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Inequity in Black and White Mesothelioma Patients’ Care


Racial Inequalities in Cancer Patient Care

Researchers from Mount Sinai Medical Center recently reviewed survival and treatment data of pleural mesothelioma patients. They wanted to determine if there was inequity in patient care between White and Black patients.

According to their analysis, Black patients were less likely to receive mesothelioma surgery. Black patients who were treated with the surgery had less favorable short-term mortality rates.

Surgical Treatment More Likely for White Patients Than Black

Mesothelioma treatment is often multimodal. This means more than one treatment is used to combat the cancer. In this study, researchers looked specifically at surgical intervention among Black and White pleural mesothelioma patients.

Patient Data Breakdown From the Study

  • 2,550 total patients studied
  • 2,462 White patients (96.5%)
  • 88 Black patients (3.5%)

There are multiple surgical options for mesothelioma varying by aggressiveness. Surgery can be used for diagnosis, removal of tumors and/or symptom management.

According to this study, Black patients were less likely to receive surgical treatment than White patients. Furthermore, when treated surgically, Black patients were likely to undergo pleurectomy/decortication (P/D). White patients were more often treated with extrapleural pneumonectomy (EPP). EPP is considered the more aggressive surgical option.

What’s the Difference Between a P/D and EPP?

Pleurectomy and Decortication (P/D) Explained

  • Pleural mesothelioma surgery to remove cancerous tissue without complete removal of the affected lung
  • Often called “lung-sparing surgery”
  • A two-part procedure with fewer risks than EPP

Extrapleural Pneumonectomy (EPP) Explained

  • Pleural mesothelioma surgery involving the removal of the affected lung and surrounding tissue
  • Considered the aggressive pleural mesothelioma surgical option
  • Can improve patient quality of life but includes extensive recovery

Less extensive surgery for Black patients is a common phenomenon. Research into other cancers, such as lung cancer and colorectal cancer, has discovered extensive surgeries are rarely provided to Black patients.

The Mount Sinai researchers found patients treated with EPP surgeries are also more likely to receive chemotherapy or radiation. According to the study, Black patients tended to receive less aggressive treatment regimens.

Why Are Black Patients Receiving Less Aggressive Mesothelioma Treatment?

According to the researchers, there are several reasons Black patients may be less likely to undergo aggressive mesothelioma treatment. Reasons include personal choice and access to care.

Potential Causes of Less Aggressive Treatment Among Black Patients
  • Personal choice
  • Differences in the level of medical care
  • Differences in access to medical care
  • Presence of comorbidities (other illnesses)
  • Patient variables
  • Tumor variables

Impact of Stage of Cancer and Patient Age on Surgical Treatment

In this particular study, the Black pleural mesothelioma patients tended to be diagnosed at a more advanced stage than their White counterparts. Researchers noted advanced stage is often associated with fewer viable surgical treatment options.

Patient age can also impact viable treatment options. Commonly, older mesothelioma patients tend to have fewer treatment options available to them. For example, older patients are more likely to have other health conditions that may complicate treatment. But, in the study, the Black patients were significantly younger than the White patients and yet tended to receive the less aggressive surgical option.

Study authors suspect this race-specific deviation from typical age-related treatment utilization trends may result from:

  1. Physician bias AND/OR
  2. Miscommunication

Impact of Surgery on Survival of White vs. Black Patients

Researchers did not find a statistically significant survival rate difference between Black and White pleural mesothelioma patients.

Despite the lack of aggressive surgeries, researchers noted Black patients had slightly more favorable long-term survival results than White patients. They noted a handful of factors they believe caused the survival benefits displayed among the Black patients.

Potential Causes of Survival Benefits Among the Black Patients

In addition to younger age, the Black patients studied were also more likely to have private health insurance.

  • 50% of the Black surgical patients had private insurance
  • 24% of the Black non-surgical patients had private insurance

However, the Black patients that received the more aggressive surgery had worse short-term mortality. The researchers note this is only a trend in the data they analyzed. They suggest further studies should be conducted to determine factors associated with patient and physician surgical choice.

Determining the cause of this disparity may help improve survival outcomes for patients regardless of race.