Changes in survival by ethnicity of patients with cancer between 1992-1996 and 2002-2006: is the discrepancy decreasing?

BACKGROUND: Patients of minority race/ethnicity have lower survival after diagnosis with most types of cancer. Little data are available concerning changes in disparity over time. Here, we examine changes in survival by race/ethnicity of patients with common cancers in two recent time periods. PATIENTS AND METHODS: We used modeled period analysis to determine relative survival (RS) for non-Hispanic white (nHw), African-American (AA), and Hispanic patients in the Surveillance, Epidemiology, and End Results database diagnosed with common solid and hematological malignancies. RESULTS: Five-year RS improved overall and for nHw for each tumor examined, ranging from + 2% points (pancreatic cancer) to + 16.4% points [non-Hodgkin's lymphoma, (NHL)]. Greater improvement was observed for AA and Hispanics than nHw in breast and prostate cancer and NHL. Less improvement was observed for AA and Hispanics than for nHw for lung and pancreatic cancer. No statistically significant improvement was observed for AA and Hispanics with myeloma or acute leukemia. Survival disparities ranging from 0.5% points (myeloma) to 13.1% points (breast) between nHw and AA remained. CONCLUSIONS: Progress has been made in decreasing disparities in survival between nHw and minorities in breast cancer, prostate cancer, and NHL. Little progress has been made in reducing disparities for the other studied cancers.

Geographic and ethnic differences in childhood leukaemia and lymphoma survival: comparisons of Philippine residents, Asian Americans and Caucasians in the United States.

BACKGROUND: Childhood cancer survival estimates from developing nations are rare. METHODS: Using the US SEER and the Manila and Rizal Cancer Registry databases in the Philippines, 5-year survival for childhood leukaemia and lymphoma in 2001-2005 among Asian Americans were compared with both Filipinos and Caucasians in the United States. Estimates for patients in the United States in earlier time periods were compared with that of Philippine residents to estimate delay in achievements of comparable levels of survival. RESULTS: Childhood leukaemia and lymphoma relative survival was much lower in Filipinos living in the Philippines (32.9 and 47.7%) than in Asian Americans (80.1 and 90.5%) and Caucasians (81.9 and 87%). Achievement of comparable survival rates of Philippine residents lagged behind by 20 to >30 years compared with patients in the United States. CONCLUSIONS: The large differences in survival estimates of US populations and Philippine residents highlight the deficiencies of paediatric cancer care delivery in the Philippines. The long survival lag underlines the need for major improvements in access to diagnostic and treatment facilities.

Expected long-term survival of patients diagnosed with acute myeloblastic leukemia during 2006-2010.

BACKGROUND: Treatment of acute myeloblastic leukemia (AML) has evolved over the past several decades. Therefore, currently available estimates of long-term survival, which are based on survival for patients treated with potentially now obsolete protocols, may not pertain to patients currently diagnosed. METHODS: Using data from the 1973-2005 database of the Surveillance, Epidemiology, and End Results Program, we empirically validated a novel model-based method to project 5- and 10-year relative survival of AML patients and we applied the method to project relative survival of AML patients in the United States diagnosed during 2006-2010. RESULTS: Empirical evaluation indicated that the modeling approach provides more accurate estimates of currently diagnosed patients than standard methods of survival analysis, such as cohort analysis or period analysis, in the majority of cases. Projected figures for 2006-2010 show 5- and 10-year relative survival estimates of 21.4% and 18.7% for all ages combined, 62.2% and 57.4% for ages 25-34, and 60.6% and 58.1% for ages 35-44. These estimates are substantially higher than the most up-to-date estimates obtained by standard survival analysis. CONCLUSION: Patients diagnosed with AML during 2006-2010 at younger ages have much higher long-term survival expectations than indicated by previously available survival statistics.

Cancer survival discrepancies in developed and developing countries: comparisons between the Philippines and the United States.

Despite the availability of population-based cancer survival data from the developed and developing countries, comparisons remain very few. Such comparisons are important to assess the magnitude of survival discrepancies and to disentangle the impact of ethnic background and health care access on cancer survival. Using the SEER 13 database and databases from the Manila and Rizal Cancer Registries in the Philippines, a 5-year relative survival for 9 common cancers in 1998-2002 of Filipino-American cancer patients were compared with both cancer patients from the Philippines, having the same ethnicity, and Caucasians in the United States, being exposed to a similar societal environment and the same health care system. Survival estimates were much higher for the Filipino-Americans than the Philippine resident population, with particularly large differences (more than 20-30% units) for cancers with good prognosis if diagnosed and treated early (colorectal, breast and cervix), or those with expensive treatment regimens (leukaemias). Filipino-Americans and Caucasians showed very similar survival for all cancer sites except stomach cancer (30.7 vs 23.2%) and leukaemias (37.8 vs 48.4%). The very large differences in the survival estimates of Filipino-Americans and the Philippine resident population highlight the importance of the access to and utilisation of diagnostic and therapeutic facilities in developing countries. Survival differences in stomach cancer and leukaemia between Filipino-Americans and Caucasians in the United States most likely reflect biological factors rather than the differences in access to health care.