Skip to main content
SpringerLink
Log in

Racial and ethnic differences in patient ratings of colorectal and non-small-cell lung cancer care: A SEER-CAHPS study

  • Original Paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Purpose

Although significant racial and ethnic disparities exist in colorectal and lung cancer treatment and survival, racial differences in patient-reported experience of care are not well understood. The purpose of this study was to examine differences in patient-reported ratings of colorectal and non-small-cell lung cancer care by race/ethnicity.

Methods

Medicare beneficiaries with AJCC stage I–IV colorectal and non-small-cell lung cancer (2003–2013) who completed a Medicare Consumer Assessment of Healthcare Providers (CAHPS) survey within 5 years of cancer diagnosis were identified in the linked SEER-CAHPS dataset. Scores were compared by race/ethnicity, defined as White, Black, or any other race/ethnicity.

Results

Of the 2,621 identified patients, 161 (6.1%) were Black, 2,279 (87.0%) White, and 181 (6.9%) any other race/ethnicity. Compared to White patients, Black patients were younger, had lower educational level, and had higher census tract poverty indicator (p < 0.001). Black patients rated their ability to get care quickly significantly lower than White patients (63.5 (SE 3.38) vs. 71.4 (SE 2.12), p < 0.01), as did patients of any other race/ethnicity (LS mean 66.2 (SE 2.89), p = 0.02). Patients of any other race/ethnicity reported their ability to get needed care significantly lower than White patients (LS mean 81.9 (SE 2.46) vs. 86.7 (SE 1.75), p = 0.02); however, there was no difference in ability to get needed care between Black and White patients.

Conclusion

Patient ratings for getting care quickly were lower in non-White patients, indicating racial disparities in perceived timeliness of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

This study used the linked SEER-CAHPS data resource. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Centers for Medicare & Medicaid Services; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-CAHPS data resource. Because SEER-CAHPS data are a limited data set, data is not available for sharing with other investigators.

References

  1. Siegel RL, Miller KD, Jemal A (2020) Cancer statistics, 2020. CA Cancer J Clin 70(1):7–30

    Article  Google Scholar 

  2. Howlader N NA, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA SEER Cancer Statistics Review, 1975–2018. National Cancer Institute. https://seer.cancer.gov/csr/1975_2018/. Updated April, 2021. Accessed 13 July 2021

  3. DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL (2019) Cancer statistics for African Americans, 2019. CA Cancer J Clin 69(3):211–233

    Article  Google Scholar 

  4. Demissie K, Oluwole OO, Balasubramanian BA, Osinubi OO, August D, Rhoads GG (2004) Racial differences in the treatment of colorectal cancer: a comparison of surgical and radiation therapy between Whites and Blacks. Ann Epidemiol 14(3):215–221

    Article  Google Scholar 

  5. Gross CP, Smith BD, Wolf E, Andersen M (2008) Racial disparities in cancer therapy: did the gap narrow between 1992 and 2002? Cancer 112(4):900–908

    Article  Google Scholar 

  6. Lai Y, Wang C, Civan JM et al (2016) Effects of cancer stage and treatment differences on racial disparities in survival from colon cancer: a united states population-based study. Gastroenterology 150(5):1135–1146

    Article  Google Scholar 

  7. Baldwin LM, Dobie SA, Billingsley K et al (2005) Explaining black-white differences in receipt of recommended colon cancer treatment. J Natl Cancer Inst 97(16):1211–1220

    Article  Google Scholar 

  8. Bach PB, Cramer LD, Warren JL, Begg CB (1999) Racial differences in the treatment of early-stage lung cancer. N Engl J Med 341(16):1198–1205

    Article  CAS  Google Scholar 

  9. Lathan CS, Neville BA, Earle CC (2006) The effect of race on invasive staging and surgery in non-small-cell lung cancer. J Clin Oncol 24(3):413–418

    Article  Google Scholar 

  10. Sineshaw HM, Wu XC, Flanders WD, Osarogiagbon RU, Jemal A (2016) variations in receipt of curative-intent surgery for early-stage Non-Small Cell Lung Cancer (NSCLC) by state. J Thorac Oncol 11(6):880–889

    Article  Google Scholar 

  11. Corso CD, Park HS, Kim AW, Yu JB, Husain Z, Decker RH (2015) Racial disparities in the use of SBRT for treating early-stage lung cancer. Lung Cancer 89(2):133–138

    Article  Google Scholar 

  12. Taioli E, Flores R (2017) Appropriateness of surgical approach in black patients with lung cancer-15 years later little has changed. J Thorac Oncol 12(3):573–577

    Article  Google Scholar 

  13. Blom EF, Ten Haaf K, Arenberg DA, de Koning HJ (2020) Disparities in receiving guideline-concordant treatment for lung cancer in the United States. Ann Am Thorac Soc 17(2):186–194

    Article  Google Scholar 

  14. Hardy D, Liu CC, Xia R et al (2009) Racial disparities and treatment trends in a large cohort of elderly black and white patients with nonsmall cell lung cancer. Cancer 115(10):2199–2211

    Article  Google Scholar 

  15. Murphy CC, Harlan LC, Warren JL, Geiger AM (2015) race and insurance differences in the receipt of adjuvant chemotherapy among patients with stage III colon cancer. J Clin Oncol 33(23):2530–2536

    Article  Google Scholar 

  16. Tawk R, Abner A, Ashford A, Brown CP (2015) Differences in colorectal cancer outcomes by race and insurance. Int J Environ Res Public Health 13(1):48

    Article  Google Scholar 

  17. Tramontano AC, Chen Y, Watson TR, Eckel A, Hur C, Kong CY (2020) Racial/ethnic disparities in colorectal cancer treatment utilization and phase-specific costs, 2000–2014. PLoS ONE 15(4):e0231599

    Article  CAS  Google Scholar 

  18. Thornblade LW, Warner S, Melstrom L, Singh G, Fong Y, Raoof M (2020) Association of race/ethnicity with overall survival among patients with colorectal liver metastasis. JAMA Netw Open 3(9):e2016019

    Article  Google Scholar 

  19. Weech-Maldonado R, Elliott MN, Adams JL et al (2015) Do racial/ethnic disparities in quality and patient experience within medicare plans generalize across measures and racial/ethnic groups? Health Serv Res 50(6):1829–1849

    Article  Google Scholar 

  20. Price RA, Haviland AM, Hambarsoomian K et al (2015) Do experiences with medicare managed care vary according to the proportion of same-race/ethnicity/language individuals enrolled in one’s contract? Health Serv Res 50(5):1649–1687

    Article  Google Scholar 

  21. Chawla N, Urato M, Ambs A et al (2015) Unveiling SEER-CAHPS(R): a new data resource for quality of care research. J Gen Intern Med 30(5):641–650

    Article  Google Scholar 

  22. Lenth R (2016) Least-squares means: the R package lsmeans. J Stat Softw 69(1):1–33

    Article  Google Scholar 

  23. Weinick RM, Elliott MN, Volandes AE, Lopez L, Burkhart Q, Schlesinger M (2011) Using standardized encounters to understand reported racial/ethnic disparities in patient experiences with care. Health Serv Res 46(2):491–509

    Article  Google Scholar 

  24. R: A language and environment for statistical computing [computer program]. Vienna, Austria: R Foundation for Statistical Computing; 2013

  25. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457

    Article  Google Scholar 

  26. Ayanian JZ, Zaslavsky AM, Guadagnoli E et al (2005) Patients’ perceptions of quality of care for colorectal cancer by race, ethnicity, and language. J Clin Oncol 23(27):6576–6586

    Article  Google Scholar 

  27. Ayanian JZ, Zaslavsky AM, Arora NK et al (2010) patients’ experiences with care for lung cancer and colorectal cancer: findings from the cancer care outcomes research and surveillance consortium. J Clin Oncol 28(27):4154–4161

    Article  Google Scholar 

  28. Cykert S, Dilworth-Anderson P, Monroe MH et al (2010) Factors associated with decisions to undergo surgery among patients with newly diagnosed early-stage lung cancer. JAMA 303(23):2368–2376

    Article  CAS  Google Scholar 

  29. Farias AJ, Toledo G, Ochoa CY, Hamilton AS (2021) Racial/ethnic disparities in patient experiences with health care in association with earlier stage at colorectal cancer diagnosis: findings from the SEER-CAHPS data. Med Care 59(4):295–303

    Article  Google Scholar 

  30. Farias AJ, Ochoa CY, Toledo G, Bang SI, Hamilton AS, Du XL (2020) Racial/ethnic differences in patient experiences with health care in association with earlier stage at breast cancer diagnosis: findings from the SEER-CAHPS data. Cancer Causes Control 31(1):13–23

    Article  Google Scholar 

  31. Weech-Maldonado R, Hall A, Bryant T, Jenkins KA, Elliott MN (2012) The relationship between perceived discrimination and patient experiences with health care. Med Care 50(9 Suppl 2):S62-68

    Article  Google Scholar 

  32. Ochoa CY, Toledo G, Iyawe-Parsons A, Navarro S, Farias AJ (2021) Multilevel influences on black cancer patient experiences with care: a qualitative analysis. JCO Oncol Pract 17(5):e645–e653

    Article  Google Scholar 

  33. Takeshita J, Wang S, Loren AW et al (2020) Association of racial/ethnic and gender concordance between patients and physicians with patient experience ratings. JAMA Netw Open 3(11):e2024583

    Article  Google Scholar 

  34. Otto AK, Reblin M, Harper FWK et al (2021) Impact of patients’ companions on clinical encounters between black patients and their non-black oncologists. JCO Oncol Pract 17(5):e676–e685

    Article  Google Scholar 

  35. Halpern MT, Urato MP, Lines LM, Cohen JB, Arora NK, Kent EE (2018) Healthcare experience among older cancer survivors: analysis of the SEER-CAHPS dataset. J Geriatr Oncol 9(3):194–203

    Article  Google Scholar 

  36. Lines LM, Cohen J, Halpern MT, Smith AW, Kent EE (2019) Care experiences among dually enrolled older adults with cancer: SEER-CAHPS, 2005–2013. Cancer Causes Control 30(10):1137–1144

    Article  Google Scholar 

  37. Mollica MA, Enewold LR, Lines LM et al (2017) Examining colorectal cancer survivors’ surveillance patterns and experiences of care: a SEER-CAHPS study. Cancer Causes Control 28(10):1133–1141

    Article  Google Scholar 

  38. Mollica MA, Weaver KE, McNeel TS, Kent EE (2018) Examining urban and rural differences in perceived timeliness of care among cancer patients: A SEER-CAHPS study. Cancer 124(15):3257–3265

    Article  Google Scholar 

  39. National Cancer Institute Division of Cancer Control & Population Sciences. Case-Mix Adjustment Guidance Web site. https://healthcaredelivery.cancer.gov/seer-cahps/researchers/adjustment_guidance.html. Updated May 12, 2020. Accessed June 18, 2020.

  40. Wickham H (2016) ggplot2: elegant graphics for data analysis. Springer, New York

    Book  Google Scholar 

Download references

Funding

This work was initially supported by a Prisma Health Cancer Care Delivery Internal Seed Grant, Prisma Health System, Greenville, SC.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Rebecca C. Wardrop

  2. Department of Health Sciences, Furman University, Greenville, SC, USA

    Anna L. Cass

  3. Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA

    Seth A. Quinn, Ashley N. Wercholuk, Alexander A. Parikh & Rebecca A. Snyder

  4. Division of Surgical Oncology, Department of Public Health, Brody School of Medicine, East Carolina University, 600 Moye Blvd. 4S-24, Greenville, NC, USA

    Rebecca A. Snyder

Authors
  1. Rebecca C. Wardrop
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna L. Cass
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seth A. Quinn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashley N. Wercholuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexander A. Parikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rebecca A. Snyder
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RCW: contributed to data curation, formal analysis, investigation, methodology, validation, writing-original draft, writing—review, and editing. ALC: contributed to data curation, funding acquisition, investigation, project administration, writing—review, and editing. SAQ: contributed to data analysis and interpretation, writing—original draft, writing—review, and editing. ANW: data analysis and interpretation, writing—original draft, writing—review, and editing. AAP: contributed to conceptualization, investigation, methodology, writing—review, and editing. RAS: contributed to conceptualization, funding acquisition, investigation, methodology, project administration, supervision, writing—original draft, writing—review, and editing.

Corresponding author

Correspondence to Rebecca A. Snyder.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to report.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wardrop, R.C., Cass, A.L., Quinn, S.A. et al. Racial and ethnic differences in patient ratings of colorectal and non-small-cell lung cancer care: A SEER-CAHPS study. Cancer Causes Control 33, 1125–1133 (2022). https://doi.org/10.1007/s10552-022-01606-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-022-01606-6

Keywords

Search

Navigation