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      Racial and Ethnic Disparities in Cancer Survival: The Contribution of Tumor, Sociodemographic, Institutional, and Neighborhood Characteristics

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          Abstract

          <div class="section"> <a class="named-anchor" id="d767486e148"> <!-- named anchor --> </a> <h5 class="section-title" id="d767486e149">Purpose</h5> <p id="d767486e151">Racial/ethnic disparities in cancer survival in the United States are well documented, but the underlying causes are not well understood. We quantified the contribution of tumor, treatment, hospital, sociodemographic, and neighborhood factors to racial/ethnic survival disparities in California. </p> </div><div class="section"> <a class="named-anchor" id="d767486e153"> <!-- named anchor --> </a> <h5 class="section-title" id="d767486e154">Materials and Methods</h5> <p id="d767486e156">California Cancer Registry data were used to estimate population-based cancer-specific survival for patients diagnosed with breast, prostate, colorectal, or lung cancer between 2000 and 2013 for each racial/ethnic group (non-Hispanic black, Hispanic, Asian American and Pacific Islander, and separately each for Chinese, Japanese, and Filipino) compared with non-Hispanic whites. The percentage contribution of factors to overall racial/ethnic survival disparities was estimated from a sequence of multivariable Cox proportional hazards models. </p> </div><div class="section"> <a class="named-anchor" id="d767486e158"> <!-- named anchor --> </a> <h5 class="section-title" id="d767486e159">Results</h5> <p id="d767486e161">In baseline models, black patients had the lowest survival for all cancer sites, and Asian American and Pacific Islander patients had the highest, compared with whites. Mediation analyses suggested that stage at diagnosis had the greatest influence on overall racial/ethnic survival disparities accounting for 24% of disparities in breast cancer, 24% in prostate cancer, and 16% to 30% in colorectal cancer. Neighborhood socioeconomic status was an important factor in all cancers, but only for black and Hispanic patients. The influence of marital status on racial/ethnic disparities was stronger in men than in women. Adjustment for all covariables explained approximately half of the overall survival disparities in breast, prostate, and colorectal cancer, but it explained only 15% to 40% of disparities in lung cancer. </p> </div><div class="section"> <a class="named-anchor" id="d767486e163"> <!-- named anchor --> </a> <h5 class="section-title" id="d767486e164">Conclusion</h5> <p id="d767486e166">Overall reductions in racial/ethnic survival disparities were driven largely by reductions for black compared with white patients. Stage at diagnosis had the largest effect on racial/ethnic survival disparities, but earlier detection would not entirely eliminate them. The influences of neighborhood socioeconomic status and marital status suggest that social determinants, support mechanisms, and access to health care are important contributing factors. </p> </div>

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          Marital status and survival in patients with cancer.

          To examine the impact of marital status on stage at diagnosis, use of definitive therapy, and cancer-specific mortality among each of the 10 leading causes of cancer-related death in the United States.
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            Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States.

            Women with early-stage breast cancers are expected to have excellent survival rates. It is important to identify factors that predict diagnosis of early-stage breast cancers.
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              Associations of social networks with cancer mortality: a meta-analysis.

              This meta-analysis integrates results of 87 studies on the associations of perceived social support, network size, and marital status with cancer survival. In controlled studies, having high levels of perceived social support, larger social network, and being married were associated with decreases in relative risk for mortality of 25%, 20%, and 12%, respectively. Moderator analyses revealed that never married patients had higher mortality rates than widowed and divorced/separated patients. Associations of social network with mortality were stronger in younger patients, and associations of marital status with mortality were stronger in studies with shorter time intervals, and in early-stage cancer. Relationships varied by cancer site, with stronger associations of social support observed in studies of patients with leukemia and lymphomas and stronger associations of network size observed in studies of breast cancer. Further randomized intervention studies are needed to test causal hypotheses about the role of social support and social network for cancer mortality. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
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                Author and article information

                Journal
                Journal of Clinical Oncology
                JCO
                American Society of Clinical Oncology (ASCO)
                0732-183X
                1527-7755
                January 2018
                January 2018
                : 36
                : 1
                : 25-33
                Article
                10.1200/JCO.2017.74.2049
                5756323
                29035642
                187cd82b-73d0-4fed-a56f-ab4572c6e089
                © 2018
                History

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