Treatment, Survival for Colon Cancer Differs by Race

November 19, 2013

By Andrew M. Seaman

NEW YORK (Reuters Health) Nov 19 - Black people with metastatic colorectal cancer are less likely to get consultations with specialists, as well as subsequent treatment with multimodality therapy, than white people, according to a new study.

Those treatment differences may explain why black patients with advanced colorectal cancer are more likely to die than their white counterparts, researchers suggest.

"This disparity in treatment does result in survival differences that are quite substantial," Dr. James Murphy told Reuters Health.

Murphy is the study's senior author and an assistant professor in the Department of Radiation Medicine and Applied Sciences at the University of California, San Diego.

Colon cancer is the second leading cause of cancer death in the U.S. Previous studies have found black people are more likely to develop colon cancer, have more advanced cancer when diagnosed and are more likely to die of the disease than patients of other races, Murphy and his colleagues note in a November 14 online report in the Journal of the National Cancer Institute.

They analyzed data on 9,935 white and 1,281 black patients with stage IV colorectal cancer from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.

All of the patients were at least 66 years old and were diagnosed between 2000 and 2007. The study followed them until they died or through 2009.

Compared to white patients, black patients were 10% less likely to undergo surgery to remove their primary tumors and 40% less likely to have liver- or lung-directed surgery. They were also 17% less likely to undergo chemotherapy and 30% less likely to have radiation.

White patients lived - on average - a little more than six months after being diagnosed. That compared to less than five months among black patients.

Overall, 95% of the patients died during the study period. Unadjusted survival analysis found a 15% higher chance of dying for black patients compared with white patients (hazard ratio 1.15; p<0.001).

Adjustment for patient, tumor, and demographic variables marginally reduced the risk of death (HR 1.08; p=0.03). After adjustment for differences in treatment, the increased risk of death for black patients disappeared.

"The findings are consistent with a lot of other findings in the cancer care literature," Sam Harper told Reuters Health. "We do see notable racial differences in survival and some of these do seem to be explained by differences in demographic factors and treatment differences."

Harper was not involved with the study but has researched racial disparities in cancer care as an assistant professor at McGill University in Montreal.

Murphy added, however, that his team's study cannot explain why the differences in treatment exist.

Differences in healthcare access, doctor biases and patient mistrust could play a role.

"I think the take-home point is that we need more research into treatment barriers to see how they can be overcome," Murphy said.

Harper agreed that more research is needed into why black patients and white patients have different treatment experiences.

"I think this continues to be an important question to focus on," he said.

Murphy said it's hard to know what patients can do to make sure they don't fall into the disparity gap.

"I think for providers just understanding that there is a disparity out there may make them aware and help reduce the disparity," he said. "But we do need more research to identify individual barriers."


J Natl Cancer Inst 2013.


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