Low colorectal cancer survival in the Mountain West state of Nevada: A population-based analysis.

Colorectal cancer (CRC) is the third greatest cancer burden in the United States. The remarkably diverse Mountain West state of Nevada has uncharacteristically high CRC mortality compared to other Western states. We aimed to study the determinants of the CRC excess burden by using data from the Nevada Central Cancer Registry from 2003-2013. Five-year cause-specific age-adjusted survival from colorectal cancer was calculated and stratified by sex, race/ethnicity and region of Nevada. Cox Proportional Hazards regression modelling was used to study the impact of demographic, social, and clinical factors on CRC survival in Nevada, assessing follow-up as accurately as possible. The extent to which differences in survival can be explained by receipt of stage-appropriate treatment was also assessed. 12,413 CRC cases from 2003-2013 in Nevada were analyzed. Five-year CRC survival was low: 56.0% (95% CI: 54.6-57.5) among males and 59.5% (95% CI: 58.0-61.1) among females; significantly lower than national 5-year survival of 65.1% and 66.5%, respectively. Low survival was driven by populous Southern Nevada; after adjustment for all covariates, Southern Nevadans were at 17% higher risk of death than their counterparts in Northwestern Nevada (HR:1.17; 95% CI:1.08-1.27). Many patients did not receive stage-appropriate treatment, although this only partly explained the poor survival, uniformly low for every race/ethnicity in Nevada. The observed disparity for this one state within a single nation merits public health attention; regardless of the state or region of residence, all Americans deserve equal opportunity for optimum health outcomes in the face of a cancer diagnosis. The current study provides baseline information critical to clinicians, public health professionals, and all relevant stakeholders as they attempt to discern why Nevada's outcomes are vastly divergent from its neighboring Western states and make plans for remediation.

Disparities in lung cancer survival and receipt of surgical treatment.

BACKGROUND: Lung cancer accounts for the greatest proportion of cancer deaths in the United States. This study aims to characterize lung cancer survival by racial/ethnic group and ascertain any modifiable determinants of identified disparities in the newly diverse Mountain West by using the state of Nevada. MATERIALS AND METHODS: 12,964 first primary lung cancer cases diagnosed between 2003 and 2010 were identified for analysis from the Nevada Central Cancer Registry and followed for vital status until December 31, 2011. Standardized age-adjusted five-year survival stratified by race/ethnicity was computed using life table methods. Hazard ratios adjusted for covariates were estimated using Cox proportional hazards regression modeling. Adjusted odds of receiving surgical treatment for localized non-small cell lung cancer by region of Nevada were compared using logistic regression. RESULTS: By the end of the follow-up period, 86% of lung cancer cases in Nevada were deceased. Five-year overall survival was 12.3% (95%CI: 11.5-13.1) for males and 18.9% (95%CI: 17.9-19.9) for females. Compared to cases in Northwestern Nevada, patients in Southern and Rural Nevada had 9% (HR:1.09; 95% CI:1.04-1.14) and 10% (HR:1.10; 95% CI:1.02-1.19) higher risk of dying from lung cancer, respectively. For localized non-small cell lung cancer (NSCLC), which is potentially curable, Southern Nevadans had 67% higher odds of not receiving surgical treatment than Northwestern Nevadans (OR 1.67; 95%CI: 1.30-2.13). CONCLUSIONS: While the prognosis for lung cancer survival in Nevada is poor for all populations, there is no racial/ethnic disparity. However, there is a considerable survival disparity by geographic region, with Southern Nevadans disproportionately impacted. Potential modifiable factors include treatment differences, particularly in receipt of surgery for potentially curative tumor types such as localized NSCLC. Further studies are required to identify barriers to receipt of surgery in Southern Nevada.

Worse Breast Cancer Outcomes for Southern Nevadans, Filipina and Black Women.

Breast cancer is the second deadliest cancer for women in the demographically unique mountainous west state of Nevada. This study aims to accurately characterize breast cancer survival among the diverse women of the flourishing Silver State. Nevada Central Cancer Registry data was linked with the National Death Index and the Social Security Administration Masterfile. Overall 5-year age-adjusted cause-specific survival, survival stratified by race/ethnicity, and stage-specific survival stratified by region of Nevada were calculated. Adjusted hazard ratios were computed with Cox proportional hazards regression. 11,111 cases of breast cancer were diagnosed from 2003 to 2010. Overall 5-year breast cancer survival in Nevada was 84.4 %, significantly lower than the US, at 89.2 %. Black and Filipina women had a higher risk of death than white women. Poor survival in the racially and ethnically diverse Las Vegas metropolitan area, with a large foreign-born population, drives Nevada's low overall survival. System-wide changes are recommended to reduce the racial/ethnic disparities seen for black and Filipina women and improve outcomes for all.