In a large national study, Black patients diagnosed with early-onset colorectal cancer received worse and less timely care than their White counterparts. Differences in health insurance coverage type, a modifiable factor, according to the findings, accounted for the largest identified contributor to the racial disparities. The study results will be presented by Nogueira et al at the 2022 ASCO Annual Meeting (Abstract 6544)
In the study, led by Leticia Nogueira, PhD, MPH, Senior Principal Scientist, Health Services Research, at the American Cancer Society, more than 147,000 non-Hispanic Black and White individuals aged 20 to 49 years newly diagnosed with colorectal cancer during 2004 to 2019 were selected from the National Cancer Database. Patients who received all care recommended by the National Comprehensive Cancer Network (staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy) for which they were eligible, according to cancer subsite and clinical and pathologic TNM stage, were considered guideline-concordant.
Demographic characteristics (age and sex), comorbidities, and health insurance coverage type were added sequentially to a series of multivariable models to estimate the contribution to racial disparities in receipt of guideline-concordant care. Racial disparities in the time from diagnosis date (among patients with rectal cancer eligible for neoadjuvant chemotherapy) and surgery date (among patients with colon cancer eligible for adjuvant chemotherapy) to the date of chemotherapy initiation were evaluated using restricted mean time to treatment.
Of the 84,728 colon and 62,483 patients with rectal cancer included in the study, 20.8% and 14.5% were Black, respectively. Black patients were 18% and 36% less likely to receive guideline-concordant care than White patients diagnosed with colon and rectal cancer, respectively.
Demographic characteristics and comorbidities combined explained less than 5% of the disparity, while health insurance coverage type explained 28.6% and 19.4% of the disparity among patients with colon and rectal cancers, respectively. Restricted mean time to chemotherapy was statistically significantly longer among Black than White patients for colon (54.0 vs. 48.7 days) and rectal cancers (49.6 vs. 40.9 days), respectively.
The study authors stressed that improved access to care could help mitigate disparities in cancer outcomes.
Disclosures: For full disclosures of the study authors, visit coi.asco.org.
