Investigators have found that Black patients with early-onset colorectal cancer in the United States may receive worse and less timely, guideline-concordant care than White patients, according to a recent study published by Nogueira et al in the Journal of Clinical Oncology.
Background
“Colorectal cancer is a leading cause of cancer death in the [United States], and the incidence and mortality rates among young adults are rising,” stressed lead study author Leticia Nogueira, PhD, MPH, Scientific Director of Health Services Research at the American Cancer Society (ACS). “Research also shows young Black individuals are more likely to die after a colorectal cancer diagnosis than White individuals. This is why addressing racial disparities is so important to ensure everyone receives needed, timely treatment to help battle this disease,” she added.
Study Methods and Results
In the recent large-scale national hospital–based study, the investigators used the National Cancer Database to analyze the data of 147,455 patients (aged 18 to 49) who were newly diagnosed with colorectal cancer from 2004 to 2019. The patients who received staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy were considered to have received guideline-concordant care. The decomposition method was used to estimate the relative contribution of demographic characteristics such as age, sex, comorbidities, health insurance coverage type, and facility type to the racial disparity in receipt of guideline-concordant care.
The investigators found that Black patients were less likely to receive guideline-concordant care for colorectal cancer. Health insurance explained 28.2% and 21.6% of the disparity among patients with colon and rectal cancers, respectively. They noted Black patients also had an increased time to adjuvant chemotherapy for colon cancer and neoadjuvant chemoradiation therapy for rectal cancer compared with White patients. Timely receipt of these cancer modalities was associated with better survival.
Conclusions
“With health insurance being the largest modifiable factor contributing to racial disparities in this study, it’s critical to eliminate this barrier,” Dr. Nogueira emphasized. “Expanding access to health insurance coverage could help improve colorectal [cancer] care and outcomes from [patients] of all racialized groups,” she suggested.
The American Cancer Society Cancer Action Network (ACS CAN) continues to advocate for policy solutions that help strengthen access to high-quality, affordable care, including Medicaid expansion. The health coverage provided by Medicaid has been shown to improve health outcomes and reduce the burden of cancer by offering access to timely prevention and early detection services as well as affordable treatment and care.
“Lack of access to high-quality, affordable, and timely care is a leading contributor to the significant cancer disparities Black [patients] experience,” underscored Lisa A. Lacasse, MBA, President of ACS CAN. “We urge lawmakers to expand Medicaid in the 10 states that haven’t already done so to help reduce colorectal cancer disparities and move us closer to our vision of ending cancer as we know it, for everyone,” she concluded.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
