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National Institutes of Health 
Cancer care services don't differ by neighborhood
Wednesday, August 8, 2012
By Andrew M. Seaman
NEW YORK (Reuters Health) - The worse outcomes among people with cancer who live in poor neighborhoods don't seem to be because they live in areas with fewer doctors and hospitals, according to a new study.
Researchers found that poor neighborhoods in the U.S. seem to have just as many doctors and hospitals capable of screening for and treating cancer as wealthy areas.
"So areas with a high amount of poverty had the same amount of care as areas with a low amount of poverty," said Dr. Elizabeth Lamont, the study's lead author from the Massachusetts General Hospital Cancer Center in Boston.
But the new study does not mean people living in those poor areas are getting the care they need, because the researchers only looked at the sheer number of facilities - not whether people had access to the services.
Lamont also said that even if the people living in those areas had access, the quality of care in their area may not be that great.
In 2008, researchers reported that poor people - especially those older than 65 years old - are more likely to die within five years after being diagnosed with either breast or colon cancer than wealthy people.
In that study, poor women with breast cancer had a 59 percent greater risk of death within five years of diagnosis than wealthy women. The link was weaker for colon cancer in poor men, which was associated with a 10 percent greater risk of death.
To see whether there is a lack of doctors or facilities in poor neighborhoods, Lamont and her colleagues identified 465 areas in the U.S. where residents typically stay for care.
The researchers, who published their findings in the Journal of Clinical Oncology, then came up with a list of 16 services needed for the screening, treatment and surveillance of breast and colorectal cancer.
Using information from the year 2000, the researchers combined several databases that allowed them to see how many doctors and services were offered in certain areas.
Among the list of 16 services, there were, on average, about 850 hospital beds, 69 doctors capable of screening for cancer, three medical oncologists, 16 mammogram facilities and 10 surgeons in each of the 465 areas.
Those numbers, according to the researchers, did not differ significantly between poor and wealthy neighborhoods.
'MISSES THE ISSUES'
Dr. Sandra Swain, president of the American Society of Clinical Oncology - which publishes the Journal of Clinical Oncology - told Reuters Health that this paper appears to rule out the availability of facilities as a problem, but "really misses the issues."
For example, she said, "We have a lot of doctors and healthcare available in D.C., and yet the mortality for breast cancer is very high."
Swain, the medical director of the Washington Cancer Institute at MedStar Washington Hospital Center, said that insurance, money, medical literacy and even transportation play roles in whether people can get cancer care.
"I think it's important that we need to look at the other issues," she said.
Lamont and her colleagues are currently working on a study that looks at the availability of these services while taking into account some of the factors Swain mentioned.
Swain also said that these results may change over time, especially since medical organizations are predicting doctor shortages in the coming years.
"I think it could be a problem in the future," she said.
SOURCE: http://bit.ly/OM2mhk Journal of Clinical Oncology, August 6, 2012.
NEW YORK (Reuters Health) - The worse outcomes among people with cancer who live in poor neighborhoods don't seem to be because they live in areas with fewer doctors and hospitals, according to a new study.
Researchers found that poor neighborhoods in the U.S. seem to have just as many doctors and hospitals capable of screening for and treating cancer as wealthy areas.
"So areas with a high amount of poverty had the same amount of care as areas with a low amount of poverty," said Dr. Elizabeth Lamont, the study's lead author from the Massachusetts General Hospital Cancer Center in Boston.
But the new study does not mean people living in those poor areas are getting the care they need, because the researchers only looked at the sheer number of facilities - not whether people had access to the services.
Lamont also said that even if the people living in those areas had access, the quality of care in their area may not be that great.
In 2008, researchers reported that poor people - especially those older than 65 years old - are more likely to die within five years after being diagnosed with either breast or colon cancer than wealthy people.
In that study, poor women with breast cancer had a 59 percent greater risk of death within five years of diagnosis than wealthy women. The link was weaker for colon cancer in poor men, which was associated with a 10 percent greater risk of death.
To see whether there is a lack of doctors or facilities in poor neighborhoods, Lamont and her colleagues identified 465 areas in the U.S. where residents typically stay for care.
The researchers, who published their findings in the Journal of Clinical Oncology, then came up with a list of 16 services needed for the screening, treatment and surveillance of breast and colorectal cancer.
Using information from the year 2000, the researchers combined several databases that allowed them to see how many doctors and services were offered in certain areas.
Among the list of 16 services, there were, on average, about 850 hospital beds, 69 doctors capable of screening for cancer, three medical oncologists, 16 mammogram facilities and 10 surgeons in each of the 465 areas.
Those numbers, according to the researchers, did not differ significantly between poor and wealthy neighborhoods.
'MISSES THE ISSUES'
Dr. Sandra Swain, president of the American Society of Clinical Oncology - which publishes the Journal of Clinical Oncology - told Reuters Health that this paper appears to rule out the availability of facilities as a problem, but "really misses the issues."
For example, she said, "We have a lot of doctors and healthcare available in D.C., and yet the mortality for breast cancer is very high."
Swain, the medical director of the Washington Cancer Institute at MedStar Washington Hospital Center, said that insurance, money, medical literacy and even transportation play roles in whether people can get cancer care.
"I think it's important that we need to look at the other issues," she said.
Lamont and her colleagues are currently working on a study that looks at the availability of these services while taking into account some of the factors Swain mentioned.
Swain also said that these results may change over time, especially since medical organizations are predicting doctor shortages in the coming years.
"I think it could be a problem in the future," she said.
SOURCE: http://bit.ly/OM2mhk Journal of Clinical Oncology, August 6, 2012.
Reuters Health
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