Disparity by Race, Socioeconomic Status in Cancer Survival Persists for Young Adults

Among adolescent and young adult cancer survivors, those who are non-Latino white have a lower risk of subsequent death compared with those of other races/ethnicities, according to a study published in JNCI Cancer Spectrum.

Researchers collected data from the California Cancer Registry to identify adolescent and young adults (aged 15-39 years) diagnosed with first primary invasive cancer, benign cancer in the brain or central nervous system, or bladder cancer in situ from 1988 to 2014. They calculated five-year overall survival improvement for adolescent and young adults compared with other age groups; hazard ratios (HRs) of death in 2001 to 2014 versus 1988 to 2000 stratified by site, stage, sex, age, race and ethnicity, and socioeconomic status; and site-specific adjusted HRs (aHRs) by time period.

Socioeconomic status and race impact survival

There were 107,747 cancer diagnoses between 1988 and 2000 and 117,746 diagnoses between 2001 and 2014. The cohort was largely comprised of patients with localized disease (46.5% and 51.6%), women (53.1% and 59.3%), those aged 35 to 39 years (41.2% and 39.1%), and non-Latino white patients (59.5% and 45.9%).

For all cancers, adolescent and young adult survival improved from the 1988 to 2000 to the 2001 to 2014 time periods, which the researchers said was largely due to reduced mortality in HIV and acquired immunodeficiency syndrome-related cancers. The strongest predictor of death was cancer stage (aHR=6.32 for distant versus localized, 95% CI, 6.20-6.45).

The aHR of death was statistically significantly higher for blacks (aHR=1.46; 95% CI, 1.42-1.50), Asian and Pacific Islanders (aHR=1.12; 95% CI, 1.09-1.15), and Latino whites (aHR=1.06; 95% CI, 1.04-1.08) compared with non-Latino whites. In addition, aHR of death was statistically significantly higher for patients of low socioeconomic status compared to high socioeconomic status (aHR=1.31; 95% CI, 1.29-1.34).

Survival disparities by stage, race and ethnicity, and socioeconomic status worsened over time.

The results “highlight new priorities in need of increased attention, including inequities in cancer care and delivery within this vulnerable population,” the authors concluded.