Significant racial and gender-based disparities exist in outcomes among patients with squamous cell carcinoma of the anus (SCCA), with black men having the lowest survival rates, according to a new study.
“SCCA has a very high cure rate with standard, nonsurgical treatments. For a cancer that is so curable, even modest differences in the rate of treatment impact disease burden and overall survival,” said lead author Muhammad S. Beg, MD, of the University of Texas Southwestern Medical Center in Dallas. “Health systems should make every effort to increase healthcare delivery to at-risk groups who are often also socioeconomically challenged. We do not see such a striking racial and gender difference in survival in most other cancers.”
The researchers published their results in Journal of the National Comprehensive Cancer Network.
They examined the differences in the rate of treatment for SCCA using SEER data from 2000 to 2012, and identified 7,882 cases of locoregional SCCA. The patients, with a median age of 58 years, included 61.2% women. The majority (86.3%) of patients were white.
Most patients (82.3%) received radiation therapy, but black men were the least likely to receive radiation therapy.
The median overall survival (OS) was 135 months. OS was lower in elderly patients age 65 years or older (68 months), men (108 months), black patients (109 months), and those who did not receive radiation therapy (121 months). The median OS was highest in white women (148 months) and lowest in black men (82 months).
A multivariable analysis found OS was independently associated with age (hazard ratio [HR], 1.19), sex (HR, 1.59), race (HR, 1.51), and radiation therapy (HR, 0.90).
Standard treatment for locoregional SCCA comprises a combination of chemotherapy and radiation therapy, with salvage surgery reserved for those with residual or recurrent disease, the researchers stated. They noted non-white populations experience delays in diagnosis and treatment and are less likely to receive guidelines-adherent treatment. Also, patients with low socioeconomic status tend to have lower health literacy, lack of health insurance, and geographic barriers to high-quality care, they stated.
In general, women are more likely to receive radiation therapy and to adhere to therapy than men.
“Our findings that black men have poor survival after adjusting for tumor and treatment characteristics suggest an impact not only of potential delays in treatment, but also underlying tumor biology,” the researchers stated.
Al B. Benson III, MD, of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago, and Chair of the NCCN Clinical Practice Guidelines in Oncology Panels for Colon, Rectal, and Anal Cancers, stated: “This report from a large cohort provides critical observations that reinforce two important concerns. First, the incidence of anal cancer is increasing secondary to rising numbers of individuals with HPV infection and the association with HIV infection. Second, healthcare disparities across diseases—including cancer—are a major problem in the United States, particularly for African American males. As tragically noted from this SEER database assessment, it is also resulting in unacceptable outcomes. The authors provide insights as to the cause of disparities and methods to address the disparities with the hope that communities across the country will intervene to assist this vulnerable population.”