Cumulative Social Risk Linked to Poorer Survival in Stage III Colorectal Cancer
Cumulative social risk was strongly associated with poorer cancer-specific survival among patients with stage III colorectal cancer (CRC), according to a new prospective cohort study published in Diseases of the Colon & Rectum.
Socioeconomic disadvantage is a well-documented contributor to adverse cancer outcomes. However, many prior interventions have relied on aggregated community data or short-term endpoints, limiting their effectiveness. This survey-based study was designed to assess survival from diagnosis to death among patients with stage III CRC according to cumulative social risk factors.
Between 2011 and 2014, investigators collaborated with the Surveillance, Epidemiology, and End Result programs in Georgia and Detroit to identify patients diagnosed with stage III colorectal cancer in the preceding year. Participants completed surveys assessing individual social risk factors, including employment status, insurance coverage, health literacy, income, and marital status. Cumulative social risk was calculated by summing the presence of these factors. The primary outcome was cancer-specific mortality. Multivariable analyses adjusted for age, sex, race, and chemotherapy receipt. Hazard ratios (HRs) with 95% confidence intervals (CIs) were reported.
Among 1173 patients, several individual social risk factors were significantly associated with higher cancer-specific mortality: preoperative unemployment (HR 1.76, 95% CI 1.30–2.39), uninsured or Medicaid insurance (HR 1.54, 95% CI 1.12–2.11), low health literacy (HR 1.40, 95% CI 1.00–1.95), annual income below $50,000 (HR 1.34, 95% CI 1.01–1.77), and being unpartnered (HR 1.34, 95% CI 1.02–1.77). Importantly, each additional social risk was associated with a 24% increased adjusted risk of cancer-specific mortality (HR 1.24, 95% CI 1.12–1.37).
The study’s survey-based design introduces potential recall bias and limits generalizability. The cross-sectional survey combined with longitudinal outcomes prevents causal inference.
Identifying patients with multiple social disadvantages may allow for targeted support programs aimed at reducing disparities in cancer outcomes, the authors concluded.
Reference
Yelorda KL, Day HS, Arnow KD, Fu SJ, Kim SA, Morris AM. Association of cumulative social risk and cancer-specific survival among patients with advanced colorectal cancer. Dis Colon Rectum. 2025;68(9):1085-1092. doi:10.1097/DCR.0000000000003851
