Disparities in Survival Outcomes Following Second Primary Cancer Diagnosis - European Medical Journal

Disparities in Survival Outcomes Following Second Primary Cancer Diagnosis

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NEW research has shown that the risk of cancer-related death is increased for Black and Hispanic patients following diagnosis of a second primary cancer compared with cancer-related death risk for White patients. This highlights the need identify and overcome the reasons underpinning this disparity and improve outcomes. 

Researchers from the American Cancer Society, Atlanta, Georgia, USA, and Brookdale University Hospital and Medical Center, New York City, USA, sought to gauge racial and ethnic disparities in 5-year relative and cause-specific survival for patients with second primary cancers. 

They performed a population-based retrospective cohort study using SEER registry data to identify 230,370 patients aged 20 years who were diagnosed with the 13 commonest second primary cancers between 1st January 2000–31st December 2013. Median follow-up duration was 54 months and, in this time, 47.6% died secondary to cancer-related causes and 7.9% died secondary to cardiovascular-related causes. 

Of those enrolled, males represented 58.4% of the population, and the racial profile for White, Black, Hispanic, and Asian or Pacific Islander was 79.5%, 9.6%, 6.4%, and 4.5%, respectively. 

Compared with White patients, the risk for cancer-related death was higher in both Black and Hispanic patients. The cancer-related death risk hazard ratio [HR] for Black patients was 1.21 (95% confidence interval [CI]: 1.18–1.23) and 1.10 for Hispanic patients (95% CI: 1.07–1.13). However, cancer-related death risk was higher in White patients compared with Asian or Pacific Islanders. Stratification by type of second primary cancer identified that cancer-related death risk was higher for 10 of the 13 commonest second primary malignancies in Black patients and seven in Hispanic patients. The greatest cancer-related death risk for Black patients was seen in uterine cancer (HR: 1.87; 95% CI: 1.63–2.15), and melanoma in Hispanic patients (HR: 1.46; 95% CI: 1.21–1.76). 

Additionally, cardiovascular-related death risk was also found to be higher in Black patients compared with White patients, whereas Asian or Pacific Islander and Hispanic patients displayed a lower risk for cardiovascular-related death than White patients.  

The findings highlight the impact of disparities for cancer survival outcomes and the authors identified that these were partially due to unfavourable stage at time of second primary cancer diagnosis in Black and Hispanic patients. For the future, further work focusing on identifying barriers to surveillance to improve earlier detection of second primary cancers will be needed in order to help bridge the gap in survival outcomes.

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