Socioeconomic status (SES) affects how cancer treatment is delivered, according to Sandra L. Wong, MD, Assistant Professor of Surgery, Uni - ver sity of Michigan, Ann Arbor.
Lung, esophageal, and pancreatic cancers cause 35% of cancer deaths in the United States. Dr Wong’s group at the University of Michigan, Ann Arbor, studied whether SES adversely affects utilization of hospital-based treatment or survival among patients with these cancers.
The study used Medicare data from 1992 to 2005 for patients with lung (N = 68,167), esophageal (N = 4350), and pancreatic (N = 12,779) cancer and assessed the effects of SES on treatment and survival rates. The study was limited to fee-for-service Medicare beneficiaries aged >65 years.
Similar imaging (mainly computed to mography) was performed for all groups, but specialized imaging (positron emission tomography) was performed more often in the group with the highest SES.
For treatment, “there was a higher utilization of cancer-directed treatments across all 3 of the cancer types and across all modalities of care,” Dr Wong said. For all the cancer types and for all socioeconomic groups, 30% to 60% received no cancer-directed treatment at all (in hospital), but patients with low SES were much more likely to receive no treatment.
For lung cancer, because 35% of patients in all SES groups presented with distant disease, “there may be under utilization of cancer-directed serv ices across the board, but it is much more pronounced in the lowest SES group,” she said (46% patients with low SES vs 38% for those with high SES).
The finding that aggressive treatment had little effect on survival is “confounded by the fact that these are such poor-prognosis cancers,” Dr Wong explained. The study revealed a pronounced variation in the types of cancer treatment received by the different socio - economic groups. Reducing variation in treatment strategy could improve healthcare efficiency without deleterious effects on outcomes, the study suggested. These findings may not be generalizable to younger patients, Dr Wong said.