African-American patients experience higher mortality than Caucasian patients after surgery for most common cancer types.
Whether longterm survival after rectal cancer surgery varies by race is less clear.
Dr Arden Morris and colleagues from Michigan examined race and longterm survival among African-American and Caucasian rectal cancer patients undergoing resection.
The research team used Surveillance, Epidemiology, and End Results Medicare data from 1992 to 2003.
The researchers identified racial differences in patient characteristics, structure, and processes of care.
|5-year survival rates for African-Americans were 41%|
|Journal of the American College of Surgeons|
The research team then assessed mortality using a Cox proportional hazards model.
The team sequentially added variables to explore the extent to which they attenuated the association between race and mortality.
African-American patients had a substantially poorer overall survival rate than Caucasian patients did.
The researchers found that the 5-year survival rates were 41% and 50%, respectively.
The team observed that African Americans were younger, more likely to reside in low income areas, and had more baseline comorbid disease.
The researchers also noted that African Americans were more likely to be diagnosed emergently and with more advanced cancer.
Accounting for demographic and clinical characteristics reduced the mortality difference, although it remained pronounced.
The researchers found that African Americans were more likely to be treated by low volume surgeons and less likely to receive adjuvant therapy.
After adjusting for provider variables, the hazard ratio for mortality by race was additionally attenuated and became statistically nonsignificant.
Dr Morris' team concludes, “Poorer long-term survival after rectal cancer surgery among African Americans is explained by measurable differences in processes of care and patient characteristics.”
“These data suggest that outcomes disparities could be reduced by strategies targeting earlier diagnosis and increasing adjuvant therapy use among African-American patients.”