Racial and ethnic disparities in cancer treatment

PL06-03

Measurable declines for overall cancer death rates for many of the top 15 cancers, along with improved survival rates, have been reported. This is the result of research focused on discovering and proving the efficacy of new interventions to reduce cancer mortality. Evidence suggests that, even in settings where proven efficacious treatments exist, some racial and ethnic subgroups are not receiving these treatments, and this may contribute to racial and ethnic disparities in survival and the risk of death from cancer. Racial disparities in cancer outcome have been attributed to many factors, including access to health services, resulting in more advanced stage at presentation and differences in tumor biology resulting in increased aggressiveness or resistance to treatment. Even on a stage for stage bases, and controlling for differences in tumor biology, disparities still remain. Recently, differences in the quality of post-diagnostic care, such as surgery, radiation therapy, chemotherapy and follow-up care have been investigated, and are thought to play a role in cancer outcome disparities.
 For example, Studies by our group and others have suggested that black women are less likely to receive optimal systemic adjuvant therapy than white women and this may account in part for the disparities in survival outcomes. For example, black patients receive less aggressive intravenous chemotherapy and have fewer consultations with oncologist and radiation oncologists. Treatment delays, while uncommon, also contribute to worse outcomes among black women. And even once treatment is initiated, black women are more likely to discontinue treatment early. Similar patterns have been observed in colon cancer and ovarian cancer. Differences in surgery may account for some of the disparities in survival from lung, esophageal and prostate cancer.
 Currently, the reasons why disparities in cancer treatment exist have not been well studied. A decision not to initiate treatment or to discontinue treatment early may be based on such factors as the side effects of medications, patient lack of knowledge about the illness or the potential benefits of the treatment, financial barriers, poor patient-physician communication, and the presence of comorbid conditions. Personal belief in the efficacy of the therapy may also play a significant role in adherence. Patients, physicians, families, and the health care system may all play greater or lesser roles in determining the quality of treatment.
 A better understanding of barriers to optimal treatment is essential as interventions can focus on improving treatment quality to reduce these health care disparities.