Racial/ethnic and age disparities in chemotherapy selection for colorectal cancer.
OBJECTIVE
To test the hypotheses that African American patients and older patients with stage IV colorectal cancer were less likely to receive newer chemotherapy agents.


METHODS
Retrospective cohort design.


METHODS
Among 5068 Surveillance, Epidemiology, and End Results-Medicare patients diagnosed as having stage IV colorectal cancer between 2000 and 2002, a total of 2466 received chemotherapy and were included in the analysis. Irinotecan hydrochloride was the first of the "newer" chemotherapy agents and was marketed in 2000 as a first-line add-on agent. Descriptive statistics were generated, and a multivariable logistic regression was run to estimate the odds of receiving irinotecan among African American patients and older patients and within 2 months of chemotherapy initiation.


RESULTS
African American patients had lower odds of initiating treatment with a newer chemotherapy than white patients (adjusted odds ratio, 0.641; 95% confidence interval, 0.453-0.907). An age disparity was also found, with all older age groups being significantly less likely to initiate treatment with a newer chemotherapy than the youngest age group: the adjusted odds of receiving newer chemotherapy agents (relative to patients aged 66-70 years) were lower and significant among patients aged 71 to 75, 76 to 80, and older than 80 years (odds ratios, 0.708, 0.527, and 0.213, respectively).


CONCLUSIONS
Disparities in chemotherapy selection exist among patients receiving chemotherapy for stage IV colorectal cancer. On initiating chemotherapy, African American patients and older patients were less likely to receive a newer agent.
Obeidat
Nour A
NA
Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA. nobeidat@khibc.jo
Pradel
Francoise G
FG
Zuckerman
Irene H
IH
Trovato
James A
JA
Palumbo
Francis B
FB
DeLisle
Sylvain
S
Mullins
C Daniel
CD
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D044469:Racial Groups; D012189:Retrospective Studies