Now, a study by researchers at the Stanford University School of Medicine shows that more equitable delivery of evidence-based care can close this gap. Furthermore, the investigators found that evidence-based care was delivered at higher rates within integrated health-care organizations – those in which one organization provides all the patient’s health-care services, hospital care and insurance. The study reports that five-year death rates were lower for all colon cancer patients treated in an integrated health-care system, and the differences in survival by race were eliminated.
The study’s findings, published online in the Journal of Clinical Oncology, support the idea that providing equitable, high-quality, evidence-based care is a powerful tool in eliminating cancer-treatment disparities.
“Historically, we’ve taken less than a critical eye on our own health-care system in terms of how we can take the lead in addressing disparities,” said lead author Kim Rhoads, MD, MPH, assistant professor of surgery. “The big takeaway in this paper is that it’s treatment, not necessarily patient factors, but following evidence-based guidelines that gives all patients the best chance for survival. Our work also suggests a real opportunity to equalize these racial differences.”
Comparing massive amounts of data
Evidenced-based treatment guidelines for most cancers have been developed by the National Comprehensive Cancer Network. Recent studies suggest that minorities tend to receive cancer care from hospitals that adhere to the network’s guidelines at lower rates. Other studies show a clear relationship between the location of care, cancer deaths and racial disparities in survival. However, many cancer registries have no details about the types of treatment a patient receives. Rhoads and her fellow researchers combined cancer registry data, California hospital characteristics and patient-discharge data to compare details about patients’ cancer and survival rates with the hospitals’ financial and structural characteristics and details about the treatments the patient received.
“There was a unique opportunity to link data sets in such a way that you can look at this problem in a really different way,” said the study’s senior author, Laura Schmidt, PhD, MPH, professor of health policy at the University of California-San Francisco. Schmidt said Rhoads was one of the first to compare massive amounts of data about the patients’ cancer survival rates with hospital treatment records for all their patients.
How Do Integrated Health Care Systems Address Racial and Ethnic Disparities in Colon Cancer? Published online before print January 26, 2015, doi: 10.1200/JCO.2014.56.8642