Blacks not receiving chemotherapy for rectal cancer, despite seeing cancer specialists, U-M study finds

Arden M. Morris, M.D., M.P.H. Assistant Professor of Surgery University of Michigan Health System 2920G Taubman Health Center 1500 East Medical Center Drive Ann Arbor, MI 48109-5331 e-mail: ammsurg@umich.edu Arden Morris, MD is an Assistant Professor of Surgery in the Division of Colorectal Surgery. Dr. Morris graduated from the University of Pennsylvania with a B.A. in mathematics. She received her M.D. degree from Rush Medical College in Chicago in 1993 and went on to complete her General Surgery residency at the Oregon Health Sciences University in Portland Oregon. From 2000 to 2002, Dr. Morris was a Robert Wood Johnson Clinical Scholar and earned a Masters of Public Health degree at the University of Washington in Seattle. She completed a fellowship in Colon and Rectal Surgery at the University of Minnesota in June of 2003. Dr. Morris joined the faculty at the University of Michigan in July 2004. Dr. Morris has won numerous awards for presentations at scientific meetings. Her primary research interests have focused on racial disparities in surgical outcomes and on the quality of surgical care.

ANN ARBOR, Mich. – Black patients and white patients are seeing rectal cancer specialists at similar rates, but blacks are still less likely to receive chemotherapy or radiation therapy, according to a new study from the University of Michigan Comprehensive Cancer Center. The study found blacks were 23 percent less likely to receive chemotherapy for rectal cancer and 12 percent less likely to receive radiation therapy than whites. “Although there wasn’t a discrepancy between African Americans and whites in the rates of consultation with an oncologist, we found a large discrepancy in the receipt of chemotherapy. This is very important. We knew that African Americans were not receiving chemotherapy for rectal cancer at the same rates as white Americans and it was contributing to their increased mortality. Now we have a better idea of where the problem lies: somewhere between the visit with the oncologist and the actual initiation of chemotherapy,” says study author Arden Morris, M.D., M.P.H., assistant professor of surgery at the U-M Medical School and chief of general surgery at the VA Ann Arbor Healthcare System. The study appeared online May 13 in the Journal of the National Cancer Institute The researchers found that 73 percent of blacks and 75 percent of whites saw a medical oncologist after being diagnosed with rectal cancer. But only 54 percent of blacks went on to receive chemotherapy, while 70 percent of whites did. Similarly, rates of referral to a radiation oncologist did not differ significantly, but only 74 percent of blacks, compared to 83 percent of whites, received radiation. The data came from the Surveillance, Epidemiology and End Results Registry’s Medicare-linked database. SEER is maintained by the National Cancer Institute and collects information about cancer incidence, treatment and mortality. The study looked at 2,582 whites and 134 blacks aged 66 and older who had been diagnosed with rectal cancer.

Long-term survival after rectal cancer surgery is up to 20 percent worse for blacks than for whites. At the same time, the addition of chemotherapy and radiation is known to improve survival in all rectal cancer patients by as much as 20 percent. Researcher suspect the lack of treatment in blacks is largely driving the decreased survival.

“We now know that the initial visit with an oncologist is not the barrier to treatment. Our next step is to better understand what are the human factors that contribute to this discrepancy. We’re interested in hearing what individual people have to say,” Morris says.

Her next study will include focus groups of people who have been treated for colorectal cancer to understand how they reached the decision to have chemotherapy or whether they feel they made a decision at all. The researchers suspect treatment discrepancies may be due in part to social differences and priorities among populations, such as patient preferences or access to resources including transportation or family care.

“Choice is important. If there’s a choice, this maybe isn’t a disparity but a preference. But if it’s not a choice, then we need to understand the barriers and find solutions,” Morris says.

In addition to Morris, study authors were Awori J. Hayanga and John D. Birkmeyer, both from the Department of Surgery at the U-M Medical School; Kevin G. Billingsley from Oregon Health and Science University; and Barbara Matthews and Laura-Mae Baldwin, both from the University of Washington.

Funding for the study was from the American Cancer Society and the National Cancer Institute.

Reference: Journal of the National Cancer Institute, Vol. 4, Issue 11, June 4, 2007; published online May 13, 2008, DOI: 10.1093/jnci/djn145

Written by: Nicole Fawcett Media contact: Nicole Fawcett E-mail: nfawcett@umich.edu Phone: 734-764-2220