Racial disparities and standard treatment in locally advanced rectal cancer: a National Cancer Database study

Abstract

Background: Mortality rates in colorectal cancer (CRC) continue to be higher in Black compared to White patients. While standard treatment modalities for locally advanced rectal cancer have been shown to improve outcomes, there are limited studies assessing the receipt of standard treatment in rectal cancer based on race. Therefore, we sought to evaluate the use of standard treatment across racial groups in locally advanced rectal cancer and its effect on survival. Methods: The National Cancer Database (NCDB) was queried for patients ≥18 years old with clinical and pathologic stage II-III rectal adenocarcinoma who received treatment from 2004 to 2014. Standard treatment was defined as complete surgical excision with either neoadjuvant or adjuvant concurrent chemoradiation. Multivariable logistic regressions were used to identify racial differences in receiving standard treatment. Cox proportional hazards were used to estimate the effects of standard vs. nonstandard treatment on survival differences based on race. Results: A total of 70,677 patients with stage II (n=35,079) or stage III (n=35,598) rectal adenocarcinoma met the inclusion criteria. On multivariate analysis, Black [odds ratio (OR): 0.75; 95% confidence interval (CI): 0.71-0.79; P<0.001] and Hispanic White (OR: 0.86; 95% CI: 0.80-0.92; P>0.001) patients were less likely to receive standard treatment compared to non-Hispanic White patients. On multivariable Cox regression, nonstandard treatment was significantly associated with worse survival [hazard ratio (HR): 1.69; 95% CI: 1.65-1.73; P<0.001] compared to standard treatment. Even after adjusting for patient, demographic, and facility characteristics, Black patients had higher mortality rates compared to White patients in the whole population (HR: 1.15; 95% CI: 1.09-1.20; P<0.0001). This survival difference between Black and non-Hispanic White patients persisted in both the standard (HR: 1.10; 95% CI: 1.03-1.19; P=0.008) and nonstandard (HR: 1.17; 95% CI: 1.10-1.25; P<0.0001) treatment subgroups. Decreased survival outcomes in Black patients were more pronounced for those who underwent nonstandard treatment, particularly when treating stage III disease (HR: 1.30; 95% CI: 1.19-1.42; P<0.0001). Conclusions: Nonstandard treatment in stage II and III rectal cancer is associated with worse survival compared to standard treatment regimens. Black patients are more likely to receive nonstandard treatment and have worse survival outcomes compared to White patients.

United States-Based Colorectal Cancer Surgical Trials Lack Representation and Adequate Reporting of Racially and Ethnically Diverse Participants: Systematic Review and Regression Analysis

“…15,16,23 When evaluating ethnicity descriptions available in surgical trials, 11 trials (73.3%) did not report the ethnicity of their participants. 3,14,[16][17][18][19][20][21][22][24][25][26] Two trials described ethnicity as "Caucasian/non-Caucasian, " 12,13 and only 2 trials reported 1 ethnicity as Hispanic (yes/no). 15,23 Only 2 studies (13.3%) had both racial and ethnic descriptions for all their participants.…”

“…1 However, substantial evidence shows that certain racial and ethnic groups, such as Blacks and Hispanic Americans, are less likely to receive appropriate screening and timely treatment for CRC compared to non-Hispanic Whites. [2][3][4] Reports have shown that racial and ethnic minorities are also underrepresented in clinical trials. 5,6 Clinical trials are essential in advancing medical knowledge and improving patient outcomes, as they provide critical information on the safety and effectiveness of new treatments.…”

“…1 However, substantial evidence shows that certain racial and ethnic groups, such as Blacks and Hispanic Americans, are less likely to receive appropriate screening and timely treatment for CRC compared to non-Hispanic Whites. 2–4…”

Disparities in Access to Radiotherapy Among Hispanic/Latinx Populations in the United States

“…Of the 39 articles, 15 studies found that patients who identified as having Hispanic/Latinx ethnicity were significantly more likely to not receive radiation treatment 17,18,20,21,23,28,33,35,[39][40][41][42][43][44][45] for prostate cancer (n = 4 articles), glioblastoma (n = 2), breast cancer (n = 1), anaplastic thyroid cancer (n = 1), pancreatic cancer (n = 1), gynecologic cancer (n = 2), rectal cancer (n = 1), NSCLC (n = 1), and pediatric sarcoma (n = 1). In addition, 10 articles revealed that Hispanic patients are more likely to receive non-guideline-concordant care, 22,[46][47][48][49][50][51][52][53][54] and this was identified in prostate cancer (n = 2 articles), gynecologic cancer (n = 2), rectal cancer (n = 1), head and neck cancer (n = 1), lung (n = 1), sarcoma (n = 1), and glioblastoma (n = 1),…”

Effectiveness and safety of neoadjuvant apatinib in combination with capecitabine and oxaliplatin for the therapy of locally advanced colorectal cancer: A retrospective study

“…Unfortunately, multiple patients are diagnosed with locally advanced CRC at the time of initial diagnosis (3,4). In such cases, neoadjuvant therapy plays a crucial role in providing patients with more opportunities for subsequent surgical resection and improving their long-term survival outcomes (5)(6)(7). Currently, the primary neoadjuvant regimen for patients with locally advanced CRC involves platinum-based chemotherapy, such as capecitabine plus oxaliplatin (XELOX) and fluorouracil (8,9).…”