Black Patients Less Likely to Receive Treatment for Colorectal Liver Metastases

September 11, 2020

This study found black patients were less likely to undergo chemotherapy or surgical resection for colorectal liver metastases and had worse survival compared to other patients.

According to a study published in JAMA Network Open, black patients were less likely to undergo chemotherapy or surgical resection for colorectal liver metastases (CRLM) and had worse survival compared to patients in other racial and ethnic groups.1

“The unfortunate reality is that minorities, especially black people, have a much lower chance of getting lifesaving cancer treatment,” senior author Mustafa Raoof, MD, surgical oncologist at City of Hope, said in a press release.2 “Health care works within a social construct, and to change health disparities, we need social change.”

Researchers performed a retrospective cohort study of adult patients included in the California Cancer Registry with synchronous CRLM from January 1, 2000 to December 31, 2012. Data were then linked to records from the Office of Statewide Health Planning and Development.

Of 16,382 patients identified, black patients were found to have the lowest median survival with a median survival of 11 months compared to 14 months for Asian patients, 14 months for Hispanic patients, 18 months for Middle Eastern patients, and 12 months for white patients. Additionally, black patients were the least likely to receive chemotherapy (59% vs 65% [white patients] vs 68% [Hispanic patients]; P < .001) or undergo liver resection (6.2% vs 10.3% [white patients] vs 9.5% [Hispanic patients]; P < .001).

“The decreased health outcomes in black patients could be attributed to factors such as lower rate of referral to cancer specialists, late detection of colorectal cancer metastases and patient-reported barriers, including fear of cancer and its treatment, costs, and the burdens of transportation and childcare during therapy,” first author Lucas Thornblade, MD, a City of Hope surgical oncology fellow, said in the release.

After controlling for age, sex, comorbidities, and extrahepatic metastasis, black patients still had a 17% higher risk of death compared with white patients (HR, 1.17; 95% CI, 1.10-1.24; P < .001). However, among patients who underwent liver resection for CRLM, there was no difference in survival observed between black and white patients (HR, 1.01; 95% CI, 0.94-1.08; P = .84).

Notably, the rate of liver resection in the US is only about 10%. Further, black patients are more likely to be diagnosed with advanced disease, with only 10.5% surviving 5 years or more, according to data from the National Cancer Institute.

“There is a vast under-utilization of liver resection as a potentially curative treatment for colorectal liver metastases,” co-author Yuman Fong, MD, the Sangiacomo Family Chair in Surgical Oncology at City of Hope, said in the release. “This missed opportunity is even more common for Black patients than for the general population.”

Altogether, the researchers suggested these results may provide a basis for a future benchmark for quality of care that all patients with CRLM, regardless of race, should be evaluated for resection by a liver surgeon in the office or tumor board setting.

“Although black race was independently associated with poor survival among patients with CRLM, this study highlights the importance of access to health care systems that perform safe liver resection,” the authors wrote.

References:

1. Thornblade LW, Warner S, Melstrom L, Singh G, Fong Y, Raoof M. Association of Race/Ethnicity With Overall Survival Among Patients With Colorectal Liver Metastasis. JAMA Network Open. doi: 10.1001/jamanetworkopen.2020.16019

2. Black people more likely than others to die from colorectal cancer spreading to the liver [news release]. Duarte, California. Published September 9, 2020. Accessed September 9, 2020. https://story.cision.com/r/3B689s