ASPO Abstracts
Insurance Status and Level of Education Predict Disparities in Receipt of Treatment and Survival for Anal Squamous Cell Carcinoma
Category: Cancer Health Disparities
Conference Year: 2020
Abstract Body:
Purpose: The incidence and mortality of anal squamous cell carcinoma (ASCC) continues to rise in
marginalized populations despite it having favorable prognosis with chemoradiation therapy. We
explored the impact of socioeconomic factors such as insurance status, income, and level of
education on treatment and survival for ASCC.
Methods: We identified patients with ASCC in the Surveillance, Epidemiology, and End Results
Program database from 2004 to 2016. Community level variables were stratified into quartiles. We
used Cox proportional hazards models and multivariate regression to explore predictors of cancer
specific survival and receipt of chemoradiation.
Results: We included a total of 10,868 patients. The median age was 55, 10.4% were black, and
65.4% were female. Greater than 80% of patients received chemoradiation; insured and Medicaid
patients comprised 79.9% and 16.3% of patients, respectively. In multivariate analysis, poorer
survival was independently associated with Medicaid (HR 1.52, 95% CI 1.34-1.74) and uninsured
status (HR 1.68, 95% CI 1.35-2.10), as well as for those from communities with the lowest rates of
high school education (HR 1.17, 95% CI 1.02-1.38), lowest income (HR 1.29, 95% CI 1.08-1.54),
and highest unemployment (HR 1.21, 95% CI 1.03-1.40). Patients were less likely to receive
treatment if they were black (OR 0.72, 95% CI 0.62-0.85), had Medicaid insurance (OR 0.71, 95%
CI 0.52-0.96), or had lowest level of education (OR 0.79, 95% CI 0.66-0.93). Income was not
independently associated with receipt of chemoradiation.
Conclusion: Socioeconomic disparities exist for cancer survival, and this is the first national
population based study to demonstrate that insurance status and educational attainment impact
both receipt of treatment and survival of ASCC. As biomedical innovations lead to higher rates of
treatment success for cancer, further research is warranted to investigate the relationship between
social factors and disparities in ASCC outcomes. A greater understanding of these dynamics can
lead to the design of targeted interventions that improve treatment delivery, reduce disparities, and
improve survival.
Keywords: anal cancer socioeconomic disparities education