Davidoff Amy J, Rapp Thomas, Onukwugha Ebere, Zuckerman Ilene H, Hanna Nader, Pandya Naimish, Mullins C Daniel
Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD 21201, USA.
Med Care. 2009 Dec;47(12):1229-36. doi: 10.1097/MLR.0b013e3181b58a85.
Race disparities in adjuvant chemotherapy for stage III colon cancer patients have been documented, and medical oncologist evaluation is a critical step in the treatment process. Recent healthcare system and environmental changes may have reduced treatment gaps.
To examine differential rates of oncologist evaluation and conditional treatment, by race, and to determine whether changing evaluation and treatment patterns reduced disparities.
Retrospective analysis of Surveillance Epidemiology and End Results-Medicare registry, enrollment, and claims data.
Patients age >65, white or African American race, diagnosed with American Joint Committee on Cancer stage III colon cancer between 1997 and 2002. N = 7176.
Oncology specialty evaluation and management visit or chemotherapy claim; receipt of 5-fluorouracil based chemotherapy. Time periods are grouped into early (1997-1998), middle (1999-2000), and late (2001-2002).
Initial adjusted oncologist evaluation rates were higher for whites compared with African American patients (58.7% vs. 42.9%), but changes over time reduced the race gap substantially. We did not find significant race-time trends in treatment rates conditional on oncologist evaluation.
Race disparities in medical oncologist evaluations diminished over time, possibly in response to increased provider supply or changing patient and provider attitudes, but there was no parallel reduction in disparities in conditional treatment rates. Projected decreases in oncologist supply suggest the need for further research on this relationship. Research on the role of supplemental medical insurance on disparities in treatment is needed, particularly as the cost of recommended adjuvant therapy increases.
已记录到III期结肠癌患者在辅助化疗方面存在种族差异，而医学肿瘤学家的评估是治疗过程中的关键一步。近期医疗保健系统和环境的变化可能缩小了治疗差距。
按种族检查肿瘤学家评估和条件性治疗的差异率，并确定评估和治疗模式的变化是否缩小了差异。
对监测、流行病学和最终结果-医疗保险登记、注册及理赔数据进行回顾性分析。
年龄>65岁、白种人或非裔美国人，在1997年至2002年期间被诊断为美国癌症联合委员会III期结肠癌的患者。N = 7176。
肿瘤专科评估及管理就诊或化疗理赔；接受基于5-氟尿嘧啶的化疗。时间段分为早期（1997 - 1998年）、中期（1999 - 2000年）和晚期（2001 - 2002年）。
与非裔美国患者相比，白种人的初始调整后肿瘤学家评估率更高（58.7%对42.9%），但随着时间推移，种族差距大幅缩小。在以肿瘤学家评估为条件的治疗率方面，我们未发现显著的种族-时间趋势。
随着时间推移，医学肿瘤学家评估中的种族差异有所减少，这可能是由于医疗服务提供者数量增加或患者及提供者态度转变所致，但条件性治疗率的差异并未相应缩小。预计肿瘤学家数量的减少表明需要对这种关系进行进一步研究。需要研究补充医疗保险在治疗差异方面的作用，尤其是在推荐的辅助治疗成本增加的情况下。
