Racial Disparities in Treatment for Rectal Cancer at Minority-Serving Hospitals

Lu, Pamela; Scully, Rebecca E.; Fields, Adam C.; Welten, Vanessa M.; Lipsitz, Stuart R.; Trinh, Quoc‐Dien; Haider, Adil H.; Weissman, Joel S.; Freund, Karen M.; Melnitchouk, Nelya

doi:10.1007/s11605-020-04744-x

Cited by 25 publications

(15 citation statements)

References 41 publications

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“…Patients in the community setting may be less likely to receive standard of care for rectal cancer, potentially due to a lack of financial and human resources to deliver multimodal oncologic therapy. 26,27 We also found that patients who received care at comprehensive community or integrative network facilities were less likely to undergo NOM compared with patients at academic centers. A potential explanation is that comprehensive community or integrative healthcare systems may have more consolidated resources that are equipped to provide multidisciplinary cancer care including surgery but may be slower to adopt newer treatment strategies such as NOM.…”

Section: Discussionmentioning

confidence: 67%

“…Our results suggest that patients at community hospitals are more likely to undergo NOM compared with those treated at academic centers. Patients in the community setting may be less likely to receive standard of care for rectal cancer, potentially due to a lack of financial and human resources to deliver multimodal oncologic therapy 26,27 . We also found that patients who received care at comprehensive community or integrative network facilities were less likely to undergo NOM compared with patients at academic centers.…”

Section: Discussionmentioning

confidence: 69%

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Current trends in nonoperative management for rectal adenocarcinoma: An unequal playing field?

Lee

Zhao

Pianka

et al. 2022

Journal of Surgical Oncology

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Background and Objectives Increasing evidence suggests patient‐oriented benefits of nonoperative management (NOM) for rectal cancer. However, vigilant surveillance requires excellent access to care. We sought to examine patient, socioeconomic, and facility‐level factors associated with NOM over time. Methods Using the National Cancer Database (2006–2017), we examined patients with Stage II–III rectal adenocarcinoma, who received neoadjuvant chemoradiation and received NOM versus surgery. Factors associated with NOM were assessed using multivariable logistic regression with backward stepwise selection. Results There were 59,196 surgical and 8520 NOM patients identified. NOM use increased from 12.9% to 15.9% between 2006 and 2017. Patients who were Black (adjusted odds ratio [aOR]: 1.36, 95% confidence interval [CI]: 1.26–1.47), treated at community cancer centers (aOR: 1.22, 95% CI: 1.12–1.30), without insurance (aOR: 1.87, 95% CI: 1.68–2.09), and with less education (aOR: 1.53, 95% CI: 1.42–1.65) exhibited higher odds of NOM. Patients treated at high‐volume centers (aOR: 0.79, 95% CI: 0.74–0.84) and those who traveled >25.6 miles for care (aOR: 0.59, 95% CI: 0.55–0.64) had lower odds of NOM. Conclusions Vulnerable groups who traditionally have difficulty accessing comprehensive cancer care were more likely to receive NOM, suggesting that healthcare disparities may be driving utilization. More research is needed to understand NOM decision‐making in rectal cancer treatment.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 69%

Current trends in nonoperative management for rectal adenocarcinoma: An unequal playing field?

Lee

Zhao

Pianka

et al. 2022

Journal of Surgical Oncology

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“…Racial disparities in access to guideline-concordant care for gynecologic malignancies have also been well established, and this study highlights inequalities in the surgical treatment of vulvar cancer. 29,[34][35][36][37][38] We found that older patients were less likely to undergo LN evaluation than younger individuals. The lower use of guideline-concordant care for elderly patients is prevalent throughout oncology.…”

Section: Discussionmentioning

confidence: 99%

Guideline-Discordant Care in Early-Stage Vulvar Cancer

Bercow

Rauh-Hain

Melamed

et al. 2022

Obstetrics &Amp; Gynecology

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“…19,32 Multiple other studies confirm that racial disparity in treatment extends beyond HNC. 21,33-36 For example, while evaluating treatment for esophageal cancer, Savitch et al established that Black race was associated with lower likelihood of receiving surgery across all cancer stages. 36 Implicit bias by surgeons may affect patient communication and the treatment modality offered.…”

Section: Discussionmentioning

confidence: 99%

“…It should be reiterated that both these studies did not stratify by HPV+ OPSCC 19 , 32 . Multiple other studies confirm that racial disparity in treatment extends beyond HNC 21,33–36 . For example, while evaluating treatment for esophageal cancer, Savitch et al established that Black race was associated with lower likelihood of receiving surgery across all cancer stages 36 .…”

Section: Discussionmentioning

confidence: 99%

Impact of Race and Insurance Status on Primary Treatment for HPV‐Associated Oropharyngeal Squamous Cell Carcinoma

Habib

Carey²,

Prasad

et al. 2021

Otolaryngol.--head neck surg.

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Objective To assess the impact of sociodemographic factors on primary treatment choice (surgery vs radiotherapy) in patients with human papillomavirus–associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Study Design Retrospective analysis of the National Cancer Database. Setting Data from >1500 Commission on Cancer institutions (academic and community) via the National Cancer Database. Methods Our sample consists of patients diagnosed with HPV+ OPSCC from 2010 to 2015. The primary outcome of interest was initial treatment modality: surgery vs radiation. We performed multivariable logistic models to assess the relationship between treatment choice and sociodemographic factors, including sex, race, treatment facility, and insurance status. Results Of the 16,043 patients identified, 5894 (36.7%) underwent primary surgery while 10,149 (63.3%) received primary radiotherapy. Black patients were less likely than White patients to receive primary surgery (odds ratio [OR], 0.80; 95% CI, 0.66-0.96). When compared with privately insured patients, those who were uninsured or on Medicaid or Medicare were also less likely to receive primary surgery (OR, 0.70 [95% CI, 0.56-0.86]; OR, 0.77 [95% CI, 0.65-0.91]; OR, 0.85 [95% CI, 0.75-0.96], respectively). Patients receiving treatment at an academic/research cancer program were more likely to undergo primary surgery than those treated at comprehensive community cancer programs (OR, 1.33; 95% CI, 1.14-1.56). Conclusion In this large sample of patients with HPV+ OPSCC, race and insurance status affect primary treatment choice. Specifically, Black and nonprivately insured patients are less likely to receive primary surgery as compared with White or privately insured patients. Our findings illuminate potential disparities in HPV+ OPSCC treatment.

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Racial Disparities in Treatment for Rectal Cancer at Minority-Serving Hospitals

Cited by 25 publications

References 41 publications

Current trends in nonoperative management for rectal adenocarcinoma: An unequal playing field?

Current trends in nonoperative management for rectal adenocarcinoma: An unequal playing field?

Guideline-Discordant Care in Early-Stage Vulvar Cancer

Impact of Race and Insurance Status on Primary Treatment for HPV‐Associated Oropharyngeal Squamous Cell Carcinoma

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