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Decreased Use of Sphincter-Preserving Procedures Among African Americans with Rectal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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Abstract

Background

Improved multimodality rectal cancer treatment has increased the use of sphincter-preserving surgery. This study sought to determine whether African American (AA) patients with rectal cancer receive sphincter-preserving surgery at the same rate as non-AA patients.

Methods

The study used the Nationwide Inpatient Sample for years 1998–2012 to compare AA and non-AA patients with rectal cancer undergoing low anterior resection or abdominoperineal resection. The logistic regression model was used to adjust for age, gender, admission type, Elixhauser comorbidity index, and hospital factors such as size, location (urban vs.rural), teaching status, and procedure volume.

Results

The search identified 22,697 patients, 1600 of whom were identified as AA. After adjustment for age and gender, the analysis showed that AA patients were less likely to undergo sphincter-preserving surgery than non-AA patients [odds ratio (OR) 0.70; 95% confidence interval (CI) 0.63–0.78; p < 0.0001). After further adjustment for the Elixhauser comorbidity index, admission type, hospital-specific factors, and insurance status, the analysis showed that AA patients still were less likely to undergo sphincter-preserving surgery (OR 0.78; 95% CI 0.70–0.87; p < 0.0001). Although the proportion of non-AA patients undergoing sphincter-preserving surgery increased during the study period (p = 0.0003), this trend was not significant for the AA patients (p = 0.13).

Conclusion

In this data analysis, the AA patients with rectal cancer had lower rates of sphincter-preserving surgery than the non-AA patients, even after adjustment for patient- and hospital-specific factors. Further work is required to elucidate why. Eliminating racial disparities in rectal cancer treatment should continue to be a priority for the surgical community.

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References

  1. DeSantis CE, Siegel RL, Sauer AG, Miller KD, Fedewa SA, Alcaraz KI, et al. Cancer statistics for African Americans, 2016: progress and opportunities in reducing racial disparities. CA Cancer J Clin. 2016;66(4):290–308.

    Article  PubMed  Google Scholar 

  2. Benson AB III, Bekaii-Saab T, Chan E, Chen YJ, Choti MA, Cooper HS, et al. Rectal cancer. J Natl Compr Cancer Netw. 2012;10:1528–64.

    Article  CAS  PubMed  Google Scholar 

  3. Loos M, Quentmeier P, Schuster T, Nitsche U, Gertler R, Keerl A, et al. Effect of preoperative radio(chemo)therapy on long-term functional outcome in rectal cancer patients: a systematic review and meta-analysis. Ann Surg Oncol. 2013;20:1816–28.

    Article  PubMed  Google Scholar 

  4. Paquette IM, Kemp JA, Finlayson SR. Patient and hospital factors associated with use of sphincter-sparing surgery for rectal cancer. Dis Colon Rectum. 2010;53:115–20.

    Article  PubMed  Google Scholar 

  5. Tjandra JJ, Kilkenny JW, Buie WD, Hyman N, Simmang C, Anthony T, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum. 2005;48:411–23.

    Article  PubMed  Google Scholar 

  6. Abbas MA, Chang GJ, Read TE, Rothenberger DA, Garcia-Aguilar J, Peters W, et al. Optimizing rectal cancer management: analysis of current evidence. Dis Colon Rectum. 2014;57:252–9.

    Article  CAS  PubMed  Google Scholar 

  7. Agency for Healthcare Research & Quality (AHRQ) MD. R. HCUP Databases. Healthcare Cost & Utilization Project (HCUP). [Internet]. vol 2016. https://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 1 Apr 2016.

  8. van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ. A modification of the elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care. 2009;47:626–33.

    Article  PubMed  Google Scholar 

  9. Austin PC, Merlo J. Intermediate and advanced topics in multilevel logistic regression analysis. Stat Med. 2017;36:3257–77.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ricciardi R, Virnig BA, Madoff RD, Rothenberger DA, Baxter NN. The status of radical proctectomy and sphincter-sparing surgery in the United states. Dis Colon Rectum. 2007;50:1117–9.

    Google Scholar 

  11. Morris AM, Billingsley KG, Baxter NN, Baldwin LM. Racial disparities in rectal cancer treatment: a population-based analysis. Arch Surg. 2004;139:151–5.

    Article  PubMed  Google Scholar 

  12. Burton S, Brown G, Daniels IR, Norman AR, Mason B, Cunningham D, et al. MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer. 2006;94:351–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Khani MH, Smedh K. Centralization of rectal cancer surgery improves long-term survival. Colorectal Dis. 2010;12:874–9.

    Article  PubMed  Google Scholar 

  14. Dietz DW, (OSTRiCh) C for OST of RC. Multidisciplinary management of rectal cancer: the OSTRICH. J Gastrointest Surg. 2013;17:1863–8.

    Article  PubMed  Google Scholar 

  15. Ayanian JZ, Zaslavsky AM, Fuchs CS, Guadagnoli E, Creech CM, Cress RD, et al. Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort. J Clin Oncol. 2003;21:1293–300.

    Article  PubMed  Google Scholar 

  16. Monson JR, Probst CP, Wexner SD, Remzi FH, Fleshman JW, Garcia-Aguilar J, et al. Failure of evidence-based cancer care in the United states: the association between rectal cancer treatment, cancer center volume, and geography. Ann Surg. 2014;260:622–5.

    Article  Google Scholar 

  17. Ellis CT, Samuel CA, Stitzenberg KB. National trends in nonoperative management of rectal adenocarcinoma. J Clin Oncol. 2016. https://doi.org/10.1200/jco.2015.64.2066.

    Google Scholar 

  18. Clarke CA, Asch SM, Baker L, Bilimoria K, Dudley RA, Fong N, et al. Public reporting of hospital-level cancer surgical volumes in California: an opportunity to inform decision making and improve quality. J Oncol Pract. 2016;12:e944–8.

    Article  PubMed  Google Scholar 

  19. Al-Refaie WB, Muluneh B, Zhong W, Parsons HM, Tuttle TM, Vickers SM, et al. Who receives their complex cancer surgery at low-volume hospitals? J Am Coll Surg. 2012;214:81–7.

    Article  PubMed  Google Scholar 

  20. Le H, Ziogas A, Lipkin SM, Zell JA. Effects of socioeconomic status and treatment disparities in colorectal cancer survival. Cancer Epidemiol Biomark Prev. 2008;17:1950–62.

    Article  PubMed  Google Scholar 

  21. Jandova J, Ohlson E, Torres MR, DiGiovanni R, Pandit V, Elquza E, Nfonsam V. Racial disparities and socioeconomic status in the incidence of colorectal cancer in Arizona. Am J Surg. 2016;212(3):485–92.

    Article  PubMed  Google Scholar 

  22. Samuel CA, Landrum MB, McNeil BJ, Bozeman SR, Williams CD, Keating NL. Racial disparities in cancer care in the Veterans affairs health care system and the role of site of care. Am J Public Health. 2014;104(Suppl):S562–71.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ricciardi R, Roberts PL, Read TE, Baxter NN, Marcello PW, Schoetz DJ. Presence of specialty surgeons reduces the likelihood of colostomy after proctectomy for rectal cancer. Dis Colon Rectum. 2011;54:207–13.

    Article  PubMed  Google Scholar 

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Acknowledgement

This work was funded by the Center for Health African American Men through Partnerships (CHAAMPS). The research reported in this publication was supported by the National Institute of Minority Health and Health Disparities through a grant from the National Institutes of Health under Award No. U54MD008620. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Disclosure

The authors have no commercial interests to disclose.

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA

    Elliot G. Arsoniadis MD, Wolfgang B. Gaertner MD, FACS, Genevieve B. Melton MD, PhD, FACS, FACMI, Robert D. Madoff MD, FACS & Mary R. Kwaan MD, MPH, FACS

  2. Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA

    Elliot G. Arsoniadis MD & Genevieve B. Melton MD, PhD, FACS, FACMI

  3. Department of Urology, University of Minnesota, Minneapolis, MN, USA

    Yunhua Fan MPH & Stephanie Jarosek Phd, RN

Authors
  1. Elliot G. Arsoniadis MD
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  2. Yunhua Fan MPH
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  3. Stephanie Jarosek Phd, RN
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  4. Wolfgang B. Gaertner MD, FACS
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  5. Genevieve B. Melton MD, PhD, FACS, FACMI
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  6. Robert D. Madoff MD, FACS
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  7. Mary R. Kwaan MD, MPH, FACS
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Corresponding author

Correspondence to Elliot G. Arsoniadis MD.

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Arsoniadis, E.G., Fan, Y., Jarosek, S. et al. Decreased Use of Sphincter-Preserving Procedures Among African Americans with Rectal Cancer. Ann Surg Oncol 25, 720–728 (2018). https://doi.org/10.1245/s10434-017-6306-4

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  • DOI: https://doi.org/10.1245/s10434-017-6306-4

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