Socioeconomic determinants of survival in patients with cancer

As part of the class I am taking this semester I am spending a lot of time thinking about social contributors to health. I am embarrassed to admit that I have previously invested little effort into understanding the role of social determinants of cancer, and much more effort into genetic, medical and behavioral determinants of cancer. And just so we are all clear, by social determinants I mean things like neighborhood, income, race and occupation. And to drive home the point, ASCO published a release this week on the role of race and socioeconomic status in head and neck cancer outcomes.

This article highlights several recurring points: poorer patients do worse, and every little bit poorer you are, the worse you do. African Americans do a lot worse, even with multivariate analysis. Also, that Hispanics may do better than non-Hispanics, further supporting the "Hispanic paradox." (To be fair, in this article in the multivariate analysis, once accounting for treatment and some other possible contributors, there is no disparity among Hispanics and non-Hispanics).

But this concept is nonetheless interesting — that cultural factors may be strong predictors of cancer outcomes. That by affecting poverty we may affect health outcomes, like cancer, downstream. Maybe resources would be well applied to completely novel things like high-quality child care and early childhood education as a means to improve cancer cure rates. In Mexico, there is an ongoing program known as Progresa, which, according to Wikipedia, provides "cash payments to families in exchange for regular school attendance, health clinic visits and nutritional support." The outcomes of Progresa families was compared to non-Progresa families here. It appears that improving income does have favorable effects on child health, and perhaps adult health as well. A truly novel idea that seems to be bearing some fruit. Stay tuned.