Study shows disparities in colon cancer

A New York Times blog recently looked at the divide between blacks and whites when it comes to colon cancer. 

The article says: "Advances in screening, diagnosis and treatment of colon cancer mean fewer people are dying of the disease today than they were 20 years ago. But not everyone is benefiting equally.

Dr. John Kauh, an oncologist who works with colon cancer patients at Grady Memorial Hospital, a public hospital in Atlanta, knows that firsthand. Many of his poorer patients, often black, indigent and without insurance, show up when their disease has already advanced to the latest stages, when cure is least likely."

A new American Cancer Society report shows the gulf among white and black colorectal cancer patients, the story says. 

"This shows that not all groups are benefiting from the advances that have been made,” Dr. Anthony S. Robbins, an author of the study and director of health services research at the American Cancer Society said in the story. “It’s a rising tide that raises some ships more than others.”

Colonoscopies are key for early detection and survival, but black patients, as a group, don't appear to get screened as regularly as white patients, the study said. That means more black patients are likely to have cancers at a later stage.

"In an editorial that accompanied the new study, Electra D. Paskett, an expert on cancer disparities at Ohio State University, said the gap between white and black patients could be reduced through several steps, most importantly screening. Only 22 states have universal health insurance coverage for colorectal cancer screening, she noted."

Dr. Paskett also pointed out that clinical trials for new cancer drugs are historically “underused” by minority patients, in part because of a widespread myth in the health profession that blacks are less interested in enrolling than whites. To the contrary, Dr. Paskett found in her research that “when eligible and asked to participate in a clinical trial, blacks were more likely to participate than whites.”

Another route Dr. Paskett proposed was the use of more “patient navigators,” a sort of cancer-ward coach or concierge who acts as a guide for patients.

“Many hospitals,” she wrote, “do not accept patients who cannot pay for care or who have public insurance, and those who do are overburdened with sick, needy patients. Patient navigators could be available both at the community level and the hospital level to promote easy access and navigation to proper care.”

Dr. Kauh of Atlanta added that he believed improved screening and other measures could make a difference, but only so much. “To me a lot of this has to do with socioeconomic issues that can’t be quickly turned around,” he said. “If you don’t have access to good health care, no matter how much education you provide patients, it’s going to be hard to make an overall difference in survival.”

The Colon Cancer Prevention Project is working to eliminate these disparities. We are now pushing for funding for a state-wide colon cancer screening program, and we are working to start a screening program for uninsured and under-insured residents in Louisville, Ky. E-mail ashepherd@c2p2ky.org to see how you can help make this happen.

--Andrea Shepherd

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