By Pam Harrison
TORONTO, May 09 (Reuters Health) - Asians who develop lung cancer take
longer to go to the doctor after symptoms develop, have more advanced disease at
the time of diagnosis, and are much less likely to be alive two years after
diagnosis than non-Asian lung cancer patients, Boston researchers report.
The study results were presented during the 96th International Conference of
the American Thoracic Society that is underway here.
Dr. Geraldine Finlay, associate professor of pulmonary and critical care
medicine, at Tufts University School of Medicine, Boston, Massachusetts,
conducted a five-year, retrospective case-control study in which she and her
colleagues compared presentation, treatment and outcomes in 42 Asian patients
with lung cancer with that of 42 other age and sex-matched non-Asian controls.
All patients were part of the New England Medical Center Cancer Center Database.
Investigators found that almost 49% of Asian patients presented with
advanced lung cancer (stage IV), "where therapeutic options are limited," as
Finlay noted, compared with 38% of non-Asians. Conversely, only 11.6% of Asians
presented with early (stage I) disease compared with 23.8% of non-Asians. The
patterns of presentation for stage II and III were similar in both groups,
investigators indicated.
Finlay told Reuters Health in an interview that Asian patients with lung
cancer sought medical attention on average about 4.4 months after developing
symptoms, compared with only 1.7 months for non-Asians. Asians were also more
likely to present with hemoptysis, or coughing up blood, she said, adding that
it was "surprising" that Asians did not appear to find coughing up blood to be
an alarming symptom.
Two years after their initial diagnosis, only 14% of Asian lung cancer
patients were alive compared with 43% of non-Asians--suggesting that delaying
seeking treatment affects survival.
In the Asian group overall, 76% of patients smoked, compared with almost 98%
of non-Asian controls. But as Finlay pointed out, Asian women with lung cancer
involved in the study often did not smoke. This may suggest that Asian men
actually were heavier smokers than non-Asians, even though there was no
statistical difference between the two groups.
Findings also revealed that Asian patients were treated differently than
non-Asians, even when the stage of disease was the same. In contrast to
non-Asians who tended to be treated with combinations of surgery, chemotherapy
and radiotherapy, "Asian patients tended to just get single-agent radiotherapy
for the same stage III and IV disease," said Finlay. This might reflect a
tendency for Asians to rely on their own cultural methods for treatment rather
than trust in mainstream medicine, she indicated.
"The other possibility was a difference in lung function between the two
groups," Finlay said. It may be that Asians with more advanced (stage III and
IV) lung cancer have worse lung disease or other diseases associated with their
smoking including cardiac disease. The presence of these factors may influence
therapeutic decision-making, Finlay suggested.
