P100 - Association of Cumulative Social Risk and 5-Year Cancer-Specific Survival Among Patients with Advanced Colorectal Cancer

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Purpose/Background: Socioeconomic disadvantage is associated with poor surgical outcomes among patients with colorectal cancer (CRC). However, many studies are limited to aggregated zip-code level rather than individual-level socioeconomic factors. Moreover, the influence of cumulative social risk factors on long-term oncologic outcomes has not been explored. Our purpose was to examine cumulative associations of multiple, co-occurring individual-level social risk factors with long-term, cancer-specific survival among patients with advanced colorectal cancer.

Methods/Interventions: Between 2011-2014, we collaborated with the Surveillance, Epidemiology and End Result (SEER) registries of Georgia to survey patients with Stage III CRC who had undergone surgery in the prior year. Cumulative social risk factors that were queried included preoperative employment, annual income, health insurance, comorbidities, marital status, health literacy, adult caregiving, and perceived discrimination. Patients were then followed per SEER site protocols in partnership with tumor registrars. The primary outcome was CRC cancer-specific survival time measured as time-to-death. Hazard ratios were estimated with multivariable Cox proportional hazards regression, adjusted for age, race, sex, and receipt of chemotherapy.

Results/Outcomes: A total of 1173 patients were followed for a median of 4.96 years. Overall cancer-specific survival differed by cumulative social risk (5-year survival: 0 social risks 82.07%, 6+ social risks 66.67%). Individually, pre-operative unemployment (HR: 1.76; 95% CI: 1.30-2.38, p< 0.001), annual income <$50,000 (HR: 1.34 95% CI: 1.01-1.77, p=0.045, having Medicaid or being uninsured (HR: 1.54; 95% CI: 1.12-2.11, p=0.008, unpartnered status (HR: 1.34; 95% CI: 1.02-1.77, p=0.035), and low health literacy (HR: 1.40; 95% CI: 1.00-1.95, p=0.049 all were associated with higher likelihood of cancer-specific mortality after adjusting for age, sex, race, and receipt of chemotherapy (Figure 1). After adjusting for demographics and treatment, each additional social risk was associated with a higher likelihood of cancer-specific death (HR: 1.16; 95% CI: 1.06-1.26, p=0.001 Figure 2).

Conclusion/Discussion: Cumulative social risk was associated with long-term cancer-specific survival after treatment for Stage III CRC. Assessing social risk may help identify patients with CRC who are at higher risk of mortality to receive support programs designed to mitigate social disadvantage.