Racial disparities in surviving colon cancer driven more by health system than patient profile, Stanford study finds
African-American patients are less likely than whites to survive colon cancer and now researchers have found that those disparities are linked more to the quality of care received than previously thought.
Led by a Robert Wood Johnson Foundation Harold Amos Scholar at Stanford University School of Medicine, the study shows that when individuals from underrepresented groups receive colon cancer treatment within an integrated health system (in which a single organization provides the patient’s insurance, outpatient health services, and hospital-based care) they are more likely to survive. The study will appear in the Journal of Clinical Oncology.
“Our study findings turn the way we think about health disparities on its head,” said lead author Kim Rhoads, MD, MPH, assistant professor of colon and rectal surgery at Stanford. “This proves that rather than simply asking ourselves what’s wrong with the patient; are they poor, uninsured, etc., we need to ask ourselves whether we are providing the right quality of care.”
Colon cancer is the third leading cause of cancer-related deaths in the United States, but blacks die at significantly higher rates than whites. After evaluating more than 30,000 patients diagnosed and treated for colon cancer, researchers discovered that all patients, including those from underrepresented groups, had a survival advantage when they were treated in integrated settings. In nonintegrated settings, racial disparities were explained by differences in the delivery of evidence-based care rather than patient profile.
“We were surprised to discover that racial disparities in colon cancer survival were eliminated when patients were treated in integrated settings, but we were most excited to find that delivering evidence-based care could eliminate racial differences in all settings” said Rhoads. “This means that fixing colon cancer disparities is in our hands. We can improve outcomes for everyone and erase racial differences in colon cancer survival if we increase access to coordinated care and improve adherence to treatment guidelines.”
The study was co-authored by Manali Patel, MD, MPH, instructor of hematology and oncology at Stanford University and Yifei Ma, MS, biostatistician at the Stanford Cancer Institute, with senior author Laura Schmidt, PhD, MSW, MPH, professor of anthropology at the University of California, San Francisco Institute for Health Policy Studies.
Source: Robert Wood Johnson Foundation