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Stanford researchers examine disparities in use of quality cancer centers

In past studies, hospitals recognized by the National Cancer Institute (NCI) have demonstrated better quality of care and better outcomes for cancer than other general acute, adult hospitals in California. These facilities, as Stanford colorectal surgeon Kim Rhoads, MD, MPH, told me, provide “everything a patient with cancer needs in order to insure the best outcome after treatment – such things as clinical services, research, clinical trials, interdisciplinary collaboration, and survivorship programs.”

Not all patients seek care or choose these facilities for treatment, though, and Rhoads and her colleagues in the medical school’s Department of Surgery and Stanford Cancer Institute recently investigated factors that influenced whether patients of various racial and ethnic minority groups with a specific type of cancer sought care at an NCI-recognized center.

The researchers looked at an all-payer, all-age, and racially and ethnically diverse dataset containing clinical information for 80,000 patients with colorectal cancer, of whom slightly fewer than five percent sought care in one of California’s nine NCI-recognized facilities. (Stanford is NCI-designated and serves San Mateo and Santa Clara Counties.) According to the study, colorectal cancer was selected because it is a high-incident cancer found in both men and women and treated in many types of hospital settings.

Using a linked dataset containing elements from the California Cancer Registry and from California’s patient discharge data, the study focused on geographic, socioeconomic and clinical characteristics that predicted use of NCI centers.

What the researchers found was that although minority groups tend to live closer to NCI-designated facilities than whites do, some minorities are less likely to use them. Of those who lived within five miles of an NCI center, 10 percent were white compared with 26 percent Asian-Pacific Islander (API), 14 percent Hispanic and 12 percent black. Researchers found that, within a patient population living nearby an NCI center, Hispanics were 29 percent less likely to use the center, while API were 41 percent more likely to go, compared with whites.

Travel distance was found to be a barrier to seeking treatment at an NCI center for all groups - as was lack of insurance. However, neighborhood education level proved to be a more important determinant. Patients who lived in neighborhoods with high levels of college education were 42 percent more likely to seek care at an NCI-designated facility than those who did not.

Rhoads, the study's senior author, said:

Our findings show that travel distance is not the most important barrier to accessing the highest quality cancer care in California. Rather, the highest hurdles seem to be socio-economic challenges.

We would be naive to suggest that the solution is for providers in NCI settings to address low education, unemployment and poverty directly. Instead, we believe that efforts should focus on leveraging available resources to build sustainable partnerships with both community groups and local institutions to positively impact cancer outcomes for the populations most in need.

In the study, the researchers emphasized that closing the gap in quality of care for minority patients with colorectal cancer in California should include educating health-care providers about the need to refer minority patients to NCI centers. Rhoads added that primary care physicians must be encouraged to look beyond their personal, professional or institutional networks when referring patients for treatment and instead take advantage of the comprehensive care provided by NCI-designated centers.

"We don't know for sure if this finding applies to other cancers, but there is evidence to show that minorities use low quality hospitals for non-cancer surgery even if a better quality hospital is available," Rhoads said. "So it is possible that this finding may hold for other cancers."

The work, which was funded in part by a grant from the Robert Wood Johnson Foundation, appears in the current issue of the journal Cancer.

Previously: Report shows continuing health disparities for racial and ethnic minorities and Foundation launches app challenge to develop tools for selecting doctors, hospitals

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