Disparities Persist in Cancer Care

Studies show racial, socioeconomic gaps continue with breast, childhood cancers

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HealthDay Reporter

SUNDAY, June 3, 2007 (HealthDay News) -- Not every cancer patient is reaping the benefits of advances in medical care, new research shows.

Two studies presented Sunday at the American Society of Clinical Oncology meeting in Chicago show that race and socioeconomic status affect cancer prognosis, at least when it comes to breast cancer and some childhood cancers.

One report found that, although overall survival among women with metastatic breast cancer has improved over the past two decades, the survival gap between black and white women is widening. And children stricken with cancer in developing countries have a dramatically poorer prognosis than children in more developed nations, although a new program may narrow that difference.

About 180,000 women are diagnosed with breast cancer each year, and 5 percent to 10 percent of those already have metastatic disease, which has spread to other parts of the body. Median survival for these patients is 18 to 24 months.

A previous study found improving survival rates. This latest study extended that effort with a nationally representative sample of women.

The researchers looked at 15,438 women newly diagnosed with advanced breast cancer between 1988 and 2003. Information on the women was obtained from the U.S. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program. Patients were divided into three groups based on their time of diagnosis: 1988-1993, 1994-1998 and 1999-2003.

Overall, one-year survival increased from 62.9 percent to between 64.4 percent and 66.6 percent, for an absolute improvement of 3.7 percent, said senior study author Dr. Sharon Giordano, an assistant professor of breast medical oncology at the University of Texas M. D. Anderson Cancer Center in Houston. Median survival also increased, from 20 to 25 months.

However, for white women, survival improved from 20 months to between 22 and 27 months. For black women, survival remained essentially unchanged -- hovering close to 17 months during the entire study period.

Meanwhile, the survival gap between black and white women simply grew.

From 1988-93, one-year survival was 63.2 percent for white women and 60.4 percent for black women. In the second time period, it was 64.9 percent and 58.1 percent, respectively. In the last time period, it was 67.6 percent and 58.8 percent, respectively.

"The absolute difference in one-year survival between black and white women increased across the three time periods, from 2.8 percent to 6.8 percent to an 8.8 percent difference," Giordano said.

"The study showed moderate improvements in breast cancer survival over time for women with metastatic disease, but the disparity in survival is worsening over time," she continued. "Survival of non-Hispanic white women has improved, while survival of black women has remained unchanged."

Giordano did not know the reasons for the trend, but speculated that it could be access to care or earlier diagnosis in white women.

"The data suggests that the gap is widening, which I think is unique information and certainly very concerning," said Dr. Ramona Swaby, a medical oncologist specializing in breast cancer at Fox Chase Cancer Center in Philadelphia. "That definitely warrants attention. The progression from scientific discovery to fixing the problem is, first, attention."

"We've known about the disparities, but it was interesting that the disparities have just gotten wider over time when breast cancer treatment and earlier diagnostic modalities are more and more available," added Dr. Melanie Palomares, assistant professor of medical oncology and population sciences at City of Hope Cancer Center in Duarte, Calif. "Much more study needs to be done."

Another study found that a high proportion of black women with stage III breast cancer refused chemotherapy. "Everyone was given access and they found a lot of refusals," Palomares said. Although no reasons for the refusals were given, this may also play a part in differing outcomes.

Disparity in care was even greater with childhood cancers, according to other research presented at the meeting. A study showed that 80 percent of patients in developed countries were surviving their disease but only 20 percent of their peers in developing countries beat the odds. The good news: Initial results of a program in low-income and middle-income nations showed that a relatively modest monetary investment and external mentoring helped improve things.

The program, "My Child Matters," was created by the Geneva-based International Union Against Cancer and Sanofi-Aventis, with additional funding from the U.S. National Cancer Institute.

Another study presented at the meeting added insult to injury; using less intensive chemotherapy pushed the three-year overall survival rate for neuroblastomas in children to 96 percent. The survival rate for this same tumor is a dismal 10 percent in poorer nations.

During 2006, "My Child Matters" oversaw 14 pilot projects in Bangladesh, Egypt, Honduras, Morocco, Philippines, Senegal, Tanzania, Ukraine, Venezuela and Vietnam. After one year, the programs saw earlier detection, improved access to care , the introduction of psychosocial support, less abandonment and better follow-up. Each project received up to $67,000 annually.

As a result of these outcomes, 12 additional projects have been funded in Bolivia, Indonesia, Kenya, Mali, Peru and Romania.

"It's an issue of medical responsibility that we transfer care for kids with cancer. because we know how to treat cancer and we can transfer that knowledge," said study author Dr. Raul C. Ribeiro, of St. Jude Children's Research Hospital in Memphis, who is a member of the "My Child Matters" steering committee.

But the pain of childhood cancer does not end with treatment.

Another study presented at the meeting looked at long-term health-care utilization among childhood cancer survivors, and found that many are not receiving specialized health care after they beat their cancer.

Some two-thirds of childhood cancer survivors report some kind of chronic physical condition; in 28 percent, that condition is severe or life-threatening.

The Childhood Cancer Survivor Study found that 12 percent of childhood cancer survivors had not had any contact with the health-care system in the previous two years. Most of these people were uninsured, males or lower income. Fourteen percent reported receiving cancer-related care and 18 percent risk-based care.

Among patients at increased risk for cardiac problems or breast cancer, just 28 percent and 49 percent, respectively, reported having received an echocardiogram or mammogram, respectively.

"Our study probably overestimates the care being received, because this is a select group of patients who are probably more aware of their long-term risks," said study leader Dr. Paul Nathan, a staff oncologist at the Hospital for Sick Children in Toronto. "Overall, health-care utilization is below what we would have hoped."

More information

Visit the National Cancer Institute for more on childhood cancers.

SOURCES: June 3, 2007, American Society of Clinical Oncology press conference, with Sharon Giordano, M.D., assistant professor, breast medical oncology, University of Texas M. D. Anderson Cancer Center, Houston; Raul C. Ribeiro, M.D., director, international outreach program, St. Jude Children's Research Hospital, Memphis, and Paul Nathan, M.D., staff oncologist, Hospital for Sick Children, Toronto; Ramona Swaby, M.D., medical oncologist, Fox Chase Cancer Center, Philadelphia; Melanie Palomares, M.D., assistant professor of medical oncology and population sciences, City of Hope Cancer Center, Duarte, Calif.

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