BETHESDA, MD — Does differential access to care explain racial disparities in treatment and outcomes of rectal cancer? A new study from the Uniformed Services University of the Health Sciences suggested that other factors are likely to be at play.
The study team, which also included researchers from the Walter Reed National Military Medical Center and the Henry M. Jackson Foundation for the Advancement of Military Medicine, sought to study treatment and outcomes of rectal cancer in the equal access Military Health System (MHS) to better understand potential racial disparities. Results were published in JNCI Cancer Spectrum.1
To do that, investigators accessed the MilCanEpi database to study a cohort of adult patients who were diagnosed with rectal adenocarcinoma between 1998 and 2014. The study compared receipt of guideline-recommended treatment per tumor stage, cancer recurrence and all-cause death between non-Hispanic white and Black patients using multivariable regression models with associations expressed as odds (AORs) or hazard ratios (AHRs) and their 95% confidence intervals (CIs).
The study included 171 Black and 845 white patients with rectal adenocarcinoma. Results indicated, overall, no differences in receipt of guideline-concordant treatment (AOR = 0.76, 95% CI = 0.45, 1.29), recurrence (AHR = 1.34, 95% CI = 0.85, 2.12), or survival (AHR = 1.08, 95% CI = 0.77, 1.54) for Black patients compared to white patients.
“However, Black patients aged <50 years at diagnosis (AOR = 0.34, 95% CI 0.13, 0.90) or with stage III or IV tumors (AOR = 0.28, 95% CI = 0.12, 0.64) were less likely to receive guideline-recommended treatment than white patients in stratified analysis,” the authors pointed out.
The study in the equal access MHS identified no overall racial disparities in rectal cancer treatment or clinical outcomes between Black and white patients, but the researchers advised that “disparities among those with early-onset or late-stage rectal cancers were noted. This suggests factors other than access to care may play a role in the observed disparities and warrants further research.”
- Eaglehouse YL, Darmon S, Gage MM, Shriver CD, Zhu K. Racial Comparisons in Treatment of Rectal Adenocarcinoma and Survival in the Military Health System. JNCI Cancer Spectr. 2024 Aug 29:pkae074. doi: 10.1093/jncics/pkae074. Epub ahead of print. PMID: 39208282.