Seeking cancer care: Health equity and access to state-of-the-art care

Minority patients may be less likely to receive optimal treatment such as surgery and chemotherapy for many cancers (Shavers, Brown 2002). Previous research has demonstrated that institutions that offer clinical treatment studies and perform a high volume of specialized care and surgeries for cancer have better patient outcomes and fewer complications than many community hospitals (Hilner, Smith, Christopher 2000). However, research has not yet examined the complicated processes though which patients select the setting in which they receive their cancer care, and how this varies by race. A mixed methods study of a random sample of 50 African American and 75 White patients at a comprehensive cancer center was designed to examine experiences with medical care, perceived racial discrimination, and use of social capital for obtaining care. Ninety-seven percent of all patients had a PCP, and the majority sought care at the cancer center through direct physician referral rather than self-referral. This suggests the importance of collaboration and referral patterns within the local and regional medical community. African American patients experienced significantly more perceived discrimination (74% v. 4%; p = 0.000) in all areas of their life including medical care, had lower family incomes, and were less likely to report being offered a clinical trial (22% v. 37%) than White patients. Qualitative findings demonstrated differences in the use of social capital for seeking cancer care. These results contribute to our understanding of the internal and external processes that influence the ability of all patients to obtain optimal cancer treatment.