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Lung Cancer Treatment For Black and Whites Unequal

New America Media, Paul Kleyman, Posted: Feb 06, 2009

African-American elders receive less treatment for lung cancer than their white counterparts, who are getting excessive treatment. The practice is causing negative health effects for both groups. That's one finding in a recently released study from the University of Washington, Seattle. Dr. Farhood Farjah, a cancer specialist at the university, writes in the January issue of Archives of Surgery that he and his colleagues set out to better explain why black patients with early-stage lung cancer have lower five-year survival rates than whites.

The researchers examined Medicare data for almost 18,000 patients(average age 75), who had comparable health insurance and whose doctors had recommended them for pulmonary resection—the removal of part of a lung -- proven to be the optimal treatment available. Sure enough, even among these insured patients, 69 percent of black elders underwent the procedure compared with 83 percent of whites recommended for the operation. But that wasn't the only surprise.

What the medical detectives didn't expect to find: There was no significant difference in the survival rate between the racial groups.

"Surgical therapy may have been overused among white patients or underused among black patients," Farjah and his coauthors wrote.

Despite this odd finding, the researchers looked beyond customary assumptions about racial bias among healthcare providers to understand the reasons for the substantial disparity between who gets wheeled into the emergency room, and who does not, even for those receiving appropriate care.

One explanation, say the authors, has to do with fears and erroneous beliefs. They cite previous research showing that older

African Americans reject surgery more often than whites, repeating the urban myth that tumors might spread when exposed to air during the operation or invoking the possibility of a cure without surgery. Black patients also express distrust of doctors and the healthcare system more often than whites, the study said.

Another major reason, the study said, is poor access to care. An earlier study showed that primary care physicians who treat black patients had less access to high-quality specialists than their white counterparts.

The study findings suggest that the referral of all candidates for partial lung removal may be a helpful tool in mitigating previously identified racial differences in survival.

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262), e-mail mediarelations@jama-archives.org, or reach the corresponding coauthor of this paper, David R. Flum by contacting Mary Guiden at 206-616-3192 or e-mail, .

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