BACKGROUND: African Americans in the United States have higher rates of colon cancer mortality than other races. This study examines the use of oxaliplatin, a novel chemotherapeutic agent approved in 2004, among African American and Caucasian American patients with stage III colon cancer to determine whether differential receipt or differential effectiveness of the drug may explain the racial disparity in colon cancer mortality. METHODS: The authors conducted a population-based retrospective cohort study of stage III colon cancer patients aged 65 years and older treated from 2004 through 2006 who initiated chemotherapy within 90 days of surgical resection (N = 1162) using Surveillance, Epidemiology and End Results-Medicare data. Patients receiving oxaliplatin (n = 477) were compared with those receiving 5-fluorouracil without oxaliplatin (n = 685). The authors estimated prevalence ratios and hazard ratios (HRs) using multivariate binomial regression and Cox models to evaluate racial differences in oxaliplatin receipt and survival. RESULTS: African Americans were as likely as Caucasian Americans to receive oxaliplatin (40.5 vs 41.1%; prevalence ratio, 0.90; 95% confidence interval [CI], 0.71-1.13). Oxaliplatin was associated with lower mortality compared with 5-fluorouracil (HR, 0.76; 95% CI, 0.58-1.00). This benefit appeared stronger among African Americans (HR, 0.31; 95% CI, 0.09-1.05) than Caucasian Americans (HR, 0.80; 95% CI, 0.60-1.06). CONCLUSIONS: In Medicare-insured patients receiving chemotherapy, the authors observed no meaningful racial disparities in receipt of oxaliplatin and, among those receiving it, potentially better survival among African Americans. Differential receipt and effectiveness of oxaliplatin-containing regimens does not appear to contribute to the previously documented racial disparities in colon cancer survival. Understanding reasons for potentially enhanced effectiveness among African Americans may inform efforts to resolve racial disparities in colon cancer outcomes.
BACKGROUND: African Americans in the United States have higher rates of colon cancer mortality than other races. This study examines the use of oxaliplatin, a novel chemotherapeutic agent approved in 2004, among African American and Caucasian American patients with stage III colon cancer to determine whether differential receipt or differential effectiveness of the drug may explain the racial disparity in colon cancer mortality. METHODS: The authors conducted a population-based retrospective cohort study of stage III colon cancerpatients aged 65 years and older treated from 2004 through 2006 who initiated chemotherapy within 90 days of surgical resection (N = 1162) using Surveillance, Epidemiology and End Results-Medicare data. Patients receiving oxaliplatin (n = 477) were compared with those receiving 5-fluorouracil without oxaliplatin (n = 685). The authors estimated prevalence ratios and hazard ratios (HRs) using multivariate binomial regression and Cox models to evaluate racial differences in oxaliplatin receipt and survival. RESULTS: African Americans were as likely as Caucasian Americans to receive oxaliplatin (40.5 vs 41.1%; prevalence ratio, 0.90; 95% confidence interval [CI], 0.71-1.13). Oxaliplatin was associated with lower mortality compared with 5-fluorouracil (HR, 0.76; 95% CI, 0.58-1.00). This benefit appeared stronger among African Americans (HR, 0.31; 95% CI, 0.09-1.05) than Caucasian Americans (HR, 0.80; 95% CI, 0.60-1.06). CONCLUSIONS: In Medicare-insured patients receiving chemotherapy, the authors observed no meaningful racial disparities in receipt of oxaliplatin and, among those receiving it, potentially better survival among African Americans. Differential receipt and effectiveness of oxaliplatin-containing regimens does not appear to contribute to the previously documented racial disparities in colon cancer survival. Understanding reasons for potentially enhanced effectiveness among African Americans may inform efforts to resolve racial disparities in colon cancer outcomes.
Authors: Jennifer S Haas; Phyllis Brawarsky; Aarthi Iyer; Garrett M Fitzmaurice; Bridget A Neville; Craig Earle Journal: Cancer Date: 2011-03-16 Impact factor: 6.860
Authors: S T Pullarkat; J Stoehlmacher; V Ghaderi; Y P Xiong; S A Ingles; A Sherrod; R Warren; D Tsao-Wei; S Groshen; H J Lenz Journal: Pharmacogenomics J Date: 2001 Impact factor: 3.550
Authors: L Iyer; S Das; L Janisch; M Wen; J Ramírez; T Karrison; G F Fleming; E E Vokes; R L Schilsky; M J Ratain Journal: Pharmacogenomics J Date: 2002 Impact factor: 3.550
Authors: A David McCollum; Paul J Catalano; Daniel G Haller; Robert J Mayer; John S Macdonald; Al B Benson; Charles S Fuchs Journal: J Natl Cancer Inst Date: 2002-08-07 Impact factor: 13.506
Authors: Gregory S Cooper; Beth Virnig; Carrie N Klabunde; Nicola Schussler; Jean Freeman; Joan L Warren Journal: Med Care Date: 2002-08 Impact factor: 2.983
Authors: Joan L Warren; Linda C Harlan; Angela Fahey; Beth A Virnig; Jean L Freeman; Carrie N Klabunde; Gregory S Cooper; Kevin B Knopf Journal: Med Care Date: 2002-08 Impact factor: 2.983
Authors: William R Carpenter; Anne-Marie Meyer; Yang Wu; Bahjat Qaqish; Hanna K Sanoff; Richard M Goldberg; Bryan J Weiner Journal: Med Care Date: 2012-08 Impact factor: 2.983
Authors: Christina DeFilippo Mack; Robert J Glynn; M Alan Brookhart; William R Carpenter; Anne Marie Meyer; Robert S Sandler; Til Stürmer Journal: Pharmacoepidemiol Drug Saf Date: 2013-01-07 Impact factor: 2.890
Authors: Ravi K Goyal; Spiros Tzivelekis; Kenneth J Rothman; Sean D Candrilli; James A Kaye Journal: Support Care Cancer Date: 2017-09-18 Impact factor: 3.603
Authors: Caitlin C Murphy; Linda C Harlan; Jennifer L Lund; Charles F Lynch; Ann M Geiger Journal: J Natl Cancer Inst Date: 2015-07-23 Impact factor: 13.506
Authors: Christina DeFilippo Mack; M Alan Brookhart; Robert J Glynn; Anne Marie Meyer; William R Carpenter; Robert S Sandler; Til Stürmer Journal: Epidemiology Date: 2015-09 Impact factor: 4.822
Authors: Dolly C Penn; YunKyung Chang; Anne-Marie Meyer; Christina DeFilippo Mack; Hanna K Sanoff; Karyn B Stitzenberg; William R Carpenter Journal: Cancer Date: 2014-09-10 Impact factor: 6.860
Authors: Yinzhi Lai; Chun Wang; Jesse M Civan; Juan P Palazzo; Zhong Ye; Terry Hyslop; Jianqing Lin; Ronald E Myers; Bingshan Li; Binghua Jiang; Ashwin Sama; Jinliang Xing; Hushan Yang Journal: Gastroenterology Date: 2016-02-02 Impact factor: 22.682
Authors: Elizabeth Golembiewski; Katie S Allen; Amber M Blackmon; Rachel J Hinrichs; Joshua R Vest Journal: JMIR Public Health Surveill Date: 2019-10-07
Authors: Kevin M Gorey; Sundus Haji-Jama; Emma Bartfay; Isaac N Luginaah; Frances C Wright; Sindu M Kanjeekal Journal: BMC Health Serv Res Date: 2014-03-22 Impact factor: 2.655