David Y Lee1, Annabelle Teng2, Rose C Pedersen3, Farees R Tavangari3, Vikram Attaluri3, Elisabeth C McLemore3, Stacey L Stern4, Anton J Bilchik1, Melanie R Goldfarb5. 1. Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA. 2. Department of Surgery, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospital Center, New York, NY, USA. 3. Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA. 4. Department of Biostatistics, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA. 5. Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA. goldfarbm@jwci.org.
Abstract
INTRODUCTION: Stage II-III rectal cancer requires multidisciplinary cancer care, and adolescents and young adults (AYA, ages 15-39 years) often do not receive optimal cancer therapy. METHODS: Overall, 3295 AYAs with clinical stage II-III rectal cancer were identified in the National Cancer Database. Factors associated with the receipt of adjuvant and surgical therapies, as well as overall survival (OS), were examined. RESULTS: The majority of patients were non-Hispanic White (72.0 %), male (57.5 %), and without comorbidities (93.8 %). A greater proportion of Black and Hispanic patients did not receive radiation (24.5 and 27.1 %, respectively, vs. 16.5 % for non-Hispanic White patients), surgery (22.4 % and 21.6 vs. 12.3 %), or chemotherapy (21.5 % and 24.1 vs. 14.7 %) compared with non-Hispanic White patients (all p < 0.05). After controlling for competing factors, Black (odds ratio [OR] 0.7, 95 % confidence interval [CI] 0.5-0.9) and Hispanic patients (OR 0.6, 95 % CI 0.4-0.9) were less likely to receive neoadjuvant chemoradiation compared with non-Hispanic White patients. Females, the uninsured, and those treated at a community cancer center were also less likely to receive neoadjuvant therapy. Having government insurance (OR 0.22, 95 % CI 010-0.49) was a predictor for not receiving surgery. Although 5-year OS was lower (p < 0.05) in Black (59.8 %) and Hispanic patients (65.9 %) compared with non-Hispanic White patients (74.9 %), on multivariate analysis race did not impact mortality. Not having surgery (hazard ratio [HR] 7.1, 95 % CI 2.8-18.2) had the greatest influence on mortality, followed by poorly differentiated histology (HR 3.0, 95 % CI 1.3-6.5), nodal positivity (HR 2.6, 95 % CI 1.9-3.6), no chemotherapy (HR 1.9, 95 % CI 1.03-3.6), no insurance (HR 1.7, 95 % CI 1.1-2.7), and male sex (HR 1.5, 95 % CI 1.1-2.0). CONCLUSION: There are racial and socioeconomic disparities in the treatment of stage II-III rectal cancer in AYAs, many of which impact OS. Interventions that can address and mitigate these differences may lead to improvements in OS for some patients.
INTRODUCTION: Stage II-III rectal cancer requires multidisciplinary cancer care, and adolescents and young adults (AYA, ages 15-39 years) often do not receive optimal cancer therapy. METHODS: Overall, 3295 AYAs with clinical stage II-III rectal cancer were identified in the National Cancer Database. Factors associated with the receipt of adjuvant and surgical therapies, as well as overall survival (OS), were examined. RESULTS: The majority of patients were non-Hispanic White (72.0 %), male (57.5 %), and without comorbidities (93.8 %). A greater proportion of Black and Hispanic patients did not receive radiation (24.5 and 27.1 %, respectively, vs. 16.5 % for non-Hispanic White patients), surgery (22.4 % and 21.6 vs. 12.3 %), or chemotherapy (21.5 % and 24.1 vs. 14.7 %) compared with non-Hispanic White patients (all p < 0.05). After controlling for competing factors, Black (odds ratio [OR] 0.7, 95 % confidence interval [CI] 0.5-0.9) and Hispanic patients (OR 0.6, 95 % CI 0.4-0.9) were less likely to receive neoadjuvant chemoradiation compared with non-Hispanic White patients. Females, the uninsured, and those treated at a community cancer center were also less likely to receive neoadjuvant therapy. Having government insurance (OR 0.22, 95 % CI 010-0.49) was a predictor for not receiving surgery. Although 5-year OS was lower (p < 0.05) in Black (59.8 %) and Hispanic patients (65.9 %) compared with non-Hispanic White patients (74.9 %), on multivariate analysis race did not impact mortality. Not having surgery (hazard ratio [HR] 7.1, 95 % CI 2.8-18.2) had the greatest influence on mortality, followed by poorly differentiated histology (HR 3.0, 95 % CI 1.3-6.5), nodal positivity (HR 2.6, 95 % CI 1.9-3.6), no chemotherapy (HR 1.9, 95 % CI 1.03-3.6), no insurance (HR 1.7, 95 % CI 1.1-2.7), and male sex (HR 1.5, 95 % CI 1.1-2.0). CONCLUSION: There are racial and socioeconomic disparities in the treatment of stage II-III rectal cancer in AYAs, many of which impact OS. Interventions that can address and mitigate these differences may lead to improvements in OS for some patients.
Authors: Samer A Naffouje; Muhammed A Ali; Sivesh K Kamarajah; Bradley White; George I Salti; Fadi Dahdaleh Journal: J Gastrointest Surg Date: 2022-04-19 Impact factor: 3.452
Authors: Michael D Toboni; Alexander Cohen; Zachary L Gentry; Stuart A Ostby; Zhixin Wang; Sejong Bae; Charles Leath Journal: Int J Gynecol Cancer Date: 2022-06-06 Impact factor: 4.661
Authors: Meryl D Colton; DeLayna Goulding; Alina Beltrami; Carrye Cost; Anna Franklin; Myles G Cockburn; Adam L Green Journal: Cancer Med Date: 2019-06-26 Impact factor: 4.452
Authors: Katerina Zakka; Renjian Jiang; Olatunji B Alese; Walid L Shaib; Christina Wu; Joel P Wedd; Marty T Sellers; Madhusmita Behera; Bassel F El-Rayes; Mehmet Akce Journal: J Hepatocell Carcinoma Date: 2019-07-22
Authors: David Banham; David Roder; Marion Eckert; Natasha J Howard; Karla Canuto; Alex Brown Journal: BMC Health Serv Res Date: 2019-10-29 Impact factor: 2.655
Authors: Olatunji B Alese; Wei Zhou; Renjian Jiang; Katerina Zakka; Zhonglu Huang; Chimuanya Okoli; Walid L Shaib; Mehmet Akce; Maria Diab; Christina Wu; Bassel F El-Rayes Journal: Front Oncol Date: 2021-12-09 Impact factor: 6.244