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Published in: World Journal of Surgery 4/2008

01-04-2008

Disparities in Oncologic Surgery

Authors: Caprice C. Greenberg, Jane C. Weeks, Steven C. Stain

Published in: World Journal of Surgery | Issue 4/2008

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Abstract

Surgical oncology is one of the most frequently studied surgical specialties with regard to disparities in quality of care. There is variation in the care received according to nonclinical factors such as age, race and ethnicity, education, income, and even geographic region. Differences exist with regard to who gets treatment, what treatment is received, and the outcomes of those treatments. Although the existence of such disparities is no longer in doubt, the etiology is still being investigated. Ongoing research and quality improvement initiatives move beyond the mere description of existing disparities in one of three ways: (1) identifying and understanding the factors that lead to disparities; (2) advancing available methods to measure and track disparities; and (3) developing an approach to improvement. In this article, we start out by offering a framework to describe potential factors that lead to disparities, using examples from surgical oncology. We then describe the approaches to measuring and tracking disparities that are being used in research and quality improvement. Finally, we attempt to illustrate how all of these factors interact and offer some potential strategies to close the gap and alleviate disparities within the discipline.
Literature
1.
go back to reference Bradley CJ, Given CW, Roberts C (2002) Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 94:490–496PubMed Bradley CJ, Given CW, Roberts C (2002) Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 94:490–496PubMed
2.
go back to reference Lathan CS, Neville BA, Earle CC (2006) The effect of race on invasive staging and surgery in non-small-cell lung cancer. J Clin Oncol 24:413–418PubMedCrossRef Lathan CS, Neville BA, Earle CC (2006) The effect of race on invasive staging and surgery in non-small-cell lung cancer. J Clin Oncol 24:413–418PubMedCrossRef
3.
go back to reference Morris AM, Billingsley KG, Baxter NN, et al. (2004) Racial disparities in rectal cancer treatment: a population-based analysis. Arch Surg 139:151–155, discussion 156PubMedCrossRef Morris AM, Billingsley KG, Baxter NN, et al. (2004) Racial disparities in rectal cancer treatment: a population-based analysis. Arch Surg 139:151–155, discussion 156PubMedCrossRef
4.
go back to reference Steyerberg EW, Earle CC, Neville BA, et al. (2005) Racial differences in surgical evaluation, treatment, and outcome of locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol 23:510–517PubMedCrossRef Steyerberg EW, Earle CC, Neville BA, et al. (2005) Racial differences in surgical evaluation, treatment, and outcome of locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol 23:510–517PubMedCrossRef
5.
go back to reference Cooper GS, Yuan Z, Landefeld CS, et al. (1996) Surgery for colorectal cancer: race-related differences in rates and survival among Medicare beneficiaries. Am J Public Health 86:582–586PubMed Cooper GS, Yuan Z, Landefeld CS, et al. (1996) Surgery for colorectal cancer: race-related differences in rates and survival among Medicare beneficiaries. Am J Public Health 86:582–586PubMed
6.
go back to reference Joslyn SA (2002) Racial differences in treatment and survival from early-stage breast carcinoma. Cancer 95:1759–1766PubMedCrossRef Joslyn SA (2002) Racial differences in treatment and survival from early-stage breast carcinoma. Cancer 95:1759–1766PubMedCrossRef
7.
go back to reference Christian CK, Niland J, Edge SB, et al. (2006) A multi-institutional analysis of the socioeconomic determinants of breast reconstruction: a study of the National Comprehensive Cancer Network. Ann Surg 243:241–249PubMedCrossRef Christian CK, Niland J, Edge SB, et al. (2006) A multi-institutional analysis of the socioeconomic determinants of breast reconstruction: a study of the National Comprehensive Cancer Network. Ann Surg 243:241–249PubMedCrossRef
8.
go back to reference Dolan JT, Granchi TS, Miller CC 3rd, et al. (1999) Low use of breast conservation surgery in medically indigent populations. Am J Surg 178:470–474PubMedCrossRef Dolan JT, Granchi TS, Miller CC 3rd, et al. (1999) Low use of breast conservation surgery in medically indigent populations. Am J Surg 178:470–474PubMedCrossRef
9.
go back to reference Gilligan MA, Kneusel RT, Hoffmann RG, et al. (2002) Persistent differences in sociodemographic determinants of breast conserving treatment despite overall increased adoption. Med Care 40:181–189PubMedCrossRef Gilligan MA, Kneusel RT, Hoffmann RG, et al. (2002) Persistent differences in sociodemographic determinants of breast conserving treatment despite overall increased adoption. Med Care 40:181–189PubMedCrossRef
10.
go back to reference Michalski TA, Nattinger AB (1997) The influence of black race and socioeconomic status on the use of breast-conserving surgery for Medicare beneficiaries. Cancer 79:314–319PubMedCrossRef Michalski TA, Nattinger AB (1997) The influence of black race and socioeconomic status on the use of breast-conserving surgery for Medicare beneficiaries. Cancer 79:314–319PubMedCrossRef
11.
go back to reference Roetzheim RG, Gonzalez EC, Ferrante JM, et al. (2000) Effects of health insurance and race on breast carcinoma treatments and outcomes. Cancer 89:2202–2213PubMedCrossRef Roetzheim RG, Gonzalez EC, Ferrante JM, et al. (2000) Effects of health insurance and race on breast carcinoma treatments and outcomes. Cancer 89:2202–2213PubMedCrossRef
12.
go back to reference Rogers A, Flowers J, Pencheon D (1999) Improving access needs a whole systems approach. BMJ 319:866–867PubMed Rogers A, Flowers J, Pencheon D (1999) Improving access needs a whole systems approach. BMJ 319:866–867PubMed
13.
go back to reference Gold M, Stevens B (1998) Measuring access to care through population-based surveys in a managed care environment. Synopsis and priorities for future efforts. Health Serv Res 33(3 Pt 2):611–624PubMed Gold M, Stevens B (1998) Measuring access to care through population-based surveys in a managed care environment. Synopsis and priorities for future efforts. Health Serv Res 33(3 Pt 2):611–624PubMed
14.
go back to reference Gulliford M, Figueroa-Munoz J, Morgan M , et al. (2002) What does “access to health care” mean? J Health Serv Res Policy 7:186–188PubMedCrossRef Gulliford M, Figueroa-Munoz J, Morgan M , et al. (2002) What does “access to health care” mean? J Health Serv Res Policy 7:186–188PubMedCrossRef
15.
go back to reference Basu J, Clancy C (2001) Racial disparity, primary care, and specialty referral. Health Serv Res 36(6 Pt 2):64–77PubMed Basu J, Clancy C (2001) Racial disparity, primary care, and specialty referral. Health Serv Res 36(6 Pt 2):64–77PubMed
16.
go back to reference Lucas FL, Stukel TA, Morris AM, et al. (2006) Race and surgical mortality in the United States. Ann Surg 243:281–286PubMedCrossRef Lucas FL, Stukel TA, Morris AM, et al. (2006) Race and surgical mortality in the United States. Ann Surg 243:281–286PubMedCrossRef
17.
go back to reference Bach PB, Pham HH, Schrag D, et al. (2004) Primary care physicians who treat blacks and whites. N Engl J Med 351:575–584PubMedCrossRef Bach PB, Pham HH, Schrag D, et al. (2004) Primary care physicians who treat blacks and whites. N Engl J Med 351:575–584PubMedCrossRef
18.
go back to reference Bradley CJ, Given CW, Roberts C (2001) Disparities in cancer diagnosis and survival. Cancer 91:178–188PubMedCrossRef Bradley CJ, Given CW, Roberts C (2001) Disparities in cancer diagnosis and survival. Cancer 91:178–188PubMedCrossRef
19.
go back to reference Roetzheim RG, Pal N, Tennant C, et al. (1999) Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst 91:1409–1415PubMedCrossRef Roetzheim RG, Pal N, Tennant C, et al. (1999) Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst 91:1409–1415PubMedCrossRef
20.
go back to reference Schrijvers CT, Coebergh JW, Mackenbach JP (1997) Socioeconomic status and comorbidity among newly diagnosed cancer patients. Cancer 80:1482–1488PubMedCrossRef Schrijvers CT, Coebergh JW, Mackenbach JP (1997) Socioeconomic status and comorbidity among newly diagnosed cancer patients. Cancer 80:1482–1488PubMedCrossRef
21.
go back to reference Tammemagi CM, Nerenz D, Neslund-Dudas C, et al. (2005) Comorbidity and survival disparities among black and white patients with breast cancer. JAMA 294:1765–1772PubMedCrossRef Tammemagi CM, Nerenz D, Neslund-Dudas C, et al. (2005) Comorbidity and survival disparities among black and white patients with breast cancer. JAMA 294:1765–1772PubMedCrossRef
22.
go back to reference Mulley AG Jr (2006) Developing skills for evidence-based surgery: ensuring that patients make informed decisions. Surg Clin North Am 86:181–192, xiPubMedCrossRef Mulley AG Jr (2006) Developing skills for evidence-based surgery: ensuring that patients make informed decisions. Surg Clin North Am 86:181–192, xiPubMedCrossRef
23.
go back to reference Sepucha KR, Fowler FJ Jr, Mulley AG Jr (2004) Policy support for patient-centered care: the need for measurable improvements in decision quality. Health Aff (Millwood) Suppl Web Exclusives:VAR54-62 Sepucha KR, Fowler FJ Jr, Mulley AG Jr (2004) Policy support for patient-centered care: the need for measurable improvements in decision quality. Health Aff (Millwood) Suppl Web Exclusives:VAR54-62
24.
go back to reference Dein S (2004) Explanatory models of and attitudes towards cancer in different cultures. Lancet Oncol 5:119–124PubMedCrossRef Dein S (2004) Explanatory models of and attitudes towards cancer in different cultures. Lancet Oncol 5:119–124PubMedCrossRef
25.
go back to reference Jones C (2002) The impact of racism on health. Ethn Dis 12:S2–10–3PubMed Jones C (2002) The impact of racism on health. Ethn Dis 12:S2–10–3PubMed
26.
go back to reference Whaley AL (2003) Ethnicity/race, ethics, and epidemiology. J Natl Med Assoc 95:736–742PubMed Whaley AL (2003) Ethnicity/race, ethics, and epidemiology. J Natl Med Assoc 95:736–742PubMed
27.
go back to reference Rathore SS, Krumholz HM (2004) Differences, disparities, and biases: clarifying racial variations in health care use. Ann Intern Med 141:635–638PubMed Rathore SS, Krumholz HM (2004) Differences, disparities, and biases: clarifying racial variations in health care use. Ann Intern Med 141:635–638PubMed
28.
go back to reference Gordon HS, Street RL Jr, Sharf BF, et al. (2006) Racial differences in trust and lung cancer patients’ perceptions of physician communication. J Clin Oncol 24:904–909PubMedCrossRef Gordon HS, Street RL Jr, Sharf BF, et al. (2006) Racial differences in trust and lung cancer patients’ perceptions of physician communication. J Clin Oncol 24:904–909PubMedCrossRef
29.
go back to reference Johnson RL, Roter D, Powe NR, et al. (2004) Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health 94:2084–2090PubMedCrossRef Johnson RL, Roter D, Powe NR, et al. (2004) Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health 94:2084–2090PubMedCrossRef
30.
go back to reference Bird ST, Bogart LM (2001) Perceived race-based and socioeconomic status(SES)-based discrimination in interactions with health care providers. Ethn Dis 11:554–563PubMed Bird ST, Bogart LM (2001) Perceived race-based and socioeconomic status(SES)-based discrimination in interactions with health care providers. Ethn Dis 11:554–563PubMed
31.
go back to reference Keating NL, Weeks JC, Borbas C, et al. (2003) Treatment of early stage breast cancer: do surgeons and patients agree regarding whether treatment alternatives were discussed? Breast Cancer Res Treat 79:225–231PubMedCrossRef Keating NL, Weeks JC, Borbas C, et al. (2003) Treatment of early stage breast cancer: do surgeons and patients agree regarding whether treatment alternatives were discussed? Breast Cancer Res Treat 79:225–231PubMedCrossRef
32.
go back to reference Ayanian JZ, Zaslavsky AM, Guadagnoli E, et al. (2005) Patients’ perceptions of quality of care for colorectal cancer by race, ethnicity, and language. J Clin Oncol 23:6576–6586PubMedCrossRef Ayanian JZ, Zaslavsky AM, Guadagnoli E, et al. (2005) Patients’ perceptions of quality of care for colorectal cancer by race, ethnicity, and language. J Clin Oncol 23:6576–6586PubMedCrossRef
33.
go back to reference Dignam JJ (2001) Efficacy of systemic adjuvant therapy for breast cancer in African-American and Caucasian women. J Natl Cancer Inst Monogr 30:36–43PubMed Dignam JJ (2001) Efficacy of systemic adjuvant therapy for breast cancer in African-American and Caucasian women. J Natl Cancer Inst Monogr 30:36–43PubMed
34.
go back to reference Earle CC, Neville BA (2004) Under use of necessary care among cancer survivors. Cancer 101:1712–1719PubMedCrossRef Earle CC, Neville BA (2004) Under use of necessary care among cancer survivors. Cancer 101:1712–1719PubMedCrossRef
35.
go back to reference Eberhard DA, Johnson BE, Amler LC, et al. (2005) Mutations in the epidermal growth factor receptor and in KRAS are predictive and prognostic indicators in patients with non-small-cell lung cancer treated with chemotherapy alone and in combination with erlotinib. J Clin Oncol 23:5900–5999PubMedCrossRef Eberhard DA, Johnson BE, Amler LC, et al. (2005) Mutations in the epidermal growth factor receptor and in KRAS are predictive and prognostic indicators in patients with non-small-cell lung cancer treated with chemotherapy alone and in combination with erlotinib. J Clin Oncol 23:5900–5999PubMedCrossRef
36.
go back to reference Freedland SJ, Isaacs WB (2005) Explaining racial differences in prostate cancer in the United States: sociology or biology? Prostate 62:243–252PubMedCrossRef Freedland SJ, Isaacs WB (2005) Explaining racial differences in prostate cancer in the United States: sociology or biology? Prostate 62:243–252PubMedCrossRef
37.
go back to reference Mitsudomi T, Kosaka T, Endoh H, et al. (2005) Mutations of the epidermal growth factor receptor gene predict prolonged survival after gefitinib treatment in patients with non-small-cell lung cancer with postoperative recurrence. J Clin Oncol 23:2513–2520PubMedCrossRef Mitsudomi T, Kosaka T, Endoh H, et al. (2005) Mutations of the epidermal growth factor receptor gene predict prolonged survival after gefitinib treatment in patients with non-small-cell lung cancer with postoperative recurrence. J Clin Oncol 23:2513–2520PubMedCrossRef
38.
go back to reference Zhang X, Chang A (2007) Somatic mutations of the epidermal growth factor receptor and non-small-cell lung cancer. J Med Genet 44:166–172PubMedCrossRef Zhang X, Chang A (2007) Somatic mutations of the epidermal growth factor receptor and non-small-cell lung cancer. J Med Genet 44:166–172PubMedCrossRef
39.
go back to reference Stewart JH (2001) Lung carcinoma in African Americans: a review of the current literature. Cancer 91:2476–2482PubMedCrossRef Stewart JH (2001) Lung carcinoma in African Americans: a review of the current literature. Cancer 91:2476–2482PubMedCrossRef
42.
go back to reference Bach PB, Guadagnoli E, Schrag D, et al. (2002) Patient demographic and socioeconomic characteristics in the SEER-Medicare database applications and limitations. Med Care 40(8 Suppl):IV–19–25CrossRef Bach PB, Guadagnoli E, Schrag D, et al. (2002) Patient demographic and socioeconomic characteristics in the SEER-Medicare database applications and limitations. Med Care 40(8 Suppl):IV–19–25CrossRef
44.
go back to reference Eberl MM, Watroba N, Reinhardt M, et al. (2007) Linked claims and medical records for cancer case management: evaluation of mammography abnormalities. Cancer 110:518–524PubMedCrossRef Eberl MM, Watroba N, Reinhardt M, et al. (2007) Linked claims and medical records for cancer case management: evaluation of mammography abnormalities. Cancer 110:518–524PubMedCrossRef
45.
go back to reference Hillner BE, McDonald MK, Desch CE, et al. (1998) A comparison of patterns of care of nonsmall cell lung carcinoma patients in a younger and Medigap commercially insured cohort. Cancer 83:1930–1937PubMedCrossRef Hillner BE, McDonald MK, Desch CE, et al. (1998) A comparison of patterns of care of nonsmall cell lung carcinoma patients in a younger and Medigap commercially insured cohort. Cancer 83:1930–1937PubMedCrossRef
46.
go back to reference West CN, Geiger AM, Greene SM, et al. (2005) Race and ethnicity: comparing medical records to self-reports. J Natl Cancer Inst Monogr 35:72–74PubMedCrossRef West CN, Geiger AM, Greene SM, et al. (2005) Race and ethnicity: comparing medical records to self-reports. J Natl Cancer Inst Monogr 35:72–74PubMedCrossRef
49.
go back to reference Smedley BD, Stith AY, Nelson AR (eds) (2003) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press, Washington, DC Smedley BD, Stith AY, Nelson AR (eds) (2003) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press, Washington, DC
50.
go back to reference Thomson GE, Mitchell F, Williams M (editors) (2006) Committee on the Review and Assessment of the NIH’s Strategic Research Plan and Budget to Reduce and Ultimately Eliminate Health Disparities. Examining the Health Disparities Research Plan of the National Institutes of Health: Unfinished Business, Washington, DC, National Academies Press Thomson GE, Mitchell F, Williams M (editors) (2006) Committee on the Review and Assessment of the NIH’s Strategic Research Plan and Budget to Reduce and Ultimately Eliminate Health Disparities. Examining the Health Disparities Research Plan of the National Institutes of Health: Unfinished Business, Washington, DC, National Academies Press
51.
go back to reference Brawley OW, Freeman HP (1999) Race and outcomes: is this the end of the beginning for minority health research?. J Natl Cancer Inst 191:1908–1909CrossRef Brawley OW, Freeman HP (1999) Race and outcomes: is this the end of the beginning for minority health research?. J Natl Cancer Inst 191:1908–1909CrossRef
52.
go back to reference Ayanian JZ, Chrischilles EA, Fletcher RH, et al. (2004) Understanding cancer treatment and outcomes: the Cancer Care Outcomes Research and Surveillance Consortium. J Clin Oncol 22:2992–2996PubMedCrossRef Ayanian JZ, Chrischilles EA, Fletcher RH, et al. (2004) Understanding cancer treatment and outcomes: the Cancer Care Outcomes Research and Surveillance Consortium. J Clin Oncol 22:2992–2996PubMedCrossRef
Metadata
Title
Disparities in Oncologic Surgery
Authors
Caprice C. Greenberg
Jane C. Weeks
Steven C. Stain
Publication date
01-04-2008
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 4/2008
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-007-9383-x

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