Patients of Hispanic ethnicity with blood cancer who live in the US-Mexico border region of Texas had adverse prognoses, according to research published in Cancer.
The Texas-Chihuahua border is a medically underserved region for people with many diseases. The study authors sought to describe blood cancer outcomes and variations experienced by people of various ethnicities living in the border region. They hypothesized that the incidence of blood cancer would be higher at the border and that outcomes would be worse.
The study included 53,578 patients from the Texas Cancer Registry (TCR) classified as Hispanic or non-Hispanic who were diagnosed with blood cancer between 1995 and 2016. Of the evaluated patients, 42,756 were non-Hispanic and 10,822 were Hispanic. Diagnoses included leukemia, myelodysplastic syndrome (MDS), and myeloproliferative neoplasm (MPN).
Hispanic patients in the study population were diagnosed at younger ages for all diseases than non-Hispanic patients (P =.0025 for MPN; P <.0001). Hispanic patients had a lower risk of developing blood cancer overall than non-Hispanic patients, but Hispanic patients had a higher incidence of blood cancer in adults younger than 40 years.
Hispanic patients had a higher incidence of acute lymphoblastic leukemia (ALL) and acute promyelocytic leukemia (APL). Both Hispanic and non-Hispanic patients along the border have a worse prognosis when diagnosed with ALL than patients in other areas of Texas.
In the unadjusted analysis, overall survival for Hispanic patients appeared better than that for non-Hispanics with acute myeloid leukemia (AML) and MDS. However, Hispanic patients had a worse overall survival when adjusted for age.
Hispanic patients with ALL younger than 70 years had a worse overall survival than non-Hispanic patients (P <.001). Hispanic patients with APL and MPN younger than 50 years also had worse overall survival (P <.05).
Hispanic patients had more comorbidities, and those living in urban areas had higher levels of poverty but lower rates of prior cancers. They were also more likely to be uninsured.
“A complex interaction between age at diagnosis, comorbidities, and barriers to health care place Hispanics who live along the border at risk for a poor prognosis,” the authors wrote. However, it’s unclear whether the differences in this study are from nonbiological factors or because of more aggressive disease.
This study did not look at genetic differences because this data was not captured in the registry. A better understanding of patient characteristics, social factors, and barriers to health care can help improve care in the region.
Bencomo-Alvarez AE, Gonzalez MA, Rubio AJ, et al. Ethnic and border differences on blood cancer presentation and outcomes: a Texas population-based study. Cancer. Published online December 3, 2020. doi:10.1002/cncr.33347