Socioeconomic status and survival outcomes in elderly cancer patients: A national health insurance service-elderly sample cohort study

Identifying predictors of COVID-related delays in cancer-specific medical care

PURPOSE

Evidence of the impact of the COVID-19 pandemic on cancer prevention and control is growing, but little is known about patient-level factors associated with delayed care. We analyzed data from a survey focused on Iowan cancer patients' COVID-19 experiences in the early part of the pandemic.

METHODS

Participants were recruited from the University of Iowa Holden Comprehensive Cancer Center's Patients Enhancing Research Collaborations at Holden (PERCH) program. We surveyed respondents on demographic characteristics, COVID-19 experiences and reactions, and delays in any cancer-related health care appointment, or cancer-related treatment appointments. Two-sided significance tests assessed differences in COVID-19 experiences and reactions between those who experienced delays and those who did not.

RESULTS

There were 780 respondents (26% response), with breast, prostate, kidney, skin, and colorectal cancers representing the majority of respondents. Delays in cancer care were reported by 29% of respondents. In multivariable-adjusted models, rural residents (OR 1.47; 95% CI 1.03, 2.11) and those experiencing feelings of isolation (OR 2.18; 95% CI 1.37, 3.47) were more likely to report any delay, where experiencing financial difficulties predicted delays in treatment appointments (OR 5.72; 95% CI 1.96, 16.67). Health insurance coverage and concern about the pandemic were not statistically significantly associated with delays.

CONCLUSION

These findings may inform cancer care delivery during periods of instability when treatment may be disrupted by informing clinicians about concerns that patients have during the treatment process. Future research should assess whether delays in cancer care impact long-term cancer outcomes and whether delays exacerbate existing disparities in cancer outcomes.

Racial disparities in the management and outcomes of primary osseous neoplasms of the spine: a SEER analysis

PURPOSE

Primary osseous neoplasms of the spine, including Ewing's sarcoma, osteosarcoma, chondrosarcoma, and chordoma, are rare tumors with significant morbidity and mortality. The present study aims to identify the prevalence and impact of racial disparities on management and outcomes of patients with these malignancies.

METHODS

The 2000 to 2020 Surveillance, Epidemiology, and End Results (SEER) Registry, a cancer registry, was retrospectively reviewed to identify patients with Ewing's sarcoma, osteosarcoma, chondrosarcoma, or chordoma of the vertebral column or sacrum/pelvis. Study patients were divided into race-based cohorts: White, Black, Hispanic, and Other. Demographics, tumor characteristics, treatment variables, and mortality were assessed.

RESULTS

2,415 patients were identified, of which 69.8% were White, 5.8% Black, 16.1% Hispanic, and 8.4% classified as "Other". Tumor type varied significantly between cohorts, with osteosarcoma affecting a greater proportion of Black patients compared to the others (p < 0.001). A lower proportion of Black and Other race patients received surgery compared to White and Hispanic patients (p < 0.001). Utilization of chemotherapy was highest in the Hispanic cohort (p < 0.001), though use of radiotherapy was similar across cohorts (p = 0.123). Five-year survival (p < 0.001) and median survival were greatest in White patients (p < 0.001). Compared to non-Hispanic Whites, Hispanic (p < 0.001) and "Other" patients (p < 0.001) were associated with reduced survival.

CONCLUSION

Race may be associated with tumor characteristics at diagnosis (including subtype, size, and site), treatment utilization, and mortality, with non-White patients having lower survival compared to White patients. Further studies are necessary to identify underlying causes of these disparities and solutions for eliminating them.

Evaluation of the association of area-level socioeconomic deprivation and breast cancer recurrence by oestrogen receptor subtypes in Scotland

BACKGROUND

Women from socioeconomically deprived areas have lower breast cancer (BC) incidence rates for screen-detected oestrogen receptor (ER) + tumours and higher mortality for select tumour subtypes. We aimed to determine if ipsilateral breast cancer recurrence (IBR) differs by Scottish Index of Multiple Deprivation (SIMD) quintile and tumour subtype in Scotland.

METHODS

Patient data for primary invasive BC diagnosed in 2007-2008 in Scotland was analysed. Manual case-note review for 3495 patients from 10 years post-diagnosis was used. To determine the probability of IBR while accounting for the competing risk of death from any cause, cumulative incidence functions stratified by ER subtype and surgery were plotted. Multivariable Cox Proportional Hazards models were used to estimate the association of SIMD accounting for other predictors of IBR.

RESULTS

Among 2819 ER + tumours, 423 patients had a recurrence and 438 died. SIMD was related to death (p = 0.018) with the most deprived more likely to have died in the 10-year period (17.7% vs. 12.9%). We found no significant differences by SIMD in prognostic tumour characteristics (grade, TNM stage, treatment, screen-detection) or risk of IBR. Among 676 patients diagnosed with ER- tumours, 105 died and 185 had a recurrence. We found no significant differences in prognostic tumour characteristics by SIMD except screen detection with the most deprived more likely than the least to have their tumours detected from screening (46.9% vs. 28%, p = 0.03). Among patients with ER- tumours, 50% had mastectomy and the most deprived had increased 5-year IBR risk compared to the least deprived (HR 3.03 [1.41-6.53]).

CONCLUSIONS

IBR is not a major contributor to mortality differences by SIMD for the majority of BC patients in our study. The lack of inequities in IBR are likely due to standardised treatment protocols and access to healthcare. The association with socioeconomic deprivation and recurrence for ER- tumours requires further study.

Temporal Change in the Use of Laboratory and Imaging Tests in One Week Before Death, 2006–2015

BACKGROUND

To analyze the trends in laboratory and imaging test use 1 week before death among decedents who died in Korean hospitals, tests used per decedents from 2006 to 2015 were examined by using the National Health Insurance Service-Elderly Sample Cohort (NHIS-ESC) dataset.

METHODS

The study population consisted of decedents aged ≥ 60 years old with a history of admission and death at a hospital, and tests recorded in the payment claims for laboratory and imaging tests according to the Healthcare Common Procedure Coding System codes were examined. Twenty-eight laboratory and 6 imaging tests were selected. For each year, crude rates of test use per decedents in each age and sex stratum were calculated. Regression analysis was used to examine the temporal changes in the test use.

RESULTS

During the follow-up period, 6,638 subjects included in the sample cohort died. The number of total laboratory and imaging tests performed on the deceased increased steadily throughout the study year from 10.3 tests/deceased in 2006 to 16.6 tests/deceased in 2015. The use of tests increased significantly in general hospitals, however, not in nursing hospitals. Laboratory tests showed yearly increase, from 9.46/deceased in 2006 to 15.57/deceased in 2015, an annual increase of 7.39%. On the other hand, the use of imaging increased from 0.86/deceased in 2006 to 1.01/deceased in 2015, which was not statistically significant.

CONCLUSION

The use of tests, especially laboratory tests, increased steadily over the years even among those elderly patients at imminent death. Reducing acute healthcare at the end of life would be one target not only to support the sustainability of the health care budget but also to improve the quality of dying and death.

Living experiences of people with advance cancer with low socioeconomic status: A systematic review of qualitative evidence

BACKGROUND

The number of patients with advanced cancer is rapidly increasing, and the subgroup of this population with low socioeconomic status has suffered more disease burden than others. However, there is no recent qualitative synthesis of primary research studies into advanced cancer patients with low socioeconomic status.

OBJECTIVE

To synthesise qualitative research findings into advanced cancer patients' experiences with low socioeconomic status, and then to help provide targeted and effective strategies to improve their quality of life.

DESIGN

A systematic review and meta-synthesis of qualitative evidence (PROSPERO: CRD42021250423).

DATA SOURCES

PubMed, Web of Science Core Collection (ISI Web of Science), Cochrane Library, Embase, OVID LWW, CINAHL Complete (EBSCO), PsycINFO (EBSCO) and MEDLINE (ISI Web of Science), China National Knowledge Infrastructure (CNKI), WangFang, and Vip databases were systematically searched from their original dates to July 2022. Qualitative data were appraised using the Joanna Briggs Institute (JBI) qualitative assessment.

FINDINGS

The findings were synthesised into the following three analytical themes: (1) multi-dimensional disease distresses; (2) barriers in coping with disease distresses; and (3) strategies for dealing with disease distresses.

CONCLUSIONS

Patients with advanced cancer with low socioeconomic status experienced complicated and interactional distresses, unique life barriers, and a wide range of adaptation strategies. These findings will provide a comprehensive perspective to promote individual-centred health care systems and services to help these vulnerable people deal with the challenges of disease and improve their quality of life.

Socioeconomic and demographic determinants of radiation treatment and outcomes in glioblastoma patients

Introduction

Poor outcomes in glioblastoma patients, despite advancing treatment paradigms, indicate a need to determine non-physiologic prognostic indicators of patient outcome. The impact of specific socioeconomic and demographic patient factors on outcomes is unclear. We sought to identify socioeconomic and demographic patient characteristics associated with patient survival and tumor progression, and to characterize treatment options and healthcare utilization.

Methods

A cohort of 169 patients with pathologically confirmed glioblastomas treated at our institution was retrospectively reviewed. Multivariable cox proportional hazards analysis for overall survival (OS) and cumulative incidence of progression was performed. Differences in treatment regimen, patient characteristics, and neuro-oncology office use between different age and depressive disorder history patient subgroups were calculated two-sample t-tests, Fisher's exact tests, or linear regression analysis.

Results

The median age of all patients at the time of initiation of radiation therapy was 60.5 years. The median OS of the cohort was 13.1 months. Multivariable analysis identified age (Hazard Ratio 1.02, 95% CI 1.00–1.04) and total resection (Hazard Ratio 0.52, 95% CI 0.33–0.82) as significant predictors of OS. Increased number of radiation fractions (Hazard Ratio 0.90, 95% CI 0.82–0.98), depressive disorder history (Hazard Ratio 0.59, 95% CI 0.37–0.95), and total resection (Hazard Ratio 0.52, 95% CI 0.31–0.88) were associated with decreased incidence of progression. Notably, patients with depressive disorder history were observed to have more neuro-oncology physician office visits over time (median 12 vs. 16 visits, p = 0.0121). Patients older than 60 years and those with Medicare (vs. private) insurance were less likely to receive as many radiation fractions (p = 0.0014) or receive temozolomide concurrently with radiation (Odds Ratio 0.46, p = 0.0139).

Conclusion

Older glioblastoma patients were less likely to receive as diverse of a treatment regimen as their younger counterparts, which may be partially driven by insurance type. Patients with depressive disorder history exhibited reduced incidence of progression, which may be due to more frequent health care contact during neuro-oncology physician office visits.

Socioeconomic status-based survival disparities and nomogram prediction for patients with multiple myeloma: Results from American and Chinese populations

Objective

This study aimed to comprehensively investigate the relationship between the survival differences and socioeconomic status (SES) in patients with multiple myeloma (MM) and construct a predictive nomogram to assess clinical outcomes of MM patients.

Methods

The Surveillance, Epidemiology, and End Results (SEER) census tract-level SES database provides two specialized attributes: SES index and rurality. Using this database, 37,819 patients diagnosed with MM between January 2007 and December 2016 were enrolled. We evaluated the effects of SES index on overall survival (OS) and myeloma-specific survival (MSS) using Kaplan-Meier curves and Cox regression analyses. Thereafter, we included 126 patients with MM from two independent medical centers in China and divided them into training (Center 1) and validation (Center 2) cohorts. Univariate and multivariate Cox analyses were used in the training cohort to construct a nomogram for predicting clinical outcomes. Nomogram performance was assessed using the area under the curve (AUC) and calibration curves.

Results

In the SEER cohort, lower SES was significantly associated with worse OS rates and MSS rates (both P < 0.001). Multivariate analysis confirmed SES as an independent predictor of survival. Subgroup analysis indicated an increasing linear trend in survival benefits in non-Hispanic White, married, insured, and urban populations with increasing SES (all P < 0.001). In the training cohort, albumin, creatinine, rurality, and SES were confirmed as independent prognostic indicators. A nomogram for OS prediction was developed using these four factors, and it showed satisfactory discrimination and calibration. The 18- and 36-month AUC values of the nomogram were 0.79 and 0.82, respectively. Based on the total nomogram points, patients were categorized into two risk levels with good separation.

Conclusion

SES strongly influences survival disparities in patients with MM. Our nomogram consisting of clinical and sociodemographic characteristics can potentially predict survival outcomes.

Factors associated with functional disability in older adults with cancer treated at reference outpatient clinics in the state of Mato Grosso, Brazil

OBJECTIVE

To analyze factors associated with functional disability in older adults with cancer treated at reference outpatient clinics in the state of Mato Grosso, Brazil.

METHODS

This is a cross-sectional study of 463 older adults aged 60 years or older. The outcome variable was functional disability, evaluated by Lawton and Brody's Instrumental Activities of Daily Living (IADL) scale. The independent variables were sociodemographic characteristics, lifestyle, social support, and health aspects. We performed bivariate and multivariate analyses and calculated prevalence ratios (PR) using Poisson regression with robust variance.

RESULTS

The prevalence of IADL functional disability was 55.3%. The variables associated with this disability in the multivariate analysis were: not working (PR=1.36; 95% confidence interval - 95%CI 1.03-1.78); low (PR=1.49; 95%CI 1.10-2.03) and moderate (PR=1.30; 95%CI 1.04-1.64) perceived affectionate support; depressive symptoms (PR=1.31; 95%CI 1.10-1.56); malnutrition (PR=1.28; 95%CI 1.03-1.59); having two or more comorbidities (PR=1.30; 95%CI 1.03-1.64), and having a companion to health services (PR=1.39; 95%CI 1.05-1.83).

CONCLUSION

In addition to physical health aspects, comorbidities, and malnutrition, functional disability was associated with emotional, social support, and work issues, reinforcing the importance of comprehensive care and actions to maintain and recover functional capacity, promoting a better quality of life, the independence of older adults with cancer, and a reduced risk of adverse biopsychosocial outcomes.

Breast cancer incidence and survival in Scotland by socio-economic deprivation and tumour subtype

Background

Women from socio-economically deprived areas are less likely to develop and then to survive breast cancer (BC). Whether associations between deprivation and BC incidence and survival differ by tumour molecular subtypes and mode of detection in Scotland are unknown.

Methods

Data consisted of 62,378 women diagnosed with invasive BC between 2000 and 2016 in Scotland. Incidence rates and time trends were calculated for oestrogen receptor positive (ER+) and negative (ER−) tumours and stratified by the Scottish Index of Multiple Deprivation (SIMD) quintiles and screening status. SIMD is an area-based measure derived across seven domains: income, employment, education, health, access to services, crime and housing. We calculated adjusted hazard ratios (aHR [95% confidence intervals]) for BC death by immunohistochemical surrogates of molecular subtypes for the most versus the least deprived quintile. We adjusted for mode of detection and other confounders.

Results

In Scotland, screen-detected ER+tumour incidence increased over time, particularly in the least deprived quintile [Average Annual Percentage Change (AAPC) = 2.9% with 95% CI from 1.2 to 4.7]. No marked differences were observed for non-screen-detected ER+tumours or ER− tumours by deprivation. BC mortality was higher in the most compared to the least deprived quintile irrespective of ER status (aHR = 1.29 [1.18, 1.41] for ER+ and 1.27 [1.09, 1.47] for ER− tumours). However, deprivation was associated with significantly higher mortality for luminal A and HER2−enriched tumours (aHR = 1.46 [1.13, 1.88] and 2.10 [1.23, 3.59] respectively) but weaker associations for luminal B and TNBC tumours that were not statistically significant.

Conclusions

Deprivation is associated with differential BC incidence trends for screen-detected ER+tumours and with higher mortality for select tumour subtypes. Future efforts should evaluate factors that might be associated with reduced survival in deprived populations and monitor progress stratified by tumour subtypes and mode of detection.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10549-022-06632-1.

Living experiences of patients with advanced cancer with low socioeconomic status: protocol for a systematic review of qualitative evidence

INTRODUCTION

The number of patients with advanced cancer is rapidly increasing, and the disease burden among those with low socioeconomic status (SES) has accordingly become a global concern. Low SES can adversely impact patients with advanced cancer. The purpose of this systematic review is to shed light on the life experiences of patients with advanced cancer with low SES to help provide targeted and effective strategies to improve their quality of life.

METHODS AND ANALYSIS

We will include the following English databases: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PubMed, MEDLINE, Embase, Web of Science, Joanna Briggs Institute (JBI) Database of Systematic Reviews, PsycINFO and OpenGrey, and the following Chinese databases: China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals and Wanfang Data Knowledge Service Platform. A comprehensive search of qualitative studies on the experiences of patients with advanced cancer with low SES will be conducted from the above databases, with no age limit. Quality assessments of the studies will be independently performed by two reviewers using the JBI Critical Assessment Checklist, and any disagreements will be resolved through a discussion with a third reviewer. Relevant data will be extracted using the JBI standardised data extraction tools. The JBI meta-aggregation tool will be used to compare, analyse and summarise the original results. The reliability and credibility of the overall quality of the studies included will be evaluated using the JBI ConQual approach.

ETHICS AND DISSEMINATION

This study is based on existing public literature and therefore does not require a formal ethics review. The results of the study may be presented in peer-reviewed international journals and presented at scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42021250423.

Fatores associados à incapacidade funcional em idosos com câncer atendidos em ambulatórios de referência no estado de Mato Grosso, Brasil

RESUMO: Objetivo: Analisar os fatores associados à incapacidade funcional em idosos com câncer atendidos em ambulatórios de referência do estado de Mato Grosso, Brasil. Métodos: Estudo transversal, com 463 idosos de 60 anos ou mais. A variável desfecho foi a incapacidade funcional, avaliada por meio da Escala de Atividades Instrumentais de Vida Diária (AIVD) desenvolvida por Lawton e Brody. As variáveis independentes foram características sociodemográficas, estilo de vida, apoio social e condições de saúde. Foram realizadas análises bivariada e múltipla, calculando-se as razões de prevalência (RP), com o uso de regressão de Poisson com variância robusta. Resultados: A prevalência de incapacidade funcional para as AIVD foi de 55,3%. As variáveis que se associaram a essa incapacidade na análise múltipla foram: não trabalhar (RP=1,36, intervalo de confiança — IC95% 1,03–1,78); percepção de apoio afetivo baixo (RP=1,49; IC95% 1,10–2,03) e médio (RP=1,30; IC95% 1,04–1,64); sintomas depressivos (RP=1,31; IC95% 1,10–1,56); desnutrição (RP=1,28; IC95% 1,03–1,59); ter duas ou mais comorbidades (RP=1,30; IC95% 1,03–1,64) e ter acompanhante aos serviços de saúde (RP=1,39; IC95% 1,05–1,83). Conclusão: Além das condições de saúde física, comorbidade e desnutrição, as questões emocionais, de apoio social e trabalho associaram-se à incapacidade funcional, reforçando a importância de uma atenção integral e de ações de manutenção e recuperação da capacidade funcional, promovendo maior qualidade de vida, a independência do idoso com câncer e a redução do risco de desfechos adversos em âmbito biopsicossocial.

Socioeconomic Environment and Survival in Patients with Digestive Cancers: A French Population-Based Study

Social inequalities are an important prognostic factor in cancer survival, but little is known regarding digestive cancers specifically. We aimed to provide in-depth analysis of the contextual social disparities in net survival of patients with digestive cancer in France, using population-based data and relevant modeling. Digestive cancers (n = 54,507) diagnosed between 2006-2009, collected through the French network of cancer registries, were included (end of follow-up 30 June 2013). Social environment was assessed by the European Deprivation Index. Multidimensional penalized splines were used to model excess mortality hazard. We found that net survival was significantly worse for individuals living in a more deprived environment as compared to those living in a less deprived one for esophageal, liver, pancreatic, colon and rectal cancers, and for stomach and bile duct cancers among females. Excess mortality hazard was up to 57% higher among females living in the most deprived areas (vs. least deprived) at 1 year of follow-up for bile duct cancer, and up to 21% higher among males living in the most deprived areas (vs. least deprived) regarding colon cancer. To conclude, we provide a better understanding of how the (contextual) social gradient in survival is constructed, offering new perspectives for tackling social inequalities in digestive cancer survival.

Prognostic impact of socioeconomic status compared to overall stage for HPV-negative head and neck squamous cell carcinoma

OBJECTIVE

To estimate the relative prognostic ability of socioeconomic status (SES) compared to overall stage for HPV-negative head and neck squamous cell carcinoma (HNSCC) MATERIALS AND METHODS: Data were obtained from the Carolina Head and Neck Cancer Epidemiology Study (CHANCE). An empirical 4-category SES classification system was created. Cox proportional hazards models, survival gradients, Bayesian information criterion (BIC), and Harrell's C index were used to estimate the prognostic ability of SES compared to stage on overall survival (OS).

RESULTS

The sample consisted of 1229 patients with HPV-negative HNSCC. Patients with low SES had significantly increased risk of mortality at 5 years compared to patients with high SES (HR 3.11, 95% CI 2.07-4.67; p < 0.001), and the magnitude of effect was similar to overall stage (HR 3.01, 95% CI 2.35-3.86; p < 0.001 for stage IV versus I). Compared to overall stage, the SES classification system had a larger total survival gradient (35.8% vs. 29.1%), similar model fit (BIC statistic of 7412 and 7388, respectively), and similar model discriminatory ability (Harrell's C index of 0.61 and 0.64, respectively). The association between low SES and OS persisted after adjusting for age, sex, race, alcohol, smoking, overall stage, tumor site, and treatment in a multivariable model (HR 2.96, 95% CI 1.92-4.56; p < 0.001).

CONCLUSION

SES may have a similar prognostic ability to overall stage for patients with HPV-negative HNSCC. Future research is warranted to validate these findings and identify evidence-based interventions for addressing barriers to care for patients with HNSCC.

[Multimorbidity patterns and functional disability in elderly Brazilians: a cross-sectional study with data from the Brazilian National Health Survey]

The presence of multimorbidity patterns has been related to functional disability in basic activities (BADLs) and instrumental activities of daily living (IADLs), which are essential for elder individuals' self-care and autonomy. The study thus aimed to estimate the association between multimorbidity patterns and presence of functional disability in elderly Brazilians. This was a cross-sectional study using data from the Brazilian National Health Survey (PNS 2013) in a sample of elderly Brazilians (≥ 60 years). The measures of functional disability were from self-completed questionnaires, categorized in basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). The multimorbidity patterns analyzed here were: (1) cardiorespiratory; (2) vascular-metabolic; and (3) mental-musculoskeletal. The adjustment variables included age, sex, schooling, and region of Brazil. Multivariate logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) with Stata 16.0. Elderly individuals classified in the mental-musculoskeletal patterns showed the highest odds of disability in BADLs (OR = 2.72; 95%CI: 2.33; 3.18), while those with the cardiopulmonary pattern showed the highest odds of disability in IADLs (OR = 2.65; 95%CI: 1.95; 3.60), compared to those without the same patterns. All the multimorbidity patterns analyzed here were associated with disability in BADLs and IADLs and should thus be considered when planning measures to prevent disabilities in elderly individuals with multimorbidity.

Occupational disparities in survival in Korean women with cancer: a nationwide registry linkage study

OBJECTIVES

We sought to examine occupational disparities in survival among Korean women diagnosed with cancer.

DESIGN

Population-based, registry-linkage study.

SETTING

South Korea.

PARTICIPANTS

Our study population comprised female workers registered in the Korean national employment insurance programme during 1995-2000 and diagnosed with cancer between 1995 and 2008. A total of 61 110 women with cancer diagnoses was included in analysis. The occupation was categorised into four groups: (1) managers, professionals and technical workers, (2) clerks, (3) service/sales workers and (4) blue-collar workers.

PRIMARY AND SECONDARY OUTCOME MEASURE

Study population were linked to the national death registry until 2009. HRs for mortality adjusting for age and year of diagnosis were calculated in the study sample and subgroups with 10 specific cancer sites including thyroid, breast, stomach, cervix, colon or lung cancer using managers, professionals and technical workers as the reference.

RESULTS

Women in service/sales (HR 1.25, 95% CI 1.15 to 1.35) and blue-collar occupations (HR 1.34, 95% CI 1.25 to 1.44) had poorer survival for all cancer sites combined, while blue-collar workers showed poorer survival for lung (HR 1.41, 95% CI 1.14 to 1.77), breast (HR 1.28, 95% CI 1.06 to 1.54), cervical cancer (HR 1.42, 95% CI 1.02 to 2.06) and non-Hodgkin's lymphoma (HR 1.69, 95% CI 1.09 to 2.77) compared with women in professional and managerial positions.

CONCLUSION

We found substantial and significant inequalities in overall survival by the occupational group among Korean women with cancer, even in the context of universal access to cancer screening and treatment.

Margin Positivity in Resectable Esophageal Cancer: Are there Modifiable Risk Factors?

BACKGROUND

Patients with esophageal cancer have poor overall survival, with positive resection margins worsening survival. Margin positivity rates are used as quality measures in other malignancies, but modifiable risk factors are necessary to develop actionable targets for improvement. Our objectives were to (1) evaluate trends in esophageal cancer margin positivity, and (2) identify modifiable patient/hospital factors associated with margin positivity.

METHODS

Patients who underwent esophagectomy from 2004 to 2015 were identified from the National Cancer Database. Trends in margin positivity by time and hospital volume were evaluated using Cochrane-Armitage tests. Associations between patient/hospital factors and margin positivity were assessed by multivariable logistic regression.

RESULTS

Among 29,706 patients who underwent esophagectomy for cancer, 9.37% had positive margins. Margin positivity rates decreased over time (10.62% in 2004 to 8.61% in 2015; p < 0.001). Older patients (≥ 75 years) were more likely to have positive margins [odds ratio (OR) 2.04, 95% confidence interval (CI) 1.42-2.92], as were patients with a Charlson-Deyo Index ≥ 3 (OR 1.84, 95% CI 1.08-3.12). Patients who received neoadjuvant therapy were less likely to have positive margins (OR 0.37, 95% CI 0.29-0.47), while laparoscopic surgical approach was associated with increased margin positivity (OR 1.70, 95% CI 1.40-2.06). As the hospital annual esophagectomy volume increased, margin positivity rates decreased (7.76% in the fourth quartile vs. 11.39% in the first quartile; OR 0.70, 95% CI 0.49-0.99).

CONCLUSIONS

Use of neoadjuvant therapy, surgical approach, and hospital volume are modifiable risk factors for margin positivity in esophageal cancer. These factors should be considered in treatment planning, and margin positivity rates could be considered as a quality measure in esophageal cancer.

Occupational Class and Cancer Survival in Korean Men: Follow-Up Study of Nation-Wide Working Population

Background: We aimed to describe inequalities in site-specific cancer survival across different occupational classes in Korean men. Methods: Subjects included cancer diagnosed members of the national employment insurance program during 1995-2008. A total of 134,384 male cases were followed by linking their data to the Death registry until 2009. Occupational classes were categorized according to the Korean Standard Occupational Classification (KSOC). Hazard ratio adjusting age and diagnosed year were calculated for each occupation by cancer sites. Results: Men in service/sales and blue-collar occupations had lower survival of all cancer sites combined and esophagus, stomach, colorectal, liver, larynx, lung, prostate, thyroid cancer and non-Hodgkin's lymphoma than men in professional and managerial positions. Cancer sites with good prognosis like prostate cancer showed wider gap across occupational class. Conclusions: Considerable inequalities in cancer survival were found by occupation among Korean men. Cancer control policy should more focus on lower socioeconomic occupational class.

Socioeconomic status and survival outcomes in elderly cancer patients: A national health insurance service-elderly sample cohort study

BACKGROUND

We hypothesized that lower socioeconomic status (SES) was associated with higher all-cause mortality in patients newly diagnosed with cancer, particularly in the elderly population.

METHODS

We collected study patients from the stratified random sample of Korean National Health Insurance Elderly Cohort (2002-2015). The Cox's proportional hazards model was used to investigate the risk factors for mortality. Income level and composite deprivation index (CDI) 2010 were used to define the SES: low, intermediate, and high SES groups. The comorbidities were measured using Charlson Comorbidity Index score. After a wash-out period (2002), the final study population was 108 626 (2003-2015).

RESULTS

In multivariate analysis, low SES was associated with poor overall survival (OS) (HR = 1.08, 95% CI: 1.05-1.12, P < 0.001) and cancer-specific survival (CSS) (HR = 1.11, 95% CI: 1.06-1.16, P < 0.001) particularly for patients aged 70-79 years. High SES was favorable prognostic factor of OS in patients aged 60-69 years (HR = 0.85, 95% CI: 0.81-0.89, P < 0.001), 70-79 years (HR = 0.90, 95% CI: 0.87-0.93, P < 0.001), and ≥80 years (HR = 0.91, 95% CI: 0.87-0.96, P < 0.001). However, SES was not associated with CSS in advanced age patients (≥80 years). Patients with low SES manifesting colorectal, urinary, liver, gastric, melanoma, and esophageal cancers demonstrated worse OS, compared to patients with intermediate SES. Also, low SES patients with urinary, liver, or colorectal cancers or melanoma demonstrated worse CSS compared to those with intermediate SES.

CONCLUSION

Low SES at the time of cancer diagnosis is associated with increased risk of OS and CSS in elderly patients. Depending on cancer sites, different patterns of OS and CSS were observed according to SES. Further elucidation of the causes underlying these phenomena is needed along with appropriate support for elderly cancer patients with low SES.