POPULATION-BASED APPROACHES USING THE SEER CANCER REGISTRY TO STUDY SURVIVAL OUTCOMES IN MYELODYSPLASTIC SYNDROMES AND CHRONIC MYELOMONOCYTIC LEUKEMIA

Abstract

Racial disparities in cancer care and outcomes have been extensively documented among patients with solid tumor malignancies, such as cancers of the colon, breast, lung, and head and neck and in hematologic malignancies. Black/African American patients have the highest death rate and shortest survival of any racial/ethnic group in the United States (US) for most cancers. With the increase of overall cancer incidence and population growth among minorities in the US, health care disparities and access to care are increasingly important priorities. In the first paper, we used the SEER cancer registry program to characterize and compare characteristics and survival outcomes between White and Black patients with myelodysplastic syndromes (MDS). We first found significant differences in epidemiological and disease characteristics between both cohorts. We then implemented various analytical methods to address challenges in data capture and diagnostic complexity in MDS in order to compare overall survival (OS) between White and Black patients. We reported an association between OS and race favoring Black patients which was unexpected. We further refined this overall association by the subgroup analyses we performed and reported a novel finding in the variation in both the direction and the magnitude of the association of race and OS between various MDS histology subsets. Our paper also shed light on the high proportion of the provisional diagnosis category of “MDS-not otherwise specified” in MDS cancer registry and its implication for disease surveillance. Again, using the SEER registry, the second paper focused on another myeloid malignancy, chronic myelomonocytic leukemia (CMML), formerly included in the MDS category, a disease characterized by dysplasia, monocytosis, and a proliferative capacity, with a generally poor prognosis. The paper explored how survival outcomes have evolved over time with a focus on long-term survivors and on subgroups defined by sex, age and race.