Socioeconomics play into lymphoma survival

By Anne Harding

NEW YORK (Reuters Health) - People with a type of cancer known as non-Hodgkin lymphoma, or NHL, are less likely to get appropriate treatment, and more likely to die of the disease, if they fall into a lower rather than higher socioeconomic level, a study in the journal Cancer shows.

NHL mortality was higher among black patients, Dr. Xianglin L. Du and his colleagues found, but once they accounted for socioeconomic status and treatment, the racial difference disappeared.

"Socioeconomic status can be a proxy for many factors, for example compliance with the therapy," Du, of The University of Texas School of Public Health in Houston, noted in an interview with Reuters Health. As a further example, he pointed out that less educated or poorer individuals might also be less able to cover out-of-pocket health care costs, less likely to have insurance, or less likely to receive early diagnosis and treatment.

Many studies have found ethnic disparities in survival for various cancers, Du and his team note in their report, but no one has investigated whether NHL mortality differs by race.

To investigate, they looked at 13,321 Medicare beneficiaries 65 and older who had been diagnosed with NHL between 1992 and 1999. There were 11,868 whites in the group, 533 African Americans, and 920 people belonging to other ethnicities.

Some 72 percent of the black patients were in the lowest income category, compared to about 22 percent of whites, and blacks were also more likely than whites to have less education.

Chemotherapy is the standard treatment for most patients with NHL, but just 43 percent of African Americans and 52 percent of whites had chemo. Radiation treatment, which also is recommended for some NHL patients, was received by 18 percent of African-American patients and 24 percent of whites.

Patients who underwent chemo or had radiation were less likely to die during the study's follow-up period; for example, average survival was 32.5 months for patients given chemo, compared to 11.9 months for those who didn't receive chemo.

In addition, the higher a person's socioeconomic status, the greater was their likelihood of survival.

The findings show, Du said, that every patient with NHL should get appropriate treatment, and that patients who do get this treatment will live longer. Improving people's educational status, he added, could help ensure that, if they get sick with NHL, they are diagnosed earlier and treated appropriately.

SOURCE: Cancer, December 1, 2008.