Examining Colorectal Cancer Treatment Patterns and Outcomes in Asian American, Native Hawaiian, and Pacific Islander...

Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) are the fastest-growing racial and ethnic group in the U.S., yet they face significant, poorly characterized disparities in colorectal cancer (CRC) care. Disaggregated data is crucial for understanding and addressing these disparities within the community.

Using the 2020 National Cancer Database (NCDB), we conducted a retrospective cohort study to examine treatment patterns and overall survival (OS) among AANHPI and non-Hispanic White (NHW) patients diagnosed with Stage I to IV CRC. We employed multivariable-adjusted logistic regression and Cox proportional hazard models to assess the risk of delayed cancer treatment and mortality across five geographic AANHPI subpopulations.

Among 873,622 patients with CRC, 42,026 were AANHPI patients (mean age, 63.2 years [SD: 14.1], 48% female), of whom 31.3% were East Asian. Compared to NHW patients, patients identified as East Asian, Southeast Asian, and Other Asian were significantly more likely to experience delayed cancer-related treatment (adjusted Odds Ratio [95% confidence interval],1.26 [1.19-1.33], 1.31 [1.22-1.40], and 1.29 [1.21-1.39], respectively). Meanwhile, AANHPI subpopulations demonstrated significantly better OS across cancer stages I-IV (adjusted Hazard Ratio range: 0.55 [Other Asian with stage I] - 0.90 [Southeast Asian with stage IV]). Patients who received surgery, chemotherapy or immunotherapy as their first-line treatment had significant risk reduction compared to those who did not undergo systemic treatment, particularly among individuals diagnosed with stage III or IV CRC.

Despite experiencing significant delays in cancer-related care, AANHPI patients demonstrated superior OS compared to NHW patients across all CRC stages. This paradoxical finding of treatment delays coupled with improved survival outcomes warrants further investigation into potential protective factors and underscores the importance of disaggregated approaches to understanding disparities within the diverse AANHPI populations.