Abstract Rationale Cancer remains the second leading cause of death for all Americans with lung, colon, and breast responsible for nearly 40% of all cancer deaths. Cancer outcomes are determined by biological factors as well as social determinants of health. It remains unknown whether the three high-burden cancers (lung, colon, and breast) disproportionately impact individuals with poor social determinants of health and whether the risk of a late-stage diagnosis and mortality varies by income, comorbidities, or insurance status. We undertook this study to explore the intersection between demographic and social determinants of health and cancer outcomes amongst the three most common cancers in the U.S. Methods This retrospective cohort study of National Cancer Database (NCDB) represents patients diagnosed between the years 2004-2022 with lung, colon, or breast cancer. Characteristics assessed included comorbidity burden, income, insurance status, stage at diagnosis and treatments received. Hazard ratios for all cause mortality were calculated. Results A population of 5,399,603 cancer patients (including 1,825,800 lung, 1,204,544 colorectal, 2,369,259 breast) were included. Lung cancer patients had significantly more comorbidities, lower incomes, and be more likely to have Medicaid or no insurance (figure 1). Lung cancer patients of all stages were also more likely to receive no treatment than their colorectal and breast cancer patients. Higher mortality was seen in all three cancers in those with lower income, Medicaid/no insurance, and higher comorbidities. Conclusions Patients with lung cancer are more likely to currently smoke or have formerly smoked. This may place them in a different demographic (e.g. lower educational attainment, lower income, etc) than those with breast or colorectal cancer. Further, tobacco use is a risk factor for other comorbid diseases such as COPD, heart disease, stroke and other smoking related cancers leading to higher comorbidity burden in this group. Recognizing the impact of social determinants of health that differ between cancer populations has implications for access to screening, the importance of tobacco cessation, navigation to cancer care services, management strategies and clinical trial design. This abstract is funded by: None
Lozier et al. (Fri,) studied this question.