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Hospital cancer care worse when whites are scarce

NEW YORK (Reuters Health) - Mortality is higher for breast and colon cancer patients treated at predominantly black hospitals, regardless of whether they themselves are black or white, according to a new study.
/ Source: Reuters

NEW YORK (Reuters Health) - Mortality is higher for breast and colon cancer patients treated at predominantly black hospitals, regardless of whether they themselves are black or white, according to a new study.

The findings help explain why African-Americans with breast cancer or colon cancer don't survive as long, on average, as their white counterparts, Dr. Arden M. Morris of the University of Michigan Medical School and the VA Ann Arbor Healthcare System and her colleagues note.

The findings also make it clear, they add, that improving hospital care must be a key element of efforts to tackle racial disparities in health.

In a previous study, Morris and her team found that black patients were more likely than white patients to die during surgery, "largely because they tended to undergo surgery at lower-quality hospitals," for example hospitals with higher mortality rates for people of any race.

In the current study, appearing in the Journal of Clinical Oncology, the researchers looked at whether hospitals might have an effect on death after patients underwent surgery.

They analyzed data on Medicare patients who had surgery for breast or colon cancer at 436 different hospitals from 1995 to 2005, including 25,571 breast cancer patients and 22,168 colon cancer patients. Roughly 10 percent were black.

Five years after breast cancer surgery, the researchers found, 62 percent of the black patients were still alive, compared to 70 percent of whites. For colon cancer, five-year survival was 41 percent for blacks and 45 percent for whites.

Once the researchers accounted for patients' age, whether or not they had other illnesses, and how advanced their disease was, they found that black patients with breast cancer were still 1.25 times more likely to die than whites, while mortality risk for black colon cancer patients was 1.13-fold greater.

But when the researchers looked at hospitals where more than 50 percent of patients were black, they found five-year mortality risk for breast cancer patients -- white or black --was 32 percent higher than for patients who received treatment at a hospital where less than 10 percent of patients were black.

For colon cancer patients, mortality risk was 27 percent greater for those treated at predominantly black hospitals.

One "expedient" way to help black patients get better cancer care would be to refer them to better hospitals, Morris and her team note.

But working to improve care at poor quality hospitals is a better solution, they say. They conclude: "Hospital-level quality improvement should be a major component of efforts to reduce disparities in cancer outcomes."

SOURCE: Journal of Clinical Oncology, August 20, 2009.