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Cancer can be treated by surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapy (including immunotherapy such as monoclonal antibody therapy) and synthetic lethality,
most commonly as a series of separate treatments (e.g. chemotherapy
before surgery). The choice of therapy depends upon the location and
grade of the tumor and the stage of the disease, as well as the general state of the patient (performance status). Cancer genome sequencing helps in determining which cancer the patient exactly has for determining the best therapy for the cancer. A number of experimental cancer treatments are also under development. Under current estimates, two in five people will have cancer at some point in their lifetime.
Complete removal of the cancer without damage to the rest of the body (that is, achieving cure with near-zero adverse effects)
is the ideal, if rarely achieved, goal of treatment and is often the
goal in practice. Sometimes this can be accomplished by surgery, but the
propensity of cancers to invade adjacent tissue or to spread to distant
sites by microscopic metastasis often limits its effectiveness; and chemotherapy and radiotherapy can have a negative effect on normal cells. Therefore, cure with nonnegligible adverse effects may be accepted as a practical goal in some cases; and besides curative intent,
practical goals of therapy can also include (1) suppressing the cancer
to a subclinical state and maintaining that state for years of good quality of life (that is, treating the cancer as a chronic disease), and (2) palliative care without curative intent (for advanced-stage metastatic cancers).
Because "cancer" refers to a class of diseases, it is unlikely that there will ever be a single "cure for cancer" any more than there will be a single treatment for all infectious diseases. Angiogenesis inhibitors were once thought to have potential as a "silver bullet" treatment applicable to many types of cancer, but this has not been the case in practice.
Types of treatments
The
treatment of cancer has undergone evolutionary changes as understanding
of the underlying biological processes has increased. Tumor removal
surgeries have been documented in ancient Egypt, hormone therapy and
radiation therapy were developed in the late 19th century. Chemotherapy,
immunotherapy and newer targeted therapies are products of the 20th
century. As new information about the biology of cancer emerges,
treatments will be developed and modified to increase effectiveness,
precision, survivability, and quality of life.
Surgery
In theory, non-hematological cancers can be cured if entirely removed by surgery, but this is not always possible. When the cancer has metastasized to other sites in the body prior to surgery, complete surgical excision is usually impossible. In the Halstedian
model of cancer progression, tumors grow locally, then spread to the
lymph nodes, then to the rest of the body. This has given rise to the
popularity of local-only treatments such as surgery for small cancers.
Even small localized tumors are increasingly recognized as possessing
metastatic potential.
Examples of surgical procedures for cancer include mastectomy for breast cancer, prostatectomy for prostate cancer, and lung cancer surgery for non-small cell lung cancer. The goal of the surgery can be either the removal of only the tumor, or the entire organ.
A single cancer cell is invisible to the naked eye but can regrow into a
new tumor, a process called recurrence. For this reason, the pathologist
will examine the surgical specimen to determine if a margin of healthy
tissue is present, thus decreasing the chance that microscopic cancer
cells are left in the patient.
In addition to removal of the primary tumor, surgery is often necessary for staging, e.g. determining the extent of the disease and whether it has metastasized to regional lymph nodes. Staging is a major determinant of prognosis and of the need for adjuvant therapy. Occasionally, surgery is necessary to control symptoms, such as spinal cord compression or bowel obstruction. This is referred to as palliative treatment.
Surgery may be performed before or after other forms of treatment. Treatment before surgery is often described as neoadjuvant.
In breast cancer, the survival rate of patients who receive neoadjuvant
chemotherapy are no different from those who are treated following
surgery.
Giving chemotherapy earlier allows oncologists to evaluate the
effectiveness of the therapy, and may make removal of the tumor easier.
However, the survival advantages of neoadjuvant treatment in lung cancer
are less clear.
Radiation therapy
Radiation therapy
(also called radiotherapy, X-ray therapy, or irradiation) is the use of
ionizing radiation to kill cancer cells and shrink tumors. Radiation
therapy can be administered externally via external beam radiotherapy (EBRT) or internally via brachytherapy.
The effects of radiation therapy are localised and confined to the
region being treated. Radiation therapy injures or destroys cells in the
area being treated (the "target tissue") by damaging their genetic
material, making it impossible for these cells to continue to grow and
divide. Although radiation damages both cancer cells and normal cells,
most normal cells can recover from the effects of radiation and function
properly. The goal of radiation therapy is to damage as many cancer
cells as possible, while limiting harm to nearby healthy tissue. Hence,
it is given in many fractions, allowing healthy tissue to recover
between fractions.
Radiation therapy may be used to treat almost every type of solid
tumor, including cancers of the brain, breast, cervix, larynx, liver,
lung, pancreas, prostate, skin, stomach, uterus, or soft tissue
sarcomas. Radiation is also used to treat leukemia and lymphoma.
Radiation dose to each site depends on a number of factors, including
the radio sensitivity of each cancer type and whether there are tissues
and organs nearby that may be damaged by radiation. Thus, as with every
form of treatment, radiation therapy is not without its side effects.
Radiation therapy kills cancer cells by damaging their DNA (the
molecules inside cells that carry genetic information and pass it from
one generation to the next) (1).Radiation therapy can either damage DNA
directly or create charged particles (free radicals) within the cells
that can in turn damage the DNA. (2) Radiation therapy can lead to dry
mouth from exposure of salivary glands to radiation. The salivary glands
lubricate the mouth with moisture or spit. Post therapy, the salivary
glands will resume functioning but rarely in the same fashion. Dry mouth
caused by radiation can be a lifelong problem.
The specifics of your brain cancer radiation therapy plan will be based
on several factors, including the type and size of the brain tumor and
the extent of disease. External beam radiation is commonly used for
brain cancer. The area radiated typically includes the tumor and an area
surrounding the tumor. For metastatic brain tumors, radiation is
sometimes given to the entire brain.
Radiation therapy uses special equipment to send high doses of radiation
to the cancer cells. Most cells in the body grow and divide to form new
cells. But cancer cells grow and divide faster than many of the normal
cells around them. Radiation works by making small breaks in the DNA
inside cell.
Radiation might not be a choice of treatment if the tumour was
diagnosed on the late stage or is located on vulnerable places.
Moreover, radiation causes significant side effects if used in children
aged 0–14. It was determined to be a beneficial treatment but it causes
significant side effects that influence the lifestyle of the young
patients. Radiotherapy is the use of high-energy rays, usually x-rays
and similar rays (such as electrons) to treat disease. It works by
destroying cancer cells in the area that's treated. Although normal
cells can also be damaged by radiotherapy, they can usually repair
themselves, but cancer cells can't. If the tumour was found on the late
stage, it requires patients to have higher radiation exposure which
might be harmful for the organs. Radiotherapy is determined to be an
effective treatment in adults but it causes significant side effects
that can influence patients' daily living. In children radiotherapy
mostly causes long-term side effects such as hearing loss and blindness.
Children who had received cranial radiotherapy are deemed at a high
risk for academic failure and cognitive delay.
A study by Reddy A.T. determined the significant decrease in IQ
with higher doses of radiation, specifically for children with brain
tumours. Radiation therapy is not the best treatment for brain tumours,
especially in young children as it causes significant damages. There are
alternative treatments available for young patients such as surgical
resection to decrease the occurrence of side effects.
Chemotherapy
Chemotherapy is the treatment of cancer with drugs ("anticancer drugs") that can destroy cancer cells. In current usage, the term "chemotherapy" usually refers to cytotoxic drugs which affect rapidly dividing cells in general, in contrast with targeted therapy (see below). Chemotherapy drugs interfere with cell division in various possible ways, e.g. with the duplication of DNA or the separation of newly formed chromosomes.
Most forms of chemotherapy target all rapidly dividing cells and are
not specific to cancer cells, although some degree of specificity may
come from the inability of many cancer cells to repair DNA damage,
while normal cells generally can. Hence, chemotherapy has the potential
to harm healthy tissue, especially those tissues that have a high
replacement rate (e.g. intestinal lining). These cells usually repair
themselves after chemotherapy.
Because some drugs work better together than alone, two or more
drugs are often given at the same time. This is called "combination
chemotherapy"; most chemotherapy regimens are given in a combination.
The treatment of some leukaemias and lymphomas requires the use of high-dose chemotherapy, and total body irradiation
(TBI). This treatment ablates the bone marrow, and hence the body's
ability to recover and repopulate the blood. For this reason, bone
marrow, or peripheral blood stem cell harvesting is carried out before
the ablative part of the therapy, to enable "rescue" after the treatment
has been given. This is known as autologous stem cell transplantation.
Targeted therapies
Targeted therapy, which first became available in the late 1990s, has
had a significant impact in the treatment of some types of cancer, and
is currently a very active research area. This constitutes the use of
agents specific for the deregulated proteins of cancer cells. Small molecule targeted therapy drugs are generally inhibitors of enzymatic
domains on mutated, overexpressed, or otherwise critical proteins
within the cancer cell. Prominent examples are the tyrosine kinase
inhibitors imatinib (Gleevec/Glivec) and gefitinib (Iressa).
Monoclonal antibody therapy is another strategy in which the therapeutic agent is an antibody which specifically binds to a protein on the surface of the cancer cells. Examples include the anti-HER2/neu antibody trastuzumab (Herceptin) used in breast cancer, and the anti-CD20 antibody rituximab, used in a variety of B-cell malignancies.
Targeted therapy can also involve small peptides as "homing devices" which can bind to cell surface receptors or affected extracellular matrix
surrounding the tumor. Radionuclides which are attached to these
peptides (e.g. RGDs) eventually kill the cancer cell if the nuclide
decays in the vicinity of the cell. Especially oligo- or multimers of
these binding motifs are of great interest, since this can lead to
enhanced tumor specificity and avidity.
Photodynamic therapy (PDT) is a ternary treatment for cancer involving a photosensitizer, tissue oxygen, and light (often using lasers). PDT can be used as treatment for basal cell carcinoma (BCC) or lung cancer; PDT can also be useful in removing traces of malignant tissue after surgical removal of large tumors. In February 2019, medical scientists announced that iridium attached to albumin, creating a photosensitized molecule, can penetrate cancer cells and, after being irradiated with light, destroy the cancer cells.
High-energy therapeutic ultrasound could increase higher-density
anti-cancer drug load and nanomedicines to target tumor sites by 20x
fold higher than traditional target cancer therapy.
Targeted therapies under pre-clinical development as potential cancer treatments include morpholino splice switching oligonucleotides, which induce ERG exon skipping in prostate cancer models, multitargeted kinase inhibitors that inhibit the PI3K with other pathways including MEK and PIM, and inhibitors of NFKB in models of chemotherapy resistance.
Immunotherapy
A renal cell carcinoma (lower left) in a
kidney specimen.
Cancer immunotherapy refers to a diverse set of therapeutic strategies designed to induce the patient's own immune system to fight the tumor. Contemporary methods for generating an immune response against tumours include intravesical BCG immunotherapy for superficial bladder cancer, and use of interferons and other cytokines to induce an immune response in renal cell carcinoma and melanoma patients. Cancer vaccines to generate specific immune responses are the subject of intensive research for a number of tumours, notably malignant melanoma and renal cell carcinoma. Sipuleucel-T is a vaccine-like strategy in late clinical trials for prostate cancer in which dendritic cells from the patient are loaded with prostatic acid phosphatase peptides to induce a specific immune response against prostate-derived cells.
Allogeneic hematopoietic stem cell transplantation
("bone marrow transplantation" from a genetically non-identical donor)
can be considered a form of immunotherapy, since the donor's immune
cells will often attack the tumor in a phenomenon known as graft-versus-tumor effect.
For this reason, allogeneic HSCT leads to a higher cure rate than
autologous transplantation for several cancer types, although the side
effects are also more severe.
The cell based immunotherapy in which the patients own Natural
Killer cells(NK) and Cytotoxic T-Lymphocytes(CTL) are used has been in
practice in Japan since 1990. NK cells and CTLs primarily kill the
cancer cells when they are developed. This treatment is given together
with the other modes of treatment such as surgery, radiotherapy or
chemotherapy and called as Autologous Immune Enhancement Therapy (AIET).
Immune Checkpoint therapy focuses on two "checkpoint" proteins,
cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) and programmed
death 1 (PD-1). Under normal conditions, the immune system utilizes
checkpoint proteins as negative feedback mechanisms to return to
homeostasis once pathogens have been cleared from the body. In tumor
microenvironment, cancer cells can commandeer this physiological
regulatory system to "put a brake" on the anti-cancer immune response
and evade immune surveillance.
2018 Nobel Prize in medicine is awarded to Dr. James Allison of
University of Texas MD Anderson Cancer Center in U.S. and Dr. Tasuku
Honjo Kyoto University in Japan for their contributions in advance of
PD-1 and CTLA-4 immune checkpoint therapy.
Hormonal therapy
The growth of some cancers can be inhibited by providing or blocking
certain hormones. Common examples of hormone-sensitive tumors include
certain types of breast and prostate cancers. Blocking estrogen or testosterone is often an important additional treatment. In certain cancers, administration of hormone agonists, such as progestogens may be therapeutically beneficial.
Angiogenesis inhibitors
Angiogenesis inhibitors prevent the extensive growth of blood vessels (angiogenesis) that tumors require to survive. Some, such as bevacizumab,
have been approved and are in clinical use. One of the main problems
with anti-angiogenesis drugs is that many factors stimulate blood vessel
growth in cells normal or cancerous. Anti-angiogenesis drugs only
target one factor, so the other factors continue to stimulate blood
vessel growth. Other problems include route of administration, maintenance of stability and activity and targeting at the tumor vasculature.
Synthetic lethality
Synthetic lethality
arises when a combination of deficiencies in the expression of two or
more genes leads to cell death, whereas a deficiency in only one of
these genes does not. The deficiencies can arise through mutations,
epigenetic alterations or inhibitors of one or both of the genes.
Cancer cells are frequently deficient in a DNA repair gene. (Also see DNA repair deficiency in cancer.) This DNA repair defect either may be due to mutation or, often, epigenetic silencing (see epigenetic silencing of DNA repair). If this DNA repair defect is in one of seven DNA repair pathways (see DNA repair pathways),
and a compensating DNA repair pathway is inhibited, then the tumor
cells may be killed by synthetic lethality. Non-tumorous cells, with the
initial pathway intact, can survive.
Ovarian cancer
Mutations in DNA repair genes BRCA1 or BRCA2 (active in homologous recombinational repair) are synthetically lethal with inhibition of DNA repair gene PARP1 (active in the base excision repair and in the microhomology-mediated end joining pathways of DNA repair).
Ovarian cancers have a mutational defect in BRCA1 in about 18% of patients (13% germline mutations and 5% somatic mutations) (see BRCA1). Olaparib, a PARP inhibitor, was approved in 2014 by the US FDA for use in BRCA-associated ovarian cancer that had previously been treated with chemotherapy.
The FDA, in 2016, also approved the PARP inhibitor rucaparib to treat
women with advanced ovarian cancer who have already been treated with at
least two chemotherapies and have a BRCA1 or BRCA2 gene mutation.
Colon cancer
In colon cancer, epigenetic defects in the WRN gene appear to be synthetically lethal with inactivation of TOP1. In particular, irinotecan inactivation of TOP1 was synthetically lethal with deficient expression of the DNA repair WRN gene in patients with colon cancer. In a 2006 study, 45 patients had colonic tumors with hypermethylated WRN gene promoters (silenced WRN expression), and 43 patients had tumors with unmethylated WRN gene promoters, so that WRN protein expression was high. Irinotecan was more strongly beneficial for patients with hypermethylated WRN promoters (39.4 months survival) than for those with unmethylated WRN promoters (20.7 months survival). The WRN gene promoter is hypermethylated in about 38% of colorectal cancers.
There are five different stages of colon cancer, and these five stages all have treatment:
- Stage 0, is where the patient is required to undergo surgery to remove the polyp (American Cancer Society).
- Stage 1, depending on the location of the cancer in the colon and lymph nodes, the patient undergoes surgery just like Stage 0.
- Stage 2 patients undergoes removing nearby lymph nodes, but
depending on what the doctor says, the patent might have to undergo
chemotherapy after surgery (if the cancer is at higher risk of coming
back).
- Stage 3, is where the cancer has spread all throughout the lymph
nodes but not yet to other organs or body parts. When getting to this
stage, Surgery is conducted on the colon and lymph nodes, then the
doctor orders Chemotherapy (FOLFOX or CapeOx) to treat the colon cancer
in the location needed (American Cancer Society). The last a patient can get is Stage 4.
- Stage 4 patients only undergo surgery if it is for the prevention of
the cancer, along with pain relief. If the pain continues with these
two options, the doctor might recommended radiation therapy. The main
treatment strategy is chemotherapy due to how aggressive the cancer
becomes in this stage, not only to the colon but to the lymph nodes.
Cancer pain management
Symptom control and palliative care
Although
the control of the symptoms of cancer is not typically thought of as a
treatment directed at the cancer, it is an important determinant of the quality of life
of cancer patients, and plays an important role in the decision whether
the patient is able to undergo other treatments. Although doctors
generally have the therapeutic skills to reduce pain, chemotherapy-induced nausea and vomiting, diarrhea, hemorrhage and other common problems in cancer patients, the multidisciplinary specialty of palliative care has arisen specifically in response to the symptom control needs of this group of patients.
Pain medication, such as morphine and oxycodone, and antiemetics, drugs to suppress nausea and vomiting, are very commonly used in patients with cancer-related symptoms. Improved antiemetics such as ondansetron and analogues, as well as aprepitant have made aggressive treatments much more feasible in cancer patients.
Cancer pain
can be associated with continuing tissue damage due to the disease
process or the treatment (i.e. surgery, radiation, chemotherapy).
Although there is always a role for environmental factors and affective
disturbances in the genesis of pain behaviors, these are not usually the
predominant etiologic factors in patients with cancer pain. Some
patients with severe pain associated with cancer are nearing the end of
their lives, but in all cases palliative therapies should be used to control the pain. Issues such as social stigma of using opioids,
work and functional status, and health care consumption can be concerns
and may need to be addressed in order for the person to feel
comfortable taking the medications required to control his or her
symptoms. The typical strategy for cancer pain management is to get the
patient as comfortable as possible using the least amount of medications
possible but opioids, surgery, and physical measures are often
required.
Historically, doctors were reluctant to prescribe narcotics to
terminal cancer patients due to addiction and respiratory function
suppression. The palliative care movement, a more recent offshoot of the hospice movement, has engendered more widespread support for preemptive pain treatment for cancer patients. The World Health Organization
also noted uncontrolled cancer pain as a worldwide problem and
established a "ladder" as a guideline for how practitioners should treat
pain in patients who have cancer.
Cancer-related fatigue
is a very common problem for cancer patients, and has only recently
become important enough for oncologists to suggest treatment, even
though it plays a significant role in many patients' quality of life.
Hospice in cancer
Hospice
is a group that provides care at the home of a person that has an
advanced illness with a likely prognosis of less than 6 months. As most
treatments for cancer involve significant unpleasant side effects, a
patient with little realistic hope of a cure or prolonged life may
choose to seek comfort care only, forgoing more radical therapies in
exchange for a prolonged period of normal living. This is an especially
important aspect of care for those patients whose disease is not a good
candidate for other forms of treatment. In these patients, the risks
related to the chemotherapy
may actually be higher than the chance of responding to the treatment,
making further attempts to cure the disease impossible. Of note,
patients on hospice can sometimes still get treatments such as radiation therapy if it is being used to treat symptoms, not as an attempt to cure the cancer.
Research
Clinical trials,
also called research studies, test new treatments in people with
cancer. The goal of this research is to find better ways to treat cancer
and help cancer patients. Clinical trials test many types of treatment
such as new drugs, new approaches to surgery or radiation therapy, new
combinations of treatments, or new methods such as gene therapy.
A clinical trial is one of the final stages of a long and careful
cancer research process. The search for new treatments begins in the
laboratory, where scientists first develop and test new ideas. If an
approach seems promising, the next step may be testing a treatment in
animals to see how it affects cancer in a living being and whether it
has harmful effects. Of course, treatments that work well in the lab or
in animals do not always work well in people. Studies are done with
cancer patients to find out whether promising treatments are safe and
effective.
Patients who take part may be helped personally by the treatment
they receive. They get up-to-date care from cancer experts, and they
receive either a new treatment being tested or the best available
standard treatment for their cancer. At the same time, new treatments
also may have unknown risks, but if a new treatment proves effective or
more effective than standard treatment, study patients who receive it
may be among the first to benefit. There is no guarantee that a new
treatment being tested or a standard treatment will produce good
results. In children with cancer, a survey of trials found that those
enrolled in trials were on average not more likely to do better or worse
than those on standard treatment; this confirms that success or failure
of an experimental treatment cannot be predicted.
Exosome research
Exosomes
are lipid-covered microvesicles shed by solid tumors into bodily
fluids, such as blood and urine. Current research is being done
attempting to use exosomes as a detection and monitoring method for a
variety of cancers.
The hope is to be able to detect cancer with a high sensitivity and
specificity via detection of specific exosomes in the blood or urine.
The same process can also be used to more accurately monitor a patient's
treatment progress. Enzyme linked lectin specific assay or ELLSA has been proven to directly detect melanoma derived exosomes from fluid samples.
Previously, exosomes had been measured by total protein content in
purified samples and by indirect immunomodulatory effects. ELLSA
directly measures exosome particles in complex solutions, and has
already been found capable of detecting exosomes from other sources,
including ovarian cancer and tuberculosis-infected macrophages.
Exosomes, secreted by tumors, are also believed to be responsible
for triggering programmed cell death (apoptosis) of immune cells;
interrupting T-cell signaling required to mount an immune response;
inhibiting the production of anti-cancer cytokines, and has implications
in the spread of metastasis and allowing for angiogenesis. Studies are currently being done with "Lectin affinity plasmapheresis" (LAP),
LAP is a blood filtration method which selectively targets the tumor
based exosomes and removes them from the bloodstream. It is believed
that decreasing the tumor-secreted exosomes in a patient's bloodstream
will slow down progression of the cancer while at the same time
increasing the patients own immune response.
Complementary and alternative
Complementary and alternative medicine
(CAM) treatments are the diverse group of medical and health care
systems, practices, and products that are not part of conventional
medicine and have not been shown to be effective. "Complementary medicine" refers to methods and substances used along with conventional medicine, while "alternative medicine" refers to compounds used instead of conventional medicine.
CAM use is common among people with cancer; a 2000 study found that 69%
of cancer patients had used at least one CAM therapy as part of their
cancer treatment.
Most complementary and alternative medicines for cancer have not been
rigorously studied or tested. Some alternative treatments which have
been investigated and shown to be ineffective continue to be marketed
and promoted.
Special circumstances
In pregnancy
The incidence of concurrent cancer during pregnancy has risen due to the increasing age of pregnant mothers and due to the incidental discovery of maternal tumors during prenatal ultrasound examinations.
Cancer treatment needs to be selected to do least harm to both the woman and her embryo/fetus. In some cases a therapeutic abortion may be recommended.
Radiation therapy is out of the question, and chemotherapy always poses the risk of miscarriage and congenital malformations. Little is known about the effects of medications on the child.
Even if a drug has been tested as not crossing the placenta to
reach the child, some cancer forms can harm the placenta and make the
drug pass over it anyway. Some forms of skin cancer may even metastasize to the child's body.
Diagnosis is also made more difficult, since computed tomography is infeasible because of its high radiation dose. Still, magnetic resonance imaging works normally. However, contrast media cannot be used, since they cross the placenta.
As a consequence of the difficulties to properly diagnose and
treat cancer during pregnancy, the alternative methods are either to
perform a Cesarean section
when the child is viable in order to begin a more aggressive cancer
treatment, or, if the cancer is malignant enough that the mother is
unlikely to be able to wait that long, to perform an abortion in order
to treat the cancer.
In utero
Fetal tumors are sometimes diagnosed while still in utero. Teratoma
is the most common type of fetal tumor, and usually is benign. In some
cases these are surgically treated while the fetus is still in the uterus.
Racial and social disparities
Cancer
is a significant issue that is affecting the world. Specifically in the
U.S, it is expected for there to be 1,735,350 new cases of cancer, and
609,640 deaths by the end of 2018. Adequate treatment can prevent many
cancer deaths but there are racial and social disparities in treatments
which has a significant factor in high death rates. Minorities are more
likely to suffer from inadequate treatment while white patients are more
likely to receive efficient treatments in a timely manner.
Having satisfactory treatment in timely manner can increase the
patients likelihood of survival. It has been shown that chances of
survival are significantly greater for white patients than for African
American patients.
The annual average mortality of patients with colorectal cancer
between 1992 and 2000 was 27 and 18.5 per 100,000 white patients and
35.4 and 25.3 per 100,000 black patients. In a journal that analyzed
multiple studies testing racial disparities when treating colorectal
cancer found contradicting findings. The Veterans administration and an
adjuvant trial found that there were no evidence to support racial
differences in treating colorectal cancer. However, two studies
suggested that African American patients received less satisfactory and
poor quality treatment compared to white patients.
One of these studies specifically was provided by the Center for
Intramural Research. They found that black patients were 41% less likely
to receive colorectal treatment and were more likely to be hospitalized
in a teaching hospital with less certified physicians compared to white
patients. Furthermore, black patients were more likely to be diagnosed
with oncologic sequelae, which is a severity of the illness in result of
poorly treated cancer. Lastly, for every 1,000 patients in the
hospital, there were 137.4 black patient deaths and 95.6 white patient
deaths.
In a breast cancer journal article analyzed the disparities of
breast cancer treatments in the Appalachian Mountains. African American
women were found to be 3 times more likely to die compared to Asians and
two times more likely to die compared to white women. According to this study, African American women are at a survival disadvantage compared to other races.
Black women are also more likely to receive less successful treatment
than white women by not receiving surgery or therapy. Furthermore, The
National Cancer Institute panel, identified breast cancer treatments,
given to black women, as inappropriate and not adequate compared to the
treatment given to white women.
From these studies, researchers have noted that there are
definite disparities in the treatment of cancer, specifically who have
access to the best treatment and can receive it in a timely manner. This
eventually leads to disparities between who is dying from cancer and
who is more likely to survive.
The cause of these disparities is generally that African
Americans have less medical care coverage, insurance and access cancer
centers than other races.
For an example, black patients with breast cancer and colorectal cancer
were shown to be more likely to have medicaid or no insurance compared
to other races.
The location of the health care facility also plays a role in why
African Americans receive less treatment in comparison to other races.
However, some studies say that African Americans don't trust doctors
and don't always seek the help they need and this explains why there are
less African Americans receiving treatment.
Others suggest that African Americans seek even more treatment than
whites and that it is simply a lack of the resources available to them.
In this case, analyzing these studies will identify the treatment
disparities and look to prevent them by discovering potential causes of
these disparities.
