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Lung Surgery Rarer For Blacks

Many older blacks with lung cancer don't get the same treatment as whites, even when they have equal access to specialized care.

The finding comes from experts at Boston's Dana-Farber Cancer Institute. The report by Christopher Lathan, MD, and colleagues appears in the Journal of Clinical Oncology.

Lung cancer is the No. 1 cause of cancer deaths. Lung cancer is a burden for all races, but it's most common and deadliest among black men, the researchers note.

They aren't the first to note racial gaps in health care. The problem has been around for a long time.

In Lathan's study, blacks and whites had equal access to cancer care. Still, the gap didn't budge. Black patients had potentially lifesaving surgery for lung cancer far less often than whites.

The issue is complex, but better communication between doctors and patients might help, the researchers suggest.

Black-White Gap

Using a national cancer database, the researchers tracked more than 21,000 lung cancer patients.

The patients were older than 65 and only got their health care through Medicare. They had been diagnosed in the 1990s with the most common type of lung cancer (nonsmall cell lung cancer).

Black patients differed from whites in these important ways:

  • They were 25 percent less likely to get invasive tests to check the stage of their lung cancer.
  • Those who got invasive tests were 45 percent less likely than whites to get lung cancer surgery.
  • Surgery was less often recommended to medically eligible blacks.
  • They were more likely than whites to turn down recommended surgery.

    All in all, more than 14,200 patients got the invasive tests and nearly 7,000 had surgery. Both were much rarer for blacks. For instance, more than nine out of 10 patients who got the invasive tests were white.

    Surprising Findings

    The results didn't match the researchers' expectations.

    "We thought that if all the patients had been staged — which suggests that they had access to the appropriate specialists and implies some level of trust in the medical system — that they would have the same rate of surgery," Lathan says in a news release.

    "We were quite surprised to find this was not the case," he continues.

    The data didn't show why more blacks than whites turned down recommended surgery (3.4 percent of blacks, compared to 2 percent of whites). Mistrust of the medical system might be a possibility, the researchers note.

    It's also not clear why surgery wasn't always recommended for medically eligible black patients.

    "Efforts must continue to ensure the appropriate quality care is available for all patients, regardless of race and ethnicity," the researchers write.

    Talking It Out

    The findings should be confirmed and might not apply to younger patients, write Lathan and colleagues. They call for greater emphasis on the doctor-patient relationship.

    Patients should "make sure they're getting all the resources they need, even if it means challenging their physicians a little bit," Lathan says in the news release.

    He also wants doctors to step up their efforts.

    "It's really important that we spend as much time thinking about how we communicate with our patients as we do about how to treat them," Lathan says.

    SOURCES: Lathan, C. Journal of Clinical Oncology, Dec. 19, 2005; online edition. WebMD Medical News: "Health Care Disparities Persist for Blacks." News release, Dana-Faber Cancer Institute.

    By Miranda Hitti
    Reviewed by Ann Edmundson, MD
    © 2005, WebMD Inc. All rights reserved

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