Gaps in Access to Cancer Care Resources May Contribute to Racial, Ethnic Disparities

Quality cancer care requires sufficient clinical resources, and a recent study found that hospitals serving high proportions of racial and ethnic minority groups in the United States were less likely to have most core cancer-related services compared with other hospitals. The findings, published in JAMA Oncology, suggest gaps in resource access may contribute to race-based care disparities, according to the authors.¹

“Black patients are often treated at hospitals with lower surgical volumes and have worse outcomes for many cancers. Compared with White patients, up to half of excess mortality experienced by Black patients with colon or breast cancer may be attributable to hospital-level factors, although the nature of those factors is unclear,” the authors explained. Among Hispanic individuals, screening levels are low across many cancer types, and some types of cancer have relatively high mortality in Hispanic populations,² they added.

In the new study, researchers identified acute care and cancer hospitals serving the highest rates of Black or Hispanic patients and assessed whether these hospitals were less likely to offer a selection of core cancer-related services. Race and ethnicity data from Medicare fee-for-service 100% files in 2020 or the most recent year available were used to determine the 10% of nonfederal cancer hospitals and acute care hospitals providing care to the highest shares of Hispanic or Black individuals, and those hospitals were assessed by availability of 34 cancer-related services based on hospital-reported data gathered from the 2020 American Hospital Association Survey.¹

A total of 432 hospitals serving Black patients and 432 serving Hispanic patients (62 of which also served Black patients) were included in the study and compared with 3509 other hospitals.

Hospital | Image credit: Andrii - stock.adobe.com

The analyses were adjusted to account for rurality and hospital bed size, as smaller hospitals may not offer specialized services, particularly when larger hospitals are nearby, the authors noted. In the analyses for hospitals serving racial and ethnic minorities, 2-sided P values lower than .05 indicated significance.

The hospitals that served racial and ethnic minorities were more often larger and likely to be urban and teaching hospitals. They also had more Medicaid beneficiaries compared with other hospitals, and they encompassed approximately 53% of and 73% of admissions among Black and Hispanic Medicare patients, respectively.

Researchers found that all core oncology services were less likely to be available at the hospitals serving racial and ethnic minority groups (OR, 0.51; P < .001). Seven of 12 diagnostic radiology services and 4 of 5 radiotherapy modalities were less likely to be offered at hospitals serving racial and ethnic minority groups ([OR, 0.73; P = .009] and [OR, 0.76; P = .03], respectively). Three out of 4 other services, such as support groups, were less likely to be available at hospitals serving racial and ethnic minorities (OR, 0.57; P < .001).

The study was limited by the use of racial demographics of Medicare fee-for-service beneficiaries, as well as a lack of data on the actual use of cancer services at the hospitals in the study. Still, the findings suggest care quality differences may contribute to racial and ethnic disparities in cancer outcomes.

“Resource disparities may alter access to timely and appropriate screening, treatment planning, cancer care delivery, and outcomes. Quality differences between, rather than within, hospitals likely account for a portion of racial disparities in inpatient care outcomes,” the authors wrote. “Disparities in cancer care resource availability likely reflect less funding for hospitals serving racial and ethnic minority groups and may affect between-hospital quality differences and hence race-based care disparities.”

References

1. Himmelstein G, Ganz PA. Distribution of cancer care resources across US hospitals by patient race and ethnicity. JAMA Oncol. Published online November 16, 2023. doi:10.1001/jamaoncol.2023.4952

2. Miller KD, Ortiz AP, Pinheiro PS, et al. Cancer statistics for the US Hispanic/Latino population, 2021. CA Cancer J Clin. 2021;71(6):466-487. doi:10.3322/caac.21695