August 24, 2005

Why blacks less likely to have chemo still unclear

NEW YORK (Reuters Health) - A recent study showed that
black patients are much less likely than white patients to
receive recommended chemotherapy after surgery for advanced
colon cancer. A new study suggests that there is no single or
simple explanation for why this is so.

To try to understand the factors involved in black-white
differences in recommended colon cancer treatment, doctors took
a look-back at 5,294 black and white patients 66 years of age
or older who had surgery for advanced colon cancer. All of them
had Medicare health insurance, and therefore the same access to

Despite having an equal opportunity to learn about
chemotherapy from a medical specialist, blacks do not receive
this therapy at equal rates, Dr. Laura-Mae Baldwin from the
University of Washington in Seattle and colleagues report in
The Journal of the National Cancer Institute.

After surgery, nearly 80 percent of both black and white
patients consulted with a doctor specializing in chemotherapy.
But only about 59 percent of black patients who consulted with
an oncologist received chemotherapy compared with 70 percent of
white patients.

Baldwin's team acknowledges that they expected to find
several specific "health system" factors that could explain the
differences and that could be addressed to improve care, but
that was not the case.

Patients' age turned out to be one of the most important
factors associated with the black-white disparity in
chemotherapy use after colon cancer surgery. Among the
"youngest" elderly patients - those between 66 and 70 years of
age - roughly 66 percent of blacks had chemotherapy compared
with about 86 percent of whites. "This is worrisome," the
authors say, because the "young" elderly are most likely to
derive a survival benefit from chemotherapy.

Severity of illness, social support, and socioeconomic
environment explained roughly 27 percent of the black-white
disparity in the 66- to 70-year-old age group. Black patients
were sicker than white patients, stayed in the hospital longer
after surgery, and lived in areas with lower high school
graduation rates.

Poorer health status and less home support could affect a
doctor's likelihood of recommending chemotherapy or a patient's
perception of their ability to tolerate chemotherapy, the
authors suggest.

Health system factors accounted for just 12 percent of the
disparity in the "youngest" elderly category.

The authors think that developing strategies to educate and
communicate the risks and benefits of chemotherapy may help
diminish some of the black-white treatment differences.

The medical literature, they note, suggests that blacks are
more likely than whites to harbor a "fatalistic" attitude
toward medical illness, to experience stigma, fear, and denial
related to a cancer diagnosis and to have an aversion to
medical treatments. They may also be more likely to misperceive
post-op chemotherapy as merely a way to ease symptoms, rather
than add-on therapy that can improve the outcome.

SOURCE: The Journal of the National Cancer Institute August
17, 2005.