Understanding racial disparities in cancer treatment and outcomes.

o p p f r 2 w i t t t recent report from the Institute of Medicine documents idespread racial disparities in medical treatment and ealth outcomes. Such disparities are particularly apparent mong patients with cancer. For many types of cancer, lack Americans have markedly higher cancer-specific ortality rates than members of other racial and ethnic roups—more than 2-fold higher in some instances. Exess cancer mortality in this group is partly attributable to igher cancer incidence rates. However, increased cancer ortality among black patients is also due in large part to orse prognoses among those already diagnosed. Reasons for higher mortality among minorities encomass both patient factors and provider and health care sysem effects. Patient factors include characteristics associted with decreased longevity, such as socioeconomic status SES), health behaviors, and comorbid conditions. At the rovider level, higher cancer mortality may reflect underse of screening, resulting in later stage at diagnosis, and nderuse of cancer-directed surgery and adjuvant therapy. inally, racial disparities may be associated with differences n the quality of care delivered by providers and by the elected settings where black patients cluster for care. Some f these settings have been associated with higher cancer ortality rates and may be less likely to provide high uality comprehensive, transitional, and follow-up care afer surgery.