DISPARITY IN U.S. CANCER CARE
May 18, 2005
Americans generally receive high-quality cancer care but closer monitoring is needed to explain significant geographic variations in practices, say researchers.
Also, cancer specialists say they need improved training in communication so they can better advise terminally ill patients about how long they have to live and help them choose the care they wish to receive.
Rand Corporation and Harvard University researchers used more than 100 measures of quality in studying the care for cancers of the breast, colon and rectum in five cities (Atlanta, Cleveland, Houston, Kansas City and Los Angeles). The researchers interviewed 2,366 patients and reviewed the medical records of these and other patients. They found:
- Overall adherence to the quality measures was 86 percent among breast cancer patients and 78 percent among those with colorectal cancer.
- More than 95 percent of breast cancer patients had at least the standard recommended number of lymph nodes removed and examined, and 92 percent of breast cancer patients who should have received the drug tamoxifen did.
- Adherence to recommendations for the number of cycles of drug treatment and the amount of drug given in each cycle ranged from 29 percent to 74 percent.
In the United States, about half a million people die of cancer each year. "Doctors have been described as poor at giving accurate prognostic information for their dying patients," who often overestimate their survival, says Dr. Christopher K. Daugherty of the University of Chicago. Daugherty added that there was little information about how doctors talk with such patients.
Geographically, adherence to quality also varies. More than twice as many patients in Hawaii survived five years after detection of stomach cancer than in Utah. In Hawaii, the median number of lymph nodes removed was more than double that in Utah.
Source: Altman, Lawrence, "Studies Find Disparity in U.S. Cancer Care," The New York Times, May 16, 2005.
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