“This study underscores the critical role that state social welfare spending, including Medicaid expansion, plays in reducing cancer outcome disparities. State-funded programs can reduce barriers to accessing cancer care and impact survival,” said ASCO Chief Medical Officer & Executive Vice President Julie R. Gralow, MD, FACP, FASCO.
ALEXANDRIA, Va. — States that increased investments in social services spending by 10% compared to those that did not increase spending – including Medicaid and other social services for socioeconomically disadvantaged individuals – showed improved five-year overall survival for non-Hispanic Black adults with cancer, according to new research. There was also a decrease in racial disparities in survival between non-Hispanic Black and white patients for many different types of cancers. The study will be presented at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting.
Study at a Glance
State welfare spending and differences in overall survival by race.
Nearly 3 million adults newly diagnosed with cancer from 2007 to 2016.
The results of this study point to the benefits of government spending on social services to reduce gaps in disparities in cancer care.
Based on health and demographic information from nearly 3 million adults with cancer, increasing social services spending was associated with increased five-year OS among non-Hispanic Black patients, resulting in a decrease in racial disparities in survival between non-Hispanic Black and white patients for many different types of cancers. Five-year OS was 10.8% lower in non-Hispanic Black compared to non-Hispanic white patients for all cancers combined.
There was a 4.55% narrowing of the five-year OS disparity in non-Hispanic Black compared to non-Hispanic white patients per 10% increase in spending. Specifically, increased public welfare spending was associated with a narrowed Black compared to non-Hispanic white five-year overall survival disparity for patients with cancers of the:
- breast (a 6.15% survival increase for Black patients led to a 39% closing of the disparity),
- cervix (a 11.9% survival increase led to a 46% closing of the disparity),
- colorectum (a 4.42% survival increase led to a 48% closing of the disparity),
- head and neck (a 9.41% survival increase led to a 38% closing of the disparity),
- liver (a 7.02% survival increase led to a 49% closing of the disparity),
- ovary (an 8.95% survival increase led to a 41% closing of the disparity),
- bladder (an 8.18% survival increase led to a 44% closing of the disparity) and
- uterus (a 14.1% survival increase led to a 40% closing of the disparity).
Results were similar after accounting for state Medicaid eligibility limits and after excluding data related to Medicaid expansions.
“There is evidence that spending by states on various social services can mitigate structural racism and partially address social determinants of health, such as financial stability, education, place of residence and insurance status, but such spending has also been associated with declines in racial and ethnic disparities, leading to unknown overall survival outcomes for patients with cancer. Our study provides some answers to some of these vexing issues,” said lead author Justin Michael Barnes, MD, MS, who is in the Department of Radiation Oncology at Washington University School of Medicine in St. Louis.
About the Study
The researchers examined records from the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) cancer database of nearly 3 million adults age 18 and older newly diagnosed with cancer from 2007 to 2016. Annual state spending data came from the U.S. Census Bureau.
The investigators evaluated the association of five-year OS and public welfare spending by race and ethnicity as well as by cancer site. The analyses accounted for age, sex, metropolitan residence, state, county-level income and education, insurance status, cancer site, stage at diagnosis and year of diagnosis.
Public welfare spending is a broad spending category that encompasses programs that provide assistance to those facing socioeconomic deprivation. Most of the spending is related to Medicaid as well as programs that provide cash assistance for individuals, such as Supplemental Security Income.
Prior research has shown associations between cancer outcomes, such as mortality, and social determinants of health, which include a variety of factors such as financial stability, education, place of residence and insurance status. Earlier research also found that racial disparities in cancer outcomes are likely related to systemic racism, resulting in disproportionately adverse conditions for Black Americans and other people of color.
The researchers hope to more closely examine the various components of public welfare expenditures to better determine which components play the most important roles. Also, they are considering additional studies to compare changes in outcomes with changes in welfare policies over time, thereby helping confirm the associations observed in this study.
This study did not receive any funding.
View the author disclosures: https://coi.asco.org/Report/ViewAbstractCOI?id=371552
View the disclosures for ASCO’s Cancer Communications Committee: https://www.asco.org/sites/new-www.asco.org/files/content-files/about-asco/pdf/2022-asco-ccc-disclosures.pdf
View the disclosures for Dr. Vokes: https://coi.asco.org/share/4SR-2FFX/Everett%20Vokes
For your readers:
- Cancer Does Not Affect All People Equally: An Expert Q&A on Cancer Disparities and Health Equity
- What Are Social Determinants of Health and How Do They Affect People With Cancer?
- Cancer.Net Blog Post in Spanish
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Founded in 1964, the American Society of Clinical Oncology, Inc. (ASCO®) is committed to the principle that knowledge conquers cancer. Together with the Association for Clinical Oncology, ASCO represents nearly 45,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of high quality, equitable patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. Conquer Cancer, the ASCO Foundation, supports ASCO by funding groundbreaking research and education across cancer’s full continuum. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation. Learn more at www.ASCO.org, explore patient education resources at www.Cancer.Net, and follow us on Facebook, Twitter, LinkedIn, and YouTube.