Survival of Blacks and Whites After a Cancer Diagnosis

Bach, Peter B.; Schrag, Deborah; Brawley, Otis W.; Galaznik, Aaron; Yakren, Sofia; Begg, Colin B.

doi:10.1001/jama.287.16.2106

Cited by 457 publications

(316 citation statements)

References 84 publications

Supporting

Mentioning

298

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 99%

Variations in gastric cancer care

Al‐Refaie

Virnig

Tseng

et al. 2009

Cancer

View full text Add to dashboard Cite

show abstract

“…Studies show that access to quality care and socioeconomic factors that limit access can have a significant role in cancer survival in men of different racial/ethnic backgrounds. 18,19 Potentially the lack of access to early detection programs and cancer screening explains part of the disparity in prostate cancer presentation. However, other investigators reported racial and ethnic disparities that persist after controlling for socioeconomic factors and access to medical care, and found that most cancer in this population is still detected by screening.…”

Section: Resultsmentioning

confidence: 99%

Disproportionate Presentation of High Risk Prostate Cancer in a Safety Net Health System

et al. 2010

View full text Add to dashboard Cite

Purpose: Most prostate cancer research is based on relatively homogenous cohorts of men, often with comparatively high socioeconomic status. We describe prostate cancer characteristics in men treated in a public health system and hypothesize a disproportionate burden of high risk disease in this population. Materials and Methods:We created a clinical registry from a review of the medical records of 377 men diagnosed with prostate cancer in the San Francisco General Hospital system, which provides care to underserved, uninsured populations. We compared sociodemographic data and cancer characteristics with those in 2 large prostate cancer databases from a community (CaPSURE™) and an academic (University of California-San Francisco tumor registry) setting to assess differences in risk distribution using the D'Amico and Cancer of the Prostate Risk Assessment scoring systems. Results: Compared to men in CaPSURE or the University of California-San Francisco tumor registry those in the San Francisco General Hospital cohort were nonwhite (76%), insured under Medicaid (31%) or uninsured (8%) and had adverse clinical characteristics, including median prostate specific antigen greater than 10 ng/ml at diagnosis and higher Gleason grade. In addition, the majority of patients (67%) had intermediate or high risk disease based on the D'Amico classification and a higher mean Cancer of the Prostate Risk Assessment score. Using ANOVA for continuous variables and the chi-square test for categorical variables, all comparisons were statistically significant (p Ͻ0.001). Conclusions: Men in the San Francisco General Hospital public health system bear a substantially higher burden of high risk disease that those in an academic or a community setting. Populations such as this would benefit most from targeted efforts for early detection and treatment to decrease prostate cancer morbidity and mortality.

show abstract

“…18,26 Blacks are more likely than whites to have aggressive histologic variants that result in a worse prognosis even with adjustment for grade, stage, and treatment. 18,23,26,27 Blacks are less likely to undergo definitive surgery, more likely to be treated by low-volume providers and in low-volume hospital settings, and more likely to experience adverse treatment-related outcomes. [28][29][30][31][32] While our data showed that black patients who accessed care were as equally likely as whites to undergo complete hematuria evaluations, our ability to identify differences in health system engagement between races is limited by the obvious selection bias inherent to claims data of insured individuals.…”

Section: Discussionmentioning

confidence: 99%