Public welfare

Racial disparities in cancer survivorship shrink with rising public welfare spending



Barnes JM, et al. Abstract 6509. Scheduled for presentation at: ASCO Annual Meeting; June 3-7, 2022; Chicago.

Disclosures: The researchers do not report any relevant financial information.

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Increased state spending on social services such as Medicaid is correlated with improved 5-year overall survival in black adults with cancer, according to study results to be presented at the ASCO annual meeting.

Increased state investment in social protection programs also led to a reduction in racial disparities in survival for several types of cancer, findings presented at a virtual press briefing Thursday showed.

Reduced racial disparities in overall survival.
Data from Barnes JM, et al. Abstract 6509. Scheduled for presentation at: ASCO Annual Meeting; June 3-7, 2022; Chicago.

Context and methods

Previous research has shown associations between cancer outcomes and social determinants of health, which include factors such as financial stability, education, place of residence and insurance status, according to Justin Michael Barnes, MD, MS, from the Department of Radiation Oncology at Washington University School of Medicine in St. Louis.

Justin Michael Barnes, MD, MS

Justin Michael Barnes

“Racial disparities in cancer outcomes are likely linked to systemic racism that has led to disproportionately unfavorable conditions regarding the social determinants of health,” Barnes told Healio. “We hypothesized that policies that directly address the social determinants of health, such as public welfare spending, could help overcome the negative social determinants of health faced by patients of color. with cancer, and subsequently reduce existing disparities.”

Public welfare includes programs such as Medicaid and Supplemental Security Income that help people facing socioeconomic hardship.

“Public welfare spending averages about $2,000 per capita per year, which is just over 20 percent of total state spending,” Barnes said during the presentation. “It varies greatly from state to state.”

Barnes and colleagues studied the associations of these expenses with 5-year SG by race and ethnicity, in addition to cancer site, among nearly 3 million adults newly diagnosed with cancer from 2007 to 2016. .

The researchers looked at patient data from the SEER program, including data from 13 states and annual state expenditure data from the US Census Bureau. They adjusted the analyzes for age, sex, metropolitan residence, state, county-level income and education, and insurance status, as well as for disease factors, including the cancer site, stage at diagnosis and year of diagnosis.

Five-year OS served as the primary outcome. Robust cluster regression models that accounted for multiple covariates allowed researchers to estimate associations between public welfare spending and survival.

Main findings

Results showed 10.8% lower 5-year OS in black patients compared to white patients for all cancers combined.

The researchers found no association between public welfare spending and 5-year OS overall or in white patients. However, they found an association in black patients, who demonstrated an 8.62% (95% CI, 4.62-12.62) increase in OS over 5 years with higher welfare spending. by 10%.

For every 10% increase in spending, the 5-year disparity in OS between black and white patients decreased by 4.55% (95% CI, 2.76-6.35). Among specific cancer types, each 10% increase in spending corresponded to an increase in 5-year OS in black patients of:

  • 14.1% for cancer of the uterus, i.e. a 40% reduction in the gap vs white patients;
  • 11.9% for cervical cancer, for a gap reduction of 46%;
  • 9.41% for head and neck cancers, a reduction of the gap by 38%;
  • 8.95% for ovarian cancer, for a gap reduction of 41%;
  • 8.18% for bladder cancer, a reduction in the gap of 44%;
  • 7.02% for liver cancer, a reduction in the gap of 49%;
  • 6.15% for breast cancer, for a reduction in the differences of 39%; and
  • 4.42% for colorectal cancer, a reduction of the gap of 48%.

The researchers observed similar results after accounting for state limits on Medicaid eligibility and excluding data related to Medicaid expansion.

“The results were largely unsurprising, because the proposed mechanism — overcoming ingrained disparities in the social determinants of health directly through public welfare spending — makes sense,” Barnes told Healio. . “However, in some subgroup analyses, namely age subgroups, there were no improvements in OS associated with public welfare spending for non-elderly patients, as these improvements were limited to elderly cancer patients.”


The study findings highlight the benefits of government investment in social services to reduce disparities in cancer care, the researchers said.

“Investment in public welfare improves oncology outcomes for some of our most socioeconomically at-risk patients, such as non-Hispanic black people, and reduces racial disparities,” Barnes told Healio. “However, I consider this hypothesis-generating data to be proof of concept, since we don’t yet know the details. As we learn more about the specific policies and expenditures that have the greatest influence on improving cancer outcomes, it will be our role as clinicians and scientists to advocate for such policies. to improve outcomes for all of our patients and help close the racial disparities gap in oncology outcomes.