EPID-08. Racial and Economic Disparities in the Modern Era of Brain Metastasis Treatment: A SEER-Based Study (2010–2022)

Abstract BACKGROUND Metastatic brain tumors (MBTs) are more common than primary brain tumors and associated with poor survival. This study examined whether race × income interaction predicts differences in treatment receipt and survival among patients with MBTs from lung, breast, melanoma, and prostate cancer METHODS We analyzed SEER data from 2010–2022, identifying adults with MBTs from lung, melanoma, breast, and prostate primaries. Treatment outcomes included receipt of chemotherapy, radiation, or surgery, and the sequence of radiation or chemotherapy relative to surgery. Survival outcomes were modeled using Cox proportional hazards regression. Unadjusted, adjusted, and interaction models (race and income) were run separately for each cancer type. Income was binarized into low and high using a cutoff of $75,000. RESULTS A total of 77,895 patients were included (69,928 lung, 3,786 melanoma, 3,588 breast, 593 prostate). Mean age was 65 years (SD 5 years), 71% were White, and 40% fell into the low-income category. In the adjusted survival model, Hispanic and Asian lung cancer patients showed improved survival compared to White patients (HR 0.93 and 0.71, CI 0.93–0.96 and 0.68–0.72, respectively, p <.001), while low-income patients had worse outcomes (HR 1.66, CI 1.14–1.18, p <.001). After interaction modeling, low-income Black patients with lung cancer had a survival advantage over low-income White patients (HR 0.92, CI 0.87–0.97, p =.001), while Asian and Hispanic patients maintained their survival advantage regardless of income. Black patients with breast MBTs experienced persistently worse survival, regardless of model (HR 1.19, CI 1.02–1.38, p =.019). CONCLUSIONS Income modifies the effect of race on survival in patients with MBTs, challenging past assumptions that race alone predicts poorer outcomes. Findings suggest that survival disparities may be driven more by socioeconomic conditions than differential treatment access.