Black patients had longer overall survival after investment in cancer welfare programs.
Overall survival (OS) at 5 years increased based on results from the National Cancer Institute’s Surveillance Epidemiology and Endpoints (SEER) Cancer Database, which showed investment in programs of public welfare, according to a study of records presented at an upcoming press briefing by the American Society for Clinical Oncology 2022 Annual Meeting.1
Five-year OS was 10.8% lower in black patients than in whites. However, investigators found that 5-year OS was higher for black patients in states with higher social expenditures.
Results showed that there was a 4.55% reduction in OS disparity over 5 years in non-Hispanic black patients compared to white patients for every 10% increase in spending. The investigators noted that the results were similar after accounting for state Medicaid eligibility limits and after excluding data related to Medicaid extensions.
“These data are thought-provoking, but they are certainly not the end,” said Justin M. Barnes, MD, radiation oncologist at Washington Medical University in St. Louis, Missouri, during a briefing. press ahead of the 2022 ASCO Annual Meeting. . “I view this data as a proof-of-concept project, a sort of investment in public welfare that appears to be helping improve oncology outcomes for some of our most socio-economically at-risk patients.”
Among breast cancer patients, increased public welfare spending led to a 6.15% increase in survival for black patients and a 39% narrowing of the gap with white patients . Patients with cervical (11.9% and 46%), colorectal (4.42% and 48%), head and neck (9.41% and 38%), liver (7.02% and 49%), ovary ( 8.95% and 41%), bladder (8.18% and 44%), and uterine cancers (14.1% and 40%) also saw increased survival and decreased disparity in due to increased expenses.2
Results from previous studies have found associations between cancer outcomes and social determinants of health, such as financial stability, education, place of residence and insurance status. Additionally, research has shown that racial disparities in cancer outcomes are likely linked to systemic racism that has led to adverse conditions for Black Americans and other patients of color.
Barnes and colleagues analyzed data on more than 2.9 million adult patients with newly diagnosed cancers collected from the SEER database between 2007 and 2016. Annual state spending data was obtained from the United States Census Bureau and included the percentage of total public welfare expenditures. The primary endpoint of the study was OS at 5 years.
Investigators performed data analysis using robust cluster regression to account for within-state correlations. Covariates included state public welfare spending, age, race/ethnicity, gender, metropolitan residence, county-level income and education, insurance, poverty at the county level. state, state, site/type of cancer and stage at diagnosis.
“This study underscores the critical role that state welfare spending, including Medicaid expansion, plays in reducing disparities in cancer outcomes,” said the medical director and executive vice president of ASCO, Julie R. Gralow, MD, winner of the 2021 Giants of Cancer Care® Award in the Community Outreach/Cancer Policy Category, said in a press release. “Publicly funded programs can reduce barriers to accessing cancer care and impact survivorship.”
- Barnes JM, Johnston KJ, Osazuwa-Peters N. State public welfare expenditures and racial/ethnic disparities in overall survival of adults with cancer. Presented at: ASCO Annual Meeting 2022; June 3-7, 2022; Chicago, IL. Abstract 6509.
- A study examining the association between Medicaid and other social service spending on racial and ethnic disparities and overall survival of newly diagnosed cancer patients. Press release. ASCO. May 26, 2022. Accessed May 26, 2022.