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Social, demographic factors linked to mortality shortly after cancer surgery
Sociodemographic disparities were associated with an increased risk for mortality 1 month after cancer-directed surgery, according to results of a SEER analysis presented at the ASCO Quality Care Symposium.
“Surgery is a treatment option for many cancers and remains the gold standard treatment across many cancer sites,” researcher Brandon A. Mahal, a fourth-year Harvard medical student and current research fellow at Dana-Farber Cancer Institute in Boston, said during a press conference. “One-month mortality is used as an important quality metric, and deaths within 1 month of surgery are considered treatment-related when quantifying operative mortality.”
Mahal and colleagues evaluated SEER data on more than 1.1 million patients with one of the most common or deadly cancers — such as lung, breast, colorectal, prostate and thyroid cancers — who underwent cancer-directed surgery. A considerable proportion of patients in the study (38.9%) were aged younger than 65 years and, thus, not eligible for Medicare.
Approximately 1 in 20 patients (n=53,498; 4.8%) died within 1 month of surgery.
Patients who had stage IV disease demonstrated the greatest risk for mortality after surgery (adjusted OR=1.89; 95% CI, 1.82-1.95).
Data also indicated the risk for mortality within 1 month of cancer surgery increased among patients who were non-white minorities (adjusted OR=1.13; 95% CI, 1.11-1.15), male (adjusted OR=1.11; 95% CI, 1.08-1.13) or older (adjusted OR=1.02; 95% CI, 1.02-1.03 per year older).
However, patients were less likely to experience mortality within 1 month of their cancer surgery if they were married (adjusted OR=0.8; 95% CI, 0.79-0.82) or insured (adjusted OR=0.88; 95% CI, 0.82-0.94). Patients who were in the top 50th percentile for income (adjusted OR=0.95; 95% CI, 0.93-0.97) or educational status (adjusted OR=0.98; 95% CI, 0.96-0.99) also were more likely to have favorable surgery outcomes.
“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,” Mahal said in a press release. “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.”
For more information:
Mahal BA. Abstract #282. Scheduled for presentation at: ASCO Quality Care Symposium; Oct. 17-18, 2014; Boston.
Disclosure: The researchers report consultant/advisory roles with and travel expenses, honoraria or research funding from Abbott, AVEO, Bayer, Bristol-Myers Squibb, Genova Dx, GlaxoSmithKline, Medivation, NCCN, Novartis, Pfizer and Up-to-Date.
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This is an interesting study highlighting some of the special risk groups we need to be aware of in patients undergoing cancer surgery. It emphasizes the need for a strong pscyhosocial support for the patients who are undergoing surgery to try to improve these outcomes for cancer treatment.