Race and Medicine

Race and Medicine

Issue: January, 2021
Disclosures: Raoof reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
October 26, 2020
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Black patients less likely to undergo treatment for colorectal liver metastases

Issue: January, 2021
Disclosures: Raoof reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Black patients with colorectal liver metastases had a lower likelihood of undergoing chemotherapy or resection and shorter survival than their counterparts of other races and ethnicities, according to a research letter in JAMA Network Open.

“Although we know that liver resection can potentially cure a significant number of patients with stage IV colorectal cancer presenting with liver metastases, only 10% actually undergo liver resection,” Mustafa Raoof, MD, researcher in the department of surgery at City of Hope National Medical Center, told Healio. “In evaluating the determinants of who does or does not receive liver resection, we found that race/ethnicity played a huge role. Patients do not get referred to doctors with expertise in managing complex disease such as stage IV colorectal cancer. This lack of referral is particularly important in vulnerable populations, such as Black patients.”

Black patients with colorectal liver metastases had a lower likelihood of undergoing chemotherapy or resection and shorter survival than their counterparts of other races and ethnicities.

Raoof and colleagues sought to determine whether the low rate of liver resection was associated with shorter survival among 16,382 adults (53% men) with liver metastases from colorectal cancer included in the California Cancer Registry between 2000 and 2012. Researchers linked the data to records from the Office of Statewide Health Planning and Development.

Results showed median survival of 11 months among Black patients compared with 12 months among white patients, 14 months among Asian and Hispanic patients and 18 months among Middle Eastern patients.

Black patients were less likely than white or Hispanic patients to receive chemotherapy (59% vs. 65% vs. 68%; P .001) or undergo liver resection (6.2% vs. 10.3% vs. 9.5% P .001).

After the researchers controlled for age, sex, comorbidities and extra hepatic metastasis, they observed a 17% higher HR for death among Black patients compared with white patients (HR = 1.17; 95% CI, 1.1-1.24). However, among those who underwent liver resection for colorectal liver metastases, researchers found no differences in survival between Black and white patients (HR = 1.01; 95% CI, 0.94-1.08).

Mustafa Raoof, MD
Mustafa Raoof

“Liver resection is a potentially curative treatment for many patients with colorectal liver metastases,” Raoof said. “It is imperative that regardless of race/ethnicity, patients with colorectal liver metastases be evaluated by liver surgeons. In the very least, these patients should be discussed in multidisciplinary tumor boards where surgeons with expertise in liver surgery are present."

Raoof said the finding that race/ethnicity was not associated with poor survival among Black patients in the cohort who underwent liver resection “suggests that the disparity in survival is a direct consequence of underutilization of life-saving treatments.”

“These data lay the foundation for health policy work,” he told Healio. “Future research already underway aims to capture implicit biases in referral practices for Black patients. Next, we would like to test policy interventions that will improve access to liver surgery.”

For more information:

Mustafa Raoof, MD, MS, can be reached at City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010; email: mraoof@coh.org.