Differences between races in patients' likelihood of surviving cancer may stem from differences in access to chemotherapy or even to the doctors who prescribe it.
Examining the medical records of patients with lung cancer, a group of Harvard University researchers led by Dr Craig Earle of the Center for Outcomes and Policy Research at the Dana-Farber Cancer Institute, Boston, found that African Americans are less likely than other races to see an oncologist (Journal of Clinical Oncology 2002;7:1716-8).
In an earlier study the same group of researchers used data from the US National Cancer Institute to look at the use of chemotherapy in advanced non-small cell lung cancer. They found that only about a quarter of patients with non-small cell lung cancer who were of Medicare age received chemotherapy (Chest 2000;117:1239-46).
In the current study the researchers went on to ask whether the unexplained variation in the use of chemotherapy for advanced lung cancer was due to access to oncologists' services, rather than to treatment decisions made after a visit to an oncologist. They found that 73% of patients with non-small cell lung cancer were referred to a medical oncologist, although only 26% ultimately received chemotherapy.
Of the non-medical factors, level of education, income, and race played significant roles in whether a patient with advanced non-small cell lung cancer was referred to a medical oncologist. Overall, white patients were significantly more likely than non-white patients to be assessed by an oncologist (74% v 70% P<0.001), and white patients in higher socioeconomic groups were more likely than other groups to be seen by an oncologist and to receive chemotherapy. Black patients were significantly less likely than patients of other races to receive chemotherapy.
“Black race, probably acting as a proxy for lower socio-economic status, was associated with both a diminished likelihood of seeing a cancer specialist and subsequently receiving chemotherapy,” the authors write.
The current study adds to research indicating that inequalities in health outcomes may be related to African Americans having less access to certain kinds of care.
“Clearly, insurance is not the only factor leading to barriers in cancer care,” write Dr Alfred Neugut and Dr Victor Grann of the Herbert Irving Comprehensive Cancer Center at Columbia University's College of Physicians and Surgeons, New York, in an accompanying editorial.