CHICAGO – In Medicare patients with poor prognosis cancers, aggressive treatments were more likely to be pursued in the patients with the highest socioeconomic status, but the treatments did not result in better 2-year survival rates.
Among Medicare patients with lung, esophageal, and pancreatic cancers, Dr. Sandra L. Wong of the University of Michigan, Ann Arbor, found that patients who ranked in the highest of five socioeconomic categories were more likely to receive aggressive treatments across all three cancer groups. Yet, after researchers adjusted for risk factors, there was no difference in the 2-year survival rates for patients at the lowest and highest socioeconomic levels.
Primary cancers of the lung, esophagus, and pancreas account for more than 35% of all cancer deaths in the United States and a sizable share of cancer-related costs, Dr. Wong observed. Survival rates have not improved much for patients with these poor prognosis cancers, yet aggressive treatment has increased in this patient group.
Dr. Wong and her colleagues examined 1992-2005 data from the Surveillance Epidemiology and End Results (SEER) registry, which is linked to Medicare claims data, for fee-for-service patients over age 65 years. There were 68,167 patients with lung cancer, 4,350 with esophageal cancer, and 12,779 with pancreatic cancer. Cancer stage at diagnosis was similar for those in the highest and lowest socioeconomic groups. Patients were placed in one of five groups based on measures derived on the basis of wealth and income, education, employment, and zip code.
Patients in the lowest socioeconomic group were more likely to be black, to need urgent admission, and to be treated at nonteaching hospitals with low patient volumes. About 35% of patients in the lowest socioeconomic status had advanced disease at diagnosis, and they were more likely to receive no cancer-directed treatments, according to the results of the study.
For all three cancer types, patients in the highest socioeconomic group were more likely to receive radiation, surgery, and chemotherapy. For the lowest socioeconomic group of patients with lung cancer, radiation therapy was given to 44%, surgery to 13%, and chemotherapy to more than 35%. For the highest socioeconomic group, the respective rates were 50%, 19%, and 39%. No cancer-directed therapy was given to 44% of patients in the lowest socioeconomic group versus 37% of the highest socioeconomic group.
Where care was delivered mattered to lung cancer outcomes, she said. When hospitals were located in high socioeconomic areas, there was a modest difference in adjusted 2-year survival for lung cancer patients based on patient socioeconomic status, at 12% for lowest and 14% for highest. But when hospitals were located in low socioeconomic areas, adjusted 2-year survival was 8% for those in the lowest socioeconomic group and 3% for those in the highest socioeconomic group.
Dr. Wong reported having no relevant financial disclosures.