Survival Rates from Gastrointestinal Tumors Improving Among African Americans
After Years of Inequality, Survival Rates Now Equivalent to Those of Caucasians
Physician-scientists at the University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center have published new research indicating that racial disparities in treating a rare gastrointestinal cancer have been greatly reduced. Leonidas G. Koniaris, M.D., associate professor of surgery at the Miller School and surgical oncologist at Sylvester, and Michael Cheung, M.D., surgical resident with the DeWitt Daughtry Family Department of Surgery, examined data of African Americans with gastrointestinal stromal tumors (GIST), a rare cancer that begins in the wall of the gastrointestinal tract.
Before 2000, African Americans were more likely to develop GIST and less likely to undergo surgical treatment for this type of cancer. New research conducted by Koniaris and Cheung, published in the July issue of the Journal of the American College of Surgeons, reveals that African Americans now have survival rates equivalent to those of Caucasians.
Racial disparities in survival rates have been demonstrated for a number of cancers, typically due to unequal access to care. Through the National Institutes of Health and Healthy People 2010, a national health promotion and disease prevention initiative, the federal government has set forth goals to explore, account for and minimize these disparities.
“Over the last decade, racial gaps in the treatment of GIST appear to have closed,” said Cheung. “Both perioperative and long-term survival have improved among African Americans.”
“Our study suggests that better diagnosis and increased use of surgery – which still provides the best chance for a cure – have contributed to improvements in care for African Americans,” said Koniaris. “In addition, increased access to new targeted therapies through medication assistance programs may be helping to eliminate racial disparities in cancer treatment.”
Koniaris and Cheung performed a statistical analysis using the Surveillance, Epidemiology and End Results (SEER) database that identified 3,795 patients diagnosed with GIST and other intestinal mesenchymal tumors between 1992 and 2005. Of those patients, slightly more than 72 percent were Caucasians, nearly 16 percent African Americans, and 9 percent Hispanics. Survival was calculated from the time of initial diagnosis to the date of last contact or death.
The Miller School scientists found that both perioperative and long-term survival had improved among African Americans since 2000. In patients diagnosed before 2000, 30-day surgical mortality was higher in African Americans. However, after 2000, 30-day surgical mortality was equivalent between African Americans and Caucasians.
Three-year disease specific survival was better in Caucasians than African Americans, before 2000. There was no racial difference in tumor stage or grade, and African Americans underwent surgical procedures less frequently than Caucasians. Koniaris and Cheung determined that African-American race and failure to undergo surgical treatment were independent predictors of poor prognosis. In patients diagnosed after 2000, three-year disease specific survival was nearly equivalent between Caucasians and African Americans, and African Americans underwent surgical procedures just as often as Caucasians. There was no difference in survival by race in patients diagnosed after 2000.