysis has improved our understanding of who gets lung NETs and identified predictors of outcomes beyond disease and treatment variables.

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