Racial disparities in colon cancer management in the National Cancer Database.

Abstract

18 Background: Racial and ethnic minorities in the US are at increased risk of developing and dying from colorectal cancer. Reasons for these disparities are multifactorial, among which are delayed presentation and initial disease management. We aimed to identify groups at highest risk to help address these disparities. Methods: Using the 2010-2017 National Cancer Database (NCDB), we analyzed clinical tumor stage at presentation and pathologic stage for adult patients (age≥18) diagnosed with primary colon cancer. We also examined trends in upstaging, downstaging, and delays >42 days between presentation and surgical intervention. We compared these outcomes by race/ethnicity using multivariable logistic or median regression, with select demographics, facility factors, and treatment details as covariates. Results: Fifty-one percent of patients with known clinical tumor stage (122,452/239,939) were diagnosed with stage III/IV at presentation, and 41% of those with known pathologic stage (123,009/298,716) had stage III/IV disease. In multivariable analysis, Black (OR 1.18, p<0.01) and Southeast Asian (OR 1.12, p=0.02) patients were significantly more likely than White patients to present with clinical stage III/IV. Black (OR 1.08, p<0.01), Hispanic (OR 1.07, p<0.01), East Asian (OR 1.28, p<0.01), and Southeast Asian (OR 1.40, p<0.01) patients were significantly more likely than White patients to have pathologic stage III/IV. Both clinical and pathological stage were available for 96,959 patients. Among those with clinical stage 0/I/II, Hispanic (OR 1.08, p=0.04), East Asian (OR 1.38, p<0.01) and Southeast Asian (OR 1.27, p=0.01) patients had significantly higher odds than White patients of being upstaged to pathologic stage III/IV. Among those with clinical stage III/IV, Black patients (OR 0.85, p=0.02) had significantly lower odds than White patients of being downstaged to pathologic stage 0/I/II. Black (OR 1.42, p<0.01), Hispanic (OR 1.33, p<0.01) and Southeast Asian (OR 1.23, p=0.05) patients had higher odds than White patients of waiting >42 days between presentation and surgery. Conclusions: Upstaging of colon cancer between diagnosis and surgery is disproportionately experienced by non-white patients. Surgical delays may partly explain this finding. Targeted interventions to avoid surgical delays as well as further research on the reasons (e.g., differences in tumor characteristics) for upstaging are needed to address this disparity.[Table: see text]