Even when receiving comparable levels of treatment, African-American patients with liver cancer have worse survival rates than patients of other races, according to City of Hope researchers.
Joseph Kim, M.D., assistant professor of surgery, and colleagues analyzed data from about 24,000 liver cancer patients nationwide to identify potential causes of disparities in outcomes. Their findings were published online Jan. 25 in Cancer, the journal of the American Cancer Society.
|Surgical oncologist Joseph Kim studies disparities in outcomes among patients with liver cancer and other gastrointestinal malignancies. (Photo by Walter Urie)|
Survival rates for liver cancer overall have improved over the years, which may be due to advances in surgical technique, new targeted therapies and increased use of liver transplantation to treat early stage tumors, Kim said.
However, survival has improved for some patients more than others. African-American and low-income patients had the poorest outcomes. Specifically, African-American patients had a 15 percent increased risk of death compared to Caucasian patients. And Asian-American patients did better: They showed a 13 percent reduced risk of death compared to Caucasian patients.
The team hypothesized that differences in access to care may have led to the differences in survivorship, Kim said, “but we still found disparate outcomes by race even with equal treatment.”
As part of the investigation, Kim studied more than 4,000 records of liver cancer patients who received liver transplantation as part of their treatment. Despite comparable care, African-Americans had the worst outcomes after transplantation, with a median survival of just over 30 months. Caucasian patients survived nearly 64 months, while Asian-Americans survived nearly 70 months and Latinos’ median survival was over 82 months.
Although reasons for the disparities are hazy, researchers believe that differences in underlying disease may play a part in outcomes.
“It is clear that access, while still an important factor, is not the primary factor in the outcome disparities we see among the different racial and ethnic groups,” said Kim. “What we are learning is that in addition to providing the best treatment, we also need to pay more attention to post-treatment variables in our overall survivorship care.”
Kim and colleagues are now studying the role of genetic factors in outcome disparities.
Collaborators included Avo Artinyan, M.D., Brian Mailey, M.D., Nicelio Sanchez-Luege, Joshua Khalili, Can-Lan Sun, M.D., Ph.D., and Smita Bhatia, M.D., M.P.H., from City of Hope, Lawrence D. Wagman, M.D., of St. Joseph Hospital in Orange, Calif., and Nicholas Nissen, M.D., and Steven D. Colquhoun, M.D., of Cedars-Sinai Medical Center.