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 Lots of previous research points to worse cancer survival odds for
people of color. But this disparity might be due in large part to
class issues like the type of insurance and access to care, the
current study concludes.
“Race or ethnicity is mostly a marker for social factors such as
poverty, insurance status, education level, etc. which is why we see
that ethnic minority individuals experience worse health and health
outcomes,” said Roshan Bastani, director of cancer disparities
research at the University of California, Los Angeles Jonsson
Comprehensive Cancer Center, in email to Reuters Health.
“It is not that race or ethnicity does not influence survival.
Rather, the effect of race or ethnicity on survival is mostly
explained by the negative social factors that are more common among
racial and ethnic minority groups,” said Bastani, who wasn’t
involved in the study.
Multiple myeloma is relatively rare; in the U.S., the lifetime risk
of getting this type of cancer is 1 in 143, and the disease causes
less than 13,000 deaths each year, according to the American Cancer
Society.
Less than 1 percent of cases are diagnosed in people younger than
35.
Black people are twice as likely to get this type of cancer as white
people, though the reasons driving this aren’t clear, according to
the cancer society.
Recent treatment for these tumors, which form in a type of white
blood cell, have improved survival odds for white patients much more
than for black patients, researchers of the current study note in
the journal Cancer.
For the study, Dr. Luciano Costa, of the University of Alabama at
Birmingham and colleagues examined cancer registry data on more than
10,000 U.S. patients diagnosed with multiple myeloma before age 65.
At the time of their diagnosis, half of the patients were at least
57 years old. Almost two-thirds were married, and most had health
insurance.
Factors that influenced survival odds more than race and ethnicity
included marital status, income, and insurance status, the study
found.
For example, an unmarried patient who lived in a low-income county
and received insurance through Medicaid, the U.S. health program for
the poor, was 25 percent less likely to survive four years after
diagnosis than a married person the same age with private insurance
living in a more affluent community, the study found.
Without any socioeconomic disadvantages, about 71 percent of
patients survived at least four years, the study found.
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With one strike against them, such as Medicaid coverage instead of
private insurance, four-year survival odds dropped to about 63
percent. With two strikes – for example being unmarried and living
in a poor community – four-year survival odds dropped to about 53
percent.
Add a third strike – unmarried on Medicaid in a poor neighborhood –
and overall four-year survival odds dropped again, to less than 47
percent.
“This finding strongly suggests that there is a huge disparity in
outcomes that could potentially be overcome by improving access and
affordability of treatments,” Costa said in an emailed statement.
Limitations of the study include a lack of details on the exact type
of multiple myeloma patients had and how advanced tumors were at the
time of diagnosis, the authors note.
“The authors conclude that race does not play a role in survival
once you take into account other socioeconomic factors such as
insurance status and neighborhood income,” said Lauren Teras,
strategic director of hematologic cancer research at the American
Cancer Society in Atlanta, Georgia.
“However, this paper also shows that in one group this is not true;
in patients with the highest expected survival—those who are
married, insured, and live in higher income areas—black patients
were at a higher risk of dying than were white patients,” Teras, who
wasn’t involved in the study, said by email.
“There is something more complex going on that we do not
understand,” Teras added.
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