Increased spending on state public welfare programs was associated with a higher 5-year overall survival (OS) rate among Black patients, according to results from a study of records from the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) cancer database. Lead author Justin M. Barnes, MD, added that increased public spending also reduced racial disparities in survival between non-Hispanic Black and white patients with several types of cancer.¹

Five-year OS was 10.8% lower among Black patients compared with Whites. However, investigators found that 5-year OS was higher for Black patients in states with greater welfare spending.

The results showed that there was a 4.55% reduction of the 5-year OS disparity in non-Hispanic Black patients compared with white patients per every 10% increase in spending. Investigators noted that the results were similar after accounting for state Medicaid eligibility limits and after excluding data related to Medicaid expansions.¹

“These data are thought provoking, but they are certainly not the end,” said Barnes, a radiation oncologist at Washington University of Medicine in St. Louis, Missouri, during a press briefing ahead of the 2022 ASCO Annual Meeting. “I see these data as a proof-of-concept project, some sort of public welfare investment seems to be helping improve oncologic outcomes for some of our most socioeconomically at-risk patients.”

Among patients with breast cancer, increased public welfare spending led to a 6.15% survival increase for Black patients and a 39% closing of the disparity with white patients. Patients with cervical (11.9% and 46%), colorectal (4.42% and 48%), head and neck (9.41% and 38%), liver (7.02% and 49%), ovarian (8.95% and 41%), bladder (8.18% and 44%), and uterine cancers (14.1% and 40%) also experienced a survival increase and a lessened disparity as a result of increased spending.²

Past study results have highlighted associations between cancer outcomes and social determinants of health, such as financial stability, education, place of residence, and insurance status. Additionally, research has shown that racial disparities in cancer outcomes are probably related to systemic racism that has led to adverse conditions for Black Americans and other patients of color.2

Barnes and colleagues analyzed data on more than 2.9 million adult patients with newly diagnosed cancers collected in the SEER database between 2007 and 2016. State annual spending data was obtained from the United States Census Bureau and included the percentage of total public welfare spending. The primary end point of the study was 5-year OS.

Investigators performed data analysis using cluster-robust regression to account for within-state correlations. Covariates consisted of state public welfare spending, age, race/ethnicity, sex, metropolitan residence, county-level income and education, insurance, state-level poverty, state, cancer site/type, and stage at diagnosis.

“This study underscores the critical role that state social welfare spending, including Medicaid expansion, plays in reducing cancer outcome disparities,” ASCO Chief Medical Officer and Executive Vice President Julie R. Gralow, MD, the 2021 Giants of Cancer Care® award winner in the community outreach/cancer policy category, said in a news release. “State-funded programs can reduce barriers to accessing cancer care and impact survival.”

References

1. Barnes JM, Johnston KJ, Osazuwa-Peters N. State public welfare spending and racial/ethnic disparities in overall survival among adults with cancer. Presented at: 2022 ASCO Annual Meeting; June 3-7, 2022; Chicago, IL. Abstract 6509.
2. A study examining the association between Medicaid and other social services spending on racial and ethnic disparities and overall survival for newly diagnosed patients with cancer. News release. ASCO. May 26, 2022. Accessed May 26, 2022.