Many blacks miss therapy for rectal cancer
By Julie Steenhuysen
CHICAGO (Reuters) - Blacks with rectal cancer are 23 percent less likely to get chemotherapy than whites, even when they see a cancer specialist, U.S. researchers said on Tuesday.
They also found that blacks were 12 percent less likely to get radiation therapy than whites. The study is the latest to show that blacks in the United States get less treatment for cancer than whites and are more apt to die from their cancers.
Both blacks and whites in the study saw cancer specialists at about the same rate, suggesting that reasons other than access to a specialist may be playing a role.
The finding came as a surprise to Dr. Arden Morris, a surgeon at the University of Michigan Medical School in Ann Arbor, who had expected to find blacks were not being referred to a cancer specialist after surgery as often as whites.
"I assumed they weren't getting recommendations," said Morris, whose study appears in the Journal of the National Cancer Institute.
Blacks are about 20 percent less likely to survive rectal cancers long term after surgery and the researchers were trying to see if lack of referrals was a factor.
Morris and colleagues studied Medicare records from 1992 to 1999 of elderly patients who had undergone surgery for rectal cancer. They collected data on age, gender, race and the use of a follow-up therapy such as radiation or chemotherapy.
They found no significant difference between the two groups in terms of how frequently they had consulted a cancer specialist.
But they did find that whites were more likely to consult both a medical oncologist, who might recommend chemotherapy, and a radiation oncologist, who treats tumors with radiation.
ONLY HALF GET CHEMO
Among people who saw an oncologist, only 54 percent of blacks received chemotherapy, compared with 70 percent of whites. The youngest, healthiest blacks in the study appeared to be least likely to get chemotherapy and blacks were less likely to get radiation therapy.
Use of treatments like chemotherapy or radiation help to boost survival from rectal cancer by as much as 20 percent.
"Unfortunately we are not getting immediate, concrete answers about what to do differently," Morris said in a telephone interview.
She said it is possible black patients are more likely to decline radiation or chemotherapy than whites because they feel a sense of hopelessness, do not trust doctors or are worried about the risks of side effects.
It is also possible that the doctors they see do not have as many resources as white patients and are inadvertently limiting care. A 2004 study in the New England Journal of Medicine found that 80 percent of black patients are getting care from just 20 percent of U.S. health providers.
Morris saw a similar pattern.
She found that 80 percent of black patients are seen in just 36 percent of U.S. hospitals. "That is a limited slice of hospitals," she said.
Morris plans to interview groups of people who have been treated for rectal cancer to find out what made them follow through with treatment.
"I'm hoping we will be able to discover more," she said.
The study was funded by the American Cancer Society and the National Cancer Institute.
(Editing by Maggie Fox and John O'Callaghan)