People Living In Poverty At Greater Risk Of Dying From Cancer

Main Category: Cancer / Oncology
Also Included In: Public Health
Article Date: 25 Jun 2008 - 3:00 PDT

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A new study looking at the survival and stages of cancer has found that people living in poor neighborhoods have a greater risk of dying after cancer than people with higher socioeconomic status.

"These patients are generally diagnosed later than others, and were less likely to get state-of-the-art cancer care," said Tim Byers, MD, MPH, lead author of the study and deputy director of the University of Colorado Cancer Center. "Being poor increases your chance of dying from cancer."

The paper, "The Impact of Socioeconomic Status on Survival After Cancer in the United States: Finding From the National Program of Cancer Registries," will be published in the Aug. 1 issue of CANCER, a journal of the American Cancer Society. The paper was published online today.

Byers, who also is a professor of Preventive Medicine and Biometrics at the University of Colorado Denver, led the study, which was commissioned by the Centers for Disease Control to ascertain how socioeconomic status (SES) affected cancer mortality in order to better define strategies "to eliminate the unequal burden of cancer by race and ethnicity in the United States."

Researchers examined all medical records of 13,598 patients diagnosed with certain cancers in 1997 in seven states. The study included 4,844 women with breast cancer, 4,332 men with prostate cancer and 4,422 men and women with colorectal cancer living in California, Colorado, Illinois, Louisiana, New York, Rhode Island and South Carolina.

The researchers followed up with the patients five years later to find out their cancer outcomes.

"We have lots of evidence that both Hispanics and African Americans have a higher risk of dying after being diagnosed with cancer," Byers said. "Some of this can be explained by biologic differences in the characteristics of certain cancers in certain people. We've seen many studies that look at race and cancer outcome, but not many have looked at socioeconomic status in addition to race as a risk factor."

The SES of each patient was calculated using the education and income levels of the census tract of residence from the 2000 Census. Fifteen percent of patients were classified as having both low SES (20 percent or more of their neighborhood had households with incomes below the Federal Poverty Level) and low education status (25 percent or more of their neighbors over age 25 had less than a high school education).

Some of the study's findings:

-- Patients with both low SES and low education were more likely to have died five years after cancer diagnosis than those with high SES. For breast cancer: 25.7 percent vs. 17.1 percent. For colorectal cancer: 52.1 percent vs. 49.4 percent. For prostate cancer: 26.2 percent vs. 18.9 percent. The study was not specific about whether the deaths were due to cancer.

-- Women from low-SES areas who underwent lumpectomy were less likely to have received radiation therapy after surgery. And those with estrogen receptor-positive breast cancer from low-SES areas were less likely to have received antiestrogen therapy.

-- Patients from low-SES areas diagnosed with regional-stage colon cancer where less likely to have received chemotherapy than those from high-SES areas.

-- Men who resided in low-SES areas were less likely to have been treated by either prostatectomy or radiation, considered the two standard first-line therapies, than their high-SES counterparts.

"Clearly, people who have access to early cancer screenings and proper cancer treatment have better outcomes than those who don't," Byers said. "Having adequate health insurance seems to decrease your risk of dying from cancer. We still need better information on how cancer outcomes are related to SES if we are to clearly identify the root causes of racial and ethnic cancer disparities in the United States."

The paper was written by Byers, Holly J. Wolf, Katrina R. Bauer, Susan Bolick-Aldrich, Vivien W. Chen, Jack L. Finch, John P. Fulton, Maria J. Schymura, Tiefu Shen, Scott Van Heest, and Xiang Yin for the Patterns of Care Study Group.

The University of Colorado Cancer Center is the Rocky Mountain region's only NCI-designated comprehensive cancer center one of just 40 in the United States. Headquartered at the University of Colorado Denver Anschutz Medical Campus in Aurora, Colo., UCCC is a consortium of 14 Colorado institutions and organizations dedicated to cancer care, research, education and prevention and control.

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