Racial disparities in rectal cancer treatment: a population-based analysis.
OBJECTIVE
We hypothesized that there are significant racial disparities in delivery of care to rectal cancer patients. We examined differential surgical and radiation treatment for these patients and determined whether blacks were less likely than whites to undergo sphincter-sparing procedures, which are associated with a higher quality of life than sphincter-ablating procedures.


METHODS
Cross-sectional cohort study.


METHODS
The Surveillance Epidemiology and End Results database provided population-based data for rectal cancer patients who were diagnosed between 1988 and 1999, were older than 35 years, and had no prior colorectal or other pelvic cancer.


METHODS
Using logistic regression, we compared receipt and type of surgical therapy and radiation therapy, controlling for age, sex, year, geography, stage, and anatomic location.


RESULTS
Among 52 864 patients, 3851 were black and 44 010 were white. Blacks were younger than whites and had more advanced disease (P<.001). Among patients who underwent operation, rates of sphincter-ablating procedure were 37% for whites and 43% for blacks (adjusted odds ratio [AOR], 1.42; 95% confidence interval [CI], 1.23-1.65). Moreover, 53% of whites and 56% of blacks received no radiation therapy for stage II to III disease (AOR, 1.30; 95% CI, 1.15-1.47).


CONCLUSIONS
Blacks with rectal cancer were diagnosed at a younger age and more advanced disease stage than whites, implying a need for more aggressive screening. After adjusting for stage and other covariates, surgical and radiation treatment also differed along racial lines. Our data suggest that treatment disparities may contribute to differences in outcome among racial/ethnic groups with rectal cancer, and they highlight the need for improving access to state-of-the-art surgical care for minority patients with rectal cancer.
Morris
Arden M
AM
Department of Surgery, Section of Colon and Rectal Surgery, University of Minnesota, Minneapolis, USA. ammsurg@umich.edu
Billingsley
Kevin G
KG
Baxter
Nancy N
NN
Baldwin
Laura-Mae
LM
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods* / Q000401:mortality; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D012004:Rectal Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D018426:SEER Program; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American