Highlights
- •Disparities in Stage IV cancer outcomes were identified using NCBD data.
- •Outcomes in pancreatic, colorectal, lung, breast, and prostate cancer were compared.
- •Differences in surgery, chemotherapy and radiation therapy treatments were found.
- •Black, low-income, uninsured, and Medicare/Medicaid patients had worse survival.
- •Adjusting for differences in treatments did not eliminate the worse survival.
Abstract
Background
Disparities in cancer outcomes for minoritized people and groups experiencing disadvantages
with Stage IV cancer is largely unknown.
Methods
Patients with Stage IV pancreatic, colorectal, lung, breast, and prostate cancer were
identified from 2004 to 2015 in the National Cancer Database. Cox proportional hazard
models were used to quantify how demographics and treatments received were associated
with overall survival.
Results
903,151 patients were included. Patients who were younger, non-Hispanic White, had
private insurance, higher income, or received care at an academic center were more
likely to receive surgery, chemotherapy, and/or radiation therapy (p < 0.001). Black
patients, those with Medicare, Medicaid, no insurance, and lower income had lower
survival rates across all five cancer types (p < 0.001). On multivariable analysis,
receipt of surgery, radiation, and chemotherapy attenuated but did not eliminate this
worse survival (p < 0.001).
Conclusions
Survival for patients with Stage IV cancer differs by socioeconomic and self-reported
racial classifications.
Keywords
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Article info
Publication history
Published online: March 10, 2023
Accepted:
March 3,
2023
Received in revised form:
February 20,
2023
Received:
December 21,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
