Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Thomas Tucker, PhD

Committee Member

Glyn Caldwell, MD, PhD

Committee Member

Bin Huang, DrPH

Committee Member

Nathan Vaderford, PhD


OBJECTIVE: This study examined whether there were differences in the development of multiple primary cancers in lung cancer patients residing in the Appalachian versus Non-Appalachian regions of Kentucky. The study also identified other factors associated with the development of another primary cancer in lung cancer patients.

HYPOTHESIS: Lung cancer patients residing in Appalachian Kentucky are more likely to develop multiple primary cancers compared to patients residing in Non-Appalachian Kentucky.

METHODS: This was a retrospective, population-based cohort study of Kentucky patients (N=26456) aged 20 years and older, diagnosed with primary lung cancer between January 1, 2000 and December 31, 2013. The study population was drawn from the Kentucky Cancer Registry. Cases were excluded if they were diagnosed with second primary cancers within 3 months after the diagnosis of their first primary lung cancer, and if they changed their residence moving from Appalachian to Non-Appalachian region or vice versa. Subjects were followed to determine if they developed subsequent primary cancers. The Cox proportional hazards model was used to control for the time from diagnosis to death or a second PC.

RESULTS: The final adjusted multivariable hazards model indicated that there were no statistically significant differences between Kentucky Appalachian and Non-Appalachian lung cancer populations with respect to the hazards of developing of a subsequent primary cancer (HR: 1.002, p=0.9713). The adjusted analysis revealed that increasing age at diagnosis, male gender, and patients having surgery increased the hazards of developing another primary cancer (HR: 1.015, p=0.0001; 1.169, p=0.012; 1.446, p=0.0003). Having a stage IV tumor decreased the hazards of the outcome by 31.6% comparing to the patients with stage II tumors (HR=0.684, p=0.0015).

CONCLUSION: No differences were found between Appalachian and Non-Appalachian lung cancer patients. Surgery was very likely associated with getting a second primary because patients who had surgery were likely to live longer, and thus, had a greater opportunity to develop a second primary. In contrast, patients who were diagnosed with stage IV lung cancer had very short survival times and were, thus, less likely to develop a second primary cancer.

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