ImportanceComprehensive data for racial and ethnic disparities after second primary cancers (SPCs) are lacking despite the growing burden of SPCs.ObjectiveTo quantify racial and ethnic disparities in survival among persons with SPCs.Design, Setting, and ParticipantsThis population-based, retrospective cohort study used data from 18 Surveillance, Epidemiology, and End Results registries in the US for persons diagnosed with the most common SPCs at age 20 years or older from January 1, 2000, to December 31, 2013 (with follow-up through December 31, 2018). Data were analyzed between January and April 2023.ExposureRace and ethnicity (Hispanic, non-Hispanic Asian or Pacific Islander, non-Hispanic Black, and non-Hispanic White).Main Outcomes and MeasuresThe main outcomes were 5-year relative survival and cause-specific survival. Cause-specific hazard ratios (HRs) were calculated for death from cancer or cardiovascular disease (CVD) in each racial and ethnic minority population compared with the White population overall and stratified by SPC type, with adjustment for sex, year and age at SPC diagnosis, and prior cancer type and stage (baseline model) and additionally for county attributes (household income, urbanicity), SPC characteristics (stage, subtype), and treatment.ResultsAmong 230 370 persons with SPCs (58.4% male), 4.5% were Asian or Pacific Islander, 9.6% were Black, 6.4% were Hispanic, and 79.5% were White. A total of 109 757 cancer-related deaths (47.6%) and 18 283 CVD-related deaths (7.9%) occurred during a median follow-up of 54 months (IQR, 12-93 months). In baseline models, compared with the White population, the risk of cancer-related death overall was higher in the Black (HR, 1.21; 95% CI, 1.18-1.23) and Hispanic (HR, 1.10; 95% CI, 1.07-1.13) populations but lower in the Asian or Pacific Islander population (HR, 0.93; 95% CI, 0.90-0.96). When stratified by 13 SPC types, the risk of cancer-related death was higher for 10 SPCs in the Black population, with the highest HR for uterine cancer (HR, 1.87; 95% CI, 1.63-2.15), and for 7 SPCs in the Hispanic population, most notably for melanoma (HR, 1.46; 95% CI, 1.21-1.76). For CVD-related death, the overall HR was higher in the Black population (HR, 1.41; 95% CI, 1.34-1.49), with elevated risks evident for 11 SPCs, but lower in the Asian or Pacific Islander (HR, 0.75; 95% CI, 0.69-0.81) and Hispanic (HR, 0.90; 95% CI, 0.84-0.96) populations than in the White population. After further adjustments for county attributes and SPC characteristics and treatment, HRs were reduced for cancer-related death and for CVD-related death and associations in the same direction remained.Conclusions and RelevanceIn this cohort study of SPC survivors, the Black population had the highest risk of both death from cancer and death from CVD, and the Hispanic population had a higher risk of death from cancer than the White population. Attenuations in HRs after adjustment for potentially modifiable factors highlight opportunities to reduce survival disparities among persons with multiple primary cancers.
Background: The burden of second primary cancers including secondary acute myeloid leukemia (sAML) is increasing in the United States; however, limited data exist regarding survival among individuals with sAML. This study aims to examine survival differences between sAML and AML arising de novo (dnAML) in relation to antecedent cancer types and the receipt of prior cancer treatment. Methods: Individuals aged ≥20 years and diagnosed with sAML or dnAML between 2001 and 2018 and followed for vital status through 2019 were identified from Surveillance, Epidemiology, and End Results 17 database, covering 27% of the US population. The differences in AML-specific survival between individuals with sAML and dnAML were examined using multivariable Cox proportional hazards regression. Trends in five-year age-standardized relative survival from 2001-2014 were assessed using Joinpoint survival model for sAML and dnAML, separately. Results: A total of 7,306 individuals diagnosed with sAML and 40,398 individuals with dnAML were included. During a median follow-up of 6 months, 78% of individuals with sAML died from AML compared to 71% of those with dnAML. In multivariable models, the risk of AML-specific mortality was 8% higher in individuals diagnosed with sAML than in those diagnosed with dnAML (hazard ratio [HR]=1.08, 95%CI=1.05-1.11), with the elevated risk more pronounced among those with younger ages at diagnosis (HR20-54 years=1.60, 95%CI=1.46-1.75 versus HR65+ years=0.99, 95%CI=0.96-1.03; Pinteraction<0.0001) and those who received chemotherapy (HRchemotherapy yes=1.14, 95%CI=1.10-1.19 versus HRchemotherapy no/unknown=0.95, 95%CI=0.90-0.99; Pinteraction=0.0004). Subgroup analysis by antecedent cancer types showed that HRs substantially varied ranging from 0.74 (95%CI=0.57-0.95) for individuals with a history of thyroid cancer to 1.78 (95%CI=1.04-3.07) for those with a history of soft tissue sarcomas. Further subgroup analysis by the receipt of chemotherapy for antecedent cancers showed that the elevated risk was generally restricted to individuals with a history of chemotherapy receipt with some variations by cancer types. Five-year relative survival significantly increased from 2001 to 2014 for both sAML and dnAML; though the increase was slower for sAML (annual percent change [APC]=0.30%, 95% CI 0.20-0.40) compared with dnAML (APC=0.77%, 95%CI=0.69-0.84). Likewise, five-year survival for the most contemporary period (2010-2018) was substantially lower for sAML (9.8%, 95%CI=9.3-10.3) than for dnAML (22.8%, 95%CI=22.3-23.2). Conclusion: Individuals with sAML had in general worse AML cause-specific survival compared with their dnAML counterparts, with the differences most pronounced among those diagnosed at younger ages and who received chemotherapy. The findings may inform targeted treatment and survivorship recommendations for cancer survivors who develop sAML. Citation Format: Ephrem Sedeta, Ahmedin Jemal, Lauren Nisotel, Hyuna Sung. Survival among adults diagnosed with secondary acute myeloid leukemia. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4379.
Background Cancer survivors have higher cardiovascular disease (CVD) mortality than the general population but comprehensive data by race and ethnicity are limited. Methods Data from 17 Surveillance, Epidemiology, and End Results (SEER) registries were used to identify adults diagnosed with invasive cancer at ages ≥20 years from 2000 to 2018. CVD mortality was calculated for five mutually exclusive race/ethnicity categories (non-Hispanic American Indian/Alaska Native [AIAN], non-Hispanic Asian or Pacific Islander [API], Hispanic, non-Hispanic Black [Black], and non-Hispanic White [White]). Standardized mortality ratios (SMR) were estimated to compare mortality rates in cancer survivors to their counterparts in the general population. Analyses were stratified by demographic factors, CVD subtype, and cancer site. Results During a mean follow up of 5.3 person-years among 5,786,876 survivors (20-64 years, 49.3%; men, 51.2%; White, 71.7%; Black, 10.1%; Hispanic, 10.9%; API, 7%, AIAN, 0.3%), 358,970 CVD deaths (cardiac death, 76.9%; cerebrovascular death, 15.9%) occurred. CVD mortality per 10,000 person-years was highest among survivors who were Black (122.9), followed by White (114.7), AIAN (86.7), API (78.6) and Hispanic (75.3). In contrast, SMRs were greatest among AIAN survivors (SMR=1.42, 95% CI=1.32-1.51), followed by API (SMR=1.39, 1.37-1.41), Hispanic (SMR=1.29, 1.27-1.30), Black (SMR=1.19, 1.17-1.20) and White (SMR=1.08, 1.07-1.08) survivors. Among survivors ages 20-64 years, Black survivors were approximately three times as likely to die from cardiac death as Hispanic or API survivors (46.7 vs. 14.5-17.6 per 10,000). SMR, however, was 1.47 among Hispanic survivors (95% CI=1.42-1.51) and 1.80 among API survivors (95% CI=1.42-1.51), greater than 1.25 among Black survivors (95% CI=1.22-1.27). Across cancer types, the highest SMR was among API survivors of pancreatic cancer (SMR=5.27, 3.83-7.08) and brain cancer (SMR=4.56, 3.10-6.48) in ages 20-64 years and among Hispanic (SMR=3.77, 3.09-4.56) and API survivors of brain cancer (SMR=3.24, 2.40-4.28) in ages ≥65 years. Conclusion Black survivors had the greatest CVD mortality of all groups, demonstrating that CVD health disparities in the general population extend to cancer survivors. Despite the lower absolute mortalities, relative risks compared to their counterparts in the general population were greatest among API and Hispanic survivors, implying a greater impact of cancer diagnosis on the risk of CVD death among survivors of these populations. Targeted primary care and cardio-oncologic intervention strategies are needed to improve CVD outcomes and achieve cardiovascular health equity among cancer survivors. Citation Format: Lauren Nisotel, Rebecca L. Siegel, Eric H. Yang, Ahmedin Jemal, Hyuna Sung. Cardiovascular disease mortality among cancer survivors by race and ethnicity in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB128.
Background Second primary cancer (SPC) burden is increasing in the US, but few studies comprehensively examined survival in persons diagnosed with SPCs in relation to survivors’ antecedent cancer types. Methods Persons aged ≥20 years and diagnosed with one of the six most common SPCs (female breast, prostate, bladder, lung, colorectum, corpus uteri) from 2000-2013 were identified from 17 Surveillance, Epidemiology, and End Results registries (n=152,204). For comparison, persons diagnosed with same type cancers occurring as first primary cancers (FPCs) were also identified (n=2,131,953). For each cancer type, differences in the risk of cancer-specific or all-cause death between SPC and FPC were estimated using multivariable Cox proportional hazards models adjusted for potential confounders. Subgroup analyses were conducted to estimate the risk difference between SPC and FPC by antecedent cancer types of those with SPCs. Results During a median follow-up of 6.5 years (interquartile range, 1.8-10.6), cancer-type specific death occurred among 34% of persons with SPCs and among 32% of persons with FPCs. The corresponding proportions for all-cause death were 67% and 53%, respectively. In multivariable models, the risk of cancer-specific death was statistically significantly higher in persons with SPC than in persons with FPC for breast (hazard ratio [HR]=1.43; 95% confidence interval [CI]=1.40-1.48), bladder (HR=1.19; 1.09-1.29), corpus uteri (HR=1.10; 1.05-1.15), and colorectal (HR=1.05, 1.03-1.07) cancer, whereas it was lower for lung cancer (HR=0.78; 0.77-0.79). The risk did not vary between groups for prostate cancer (HR=0.92; 0.79-1.06). Subgroup analyses showed large variations in HRs across survivors by antecedent cancer types. In particular, the highest HR associated with SPC (vs FPC) was among ovarian cancer survivors for colorectal cancer (HR=1.31; 1.10-1.56), gallbladder cancer survivors for breast cancer (HR=1.78; 1.09-2.91), head and neck cancer survivors for uterine cancer (HR=1.69, 1.05-2.72), gallbladder cancer survivors for bladder cancer (HR=1.87; 1.06-3.22), while the lowest HR for lung cancer was among testicular cancer survivors (HR=0.54; 0.38-0.76). Associations were generally consistent across strata of diagnosis years, race/ethnicity, household income, and urbanicity. The risks of all-cause death were also higher among persons with SPC vs FPC, including prostate cancer. Persons with second primary prostate cancer were almost twice as likely to die from all causes as persons with first prostate cancer (HR=1.83; 1.80-1.87). Conclusion Persons with SPC generally have a higher risk of cancer-specific and all-cause death than those with FPC, suggesting that intensive SPC surveillance may benefit those at increased risk of developing SPC. Importantly, the risk difference substantially varied by survivors’ antecedent cancer type, highlighting a need for targeted strategies for treatment and survivorship care for persons with SPCs. Citation Format: Hyuna Sung, Lauren Nisotel, Ephrem Sedeta, Farhad Islami, Ahmedin Jemal. Survival of most commonly diagnosed second primary cancers among adult cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB129.
12093 Background: Racial and ethnic disparities in survival after first primary cancer diagnoses have been well documented. Yet comprehensive data for disparities after subsequent primary cancer (SPC) are lacking despite the growing burden of SPCs. Methods: This study included 230,370 persons diagnosed with one of the 13 common SPCs at ages≥20 years during 2000-2013 in 18 Surveillance, Epidemiology, and End Results registries. Cause-specific proportional hazards models were used to estimate HR (hazard ratio), overall and stratified by SPC types, comparing the risk of cancer or cardiovascular death in Hispanic, non-Hispanic Asian or Pacific Islander (API), or non-Hispanic Black (Black) persons to that in non-Hispanic White (White) persons. HRs were adjusted for sex, first primary cancer type and stage, age and year of SPC diagnosis (base model); and additionally household income, urbanicity, SPC stage, subtype, and treatment receipt (surgery, radiotherapy, chemotherapy) (final model). Results: During 54 months of median follow-up, 109,757 cancer deaths and 18,283 cardiovascular deaths occurred among persons with SPCs. Overall, HRs for cancer death were higher among Black (HR = 1.21, 95% CI = 1.18-1.23) and Hispanic (HR = 1.10, 95% CI = 1.07-1.13) persons compared with White persons, but lower among API persons (HR = 0.93, 95% CI = 0.90-0.96) in the base model. When stratified by SPC types, the increased HRs were evident for 10 of 13 cancers among Black persons with the greatest HR among those with uterine corpus cancer (HR = 1.87, 95%CI = 1.63-2.15) and for 7 of 13 cancers among Hispanic persons with the highest HR among those with melanoma (HR = 1.46, 95%CI = 1.21-1.76). For cardiovascular death, compared with White persons, the overall HR was higher among Black (HR = 1.42, 95% CI = 1.35-1.49) persons but lower among API (HR = 0.75, 95%CI = 0.69-0.81) and Hispanic (HR = 0.90, 95% CI = 0.84-0.96) persons. The risk of cardiovascular death was higher for 11 of 13 cancers among Black persons with the greatest HR among those with pancreatic (HR = 1.80, 95%CI = 1.17-2.75), thyroid (HR = 1.70, 95%CI = 1.12-2.57), and kidney (HR = 1.63, 95%CI = 1.38-1.93) cancers. Additional adjustments in the final model reduced the elevated HRs substantially especially for cancer death among Black or Hispanic persons, although the associations remained statistically significant for most cancers. Conclusions: Among persons with SPCs, Black persons had a higher risk of death from both cancer and cardiovascular disease, whereas Hispanic persons had a higher risk of death from cancer. Adjusting for differences in potentially modifiable factors attenuated the associations substantially, highlighting opportunities for interventions toward health equities among cancer survivors.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.