Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups.

Abstract

Vast differences in barriers to care exist among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups and may manifest as disparitiesin stage atpresentation and access totreatment. Thus, we characterized AANHPI patients with stage 0-IV colon cancer and examined differences in (1) stage at presentation and (2) time to surgery relative to white patients. We assessed all patients in the National Cancer Database (NCDB) with stage 0-IV colon cancer from 2004 to 2016 who identified as white, Chinese, Japanese, Filipino, Native Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, and Pacific Islander. Multivariable ordinal logistic regression defined adjusted odds ratios (AORs), with 95% confidence intervals (CI), of (1) patientspresenting withadvanced stage colon cancer and (2) patients with stage 0-III colon cancerreceiving surgery at ≥60days versus 30-59days versus <30days postdiagnosis, adjusting for sociodemographic/clinical factors. Among 694,876 patients, Japanese [AOR1.08 (95% CI 1.01-1.15), p<0.05], Filipino [AOR1.17 (95% CI 1.09-1.25), p<0.001], Korean [AOR1.09 (95% CI 1.01-1.18), p<0.05], Laotian [AOR1.51 (95% CI 1.17-1.95), p<0.01], Kampuchean [AOR1.33 (95% CI 1.04-1.70), p<0.01], Thai [AOR 1.60 (95% CI 1.22-2.10), p=0.001], and Pacific Islander [AOR1.41 (95% CI 1.20-1.67), p<0.001] patients were more likely to present with more advanced colon cancer compared with white patients. Chinese [AOR1.27 (95% CI 1.17-1.38), p<0.001], Japanese [AOR 1.23 (95% CI 1.10-1.37], p<0.001], Filipino [AOR1.36 (95% CI 1.22-1.52), p<0.001], Korean [AOR1.16 (95% CI 1.02-1.32), p<0.05], and Vietnamese [AOR1.55 (95% CI 1.36-1.77), p<0.001] patients were more likely to experience greater time to surgery than white patients. Disparities persisted when comparing among AANHPI subgroups. Our findings reveal key disparities in stage at presentation and time to surgery by race/ethnicity among AANHPI subgroups. Heterogeneity upon disaggregation underscores the importance of examining and addressing access barriers and clinical disparities.