麻豆传媒

In those undergoing curative surgery for gastrointestinal (GI) tract cancers, Black patients were less likely to receive standard of care treatment, a large retrospective study found.

Among more than half a million such patients, lower odds of negative surgical margins (odds ratio [OR] 0.96, 95% CI 0.93-0.98) and adequate lymphadenectomy (OR 0.89, 95% CI 0.87-0.91) were observed for Black versus white patients, according to Sajid Khan, MD, of the Yale School of Medicine in New Haven, Connecticut, and colleagues.

And as described in , Black patients were more likely to not be recommended for chemotherapy and radiotherapy or to receive either of these modalities:

• Not recommended for chemotherapy (OR 1.15, 95% CI 1.10-1.21)
• Not recommended for radiotherapy (OR 1.49, 95% CI 1.35-1.64)
• Not receiving chemotherapy (OR 1.68, 95% CI 1.55-1.82)
• Not receiving radiotherapy (OR 2.18, 95% CI 1.97-2.14)

"Black patients were more likely than White patients to receive substandard cancer care," the group wrote. "These observed differences in care are concerning in their own right, but they may also contribute to the worse survival outcomes that have been reported among Black patients with gastrointestinal tract cancer."

Khan and colleagues cited the 2003 Institute of Medicine (IOM) report that found that . They said their goal was to provide an update on how GI tract cancer patients have fared since the time of the report's release.

In their study, they found that Black patients had lower odds of negative surgical margins following esophagectomy proctectomy, and biliary resections (with ORs ranging from 0.71-0.75). And also had lower odds of adequate lymphadenectomy following enterectomy, esophagectomy, colectomy, pancreatectomy, proctocolectomy, and proctectomy (ORs of 0.71-0.93).

"That the reported inequalities hold for almost all modalities and cancer sites suggests their systemic nature," Shervin Assari, MD, MPH, of the Charles R. Drew University of Medicine and Science in Los Angeles, and Helena Hansen, MD, PhD, of the University of California Los Angeles, stated in an . "If this was not bad enough, these inequalities may be an underestimation of the true disparities, given that Black patients are less likely to receive any diagnosis or treatment."

"Even when Black patients overcome barriers to their diagnosis and treatment (e.g., mistrust in the health care system) and accept adjunct therapies such as chemotherapy, they still may receive substandard treatment," they wrote.

For their study, Khan and colleagues examined data on 565,124 adults in the (NCDB) who were diagnosed with and undergoing surgery for a GI tract cancer from 2004 to 2017.

About 55% of patients were men, 84% were white, and 11% were Black. Half were on Medicare. The colon was the most common primary cancer site (45%). Most patients had negative margins (89%) and adequate lymphadenectomy (71%) following surgery.

Median follow-up was 41 months. Negative margins and adequate lymphadenectomies were both associated with longer median survival (87 vs 23 months, 81 vs 58 months, respectively; P<0.001 for both).

The authors acknowledged limitations to the data. The NCDB excludes patient factors, such as body mass index, which may contribute to disparities in surgical care. Also, survival analyses only looked at time from diagnosis versus time from surgery.

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