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Racial, insurance disparities influence chemotherapy receipt for colon cancer
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Racial disparities in adjuvant chemotherapy receipt have recently reemerged among patients with stage III colon cancer, according to study results.
The researchers attributed these declines in the use of chemotherapy to economic downturn and an increase in Medicaid coverage.
Although the incidence of and mortality rates from colon cancer have declined since 1990 in the U.S., black patients continue to experience worse outcomes compared with white patients, according to study background.
“The NCI’s population-based patterns of care studies are an incredible resource that provide the opportunity to better understand how cancer treatment is delivered outside the confines of clinical trials,” Caitlin C. Murphy, MPH, CPH, pre-doctoral fellow in the department of epidemiology at the Gillings School of Public Health at the University of North Carolina at Chapel Hill, told HemOnc Today. “We had the unique opportunity to examine both treatment disparities and if and how disparities have changed over time.”
Caitlin C. Murphy
Murphy and colleagues randomly sampled patients diagnosed with stage III colon cancer in the years 1990, 1991, 1995, 2000, 2005 and 2010 using SEER registries. The analysis included 835 non-Hispanic white patients (mean age, 70.4 years) and 384 black patients (mean age, 64.8 years).
More white patients had private insurance (78.6% vs. 61.9%), whereas more black patients had Medicare (21.1% vs. 16.6%) or Medicaid (17% vs. 4.8%).
Adjuvant chemotherapy receipt increased among all patients between 1990 and 1991 (white, 58%; black, 45%), and that increase persisted through 2005 (white, 72%; black, 71%). However, chemotherapy receipt decreased in 2010 (white, 66%; black, 57%).
Analyses adjusted for age, comorbidity, insurance and year of diagnosis indicated black patients were less likely to receive adjuvant chemotherapy than white patients (RR = 0.82; 95% CI, 0.72-0.93).
Among black patients, adjuvant chemotherapy receipt did not differ whether patients had private insurance (RR = 0.8; 95% CI, 0.69-0.93), Medicare (RR = 0.84; 95% CI, 0.69-1.02) or Medicaid (RR = 0.84; 95% CI, 0.69-1.02). However, a greater proportion of black patients utilized Medicaid during all years of the study compared with white patients.
The researchers acknowledged limitations of their study, including their inability to ascertain patient and physician treatment preferences. Further, the study excluded uninsured patients, which may have affected overall outcomes.
“It is important to monitor the extent to which treatment disparities have persisted since 2010,” Murphy said. “The types of chemotherapy drugs available to patients — and their costs — continue to change. A key next step is to better understand how changes in insurance coverage and health policy will impact disparities in cancer treatment.” – by Cameron Kelsall
For more information:
Caitlin C. Murphy, MPH, CPH, can be reached at the Gillings School of Public Health at The University of North Carolina at Chapel Hill, 170 Rosenau Hall CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599; email: ccmurphy@email.unc.edu.
Disclosure: The researchers report no relevant financial disclosures.
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