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Socioeconomic and racial disparities in survival for patients with stage IV cancer


      • 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.



      Disparities in cancer outcomes for minoritized people and groups experiencing disadvantages with Stage IV cancer is largely unknown.


      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.


      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).


      Survival for patients with Stage IV cancer differs by socioeconomic and self-reported racial classifications.


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