The recent efforts to close the gaps in therapy for various kinds of cancer between Black and White Medicare patients have failed, a Yale University study released this week found.
A group of researchers from the Yale School of Medicine sought to determine whether the racial disparities in cancer therapy had diminished since they were originally recognized in the early 1990s. They used the Surveillance, Epidemiology, and End Results (SEER) Medicare database to evaluate patients who had been diagnosed with prostate, breast, colorectal and lung cancer between 1992 and 2002 and still found glaring racial gaps in cancer care.
“Efforts to mitigate cancer care disparities between 1992 and 2002 appear to have been unsuccessful,” says Cary P. Gross, M.D., associate professor of medicine at Yale School of Medicine. “Future efforts to reduce cancer disparities should be incorporated into a larger framework that encompasses access to high-quality comprehensive care for all patients with cancer.”
The report, titled “Racial Disparities in Cancer Therapy: Did the Gap Narrow Between 1992 and 2002?”, will appear in the February 15, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society. Other authors of the study included Elizabeth Wolf and Martin Andersen at Yale and Benjamin D. Smith, M.D., of Wilford Hall Medical Center in San Antonio, Texas.
In total, they studied 7,775 colon, 1,745 rectal, 11,207 lung, 40,457 breast and 82,238 prostate cancer cases of individuals ages 66 to 85. The researchers found that there was no decrease in the size of the racial disparities during the 10-year period. There was little or no increase in the proportion of Black and White patients receiving therapy. Blacks were still significantly less likely than Whites to receive therapy for lung, breast, colon and prostate cancers.
For example, 64 percent of Black and 78.5 percent of White early stage lung cancer patients underwent surgical resection (the largest disparity in the study); 77.8 percent of Black and 85.8 percent of White breast cancer patients received radiation after a lumpectomy; 52.1 percent and 64.1 percent of Black and White stage three colon cancer patients, respectively, received adjuvant therapy; and 72.4 percent of Black and 77.2 percent of White early stage prostate cancer patients received definitive therapy.
“There was no notable decrease in racial disparities over a 10-year period in any of the cancer therapies for which a disparity was noted,” the researchers write in the study. “The inability to close the racial gap in cancer therapy is particularly disappointing given the substantial attention to and investment in identifying and reducing racial disparities in cancer incidence, screening, and outcomes during the study period.”
The Black patients were substantially more likely than Whites to reside in areas with low median income and have no documented encounters with physician encounters, the study found. However, access and socio-economic status does not “explain away” the racial disparities. Even when the racial groups were limited to those patients who had access to a doctor before they were diagnosed with cancer, the racial disparities still persists, the study found.
Not only do disparities persist, but the overall quality of cancer therapy has not improved.
“Perhaps a rising tide will raise all boats,” conclude the researchers in the report. “Future efforts to reduce disparities should be incorporated into a larger quality improvement framework, as our results suggest that all patients would benefit from greater attention to measuring and improving quality of cancer care.”
–Ibram Rogers
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