BACKGROUND: American Indians/Alaskan Natives (AI/ANs) have the worst 5-year cancer survival of all racial/ethnic groups in the United States. Causes for this disparity are unknown. The authors of this report examined the receipt of cancer treatment among AI/AN patients compared with white patients. METHODS: This was a retrospective cohort study of 338,204 patients who were diagnosed at age ≥65 years with breast, colon, lung, or prostate cancer between 1996 and 2005 in the Surveillance, Epidemiology, and End Results-Medicare database. Nationally accepted guidelines for surgical and adjuvant therapy and surveillance were selected as metrics of optimal, guideline-concordant care. Treatment analyses compared AI/ANs with matched whites. RESULTS: Across cancer types, AI/ANs were less likely to receive optimal cancer treatment and were less likely to undergo surgery (P ≤ .025 for all cancers). Adjuvant therapy rates were significantly lower for AI/AN patients with breast cancer (P < .001) and colon cancer (P = .001). Rates of post-treatment surveillance also were lower among AI/ANs and were statistically significantly lower for AI/AN patients with breast cancer (P = .002) and prostate cancer (P < .001). Nonreceipt of optimal cancer treatment was associated with significantly worse survival across cancer types. Disease-specific survival for those who did not undergo surgery was significantly lower for patients with breast cancer (hazard ratio [HR], 0.62), colon cancer (HR, 0.74), prostate cancer (HR, 0.52), and lung cancer (HR, 0.36). Survival rates also were significantly lower for those patients who did not receive adjuvant therapy for breast cancer (HR, 0.56), colon cancer (HR, 0.59), or prostate cancer (HR, 0.81; all 95% confidence intervals were <1.0). CONCLUSIONS: Fewer AI/AN patients than white patients received guideline-concordant cancer treatment across the 4 most common cancers. Efforts to explain these differences are critical to improving cancer care and survival for AI/AN patients.
BACKGROUND: American Indians/Alaskan Natives (AI/ANs) have the worst 5-year cancer survival of all racial/ethnic groups in the United States. Causes for this disparity are unknown. The authors of this report examined the receipt of cancer treatment among AI/AN patients compared with white patients. METHODS: This was a retrospective cohort study of 338,204 patients who were diagnosed at age ≥65 years with breast, colon, lung, or prostate cancer between 1996 and 2005 in the Surveillance, Epidemiology, and End Results-Medicare database. Nationally accepted guidelines for surgical and adjuvant therapy and surveillance were selected as metrics of optimal, guideline-concordant care. Treatment analyses compared AI/ANs with matched whites. RESULTS: Across cancer types, AI/ANs were less likely to receive optimal cancer treatment and were less likely to undergo surgery (P ≤ .025 for all cancers). Adjuvant therapy rates were significantly lower for AI/AN patients with breast cancer (P < .001) and colon cancer (P = .001). Rates of post-treatment surveillance also were lower among AI/ANs and were statistically significantly lower for AI/AN patients with breast cancer (P = .002) and prostate cancer (P < .001). Nonreceipt of optimal cancer treatment was associated with significantly worse survival across cancer types. Disease-specific survival for those who did not undergo surgery was significantly lower for patients with breast cancer (hazard ratio [HR], 0.62), colon cancer (HR, 0.74), prostate cancer (HR, 0.52), and lung cancer (HR, 0.36). Survival rates also were significantly lower for those patients who did not receive adjuvant therapy for breast cancer (HR, 0.56), colon cancer (HR, 0.59), or prostate cancer (HR, 0.81; all 95% confidence intervals were <1.0). CONCLUSIONS: Fewer AI/AN patients than white patients received guideline-concordant cancer treatment across the 4 most common cancers. Efforts to explain these differences are critical to improving cancer care and survival for AI/AN patients.
Authors: Caprice C Greenberg; Stuart R Lipsitz; Bridget Neville; Haejin In; Nathanael Hevelone; Stacy A Porter; Christine Weeks; Ashish K Jha; Atul A Gawande; Deborah Schrag; Jane C Weeks Journal: Arch Surg Date: 2011-06-20
Authors: Kathleen Thiede Call; Donna D McAlpine; Pamela Jo Johnson; Timothy J Beebe; James A McRae; Yunjie Song Journal: Med Care Date: 2006-06 Impact factor: 2.983
Authors: Arden M Morris; Kevin G Billingsley; Awori J Hayanga; Barbara Matthews; Laura-Mae Baldwin; John D Birkmeyer Journal: J Natl Cancer Inst Date: 2008-05-13 Impact factor: 13.506
Authors: David K Espey; Xiao-Cheng Wu; Judith Swan; Charles Wiggins; Melissa A Jim; Elizabeth Ward; Phyllis A Wingo; Holly L Howe; Lynn A G Ries; Barry A Miller; Ahmedin Jemal; Faruque Ahmed; Nathaniel Cobb; Judith S Kaur; Brenda K Edwards Journal: Cancer Date: 2007-11-15 Impact factor: 6.860
Authors: Fa Chen; Fei Wang; Christina E Bailey; Harvey J Murff; Jordan D Berlin; Xiao-Ou Shu; Wei Zheng Journal: Am J Cancer Res Date: 2020-10-01 Impact factor: 6.166
Authors: Stacey Shiovitz; Aasthaa Bansal; Andrea N Burnett-Hartman; Andrew Karnopp; Scott V Adams; Victoria Warren-Mears; Scott D Ramsey Journal: Cancer Epidemiol Biomarkers Prev Date: 2015-05-18 Impact factor: 4.254
Authors: Sarah Hohl; Yamile Molina; Lisel Koepl; Kerri Lopez; Eric Vinson; Hannah Linden; Scott Ramsey Journal: Support Care Cancer Date: 2015-12-05 Impact factor: 3.603
Authors: Vlad V Simianu; Arden M Morris; Thomas K Varghese; Michael P Porter; Jeffrey A Henderson; Dedra S Buchwald; David R Flum; Sara H Javid Journal: Am J Surg Date: 2016-01-09 Impact factor: 2.565