Disparities in Outcomes following Resection of Locally Advanced Rectal Cancer

Area of Science:

• Oncology
• Surgical Oncology
• Health Services Research

Background:

• Surgical margins are critical for rectal cancer outcomes.
• Existing research suggests racial and ethnic disparities in cancer care.

Purpose of the Study:

• To investigate associations between margin status and race/ethnicity, region, and facility type in locally advanced rectal cancer (LARC).

Main Methods:

• Analysis of 58,389 patients with stage II-III LARC (2004-2018) from the National Cancer Database.
• Inverse probability of treatment weighting (IPTW) used to adjust for confounding factors.
• Examined margin positivity rates based on race/ethnicity, region, and facility type.

Main Results:

• Non-Hispanic Black (NHB) patients had a 12% higher likelihood of positive margins compared to non-Hispanic White (NHW) patients (p=0.029).
• Northeast region showed 9% lower margin positivity vs. South; NHB patients in the West had higher positive margins than NHW patients.
• Academic/research centers had lower positive margins than community centers; NHB patients had higher positive margins than non-Hispanic Other patients within academic centers.

Conclusions:

• Disparities in surgical management of LARC exist for NHB patients.
• These disparities vary by geographic region and healthcare facility type.
• Further research is needed to identify the underlying causes of these inequities.