The role of income disparities on survival in metastatic clear cell renal cell carcinoma in the targeted therapy era

Eur J Health Econ. 2020 Jul 29. doi: 10.1007/s10198-020-01223-7. Online ahead of print.


PURPOSE: The influence of socioeconomic status on metastatic clear cell renal cell carcinoma (RCC) in the target therapy era is still unknown. This study aimed to assess the role of income disparities on prognosis of mRCC in the targeted therapy era.

PATIENTS AND METHODS: Data of patients with mRCC were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Median household income (MHI) was used to represent patients’ socioeconomic status, and its role on overall survival (OS) and cancer-specific survival (CSS) was evaluated.

RESULTS: A total of 3791 patients with clear cell mRCC diagnosed between 2010 and 2015 were enrolled in cohort one. There was an obvious imbalance of race and insurance status in patients with difference MHI. Compared with patients in the poorest quartile 1 (Q1), those in the wealthiest Q4 had a 4-month prolonged OS (P < 0.01) and a 5-month prolonged CSS (P < 0.01), and those in Q3 and Q4 had significantly lower death risk. High income decreased cumulative cancer-specific mortality rates, and potentially favored survival in most subgroups. 6619 patients diagnosed between 2004 and 2015 were included in cohort two. We found that only those with Q4 income achieved a prolonged survival with statistical significance by comparing between patients diagnosed in 2004-2009 and 2010-2015.

CONCLUSION: In the targeted therapy era, there were survival gaps of mRCC between patients with low- and high-income. Measures should be taken to develop a comprehensive and financially sustainable plan of cancer treatment for greater equity.

PMID:32728988 | DOI:10.1007/s10198-020-01223-7