Colorectal carcinoma in poor blacks

Abstract

BACKGROUNDDeath rates for most cancers continue to be higher for African Americans, particularly those in inner cities. Harlem Hospital serves a poor, predominantly African‐American community in New York City.METHODSTumor registry records for 615 patients treated for colorectal carcinoma at Harlem Hospital between 1973 and 1992 were reviewed.RESULTSOf the patients, 45.2% were male and 54.8% female, 97.2% were black, and 82% resided in Harlem. All patients were symptomatic at the time of diagnosis;15.3% were first diagnosed intraoperatively; 8.4% were in American Joint Committee on Cancer Stage I, 20.8% Stage II, 22.8% Stage III, 39.0% Stage IV, and 8.0% could not be staged. Colon resection with intention of cure was performed on 50.6%, 21.5% had palliative resection, and 11.6% had colostomy or other palliative surgery. Adjuvant chemotherapy or radiotherapy was given to 6.2%; 16.9% had no surgical treatment because of advanced stage, poor condition, or refusal of surgery; 12.7% presented with perforation or intestinal obstruction. Operative mortality was 15.3% overall and 10.6% for 311 patients who had surgery with intention of cure. Twenty‐five patients had local recurrence, 86 had subsequent distant metastases, and 33 patients had both local and distant recurrence. Forty‐nine patients (8%) were lost to follow‐up. The 5‐year crude survival rate for 615 patients was 18.7%. The relative survival rate was 19.7%, substantially lower than the national average for the same years.CONCLUSIONSAlthough colorectal carcinoma mortality continues to decline nationally, in this population of poor blacks the mortality rate remained high and unchanged. The most important cause of this is late presentation at an incurable stage, resulting from the combined effects of poverty, lack of education, and lack of access to primary care. Culturally sensitive educational programs and accessible health care systems for the poor are needed. Cancer 2002;94:2327–32. © 2002 American Cancer Society.DOI 10.1002/cncr.10486

African-American and Caucasian disparities in colorectal cancer mortality and survival by data source: An epidemiologic review

“…These include varied screening patterns [31,[49][50][51] [8][9][10]48], and differences in treatment offered or accepted [11,19,22,29,32,55,[58][59][60][61][62] including racial differences in the compliance of treatment regimens. In addition, socioeconomic [9,10,14,47] and sociodemographic [47,63] factors including education [12,62], religious involvement and social support [63,64], poverty level [12], insurance status [16], physical activity, obesity, and attitudes and beliefs [65] about cancer fatalism [66] may contribute to CRC racial disparities in survival.…”

“…According to the American Cancer Society, when CRC is detected at an early localized stage, the fiveyear relative survival rate is 90%; however, only 39% of CRCs are discovered at this stage [1]. Overall and stage specific five-year CRC survival rates are higher for Caucasians compared with African-Americans [1,5], and differences are largely attributable to the stage of disease at diagnosis [6][7][8][9][10][11][12]. African-Americans tend to present with an advanced disease stage and have a poorer clinical outcome than do Caucasians [7][8][9][13][14][15][16][17][18].…”

Establishing a General Medical Outpatient Clinic for Cancer Survivors in a Public City Hospital Setting

“…These individuals face unique challenges compared to others who have more resources: they are more likely to be diagnosed at a later stage and are less likely to have adequate general medical care and to receive needed psychosocial services. [8][9][10][11][12][13][14][15][16][17] Our public city hospital survivorship model combines oncology-related care with internal medicine services into one clinic staffed by medical internists with the goal of providing comprehensive long-term medical and psychosocial services to the multi-ethnic, low-income population of adult cancer survivors. Because of the late-stage diagnoses in our patient population and their complex non-cancer conditions, we chose not to limit the definition of "survivorship" to the post-treatment period as in the IOM report, but rather we incorporated the broader definition espoused by the National Cancer Institute and National Coalition of Cancer Survivors that defines survivors as all cancer patients from diagnosis forward.…”

Knowledge and perceptions of colorectal cancer screening among urban African Americans

“…[19][20][21][22] African Americans have exhibited higher rates of late-stage CRC diagnosis and less overall decline in colorectal deaths than whites over the past decade. [23][24][25] Barriers to CRC screening include the inconvenient or impractical nature of the tests, [26][27][28][29] the embarrassing or unpleasant nature of the tests, 28,29 fatalistic cancer beliefs, 30,31 and participants not wanting to know that something is wrong. 28,32,33 Studies of African Americans have shown that these barriers and others, such as lack of physician recommendation, limited CRC knowledge, and the uncomfortable nature of tests, may contribute to inadequate screening 16,[34][35][36] Although prior qualitative studies have explored how knowledge, socio-culturally mediated attitudes and perceptions, and testing preferences influence screening for breast and prostate cancer among African Americans, [37][38][39][40] few qualitative studies have been conducted with African Americans on CRC screening.…”