Temporal trends in Black‐White disparities in cancer surgery and cancer‐specific survival in the United States between 2007 and 2015

Abstract

Background The American Society of Clinical Oncology (ASCO) has strived to address racial/ethnic disparities in cancer care since 2009. Surgery plays a pivotal role in cancer care; however, it is unclear whether and how racial/ethnic disparities in cancer surgery have changed over time. Methods This cohort study included 1,113,256 White and Black cancer patients across 9 years (2007–2015) using patient data extracted from the Surveillance, Epidemiology, and End Results (SEER)‐18 registries. Patient data were included from 2007 to adjust insurance status and by 2015 to obtain at least a 3‐year survival follow‐up (until 2018). The primary outcome was a surgical intervention. The secondary outcomes were the use of (neo)adjuvant chemotherapy and cancer‐specific survival (CSS). Adjusted associations of the race (Black/White) with the outcomes were measured in each cancer type and year. Results The gap between surgery rates for Black and White patients narrowed overall, from an adjusted odds ratio (aOR) of 0.621 (0.592–0.652) in 2007 to 0.734 (0.702–0.768) in 2015. However, the racial gap persisted in the surgery rates for lung, breast, prostate, esophageal, and ovarian cancers. In surgically treated patients with lymph node metastasis, Black patients with colorectal cancer (CRC) were less likely to receive (neo)adjuvant chemotherapy than White patients. Black patients undergoing surgery were more likely to have a worse CSS rate than White patients undergoing surgery. In breast cancer patients, the overall trend was narrow, but continuously present, with an adjusted hazard ratio (aHR) of 1.224 (1.278–1.173) in 2007 and 1.042 (1.132–0.96) in 2015. Conclusions Overall, progress has been made toward narrowing the Black‐White gap in cancer surgical opportunity and survival. Future efforts should be directed toward those specific cancers for which the Black‐White gap continues. Additionally, it is worth addressing the Black‐White gap regarding the use of (neo)adjuvant chemotherapy for CRC treatment.

Health insurance and neighborhood poverty as mediators of racial disparities in advanced disease stage at diagnosis and nonreceipt of surgery for women with breast cancer

“…Our result concerning the increased likelihood of Black women with breast cancer to not receive surgery as treatment was also found in prior studies. 7,32,35,36 To our knowledge, no other studies have investigated potential mediators of the race effect on disparities in nonreceipt of surgery. In this study, the mediating impact of insurance status and neighborhood poverty were even less impactful for nonreceipt of surgery.…”

“…Many studies and statistical reports have documented racial (Black/White) disparities in breast cancer mortality/survival over several decades 2–5 . Despite knowledge of racial disparities in many cancer outcomes and corresponding efforts to redress these inequities, Black women still bear a significantly higher burden of breast cancer than White women 6,7 . We recently reported that although breast cancer survival had improved for all women in Florida and Black/White disparities had decreased, Black women still experienced over twice the rate of breast cancer death compared to their White counterparts in the most recent time period 8 .…”

“…[2][3][4][5] Despite knowledge of racial disparities in many cancer outcomes and corresponding efforts to redress these inequities, Black women still bear a significantly higher burden of breast cancer than White women. 6,7 We recently reported that although breast cancer survival had improved for all women in Florida and Black/White disparities had decreased, Black women still experienced over twice the rate of breast cancer death compared to their White counterparts in the most recent time period. 8 Thus, despite awareness and efforts to mitigate disparities in breast cancer outcomes by race over the past several decades, progress has been slow.…”

Recent advances in photothermal therapy-based multifunctional nanoplatforms for breast cancer

“…The current therapeutic approaches for BC mainly consist of chemotherapy, hormone therapy, and surgery ( Aghanejad et al, 2013 ; Kadkhoda et al, 2022 ; Zhong et al, 2022 ). However, disadvantages such as adverse side effects for patients, drug resistance, and residual tumor cells greatly limit their therapeutic effect and may lead to cancer recurrence ( Waks and Winer, 2019 ; Kadkhoda et al, 2021 ).…”

Role of Functionalized Peptides in Nanomedicine for Effective Cancer Therapy

“…Cancer is a leading cause of death worldwide, accounting for approximately 10 million deaths in 2020 [1,2]. Cancer treatments include chemotherapy, phototherapy, radiation therapy, and surgery [3][4][5][6][7][8][9][10][11][12]. Chemotherapy is a traditional treatment for cancer and can effectively treat cancer, even at low doses [13][14][15].…”