Underuse of surgical resection in black patients with nonmetastatic colorectal cancer: location, location, location.

OBJECTIVES: Studies have reported potential underuse of surgical resection in black patients with nonmetastatic colorectal cancer. Our objective was to determine the independent, adverse effect of race on surgical resection, controlling for tumor location, comorbidity, and socioeconomic/insurance status. METHODS: All cases of nonmetastatic colon/rectal cancer reported to our state's Central Cancer Registry from 1996 to 2002 were identified and linked to Inpatient/Outpatient Surgery Files and the 2000 Census. Comorbidity (Deyo-Charlson Index) was calculated using ICD-9-CM codes and educational level/income were estimated at the zip code level. Characteristics between whites and blacks were compared using [chi]2 tests. Odds ratios (OR) of resection were calculated using logistic regression analysis. RESULTS: We identified 5590/1932 white and 1906/466 black patients with colon/rectal cancer. Blacks were more likely to be younger, not married, rural, less educated, live in poverty, and uninsured/covered by Medicaid compared with whites (all P < 0.001). Underuse of surgery was far greater among blacks with rectal cancer (82.0% vs. 89.3% in whites, P< 0.001) compared with blacks with colon cancer (92.9% vs. 94.5% in whites, P < 0.001). After controlling for comorbidity/socioeconomic/insurance status and tumor location, the adjusted OR (95% CI) for resection for blacks with colon cancer and blacks with rectal cancer living in poverty were 0.67 (0.51­0.88) and 0.20 (0.07­0.57), respectively. CONCLUSIONS: Black race is a powerful, independent predictor of underuse of surgery in rectal cancer patients living in poverty. It is incumbent on the gastroenterology/surgical community to determine whether misperceptions about rectal surgery or barriers to successfully navigating multidisciplinary, rectal cancer care may account for these disparities.

Underuse of surgical resection for localized, non-small cell lung cancer among whites and African Americans in South Carolina.

BACKGROUND: Early studies using Medicare data reported racial disparities in surgical treatment of localized, non-small cell lung cancer. We analyzed the independent effect of race on use of surgical resection in a recent, population-based sample of patients with localized non-small cell lung cancer, controlling for comorbidity and socioeconomic status. METHODS: All cases of localized non-small cell lung cancer reported to our state Cancer Registry between 1996 and 2002 were identified and linked to the Inpatient/Outpatient Surgery Files and 2000 Census. Comorbidity (Romano-Charlson index) was calculated using administrative data codes. Educational level and income were estimated using census data. Characteristics of white and African American patients were compared using chi(2) tests. Odds ratios of resection and 95% confidence intervals were calculated using logistic regression. RESULTS: We identified 2,506 white and 550 African American patients. African Americans were more likely to be younger, male, not married, less educated, poor, and uninsured or covered by Medicaid (all p < 0.0001), and to reside in rural communities (p = 0.0005). Use of surgical resection across races was lower than previously reported, and African Americans were significantly less likely to undergo surgery compared with whites (44.7% versus 63.4%; p < 0.0001). Even after controlling for sociodemographics, comorbidity, and tumor factors, the adjusted odds ratio for resection for African Americans was 0.43 (95% confidence interval, 0.34 to 0.55). CONCLUSIONS: Underuse of surgical resection for localized, non-small cell lung cancer is a persistent problem, particularly among African Americans. Further studies are urgently needed to identify the patient-, physician-, and health system-related factors underlying these observations and optimize resection rates for non-small cell lung cancer.