Co-morbid risk factors and NSAID use among white and black Americans that predicts overall survival from diagnosed colon cancer

Abstract

Black Americans (BA) have higher incidence and higher mortality rates for colorectal cancers (CRC) as compared to White Americans (WA). While there are several identified risk factors associated with the development of CRC and evidence that high levels of adequate screening can reduce differences in incidence for CRC between BA and WA, there remains little data regarding patient co-morbid contributions towards survival once an individual has CRC. Here we set out to identify patient risk factors that influenced overall survival in a cohort of 293 BA and 348 WA with colon cancer. Amid our cohort, we found that patients' age, tobacco usage, and pre-diagnosed medical conditions such as hypertension and diabetes were associated with shorter overall survival (OS) from colon cancer. We identified pre-diagnosed hypertension and diabetes among BA were responsible for one-third of the colon cancer mortality disparity compared with WA. We also identified long-term regular use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, was associated with shorter OS from colon cancer among WA >65 years of age, but not younger WA patients or any aged BA patients. Our results raise the importance of not only treating the colon cancer itself, but also taking into consideration co-morbid medical conditions and NSAID usage to enhance patient OS. Further evaluation regarding adequate treatment of co-morbidities and timing of NSAID continuance after cancer therapy will need to be studied.

Insights into disparities observed with COVID‐19

“…For ages 65 years and older, African Americans had 9%, 27%, 25% and 40% of 0, 1, 2 and 3 co‐morbid risk factors, respectively, compared to White Americans that had 20%, 28%, 23% and 29%, respectively, and Latinx that had 10%, 30%, 33% and 28%, respectively [28]. Thus, based on high risk co‐morbidities, African Americans seem to possess the higher risk for adverse outcomes from COVID‐19 [29]. In a study involving nearly 6 million U.S. veterans, African American veterans were twice as likely to test positive for the SARS‐CoV‐2 even after adjusting for urban versus rural residence [30].…”

Examining colorectal cancer screening uptake and health provider recommendations among underserved middle aged and older African Americans

“… 80 , 81 African Americans with multiple chronic conditions should be prompted by providers for timely CRC screening since it is linked poorer outcomes, including death, in this population. 82 , 83 Due to African Americans being less likely to get screened for CRC, appropriate CRC education and culturally tailored strategies are needed to increase awareness of the value of CRC screenings. 84 …”

Commencing colorectal cancer screening at age 45 years in U.S. racial groups

“…Third, colonic microenvironment may be altered in NHB to favor CRC, with increased infl ammation to generate in flammation-associated microsatellite alterations (30), which are associated with metastasis and poor survival (31)(32)(33)(34). Indeed, use of NSAIDs had no deleterious consequences in older NHB CRC patients as compared to shorter survival for older NHW CRC patients (35). The cytotoxic immune cell response to cancer may be hampered in NHB CRCs compared to NHW (26,36,37).…”