Researchers are aware that Black cancer patients experience worse outcomes than white cancer patients due to the differences in access to health care. According to a report in Cancer Network, studies show that Black cancer patients are diagnosed at later stages of cancer and are less able to receive treatment. Although disparities faced by the Black community have recently gained national attention, access to medical care has not received much attention.
A National Cancer Database from 2004 through 2016 gives evidence that integrated network cancer programs and similar programs result in higher overall survival than community cancer programs. The study found in part that a better understanding of socioeconomic differences may result in better overall survival for neck and head cancer patients.
In addition, marital status, race, gender, insurance, and socioeconomic status (sociodemographic variables) were associated with neck and head cancer mortality, including the stage of the cancer at diagnosis.
The following is a report on the five-year overall survival of non-Hispanic Black patients against Asian/Pacific Islanders, Hispanics, American Indians, and Alaska Native patients.
Data From the SEER Database
Data were taken from the SEER database in the years 2007 through 2016. Patients in the study were eighteen or older (mean age 56) when they were diagnosed with primary head and neck cancer. All patients (72% male) were in an ethnic and racial minority group. Sixty-four percent had private insurance.
Of the total 21,966 patients in the study:
- 9229 were non-Hispanic Black
- 6893 were Hispanic
- 5342 were Asian and Pacific Islanders
- 502 were American Indian and Alaska Natives
Socio-demographic variables, when compared against overall group characteristics such as gender, occupation, education, age, and the number of people in the household, were consistent with the subgroups.
Comparing education, occupation, and other socioeconomic status:
- Non-Hispanic Black ranked very low
- Hispanic as low
- Asian and Pacific Islanders as high
- American Indian and Alaska Natives as medium
Researchers were able to identify the stage of presentation for 11,269 patients in the database.
The unadjusted overall survival analysis for a five-year period gave the lowest score to non-Hispanic Blacks. Their score was much lower when compared to the other non-White groups.
Females with neck and head cancer scored higher overall survival than males (64% vs 53% respectively). Yet males had 41% greater survival odds than females if diagnosed at a late stage. Patients in the low socioeconomic group had increased odds of diagnosis at a late stage compared to patients in a high socioeconomic class.
Patients who had private insurance had a higher overall survival when comparing patients with Medicaid (63% vs. 42%). Uninsured patients scored 49%.
Participants in a high socioeconomic group had the highest overall survival in comparison to the other groups. The group with cancer that had not spread (localized) showed higher overall survival than patients receiving regional therapies that deliver chemotherapy or radiation. Tumors that had spread (metastasized) were in the lowest-rated group.
The last comparison analyzed people who were covered by Medicaid insurance together with those who were uninsured. The first group showed a 60% higher risk of being diagnosed after cancer had spread. The second group was given 70% higher odds of presenting at a later stage when compared to those patients who were privately insured.
Looking Forward
The trial investigators believe that the information they received from this data will help reduce health disparities for ethnic and racial groups.
