Hospitals are shortchanging Black cancer patients

A new analysis from researchers at the American Cancer Society suggests that the distressing disparity in outcomes for Black and White colon cancer patients could narrow if hospitals simply treated all patients with the same level of high-quality care.

The disparity in rates and deaths from colorectal cancer among Black people has been a longstanding problem in cancer care. Black individuals are 20% more likely to be diagnosed with colon cancer and 40% more likely to die from it. They’re also more likely to be diagnosed at a younger age than their White counterparts.

Many theories have been floated to explain the poorer prognosis for Black patients. Access to high-quality care has long been considered the main culprit, with various other factors potentially contributing: delayed screening, being treated at subpar facilities, health insurance status and socioeconomic barriers to consistent care, like lack of paid sick leave or transportation to treatment.

But those issues can’t account for all of the problem. As a January report from the American Cancer Society pointed out, later diagnoses and poor survival rates for Black individuals persist across all cancers regardless of socioeconomic and insurance status.

Researchers have also looked at whether some differences exist in the biology of the tumors themselves. Recent work from the Memorial Sloan Kettering Cancer Center suggests that colorectal cancer patients of African ancestry have tumors that are less likely to respond to certain advanced treatments, like immunotherapy. Meanwhile, a mutation called APC, which for other groups is a good predictor of survival, seemed to have no effect on outcomes for Black patients.

The new ACS analysis suggests there’s more to the story — and that oncology practices need to reflect on whether they are always offering equitable care.

The nonprofit’s researchers used colon cancer cases reported in the National Cancer Database between 2004 and 2019 to look for differences in care along the entire treatment path for Black and White patients diagnosed with early onset colorectal cancer. “We have these very comprehensive, detailed guidelines for the type of cancer you’re diagnosed with,” says Leticia Nogueira, who led the study. The question her team asked: Are Black patients receiving care in concordance with guidelines?

The answer is no. For every stop along the road from diagnosis to treatment — from staging of their disease, surgery, radiation to chemotherapy — Black patients were less likely to receive concordant care.

In one of the most striking findings, Black colorectal cancer patients undergoing surgery to have tumors removed had far fewer lymph nodes evaluated, a step that typically determines whether they should receive chemotherapy. “It is very hard to find a reason why a patient who is under anesthesia, inside of the operating room, already undergoing surgery, would be less likely to receive this kind of guideline-concordant care,” Nogueira says.