Racial Differences in the Treatment of Early-Stage Lung Cancer

Bach, Peter B.; Cramer, Laura D.; Warren, Joan L.; Begg, Colin B.

doi:10.1056/nejm199910143411606

Cited by 916 publications

(610 citation statements)

References 24 publications

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“…In striking contrast to studies that demonstrated an association between nonwhite race and inferior cancer care and, ultimately, unfavorable long-term survival, [14][15][16][17][18][19][20][21] we observed that nonwhite race predicted improved surgical care, as defined by adequate lymph node evaluation. Because African Americans and Hispanics tend to be uninsured and of lower socioeconomic status, it is possible that university centers are the likely providers of their surgical care: These findings are contrary to popular opinion.…”

Section: Discussioncontrasting

confidence: 99%

Variations in gastric cancer care

Al‐Refaie

Virnig

Tseng

et al. 2009

Cancer

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BACKGROUND:Race is associated with patterns of presentation and survival outcomes of gastric cancer in the United States. However, the impact of race on the receipt of guideline‐recommended care is not well characterized. By using current recommendations, the authors examined the association between race and guideline‐recommended treatments and identified factors that are predictive of variations in gastric cancer care.METHODS:By using the National Cancer Database for 1998 through 2005, 106,002 patients with gastric adenocarcinoma were identified. Multivariate analysis techniques were used to examine the association between race, the receipt of guideline‐recommended care, and survival after adjusting for covariates.RESULTS:Although African‐American and Hispanic patients were more likely to undergo adequate lymphadenectomy (≥15 lymph nodes) and to receive care at comprehensive cancer centers and high‐volume facilities (for all, P ≤ .001), they were less likely to receive adjuvant multimodality therapy for American Joint Committee on Cancer stage IB through IV, lymph node‐negative (M0) disease. Up to 60% of all patients who underwent gastrectomy failed to receive adequate lymphadenectomy and adjuvant multimodality therapy. The delivery of multimodality therapy varied significantly by stage and lymph node evaluation (P ≤ .001). These findings persisted on our multivariate analyses, indicating that African‐American and Hispanic patients received adequate lymph node evaluation (P ≤ .001), whereas they were associated with receiving no adjuvant multimodality therapy (P ≤ .025).CONCLUSIONS:There were significant variations in treatment for gastric cancer among ethnic groups in the United States. It was noteworthy that, although nonwhite race was associated with improved surgical care, gastric cancer care remained suboptimal overall. Cancer programs need to identify procedures to maximize the delivery of adequate gastric cancer care to all patients. Cancer 2010. © 2010 American Cancer Society.

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Section: Discussioncontrasting

confidence: 99%

Variations in gastric cancer care

Al‐Refaie

Virnig

Tseng

et al. 2009

Cancer

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“…First, almost all patients in this study were Caucasian. In the USA, the patients had different ethnic backgrounds and it has been demonstrated that differences in performing preoperative staging investigations, TNM stage and use of treatment modalities were not only present for SES but also for race (Klabunde et al, 1998;Bach et al, 1999;Merrill et al, 2000;Dominitz et al, 2002;Tomar et al, 2004;Ward et al, 2004;Steyerberg et al, 2005). As a consequence, race might be a more important factor compared to SES.…”

Section: Discussionmentioning

confidence: 99%

The role of socio-economic status in the decision making on diagnosis and treatment of oesophageal cancer in The Netherlands

et al. 2006

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In the United States (USA), a correlation has been demonstrated between socio-economic status (SES) of patients on the one hand, and tumour histology, stage of the disease and treatment modality of various cancer types on the other hand. It is unknown whether such correlations are also involved in patients with oesophageal cancer in The Netherlands. Between 1994 and 2003, 888 oesophageal cancer patients were included in a prospective database with findings on the diagnostic work-up and treatment of oesophageal cancer. Socio-economic status of patients was defined as the average net yearly income. Linear-by-linear association testing revealed that oesophageal adenocarcinoma was more frequently observed in patients with higher SES and squamous cell carcinoma in patients with lower SES (P ¼ 0.02). Multivariable logistic regression analysis showed no correlation between SES and staging procedures and preoperative TNM stage. The adjusted odds ratio (OR) for stent placement was 0.82 (95% CI 0.71 -0.95), indicating that with an increase in SES by 1200 h, the likelihood that a stent was placed declined by 18%. Patients with a higher SES more frequently underwent resection or were treated with chemotherapy (OR: 1.15; 95% CI 1.01 -1.32 and OR: 1.16; 95% CI 1.02 -1.32, respectively). Socio-economic factors are involved in oesophageal cancer in The Netherlands, as patients with a higher SES are more likely to have an adenocarcinoma and patients with a lower SES a squamous cell carcinoma. Moreover, the correlations between SES and different treatment modalities suggest that both patient and doctor determinants contribute to the decision on the most optimal treatment modality in patients with oesophageal cancer.

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“…Recent studies have demonstrated ethnic differences in survival rates of patients with lung, endometrial, and cervical carcinoma 1,6,8,[11][12][13][14][15][16] Most of these studies attribute this difference in survival rate to the greater percentage of AAs presenting at an advanced stage, having poor socioeconomic status with impediments to care. 1,6,8,[11][12][13][14] Other studies suggest an intrinsic genetic or social factor that may adversely affect cancer survival. 6,15,17 Mundt et al examined 555 patients with advanced invasive cervical carcinoma and found a decreased 8-year survival rate for AAs at 48% compared with 61% for Caucasians.…”

Section: Discussionmentioning

confidence: 99%

Equal care ensures equal survival for African‐American women with cervical carcinoma

Farley¹,

Hines²,

Taylor³

et al. 2001

Cancer

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BACKGOUND.It was the purpose of this study to investigate whether race is an independent prognostic factor in the survival of patients with cervical carcinoma in a health care system with minimal racial bias, and few barriers to access to care. METHODS. RESULTS.One thousand five hundred fifty-three patients were obtained for review.Sixty-five percent of patients were Caucasian, and 35% were minorities. Of the minorities, 29% were African Americans (AAs). Mean age of diagnosis was similar among AAs and Caucasians, 44 and 42 years, respectively. There was no statistically significant difference between the distribution of age, stage, grade, or histology between Caucasians and AAs. Forty-six percent of patients were treated with surgery and 56% with radiation therapy, with no difference in type of treatment between the Caucasian and AA groups. Five-and 10-year survival rates for Caucasians and AAs were 75%, and 76%, and 64% 65% (P ϭ 0.59), respectively. CONCLUSIONS.In an equal access, unbiased, nonracial environment, race is not an independent predictor of survival for patients with cervical carcinoma. This study has shown, for the first time to the authors' knowledge, that when they receive equal treatment for cervical carcinoma, AA women's survival can approach that of their nonminority counterparts (75% at 10 years). Cancer 2001;91:869 -73.

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Racial Differences in the Treatment of Early-Stage Lung Cancer

Cited by 916 publications

References 24 publications

Variations in gastric cancer care

Variations in gastric cancer care

The role of socio-economic status in the decision making on diagnosis and treatment of oesophageal cancer in The Netherlands

Equal care ensures equal survival for African‐American women with cervical carcinoma

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