Evaluating disparities in inpatient surgical cancer care among American Indian/Alaska Native patients

Am J Surg. 2016 Aug;212(2):297-304. doi: 10.1016/j.amjsurg.2015.10.030. Epub 2016 Jan 9.


Background: American Indian/Alaska Native (AI/AN) patients with cancer have the lowest survival rates of all racial and ethnic groups, possibly because they are less likely to receive "best practice" surgical care than patients of other races.

Methods: Prospective cohort study comparing adherence with generic and cancer-specific guidelines on processes of surgical care between AI/AN and non-Hispanic white (NHW) patients in Washington State (2010 to 2014) was conducted.

Results: A total of 156 AI/AN and 6,030 NHW patients underwent operations for 10 different cancers, and had similar mean adherence to generic surgical guidelines (91.5% vs 91.9%, P = .57). AI/AN patients with breast cancer less frequently received preoperative diagnostic core needle biopsy (81% vs 94%, P = .004). AI/AN patients also less frequently received care adherent to prostate cancer-specific guidelines (74% vs 92%, P = .001).

Conclusion: Although AI/ANs undergoing cancer operations in Washington receive similar overall best practice surgical cancer care to NHW patients, there remain important, modifiable disparities that may contribute to their lower survival.

Keywords: American Indian/Alaska Natives; Cancer; Process of care; Surgery.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alaskan Natives / statistics & numerical data*
  • Female
  • Healthcare Disparities / statistics & numerical data*
  • Hospitalization / statistics & numerical data
  • Humans
  • Indians, North American / statistics & numerical data*
  • Male
  • Middle Aged
  • Neoplasms / epidemiology*
  • Neoplasms / surgery*
  • Population Surveillance
  • Prospective Studies
  • Quality Improvement / statistics & numerical data
  • Registries
  • Washington / epidemiology
  • Young Adult