Increased Social Spending by States Linked to Improved OS for Black Patients With Cancer

When states increased investment in social services for those in need, the survival gap between Black and White patients with cancer shrank—and the more states spent, the more they closed the gap, according to data unveiled today ahead of the annual meeting of the American Society of Clinical Oncology (ASCO).

The analysis, led by Justin Michael Barnes, MD, MS, a radiation oncology resident at the Washington University School of Medicine in St. Louis, found that for every 10% increase in public welfare spending, there was a 4.55% narrowing of the 5-year overall survival (OS) disparity between non-Hispanic Black and non-Hispanic White patients with cancer.

For this study, investigators examined data from the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) cancer database, which includes data from almost 3 million adults newly diagnosed with cancer from 2007 to 2016. For state spending data, they used US Census Bureau data.

Barnes presented an overview of the study, “State Public Welfare Spending and Racial/Ethnic Disparities in Overall Survival Among Adults With Cancer,” during a press preview of selected abstracts to be presented during ASCO, which will hold its first in-person meeting since 2019 in Chicago from June 3-7, 2022.

“We know from extensive prior research that cancer outcomes are worse for minorities,” Barnes said, citing 2019 data that showed OS across all cancer types found a 5-year survival rate of 68% for White patients compared with 63% for Black patients.

Although some of the disparity in outcomes may be related to access to care, other factors could be social determinants of health, including financial stability, type of housing, and “social and environmental conditions and stressors that prevent people from getting the care they need—likely due to longstanding structural racism,” he said.

The study examined the association between 5-year OS and public welfare spending by race and ethnicity, as well as by the type of cancer. Investigators accounted for differences in age, gender, state of residence, whether the person lived in a metropolitan area, income, education, insurance status, and cancer stage at diagnosis.

Although spending by states can reduce the effects of structural racism and social determinants of health, this study offered some answers to how such spending translates into survival, Barnes said.

Of note, Barnes explained, the relationship between increased public welfare spending and narrowing disparities in cancer survival appeared to be greatest among older patients. This was noteworthy, given the ongoing focus on the connection between Medicaid expansion and reduced cancer mortality. For example, Barnes was the lead author on a 2021 study that highlighted the link between Medicaid expansion and reduced mortality, especially in pancreatic cancer.

The authors found that the increased public welfare spending by states was associated with a narrowed 5-year OS disparity between Black and White patients in the multiple cancer types, including:

• In breast cancer, a 6.2% survival increase for Black patients translated into a 39% closing of disparity.
• In cervical cancer, an 11.9% survival increase led to a 46% closing of the disparity.
• In colorectal cancer, a 4.4% survival increase led to a 48% closing of the disparity.
• In uterine cancer, a 14.1% survival increase led to a 40% closing of the disparity.
• In liver cancer, a 7.0% survival increase led to a 49% closing of the disparity.

The SEER data covered information from 13 states considered representative of the US population, Barnes explained. The states included were: Alaska, California, Connecticut, Georgia, Hawaii, Iowa, Kentucky, Louisiana, Mississippi, New Jersey, New Mexico, Utah, and Washington.

Reference

Barnes JM, Johnston KJ, Osazuwa-Peters N. State public welfare spending and racial/ethnic disparities in overall survival among adults with cancer. Presented at: American Society of Clinical Oncology 2022 Annual Meeting; Chicago, IL; June 3-7, 2022. Abstract 6509.