Research led by the American Cancer Society shows that among cancer survivors, Black and Hispanic individuals who have a second primary cancer have poorer survival than their White counterparts in the U.S.
In a study including more than 200,000 people, Black and Hispanic patients were 21% and 10% more likely to die, respectively, from a second cancer than White patients. Black cancer survivors also had a 41% higher risk of cardiovascular death than White cancer survivors.
“These disparities were, in part, attributable to unfavorable stage distributions at second primary cancer diagnosis among Black and Hispanic populations, particularly for breast cancer, uterine cancer, and melanoma,” said Hyuna Sung, lead author of the study published in JAMA Network Open and senior principal scientist of cancer surveillance research at the American Cancer Society, in a press statement.
“Complementing the currently expanding knowledge on second primary cancer risk and care, the findings highlight research priorities to address survival disparities among the growing population of multiple primary cancer survivors.”
The population-based, retrospective cohort study included 230,370 people with second primary cancer who were diagnosed between 2000 and 2013. Overall, the group composition was 4.5% Asian or Pacific Islander, 9.6% Black, 6.4% Hispanic, and 79.5% White. The investigators assessed the impact of ethnicity on five-year survival and cause-specific survival.
Over a follow-up period ranging from one to eight years, a total of 109,757 cancer-related deaths (47.6%) and 18,283 cardiovascular disease-related deaths (7.9%) occurred in the group.
After adjusting for potential confounding factors, the team found that the risk of overall cancer-related death was 21% and 10% higher in Black and Hispanic second cancer patients, respectively, compared with White. But Asian or Pacific Islanders had similar or slightly better (7% improvement) survival than White second cancer patients.
The researchers also looked more specifically at survival from specific types of cancer and links with ethnicity or population group. Ten second cancer types had a worse outcome in Black individuals versus White, with the biggest difference seen for uterine cancer where Black women had an 87% lower survival than White women. Similarly, seven cancer types had a worse outcome in the Hispanic versus the White population, with the worst disparity seen in melanoma where Hispanic individuals were 46% more likely to die than White people with the same second cancer type.
Cardiovascular disease related death was 41% more common in Black second primary cancer patients than White. However, Asian or Pacific Islander second cancer patients were 25% less likely and Hispanic patients 10% less likely to die from cardiovascular causes than White patients.
“Persons with multiple primary cancers may face unique challenges such as limited treatment options, multiple chronic morbidities, complexity in navigating health care systems, and exacerbated financial hardship” said Sung.
“Issues of financial hardship may be particularly relevant to the observed racial and ethnic disparities in second primary cancer survival as prior cancer-related disruptions and employment consequences are disproportionately experienced by racial and ethnic minority groups.”
