Long‐Term Survival Disparities by Race and Ethnicity Among Cancer Survivors in United States

BACKGROUND: Cancer survivors are increasingly living beyond 5 years post-diagnosis and are projected to exceed 26,000,000 in the United States (US) by 2040. Research is needed on racial and ethnic differences in long-term survival. METHODS: In this retrospective cohort study of 10,895,183 individuals diagnosed with cancer from the US population-based Surveillance Epidemiology and End Result (SEER) data (2000-2021), we compared survival outcomes up to 15 years post-diagnosis across 6 mutually exclusive racial/ethnic groups: Hispanics, and non-Hispanic White, Black, Asian, American Indian/Alaska Native (AI/AN), and Native Hawaiian and other Pacific Islander (NHPI). RESULTS: Overall, Hispanic and non-Hispanic Black, Asian, AI/AN, and NHPI cancer survivors had persistently poorer survival outcomes compared to non-Hispanic White cancer survivors. AI/AN men and women, NHPI men, and Black women experienced the poorest outcomes. Survival gaps widened over time. By year 15, male AI/AN and NHPI and female AI/AN and Blacks were more than 25% more likely to die compared to their White counterparts. These disparities were most pronounced among individuals with advanced-stage cancers and persisted across counties with various income levels. Racial/ethnic differences varied by cancer site. CONCLUSIONS: Long-term survival disparities by race and ethnicity persist and widen beyond 5 years post-diagnosis, particularly among non-Hispanic AI/AN individuals, NHPI men, and Black women. These trends are not solely explained by income or cancer stage, highlighting the need for long-term, risk-based and tailored survivorship care to reduce racial and ethnic differences in cancer outcomes.