Disparities in Treatment Outcomes Among Non-Hispanic Black Patients With Locally Advanced Rectal Cancer

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Non-Hispanic Black patients with locally advanced rectal cancer may experience poorer treatment outcomes independent of the sociodemographic, clinical, and pathologic factors that often influence racial and ethnic disparities in this patient population, according to a recent study published by Shulman et al in JAMA Network Open.


“There has been a substantial body of literature related to racial [and] ethnic differences in survival outcomes for colorectal cancer, but there hasn’t really been a study looking comprehensively into the potential multitude of factors affecting racial and ethnic disparities in treatment response to neoadjuvant therapy for locally advanced rectal cancer,” stressed co–senior study author Sanjeevani Arora, PhD, Assistant Professor in the Cancer Prevention and Control Research Program at Fox Chase Cancer Center.

Study Methods and Results

In the recent study, investigators used the National Cancer Database to analyze the social determinants of health as well as the demographic, clinical, and pathologic factors known to predict response to neoadjuvant therapy in patients with locally advanced rectal cancer.

“We wanted to first determine if racial [and] ethnic differences were also noted in treatment response,” explained co–senior study author Shannon Lynch, PhD, MPH, Assistant Professor in the Cancer Prevention and Control Research Program and Assistant Director of the Office of Community Outreach and Engagement at Fox Chase Cancer Center. “Next, we sought to evaluate whether these differences might be explained in part by social determinants of health—like where a [patient] lives, their education or economic circumstances, or whether or not a patient has insurance—given [that] social determinants are generally known to contribute to racial [and] ethnic disparities in cancer more broadly,” she added.

The investigators discovered that compared with non-Hispanic White patients, Hispanic and non-Hispanic Black patients had worse treatment outcomes. After adjusting for social determinants of health and clinical factors, non-Hispanic Black patients continued to experience less favorable treatment responses.


 “Our findings suggest that other factors we weren’t able to measure or evaluate using this existing data resource, such as access to services or more detailed socioeconomic or clinical data, could be playing a role in differences we see in treatment response by race [and] ethnicity,” noted Dr. Lynch.

“Apart from the above factors, one thing we didn’t look at is the biological component, attributes such as gene mutations and inherited genetic conditions. This study shows that also could be a missing piece to help explain why these disparities continue to exist despite advances in treatment,” Dr. Arora suggested.

The investigators concluded that their findings may represent the first step in assessing some of the sociobiological factors that may influence treatment outcomes and highlight the significance of cultivating diversity in clinical trials that assess treatment response.

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