Disparities in cancer care reflect hospital resources

Hospital quality among factors leading to survival differences

ANN ARBOR, Mich. - Hospitals that treat more black cancer patients have
worse survival rates on average for patients with breast and colon
cancer, regardless of race, according to a new study from the University
of Michigan Comprehensive Cancer Center.

The research helps explain why African-Americans with breast or colon
cancer are less likely than white patients to survive the disease.

“This work highlights the importance of how where a patient receives
treatment for cancer affects survival after cancer surgery. An important
next step will be to determine which system factors are amenable to
interventions aimed at improving the quality of cancer care,” says
study author Tara M. Breslin, M.D., assistant professor of surgery at
the U-M Medical School.

The study used five year survival data from the Surveillance
Epidemiology and End Results-Medicare-linked database, a federal
collection of cancer incidence, survival, and prevalence. The
researchers analyzed data from 25,571 breast cancer patients, 9.7
percent of whom were black, and 22,168 colon cancer patients, 11.8
percent of whom were black. The patients were treated in 436 hospitals. 


The study appears in the Aug. 20 issue of the Journal of Clinical
Oncology.

Survival rates were lower for black patients than for white patients
with both breast and colon cancer. But hospitals where more than half
the patients were black had an increased risk of dying after five years
for both black and white patients, compared to hospitals where fewer
than 10 percent of patients were black.

All breast cancer patients treated at predominantly black hospitals had
a 32 percent increased risk of death after five years, compared with
those treated at hospitals that see few black patients. Similarly, colon
cancer patients had a 27 percent higher risk of dying at five years.

The researchers also examined patient factors, such as age, cancer
stage, other medical conditions and socioeconomic status. They found
that after accounting for these factors, black patients still had higher
mortality rates.

“Efforts aimed at increasing early detection through screening and
decreasing incidence with preventative services are essential for
decreasing racial disparities in mortality, but where a patient receives
care after a cancer diagnosis may be equally important,” says senior
study author Arden M. Morris, M.D., M.P.H., assistant professor of
surgery at the U-M Medical School and chief of general surgery at the VA
Ann Arbor Healthcare System.

The study did not identify what specific hospital factors were at play,
but the researchers plan further analyses to determine which hospital
systems and aspects of standard therapy are poorly delivered or absent
in hospitals serving a high percentage of minority patients.

Cancer statistics: 194,280 Americans will be diagnosed with breast
cancer this year, and 106,100 will be diagnosed with colon cancer,
according to the American Cancer Society.

Additional authors: Niya Gu, Sandra L. Wong, Emily V. Finlayson,
Mousumi Banerjee and John D. Birkmeyer, all from U-M

Funding: National Cancer Institute

Reference: Journal of Clinical Oncology, Vol. 27, No. 24, pp.
3945-3950

Resources:
U-M Cancer AnswerLine, 800-865-1125
U-M Comprehensive Cancer Center, www.mcancer.org