Treatment Differences for Adrenocortical Carcinoma by Race and Insurance Status

Area of Science:

• Oncology
• Health Services Research
• Health Disparities

Background:

• Adrenocortical carcinoma (ACC) is a rare malignancy with variable clinical outcomes.
• Understanding disparities in ACC treatment and outcomes based on race and insurance status is crucial for equitable healthcare.

Purpose of the Study:

• To investigate whether race and insurance status influence the treatment and clinical outcomes of patients diagnosed with adrenocortical carcinoma (ACC).

Main Methods:

• Retrospective review of adrenocortical carcinoma (ACC) patients from the National Cancer Database (2004-2017).
• Race was categorized as White versus minority (Black and Hispanic).
• Insurance was classified as private insurance (PI) versus other (Medicaid/uninsured/unknown).
• Metastatic (M-ACC) and non-metastatic (NM-ACC) disease were defined at diagnosis.

Main Results:

• White patients and those with PI were more likely to receive timely surgery and multimodality care for both NM-ACC and M-ACC.
• Patients with PI had shorter durations from diagnosis to treatment and surgery.
• M-ACC patients with PI were more likely to receive chemotherapy and have lymph nodes examined.
• Multivariable analysis indicated that minority race and lack of PI were associated with lower odds of receiving surgery.
• Postoperative length of stay was shorter for White NM-ACC and M-ACC patients.

Conclusions:

• Disparities exist in the receipt of timely surgery and multimodality care for adrenocortical carcinoma (ACC) based on race and insurance status.
• Despite these treatment differences, 90-day mortality and overall survival were similar across racial and insurance groups.
• These findings highlight the need to address systemic barriers to equitable cancer care.