Documents

ABSTRACT

OBJECTIVE

The aim of this study was to investigate the association of home socioeconomic status (SES) with days at home and survival after treatment of spinal metastases.

METHODS

This population cohort study included all patients in the Ontario Cancer Registry treated from 2007 to 2019 with surgery or radiation therapy (RT) for spinal metastasis. Ordinal categories of SES (SES1–SES5) were defined using home neighborhood material deprivation scores. Outcomes included adjusted median differences (aMD) in the number of days at home and adjusted hazard ratios (aHRs) of mortality for patients of differing SES. Secondary care access outcomes included receiving stereotactic body RT for treatment, the timing of palliative care initiation, and the distance from home to the nearest cancer center.

RESULTS

There were 35,896 patients (55% male, mean age 64.4 years) identified; 7397 (21%) resided in relatively resource-deprived neighborhoods and 7080 (20%) resided in relatively resource-affluent neighborhoods. Patients living in the lowest SES neighborhoods had the fewest days at home (SES1 vs SES5, aMD −47) and shortest survival (SES1 vs SES5, aHR 1.14). There was significant mediation attributable to differences in primary cancer (days at home [15.6%], survival [25.7%]) and frailty (days at home [5.9%], survival [7.7%]) between neighborhood SES. Patients residing in lower SES neighborhoods were less often treated with stereotactic body RT (adjusted OR 0.38), had later initiation of palliative care (aHR 0.94), and lived farther from cancer centers (adjusted mean difference 16.5 km).

CONCLUSIONS

Patients with spinal metastases living in lower SES neighborhoods had fewer days at home and shorter survival, which was partially mediated by differences in primary cancer and possibly posttreatment access to oncology care. These findings will support advocacy efforts championing equity in cancer care.