Monday, July 8, 2013
A new analysis has found that among patients with chronic lymphocytic leukemia, African Americans more commonly present with advanced disease, and they tend to have shorter survival times than whites despite receiving the same care
The results suggest that biological factors may account for some racial disparities in cancer survival. Among cancer patients, minorities tend to have a worse prognosis than whites for reasons that are unclear. In African American patients, lower socioeconomic status and limited access to high-quality care often can play a role, but some researchers propose that certain cancers can behave more aggressively in minority individuals, which also can lead to worse outcomes. Because chronic lymphocytic leukemia (CLL), a type of blood cancer, is rare in African Americans, investigators from The University of Texas MD Anderson Cancer Center in Houston and the Duke University Medical Center in Durham led a study that combined the two centers' experiences with African American and white patients. Their analysis included 84 African American patients and 1,571 non-black patients referred to the two centers. All patients, regardless of race, had access to healthcare services and received the same treatments. "We sought to isolate race as a prognostic factor from other known demographic and clinical prognostic parameters in CLL," explained Dr. Falchi. The investigators found that while the time from diagnosis (made either incidentally or because of clinical symptoms) to referral was shorter for African Americans than white patients, African Americans were more likely to have CLL that was more advanced at the time of referral. Also, although African Americans responded as well to first-line therapy as white patients, their cancer progressed more rapidly and their survival was shorter. The inferior survival of African American patients persisted when patients were grouped according to factors related to the severity of their disease. "These findings suggest that while inducing similarly high response rates, standard treatments do not overcome racial differences in outcome among patients with CLL," said Dr. Ferrajoli. She added that a number of questions remain unanswered. For example, do distinct biologic characteristics of African American patients with CLL account for the disparities seen in this study?