Explaining Black–White Differences in Receipt of Recommended Colon Cancer Treatment

Baldwin, Laura Mae; Dobie, Sharon A.; Billingsley, Kevin G.; Cai, Yong; Wright, George E.; Dominitz, Jason A.; Barlow, William E.; Warren, Joan L.; Taplin, Stephen H.

doi:10.1093/jnci/dji241

Cited by 174 publications

(147 citation statements)

References 62 publications

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“…18 We can also learn from the causes evoked in studies on Black and White disparities. 48 Black individuals are more likely than white individuals to have a defeatist attitude toward medical illness, to experience stigma, fear and denial related to a cancer diagnosis, to mistrust the healthcare system, to have misperceptions about cancer and treatment benefits, to miss their medical visits and to be less participatory. Medical professionals may also have more difficulty to communicate, to present treatment enthusiastically, to provide care of high quality to black or low SES patients.…”

Section: Discussionmentioning

confidence: 99%

Social class is an important and independent prognostic factor of breast cancer mortality

Bouchardy

Verkooijen

Fioretta

2006

Intl Journal of Cancer

121

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Reasons of the important impact of socioeconomic status on breast cancer prognosis are far from established. This study aims to evaluate and explain the social disparities in breast cancer survival in the Swiss canton of Geneva, where healthcare costs and life expectancy are among the highest in the world. This populationbased study included all 3,920 female residents of Geneva, who were diagnosed with invasive breast cancer before the age of 70 years between 1980 and 2000. Patients were divided into 4 socioeconomic groups, according to the woman's last occupation. We used Cox multivariate regression analysis to identify reasons for the socioeconomic inequalities in breast cancer survival. Compared to patients of high social class, those of low social class had an increased risk (unadjusted hazard ratio [HR] 2.4, 95% CI: 1.6-3.5) of dying as a result of breast cancer. These women were more often foreigners, less frequently had screen-detected cancer and were at more advanced stage at diagnosis. They less frequently underwent breast-conserving surgery, hormonal therapy, and chemotherapy, in particular, in case of axillary lymph node involvement. When adjusting for all these factors, patients of low social class still had a significantly increased risk of dying of breast cancer (HR 1.8, 95% CI: 1.2-2.6). Overmortality linked to low SES is only partly explained by delayed diagnosis, unfavorable tumor characteristics and suboptimal treatments. Other factors, not measured in this study, also could play a role. While waiting for the outcome of other researches, we should consider socioeconomic status as an independent prognostic factor and provide intensified support and surveillance to women of low social class. ' 2006 Wiley-Liss, Inc.Key words: breast carcinoma; socioeconomic status; incidence; mortality; survivalIn North America and Western Europe, breast cancer accounts for more than 30% of new cancer cases and for 25% of cancer deaths among women. Breast cancer mortality rates are now decreasing because of the widely generalized use of mammography screening and the improvement in treatment. 1 Besides stage, tumor characteristics and treatment, only few factors are recognized as independent prognostic factors. Socioeconomic status (SES) could be one of them.Breast cancer occurs more frequently in wealthy countries 2 and among women with high SES. 3 This is partly due to a higher prevalence of breast cancer risk factors, such as older age at first pregnancy, low parity, high-calorie intake, sedentary occupation and use of hormonal replacement therapy in women with high SES. [3][4][5] On the other hand, breast cancer survival is in general lower in less affluent countries 6 and in women with low income or educational level. 3

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Section: Discussionmentioning

confidence: 99%

Social class is an important and independent prognostic factor of breast cancer mortality

Bouchardy

Verkooijen

Fioretta

2006

Intl Journal of Cancer

121

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“…Health disparities are an important public health concern with several studies documenting racial and socioeconomic disparities in screening, incidence, stage at diagnosis, and mortality 6,8,10,[14][15][16][17][18][19][20][21][22][23] . As physician recommendation is a key determinant of patients' acceptance of screening, adequate access may be an important contributor to disparity.…”

Section: Introductionmentioning

confidence: 99%

Higher Physician Density is Associated with Lower Incidence of Late-stage Colorectal Cancer

2010

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“…A number of studies have shown that older individuals with cancer are at risk for receiving less than optimal care [2][3][4]. In particular, several investigators have found that substantial percentages of older individuals with stage III (node-positive) colon cancer do not receive chemotherapy [5,6], and this is particularly marked among black elderly [5][6][7]. This is of great concern, because chemotherapy is associated with substantially better survival in stage III colon cancer [8][9][10][11][12][13], and the beneficial effects of chemotherapy are still apparent in older adults [8,14,15], at least up to age 80.…”

Section: Introductionmentioning

confidence: 99%

“…While there have been substantial numbers of studies of factors associated with less than definitive treatment of cancer [2][3][4][5]7], there have been few studies on factors associated with the appropriate evaluation of the newly diagnosed cancer patient. In this study we used the Surveillance Epidemiology and End Results (SEER)-Medicare linked database to examine factors associated with medical oncology consultation and the impact of such consultation on chemotherapy use.…”

Section: Introductionmentioning

confidence: 99%

Referral to Medical Oncology: A Crucial Step in the Treatment of Older Patients with Stage III Colon Cancer

Luo¹,

Giordano

Freeman

et al. 2006

The Oncologist

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Purpose. Adjuvant chemotherapy for stage III colon cancer produces a substantial survival benefit, but many older patients do not receive chemotherapy. This study examines factors associated with medical oncology consultation and evaluates the impact of such consultation on chemotherapy use.Patients and Methods. We used the Surveillance Epidemiology and End Results-Medicare linked database and identified 7,569 patients, aged 66-99, with stage III colon cancer diagnosed from 1992-1999. Modified Poisson regression was used to assess the relative risk for seeing a medical oncologist and for receiving chemotherapy as a function of individual characteristics.Results. 78.08% of patients saw a medical oncologist within 6 months of diagnosis. Patients who were female, white, married, had low comorbidity scores, were diagnosed in more recent years, or had four or more positive lymph nodes were more likely to see a medical oncologist. Patients seeing a medical oncologist were 10 times more likely to receive chemotherapy (odds ratio, 9.98; 95% confidence interval, 8.21-12.14), after controlling for demographic and tumor characteristics. Chemotherapy use increased over time, but was substantially lower among older, black, and unmarried patients.Conclusions. Referral to medical oncology is one of the most important factors associated with receipt of chemotherapy among older patients with stage III colon cancer. Comorbidity decreases the likelihood of receiving chemotherapy, but its effect is the same for those who see a medical oncologist and all patients combined. Ensuring that high-risk patients are referred to medical oncology is a crucial step in quality care for patients with colon cancer.

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Explaining Black–White Differences in Receipt of Recommended Colon Cancer Treatment

Cited by 174 publications

References 62 publications

Social class is an important and independent prognostic factor of breast cancer mortality

Social class is an important and independent prognostic factor of breast cancer mortality

Higher Physician Density is Associated with Lower Incidence of Late-stage Colorectal Cancer

Referral to Medical Oncology: A Crucial Step in the Treatment of Older Patients with Stage III Colon Cancer

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