Mixed Race Studies

Evidence-based care eliminates racial disparity in colon cancer survival rates, study finds

Stanford Medicine News Center
2015-01-26

Lisa Marie Potter
Office of Communication & Public Affairs

A new study finds that equitable delivery of evidence-based care eliminates the racial disparity in colon-cancer survival rates.

For the past two decades, the National Cancer Institute has documented a persistent racial disparity in colon cancer survival rates in the United States.

African-American patients have consistently had lower survival rates when compared with white patients, despite a nationwide decline in colon cancer deaths overall.

Now, a study by researchers at the Stanford University School of Medicine shows that more equitable delivery of evidence-based care can close this gap. Furthermore, the investigators found that evidence-based care was delivered at higher rates within integrated health-care organizations — those in which one organization provides all the patient’s health-care services, hospital care and insurance. The study reports that five-year death rates were lower for all colon cancer patients treated in an integrated health-care system, and the differences in survival by race were eliminated.

The study’s findings, published online Jan. 26 in the Journal of Clinical Oncology, support the idea that providing equitable, high-quality, evidence-based care is a powerful tool in eliminating cancer-treatment disparities.

“Historically, we’ve taken less than a critical eye on our own health-care system in terms of how we can take the lead in addressing disparities,” said lead author Kim Rhoads, MD, MPH, assistant professor of surgery. “The big takeaway in this paper is that it’s treatment, not necessarily patient factors, but following evidence-based guidelines that gives all patients the best chance for survival. Our work also suggests a real opportunity to equalize these racial differences.”…

Read the entire press release here.

How Do Integrated Health Care Systems Address Racial and Ethnic Disparities in Colon Cancer?

Journal of Clinical Oncology
Published online: 2015-01-26
DOI: 10.1200/JCO.2014.56.8642

Kim F. Rhoads, Colon and rectal surgeon, Colorectal surgeon, Surgical oncologist; Assistant Professor of Surgery at the Stanford University Medical Center
Stanford Cancer Institute
Stanford University School of Medicine

Manali I. Patel, MD
Stanford Cancer Institute
Stanford University School of Medicine

Yifei Ma, Statistician
Stanford University School of Medicine

Laura A. Schmidt, Professor of Health Policy
Philip R. Lee Institute for Health Policy Studies
University of California, San Francisco

Presented as a poster at the American Society of Clinical Oncology Quality Care Symposium, San Diego, CA, November 30-December 1, 2012.

Purpose: Colorectal cancer (CRC) disparities have persisted over the last two decades. CRC is a complex disease requiring multidisciplinary care from specialists who may be geographically separated. Few studies have assessed the association between integrated health care system (IHS) CRC care quality, survival, and disparities. The purpose of this study was to determine if exposure to an IHS positively affects quality of care, risk of mortality, and disparities.

Patients and Methods: This retrospective secondary-data analysis study, using the California Cancer Registry linked to state discharge abstracts of patients treated for colon cancer (2001 to 2006), compared the rates of National Comprehensive Cancer Network (NCCN) guideline–based care, the hazard of mortality, and racial/ethnic disparities in an IHS versus other settings.

Results: More than 30,000 patient records were evaluated. The IHS had overall higher rates of adherence to NCCN guidelines. Propensity score–matched Cox models showed an independent and protective association between care in the IHS and survival (hazard ratio [HR], 0.87; 95% CI, 0.85 to 0.90). This advantage persisted across stage groups. Black race was associated with increased hazard of mortality in all other settings (HR, 1.15; 95% CI, 1.04 to 1.27); however, there was no disparity within the IHS for any minority group (P > .11 for all groups) when compared with white race.

Conclusion: The IHS delivered higher rates of evidence-based care and was associated with lower 5-year mortality. Racial/ethnic disparities in survival were absent in the IHS. Integrated systems may serve as the cornerstone for developing accountable care organizations poised to improve cancer outcomes and eliminate disparities under health care reform.

Read or purchase the article here.