Guideline-concordant cancer care and survival among American Indian/Alaskan Native patients

Authors

  • Sara H. Javid MD,

    Corresponding author
    1. Department of Surgery, Surgical Outcomes Research Center, School of Medicine, University of Washington, Seattle, Washington
    • Corresponding author: Sara H. Javid, MD, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195; Fax: (206) 543-8136; sjavid@uw.edu

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  • Thomas K. Varghese MD, MS,

    1. Department of Surgery, Surgical Outcomes Research Center, School of Medicine, University of Washington, Seattle, Washington
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  • Arden M. Morris MD,

    1. Department of Surgery, School of Medicine, University of Michigan
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  • Michael P. Porter MD, MS,

    1. Department of Urology, Surgical Outcomes Research Center, School of Medicine, University of Washington, Seattle, Washington
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  • Hao He PhD,

    1. Department of Surgery, Surgical Outcomes Research Center, School of Medicine, University of Washington, Seattle, Washington
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  • Dedra Buchwald MD,

    1. Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, Washington
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  • David R. Flum MD, MPH,

    1. Department of Surgery, Surgical Outcomes Research Center, School of Medicine, University of Washington, Seattle, Washington
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  • for the Collaborative to Improve Native Cancer Outcomes (CINCO)


  • We acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development, and Information, Centers for Medicare and Medicaid Services; Information Management Services, Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

  • The Collaborative to Improve Native Cancer Outcomes includes: D. Buchwald, D.R. Flum, E.M. Garroutte, A.A. Gonzales, J.A. Henderson, P. Nez Henderson, D.L. Patrick, S.P. Tu, and R.L. Winer.

  • This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The ideas and opinions expressed herein are those of the author(s), and endorsement by the State of California, the Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be concluded.

Abstract

BACKGROUND

American Indians/Alaskan Natives (AI/ANs) have the worst 5-year cancer survival of all racial/ethnic groups in the United States. Causes for this disparity are unknown. The authors of this report examined the receipt of cancer treatment among AI/AN patients compared with white patients.

METHODS

This was a retrospective cohort study of 338,204 patients who were diagnosed at age ≥65 years with breast, colon, lung, or prostate cancer between 1996 and 2005 in the Surveillance, Epidemiology, and End Results-Medicare database. Nationally accepted guidelines for surgical and adjuvant therapy and surveillance were selected as metrics of optimal, guideline-concordant care. Treatment analyses compared AI/ANs with matched whites.

RESULTS

Across cancer types, AI/ANs were less likely to receive optimal cancer treatment and were less likely to undergo surgery (P ≤ .025 for all cancers). Adjuvant therapy rates were significantly lower for AI/AN patients with breast cancer (P < .001) and colon cancer (P = .001). Rates of post-treatment surveillance also were lower among AI/ANs and were statistically significantly lower for AI/AN patients with breast cancer (P = .002) and prostate cancer (P < .001). Nonreceipt of optimal cancer treatment was associated with significantly worse survival across cancer types. Disease-specific survival for those who did not undergo surgery was significantly lower for patients with breast cancer (hazard ratio [HR], 0.62), colon cancer (HR, 0.74), prostate cancer (HR, 0.52), and lung cancer (HR, 0.36). Survival rates also were significantly lower for those patients who did not receive adjuvant therapy for breast cancer (HR, 0.56), colon cancer (HR, 0.59), or prostate cancer (HR, 0.81; all 95% confidence intervals were <1.0).

CONCLUSIONS

Fewer AI/AN patients than white patients received guideline-concordant cancer treatment across the 4 most common cancers. Efforts to explain these differences are critical to improving cancer care and survival for AI/AN patients. Cancer 2014;120:2183–2190. © 2014 American Cancer Society.

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