Evidence-Based Care Can Eliminate Gaps in Cancer Survival Rates

Although African Americans have had lower colon cancer survival rates over the past 2 decades compared with white patients, researchers at the Stanford University School of Medicine have found evidence-based care can remove the racial disparity.

In a study published in the Journal of Clinical Oncology, the authors reported that equitable, high-quality, evidence-based care, delivered at higher rates within integrated healthcare organizations, closed the gap in colon cancer survival rates between white and African American patients.

“Historically, we’ve taken less than a critical eye on our own healthcare system in terms of how we can take the lead in addressing disparities,” lead author Kim Rhoads, MD, MPH, assistant professor of surgery at the Stanford University Medical Center, said in a statement. “The big takeaway in this paper is that it’s treatment, not necessarily patient factors, but following evidence-based guidelines that gives all patients the best chance for survival. Our work also suggests a real opportunity to equalize these racial differences.”

Dr Rhoads and her colleagues analyzed cancer registry data, California hospital characteristics, and patient-discharge data to compare details about survival rates with details about the treatments the patient received and the hospitals’ financial and structural characteristics. The study looked at 33,593 patients diagnosed between 2001 and 2006 and followed the patients’ progress for 5 years.

Integrated systems provided a higher rate of evidence-based care for colon cancer for minorities than nonintegrated systems. Patients at integrated systems also had higher survival rates overall with no racial disparities in survival rates within the system.

“In integrated systems, there’s already a big push to thinking about following evidence-based guidelines, so everyone within that system is in the same mindset,” said co-author Manali Patel, MD, MPH, instructor of medicine in Stanford’s Division of Oncology. “It’s easier to do the right thing when you have the system-level support to do so.”

However, Dr Rhoads added that outside of an integrated system, patients become their own advocate to piece together appropriate treatment.

“With healthcare reform, millions more patients are coming into the system, and we’re going to need to become more integrated in order to meet the demand. We’re going to need to work more closely together, decrease variations in care and standardize what we do,” Dr Rhoads said.