• Carrie Printz

Cancer Care Not Reaching Some Populations

Cancer disparities conference focuses on better prevention, treatment

More than 1 million cancer survivors are declining care due to cost concerns, and minorities are especially vulnerable, according to a study by Kathryn Weaver, PhD, a cancer prevention fellow at the National Cancer Institute.

The study was 1 of more than 200 abstracts presented at the Science of Cancer Health Disparities Conference held in February 2009 in Carefree, Arizona, and sponsored by the American Association of Cancer Research.

According to Dr. Weaver and colleagues, Hispanic and African-American cancer survivors are twice as likely to go without services due to cost. Survivors are going without—or significantly delaying—dental care, general medical care, mental health, or prescription drugs, Dr. Weaver says, adding that this scenario occurred even among insured patients.

Dr. Weaver's group studied data from the Centers for Disease Control and Prevention's National Health Interview Survey to identify 6,602 adult cancer survivors.

Overall, the prevalence for foregoing medical care due to cost was 7.8% for general medical care, 9.9% for prescription medication, 11.3% for dental care, and 2.7% for mental health care.

Compared with non-Hispanic whites, Hispanics were 2.14-fold more likely to forego prescription medications due to cost concerns, and African-Americans were 87% more likely to forego prescriptions. With regard to dental care, Hispanics were 2.31-fold more likely to go without, and African-Americans were 57% more likely to do the same. The differences persisted after adjustments were made for education, health insurance coverage, and noncancer comorbidities.

In light of these results, clinicians should make more of an effort to connect patients with charity or low-cost care, Dr.Weaver notes.

Here are some additional highlights from studies presented at the conference.

Colorectal Cancer Screening Capacity Key in Rural Areas

Arizona has the ability to expand colorectal screening capacity by nearly 37%, according to a study conducted by Jose Benuzillo, MS, a PhD student at the University of Utah in Salt Lake City. Because the population of retirees moving to Arizona is expected to swell—making it the 10th largest state by 2030—and because this age group is the most at risk for gastrointestinal cancers, the need for screening is paramount, notes Mr.Benuzillo.

The study also concluded that the potential increase in screenings is greater for rural than urban areas—a significant finding because screening rates are lower in rural areas, he says.

Although the study focused on Arizona, researchers reported a similar potential increase in New Mexico. A nationally representative survey conducted by the National Cancer Institute demonstrated similar results.

Benuzillo and colleagues surveyed 105 gastroenterologists and colorectal surgeons in Arizona. The urban physicians reported that they performed 8312 endoscopic procedures per week in 2004 and could increase capacity by 35.7%. Rural physicians, meanwhile, performed 405 procedures per week and estimated they could increase them by 53.1%, or 215 procedures per week.

Urban physicians said they needed more physicians to increase capacity, while rural physicians were more likely to state they needed increased compensation.

“About 27% of rural physicians noted they did not need additional resources to increase their screening capacity,” Mr.Benuzillo says.

Cancer Screening Rates Low Among Older South Asian Immigrants

Screening rates are low among older South Asian immigrants because of a lack of knowledge about available services and the benefits of screening, according to Abhijit S. Prabhughate, a doctoral candidate at the Jane Addams College of Social Work at the University of Illinois at Chicago. “They're an understudied group,” says Prabhughate. “More than 40% of the South Asian immigrants in our study did not have health insurance, and little is known about their risk.”

Of the 331 people surveyed, 84% were born in India and 14% were born in Pakistan. Although the majority had lived in the US for a decade, only 64% had a regular family physician. Their reasons for not being screened for breast cancer included not wanting to know if they had cancer, their family not wanting them to get tested, embarrassment, fear of losing their job, language difficulties, and not knowing where to get tested. However, the respondents were more likely to undergo screening if they were encouraged by family or friends or if they had health insurance.

Human Papillomavirus Often Misunderstood Among Hispanics Living on Texas-Mexico Border

Survivors are going without—or significantly delaying—dental care, general medical care, mental health, or prescription drugs.

A new study among Hispanics regarding knowledge, attitudes, and cultural responses to the human papillomavirus (HPV) found that both men and women had little knowledge of HPV and significant misunderstandings that should be addressed to reduce the risk of cervical cancer in this population.

The study was conducted by Maria Fernandez, PhD, assistant professor at the University of Texas Health Science Center at Houston School of Public Health. She and her colleagues conducted 5 focus groups in Brownsville, Texas, that included 30 Hispanic women and 11 Hispanic men. The women believed that a diagnosis of HPV was a diagnosis of cancer; in addition, they had fatalistic attitudes about a cancer diagnosis. The men initially attributed their partners' HPV diagnosis to infidelity. However, after a brief explanation, the men and women began to understand the ambiguity of HPV infection and believed that male partners would support women as they sought health care for the infection.

“Understanding Hispanics' cultural norms and values concerning disease, sexuality, and gender is essential to designing successful interventions,” Dr. Fernandez notes. “Although this is a qualitative study, and we can't generalize, it does show that we need to go beyond providing basic information on HPV.”

New Techniques to Treat Gastrointestinal Cancers

Distinguishing patients who will benefit from treatment versus those who will not was 1 of the key questions discussed at the Sixth Annual Gastrointestinal Cancers Symposium held in January 2009 in San Francisco.

“In an era when the cost of cancer care continues to increase, the ability to tailor treatment to each patient's disease could lead to improved outcomes and fewer side effects for patients as well as significant cost savings,” says Jennifer C. Obel, MD, a gastrointestinal cancer specialist at NorthShore University Health System in suburban Chicago, Illinois, and moderator of a news conference held prior to the symposium. Below are some highlights from the symposium.

K-ras Testing in Colorectal Cancer Could Save Millions

Patients with metastatic colorectal cancer benefit from cetuximab, but the benefit is limited to those with the wild-type form of the K-ras gene, not mutated K-ras, according to Veena Shankaran, MD, of the Veterans Affairs Midwest Center for Health Services and Policy Research in Chicago, Illinois. Although it is not yet reflected in pharmaceutical labeling, practice guidelines and clinical trials have incorporated K-ras testing as a standard procedure prior to cetuximab treatment. Dr. Shankaran and colleagues developed an economic model estimating that $604 million could be saved by routine K-ras testing. This figure does not include the additional costs associated with clinic appointments, infusion visits, and managing toxicity. “Development of other validated predictive molecular markers will save enormous amounts of money for our healthcare system and spare patients ineffective and toxic therapies,” Dr. Shankaran adds.

“This type of study is quite timely when you consider that cancer care costs are growing at a rate of 15% a year—nearly 3 times the increase in overall health care costs in 2007,” says Dr. Obel.

Some Genotypes Help Predict Response to Pancreatic Cancer Therapy

A number of genotypes are significant predictors of tumor response to therapy, tumor respectability, and overall survival in patients with pancreatic cancer, says Donghui Li, PhD, associate professor of gastrointestinal medical oncology at the University of Texas M.D.Anderson Cancer Center in Houston.

The goal of Dr. Li's study was to determine whether genetic markers (genetic variations in DNA mismatch repair) are associatedwith outcome and response to gemcitabine, the standard drug for pancreatic cancer. Dr. Li and colleagues studied 154 patients with resectable tumors who had received preoperative treatment with gemcitabine. Dr. Li and colleagues also observed that although some genotypes had weak effects, a strong combined genotype effect was detected; the median survival time decreased as the number of variant genotypes increased.

Ultimately, the goal is to identify a panel of genes that may help predict patients' response to therapy and identify those patients who will truly benefit from tumor resection.

“The observations need to be confirmed in three different patient populations—if they are, markers can be applied in future personalized cancer therapy,” Dr. Li notes.

EGF Gene Polymorphism and GERD May Increase Esophageal Cancer Risk

Individuals with gastroesophageal reflux disease (GERD) and the epidermal growth factor (EGF) polymorphism were found to have a 9.7-fold increased incidence of esophageal cancer in a study presented by Winston Cheung, PhD, of the University of Toronto. In addition, those patients who had experienced GERD for 15 years or longer and had the most abnormal EGF genotype had a 22.4-fold increased risk of esophageal cancer.

The study sought to determine how the EGF gene polymorphism and GERD interact to cause esophageal cancer, which has increased 4-fold in white males in the US over the past decade. Researchers compared blood samples from 309 patients with esophageal cancer with those of a control group of 275 healthy adults. Dr.Cheung concluded that:

  • 1Genes and the environment may interact together increase the risk of esophageal cancer, particularly the EGF A6/G gene polymorphism and GERD;
  • 2Risk associations are strongest with more frequent and long-standing GERD, with a greater number of variants; and
  • 3Current findings may have important implications for selecting patients for esophageal cancer screening programs.

“We've known that GERD is a risk factor, but we've never been able to predict by genetic variations who is at risk, notes Dr. Obel. “These results could help us identify the disease earlier when it's more treatable.”