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A Population-Based Analysis

Arden M. Morris, MD, MPH; Kevin G. Billingsley, MD; Nancy N. Baxter, MD, PhD; Laura-Mae Baldwin, MD, MPH

Arch Surg. 2004;139:151-155.

Hypothesis  We hypothesized that there are significant racial disparities in delivery of care to rectal cancer patients. We examined differential surgical and radiation treatment for these patients and determined whether blacks were less likely than whites to undergo sphincter-sparing procedures, which are associated with a higher quality of life than sphincter-ablating procedures.

Design  Cross-sectional cohort study.

Patients and Setting  The Surveillance Epidemiology and End Results database provided population-based data for rectal cancer patients who were diagnosed between 1988 and 1999, were older than 35 years, and had no prior colorectal or other pelvic cancer.

Main Outcome Measures  Using logistic regression, we compared receipt and type of surgical therapy and radiation therapy, controlling for age, sex, year, geography, stage, and anatomic location.

Results  Among 52 864 patients, 3851 were black and 44 010 were white. Blacks were younger than whites and had more advanced disease (P<.001). Among patients who underwent operation, rates of sphincter-ablating procedure were 37% for whites and 43% for blacks (adjusted odds ratio [AOR], 1.42; 95% confidence interval [CI], 1.23-1.65). Moreover, 53% of whites and 56% of blacks received no radiation therapy for stage II to III disease (AOR, 1.30; 95% CI, 1.15-1.47).

Conclusions  Blacks with rectal cancer were diagnosed at a younger age and more advanced disease stage than whites, implying a need for more aggressive screening. After adjusting for stage and other covariates, surgical and radiation treatment also differed along racial lines. Our data suggest that treatment disparities may contribute to differences in outcome among racial/ethnic groups with rectal cancer, and they highlight the need for improving access to state-of-the-art surgical care for minority patients with rectal cancer.

From the Department of Surgery, Section of Colon and Rectal Surgery, University of Minnesota, Minneapolis (Drs Morris and Baxter); and the Departments of Surgery (Dr Billingsley) and Family Practice (Dr Baldwin), University of Washington, Seattle.

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