San Francisco—Differences in how various groups of patients with colorectal cancer interact with the health care system may help explain why survival rates for this cancer are lower among blacks than whites, according to research presented at the annual meeting of the Surgical Outcomes Club, held in conjunction with the American College of Surgeons Clinical Congress.
Although numerous studies have documented that racial disparities in the outcomes of cancer care are a persistent and vexing aspect of health care delivery, few have explained why such disparities exist. In part, this relates to the limitations of quantitative methods traditionally used for health care outcomes research, which focus on measuring differences in outcomes and associated factors but do not explain the influence of patients’ relationships with health care professionals and health care systems. To better understand how these relationships explain disparate outcomes, Arden Morris, MD, chief of colorectal surgery at the University of Michigan, and colleagues incorporated a qualitative approach to a study of racial disparities in treatment and outcomes for patients with stage 3 colorectal cancer.
Although survival is similarly poor among blacks and whites for pancreatic, lung, and esophageal cancers, survival differences are much more pronounced for intermediate-prognosis cancers, which have outcomes that are particularly sensitive to treatment, explained Morris. For example, the 5-year survival for colon, bladder, and uterine cancer is as much as 20% lower for black patients relative to whites. For colon cancer, Morris found, black patients were much less likely than white patients to receive evidence-based treatment.
“Based on our data, all subpopulations are undertreated, but black patients are more undertreated than others,” Morris said. “After adjusting for numerous patient, provider, and hospital characteristics, a statistically significant difference in use of care persisted among black and white patients who had health insurance.”
Using qualitative methods—focus group and semistructured interview techniques—to better explain this phenomenon among patients with stage 3 colorectal cancer, Morris found important differences in how patients interact with the health care system that might help explain why use of care and subsequent outcomes are worse among blacks than whites. In general, trust in health care professionals and the health care system was lower among black patients than white patients, and this lack of trust resulted in a lower likelihood of black patients accepting recommendations for chemotherapy.
In addition, the researchers found that less affluent patients, who were often black, also tended to perceive that time away from work related to chemotherapy would interfere with their ability to provide for their families. In contrast, white and more affluent patients thought that chemotherapy offered a better chance of survival that would in the long run result in a greater likelihood for them to support their families.