TRENDS IN THE SURVIVAL OF AMERICAN-INDIAN, HISPANIC, AND NON-HISPANICWHITE CANCER-PATIENTS IN NEW-MEXICO AND ARIZONA, 1969-1994

BACKGROUND. The burden of cancer mortality falls disproportionately on cancer patients belonging to ethnic minority groups. In the U.S., Afr ican American, Hispanic, and American Indian cancer patients are diagn osed at a more advanced stage and receive less appropriate treatment, resulting in poorer outcomes and higher mortality, than white cancer p atients. The authors hypothesized that cancer control strategies based on earlier detection and more effective treatment may be most effecti ve in increasing survival in groups with more advanced disease at diag nosis. less appropriate treatment, and lower survival. METHODS. Data c ollected by the New Mexico Tumor Registry, a member organization of th e Surveillance, Epidemiology, and End Results (SEER) Program of the Na tional Cancer Institute, afforded the authors an opportunity to invest igate this hypothesis by studying trends in cancer survival for Americ an Indians, Hispanics, and non-Hispanic whites. The authors examined t emporal trends and ethnic disparities in survival for in situ and inva sive incident cancer cases at 25 sites diagnosed from 1969 through 199 4 in New Mexico residents and in American Indians residing in Arizona. RESULTS, The distribution of stage became more favorable and the perc entage of patients receiving appropriate treatment increased for all t hree ethnic groups during the study period. Survival improved for pati ents with cancer at most sites in each ethnic group; however, because the increase in survival was greater for non-Hispanic whites than for American Indians or Hispanics, the number of sites associated with dis parities in survival among non-Hispanic whiles, American Indians, and Hispanics increased. Differences in the distribution of age, gender, s tage at diagnosis, histologic grade, and treatment did not completely explain the improved survival or the ethnic disparities regarding surv ival. CONCLUSIONS. Increased cancer control efforts were associated wi th earlier diagnosis, more patients receiving appropriate therapy, and improved survival for non-Hispanic whites, American Indians, and Hisp anics. However, the improvement was greatest for non-Hispanic whites, and disparities in survival results for the different ethnic groups wi dened over the period of study. Cancer control strategies need to addr ess the specific social, cultural, and biologic prognostic factors tha t affect different ethnic groups if disparities in outcomes are to be reduced. (C) 1998 American Cancer Society.