Integrated Health Care Reduced Racial Disparities in Colon Cancer Treatment

Kim F. Rhoads, MD, MS, MPH, FACS Assistant Professor of Surgery Director, Community Partnership Program Stanford Cancer Institute Unit Based Medical Director, E3 Surgery and Surgical Subspecialties Stanford University Stanford, Ca 94305MedicalResearch.com Interview with:
Kim F. Rhoads, MD, MS, MPH, FACS
Assistant Professor of Surgery
Director, Community Partnership Program
Stanford Cancer Institute Unit Based Medical Director, E3 Surgery and Surgical Subspecialties Stanford University Stanford, Ca 94305

Medical Research: What is the background for this study? What are the main findings?

Dr. Rhoads: Colon cancer is the 3rd most common cancer in US men and women and is the 2nd most common cause of cancer death. For at least 2 decades, minorities with colon cancer have suffered a 15-20% additional risk of death when compared with non-minority patients. Our study set out to understand the influence of the location where treatment was delivered and the quality of care received, on overall survival and racial disparities.

We examined more than 30,000 patients who were diagnosed and treated for colon cancer in California from 2001 through 2006.  Using cancer registry data linked to state level inpatient data and hospital information, we compared the rates of National Comprehensive Cancer Network (NCCN) guideline adherence and mortality by location of care and by race. We found that patients treated within an integrated health system (IHS) received NCCN guideline based care at higher rates than those treated outside the system—about 3% higher rates of surgery; and more than 20% higher rates of stage appropriate chemotherapy. The rates of guideline based care were nearly equal between the racial groups treated inside the IHS.  Propensity score matched comparisons revealed a lower risk of death for all patients and no racial disparities associated with treatment within the Integrated system.  For patients treated outside IHS, the disparity in mortality was explained by accounting for differences in receipt of evidence based care by race.

Medical Research: What should clinicians and patients take away from your report?

Dr. Rhoads: While some readers may think that the study suggests they should try to become like the IHS we studied,  due to insurmountable bureaucracy, this will be unfeasible. Therefore, we want to highlight the most important finding in this study, which is that patients treated outside IHS may also reach best possible (and equitable) outcomes when evidence based care is provided. That is to say, there is a clear role for providers and health systems to address longstanding  cancer disparities. Providers who work in non-integrated systems should be particularly attentive to patients who need additional care based on NCCN guidelines to make sure that they do not get lost to follow up during hand-offs between multi-disciplinary cancer care providers.   We hope that this work will highlight the importance of delivering evidence based care. Evidence based treatment guidelines for the majority of cancers have been developed by the NCCN. The guidelines are publicly available, free of charge, to both patients and providers via the World Wide Web (www.nccn.org).

We also hope that our work will encourage third party payers and other hospital level policy makers to incentivize adherence to NCCN guidelines in an effort to improve colon cancer survival for all patients while simultaneously addressing colon cancer disparities.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Rhoads: We plan to conduct future studies to determine if guideline based care is associated with the elimination of disparities. in other types of cancer.  We are also exploring ways to increase patient use of the NCCN colon cancer guidelines (patient compendium) for advocacy and participation in shared decision making.

Citation:

How Do Integrated Health Care Systems Address Racial and Ethnic Disparities in Colon Cancer?

Rhoads KF1, Patel MI2, Ma Y2, Schmidt LA2.
J Clin Oncol. 2015 Jan 26. pii: JCO.2014.56.8642. [Epub ahead of print]

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MedicalResearch.com Interview with:, Kim F. Rhoads, MD, MS, MPH, FACS, & Assistant Professor of Surgery (2015). Integrated Health Care Reduced Racial Disparities in Colon Cancer Treatment MedicalResearch.com