Racial and Socioeconomic Treatment Disparities in Adolescents and Young Adults with Stage II–III Rectal Cancer

• Published in: Annals of surgical oncology Vol. 24; no. 2; pp. 311 - 318
• Main Authors: Lee, David Y., Teng, Annabelle, Pedersen, Rose C., Tavangari, Farees R., Attaluri, Vikram, McLemore, Elisabeth C., Stern, Stacey L., Bilchik, Anton J., Goldfarb, Melanie R.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-02-2017; Springer Nature B.V
• Subjects: Adenocarcinoma - ethnology; Adenocarcinoma - mortality; Adenocarcinoma - therapy; Adolescent; Adult; African Americans - statistics & numerical data; Combined Modality Therapy; European Continental Ancestry Group - statistics & numerical data; Female; Follow-Up Studies; Healthcare Disparities; Healthcare Policy and Outcomes; Hispanic Americans - statistics & numerical data; Humans; Male; Medicine; Medicine & Public Health; Oncology; Prognosis; Rectal Neoplasms - ethnology; Rectal Neoplasms - mortality; Rectal Neoplasms - therapy; Socioeconomic Factors; Surgery; Surgical Oncology; Survival Rate; Young Adult; Black Patient; National Cancer Database; Rectal Cancer; Hispanic Patient; Overall Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-016-5626-0

Introduction
Stage II–III rectal cancer requires multidisciplinary cancer care, and adolescents and young adults (AYA, ages 15–39 years) often do not receive optimal cancer therapy.
Methods
Overall, 3295 AYAs with clinical stage II–III rectal cancer were identified in the National Cancer Database. Factors associated with the receipt of adjuvant and surgical therapies, as well as overall survival (OS), were examined.
Results
The majority of patients were non-Hispanic White (72.0 %), male (57.5 %), and without comorbidities (93.8 %). A greater proportion of Black and Hispanic patients did not receive radiation (24.5 and 27.1 %, respectively, vs. 16.5 % for non-Hispanic White patients), surgery (22.4 % and 21.6 vs. 12.3 %), or chemotherapy (21.5 % and 24.1 vs. 14.7 %) compared with non-Hispanic White patients (all
p
 < 0.05). After controlling for competing factors, Black (odds ratio [OR] 0.7, 95 % confidence interval [CI] 0.5–0.9) and Hispanic patients (OR 0.6, 95 % CI 0.4–0.9) were less likely to receive neoadjuvant chemoradiation compared with non-Hispanic White patients. Females, the uninsured, and those treated at a community cancer center were also less likely to receive neoadjuvant therapy. Having government insurance (OR 0.22, 95 % CI 010–0.49) was a predictor for not receiving surgery. Although 5-year OS was lower (
p
 < 0.05) in Black (59.8 %) and Hispanic patients (65.9 %) compared with non-Hispanic White patients (74.9 %), on multivariate analysis race did not impact mortality. Not having surgery (hazard ratio [HR] 7.1, 95 % CI 2.8–18.2) had the greatest influence on mortality, followed by poorly differentiated histology (HR 3.0, 95 % CI 1.3–6.5), nodal positivity (HR 2.6, 95 % CI 1.9–3.6), no chemotherapy (HR 1.9, 95 % CI 1.03–3.6), no insurance (HR 1.7, 95 % CI 1.1–2.7), and male sex (HR 1.5, 95 % CI 1.1–2.0).
Conclusion
There are racial and socioeconomic disparities in the treatment of stage II–III rectal cancer in AYAs, many of which impact OS. Interventions that can address and mitigate these differences may lead to improvements in OS for some patients.