Black patients less likely to receive guideline-concordant cancer care

Black cancer patients are less likely to receive guideline-concordant care than white counterparts, researchers reported in Advances in Radiation Oncology this month. These treatment disparities could have a profound impact on minority mortality rates.

First author Penny Fang, MD, and colleagues said in the journal that, while previous work has suggested gaps in care between white and non-white cancer patients, research into the phenomenon has lagged.

“Racial disparities in cancer treatment and outcomes have been demonstrated in several population-based studies, though targets for any interventions to improve disparities have been challenging to identify,” Fang and co-authors wrote. And, though cancer treatment guidelines have been developed to avoid disproportionate care, the problem is persisting.

Using SEER-Medicare data, Fang and her team evaluated more than 37,000 patients who had been diagnosed with either stage III breast, stage I or III non-small cell lung or stage III prostate cancer between 2006 and 2011. Using insurance claims, the research team identified patients’ chemo, surgery and radiation treatments.

Black patients received less guideline-concordant curative treatment than non-Hispanic whites, the authors reported. Black breast cancer patients were 8 percent less likely than white women to receive post-mastectomy radiation therapy. Black stage I non-small cell lung patients were 14 percent less likely than whites to receive either stereotactic radiation or surgery.

Men with stage III prostate cancer were also 13 percent more likely to receive radiation therapy or prostatectomy if they were white, Fang et al. said. Gaps in guideline concordance directly impacted racial mortality disparities.

“We found that the absolute magnitude of disparities in guideline concordance between black and white patients was generally consistent across disease sites, disease stages and across treatment modalities,” the researchers wrote. “These disparities in adherence to guidelines was between 5 percent and 14 percent, demonstrating underuse of curative treatments and guideline-concordant care in black compared with white patients across the board.”

Black patients were generally at a socioeconomic disadvantage, the study stated, because they were clinically more prone to medical comorbidities and were more likely to fall in lower income or education brackets. Still, the authors said overcoming socioeconomic treatment gaps is a feasible aim.

“Our results suggest that, despite these large baseline socioeconomic differences, overcoming treatment disparities is a targetable goal that could potentially help narrow the gap in outcomes between populations, at least among older patients,” they wrote. “Quality benchmarking of guideline-concordant care may represent an actionable target to improve disparities in receipt of curative cancer treatment and in disparities in survival outcomes.”