Racial disparities in receipt of standard chemoradiation in anal squamous cell carcinoma, an analysis of the National Cancer Database

Bian, Shelly X.; Chen, Dennis H; Lin, Eugene

doi:10.1002/cam4.3625

Cited by 8 publications

(6 citation statements)

References 25 publications

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“…For instance, Hines et al observed colorectal cancer patients with stage II through IV tumors were at greater risk for receiving noncompliant care, attributing this to the additional need for neoadjuvant and adjuvant chemotherapy in stage II and III disease [17]. However, our results are consistent with other studies on ASCC, including those from Bian et al and Kole et al [16,42]. Bian et al performed a retrospective analysis of ASCC patients with stage II and III disease in the National Cancer Database (NCD) and found patients with stage III (as compared to lower stage II disease) and poorly differentiated or undifferentiated tumors were more likely to receive standard therapy [42].…”

Section: Discussionsupporting

confidence: 90%

Population-Based Analysis of National Comprehensive Cancer Network (NCCN) Guideline Adherence for Patients with Anal Squamous Cell Carcinoma in California

Kumar

Rosario

Chang

et al. 2023

Cancers

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Purpose: We analyzed adherence to the National Comprehensive Cancer Network treatment guidelines for anal squamous cell carcinoma in California and the associated impacts on survival. Methods: This was a retrospective study of patients in the California Cancer Registry aged 18 to 79 years with recent diagnoses of anal squamous cell carcinoma. Predefined criteria were used to determine adherence. Adjusted odds ratios and 95% confidence intervals were estimated for those receiving adherent care. Disease-specific survival (DSS) and overall survival (OS) were examined with a Cox proportional hazards model. Results: 4740 patients were analyzed. Female sex was positively associated with adherent care. Medicaid status and low socioeconomic status were negatively associated with adherent care. Non-adherent care was associated with worse OS (Adjusted HR 1.87, 95% CI = 1.66, 2.12, p < 0.0001). DSS was worse in patients receiving non-adherent care (Adjusted HR 1.96, 95% CI = 1.56, 2.46, p < 0.0001). Female sex was associated with improved DSS and OS. Black race, Medicare/Medicaid, and low socioeconomic status were associated with worse OS. Conclusions: Male patients, those with Medicaid insurance, or those with low socioeconomic status are less likely to receive adherent care. Adherent care was associated with improved DSS and OS in anal carcinoma patients.

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Section: Discussionsupporting

confidence: 90%

Population-Based Analysis of National Comprehensive Cancer Network (NCCN) Guideline Adherence for Patients with Anal Squamous Cell Carcinoma in California

Kumar

Rosario

Chang

et al. 2023

Cancers

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“…Racial disparities in receipt of standard treatment has been shown in numerous cancers, including breast, prostate, lung, gynecologic, and gastrointestinal cancers ( 1 , 16 - 20 ). In a SEER analysis evaluating breast, non-small cell lung, and prostate cancer, Black patients were less likely to receive guideline concordant treatment than White patients, and mortality risks were lowered after adjusting for standard treatment ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…In a SEER analysis evaluating breast, non-small cell lung, and prostate cancer, Black patients were less likely to receive guideline concordant treatment than White patients, and mortality risks were lowered after adjusting for standard treatment ( 19 ). In an NCDB study evaluating standard treatment for locally advanced anal squamous cell carcinoma, racial survival differences that were present between Black and White patients were rectified in the subgroup that received standard treatment ( 20 ). In summation, these studies emphasize the importance of eliminating barriers to receipt of standard treatment to decrease racial disparities of standard treatment and survival outcomes.…”

Section: Discussionmentioning

confidence: 99%

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

Vassantachart

Marietta

Mehta

et al. 2022

J Gastrointest Oncol

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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.

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“…11,12 Larger studies have focused on some of the socioeconomic factors such as median household income, race, or sex. [13][14][15] A large US study describing the effect of various socioeconomic determinants, such as income, race, insurance status, education level on treatment delay, and survival, is lacking in the literature.…”

Section: Desigualdades Socio-económicas En Casos De Cáncer Anal: Efec...mentioning

confidence: 99%

Socioeconomic Disparities in Anal Cancer: Effect on Treatment Delay and Survival

Nepal,

Zafar,

Liu

et al. 2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Socioeconomic inequities have implications in access to health care and may be associated with disparities in treatment and survival. OBJECTIVE: To investigate the impact of socioeconomic inequities on time to treatment and survival of anal squamous cell carcinoma. DESIGN: This is a retrospective study using a nationwide dataset. SETTINGS: The patients were selected from National Cancer Database enrolled from 2004 to 2016. PATIENTS: We identified patient with stage I-III squamous cell carcinoma of anus who were treated with chemoradiation. MAIN OUTCOMES MEASURES: Socioeconomic factors, including race, insurance status, median household income, and percentage of no high school degrees were included. The association of these factors with treatment delay and overall survival were investigated. RESULTS: A total of 24,143 patients who underwent treatment for Grade I-III squamous cell carcinoma of anus were identified. Median age was 60 years and 70% were female. The median time to initiation of treatment was 33 days. Patients from zip codes with lower median income, higher percentage of no high school degree, and patients with other government insurance followed by Medicaid insurance had treatment initiated after 60 days from diagnosis. Kaplan-Meier survival analysis showed that the late treatment group had worse overall survival compared to early treatment group (98 vs 125 months; p < 0.001). LIMITATIONS: No detailed information about chemoradiotherapy regimen, completion of treatment, recurrence, disease free survival and individual level socioeconomic condition and risk factors. CONCLUSION: Patients from communities with lower median income, level of education, and enrolled in public insurance had longer time to treatment. Lower socioeconomic status was also associated with poorer overall survival. These results warrant further analysis and measures to improve access to care to address this disparity. See Video Abstract.

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Racial disparities in receipt of standard chemoradiation in anal squamous cell carcinoma, an analysis of the National Cancer Database

Cited by 8 publications

References 25 publications

Population-Based Analysis of National Comprehensive Cancer Network (NCCN) Guideline Adherence for Patients with Anal Squamous Cell Carcinoma in California

Population-Based Analysis of National Comprehensive Cancer Network (NCCN) Guideline Adherence for Patients with Anal Squamous Cell Carcinoma in California

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

Socioeconomic Disparities in Anal Cancer: Effect on Treatment Delay and Survival

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