Black patients more likely to receive ‘substandard’ GI tract cancer care
Black patients were less likely to receive quality oncologic treatment for gastrointestinal tract cancers compared with white patients, according to a study published in JAMA Network Open.
“Racial and ethnic disparities have long been reported in the health care system, and the COVID-19 pandemic has further highlighted these inequities in medicine with disproportionately higher rates of both infection and death in Black and Hispanic patients,” Baylee F. Bakkila, BA, BS, a medical student at Yale School of Medicine, and colleagues wrote. “Cancer treatment has not been immune to these incongruities, with racial and ethnic disparities consistently observed in survival outcomes.”
Seeking to better understand racial disparities in quality of care of patients with GI tract cancers, Bakkila and colleagues used the National Cancer Database to identify 565,124 U.S. adults (age range at diagnosis, 60 to 69 years; 83.5% white; 54.7% men) who underwent surgical resection of GI tract cancers.
According to study results, Black patients were less likely to have negative surgical margins overall (OR = 0.96; 95% CI, 0.93-0.98) and after esophagectomy (OR = 0.71; 95% CI, 0.58-0.87), proctectomy (OR = 0.71; 95% CI, 0.66-0.76) and biliary resection (OR = 0.75; 95% CI, 0.61-0.91), compared with white patients.
Black patients also were 3% less likely to have adequate lymphadenectomy overall and 29% less likely after enterectomy.
Further, compared with white patients, Black patients were more likely not to be recommended for chemotherapy (OR = 1.15; 95% CI, 1.10-1.21) and radiotherapy (OR = 1.49; 95% CI, 1.35-1.64) due to comorbidities and more likely not to receive recommended chemotherapy (OR = 1.68; 95% CI, 1.55-1.82) and radiotherapy (OR = 2.18; 95% CI, 1.97-2.41) for unknown reasons.
“The findings of this cohort study suggest that Black patients with gastrointestinal tract cancer are more likely than their white counterparts to receive surgical and adjuvant treatment that deviates from the standard of care,” the researchers wrote. “These findings suggest that potential lapses in the health care system by clinicians and hospital systems contribute to racial and ethnic differences in survival by way of treatment disparities.”