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SOCIOECONOMIC RISK FACTORS IN STAGE IV SQUAMOUS CELL CARCINOMA OF THE ANAL CANAL: AN ANALYSIS OF THE NATIONAL CANCER DATA BASE
Juliane Y. Cruz*1, Elyse LeeVan1, Gabriel Akopian1,2, Kevin S. King2, Howard S. Kaufman1,2
1Surgery, Huntington Hospital, Pasadena, CA; 2Huntington Medical Research Institutes, Pasadena, CA
Background
The incidence of squamous cell carcinoma (SCC) of the anal canal has increased by 2.2% per year in the past decade, and approximately 13% of individuals present with Stage IV disease. Well established risk factors for anal cancer include tobacco use, a history of human papillomavirus (HPV) and/or human immunodeficiency virus (HIV) infection, and immunosuppression. Previous studies have also identified lower socioeconomic status and treatment at public hospitals to be associated with anal cancer. Given the increasing incidence of SCC of the anal canal, the purpose of this study was to identify demographic and socioeconomic risk factors that may be prevalent among patients presenting with Stage IV disease.
Methods
The National Cancer Data Base (NCDB) Participant User File (PUF) was queried to identify adult patients SCC of the anal canal from 2004-2014. The following demographic factors were analyzed: age, gender, insurance status, status of high school education, income, comorbidities, distance from treatment facility, and size of the community of residence. High school education was defined as greater than 85% of people receiving a high school diploma or equivalent within each patient's zip code. Income was defined as the percentage of people in the same zip code with a median income of ≤$30,000. Chi-squared tests were used to determine if there were any significant demographic factors associated with presentation with Stage IV disease.
Results
The database identified a total of 54,069 patients with SCC of the anal canal, and 3,377 patients were identified with Stage IV disease. All of the demographic factors analyzed are included in the table. Factors found to be statistically significant in association with presentation at a late stage included older age, distance from treatment facility, and type of insurance. Women were more to likely have anal cancer than men and more likely to present with earlier disease.
Conclusion
In this large NCDB study of patients with SCC of the anal canal, private insurance status was associated with earlier presentation and diagnosis. Lower income and the lack of a high school education were not associated with presentation at a later stage of disease. This study period ended in 2014, before access to healthcare was expanded through the Affordable Care Act. Additional studies with more recent data will be necessary to determine the effects of access on anal cancer statistics. Finally, further improvements in the management of SCC of the anal canal are likely to be made by efforts focused on prevention and earlier detection.
Demographic
factor | Stage IV (n=3377) | Local/regional disease (n=50,692) | p-value | | Female | 2010 (59.5%) | 31053 (61.3%) | 0.01 | | Age (years) | 61.44 ± 0.23 | 59.84± 0.01 | 0.01 | | Distance (miles) | 28.99 ±1.77 | 24.51 ± 0.45 | 0.04 | | Region | | | 0.32 | | Metro | 1740 (53.8%) | 26798 (54.8%) | | | Rural | 303 (9.3%) | 4726 (9.68%) | | | Urban | 1186 (36.7%) | 17303 (35.4%) | | | High school education | 1045 (32.4%) | 16738 (34.1%) | 0.33 | | Median income≤$30k | 528 (16.4%) | 7223 (14.7%) | 0.08 | | Insurance type | | | | | Medicaid | 382 (11.7%) | 4598 (9.3%) | 0.01 | | Medicare | 1327 (40.5%) | 19566 (39.5%) | 0.01 | | Not insured | 218 (6.7%) | 2562 (5.4%) | 0.01 | | Government | 44 (1.3%) | 696 (1.4%) | 0.37 | | Private | 1302 (39.8%) | 22038 (44. %) | 0.01
| | Charslon Deyo Score | | | 0.13 | | 0 | 2692 (79.7%) | 40453 (79.8%) | | | 1 | 457 (13.5%) | 6331 (12.5%) | | | 2 | 228 (6.75%) | 3908 (7.7%) | |
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