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Cancers
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Socio-Demographic Factors and Cancer Research
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Socio-Demographic Factors and Cancer Research

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 13441

Special Issue Editors

Dr. Mitchell S. Fourman

E-Mail Website
Guest Editor
Department of Orthopedic Surgery, Montefiore Einstein, Albert Einstein College of Medicine, Bronx, NY 10467, USA
Interests: spinal deformity; adult degenerative spine pathology; metastatic cancer to the spine; primary spine tumors; Scheuermann's kyphosis
Special Issues, Collections and Topics in MDPI journals
Dr. Amanda N. Goldin

E-Mail Website
Guest Editor
Department of Orthopaedic Surgery, University of California Irvine School of Medicine, Orange, CA, USA
Interests: socioeconomic disparities; sarcoma; metastatic cancer care; benign and malignant bone; soft tissue tumors; reconstruction after oncologic surgery

Special Issue Information

Dear Colleagues,

It is well established that socioeconomic factors influence cancer treatment outcomes, even when optimal therapies are employed. These contributors are often modifiable and community/culture-dependent, warranting focused research.

We are pleased to invite you to contribute to a Special Issue focused on the socioeconomic and sociodemographic factors that influence cancer care and research.

This Special Issue aims to address the specific socioeconomic factors that influence the care of individual or a broad spectrum of cancers, with a focus on both global and region-specific factors. It also seeks to further understand the application of unique analysis technologies such as AI for the identification and management of the influence that these socioeconomic factors have on the provision and outcomes of cancer care.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

  • Socioeconomic disparities
  • Culture-specific cancer outcomes
  • Disparities in cancer care delivery across regions
  • AI and machine learning algorithms to predict cancer outcomes using sociodemographic factors
  • Qualitative research on the provision of cancer care in economically deprived regions

We look forward to receiving your contributions.

Dr. Mitchell S. Fourman
Dr. Amanda N. Goldin
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • socioeconomic disparity
  • cancer delivery
  • cancer survival
  • metastatic cancer
  • culture-specific cancer outcomes
  • AI
  • machine learning

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Published Papers (9 papers)

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Research

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14 pages, 2300 KiB  
Article
Relationship Among Body Mass Index, Survival, Cancer Treatment and Health-Related Quality of Life Among Older Patients with Bladder Cancer
by Mitesh Rajpurohit, Mojgan Golzy, Nai-Wei Chen, Katie S. Murray and Geoffrey Rosen
Cancers 2025, 17(7), 1200; https://doi.org/10.3390/cancers17071200 - 1 Apr 2025
Viewed by 543
Abstract
Background: The relationship between body composition and bladder cancer outcomes is complex. While a higher body mass index (BMI) has been associated with an increased risk of bladder cancer development, its impact on survival outcomes is less clear. This study aimed to explore [...] Read more.
Background: The relationship between body composition and bladder cancer outcomes is complex. While a higher body mass index (BMI) has been associated with an increased risk of bladder cancer development, its impact on survival outcomes is less clear. This study aimed to explore the association between BMI, survival, health-related quality of life, and the performance of ADLs in a cohort of older patients with bladder cancer. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey, including patients diagnosed with bladder cancer who had recorded BMI values. Analysis of variance was used to assess the association between BMI categories and patient demographics as well as cancer/treatment characteristics. Generalized linear models examined the impact of BMI on health-related quality of life, as measured by the physical and mental component summary scores when controlling for confounding variables. Kaplan–Meier survival curves across BMI categories were compared using log-rank tests. Results: The final cohort consisted of 8013 patients (age ≥ 65) with a mean age of 77.7 ± 7.1 years, the majority of whom were White (85.6%) and male (74.8%). We observed no significant association between BMI and cancer/treatment characteristics. The severely obese subgroup had the highest rate of disability in performing ADLs (18.3%) followed by the underweight subgroup (10.3%). Overweight patients exhibited the highest physical and mental component summary scores, indicating better health-related quality of life. BMI was a significant predictor of overall survival, with overweight, obese, and severely obese patients demonstrating improved survival compared to those with healthy or underweight BMI. These findings remained statistically significant in multivariable analysis. Conclusions: Our findings suggest a dual role of BMI in older patients with bladder cancer: higher BMI provides a survival advantage and, to an extent, a QoL advantage. At the same time, severe obesity did lead to the lowest QoL despite improved survival outcomes. These results underscore the complex interplay between BMI, survival, and QoL in this bladder cancer population. Full article
(This article belongs to the Special Issue Socio-Demographic Factors and Cancer Research)
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13 pages, 838 KiB  
Article
The Impact of Homelessness on Lung Cancer Survival and Healthcare Utilization in the Hungarian Universal Healthcare System
by Daniel Heilig, Ákos Szabó, Petra Fadgyas-Freyler and Judit Simon
Cancers 2025, 17(7), 1158; https://doi.org/10.3390/cancers17071158 - 29 Mar 2025
Viewed by 399
Abstract
Differences in the lifestyle and health-service-seeking behavior of persons experiencing homelessness (PEH) are well known. However, a comprehensive estimation of the resulting healthcare utilization differences and health outcome impacts are so far under-researched, especially at the national level. We aim to close this [...] Read more.
Differences in the lifestyle and health-service-seeking behavior of persons experiencing homelessness (PEH) are well known. However, a comprehensive estimation of the resulting healthcare utilization differences and health outcome impacts are so far under-researched, especially at the national level. We aim to close this gap of evidence for lung cancer within the Hungarian universal healthcare system. We analyzed lung cancer-related information for the PEH population in the Hungarian national central health insurance register dataset and a matched control population between 2015 and 2021. In this period, 11,857 people were registered as homeless for the majority of at least one year. To capture the effect of homelessness, we created a categorical “homelessness length index” (HLI) according to the proportion of time an individual experienced homelessness during the investigation period (HLI 0: 0; HLI 1: >0–1/3; HLI 2: >1/3–2/3; HLI 3: >2/3). PEH individuals were matched 1:5 with a non-PEH control sample adjusted for age, sex and region. We conducted Kaplan–Meier survival analysis and Cox proportional hazards (CPH) regression adjusted for age, sex, HLI and average lung cancer-related healthcare costs. Our final analysis sample consisted of 641 patients (233 PEH, 408 control) who were newly diagnosed with lung cancer during the observation period. The lung cancer prevalence in the PEH group was 1.97% as opposed to 0.69% in the control group. The Kaplan–Meier curve showed lower average survival times for the PEH group, compared to the control group. Lung cancer associated costs between diagnosis and death/censoring were substantially different with average per patient cumulative costs of EUR 3668 in the PEH group compared to EUR 6827 in the control group (2018 prices). This translated to an average 47% lower annual lung cancer-related healthcare cost per PEH patient. CPH analysis showed that after disease severity, the degree of time spent in homelessness had the most significant effect on mortality, with a HR of 1.47 associated with both HLI 2 and 3 (95% CI: 1.08–2.00 and 1.01–2.14, respectively). We find that in Hungary, homelessness is associated with a much higher lung cancer burden linked to a three-times-higher prevalence, lower overall survival and almost 50% lower annualized disease-specific healthcare costs. Worse outcomes are mainly driven by long-term homelessness. Results could not be further refined according to lifestyle-related factors due to data availability limitations. Full article
(This article belongs to the Special Issue Socio-Demographic Factors and Cancer Research)
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10 pages, 1005 KiB  
Article
A Retrospective Analysis of Breast Cancer Mortality among Jewish and Muslim Arab Women in Israel: The Role of Sociodemographic Factors
by Ronit Pinchas-Mizrachi and Dan Bouhnik
Cancers 2024, 16(15), 2763; https://doi.org/10.3390/cancers16152763 - 5 Aug 2024
Viewed by 1430
Abstract
Breast cancer mortality rates vary across ethnic groups in Israel, where protective factors such as high fertility and breastfeeding rates may be moderated by socioeconomic factors and mammography rates. We aim to investigate disparities in breast cancer mortality between Jewish and Muslim Arab [...] Read more.
Breast cancer mortality rates vary across ethnic groups in Israel, where protective factors such as high fertility and breastfeeding rates may be moderated by socioeconomic factors and mammography rates. We aim to investigate disparities in breast cancer mortality between Jewish and Muslim Arab women in Israel and examine how sociodemographic variables and number of children are associated with mortality. Our retrospective follow-up study uses data from the Israeli Central Bureau of Statistics and multivariable Cox regression models, adjusting for age, number of children, country of origin, locality size, and socioeconomic status. Compared to Jewish women, Muslim Arab women exhibited lower breast cancer mortality rates. However, after adjusting for multiple sociodemographic variables, no significant differences persisted between Jewish and Muslim Arab women. Having more than three children was associated with lower mortality among Muslim Arab women but not among Jewish women. European/American origin, larger localities, and medium socioeconomic status were associated with higher mortality. Sociodemographic factors may therefore explain the disparities in breast cancer mortality between Jewish and Muslim Arab women in Israel. Targeted intervention programs that consider the unique characteristics and risk factors of different ethnic groups are needed to reduce disparities and improve outcomes. Full article
(This article belongs to the Special Issue Socio-Demographic Factors and Cancer Research)
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11 pages, 239 KiB  
Article
Predictors of Clavien–Dindo Grade III–IV or Grade V Complications after Metastatic Spinal Tumor Surgery: An Analysis of Sociodemographic, Socioeconomic, Clinical, Oncologic, and Operative Parameters
by Rafael De la Garza Ramos, Jessica Ryvlin, Ali Haider Bangash, Mousa K. Hamad, Mitchell S. Fourman, John H. Shin, Yaroslav Gelfand, Saikiran Murthy and Reza Yassari
Cancers 2024, 16(15), 2741; https://doi.org/10.3390/cancers16152741 - 1 Aug 2024
Cited by 1 | Viewed by 1128
Abstract
The rate of major complications and 30-day mortality after surgery for metastatic spinal tumors is relatively high. While most studies have focused on baseline comorbid conditions and operative parameters as risk factors, there is limited data on the influence of other parameters such [...] Read more.
The rate of major complications and 30-day mortality after surgery for metastatic spinal tumors is relatively high. While most studies have focused on baseline comorbid conditions and operative parameters as risk factors, there is limited data on the influence of other parameters such as sociodemographic or socioeconomic data on outcomes. We retrospectively analyzed data from 165 patients who underwent surgery for spinal metastases between 2012–2023. The primary outcome was development of major complications (i.e., Clavien–Dindo Grade III–IV complications), and the secondary outcome was 30-day mortality (i.e., Clavien–Dindo Grade V complications). An exploratory data analysis that included sociodemographic, socioeconomic, clinical, oncologic, and operative parameters was performed. Following multivariable analysis, independent predictors of Clavien–Dindo Grade III–IV complications were Frankel Grade A–C, lower modified Bauer score, and lower Prognostic Nutritional Index. Independent predictors of Clavien–Dindo Grade V complications) were lung primary cancer, lower modified Bauer score, lower Prognostic Nutritional Index, and use of internal fixation. No sociodemographic or socioeconomic factor was associated with either outcome. Sociodemographic and socioeconomic factors did not impact short-term surgical outcomes for metastatic spinal tumor patients in this study. Optimization of modifiable factors like nutritional status may be more important in improving outcomes in this complex patient population. Full article
(This article belongs to the Special Issue Socio-Demographic Factors and Cancer Research)
15 pages, 269 KiB  
Article
Healthcare Costs and Resource Utilisation of Italian Metastatic Non-Small Cell Lung Cancer Patients
by Nicola Gentili, William Balzi, Flavia Foca, Valentina Danesi, Mattia Altini, Angelo Delmonte, Giuseppe Bronte, Lucio Crinò, Nicoletta De Luigi, Marita Mariotti, Alberto Verlicchi, Marco Angelo Burgio, Andrea Roncadori, Thomas Burke and Ilaria Massa
Cancers 2024, 16(3), 592; https://doi.org/10.3390/cancers16030592 - 30 Jan 2024
Cited by 2 | Viewed by 1870
Abstract
This study evaluated the economic burden of metastatic non-small cell lung cancer patients before and after the availability of an immuno-oncology (IO) regimen as a first-line (1L) treatment. Patients from 2014 to 2020 were categorized according to mutational status into mutation-positive and negative/unknown [...] Read more.
This study evaluated the economic burden of metastatic non-small cell lung cancer patients before and after the availability of an immuno-oncology (IO) regimen as a first-line (1L) treatment. Patients from 2014 to 2020 were categorized according to mutational status into mutation-positive and negative/unknown groups, which were further divided into pre-1L IO and post-1L IO sub-groups depending on the availability of pembrolizumab monotherapy in 1L. Healthcare costs and HCRU for a 1L treatment and overall follow-up were reported as the mean total and per-month cost per patient by groups. Of 644 patients, 125were mutation-positive and 519 negative/unknown (229 and 290 in pre- and post-1L IO, respectively). The mean total per-patient cost in 1L was lower in pre- (EUR 7804) and post-1L IO (EUR 19,301) than the mutation-positive group (EUR 45,247), persisting throughout overall disease follow-up. However, this difference was less when analyzing monthly costs. Therapy costs were the primary driver in 1L, while hospitalization costs rose during follow-up. In both mutation-positive and post-IO 1L groups, the 1L costs represented a significant portion (70.1% and 66.3%, respectively) of the total costs in the overall follow-up. Pembrolizumab introduction increased expenses but improved survival. Higher hospitalisation and emergency room occupation rates during follow-up reflected worsening clinical conditions of the negative/unknown group than the mutation-positive population. Full article
(This article belongs to the Special Issue Socio-Demographic Factors and Cancer Research)
21 pages, 2751 KiB  
Article
Machine Learning as a Tool for Early Detection: A Focus on Late-Stage Colorectal Cancer across Socioeconomic Spectrums
by Hadiza Galadima, Rexford Anson-Dwamena, Ashley Johnson, Ghalib Bello, Georges Adunlin and James Blando
Cancers 2024, 16(3), 540; https://doi.org/10.3390/cancers16030540 - 26 Jan 2024
Cited by 2 | Viewed by 3006
Abstract
Purpose: To assess the efficacy of various machine learning (ML) algorithms in predicting late-stage colorectal cancer (CRC) diagnoses against the backdrop of socio-economic and regional healthcare disparities. Methods: An innovative theoretical framework was developed to integrate individual- and census tract-level social determinants of [...] Read more.
Purpose: To assess the efficacy of various machine learning (ML) algorithms in predicting late-stage colorectal cancer (CRC) diagnoses against the backdrop of socio-economic and regional healthcare disparities. Methods: An innovative theoretical framework was developed to integrate individual- and census tract-level social determinants of health (SDOH) with sociodemographic factors. A comparative analysis of the ML models was conducted using key performance metrics such as AUC-ROC to evaluate their predictive accuracy. Spatio-temporal analysis was used to identify disparities in late-stage CRC diagnosis probabilities. Results: Gradient boosting emerged as the superior model, with the top predictors for late-stage CRC diagnosis being anatomic site, year of diagnosis, age, proximity to superfund sites, and primary payer. Spatio-temporal clusters highlighted geographic areas with a statistically significant high probability of late-stage diagnoses, emphasizing the need for targeted healthcare interventions. Conclusions: This research underlines the potential of ML in enhancing the prognostic predictions in oncology, particularly in CRC. The gradient boosting model, with its robust performance, holds promise for deployment in healthcare systems to aid early detection and formulate localized cancer prevention strategies. The study’s methodology demonstrates a significant step toward utilizing AI in public health to mitigate disparities and improve cancer care outcomes. Full article
(This article belongs to the Special Issue Socio-Demographic Factors and Cancer Research)
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Review

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26 pages, 1320 KiB  
Review
Sleep and Cancer
by Courtney M. Vaughn and Bradley V. Vaughn
Cancers 2025, 17(6), 911; https://doi.org/10.3390/cancers17060911 - 7 Mar 2025
Viewed by 1985
Abstract
Background/Objectives: Sleep issues are common in the general population, and these problems occur even more frequently for people with cancer. Sleep problems may pre-exist a patient’s cancer diagnosis, and there is a growing interest in understanding the impact of sleep on cancer [...] Read more.
Background/Objectives: Sleep issues are common in the general population, and these problems occur even more frequently for people with cancer. Sleep problems may pre-exist a patient’s cancer diagnosis, and there is a growing interest in understanding the impact of sleep on cancer development and progression. Sleep disorders may impact cancer through altered metabolism, impacts on immune response, and alterations in hormones and gene expression. Sleep disorders may also arise after, or be aggravated by, an individual’s cancer and cancer treatment. Treating a person with cancer’s sleep disorder may help improve their healing, mental health, cognition, and overall resilience. Methods: Studies examining a variety of aspects of the relationship between sleep and cancer were found by searching the National Library of Medicine and characterized by their specific information provided on the relationship between sleep and cancer. Results: This review article summarizes our current understanding of the complex inter-relationship between sleep and cancer, the underlying mechanisms that create these connections, and the methods and impact of treating sleep issues in cancer patients. The article also outlines an approach to sleep complaints for clinicians caring for patients with cancer. Conclusions: Significant research is still needed to understand the full relationship between sleep disorders and cancer. The impact of sleep issues on cancer and of cancer on sleep appears to be specific to the tissue and the molecular type of cancer. The treatment of sleep disorders is multimodal, and offers a promising avenue to improve the health and quality of life of cancer patients. Full article
(This article belongs to the Special Issue Socio-Demographic Factors and Cancer Research)
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24 pages, 1036 KiB  
Review
Technological Resources for Physical Rehabilitation in Cancer Patients Undergoing Chemotherapy: A Scoping Review
by Anabela Amarelo, Marisa Mota, Bruno Amarelo, Marta Campos Ferreira and Carla Sílvia Fernandes
Cancers 2024, 16(23), 3949; https://doi.org/10.3390/cancers16233949 - 25 Nov 2024
Cited by 1 | Viewed by 1438
Abstract
Background/Objectives: Cancer patients undergoing chemotherapy often face challenges that reduce their physical function and quality of life. Technological resources offer innovative solutions for physical rehabilitation, but the extent of their application in this context remains unclear. This scoping review aims to explore [...] Read more.
Background/Objectives: Cancer patients undergoing chemotherapy often face challenges that reduce their physical function and quality of life. Technological resources offer innovative solutions for physical rehabilitation, but the extent of their application in this context remains unclear. This scoping review aims to explore and map the various technological tools used to support physical rehabilitation in cancer patients during chemotherapy, focusing on their potential to improve outcomes and enhance patient care. Methods: A scoping review was conducted following the Joanna Briggs Institute (JBI) guidelines and the PRISMA-ScR framework. Comprehensive searches were performed in the MEDLINE, CINAHL, Scopus, SPORTDiscus, and COCHRANE databases. The included studies focused on the technological resources used in physical rehabilitation for cancer patients undergoing chemotherapy. Data extraction followed the World Health Organization’s “Classification of Digital Health Interventions v1.0” to categorize the technologies. Results: A total of 32 studies met the inclusion criteria. The most commonly used technologies included wearable devices (16 studies), web-based platforms and telerehabilitation systems (7 studies), mHealth applications (6 studies), virtual reality (2 studies), and exergaming (3 studies). These tools were designed to enhance physical function, manage treatment-related symptoms, and improve overall quality of life. Wearable devices were particularly effective for monitoring physical activity, while web-based platforms and mHealth applications supported remote rehabilitation and patient engagement. Conclusions: Technological resources offer significant opportunities for personalized rehabilitation interventions in cancer patients undergoing chemotherapy. However, further research is needed to evaluate the long-term effectiveness, cost-efficiency, and clinical integration of these tools to ensure broader accessibility and sustainable impact. Full article
(This article belongs to the Special Issue Socio-Demographic Factors and Cancer Research)
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Other

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15 pages, 1218 KiB  
Systematic Review
Racial and Socioeconomic Disparity in Breast Cancer Mortality: A Systematic Review and Meta-Analysis
by Helena Fiats Ribeiro, Fernando Castilho Pelloso, Beatriz Sousa da Fonseca, Camila Wohlenberg Camparoto, Maria Dalva de Barros Carvalho, Vlaudimir Dias Marques, Mariá Romanio Bitencourt, Kely Paviani Stevanato, Pedro Beraldo Borba, Deise Helena Pelloso Borghesan, Paulo Acácio Egger, Ana Carolina Jacinto Alarcão, Roberto Kenji Nakamura Cuman, Isabella Morais Tavares Huber, Márcia Edilaine Lopes Consolaro, Constanza Pujals, Carlos Laranjeira, Raíssa Bocchi Pedroso and Sandra Marisa Pelloso
Cancers 2025, 17(10), 1641; https://doi.org/10.3390/cancers17101641 - 13 May 2025
Viewed by 446
Abstract
Background/Objectives: Breast cancer is one of the leading causes of female mortality worldwide, but significant racial and socioeconomic disparities persist in disease outcomes. This review aimed to analyze racial and socioeconomic inequalities in mortality and survival from breast cancer, identifying the impact [...] Read more.
Background/Objectives: Breast cancer is one of the leading causes of female mortality worldwide, but significant racial and socioeconomic disparities persist in disease outcomes. This review aimed to analyze racial and socioeconomic inequalities in mortality and survival from breast cancer, identifying the impact of social risk factors on access to diagnosis and treatment. Methods: A systematic literature review and meta-analysis was performed following PRISMA guidelines. Eighteen studies published between 2014 and 2024 were included, with 11 contributing to the meta-analysis. Random-effect models were used to assess correlations between socioeconomic status, race, and clinical outcomes, including heterogeneity and publication bias analyses. Results: The strongest associations were observed between income, race, and breast cancer survival, with survival significantly worse among Black women and low-income populations (p < 0.001). Income also showed a strong positive correlation with clinical outcomes. In contrast, the overall effect on mortality was not statistically significant (p = 0.290), likely due to high heterogeneity across studies (I2 = 100%). These findings suggest that structural disparities in access to healthcare and early detection substantially affect survival rates. Conclusions: Racial and socioeconomic disparities in breast cancer outcomes remain critical public health challenges. Targeted policies to expand early diagnosis and ensure equitable access to effective treatment are essential to reduce these disparities and improve survival in underserved populations. Full article
(This article belongs to the Special Issue Socio-Demographic Factors and Cancer Research)
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