© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 5, 334-357,
March 6, 2002
© 2002 Oxford University Press
REVIEW |
Racial and Ethnic Disparities in the Receipt of Cancer Treatment
Affiliation of authors: Health Services and Economic Branch, Applied Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD.
Correspondence to: Vickie L. Shavers, Ph.D., National Institutes of Health, 6130 Executive Blvd., EPN 4005, MSC 7344, Bethesda, MD 20892–7344 (e-mail: shaversv{at}mail.nih.gov).
A disproportionate number of cancer deaths occur among racial/ethnic minorities, particularly African Americans, who have a 33% higher risk of dying of cancer than whites. Although differences in incidence and stage of disease at diagnosis may contribute to racial disparities in mortality, evidence of racial disparities in the receipt of treatment of other chronic diseases raises questions about the possible role of inequities in the receipt of cancer treatment. To evaluate racial/ethnic disparities in the receipt of cancer treatment, we examined the published literature that addressed access/use of specific cancer treatment procedures, trends in patterns of use, or survival studies. We found evidence of racial disparities in receipt of definitive primary therapy, conservative therapy, and adjuvant therapy. These treatment differences could not be completely explained by racial/ethnic variation in clinically relevant factors. In many studies, these treatment differences were associated with an adverse impact on the health outcomes of racial/ethnic minorities, including more frequent recurrence, shorter disease-free survival, and higher mortality. Reducing the influence of nonclinical factors on the receipt of cancer treatment may, therefore, provide an important means of reducing racial/ethnic disparities in health. New data resources and improved study methodology are needed to better identify and quantify the full spectrum of nonclinical factors that contribute to the higher cancer mortality among racial/ethnic minorities and to develop strategies to facilitate receipt of appropriate cancer care for all patients.
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