With Dartmouth Medical School (DMS) faculty member Tracy Onega, Ph.D., as lead author, and her DMS colleague David C. Goodman, M.D., as principal investigator, the researchers examined records for more than 200,000 Medicare recipients who received cancer treatment between 1998 and 2003. The analysis focused on one- and three-year mortality for patients with lung, breast, colorectal, and prostate cancer, and used National Cancer Institute (NCI) comprehensive or clinical cancer centers to evaluate the influence of place of service, based on their standing as highly specialized cancer care settings. Of the sample population, 9% were African-American. A higher proportion of African Americans attended an NCI cancer center than did Caucasians (11.1% vs. 6.9%).
“We have known for some time that African Americans die in greater numbers from cancer than Caucasians,” says Onega, an assistant professor of community and family medicine at DMS and the director of the New Hampshire Mammography Network at the cancer center. “The question is, why? This research shows that where patients are treated can influence those outcomes significantly.”
The researchers found that across all cancer-care settings within the study population, the likelihood of dying from cancer or other causes at one year was 13% higher for African Americans. At three years, their risk was 23% higher than for their Caucasian counterparts.
While looking at patients who received care only at NCI cancer centers such as Norris Cotton, however, the investigators found no significant racial differences in the likelihood of dying one year and three years after a cancer diagnosis. The same held true in comparisons of death rates among the African-American study population: those receiving care at an NCI cancer center died less often at one year and three years than did those treated elsewhere.
“The next step,” Onega says, “is to understand the components of treatment location that most dramatically affect differences in care, and ultimately outcomes, for all cancer patients.”
Goodman is a professor of pediatrics and of health policy at DMS, director of the Center for Health Policy Research at the Dartmouth Institute (TDI) for Health Policy and Clinical Practice, and co-principal investigator for the Dartmouth Atlas of Healthcare.
Dartmouth colleagues also contributing to the study were biostatistician Eugene Demidenko, Ph.D., a DMS research professor of community and family medicine; Eric J. Duell, Ph.D., an assistant professor of community and family medicine at DMS; and Xun Shi, Ph.D., an associate professor of geography at Dartmouth College.
In addition to Onega and Goodman, Duell and Demidenko are affiliated with TDI and with Norris Cotton, an NCI-designated, comprehensive cancer center.
Mary Hawkins, Director of Communications, Norris Cotton Cancer Center, 603-653-3615 or Mary.S.Hawkins@dartmouth.edu; or
David Corriveau, Media Relations Officer, Dartmouth Medical School, at David.A.Corriveau@Dartmouth.edu or 603-653-0771