Racial Disparities in Survival Outcomes of Colorectal Cancer Patients After Surgical Resection

Abstract

Introduction: Colorectal cancer is one of the most common cancers in the United States. Significant disparities exist among racial and ethnic minorities diagnosed with colorectal cancer compared to non-Hispanic Whites. However, understanding of survival outcomes following curative surgical resection in this population is limited.Objective: To evaluate the association between race and colorectal cancer-specific mortality in patients who were treated with major surgical resection of the colon.Materials and Methods: This study was a retrospective cohort analysis using the Surveillance, Epidemiology, and End Results (SEER) Program database from 2010 to 2016. The patient population consisted of adult patients (≥18 years old) diagnosed with a primary malignancy of colorectal cancer treated with major surgical resection of the colon. The main outcome measures were survival time at one and five years following diagnosis and cancer-specific death.Results: A total of 120,598 patients with primary colorectal malignancy treated with surgical resection of the colon were identified. Across all racial groups, most patients presented with moderately differentiated colorectal cancer. Non-Hispanic Blacks had the highest proportion of diffuse metastases (p<0.001). After adjusting for covariates, Hispanic respondents had the lowest one-year survival (adjusted HR: 1.26, 95%CI (1.21-1.31) and five-year survival when compared to Whites (adjusted HR: 1.13, 95%CI: 1.10-1.15). Factors associated with a shorter survival include age ≥ 70 years old, unmarried status, metastatic disease, and highgrade tumors (p<0.001).Conclusions: Racial disparities exist in the overall survival of patients with colorectal cancer who are treated with surgical resection of the colon. Hispanic patients had the highest hazard of death, followed by Non-Hispanic Asian-Pacific Islanders and Non-Hispanic Blacks, compared to Whites. While surgical resection can be curative, the quality and accessibility of post-operative care may differentiate survival outcomes among racial groups.

Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia

“…We found that the 5‐year CRC survival rates were lower among Black patients in comparison to White patients (65.4% vs. 69.9%). This is consistent with prior literature that reported overall 5‐year CRC survival rates for Black adults have consistently been below that of White adults, with Black adults' overall survival rates at 61% and White adults' survival rates at 67% during 2000–2016 in the United States 3 . Further, we found that Black patients living in low‐education (59.4% vs. 67.3%) regions appeared to have lower 5‐year survival rates compared to those not living in low‐education regions.…”

“…This is consistent with prior literature that reported overall 5-year CRC survival rates for Black adults have consistently been below that of White adults, with Black adults' overall survival rates at 61% and White adults' survival rates at 67% during 2000-2016 in the United States. 3 Further, we found that Black patients living in low-education (59.4% vs. 67.3%) regions appeared to have lower 5-year survival rates compared to those not living in low-education regions. Compared with findings from other studies, the 5-year survival rate was 72.4% for the lowest SES quintile compared to 78.9% in the highest SES quintile for CRC patients, 23 which is in line with our findings.…”

Factors Associated With Racial and Ethnic Disparities in Locally Advanced Rectal Cancer Outcomes

“…[23][24][25][26][27][28] Historically, if studies examining LARC have incorporated SDOH, it has been to a limited extent. 19,20,24,[29][30][31][32][33][34][35] As an illustration, a recent study of patients with colorectal cancer undergoing surgery 36 demonstrated decreased 1-and 5-year survival for Asian, Hispanic, non-Hispanic Black, and Pacific Islander patient populations compared with White patients. This disparity persisted after adjustment for multiple demographic variables, including insurance status and marital status, with Hispanic patients exhibiting the worst survival decrement.…”

“…This disparity persisted after adjustment for multiple demographic variables, including insurance status and marital status, with Hispanic patients exhibiting the worst survival decrement. 36 However, multiple additional factors are evidently at work. Herein, we have undertaken an analysis using a focused inventory of SDOH in addition to prognostically relevant demographic, clinical, and pathologic data within a contemporary National Cancer Database (NCDB) cohort.…”

“…As an illustration, a recent study of patients with colorectal cancer undergoing surgery demonstrated decreased 1- and 5-year survival for Asian, Hispanic, non-Hispanic Black, and Pacific Islander patient populations compared with White patients. This disparity persisted after adjustment for multiple demographic variables, including insurance status and marital status, with Hispanic patients exhibiting the worst survival decrement . However, multiple additional factors are evidently at work.…”