Survival of cancer patients by economic status in a free care setting

Abstract

Patients with lung, breast, and colorectal cancer were classified as to their economic status for comparison of survival. Patients at the City of Hope Medical Center are admitted and treated without regard to their economic status, providing an excellent place to test the effect of low economic status on survival. In none of these disease sites was an effect of low economic status observed, even when adjusting for age, sex, stage, smoking status, and alcohol usage. The only variable that consistently predicted survival was stage of disease; when accounting for stage, there was no independent effect of low economic status. In the presence of uniform care, low economic status as defined in this study is not a factor in patient survival.

Socioeconomic status and survival from soft-tissue sarcomas: a population-based study in northern Italy.

“…[2][3][4][5] In recent years, considerable attention has been paid to differential prognosis among cancer patients according to socioeconomic status (SES), particularly for breast and colon cancer. [6][7][8][9] Differences in survival are interpreted as related to earlier access to diagnosis and therapy of higher social class patients.…”

Social Inequalities and Cancer

“…In the early literature, even stage of disease has been taken as a confounder instead of an explanatory variable (for example : Linden, 1969;Lipworth et al, 1972;Keirn & Metter, 1985).…”

“…In childhood leukaemia, no social class differences in treatment modality were detected by McWhirter et al (1983). Keirn and Metter (1985) found that there were no differences in survival by economic status among lung, breast and colorectal cancer patients treated in a hospital that accepted patients regardless of race or ability to pay noted that the lack of a significant racial difference in the Veterans Administration study (Page & Kuntz, 1980) low. Therefore the study population may have been too homogeneous with respect to socioeconomic status.…”

“…Therefore the study population may have been too homogeneous with respect to socioeconomic status. The same criticism might be applied to the study of Keirn and Metter (1985).…”

“…Quality of treatment received may vary between hospitals. The fact that social class differences have tended to be smaller in studies based on one hospital only than in studies covering several treatment centres (Weston et al, 1987versus Savage et al, 1984Berg et al, 1977versus Linden, 1969 in stomach and oesophagus cancer and leukaemia; Keirn &Metter, 1985 versus Linden, 1969 in lung, breast andcolorectal cancers;Chirikos & Horner, 1985versus Dayal et al, 1987 in colorectal cancer) also provides some support for the role of treating hospital. It is, however, also possible that the socioeconomic background of the patients is similar within the single hospitals and the differences are not observed because of a narrow spectrum of socioeconomic status rather than uniform treatment.…”