Grouping Asian and Pacific Islander patients together may hide disparities in cancer outcomes between these groups, according to researchers. 

The researchers found that Asian patients with common cancers tended to have better overall survival (OS) outcomes than White patients, but Pacific Islander patients with these cancers typically had worse OS outcomes than White patients. 

These results were published in JAMA Network Open

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The researchers analyzed data from a national hospital-based oncology database enriched for Pacific Islander and Asian populations. The cohort included patients who were diagnosed with 9 common cancers from January 2004 through December 2017. 

There were nearly 6 million eligible patients, including 60,047 East Asian patients, 25,966 South Asian patients, 42,815 Southeast Asian patients, 11,512 Pacific Islander patients (including Native Hawaiians), and more than 5.8 million White patients. 

The cancers represented were breast cancer (32%), prostate cancer (16%), kidney or bladder cancer (12%), lung cancer (11%), colorectal cancer (11%), melanoma (8%), endometrial cancer (5%), lymphoma (4%), and oral cavity cancer (1%). 

The researchers found that, compared with White patients, Asian patients had a lower comorbidity burden (adjusted odds ratio [aOR], 0.53; 95%CI, 0.48-0.58) and Pacific Islander patients had a higher comorbidity burden (aOR, 1.70; 95% CI, 1.47-1.94). 

“The high comorbidity burden among Native Hawaiian and other Pacific Islander patients may impact critical treatment decisions, such as surgical candidacy or consideration for clinical trial enrollment,” the researchers wrote. “This may, in part, translate to inferior cancer outcomes.”  

However, the researchers observed inferior OS among Pacific Islander patients and superior OS among Asian patients in an analysis adjusted for comorbidity burden and other confounders.

In the multivariable analysis, East Asian, South Asian, and Southeast Asian patients typically had superior OS when compared with White patients. 

Pacific Islander patients, on the other hand, tended to have inferior OS when compared with White patients. In fact, there were no cancers for which Pacific Islanders had superior OS to White patients. 

Adjusted hazard ratios for OS by race/ethnicity and cancer type (95% CI)

Cancer Type

Pacific Islander

East Asian

South Asian

Southeast Asian

Breast Cancer

1.09 (1.00-1.18)

0.69 (0.66-0.72)

0.72 (0.67-0.77)

0.78 (0.74-0.82)

Colorectal Cancer

0.95 (0.85-1.07)

0.75 (0.72-0.78)

0.67 (0.61-0.73)

0.88 (0.84-0.93)

Endometrial Cancer

1.30 (1.12-1.50)

0.84 (0.76-0.92)

0.83 (0.71-0.96)

0.93 (0.84-1.02)

Kidney or Bladder Cancer

0.89 (0.77-1.01)

0.75 (0.71-0.80)

0.69 (0.62-0.76)

0.86 (0.79-0.93)

Lung Cancer

1.08 (0.99-1.17)

0.72 (0.70-0.75)

0.71 (0.65-0.78)

0.79 (0.76-0.83)


1.35 (1.11-1.63)

1.00 (0.93-1.07)

1.00 (0.89-1.14)

1.26 (1.16-1.37)


1.03 (0.72-1.47)

0.99 (0.81-1.22)

1.24 (0.82-1.89)

1.21 (0.92-1.58)

Oral Cavity Cancer

1.56 (1.14-2.13)

0.74 (0.64-0.86)

0.92 (0.79-1.07)

0.77 (0.62-0.95)

Prostate Cancer

1.29 (1.14-1.46)

0.67 (0.63-0.71)

0.66 (0.59-0.74)

0.79 (0.73-0.85)

“Our findings directly contrast with prior studies using similar databases reporting superior OS for breast, prostate, lung, endometrial, lymphoma, and oral cavity cancers among aggregated Asian and Native Hawaiian and other Pacific Islander populations compared with White populations,” the researchers wrote. “The continued aggregation of these 2 groups perpetuates the impression that Native Hawaiian and other Pacific Islander patients with cancer have better outcomes than reality.”


Taparra K, Qu V, Pollom E. Disparities in survival and comorbidity burden between Asian and Native Hawaiian and other Pacific Islander patients with cancer. JAMA Netw Open. Published online August 12, 2022. doi:10.1001/jamanetworkopen.2022.26327