Why blacks less likely to have chemo still unclear
|
|
A recent study showed that black patients are much less likely than white patients to receive recommended chemotherapy after surgery for advanced colon cancer. A new study suggests that there is no single or simple explanation for why this is so.
To try to understand the factors involved in black-white differences in recommended colon cancer treatment, doctors took a look-back at 5,294 black and white patients 66 years of age or older who had surgery for advanced colon cancer. All of them had Medicare health insurance, and therefore the same access to care.
Despite having an equal opportunity to learn about chemotherapy from a medical specialist, blacks do not receive this therapy at equal rates, Dr. Laura-Mae Baldwin from the University of Washington in Seattle and colleagues report in The Journal of the National Cancer Institute.
After surgery, nearly 80 percent of both black and white patients consulted with a doctor specializing in chemotherapy. But only about 59 percent of black patients who consulted with an oncologist received chemotherapy compared with 70 percent of white patients.
Baldwin’s team acknowledges that they expected to find several specific “health system” factors that could explain the differences and that could be addressed to improve care, but that was not the case.
Patients’ age turned out to be one of the most important factors associated with the black-white disparity in chemotherapy use after colon cancer surgery. Among the “youngest” elderly patients - those between 66 and 70 years of age - roughly 66 percent of blacks had chemotherapy compared with about 86 percent of whites. “This is worrisome,” the authors say, because the “young” elderly are most likely to derive a survival benefit from chemotherapy.
Severity of illness, social support, and socioeconomic environment explained roughly 27 percent of the black-white disparity in the 66- to 70-year-old age group. Black patients were sicker than white patients, stayed in the hospital longer after surgery, and lived in areas with lower high school graduation rates.
Poorer health status and less home support could affect a doctor’s likelihood of recommending chemotherapy or a patient’s perception of their ability to tolerate chemotherapy, the authors suggest.
Health system factors accounted for just 12 percent of the disparity in the “youngest” elderly category.
The authors think that developing strategies to educate and communicate the risks and benefits of chemotherapy may help diminish some of the black-white treatment differences.
The medical literature, they note, suggests that blacks are more likely than whites to harbor a “fatalistic” attitude toward medical illness, to experience stigma, fear, and denial related to a cancer diagnosis and to have an aversion to medical treatments. They may also be more likely to misperceive post-op chemotherapy as merely a way to ease symptoms, rather than add-on therapy that can improve the outcome.
SOURCE: The Journal of the National Cancer Institute August 17, 2005.
Print Version
Tell-a-Friend comments powered by Disqus
