African Americans die from cancer at higher rates than whites, studies have shown. Now, a new study led by Tracy Onega, PhD, MA, of Dartmouth Medical School finds that where patients are treated may partly explain these disparities in mortality.
In “Race versus place of service in mortality among Medicare beneficiaries with cancer,” published early online in the peer-reviewed journal, Cancer, Dartmouth researchers report that when patients of both races were treated at similar, specialized cancer care institutions, mortality rates were roughly equal. And importantly, there was a substantial decrease in the rate of deaths among African-Americans.
Onega and co-authors Eric J. Duell, PhD, MS; Xun Shi, PhD; Eugene Demidenko, PhD, and David C. Goodman, MD, MS, looked at records for more than 200,000 Medicare recipients treated for cancer between 1998 and 2003. The analysis focused on one- and three-year mortality for patients with lung, breast, colorectal, and prostate cancer. National Cancer Institute (NCI) comprehensive or clinical cancer centers were used to evaluate the influence of place of service, based on their standing as highly specialized cancer care settings. Of the sample population, 9 percent were African American. A higher proportion of African Americans attended NCI cancer centers than Caucasians (11.1% vs. 6.9%).
The researchers found that across all cancer care settings within the study population, the likelihood of dying from cancer or other causes at one year was 13 percent higher for African Americans. At three years, their risk was 23 percent higher than their Caucasian counterparts.
However, when the investigators looked only at patients who received care at NCI Cancer Centers, there were no significant racial differences in the likelihood of dying at one and three years after a cancer diagnosis. The same was true when comparing death rates among the African American study population; those receiving care at an NCI cancer center had lower death rates at one and three years than those treated elsewhere.
“We have known for some time that African Americans die from cancer at higher rates than Caucasians. The question is, why? This research shows that where patients are treated can influence those outcomes significantly,” Onega said. “The next step is to understand the components of treatment location that most dramatically affect differences in care, and ultimately outcomes, for all cancer patients.”
With the exception of Dr. Shi, who is a member of the Department of Geography at Dartmouth College, the authors are affiliated with the Dartmouth Institute for Health Policy and Clinical Practice. Drs. Onega, Duell, Demidenko and Goodman are members of Dartmouth-Hitchcock’s Norris Cotton Cancer Center, which is an NCI-designated comprehensive cancer center.
Article: “Race versus place of service in mortality among Medicare beneficiaries with cancer.” Tracy Onega, Eric J. Duell, Xun Shi, Eugene Demidenko, and David C. Goodman. Cancer; Published Online: March 22, 2010 (DOI: 10.1002/cncr.25097)