CTS: Women Outlive Men During Lung Cancer Trials

  • by
    Contributing Writer, MedPage Today

Action Points

  • Explain to interested patients this is a retrospective study and involves an advanced form of lung cancer.
  • This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until publication in a peer-reviewed journal.

Being a woman is a clear advantage, Corey Langer, M.D., director of thoracic oncology at the University of Pennsylvania, said at the 2008 Chicago Multidisciplinary Symposium on Thoracic Cancer.

"Across the board, independent of race or partnering status, men did worse than women," said Dr. Langer. "This is an observation that has been repeatedly observed in multiple epithelial malignancies, not just lung cancer."

What he also found was a lack of influence for survival among patients who had a partner.

"If a man was partnered or alone, he did just as well regardless of status," he said. "The same held true for women. These observations are actually in contrast to those previously made by the Radiation Therapy Oncology Group (RTOG) in head-and- neck cancer where single men did far worse than partnered men.

"Why this distinction exists between head-and-neck and lung cancer remains a bit unclear," he said. "It may have to do with the intrinsic biology of the disease in lung cancer which governs outcome.

"In head-and-neck cancer there are many other factors that may affect outcome that go beyond the intrinsic biology. Given the aggressive nature of combined modality therapy and proper support systems required for recovery and post-surgical treatment for head-and-neck disease, logistic issues certainly hold sway and a partnered man is far more likely to have that than a single man."

Dr. Langer and colleagues examined outcomes in nine RTOG studies of patients who had inoperable tumors. They stratified the outcomes by sex, race, partner status, and also stratified by the time period of the studies to account for changes in treatment.

They determined that men had a 23% greater mortality in the study period than women, a difference that was statistically significant at the P=0.0008 level. In contrast, single individuals had a non-significant 7% lower risk of mortality than married individuals (P=0.2867) and non-whites had a non-significant 1% less risk (P=0.8585).

The studies included 707 Caucasian men and 457 Caucasian women and 145 non-white men and 42 non-white women. The treatment period were broken down from 1991-1994, 1995-1998, and 1999-2002. Age, performance status, weight loss, tumor stage, histology, location of the primary tumor, biological equivalent dose, and education level were adjusted in the statistical model.

Among other findings, all of which were statistically significant (P<0.05):

  • White males (HR=1.25) and non-white males (HR=1.28) had significantly higher mortality than white females.
  • Single males (HR=1.35) and married males (HR=1.23) had significantly lower overall survival than married females.
  • Married white males (HR=1.23), single white males (HR=1.46), and married non-white males (HR=1.33) had significantly lower overall survival than married white females.

Dr. Langer said there were too few non-white women in the study to make meaningful relevant comparisons.

"Race and marital status were not independently predictive for overall survival," he said.

"In just about every type of cancer -- except those exclusive to men or women -- women do better than men," said radiation oncologist Jeffrey Bradley, M.D., of Washington University in St. Louis.

"I don't think we know why that is," said Dr. Bradley who moderated a press briefing at which Dr. Langer described his work. The differences in outcomes in men versus women in various cancers have been observed for decades, so he was not surprised that the some trends held true in lung cancer patients.

The meeting was co-sponsored by the American Society for Therapeutic Radiology and Oncology, the American Society of Clinical Oncology, the International Association for the Study of Lung Cancer, and the University of Chicago.

Neither Dr. Langer nor Dr. Bradley had conflicts of interest to disclose.

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