{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:36:08Z","timestamp":1787495768916,"version":"build-2736575974"},"reference-count":55,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"15","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["J Clin Oncol"],"published-print":{"date-parts":[[2026,5,20]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Despite narrowing racial gaps, disparities persist across cancer types and socioeconomic levels. The diminishing returns hypothesis suggests that economic advantage yields fewer health benefits for Black individuals but is largely unexplored in the context of cancer. We examined the diminishing returns among Black and White individuals across cancer types using a nationally representative study population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The study analyzed cancer-specific survival among 5.3 million non-Hispanic Black and White adults diagnosed with primary cancer (2006-2020) using SEER-22. We assessed how race and neighborhood socioeconomic status (SES) jointly affects survival across 21 cancer types. A 10-level race-SES variable was created, using White individuals in the highest-SES group as the reference. The main outcome was cancer-specific death. Diminishing returns were defined quantitively and qualitatively as worse survival for Black individuals even at higher SES. Cox models adjusted for demographics and clinical factors, with multiple imputation for missing data. Social gradients were also evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Black women showed strong evidence of diminishing returns overall and for seven cancers, especially uterine and breast cancers. A social gradient was also evident in cancers with diminishing returns, except uterine cancer. For Black men, diminishing returns were not observed across all cancers combined but was present in eight cancers\u2014including prostate and colorectal cancers. Most cancers among men exhibited a strong social gradient. Findings were consistent by time period and upon restricting to localized and regional disease in sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Higher SES improves cancer survival for White patients but not Black patients, worsening racial disparities for certain cancers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco-25-01038","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T21:00:16Z","timestamp":1770066016000},"page":"1430-1440","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":6,"title":["Diminishing Returns Among Black Patients With Cancer: The Intersection of Race and Neighborhood Socioeconomic Status"],"prefix":"10.1200","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6723-9540","authenticated-orcid":true,"given":"Lauren E.","family":"McCullough","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Emory University, Atlanta, GA"},{"name":"Population Science, American Cancer Society, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7321-6003","authenticated-orcid":true,"given":"Lauren E.","family":"Barber","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Emory University, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0499-2663","authenticated-orcid":true,"given":"Rebecca","family":"Nash","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Emory University, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0170-2592","authenticated-orcid":true,"given":"Lindsay J.","family":"Collin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Emory University, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0763-5231","authenticated-orcid":true,"given":"Maret L.","family":"Maliniak","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Emory University, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_9_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21871"},{"key":"e_1_3_9_3_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21874"},{"key":"e_1_3_9_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-019-05340-7"},{"key":"e_1_3_9_5_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.74.2049"},{"key":"e_1_3_9_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.38183"},{"key":"e_1_3_9_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-023-07053-4"},{"key":"e_1_3_9_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40985-016-0025-4"},{"key":"e_1_3_9_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/sipr.12042"},{"key":"e_1_3_9_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2020.100561"},{"key":"e_1_3_9_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/jncimonographs\/lgu020"},{"key":"e_1_3_9_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci8090176"},{"key":"e_1_3_9_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/ssqu.12092"},{"key":"e_1_3_9_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2014.11.024"},{"key":"e_1_3_9_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(99)00209-9"},{"key":"e_1_3_9_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11113-013-9299-0"},{"key":"e_1_3_9_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13524-011-0082-8"},{"key":"e_1_3_9_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-016-0239-7"},{"key":"e_1_3_9_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-017-0381-x"},{"key":"e_1_3_9_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/bs7040068"},{"key":"e_1_3_9_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2016.10.008"},{"key":"e_1_3_9_22_2","unstructured":"Data from: Surveillance Epidemiology and End Results (SEER) Program: SEER*StatDatabase: Incidence\u2014SEER Research Plus Limited-Field Specialized Data (with Census Tract Attributes) 22 Registries (excl AK IL and MA) Nov 2022 Sub (2006-2020) <Vintage 2020 Pops by Tract 2010 Geographies>\u2014Linked To Census Tract Attributes SEER 22 excl AK and IL Census 2010 Geographies Time Dependent (2006-2020; 2008 copied to 06 07; 2017 copied to 18 19 20) National Cancer Institute DCCPS Surveillance Research Program released August 2023 based on the November 2022 submission. www.seer.cancer.gov"},{"key":"e_1_3_9_23_2","volume-title":"Incidence Data with Census Tract Attributes Database","author":"National Institutes of Health","unstructured":"National Institutes of Health: Incidence Data with Census Tract Attributes Database. https:\/\/seer.cancer.gov\/data\/specialized\/available-databases\/census-tract-request\/"},{"key":"e_1_3_9_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-013-0310-1"},{"key":"e_1_3_9_25_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1011240019516"},{"key":"e_1_3_9_26_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1008811432436"},{"key":"e_1_3_9_27_2","volume-title":"SEER Cause-specific Death Classification","author":"National Institutes of Health","unstructured":"National Institutes of Health: SEER Cause-specific Death Classification. https:\/\/seer.cancer.gov\/causespecific\/#footnotea"},{"key":"e_1_3_9_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.34479"},{"key":"e_1_3_9_29_2","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions (version 6.5)","author":"Deeks JJ","year":"2024","unstructured":"Deeks JJ, Higgins JPT, Altman DG, et al: Chapter 10: Analysing data and undertaking meta-analyses, in Higgins JPT, Thomas J, Chandler J, et al (eds): Cochrane Handbook for Systematic Reviews of Interventions (version 6.5). London, UK, Cochrane, 2024"},{"key":"e_1_3_9_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.08.001"},{"key":"e_1_3_9_31_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v045.i03"},{"key":"e_1_3_9_32_2","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2021","unstructured":"R Core Team: R: A Language and Environment for Statistical Computing. 2021. https:\/\/www.R-project.org\/"},{"key":"e_1_3_9_33_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0295915"},{"key":"e_1_3_9_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2013.12.039"},{"key":"e_1_3_9_35_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2200244"},{"key":"e_1_3_9_36_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djae118"},{"key":"e_1_3_9_37_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.45906"},{"key":"e_1_3_9_38_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1104630"},{"key":"e_1_3_9_39_2","doi-asserted-by":"publisher","DOI":"10.1136\/ijgc-2024-005599"},{"key":"e_1_3_9_40_2","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkad036"},{"key":"e_1_3_9_41_2","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2023.29.4.420"},{"key":"e_1_3_9_42_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2024.5794"},{"key":"e_1_3_9_43_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2007.131383"},{"key":"e_1_3_9_44_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-021-04190-y"},{"key":"e_1_3_9_45_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-023-01649-8"},{"key":"e_1_3_9_46_2","doi-asserted-by":"publisher","DOI":"10.1188\/21.CJON.S1.17-24"},{"key":"e_1_3_9_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2018.04.013"},{"key":"e_1_3_9_48_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.52061"},{"key":"e_1_3_9_49_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-022-11720-z"},{"key":"e_1_3_9_50_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.060749"},{"key":"e_1_3_9_51_2","first-page":"207","article-title":"The weathering hypothesis and the health of African-American women and infants: Evidence and speculations","volume":"2","author":"Geronimus AT","year":"1992","unstructured":"Geronimus AT: The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethn Dis 2:207-221, 1992","journal-title":"Ethn Dis"},{"key":"e_1_3_9_52_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.43203"},{"key":"e_1_3_9_53_2","first-page":"169","volume-title":"Setting the record straight on racial wealth inequality","author":"Addo FR","year":"2024","unstructured":"Addo FR, Darity WA Jr., Myers SL Jr.: Setting the record straight on racial wealth inequality. AEA Papers and Proceedings 114:169-173, 2024"},{"key":"e_1_3_9_54_2","volume-title":"Examining the black-white Wealth Gap","author":"McIntosh K","year":"2020","unstructured":"McIntosh K, Moss E, Nunn R, et al: Examining the black-white Wealth Gap. Brookings Institution, 2020. https:\/\/www.brookings.edu\/articles\/examining-the-black-white-wealth-gap\/"},{"key":"e_1_3_9_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2019.02.004"},{"key":"e_1_3_9_56_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-023-00811-1"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO-25-01038","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T22:00:41Z","timestamp":1778882441000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO-25-01038"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":55,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2026,5,20]]}},"alternative-id":["10.1200\/JCO-25-01038"],"URL":"https:\/\/doi.org\/10.1200\/jco-25-01038","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]},"assertion":[{"value":"2025-05-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-29","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}