Research takes aim at inequities in cancer treatment
By Robert Levy
David Harrington, PhD (right), chair of Dana-Farber's Department of Bio-statistical Science, and Paul Catalano, ScD, the department's associate chair, are exploring why cancer survival rates are higher in some population groups than others.
It is one of the best-known, and least-acceptable, statistics about cancer: African-Americans are more likely to die of the disease than their white peers — 33 percent more likely, on average. Death rates for blacks with lung cancer are 22 percent higher than for whites. In the case of colorectal cancer, the gap is even bigger, at 34 percent.
Why the divergence? Here, matters are less clear. Is it because blacks as a group have poorer access to quality medical care, or because they tend not to seek treatment until their disease is more advanced and harder to cure? Do blacks and whites with comparable diseases receive comparable care? Have cancer-prevention campaigns been as effective in the black community as in the white population?
African Americans are among the groups that stand to benefit from new "population-based" studies by Dana-Farber researchers.
Previous research doesn't offer much of a guide for answering these questions. Past studies have managed to be both contradictory and inconclusive when it comes to the reasons for disparities in health and the outcomes of treatment.
That's the incentive for a new five-year, $34 million study taking the most thorough look ever at racial and demographic inequities in cancer care. The study, which will focus on lung and colorectal cancer, involves seven cancer centers across the country — six of which will gather information from patients and caregivers. One, the Dana-Farber/Harvard Cancer Center (DF/HCC), will receive data from the other sites and tally it so analyses can be made and conclusions drawn.
But the DF/HCC will be far more than a "number crunching" facility, complex as that function is. Bio-statisticians at Dana-Farber and Harvard Medical School will be central in discussions of how the information should be gathered, what data is needed, and how it should be analyzed.
This five-year, $34 million study is taking the most thorough look ever at racial and demographic inequities in cancer care.
"This study, sponsored by the National Cancer Institute, is the first to look at treatment outcomes and quality-of-life measures while patients are receiving care," says David Harrington, PhD, chair of the Institute's Department of Biostatis-tical Science and principal investigator for one portion of the grant. "What distinguishes this project is the ability to survey patients and their physicians early in the treatment process or shortly afterward," rather than reviewing outcomes many years later.
The centers involved in the study, known as the Cancer Care Outcomes Research and Surveil-lance Consortium (CanCORS), plan to enroll about 10,000 patients diagnosed with lung or colorectal cancer at six sites around the country; no Dana-Farber patients will be involved. Investigators plan to gather information through patient interviews and questionnaires. They will also monitor patients' progress through medical records and follow-up interviews. Detailed data on each patient — all of it confidential — will be fed into a database at Dana-Farber over a secure Internet site.
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