Black, Hispanic individuals experience poorer outcomes after second cancer diagnosis
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Key takeaways:
- Nearly half of those diagnosed with second primary cancers died of cancer.
- Black and Hispanic individuals exhibited higher risk for cancer-related death and cardiovascular-related death than white individuals.
An analysis of individuals diagnosed with second primary cancers showed Black individuals exhibited considerably higher risks for cancer-related and cardiovascular-related deaths than white individuals.
The findings — published in JAMA Network Open — highlight a need to address racial disparities in outcomes among survivors of multiple primary cancers, researchers concluded.
“Over 20% of newly diagnosed cancers in the U.S. occur among [people] with a cancer history,” Hyuna Sung, PhD, senior principal scientist of cancer surveillance research at American Cancer Society, and colleagues wrote. “The proportion is expected to increase, highlighting a critical need to better understand outcomes in persons with multiple primary cancers.”
Background and methodology
The burden of second primary cancers in the United States is growing; however, data are lacking about racial or ethnic disparities in outcomes, according to study background.
Sung and colleagues conducted a population-based retrospective cohort study to quantify racial and ethnic disparities in survival among individuals with second primary cancers.
Researchers used 18 SEER registries to identify individuals aged 20 years or older diagnosed with the 13 most common second primary cancers between Jan. 1, 2000, and Dec. 31, 2013.
Five-year relative survival and cause-specific survival served as the main outcomes.
Researchers calculated cause-specific HRs for death due to cancer or cardiovascular disease for each racial and ethnic minority population compared with the white population. They stratified results by second primary cancer type, adjusting for various characteristics.
The analysis included 230,370 individuals (58.4% male; 79.5% white, 9.6% Black, 6.4% Hispanic, 4.5% Asian or Pacific Islander).
Results
During median follow-up of 54 months, 109,757 (47.6%) of the cohort died due to cancer-related causes and 18,285 (7.9%) died due to cardiovascular-related causes.
Compared with white individuals, risk for cancer-related death appeared higher among Black individuals (HR = 1.21; 95% CI, 1.18-1.23) and Hispanic individuals (HR = 1.1; 95% CI, 1.07-1.13). Asian or Pacific Islander individuals exhibited a lower risk for cancer-related death than white individuals (HR = 0.93; 95% CI, 0.9-0.96).
When stratified by the 13 evaluated types of second primary cancer, risk for cancer-related death appeared higher for 10 malignancies among Black individuals — the highest being uterine cancer (HR = 1.87; 95% CI, 1.63-2.15). Risk for cancer-related death appeared higher for seven malignancies among Hispanic individuals, the highest being melanoma (HR = 1.46; 95% CI, 1.21-1.76).
“These disparities were, in part, attributable to unfavorable stage distributions at second primary cancer diagnosis among Black and Hispanic populations — particularly for breast cancer, uterine cancer and melanoma,” Sung said in a press release.
Analyses of cardiovascular-related death showed higher risk for Black individuals (HR = 1.41; 95% CI, 1.34-1.49) than white individuals. Asian or Pacific Islander individuals (HR = 0.75; 95% CI, 0.69-0.81) and Hispanic individuals (HR = 0.9; 95% CI, 0.84-0.96) exhibited lower risk for cardiovascular-related death than white individuals.
Researchers acknowledged study limitations. Cause-of-death information obtained from death certificates is subject to misclassification, as is data about race or ethnicity obtained from SEER registries. In addition, cancer registry data does not allow for detailed analyses about specific patient or health care system factors that may contribute to the disparities observed.
Implications and next steps
The findings highlight the need to focus research efforts on survival disparities among the increasing number of individuals diagnosed with second primary cancers, Sung and colleagues concluded
This includes examining barriers to surveillance tests, such as financial hardship, health literacy or lack of physician recommendation.
“Substantial reductions in HRs for cancer-related death after adjustment for [second primary cancer] characteristics and treatment receipt suggest opportunities to mitigate the survival disparities via equitable access to early detection and stage-appropriate, guideline-concordant care,”
References:
- New study shows substantial racial and ethnic disparities among survivors of second primary cancers in the US (press release). Available at: https://pressroom.cancer.org/releases?item=1246. Published Aug. 4, 2023. Accessed Aug. 8, 2023.
- Sung, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.27429.
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