Postoperative Cancer Mortality Is Declining, But Racial Disparities Are Not Changing

A study found that while mortality rates after cancer surgery are on the decline, the racial gap between Black and White patients is not narrowing.

“Black US residents have higher rates of mortality for most of the 15 leading causes of death in the US, including cancer, which is the second highest cause of death. In addition, Black patients face more challenges related to cancer care and treatment as they are more likely to receive their cancer diagnoses at more advanced stages than White patients and have higher rates of mortality following cancer surgery,” the authors of the study wrote.

The researchers conducted a cross-sectional study using national Medicare data to assess changes in postoperative mortality rates in Black and White patients between Jan. 1, 2007, and Nov. 30, 2016. Patients who underwent surgical resection for colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung, or prostate cancer and were enrolled in Medicare Part A were eligible for inclusion.

Over the study period, 870,929 cancer surgeries were performed. During the baseline year, 103,446 patients underwent surgery: 96,210 White patients and 7,236 Black patients. The Black patients were younger (mean [standard deviation (SD)] age, 73 [6.4] years vs. 74.5 [6.8] years) and were less likely to be male (n=3,986 [55.1%] vs. n=55,527 [57.7%]).

National rates of mortality after surgery for cancer were on the decline for Black (−0.12%; 95% confidence interval [CI], −0.17% to −0.06% per year) and White (−0.14%; 95% CI, −0.16% to −0.13% per year) patients. The reduced mortality rate, according to the researchers, was mainly due to within-hospital mortality improvements (Black patients: 0.10% annually; 95% CI, −0.15% to −0.05%; P<0.001; White patients: 0.13%; 95% CI, −0.14% to −0.11%; P<0.001) compared to between-hospital mortality improvements. Changes did not largely differ among the different cancer types over the course of the study.

The study was published in JAMA Network Open.

The researchers concluded that their study gives providers “mixed news” in terms of reducing racial disparities in postoperative mortality.

“All improvements in mortality seem to be associated with within-hospital vs between-hospital differences. These findings suggest that although interventions, policies, and advancements in technology have improved mortality for all patients, they have not targeted disparities between Black and White patients,” they wrote.