Patients who are uninsured, nonwhite, less educated, poorer, not married, older, male, or have advanced-stage cancer have a higher mortality risk within 1 month of cancer surgery, according to a database analysis of more than one million patients presented at the 2014 ASCO Quality Care Symposium.
“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 a press release.
Mahal et al analyzed data from 1,110,236 patients in the National Cancer Institute’s SEER database who were diagnosed with cancer between 2004 and 2011 and received surgery for their malignancy. The researchers selected patients with any of the 10 most frequently diagnosed or most fatal cancers, including prostate, colorectal, breast, lung, ovarian, pancreatic, esophageal, kidney, thyroid, head and neck, non-Hodgkin lymphoma, melanoma, bladder, liver, and endometrial.
Of the entire cohort, nearly 1 in 20 patients (n = 53,498; 4.8%) died within 1 month of receiving surgery for their malignancy. “One-month mortality is used as an important quality metric, and deaths within 1 month of surgery are considered treatment-related when quantifying operative mortality,” said Mahal at a presscast held in advance of the symposium.
Using multivariable logistic regression modeling, Mahal et al identified sociodemographic factors associated with mortality after cancer surgery among the 53,498 patients who died within 1 month after surgery.
The 1-month mortality odds following surgery were 89%, 2%, 13%, and 11% higher for patients who had stage IV disease (adjusted odds ratio [AOR] = 1.89; 95% CI, 1.82-1.95; P <.001), were older (AOR = 1.02; 95% CI, 1.02-1.03; P <.001), were nonwhite minorities (AOR = 1.13; 95% CI, 1.11—1.15; P <.001), or were males (AOR = 1.11; 95% CI, 1.08-1.13; P <.001), respectively.
A lower mortality risk 1 month following cancer surgery was associated with patients who were insured (AOR = 0.88; 95% CI, 0.82-0.94; P <.001), married (AOR = 0.80; 95% CI, 0.79-0.82; P <.001), had an income in the top 50th percentile (AOR = 0.95; 95% CI, 0.93-0.97; P <.001), or had an educational status in the top 50th percentile (AOR = 0.98; 95% CI, 0.96-0.99; P = .043).
According to ASCO, previous research has shown that mortality within 1 month of cancer surgery is closely tied to hospital and surgeon volume. Further, several of the higher-risk groups identified by Mahal et al—including minorities, uninsured, and poorer patients—are more likely to have surgery at underperforming hospitals with lower volume.
“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,” Mahal said in the press release.
Mahal BA, Inverso G, Aizer AA, et al. Incidence and determinants of 1-month mortality after cancer-directed surgery. Presented at: 2014 ASCO Quality Care Symposium; October 17-18, 2014; Boston, MA. Abstract 282.