Socioeconomic Disparities in Anal Cancer: Effect on Treatment Delay and Survival

Abstract

BACKGROUND: Socioeconomic inequities have implications in access to health care and may be associated with disparities in treatment and survival. OBJECTIVE: To investigate the impact of socioeconomic inequities on time to treatment and survival of anal squamous cell carcinoma. DESIGN: This is a retrospective study using a nationwide dataset. SETTINGS: The patients were selected from National Cancer Database enrolled from 2004 to 2016. PATIENTS: We identified patient with stage I-III squamous cell carcinoma of anus who were treated with chemoradiation. MAIN OUTCOMES MEASURES: Socioeconomic factors, including race, insurance status, median household income, and percentage of no high school degrees were included. The association of these factors with treatment delay and overall survival were investigated. RESULTS: A total of 24,143 patients who underwent treatment for Grade I-III squamous cell carcinoma of anus were identified. Median age was 60 years and 70% were female. The median time to initiation of treatment was 33 days. Patients from zip codes with lower median income, higher percentage of no high school degree, and patients with other government insurance followed by Medicaid insurance had treatment initiated after 60 days from diagnosis. Kaplan-Meier survival analysis showed that the late treatment group had worse overall survival compared to early treatment group (98 vs 125 months; p < 0.001). LIMITATIONS: No detailed information about chemoradiotherapy regimen, completion of treatment, recurrence, disease free survival and individual level socioeconomic condition and risk factors. CONCLUSION: Patients from communities with lower median income, level of education, and enrolled in public insurance had longer time to treatment. Lower socioeconomic status was also associated with poorer overall survival. These results warrant further analysis and measures to improve access to care to address this disparity. See Video Abstract.