Socioeconomic status, race may predict refusal of surgery for metastatic bone cancer
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Key takeaways:
- Lower socioeconomic status was associated with higher odds of refusing recommended surgical resection.
- Black patients were 35% more likely to refuse treatment compared with white patients.
SAN FRANCISCO — Results presented here showed socioeconomic status and race/ethnicity may be independent predictors of refusal of surgery among patients with metastatic bone cancer.
Using the National Cancer Institute Surveillance, Epidemiology and End Results database from Jan. 1, 2010, to Dec. 31, 2018, Kyle A. Mani, BS, and colleagues divided the Yost Index, a geo-coded area socioeconomic status (SES) score, into quintiles using Census tract-level American Community Survey 5-year estimates. Researchers also performed multivariate Cox regression models to calculate crude and adjusted hazard ratios of overall survival, adjusted for age, sex, cancer site and treatment modality.
“Our results show there were significant demographic differences across SES quintiles,” Mani said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “Notably, patients in the lowest SES group showed significant racial heterogeneity compared to the highest SES group.”
Mani added patients in the higher SES quintiles were more likely to be married and to live in urban vs. rural areas compared with patients in lower SES quintiles.
Patients in the highest SES quintile had a 31% higher rate of being recommended for surgery compared with patients in the lowest quintile after calculating for age-adjusted incidence rates, according to Mani. He said patients with lower SES status had an association with higher odds of refusing recommended surgical resection.
“Of all our patients, approximately 15,000, or 10%, were recommended for surgical resection. Of these, nearly 20% refused surgery and patients with the lowest SES quintile had nearly 60% higher odds of refusing recommended surgical resection compared to those in the highest quintile,” Mani said.
In addition, Mani said Black patients were 35% more likely to refuse treatment compared with white patients.
“We also found that marital status was an important factor, as single patients were approximately twice as likely to refuse treatment compared to those that were married,” Mani said.
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Eleswarapu AS, et al. Paper 47. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Feb. 12-16, 2024; San Francisco.
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