LUNG CANCER: Study Shows Racial Disparities in Treatment
Researchers at New York's Sloan-Kettering Cancer Center have uncovered a 12.7% disparity among lung cancer surgery rates between whites and blacks. In a study published in the current New England Journal of Medicine, researchers determined that, of a test population of nearly 11,000 Medicare patients found to have early stage lung cancer, 76.7% of whites received surgical treatment while only 64% of blacks did. According to the New York Times, survival rates without surgery varied as well, with 34.1% of whites but only 26.4% of blacks surviving five years after diagnosis (Grady, 10/14). Peter Bach, lung specialist and epidemiologist at Sloan-Kettering, stated, "We believe the difference in surgical treatment accounts for more than half the difference in mortality. If they were treated equally, we expect that 31% of blacks would be alive at five years." The Wall Street Journal reports that lung cancer is the leading cause of death from cancer in the U.S. among all races, particularly for black men (Winslow, 10/14).
Who's to Blame?
Notably, explanations commonly offered for racial disparities in medical care -- differences in socio-economic status, insurance coverage, access to care and general health --don't hold for the NEJM research. All patients in the study were covered by the federal Medicare program, and researchers compared blacks and whites with similar socio-economic backgrounds and access to care. Bach notes, "This is not about access to care. We don't know why this is happening" (USA Today, 10/14). Dr. Harold Freeman of the President's Cancer Panel suggests that black patients "are disproportionately poor and less-educated. Doctors recommending major surgery might worry that such patients will follow directions such as taking medications and following clinic visits, and that their support systems at home may be insufficient for a good recovery" ("World News Tonight," ABC, 10/13). But Dr. Hugh Stallworth, national vice president of the American Cancer Society, said, "This study suggests that, possibly, physicians are treating cancer patients not just based upon their illness and recommended treatment, but on the basis of their race" (New York Times, 10/14).
The Sloan-Kettering study, however, is just the latest in a string of reports revealing that minorities receive, on average, less optimal medical care than do whites. A separate study released today by the Kaiser Family Foundation found that about 35% of blacks and 36% of Latinos believe that they have been unfairly treatment when seeking medical care, "specifically because of their race of ethnicity," (Winslow, 10/14). "So this is not new," Dr. Stallworth continued, "But each time we hear it, it's surprising and rather shocking, specifically as it relates to cancer. It's quite concerning." The study could not determine if doctors were less likely to recommend surgery to black patients, or if black patients were more likely to refuse surgical treatment. Yet Stallworth "can't believe that number of people would not avail themselves of the recommended treatment." He indicated that the surgical rate disparity could be due, at least in part, to communication gaps. He said, "We know that patients, black and white, feel more comfortable with physicians that are like them. ... And physicians relate better to patients who are more like them." While 12% of the United States population is black, only 4% of doctors are.
Stallworth explains, "What has been suggested is that we may need to look at our medical training programs and begin to introduce some type of cultural sensitivity." However, in an editorial accompanying the study in NEJM, Drs. Talmadge King and Paul Brunetta of the University of California-San Francisco question the feasibility of such measures. Dr. King said, "I think there's a very, very complex interaction we need to understand better so that we can partner with patients who may not feel comfortable interacting with us" (New York Times, 10/14). Moreover, the two physicians, observe that if the surgical disparity is even partially due to racial discrimination, "then the medical establishment begins to share a portion of the tobacco industry's culpability for the dismal outcome of patients with this disease,"(Bowman, Scripps Howard News Service/Nando Times, 10/14).