Death of Patients Within 1 Month of Cancer Surgery Influenced by Social and Demographic Factors
In a new study of more than 1.1 million patients who underwent surgery for the most common or fatal cancers, nearly 1 in 20 (4.8%) patients died within 1 month of the procedure. The risk of death was highest among patients who were not married, uninsured, non-white, male, older, less educated, poorer, or had advanced-stage cancer. The findings, reported at the 2014 ASCO Quality Care Symposium (Abstract 282), suggest that efforts to reduce sociodemographic disparities in 1-month cancer surgery death rates may substantially improve survival among patients with cancer.
One-month mortality after surgery is an important measure of health-care quality but there is no consensus as to why disparities in this outcome exist. Previous research has shown that 1-month mortality after cancer surgery is closely linked to hospital and surgeon volume, and minorities, uninsured, and poorer patients are disproportionately more likely to receive care at lower-volume, underperforming hospitals.
“We’ve known that surgery carries a range of risks and our findings offer new guidance on how certain social and demographic factors contribute to real-world cancer surgery outcomes,” said lead study author Brandon A. Mahal, a fourth-year Harvard medical student and current research fellow at Dana-Farber Cancer Institute in Boston. “Given our results, it is clear that there is a lot we can do to improve outcomes for all patients. Many factors contribute to these disparities but we can start by identifying and supporting improvements for underperforming hospitals as well as more proactively offering social support services to patients at high risk of poorer outcomes.”
Study Details
Researchers analyzed national cancer registry (SEER) data on more than 1.1 million patients who underwent cancer surgery. The patients were diagnosed with one of the most common or most fatal cancers, including lung, breast, colorectal, prostate, thyroid, esophageal, pancreatic, endometrial, ovarian, head and neck, liver, bladder, melanoma, kidney, and non-Hodgkin lymphoma.
Overall, 53,498 patients (4.8%) died within 1 month of undergoing cancer surgery, a higher mortality rate than suggested in previous, smaller studies, which focused mainly on academic centers. Patients in the study who were married, insured, or who had a top 50th percentile income or educational status had 20%, 12%, 5%, and 2% lower odds, respectively, of dying from cancer surgery within a month. Furthermore, patients who were non-white minority, male, older, or who had stage IV disease had 13%, 11%, 2%, and 89% higher odds of dying, respectively, within 1 month of cancer surgery.
While these findings are consistent with prior research on surgical outcomes among Medicare patients, this study is the first to demonstrate that these disparities are still highly prevalent among younger populations (38.9% of patients evaluated in this study were younger than 65 and not eligible for Medicare).
For full disclosures of the study authors, view the study abstract at abstract.asco.org.
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®.
