Table 3.
Studies focusing on Black-White differences in cancer-directed therapy.
| Years of study, Reference | Population | Outcome | Race Groupings | HR, 95% CI | Disparity |
|---|---|---|---|---|---|
| 1990-6 Banerjee et al. (39) |
KCC1
N=651 |
Racial differences in treatment –breast cancer | BCS2± RT3
vs. Mastectomy ± RT White vs. Black (ref) |
Multivariate Odds Ratios | No racial differences in Breast Conserving surgery vs. mastectomy however Black women with regional stage disease more likely to receive tamoxifen or chemotherapy. Multivariate adjustment included race, hormone receptor status, tumor size and grade, positive nodes, age at diagnosis, SES, insurance, marital status and comorbidities. |
| Localized | 0.81 (0.4-1.65) | ||||
| Regional | 1.65 (0.65-4.16) | ||||
| tamoxifen | |||||
| White vs. Black (ref) | |||||
| Localized | 0.85 (0.35-2.07) | ||||
| Regional | 4.59 (1.52-13.9) | ||||
| Chemotherapy White vs. Black (ref) | |||||
| Localized | 1.3 (0.52-3.26) | ||||
| Regional | 3.10 (1.09-8.81) | ||||
| 1996-2005 Simon et al. (40) |
HFHS4
N=2234 |
Racial differences in the use of and timing of adjuvant chemo-therapy- Breast | Chemo | Multivariate Odds Ratio | No Black-White differences in use or timing of adjuvant chemotherapy after adjusting for age, tumor characteristics comorbidities, and SES variables. |
| Black | 1.01 (0.72-1.42) | ||||
| White | Ref | ||||
| Chemo delay >60 days | |||||
| Black | 1.18 (0.8-1.74) | ||||
| White | Ref | ||||
| 1994-7 Du and Simon (18) |
KCC N=588 |
Racial differences in patterns and costs of care, stage 1-3 - Breast | Surgery (Black vs. White): | No Black-White differences in treatment or cost of care at the KCC. | |
| Lumpectomy | 97% vs. 96% | ||||
| Lumpectomy + RT | 82% vs. 76% | ||||
| Mastectomy + RT | 25% vs. 16% | ||||
| Chemotherapy | 41% vs. 42% | ||||
| Tamoxifen | 71% vs. 74% | ||||
| Mean 1-Year total treatment costs (Black vs. White) | $16,348 vs. | ||||
| $ 15,120 | |||||
| 2004-14 Beebe-Dimmer et al. (41) |
SEER5-Medicare N=8828 |
Treatment pattern by race - de novo stage IV prostate cancer; age ≥66yrs | No treatment: | Multivariable Odds Ratios | Black vs. White men more likely to have no treatment and more likely to have orchiectomy. |
| Black vs. White | 2.15 (1.7-2.71) | ||||
| Orchiectomy: | |||||
| Black vs. White | 10.1 vs. 6.1% | ||||
| 1988-1992 Schwartz et al. (27) |
DMA6-SEER: N=8679 |
Racial disparities in treatment, OS and DSS - prostate | Localized Black vs. White: | Black vs. White men less likely to have radical prostatectomy and more likely to have no treatment. | |
| Radical prostatectomy | 16 vs. 26% | ||||
| RT | 36 vs. 38% | ||||
| No treatment | 48 vs. 36% | ||||
| (p,0.001) | |||||
| Regional Black vs. White: | |||||
| Radical prostatectomy | 26% vs. 47% | ||||
| RT | 30% vs. 28% | ||||
| No treatment | 44% vs. 24% | ||||
| (p<0.001) | |||||
| 2009-10 Xu et al. (42) |
SEER-DMA N=260 |
Treatment choice for localized disease – prostate | Treatment choice: Black vs. White: | Multivariable Odds Ratio | Black men were less likely than White men to have surgery or radiation compared to watchful waiting, however there were no differences in choice of surgery or radiation by race. |
| Surgery vs. WW/AS7 | 0.42 (0.05-0.31) | ||||
| Radiation vs. WW/AS | 0.13 (0.02-0.69) | ||||
| Radiation vs. surgery | 0.31 (0.06-1.63) |
1KCC, Karmanos Cancer Center.
2BCS, Breast conserving surgery.
3RT, Radiation therapy.
4HFHS, Henry Ford Health System.
5SEER, Surveillance, Epidemiology and End Results.
6DMA, Detroit Metropolitan Area.
7WW/AS, Watchful waiting/active surveillance.