Association of Race and Socioeconomic Status and Outcomes of Patients with Rectal Cancer

Abstract

Few studies have evaluated disparities of race and socioeconomic status (SES) with outcomes in patients with rectal cancer. We hypothesize that disparities exist in the treatment and outcomes among patients with rectal cancer. Medical records of all patients with rectal cancer treated from 2000 to 2009 at an NCI cancer center (Fox Chase Cancer Center) and an urban academic center (Temple University Hospital) were retrospectively reviewed from a prospectively maintained tumor registry database. SES was estimated using census data. Quartiles of income and education based on zip codes were calculated. Lowest vs other quartiles were compared. Clinicopathologic variables included: initial stage, chemotherapy refusal, sphincter preservation, and overall survival (OS). A total of 748 patients were included in the analysis (581 white, 135 black, 6 other, 26 unknown). No difference in race, SES, or insurance status was seen with regard to stage at presentation. Chemotherapy and radiation refusal was rare. After excluding stage IV patients; sphincter preservation was more common among those with higher income. Median OS for all stages was worse for nonwhite patients (31 vs 50months, p<.001), and those with low income and education. OS disparities were most pronounced among nonwhite patients with advanced disease. Insurance was not associated with a survival difference. Age, stage, and race were independent predictors of survival. Disparity exists in outcomes of patients with rectal cancer. Nonwhite race is associated with worse OS, and lower SES is associated with lower OS and sphincter preservation among patients with rectal cancer.