Pamela W Lu1,2, Rebecca E Scully3, Adam C Fields3, Vanessa M Welten3, Stuart R Lipsitz4, Quoc-Dien Trinh4,5, Adil Haider4,6, Joel S Weissman4, Karen M Freund7, Nelya Melnitchouk8,9. 1. Division of Gastrointestinal and General Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. pwlu@partners.org. 2. Center for Surgery and Public Health, Brigham and Woman's Hospital, Harvard Medical School, 1620 Tremont St., Boston, MA, 02120, USA. pwlu@partners.org. 3. Division of Gastrointestinal and General Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. 4. Center for Surgery and Public Health, Brigham and Woman's Hospital, Harvard Medical School, 1620 Tremont St., Boston, MA, 02120, USA. 5. Division of Urologic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 6. Medical College, Aga Khan University, Karachi, Pakistan. 7. Department of Medicine, Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA. 8. Division of Gastrointestinal and General Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. nmelnitchouk@bwh.harvard.edu. 9. Center for Surgery and Public Health, Brigham and Woman's Hospital, Harvard Medical School, 1620 Tremont St., Boston, MA, 02120, USA. nmelnitchouk@bwh.harvard.edu.
Abstract
BACKGROUND: Racial disparities exist in patients with rectal cancer with respect to both treatment and survival. Minority-serving hospitals (MSHs) provide healthcare to a disproportionately large percent of minority patients in the USA. We examined the effects of rectal cancer treatment at MSH to understand drivers of these disparities. METHODS: The NCDB was queried (2004-2015), and patients diagnosed with stage II or III rectal adenocarcinoma were identified. Racial case mix distribution was calculated at the institutional level, and MSHs were defined as those within the top decile of Black and Hispanic patients. Logistic regression was used to identify predictors of receipt of standard of care treatment. Survival was assessed using the Kaplan-Meier method, and Cox proportional hazards models were used to evaluate adjusted risk of death. Analyses were clustered by facility. RESULTS: A total of 68,842 patients met the inclusion criteria. Of these patients, 63,242 (91.9%) were treated at non-MSH, and 5600 (8.1%) were treated at MSH. In multivariable analysis, treatment at MSH (OR 0.70 95%CI 0.61-0.80 p < 0.001) and Black race (OR 0.75 95%CI 0.70-0.81 p < 0.001) were associated with significantly lower odds of receiving standard of care. In adjusted analysis, Black patients had a significantly higher risk of mortality (HR 1.20 95%CI 1.14-1.26 p < 0.001). CONCLUSIONS: Treatment at MSH institutions and Black race were associated with significantly decreased odds of receipt of recommended standard therapy for locally advanced rectal adenocarcinoma. Survival was worse for Black patients compared to White patients despite adjustment for receipt of standard of care.
BACKGROUND: Racial disparities exist in patients with rectal cancer with respect to both treatment and survival. Minority-serving hospitals (MSHs) provide healthcare to a disproportionately large percent of minority patients in the USA. We examined the effects of rectal cancer treatment at MSH to understand drivers of these disparities. METHODS: The NCDB was queried (2004-2015), and patients diagnosed with stage II or III rectal adenocarcinoma were identified. Racial case mix distribution was calculated at the institutional level, and MSHs were defined as those within the top decile of Black and Hispanic patients. Logistic regression was used to identify predictors of receipt of standard of care treatment. Survival was assessed using the Kaplan-Meier method, and Cox proportional hazards models were used to evaluate adjusted risk of death. Analyses were clustered by facility. RESULTS: A total of 68,842 patients met the inclusion criteria. Of these patients, 63,242 (91.9%) were treated at non-MSH, and 5600 (8.1%) were treated at MSH. In multivariable analysis, treatment at MSH (OR 0.70 95%CI 0.61-0.80 p < 0.001) and Black race (OR 0.75 95%CI 0.70-0.81 p < 0.001) were associated with significantly lower odds of receiving standard of care. In adjusted analysis, Black patients had a significantly higher risk of mortality (HR 1.20 95%CI 1.14-1.26 p < 0.001). CONCLUSIONS: Treatment at MSH institutions and Black race were associated with significantly decreased odds of receipt of recommended standard therapy for locally advanced rectal adenocarcinoma. Survival was worse for Black patients compared to White patients despite adjustment for receipt of standard of care.
Authors: Diamantis I Tsilimigras; Djhenne Dalmacy; J Madison Hyer; Adrian Diaz; Alizeh Abbas; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2021-05-25 Impact factor: 5.344