title: Evaluating disparities in inpatient surgical cancer care among American Indian/Alaska Native patients.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors: Surgical Outcomes Research Center, Department of Surgery, University of Washington, UW Medical Center, Box 354808, 1107 NE 45th Street, Suite 502, Seattle, WA 98105, USA.
authors: Vlad V
authors: VV
authors: Simianu
authors: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors: Arden M
authors: AM
authors: Morris
authors: Surgical Outcomes Research Center, Department of Surgery, University of Washington, UW Medical Center, Box 354808, 1107 NE 45th Street, Suite 502, Seattle, WA 98105, USA.
authors: Thomas K
authors: TK
authors: Varghese
authors: Department of Urology, University of Washington, Seattle, WA, USA.
authors: Michael P
authors: MP
authors: Porter
authors: Black Hills Center for American Indian Health, Rapid City, SD, USA.
authors: Jeffrey A
authors: JA
authors: Henderson
authors: Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors: Dedra S
authors: DS
authors: Buchwald
authors: Surgical Outcomes Research Center, Department of Surgery, University of Washington, UW Medical Center, Box 354808, 1107 NE 45th Street, Suite 502, Seattle, WA 98105, USA.
authors: David R
authors: DR
authors: Flum
authors: Surgical Outcomes Research Center, Department of Surgery, University of Washington, UW Medical Center, Box 354808, 1107 NE 45th Street, Suite 502, Seattle, WA 98105, USA. Electronic address: sjavid@uw.edu.
authors: Sara H
authors: SH
authors: Javid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072957:Alaska Natives / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D011159:Population Surveillance; D011446:Prospective Studies; D058996:Quality Improvement / Q000706:statistics & numerical data; D012042:Registries; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
keywords: American Indian/Alaska Natives; Cancer; Process of care; Surgery