In a new, large national hospital-based study, researchers at the American Cancer Society (ACS), found individuals racialized as Black in the United States with early-onset colorectal cancer received worse and less timely, guideline-concordant care than individuals racialized as White. This cancer care included surgery, chemotherapy, and radiotherapy. The study pointed to health insurance, a modifiable factor, as the largest contributor to racial disparities in receipt of guideline-concordant care. The findings are published today in the Journal of Clinical Oncology (JCO).
“Colorectal cancer is a leading cause of cancer death in the U.S. and the incidence and mortality rates among young adults are rising,” said Dr. Leticia Nogueira, scientific director, health services research at the American Cancer Society and lead author of the study. “Research also shows young Black individuals are more likely to die after a colorectal cancer diagnosis than White individuals. This is why addressing racial disparities is so important to ensure everyone receives needed, timely treatment to help battle this disease.”
For the study, researchers analyzed data from individuals 18-49 years of age selected from the National Cancer Database. The men and women were racialized as non-Hispanic Black and White and newly diagnosed with colorectal cancer from 2004 to 2019. Patients who received recommended care (staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy) were considered to have received guideline-concordant care. The decomposition method was used to estimate the relative contribution of demographic characteristics (age and sex), comorbidities, health insurance coverage type, and facility type to the racial disparity in receipt of guideline-concordant care.
The results showed of the 84,882 colon and 62,573 rectal cancer patients, individuals racialized as Black were more likely not to receive guideline-concordant care for colon and rectal cancer. Health insurance explained 28.2% and 21.6% of the disparity among colon and rectal cancer patients, respectively. Individuals racialized as Black also had increased time to adjuvant chemotherapy for colon cancer and neoadjuvant chemoradiation for rectal cancer compared to individuals racialized as White. Timely receipt of these cancer modalities is associated with better survival.
“With health insurance being the largest modifiable factor contributing to racial disparities in this study, it’s critical to eliminate this barrier,” added Nogueira. “Expanding access to health insurance coverage could help improve colorectal care and outcomes from individuals of all racialized groups.”
The American Cancer Society Cancer Action Network (ACS CAN), ACS’ advocacy affiliate, advocates for policy solutions that help improve access to high-quality, affordable care, including Medicaid expansion. The health coverage provided by Medicaid helps improve health outcomes and helps reduce the burden of cancer by offering access to timely prevention and early detection services, as well as affordable treatment and care.
“Lack of access to high quality, affordable and timely care is a leading contributor to the significant cancer disparities Black people experience,” said Lisa A. Lacasse, president of ACS CAN. “We urge lawmakers to expand Medicaid in the 10 states that haven’t already done so to help reduce colorectal cancer disparities and move us closer to our vision of ending cancer as we know it, for everyone.”
This story was published by the American Cancer Society Cancer Action Network on November 8, 2023. It is republished with permission.