Cancer care found to vary by region, race

ORLANDO, Fla. -- Whether patients receive the best possible cancer care in the United States varies greatly depending on where they live and their race, according to several studies released yesterday.

Doctors treating black women with breast cancer, for instance, wait on average three months longer to test them and begin treatment for their cancer than they do for white women, one study found.

Another study said that about half of patients with stomach cancer had their tumors and surrounding lymph nodes completely removed, and this varied greatly by region.

And a systematic survey of breast and colon cancer care found that many patients do not get the recommended care.

Sherri Sheinfeld Gorin of Columbia University and colleagues checked the records of nearly 50,000 women over age 64 with breast cancer.

They analyzed how long it took for women to get biopsied for cancer after visiting a doctor because of a suspect mammogram. They also analyzed how long it took from the time of a positive biopsy to the first treatment, such as surgery, and combined these two factors into a number they called the clinical delay.

Nearly 27 percent of black women had a clinical delay of three months, compared with 17 percent of Hispanic women and 15 percent of white women, Gorin said.

''A delay of two months can reduce five-year survival by 10 percent to 15 percent," said Dr. David Johnson, an oncologist at Vanderbilt University in Nashville who is president of the American Society of Clinical Oncology. ''That may be one of the reasons that African-American women are not doing as well."

Dr. Natalie Coburn of Princess Margaret Hospital in Toronto and her colleagues surveyed the records of 10,000 patients with stomach cancer, which affects nearly 22,000 Americans a year and kills more than 11,500.

There are guidelines released by specialty cancer societies for treating gastric cancer: Patients are supposed to have the entire cancerous area removed and 15 nearby lymph nodes taken out and tested to ensure that the cancer has not spread.

On average, doctors checked only nine lymph nodes per patient and only 32 percent of patients received the recommended full extent of surgery and lymph node removal.

In a separate development regarding cancer treatment, doctors said a medication used to reduce the need for transfusions in patients with a deadly blood disorder now appears to be successful in treating the disease itself.

Specialists said the experimental drug, Revlimid, now appears to be the first effective treatment for many people with myelodysplastic syndrome, or MDS, which is more common than leukemia.

MDS refers to a group of disorders caused by bone marrow not making enough healthy, mature blood cells. About 15,000 to 20,000 new cases are diagnosed each year in the United States. Patients usually suffer anemia and fatigue and need blood transfusions about every eight weeks to stay alive.

After about six months on the drug, 66 percent no longer needed blood transfusions, said the study's leader, Dr. Alan List of the H. Lee Moffitt Cancer Center in Tampa. A year later, three-fourths of them still do not need transfusions.

''It may be, if not eradicating the disease, putting it into what I would call deep remission," said Johnson, who is familiar with the research. Revlimid is not yet on the market but almost certainly will be because of these findings, he added.

Material from the Associated Press was included in this report.