Skip to main content
SSO 2024 Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Recorded for On-Demand Viewing
Recorded for On-Demand Viewing
Back

Disparities in Surgical Oncologic Care

E126: Impact of Racialized Residential Segregation on Guideline Concordant Cancer Care and Survival

    ePoster Abstract Author(s)

  • Muhammad Talha Waheed, MD

    Research Fellow
    Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
    Duarte, California, United States

    • Submitter(s)

  • Muhammad Talha Waheed, MD

    Research Fellow
    Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
    Duarte, California, United States

    • Author(s)

  • Muhammad Talha Waheed, MD

    Research Fellow
    Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
    Duarte, California, United States

  • Kevin M. Sullivan, MD (he/him/his)

    Clinical Fellow
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
    Pasadena, California, United States

  • SH

    Sidra Haye, PhD

    Postdoctoral fellow
    Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, United States

  • PI

    Philip Ituarte, PhD

    Assistant Professor
    Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, United States

  • Laleh Melstrom, MD

    Associate Professor
    Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA
    La Verne, California, United States

  • Yanghee Woo, MD

    Associate Professor
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
    Duarte, California, United States

  • Thinzar M. Lwin, MD (she/her/hers)

    Assistant Professor
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, California, United States

  • LE

    Loretta Erhunmwunsee, MD

    Associate Professor
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, United States

  • GS

    Gagandeep Singh, MD

    Clinical Professor
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, California, United States

  • IP

    Isaac B. Paz, MD

    Clinical Professor
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, United States

  • Yumon Fong, MD

    Professor
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
    Duarte, CA, California, United States

  • VS

    Victoria L. Seewaldt, MD

    Professor
    Department of Population Science, City of Hope National Medical Center, Duarte, CA, United States

  • Mustafa Raoof, MD, MS

    Assistant Professor
    Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
    Duarte, California, United States

Introduction: Racial segregation - a manifestation of structural racism - is associated with cancer-related mortality. Prior work has used county-level or older data, and/ or focused on a few cancer types. To identify the shared mechanisms driving disparate cancer mortality, we comprehensively quantify the impact of racial-economic segregation by examining patient-level accessibility, timeliness, and appropriateness of cancer treatment across multiple cancer types.

Methods: This is a retrospective analysis of the California Cancer Registry (2000-2020) linked to Office of Statewide Health Planning and Development Patient Discharge Database. Primary exposure - residential economic segregation – was defined as: Index of Concentration of Extremes for Race/Ethnicity and Income (ICERI). Top quintile ICERI (Privileged Areas, PA – White and wealthy majority) were compared to bottom quintile ICERI (Deprived Areas, DA – Black and poor majority) with respect to survival, access, timeliness, and appropriateness (guideline-concordance) of cancer treatment.

Results: Data from 318,641 individuals (median age 68 years; 47% female) was analyzed (112,893 lung, 13,970 esophagus, 13,747 stomach, 25,885 pancreas, 110,592 colon, 41,554 rectum). DA (v. PA) residents were less likely to have stage 1 cancer at diagnosis (19% v. 24%), receive care at an NCI-designated cancer center (8% v. 10%), or initiate any therapy within 4 weeks of diagnosis (48% v. 58%) [all p< 0.001]. DA residents (v. PA) had the worst survival across all disease sites with highest disparity in rectal cancer (HR: 1.44, p < 0.001). On stage-specific analysis, there was a disproportionate survival disparity for locoregional disease (stage I-III) (Fig 1). Explaining the survival disparities, PA (v. DA) residents were more likely to receive guideline-concordant care: 1) Surgery for stage I-III lung  (65% v. 47%), esophageal (60% v. 49%) and rectal (95% v. 92%) cancer [all p< 0.001]; or 2) Surgery and chemotherapy for stage I-III pancreatic (42% v. 29%) and stage II-III stomach cancer (60% v. 50%) [both, p< 0.001].

Conclusions: Residential segregation has a disproportionate impact on cancer mortality for stage 1-3 patients across multiple cancer types; and should be the priority for policies improving accessibility, timeliness, and appropriateness of cancer treatment.

Learning Objectives:

  • Upon completion, participant will be able to appreciate the differences in access to healthcare for patients residing in majority poor black areas vs majority wealthy white areas.
  • Upon completion, participant will be able to describe the differences in cancer mortality and treatment appropriateness for patients living in majority poor black areas vs majority wealthy white areas.
  • Upon completion, participant will be able to list the cancers that are disproportionately impacted for locoregional disease and need to be prioritized by governmental policies.