Black and Hispanic cancer survivors with subsequent primary malignancies may have a higher risk of mortality compared with White patients, according to new findings presented by Sung et al at the 2023 ASCO Annual Meeting (Abstract 12093). The new research demonstrated that Black patients with subsequent primary cancers may also have a higher risk of mortality from cardiovascular disease.
Study Methods and Results
In the new study, investigators used 18 Surveillance, Epidemiology, and End Results registries to analyze the data of 230,370 patients aged 20 years and older who were diagnosed with one of the 13 common types of subsequent primary cancers from 2000 to 2013. The investigators then used cause-specific proportional hazards models to estimate the hazard ratio (HR)—overall and stratified by subsequent primary cancers—comparing the risk of cancer or cardiovascular disease mortality in Hispanic, non-Hispanic Asian and Pacific Islander, or non-Hispanic Black patients with the risk of mortality in non-Hispanic White patients. Hazard ratios were adjusted for sex, age, first primary cancer type and stage, and year of subsequent primary cancer diagnosis in the base model in addition to household income, urbanicity, subsequent primary cancer stage, subtype, and treatment receipt in the final model.
After a median follow-up of 54 months, the investigators discovered that 109,757 deaths from cancer and 18,283 deaths from cardiovascular disease occurred among patients with subsequent primary cancers. Overall, the hazard ratios for cancer mortality were higher among Black patients (HR = 1.21, 95% confidence interval [CI] = 1.18–1.23) and Hispanic patients (HR = 1.10, 95% CI = 1.07–1.13) compared with White individuals, but lower among Asian and Pacific Islander patients (HR = 0.93, 95% CI = 0.90–0.96) in the base model.
When stratified by subsequent primary cancer types, the increased hazard ratios were evident for 77% (n = 10/13) of the cancers among Black patients, with the greatest ratios among those with uterine corpus cancer (HR = 1.87, 95% CI = 1.63–2.15). Increased hazard ratios were also detected for 54% (n = 7) of the cancers among Hispanic patients, with the highest ratios among those with melanoma (HR = 1.46, 95% CI = 1.21–1.76).
For cardiovascular disease mortality, compared with White patients, the overall hazard rstios were higher among Black patients (HR = 1.42, 95% CI = 1.35–1.49) but lower among Asian and Pacific Islander patients (HR = 0.75, 95% CI = 0.69–0.81) and Hispanic patients (HR = 0.90, 95% CI = 0.84–0.96). The risk of cardiovascular disease mortality was higher for 85% (n = 11/13) of the cancers among Black patients, with the greatest hazard ratios among those with pancreatic cancer (HR = 1.80, 95% CI = 1.17–2.75), thyroid cancer (HR = 1.70, 95% CI = 1.12–2.57), and renal cell carcinoma (HR = 1.63, 95% CI = 1.38–1.93).
Additional adjustments in the final model reduced the elevated hazard ratios substantially, especially for cancer mortality among Black and Hispanic patients—although the associations remained statistically significant for most cancers.
Conclusions
The investigators noted that adjusting for differences in potentially modifiable factors attenuated the associations substantially, highlighting potential research priorities to address survival disparities among the growing population of multiple primary cancer survivors.
Disclosure: For full disclosures of the study authors, visit meetings.asco.org.
