Racial differences in kidney cancer care, outcome

NEW YORK (Reuters Health) - There are disparities in the treatment and outcome between older black and white patients who have renal cell cancer, with blacks having significantly lower survival rates, according to a new study.

However, the lower rates of nephrectomy (surgical removal of the kidney) and the higher rates of comorbid illnesses in black patients largely explain the survival difference, the study found.

In recent years, 5-year survival rates for renal cell cancer have improved among whites, the authors explain in the Journal of Clinical Oncology, but there has been little change in survival rates among blacks.

Dr. Sonja I. Berndt from the National Cancer Institute in Bethesda, Maryland and colleagues examined data for 964 black and 10,482 white Medicare beneficiaries with renal cell cancer.

Blacks were much more likely than whites to have other illnesses, in addition to kidney cancer, the authors found.

Far fewer black patients (61 percent) than white patients (70 percent) underwent surgery to remove the kidney, the report indicates. Blacks were still less likely than whites to undergo surgery after adjustment for a number of factors.

Blacks survived a median of 2.5 years, while whites survived a median of 3.2 years, the investigators report, but this difference was eliminated when they adjusted for other illnesses present in blacks and treatment type.

Among blacks who had their kidney removed, the survival rates were worse compared with those for whites who had their kidney removed. In contrast, blacks who did not have kidney removal surgery had better survival rates than whites who did not have the surgery.

"Although the reasons for the disparity in treatment are not entirely clear and need to be examined in future studies," the authors conclude, "this study suggests black patients may benefit from efforts to improve the availability of health care and interventions to reduce comorbid illness."

SOURCE: Journal of Clinical Oncology, August 20, 2007.