Overall Survival Rates Differ Among Patients with Cancer of Different Races and Ethnicities

White, black and Hispanic patients of leading cancer types all had worse rates of cancer-specific and overall survival compared to Asian patients of the same cancer types, according to a study published in JAMA Network Open.

Researchers examined the differences in the stage of 9 leading cancers at diagnosis, use of therapy, overall survival, and cancer-specific survival levels among patients through the lens of different racial and ethnic groups.

“Overall, compared with Asian patients, black patients were more likely to have metastatic disease at diagnosis, black and Hispanic patients were less likely to receive definitive treatment, and white, black, and Hispanic patients had worse odds of cancer-specific and overall survival,” wrote the researchers.

Multivariable logistic and Cox regression measures were utilized to evaluate the stage of 9 leading cancer types at diagnosis, treatment, and survival. The researchers used the Surveillance, Epidemiology, and End Results (SEER) database to collect data for more than 5 years.

The cancer types included in this study were prostate, ovarian, breast, stomach, pancreatic, lung, liver, esophageal, or colorectal cancers.

A total of 950,377 (499,070 [52.5%] men) Asian, black, white, and Hispanic patients were included in the study. Overall, the population included 681,251 white patients (71.7%; mean [SD] age, 65 [12] years), 116,015 black patients (12.2%; mean [SD] age, 62 [12] years), 65,718 Asian patients (6.9%; mean [SD] age, 63 [13] years), and 87,393 Hispanic patients (9.2%; mean [SD] age, 61 [13] years).

“We found that white patients were more likely than Asian patients to develop metastasis in stomach, lung, liver and/or IHBD, and colorectal cancers,” wrote the researchers. “We also found that black patients were more likely to have metastatic prostate, ovarian, breast, and colorectal cancers than Asian patients.”

Comprehensive data on stage of diagnosis, treatment, and survival that was not previously reported allows the potential for this study to help find different management strategies for leading cancer types based on race and ethnicity with the goal of improving outcomes. More, examining leading cancer types with a large sample of patients enables the researchers to have more confidence in the data.

As for limitations, the first is the absence of patients who identified as mixed race or ethnicity. More, because of a lack of relevant data, the researchers did not examine the “associations of chemotherapy and molecular-targeted treatment with survival.” Both of these variables could impact patient overall survival.

Moving forward, the researchers recommend the further investigation of leading cancer types, specifically for the sensitivity to chemotherapy and mixed race or ethnicity variables they could not include in this study. Examining data on migration, socioeconomic status, educational background, employment status, and smoking and alcohol use, which is not included in the SEER data, could also bring about nuances in the data.

“We aimed to develop a comprehensive summary of cancer metastasis, treatment, and survival in the United States among patients from different racial/ethnic groups, which could serve as a reference source,” wrote the researchers. “Related health strategies to promote primary prevention, cancer screening, early diagnosis, and treatment options should be specifically targeted to improve cancer survival among patients from different racial/ethnic groups in the United States.”

Reference:

Zhang C, Zhang C, Wang Q, et al. Differences in Stage of Cancer at Diagnosis, Treatment, and Survival by Race and Ethnicity Among Leading Cancer Types. JAMA Network Open. doi:10.1001/jamanetworkopen.2020.2950.