Prognostic Markers

There is a lack of data examining the socioeconomic impact of race, gender, and insurance status on the outcome of patients with non-primary malignancies. Current data is limited to small series of patients and a low-quality of evidence.  Similar to studies in other types of cancers, lack of insurance or having Medicaid, lower household income and black race were associated with a poor outcome. The studies reviewed showed rapidly growing histologies to be most often lung, gastrointestinal, and renal. The slower growing histologies were most often breast, prostate and thyroid. There were no studies describing the type of lesion (lytic vs blastic) as a predictor. There is likely no way to improve the quality of evidence for these studies as it would be near impossible to maintain equipoise while performing a prospective randomized study on this topic, however future studies on the use of prospectively collected data from multicenter or international collaborations may shed insight into the impact of these socioeconomic factors.