In a new study of more than 1.1 million patients who underwent surgery for the most common or deadly cancers reports nationwide, nearly 1 in 20 (4.8 percent) patients died within one month of the procedure.

The risk of death was highest among patients who were not married, uninsured, non-white, male, older, less educated, poorer, or had advanced stage cancer.

The findings suggest that efforts to reduce socio-demographic disparities in one-month cancer surgery death rates may substantially improve survival among patients with cancer.

One-month mortality after surgery is an important measure of health care quality but there is no consensus as to why disparities in this outcome exist.

Previous research has shown that one-month mortality after cancer surgery is closely linked to hospital and surgeon volume, and minorities, uninsured, and poorer patients are disproportionately more likely to receive care at lower volume, underperforming hospitals.

“We’ve known that surgery carries a range of risks and our findings offer new guidance on how certain social and demographic factors contribute to real-world cancer surgery outcomes,” said lead study author Brandon A. Mahal, a fourth-year Harvard medical student and current research fellow at Dana-Farber Cancer Institute in Boston.

“Given our results, it is clear that there is a lot we can do to improve outcomes for all patients. Many factors contribute to these disparities but we can start by identifying and supporting improvements for underperforming hospitals as well as more proactively offering social support services to patients at high risk of poorer outcomes.”

Researchers analysed national cancer registry (SEER) data on more than 1.1 million patients who underwent cancer surgery.

The patients were diagnosed with one of the most common or most fatal cancers, including lung, breast, colorectal, prostate, thyroid, oesophageal, pancreatic, endometrial, ovarian, head and neck, liver, bladder, melanoma, kidney, and non-Hodgkin lymphoma.

Overall, 53,498 patients (4.8 percent) died within one month of undergoing cancer surgery, a higher mortality rate than suggested in previous, smaller studies, which focused mainly on academic centres. 

Patients in the study who were married, insured, or who had a top 50th percentile income or educational status had 20 percent, 12 percent, 5 percent, and 2 percent lower odds of dying from cancer surgery within a month. 

Furthermore, patients who were non-white minority, male, or older, or who had stage IV disease had 13 percent, 11 percent, 2 percent, and 89 percent higher odds of dying within one month of cancer surgery. 

While these findings are consistent with prior research on surgical outcomes among Medicare patients, this study is the first to demonstrate that these disparities are still highly prevalent among younger populations (38.9 percent of patients evaluated in this study were younger than 65 and not eligible for Medicare).

Source: ASCO