Discrimination in Healthcare

45% of patients with advanced rectal cancer don’t receive the recommended treatment for this disease.

Rectal cancer is a problem.  Forecasts call for 39,000 new cases of this type of cancer in the US by the end of this year.  Rectal cancer is the largest subcategory of colorectal cancer, and is the second leading cause of cancer death in the US (roughly 15,000 deaths per year).

Colorectal cancer is most common among African-Americans.

Minorities (African-American, Latino and Native American) are less likely to receive regular screening for rectal cancer, which means that when the cancer is identified, it is usually at an advanced state.

The gold standard for treatment is neoadjuvant chemoradiation therapy (NACRT) before surgery.  This approach uses three complementary approaches to treating rectal cancer, and produces better results than chemotherapy or surgery alone.

However, almost half of Americans with advanced rectal cancer don’t receive the recommended treatment for it.  Why?

A statistical analysis of advanced rectal cancer cases treated between 2004 and 2009 identified the following factors as related to whether patients received the optimal treatment or not:

  • Age
  • Presence of comorbidities (e.g., other disease conditions)
  • Primary tumor size
  • Lymph node involvement
  • Non-Hispanic white ethnicity
  • Lack of private insurance
  • Being treated at a non-high case volume facility

In plain English, if you are white or have private insurance, you’re more likely to get the NACRT treatment.  If you’re minority, have other serious illnesses, don’t have health insurance, or are being treated by doctors who don’t handle a large volume of these cases, you’re much less likely to have NACRT offered to you.

Most of these characteristics are related to ethnicity, wealth and where you live.  Minorities, the poor and those living in rural areas are less likely to get the best care.

Why does NACRT matter?

The five year survival rate for persons with advanced rectal cancer (Stages II and III) treated with NACRT is 72%.  For those treated with surgery alone, it’s 45%.  For those treated with chemo alone, it’s 49%.  So the course of treatment can make a huge different for the patient.

Recommendations:

  • Regular screening is a must.  You may want to go beyond normal guidelines, because rectal cancer is becoming more common among younger adults.
  • Second opinions are a must.  The first doctor you see may not know the best course of treatment.

Finally, one oncologist I know swears by a smoothie that is a mix of kale or spinach (2 cups), one green apple and a one-inch-thick ring of pineapple.  One of these a day may keep cancer away — for than one can help the consumer lose weight.

Finally, as a society, we need to decide:  does the right to “Life, Liberty and the Pursuit of Happiness” enshrined in the Declaration of Independence include a right to healthcare?  Can you in fact use any of your other rights without some reasonable level of health?


Sources:

  1. Cho, Stephen, “Substantial Increase in Use of Neoadjuvant Chemoradiotherapy for Rectal Cancer”, Oncology Nurse Advisor,  14 April 2016.  http://www.oncologynurseadvisor.com/daily-oncology-news/rectal-cancer-neoadjuvant-chemoradiotherapy-nacrt-substantial-increase/article/489751/
  2. National Cancer Institute, “SEER Stat Fact Sheets: Colon and Rectum Cancer”.  https://seer.cancer.gov/statfacts/html/colorect.html
  3. http://fightcolorectalcancer.org/prevent-it/facts-about-colorectal-cancer/
  4. 2016 Gastrointestinal Cancers Symposium, “Changes in treatment patterns for patients with locally advanced rectal cancer in the United States over the past decade: An analysis from the National Cancer Data Base (NCDB),” 23 January 2016.  https://www.mdlinx.com/oncology/conference-abstract.cfm/56212/?conf_id=231384&searchstring=&coverage_day=0&nonus=0&page=4
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