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Anal cancer survival poorer among patients with low socioeconomic status
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The socioeconomic status of patients with anal cancer may influence their survival rates, according to new research published in Cancer.
Daniel J. Becker, MD, of Perlmutter Cancer Center at NYU Langone Health, and colleagues wrote that although outcomes for patients with squamous cell carcinoma of the anus (SCCA) have improved, the benefits of recent technological and clinical advances might not be shared by patients with different socioeconomic status.
“Our findings reveal that U.S. residents who have anal cancer and live in areas of poverty have worse survival than those who live in more affluent areas, even after accounting for differences in age, stage and race,” Becker said in a press release. “Anal cancer is often a curable disease, and, in light of the tremendous resources available in U.S. health care, we do not believe that poverty should determine cancer outcomes.”
Using SEER data, Becker and colleagues identified 9,550 patients who received a diagnosis of SCCA from 2004 to 2013, and analyzed whether area-based median household income predicted survival of patients. The median age of the patients was 58 years old, 63% were women, 85% were white and 38% were married. Investigators defined socioeconomic status by census-tract median household income and divided in quintiles.
The researchers found that patients living in areas with lower median household incomes had worse overall survival and cancer-specific survival (CSS) compared with patients from the highest income areas.
Mortality hazard ratios for lowest to highest income were 1.32 (95% CI, 1.18–1.49), 1.31 (95% CI, 1.16–1.48), 1.19 (95% CI, 1.06–1.34), and 1.16 (95% CI, 1.03–1.3). Similarly, hazard ratios for CSS from lowest to highest income were 1.32 (95% CI, 1.13–1.53), 1.34 (95% CI, 1.15–1.57), 1.27 (95% CI, 1.09–1.48), and 1.22 (95% CI, 1.05–1.43).
When researchers looked only at cancer-related deaths, they found that patients in the lowest income areas had a 34% increased risk compared with 22% in the higher income areas.
Factors like older age, black race, male sex, unmarried status, earlier year of diagnosis, higher tumor grade and later stage of disease were also predictors of worse CSS, according to the study.
The authors noted that further research is needed to determine the mechanism by which socioeconomic inequalities impact cancer care and outcomes.
“The ultimate goal is to make sure that all patients receive high quality care, regardless of their wealth or zip code,” Becker said in the press release. “Additional resources are urgently needed to study and address disparities in anal cancer care and outcomes.” – by Alex Young
Disclosures: The authors reported no relevant financial disclosures.
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