Although the incidence and mortality of colon cancer in the U.S. has declined over the past two decades, African-Americans still suffer worse outcomes than do whites. Variations in treatment may contribute to the differences in mortality rate.
Ms. Caitlin Murphy, predoctoral fellow with the department of epidemiology at the University of North Carolina Gillings School of Global Public Health, led a recent study that randomly sampled patients diagnosed with stage III colon cancer.
Ms. Murphy is also a predoctoral fellow in the gastroenterology epidemiology training program at UNC’s School of Medicine. The program supported her travel to the National Cancer Institute, where she accessed the organization’s Surveillance, Epidemiology and End Results (SEER) cancer registries.
Examining six pools of patients from 1990, 1991, 1995, 2000, 2005 and 2010, Ms. Murphy and co-authors found significant differences, based upon race, as to which Stage III colon cancer patients received chemotherapy.
Chemotherapy treatment among both White and Black patients increased between 1990/1991 (White, 58 percent; African-American, 45 percent) and the year 2005 (White, 72 percent; African-American, 71 percent), but then decreased by the year 2010 (White, 66 percent; African-American, 57 percent).
[Photo: A UNC study found a disparity in the rates at which African-American and White stage III colon cancer patients received chemotherapy, a disparity likely due to differences in the ability to pay for the cancer treatment. Image courtesy of BET.]
There were marked racial disparities during 1990-1991 and again in 2010, with African-American patients less likely to receive chemotherapy as compared with white patients.
The overall study findings suggest that differences in whether chemotherapy is administered are likely not the result of differences in patient characteristics. Rather, the racial disparity seen in 2010 may reflect differences in the ability to pay for cancer treatment during the economic downturn that followed the 2008 financial crisis.
National expenditures for colorectal cancer were among the highest of all major cancer types in 2010, and African-Americans were affected disproportionately by the 2008 recession.
The role of insurance in the receipt of chemotherapy treatment is somewhat unclear, however. The researchers anticipated that differences in treatment would dissipate when comparing white and African-American patients with the same type of insurance, but analysis showed disparities at all levels of insurance coverage (private insurance, Medicare and Medicaid).
“We expected some of the differences in chemotherapy receipt to be explained by differences in insurance,” Ms. Murphy said. “Previous research has shown fewer Medicaid patients receive timely, guideline-recommended cancer therapies, and more African-American patients [than White patients] in our study had Medicaid. When we compared receipt of chemotherapy by race within each insurance category, however, the disparity persisted similarly across all types of insurance.”
Ms. Murphy said there also may be other differences between African-American and White patients that play important roles in treatment decisions. These might include underlying health status, patient preferences or variability in the burden of cost-sharing from premium and deductible expenses.
As insurance coverage and health policy continue to change under the Affordable Care Act, it is important to monitor the degree to which disparities in the receipt of cancer treatment remain. With a limited number of oncologists and an increasing number of patients with cancer, the ability of patients to find a physician willing to accept a particular type of insurance may continue to influence whether a cancer patient can receive chemotherapy treatment.
The full article, titled “Race and Insurance Differences in the Receipt of Adjuvant Chemotherapy Among Patients With Stage III Colon Cancer,” was published online July 6 in the Journal of Clinical Oncology.