Study Finds Discrimination Against Disabled Patients

Audrey Robinson, now in her 50s, was a 10-year stroke survivor when she was diagnosed with early stage breast cancer.

The stroke left Robinson visibly disabled. One side of her body is entirely limp and motionless. Robinson walks with a complex cane, and uses her working arm and leg to drag and support her weak side.

Although Robinson's disability made her a veteran of the health care system, she was unprepared for the way the breast cancer surgeon treated her.

She waited more than four hours to enter an examination room.

But even when the doctor did arrive, he didn't treat Robinson with the respect she might have expected.

"After making us wait... the door swung open, the doctor swooped in and proceeded to make me feel worthless," Robinson says. "No apologies were made. He was abrupt, impatient, and never looked me in the eyes. I could've been there with horns on my head and he wouldn't have noticed.

"I'm not the kind to speak up but I did," she says.

Her story came as a real surprise to me -- I happen to know the offending surgeon and have always known him to be caring and respectful. But, as a new study suggests, the surgeon's poor manners might have been related to Robinson's disability.

Women with early stage breast cancer who are also disabled are less likely to be offered today's best treatment options, according to research published in today's Annals of Internal Medicine.

For example, lumpectomy (removal of the breast cancer) followed by radiation of the rest of the breast is just as effective a treatment as mastectomy (removal of the whole breast). And a woman who undergoes lumpectomy doesn't necessarily lose her breast the way she would from a mastectomy.

But women with disabilities were 20 percent less likely to be offered breast-saving treatment, according to the study. And the disabled women who underwent lumpectomy were about 20 percent less likely to be given necessary radiation after lumpectomy.

Every woman's life is precious and deserves the best care possible. So, why does this happen?

Unfortunately, the research is somewhat true. Patients with multiple medical issues need a lot of attention in the doctor's office, and doctors tend to be impatient.

It turns out that many complex factors influence these health care decisions.

Women who are disabled tend to have limited financial resources, insurance coverage, social networks, transportation options and back-up plans. A disabled patient may have nowhere to turn in case of bad weather, a broken wheelchair or a no-show transport team.

Disabled patients also tend to have other medical problems and emotional challenges that can be almost as threatening and all-consuming as their breast cancer. For example, dialysis patients have to juggle hours of dialysis treatment with their daily radiation therapies.

Many of these challenges can make the logistical demands of regular treatments hard to meet.

So what can a woman do?

Each woman who faces breast cancer -- fully able or disabled -- needs to work carefully with her doctor to figure out her best treatment options against breast cancer.

While weighing the pros and cons of any treatment option, ask your doctor about other medical issues.

You, as a patient, own your choice. Any given treatment decision may require special arrangements -- assisted transportation, coordination with other therapies like dialysis, etc. It may help to ask for a social service consultation, to find out all of the resources that are available to you.

Dr. Marisa Weiss is president and founder of www.breastcancer.org

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