In a study using California Cancer Registry data reported in the Journal of Clinical Oncology, Ellis et al found that the stage at diagnosis was the greatest contributor to racial/ethnic disparities in cancer-specific survival, with neighborhood socioeconomic status and marital status also being important contributors.
Study Details
The study included data on 877,662 cancer cases and 222,042 cancer-specific deaths among black, Hispanic, Asian American/Pacific Islander, and white patients diagnosed with breast, prostate, colorectal, or lung cancer between 2000 and 2013 in California. The percentage contribution of tumor, treatment, hospital, sociodemographic, and neighborhood factors to overall racial/ethnic survival disparities was estimated from a sequence of multivariable Cox proportional hazards models.
Factors in Disparity
In baseline models, black patients had the lowest survival for all types of cancer, and Asian American/Pacific Islander patients had the highest survival. The stage at diagnosis appeared to be the greatest contributor to survival disparities, accounting for 24% of disparities in breast cancer, 24% in prostate cancer, and 16% to 30% in colorectal cancer.
With regard to other contributors:
Overall, neighborhood socioeconomic status was an important factor in all cancers, but only for black and Hispanic patients, and the influence of marital status was greater in men than in women.
The investigators concluded: “Stage at diagnosis had the largest effect on racial/ethnic survival disparities, but earlier detection would not entirely eliminate them. The influences of neighborhood socioeconomic status and marital status suggest that social determinants, support mechanisms, and access to health care are important contributing factors.”
The study was supported by the Stanford Cancer Institute and the National Cancer Institute.
Libby Ellis, PhD, of the Cancer Prevention Institute of California, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.