Black Population Receives Worse Care Vs White Population for CRC Treatment

Data demonstrated that health insurance was the leading cause of the racial disparity, resulting in 28.2% and 21.6% of the disparity among patients with colon and rectal cancer, respectively.

Patients who are Black with early-onset colorectal cancer (CRC) are more likely to experience less timely and worse care than patients who are White, according to data from a hospital-based study published in the Journal of Clinical Oncology.¹ 

Compared with patients who are White, patients who are Black had increased time to receive adjuvant chemotherapy for colon cancer (HR, 1.28; 95% CI, 1.24-1.32). Patients who are Black also had increased time to receive neoadjuvant chemoradiation for rectal cancer (HR, 1.42; 95% CI, 1.37-1.47) compared with those who are White.

“Colorectal cancer is a leading cause of cancer death in the US and the incidence and mortality rates among young adults are rising,” lead author Leticia Nogueira, PhD, MPH, scientific director of health services research at the American Cancer Society, said in a press release about the study.² “Research also shows young Black [patients] are more likely to die after a colorectal cancer diagnosis than White [patients]. This is why addressing racial disparities is so important to ensure everyone receives needed, timely treatment to help battle this disease.”

The study analyzed data from 147,455 patients between the ages of 18 and 49 who were non-Hispanic Black and White diagnosed with early-onset CRC between 2004 and 2019. Patients who received recommended care, such as staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy, were said to have received guideline-concordant care. Factors such as age, sex, comorbidities, health insurance coverage type, and facility type were taken into consideration to assess the effect of demographic characteristics on racial disparity.

Of the 147,455 patients with CRC, 84,882 patients had colon cancer, and 62,573 patients had rectal cancer. Of those populations, 20.8% and 14.5% were Black. Patients who were Black were more likely to not receive guideline-concordant care for colon cancer (adjusted OR, 1.18; 95% CI, 1.14-1.22), and for rectal cancer (adjusted OR, 1.27; 95% CI, 1.21-1.33). The OR was adjusted for age and sex.

Data demonstrated that health insurance was the leading cause of the racial disparity, resulting in 28.2% and 21.6% of the disparity among patients with colon and rectal cancer, respectively.

“With health insurance being the largest modifiable factor contributing to racial disparities in this study, it’s critical to eliminate this barrier,” Nogueira continued. “Expanding access to health insurance coverage could help improve colorectal care and outcomes from [patients] of all racialized groups.”

Past studies have also demonstrated that, while CRC mortality rates have decreased from 1985 to 2008 in all stages of CRC, the decreases have been smaller for patients who are Black.³ For the localized stage, mortality rates decreased by 30.3% in patients who were White compared with 13.2% of patients who were Black; for the regional stage, declines were 48.5% in patients who were White compared with 34.0% in patients who were Black; and for distant stage, declines were 32.6% in patients who were White compared with 4.6% in patients who were Black.

References

1. Nogueira LM, May FP, Yabroff KR, Siegel RL. Racial disparities in receipt of guideline-concordant care for early-onset colorectal cancer in the United States. J Clin Oncol. Published online November 8, 2023. doi:10.1200/jco.23.00539
2. Black patients with early-onset colorectal cancer received worse and less timely care than white patients, new study shows. News release. American Cancer Society. November 8, 2023. Accessed November 15, 2023. https://tinyurl.com/ycxt7rkv
3. Robbins AS, Siegel RL, Jemal A. Racial disparities in stage-specific colorectal cancer mortality rates from 1985 to 2008. J Clin Oncol. Published online December 19, 2011. 2012;30(4):401-405. doi:10.1200/jco.2011.37.5527