Separate research from UC-Davis, published in 2015, showed the impact of health insurance status: Uninsured patients and those on Medi-Cal — California’s version of the federal Medicaid program for low-income people — had worse cancer care and outcomes than people with private insurance.
The research published this month showed the most critical factor in survival was finding the cancer early, which the report said underscores the importance of screening. One hundred percent of breast cancer patients survived at least five years if their disease was detected at stage 1. Only 28 percent of patients lived that long if their cancer was found when it was at stage 4, the most advanced stage. Most types of cancer show similarly stark disparities.
Stages, which depend in part on the size of the tumor and whether the cancer has spread, are a gauge of how serious the disease is.
“The earlier things are picked up, the more likely it is that treatment is successful,” said Dr. Kenneth Kizer, senior author of the study and director of the UC-Davis Institute for Population Health Improvement.
Cancer screening and treatment for African-Americans lag behind other racial and ethnic groups, said Dr. Nancy Lee, who is on the board of Black Women’s Health Imperative, a national organization that seeks to improve the health of black women. Long-standing and sometimes unrecognized bias in the health care system disadvantages black patients in a way that can compromise their medical outcomes, said Lee, who previously led the cancer division of the U.S. Centers for Disease Control and Prevention.
White women in California are more likely to get breast cancer, the most common cancer among women, but black women are more likely to die from it, the UC-Davis report found.
Bobby Smith’s wife, an African-American, died 13 years ago after her breast cancer moved into her lymph nodes and eventually metastasized to her brain. Smith said he doesn’t believe doctors gave her all the information she needed to make the best decisions about her treatment. “Health care professionals treat and serve people of color differently,” said Smith, who lives in Los Angeles.
The UC-Davis report used data from the California Cancer Registry, a repository of data on cancer patients dating to 1988 that contains information on patient demographics, diagnosis, initial treatment and outcomes.
The rates reported in the study measure “relative” survival, which represents survival in the absence of other causes of death. The study showed patients with prostate, breast, melanoma and uterine cancers had among the highest survival rates: More than 80 percent of them lived at least five years after their diagnosis.
Survival did not improve for patients with some cancers, including bladder, cervical and testicular. And fewer than 20 percent of patients with cancers of the lung, liver, pancreas and esophagus lived past five years.
For breast cancer patients, five-year survival improved from 85 percent among those diagnosed between 1990 and 1994 to 90 percent among those diagnosed between 2006 and 2010.
The patterns were similar for lung cancer, the second most commonly diagnosed cancer in California and the leading cause of cancer deaths nationwide. The disease tends to be diagnosed late, and patients with stage 4 cancer had just a 4 percent survival rate after five years.
Kizer of UC-Davis said new treatments offer great promise for cancer patients, but how much money they have and who their insurers are may well determine whether or not they reap the benefits.
Cancer is hard enough for people with means and education, said Susan Lasker Hertz, 61, a Colorado nurse who was diagnosed with stage 2 breast cancer in 2009 and then developed leukemia three years later. Hertz, who is now in remission from both cancers, said her knowledge and experience helped her navigate the health care system and get treated quickly after her diagnosis. But it wasn’t easy.
“I am an educated, white, highly knowledgeable health care professional,” she said, “and it is still overwhelming.”
Sourced by KHN, KHN’s coverage in California is supported in part by Blue Shield of California Foundation.