title: Racial and Socioeconomic Treatment Disparities in Adolescents and Young Adults with Stage II-III Rectal Cancer.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
authors.forename: David Y
authors.initials: DY
authors.lastname: Lee
authors.affiliation: Department of Surgery, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Teng
authors.affiliation: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Rose C
authors.initials: RC
authors.lastname: Pedersen
authors.affiliation: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Farees R
authors.initials: FR
authors.lastname: Tavangari
authors.affiliation: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Vikram
authors.initials: V
authors.lastname: Attaluri
authors.affiliation: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Elisabeth C
authors.initials: EC
authors.lastname: McLemore
authors.affiliation: Department of Biostatistics, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Stern
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
authors.forename: Anton J
authors.initials: AJ
authors.lastname: Bilchik
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA. goldfarbm@jwci.org.
authors.forename: Melanie R
authors.initials: MR
authors.lastname: Goldfarb
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011379:Prognosis; D012004:Rectal Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D012959:Socioeconomic Factors; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult