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A Patient's Race/Ethnicity Does Not Explain the Underuse of Appropriate Adjuvant Therapy in Colorectal Cancer

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Diseases of the Colon & Rectum

Introduction

To improve colorectal cancer outcomes, appropriate adjuvant therapy (chemotherapy, radiation therapy) should be given. Numerous studies have demonstrated underuse of adjuvant therapy in colorectal cancer. The current study examines variables associated with underuse of adjuvant therapy.

Methods

Three population-based databases were linked: California Cancer Registry, California Patient Discharge Database, 2000 Census. All colorectal cancer patients diagnosed from 1994 to 2001 were studied. Patient characteristics (age, gender, race/ethnicity, comorbidities, payer, diagnosis year, socioeconomic status) were used in five multivariate regression analyses to predict receipt of chemotherapy for Stage III colon cancer, and receipt of chemotherapy and radiation therapy for Stages II, III rectal cancer.

Results

The overall cohort was 18,649 Stage III colon cancer and Stages II, III rectal cancer patients. Mean age was 68.9 years, 50 percent male, 74 percent non-Hispanic white, 6 percent black, 11 percent Hispanic, 9 percent Asian, and 65 percent had no significant comorbid disease. Receipt of chemotherapy was 48 percent for Stage III colon cancer, 48 percent for Stage II rectal cancer, and 66 percent for Stage III rectal cancer. Receipt of radiation therapy was 52 percent for Stage II rectal cancer and 66 percent for Stage III rectal cancer. In all five models, low socioeconomic status predicted underuse of chemotherapy or radiation therapy (P < 0.016). Race/ethnicity was not statistically associated with underuse in any of the models.

Conclusions

Most literature identifies race/ethnicity as the reason for disparate receipt of adjuvant therapy in colorectal cancer. Using a more robust database of three population-based sources, our analysis demonstrates that socioeconomic status is a more important predictor of (in)appropriate care than race/ethnicity. Explicit measures to improve care to the poor with colorectal cancer are needed.

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Authors and Affiliations

  1. Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, 72-215 Center for Health Sciences, Box 956904, Los Angeles, California, 90095-6904, USA

    Marcia L. McGory M.D., Evan Sekeris Ph.D. & Clifford Y. Ko M.D., M.S., M.S.H.S.

  2. Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA

    David S. Zingmond M.D., Ph.D.

  3. Department of Health Services, University of California Los Angeles School of Public Health, Los Angeles, California, USA

    Roshan Bastani Ph.D.

  4. Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA

    Clifford Y. Ko M.D., M.S., M.S.H.S.

Authors
  1. Marcia L. McGory M.D.
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  2. David S. Zingmond M.D., Ph.D.
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  3. Evan Sekeris Ph.D.
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  4. Roshan Bastani Ph.D.
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  5. Clifford Y. Ko M.D., M.S., M.S.H.S.
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Corresponding author

Correspondence to Marcia L. McGory M.D..

Additional information

Supported by Limited Project Grant from The American Society of Colon and Rectal Surgeons; Asian American Network for Cancer Awareness, Research, and Training Grant from the National Cancer Institute (#5U01CA086322-06); and the Robert Wood Johnson Clinical Scholars Program at UCLA.

Read at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, April 30 to May 5, 2005; Recipient of the Piedmont Society of Colon and Rectal Surgeons Awards for Clinical Podium Presentation.

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McGory, M.L., Zingmond, D.S., Sekeris, E. et al. A Patient's Race/Ethnicity Does Not Explain the Underuse of Appropriate Adjuvant Therapy in Colorectal Cancer. Dis Colon Rectum 49, 319–329 (2006). https://doi.org/10.1007/s10350-005-0283-6

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  • DOI: https://doi.org/10.1007/s10350-005-0283-6

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