A research letter published by Thornblade et al in JAMA Network Open examined the impact of race or ethnicity on rates of chemotherapy, liver resection, and survival among patients with metastatic colorectal cancer.
“The unfortunate reality is that minorities, especially Black people, have a much lower chance of receiving life-saving cancer treatment. Health care works within a social construct, and to change health disparities, we need social change,” said senior author Mustafa Raoof, MD, a surgical oncologist at City of Hope.
Disparities Found
Researchers retrospectively looked at the data of 16,382 adult patients in the California Cancer Registry and found that Black patients were the least likely to receive chemotherapy (59% compared to 65% among White patients) and had a 17% higher chance of death compared to White patients—even when the scientists controlled for age, sex, and comorbidities. Importantly, among patients who underwent liver resection, there was no difference in survival between Black and White patients.
“These troubling statistics are the result of a disparity in access to health care,” said Dr. Raoof. “We observed that if Black people with metastatic colorectal cancer had access to subspecialists with expertise in liver resection, they would not experience higher numbers of unnecessary deaths due to underutilization of life-saving therapies.”
The study lays the foundation for future work focusing on the specific barriers that Black patients face in obtaining therapies such as liver resection. “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,” said first study author Lucas Thornblade, MD, a surgical oncology fellow at City of Hope.
Next Steps
The study suggests a future benchmark for quality care: all patients with colorectal cancer that has spread to the liver, regardless of race, should be evaluated for surgery by a liver surgeon in the office or in a tumor board setting (meaning by a group of subspecialists).
The rate of liver resection in the United States is only about 10%, said study coauthor Yuman Fong, MD, the Sangiacomo Family Chair in Surgical Oncology at City of Hope. “There is a vast underutilization of liver resection as a potentially curative treatment for colorectal liver metastases. This missed opportunity is even more common for Black patients than for the general population.”
The study authors concluded: “We found that Black patients were least likely to undergo chemotherapy or surgical resection for colorectal liver metastases and had the worst survival compared with patients in other racial/ethnic groups. Benchmarks for improving survival among patients in minority populations who have cancer include maximizing opportunities to visit a cancer specialist, optimizing chances of undergoing state-of-the-art surgical therapy, and ensuring receipt of adjuvant therapy when appropriate. Although Black race was independently associated with poor survival among patients with colorectal liver metastases, this study highlights the importance of access to health-care systems that perform safe liver resection. The finding that access to surgical resection may be associated with reduced racial differences in survival has been mirrored for other cancers.”
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
