Background
Reports indicate that blacks have lower survival following the diagnosis of a poor prognosis cancer, compared with whites. We explored the extent to which this disparity is attributable to the underuse of surgery.
Study Design
Using the SEER-Medicare database we identified 57,364 patients, ages ≥65, with a new diagnosis of non-metastatic liver, lung, pancreatic and esophageal cancer, from 2000-2005. We evaluated racial differences in resection rates after adjustment for patient, tumor and hospital characteristics, using hierarchical logistic regression. Cox proportional hazards regression was used to assess racial differences in survival, after adjusting for patient, tumor and hospital characteristics, and receipt of surgery.
Results
Compared with whites, blacks were less likely to undergo surgery for liver (adjusted OR [aOR], 0.49, 95%CI 0.29-0.83), lung (aOR 0.62 95%CI 0.56-0.69), pancreas (aOR 0.53, 95%CI 0.41-0.70) and esophagus cancers (aOR 0.64, 95%CI 0.42-0.99). Hospitals varied in their surgery rates among patients with potentially resectable disease. However, resection rates were consistently lower for blacks, regardless of the resection rate of the treating hospital. Although there were no racial differences in overall survival with liver and esophageal cancer, blacks experienced poorer survival for lung (adjusted HR [aHR]1.05, 95%CI 1.00-1.10) and pancreas cancer (aHR 1.15, 95%CI 1.03-1.30). In both instances, there were no residual racial disparities in overall survival after further adjusting for use of surgery.
Conclusions
Blacks are less likely to undergo surgery following the diagnosis of a poor prognosis cancer. Our findings suggest that surgery is an important predictor of overall mortality, and that efforts to reduce racial disparities will require stakeholders to gain a better understanding of why elderly blacks are less likely to get to the operating room.
