Disparities in Oncologic Surgery

World Journal of Surgery - Tập 32 - Trang 522-528 - 2008
Caprice C. Greenberg1,2, Jane C. Weeks2, Steven C. Stain3
1Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, USA
2Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, USA
3Department of Surgery, Albany Medical College, Albany, USA

Tóm tắt

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.

Tài liệu tham khảo

Bradley CJ, Given CW, Roberts C (2002) Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 94:490–496 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 24:413–418 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 156 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 23:510–517 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 86:582–586 Joslyn SA (2002) Racial differences in treatment and survival from early-stage breast carcinoma. Cancer 95:1759–1766 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 243:241–249 Dolan JT, Granchi TS, Miller CC 3rd, et al. (1999) Low use of breast conservation surgery in medically indigent populations. Am J Surg 178:470–474 Gilligan MA, Kneusel RT, Hoffmann RG, et al. (2002) Persistent differences in sociodemographic determinants of breast conserving treatment despite overall increased adoption. Med Care 40:181–189 Michalski TA, Nattinger AB (1997) The influence of black race and socioeconomic status on the use of breast-conserving surgery for Medicare beneficiaries. Cancer 79:314–319 Roetzheim RG, Gonzalez EC, Ferrante JM, et al. (2000) Effects of health insurance and race on breast carcinoma treatments and outcomes. Cancer 89:2202–2213 Rogers A, Flowers J, Pencheon D (1999) Improving access needs a whole systems approach. BMJ 319:866–867 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):611–624 Gulliford M, Figueroa-Munoz J, Morgan M , et al. (2002) What does “access to health care” mean? J Health Serv Res Policy 7:186–188 Basu J, Clancy C (2001) Racial disparity, primary care, and specialty referral. Health Serv Res 36(6 Pt 2):64–77 Lucas FL, Stukel TA, Morris AM, et al. (2006) Race and surgical mortality in the United States. Ann Surg 243:281–286 Bach PB, Pham HH, Schrag D, et al. (2004) Primary care physicians who treat blacks and whites. N Engl J Med 351:575–584 Bradley CJ, Given CW, Roberts C (2001) Disparities in cancer diagnosis and survival. Cancer 91:178–188 Roetzheim RG, Pal N, Tennant C, et al. (1999) Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst 91:1409–1415 Schrijvers CT, Coebergh JW, Mackenbach JP (1997) Socioeconomic status and comorbidity among newly diagnosed cancer patients. Cancer 80:1482–1488 Tammemagi CM, Nerenz D, Neslund-Dudas C, et al. (2005) Comorbidity and survival disparities among black and white patients with breast cancer. JAMA 294:1765–1772 Mulley AG Jr (2006) Developing skills for evidence-based surgery: ensuring that patients make informed decisions. Surg Clin North Am 86:181–192, xi 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 Dein S (2004) Explanatory models of and attitudes towards cancer in different cultures. Lancet Oncol 5:119–124 Jones C (2002) The impact of racism on health. Ethn Dis 12:S2–10–3 Whaley AL (2003) Ethnicity/race, ethics, and epidemiology. J Natl Med Assoc 95:736–742 Rathore SS, Krumholz HM (2004) Differences, disparities, and biases: clarifying racial variations in health care use. Ann Intern Med 141:635–638 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 24:904–909 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 94:2084–2090 Bird ST, Bogart LM (2001) Perceived race-based and socioeconomic status(SES)-based discrimination in interactions with health care providers. Ethn Dis 11:554–563 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 79:225–231 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 23:6576–6586 Dignam JJ (2001) Efficacy of systemic adjuvant therapy for breast cancer in African-American and Caucasian women. J Natl Cancer Inst Monogr 30:36–43 Earle CC, Neville BA (2004) Under use of necessary care among cancer survivors. Cancer 101:1712–1719 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 23:5900–5999 Freedland SJ, Isaacs WB (2005) Explaining racial differences in prostate cancer in the United States: sociology or biology? Prostate 62:243–252 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 23:2513–2520 Zhang X, Chang A (2007) Somatic mutations of the epidermal growth factor receptor and non-small-cell lung cancer. J Med Genet 44:166–172 Stewart JH (2001) Lung carcinoma in African Americans: a review of the current literature. Cancer 91:2476–2482 http://seer.cancer.gov/. Accessed on 12 August 2007 http://healthservices.cancer.gov/seermedicare/ Accessed on 12 August 2007 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–19–25 http://www.facs.org/cancer/ncdb/ Accessed on 12 August 2007 Eberl MM, Watroba N, Reinhardt M, et al. (2007) Linked claims and medical records for cancer case management: evaluation of mammography abnormalities. Cancer 110:518–524 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 83:1930–1937 West CN, Geiger AM, Greene SM, et al. (2005) Race and ethnicity: comparing medical records to self-reports. J Natl Cancer Inst Monogr 35:72–74 http://grants.nih.gov/grants/guide/notice-files/not94-100.html Accessed on 18 August 2007 http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html Accessed on 18 August 2007 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 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 Brawley OW, Freeman HP (1999) Race and outcomes: is this the end of the beginning for minority health research?. J Natl Cancer Inst 191:1908–1909 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 22:2992–2996