Reply to the influence of Hispanic ethnicity on nonsmall cell lung cancer histology and patient...
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foreign-born cases from SEER data. Although Saeed et al did not indicate that they excluded Hispanic cases with an unknown birthplace from their analysis, the nativity distri- bution of Hispanic cases (with 85.8% of cases being born in the United States) 1 is inconsistent with national popula- tion data that demonstrated that approximately 55% of US Hispanics are born in the United States. 4 Furthermore, applying our validated method for imputing nativity in cancer registry data 5 to the 10% of Hispanic NSCLC cases without registry or death certificate birthplace information in the California Cancer Registry (which comprises approx- imately 50% of SEER cases) during the same years as the study by Saeed et al, 1 we estimated approximately 51% of Hispanic patients with NSCLC to be US-born. We are encouraged to note research that acknowl- edges the heterogeneity of cancer incidence and outcomes across detailed racial/ethnic groups. However, with regard to the article by Saeed et al, 1 the lack of transparency and full disclosure in the methods, critical use of the data, and integration of relevant literature call into question their results and conclusions. SEER data are well respected and widely used for establishing population-level patterns in cancer incidence and outcomes that, in turn, inform pub- lic health and clinical action. Thus, analyses using these data must involve careful attention to data limitations to avoid generating potentially faulty results, which can be significant and far-reaching. FUNDING SUPPORT Supported by the National Cancer Institute (NCI)’s Surveillance, Epi- demiology, and End Results (SEER) Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California. The collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the NCI’s SEER Program under contract HHSN261201000140C awarded to the Cancer Pre- vention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #1U58 DP000807-01 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California, the California Department of Health Services, the NCI, or the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred. CONFLICT OF INTEREST DISCLOSURES The authors made no disclosures. REFERENCES 1. Saeed AM, Toonkel R, Glassberg MK, et al. The influence of Hispanic ethnicity on nonsmall cell lung cancer histology and patient survival: an analysis of the Survival, Epidemiol- ogy, and End Results database. Cancer. 2012;118:4495- 4501. 2. Gomez SL, Glaser SL. Quality of birthplace information obtained from death certificates for Hispanics, Asians, and Pacific Islanders. Ethn Dis. 2004;14:292-295. 3. Gomez SL, Glaser SL. Quality of cancer registry birthplace data for Hispanics living in the United States. Cancer Causes Control. 2005;16:713-723. 4. Pew Hispanic Center. Statistical Portrait of Hispanics in the United States,2008. pewhispanic.org/factsheets/fact- sheet.php? FactsheetID¼58. Accessed January 21, 2010. 5. Keegan TH, Quach T, Shema S, Glaser SL, Gomez SL. The influence of nativity and neighborhoods on breast can- cer stage at diagnosis and survival among California His- panic women. BMC Cancer.2010;10:603. Scarlett Lin Gomez, PhD Cancer Prevention Institute of California Fremont, California Department of Health Research and Policy Stanford Cancer Center Stanford University School of Medicine Stanford, California Clayton W. Schupp, PhD Cancer Prevention Institute of California Fremont, California Manali Patel, MD Department of Medicine Stanford University School of Medicine Stanford, California DOI: 10.1002/cncr.27799, Published online: October 1, 2012 in Wiley Online Library (wileyonlinelibrary.com) Reply to the Influence of Hispanic Ethnicity on Nonsmall Cell Lung Cancer Histology and Patient Survival An Analysis of the Survival, Epidemiology, and End Results Database Racial and ethnic disparities in lung cancer incidence and/ or mortality remain a significant health care concern. De- spite attempts at corrective measures, these disparities per- sist. Identifying the etiologies leading to cancer disparities, especially for patients with lung cancer, would improve the Cancer March 15, 2013 1287 Correspondence
Transcript of Reply to the influence of Hispanic ethnicity on nonsmall cell lung cancer histology and patient...
foreign-born cases from SEER data. Although Saeed et aldid not indicate that they excluded Hispanic cases with anunknown birthplace from their analysis, the nativity distri-bution of Hispanic cases (with 85.8% of cases being bornin the United States)1 is inconsistent with national popula-tion data that demonstrated that approximately 55% of USHispanics are born in the United States.4 Furthermore,applying our validated method for imputing nativity incancer registry data5 to the 10% of Hispanic NSCLC caseswithout registry or death certificate birthplace informationin the California Cancer Registry (which comprises approx-imately 50% of SEER cases) during the same years as thestudy by Saeed et al,1 we estimated approximately 51% ofHispanic patients with NSCLC to be US-born.
We are encouraged to note research that acknowl-edges the heterogeneity of cancer incidence and outcomesacross detailed racial/ethnic groups. However, with regardto the article by Saeed et al,1 the lack of transparency andfull disclosure in the methods, critical use of the data, andintegration of relevant literature call into question theirresults and conclusions. SEER data are well respected andwidely used for establishing population-level patterns incancer incidence and outcomes that, in turn, inform pub-lic health and clinical action. Thus, analyses using thesedata must involve careful attention to data limitations toavoid generating potentially faulty results, which can besignificant and far-reaching.
FUNDING SUPPORTSupported by the National Cancer Institute (NCI)’s Surveillance, Epi-demiology, and End Results (SEER) Program under contractHHSN261201000140C awarded to the Cancer Prevention Instituteof California. The collection of cancer incidence data used in this studywas supported by the California Department of Health Services as partof the statewide cancer reporting program mandated by CaliforniaHealth and Safety Code Section 103885; the NCI’s SEER Programunder contract HHSN261201000140C awarded to the Cancer Pre-vention Institute of California, contract HHSN261201000035Cawarded to the University of Southern California, and contractHHSN261201000034C awarded to the Public Health Institute; andthe Centers for Disease Control and Prevention’s National Program ofCancer Registries, under agreement #1U58 DP000807-01 awarded tothe Public Health Institute. The ideas and opinions expressed herein arethose of the authors, and endorsement by the State of California, theCalifornia Department of Health Services, the NCI, or the Centers forDisease Control and Prevention or their contractors and subcontractorsis not intended nor should be inferred.
CONFLICT OF INTEREST DISCLOSURESThe authors made no disclosures.
REFERENCES1. Saeed AM, Toonkel R, Glassberg MK, et al. The influence
of Hispanic ethnicity on nonsmall cell lung cancer histologyand patient survival: an analysis of the Survival, Epidemiol-ogy, and End Results database. Cancer. 2012;118:4495-4501.
2. Gomez SL, Glaser SL. Quality of birthplace informationobtained from death certificates for Hispanics, Asians, andPacific Islanders. Ethn Dis. 2004;14:292-295.
3. Gomez SL, Glaser SL. Quality of cancer registry birthplacedata for Hispanics living in the United States. Cancer CausesControl. 2005;16:713-723.
4. Pew Hispanic Center. Statistical Portrait of Hispanics in theUnited States,2008. pewhispanic.org/factsheets/fact-sheet.php? FactsheetID¼58. Accessed January 21, 2010.
5. Keegan TH, Quach T, Shema S, Glaser SL, Gomez SL.The influence of nativity and neighborhoods on breast can-cer stage at diagnosis and survival among California His-panic women. BMC Cancer.2010;10:603.
Scarlett Lin Gomez, PhDCancer Prevention Institute of California
Fremont, CaliforniaDepartment of Health Research and Policy
Stanford Cancer CenterStanford University School of Medicine
Stanford, California
Clayton W. Schupp, PhDCancer Prevention Institute of California
Fremont, California
Manali Patel, MDDepartment of Medicine
Stanford University School of MedicineStanford, California
DOI: 10.1002/cncr.27799, Published online: October 1, 2012 inWiley Online Library (wileyonlinelibrary.com)
Reply to the Influence ofHispanic Ethnicity on NonsmallCell Lung Cancer Histology andPatient Survival
An Analysis of the Survival,Epidemiology, and End Results Database
Racial and ethnic disparities in lung cancer incidence and/or mortality remain a significant health care concern. De-spite attempts at corrective measures, these disparities per-sist. Identifying the etiologies leading to cancer disparities,especially for patients with lung cancer, would improve the
Cancer March 15, 2013 1287
Correspondence
quality of life for millions of Americans, reduce human andhealth care costs, and improve health care delivery on anational scale. Potential causes to consider include access tocare, environmental agents, molecular factors, and socialcontexts. In our analysis, it is important to emphasize thatwe sought to utilize the Survival, Epidemiology, and EndResults (SEER) database to investigate a clinically relevantscenario1-5 regarding care for patients with lung cancer andunderstand what conclusion might be made from such agroup. As in any analysis attempting to understand thesefactors, we recognize that a complex interaction of multiplevariables and potential confounders is present.
Both Lin-Gomez et al and Pinheiro discuss the meth-ods used, and are appropriate for doing so. They raise theepidemiologic argument that analysis of incomplete datashould be included because missing data might be a poten-tial indication of disparities. In our analysis, we excludedpatients with incomplete information regarding staging,place of birth, and treatment. The intention of our analysiswas to address a clinically relevant scenario, not a pure epi-demiologic question. Furthermore, we included only cer-tain histological subtypes that were consistent with theclinically relevant scenario of nonsmall cell lung cancerencountered by clinicians. The analysis as reported allowedfor an accurate examination of therapies and outcomes. Acomplete description of the methods is limited by theword count in the article and further description of thepatient selection used is worthwhile. Nonetheless, clinicalanalyses performed without carefully selected inclusion andexclusion criteria are subject to the bias. Our conclusionremains correct that for treated patients, based on an analy-sis of the SEER database, Hispanic ethnicity may be associ-ated with an improved outcome.
Nonetheless, given that the study remains retrospec-tive in nature, the findings are hypothesis-generating andneed to be confirmed by future studies. In the last 10years, studies have identified several critical molecularpathways involved in NSCLC.6,7 We have initiatedfunded research studies to further investigate a panel ofgenomic markers within the NSCLC patients treated atour institution. We believe one important way to elimi-nate cancer disparities will be through the development ofindividualized treatment paradigms that account for allpotential treatment-related factors.
FUNDING SUPPORTSupported in part by a grant from the James and Esther King GrantFoundation (3KN03) and a Florida Biomedical grant.
CONFLICT OF INTEREST DISCLOSURESThe authors made no disclosures.
REFERENCES1. Saeed AM, Toonkel R, Glassberg MK, et al. The influence
of Hispanic ethnicity on nonsmall cell lung cancer histologyand patient survival: an analysis of the Survival, Epidemiol-ogy, and End Results database. Cancer. 2012;118:4495-4501.
2. Lally BE, Detterbeck FC, Geiger AM, et al. The risk ofdeath from heart disease in patients with nonsmall cell lungcancer who receive postoperative radiotherapy: analysis ofthe Surveillance, Epidemiology, and End Results database.Cancer. 2007;110:911-917.
3. Lally BE, Geiger AM, Urbanic JJ, et al. Trends in the out-comes for patients with limited stage small cell lung cancer:an analysis of the Surveillance, Epidemiology, and EndResults database. Lung Cancer. 2009;64:226-231.
4. Lally BE, Wright JL, Koniaris LG, et al. Is radiation therapybecoming more effective in treating non-small cell lung can-cer?Int J Radiat Oncol Biol Phys. 2010;78(3 suppl):S201.
5. Lally BE, Zelterman D, Colasanto JM, Haffty BG, Detter-beck FC, Wilson LD.Postoperative radiotherapy for stage IIor III non-small-cell lung cancer using the surveillance, epi-demiology, and end results database. J Clin Oncol.2006;24:2998-3006.
6. Olaussen KA, Dunant A, Fouret P, et al; IALT Bio Investi-gators.DNA repair by ERCC1 in non-small-cell lung cancerand cisplatin-based adjuvant chemotherapy. N Engl J Med.2006;355:983-991.
7. Zheng Z, Chen T, Li X, Haura E, Sharma A, BeplerG.DNA synthesis and repair genes RRM1 and ERCC1 inlung cancer. N Engl J Med. 2007;356:800-808.
Brian E. Lally, MDDepartment of Radiation Oncology, Miller School of Medicine
University of Miami, Miami, Florida
Jennifer J. Hu, PhDDepartment of Epidemiology and Public Health, Miller School of Medicine
University of Miami, Miami, Florida
Leonidas Koniaris, MDDepartment of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
DOI: 10.1002/cncr.27797, Published online: October 1, 2012 inWiley Online Library (wileyonlinelibrary.com)
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