The Surprise Impact of Socioeconomic Status on Mesothelioma Survival

New research suggests that the socioeconomic status of some mesothelioma patients may have a greater influence on survival than how close they live to high-level cancer care.

Researchers in Australia, a country with a long history of asbestos use and a high per capita incidence of malignant mesothelioma, assessed the cases of more than 900 pleural mesothelioma patients listed in the New South Wales Cancer Registry.

Even though all of the patients in the study had received some level of compensation for their illness, their mesothelioma treatments and outcomes differed based on their socioeconomic status.

Factors Impacting Mesothelioma Survival

The median overall survival of mesothelioma patients in the new study was 10 months. Sixty-seven percent of participants lived in major cities, in closer proximity to what the report calls “oncological multidisciplinary teams” (MDT). The rest were in more remote areas.

Most of the factors that seemed to have an impact on their survival were in line with previous mesothelioma studies. Being older than 70, being male, and having a non-epithelial mesothelioma subtype all carried a worse prognosis.

Socioeconomic Status and Mesothelioma Treatment

The bigger surprise was that a patient’s status on the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) appeared to play just as big a role in mesothelioma survival as any of previously-identified factors, including their location. The study found no survival advantage to living in a larger city.

“Patient’s geographic location and distance to MDT did not impact chemotherapy, adjuvant radiotherapy or extrapleural pneumonectomy provision,” writes author and oncologist Anthony Linton, MD, of the Asbestos DIseases Research Institute in Sydney.

What did impact treatment was socioeconomic status. The lower a patient fell on the IRSAD scale, the worse their mesothelioma prognosis, a fact that may have been due, at least in part, to differences in the way they were treated.

Although chemotherapy has consistently been shown to offer a (modest) mesothelioma survival advantage, the team found that socioeconomically disadvantaged patients were significantly less likely to receive it (37% vs. 55% for wealthier patients) – no matter where they lived.

“This study provides evidence for differences in the treatment and survival according to socioeconomic status for compensated malignant pleural mesothelioma patients in New South Wales,” concludes the report.

More Research Warranted

The new report does not address the possible reasons for the disparities in mesothelioma treatment and survival but calls for further research that would also include mesothelioma patients who had not received compensation.

Pleural mesothelioma, a malignancy of the membranous tissue surrounding the lungs, is one of the rarest types of cancer and is caused almost exclusively by exposure to asbestos, often in a work setting.

Australia and more than 50 other countries have now banned asbestos. However, plumbers, electricians, auto mechanics, shipyard workers, veterans, and anyone who mined, handled or even lived near asbestos in the past can still be at risk for developing mesothelioma decades after their initial exposure.

Source:

Linton, A, et al, “Geographic and socioeconomic factors in patients with malignant pleural mesothelioma in New South Wales and their impact upon clinical outcomes”, January 31, 2017, Respirology, Epub ahead of print