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Age-, Race-, and Ethnicity-Related Differences in the Treatment of Nonmetastatic Rectal Cancer: A Patterns of Care Study From the National Cancer Data Base

¹ Department of Surgery, Medical University of South Carolina, 25 Courtenay Drive, Suite 7018 (MSC 295), Charleston, SC 29425, USA
² Commission on Cancer, American College of Surgeons, 633 North Saint Clair Street, Chicago, IL 60611, USA
³ Division of Surgery, Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Unit 444, P.O. Box 301402, Houston, TX 77230-1402, USA

Correspondence: Address correspondence and reprint requests to: Nestor F. Esnaola, MD, MPH; E-mail: esnaolan{at}musc.edu

Background: Recent studies suggest that older patients and minorities are less likely to receive surgical and adjuvant therapy for rectal cancer. We analyzed the independent effect of age and race/ethnicity on treatment for rectal cancer controlling for comorbidity and socioeconomic status using a nationwide sample Methods: We identified 35,695 patients with rectal adenocarcinoma diagnosed between 2003 and 2005 using the National Cancer Data Base. Comorbidity was calculated from medical records and administrative data. Educational level and income were estimated from census data. Characteristics were compared across groups by ² tests. Odds ratios of surgical and adjuvant therapy and 95% confidence intervals were calculated by logistic regression.

Results: A total of 51% of patients were age 65, 8.7% were African American, and 4.9% were Hispanic. Younger patients, African Americans, and Hispanics were more likely to present with advanced disease compared with older, white patients (P < .001). Age 65 was associated with underuse of surgery and adjuvant therapy (P < .001). Only 85.1% of African Americans were resected, compared with 90.7% of whites (adjusted odds ratio, .62; 95% confidence interval, .54–.71). Among resected patients, race/ethnicity had no effect on rates of sphincter preservation or adjuvant therapy.

Conclusions: A high proportion of older patients with rectal cancer do not receive appropriate surgical or adjuvant therapy, even when controlling for comorbidity. African American patients are also less likely to undergo resection, but are equally likely to undergo sphincter preservation and adjuvant therapy compared with whites. Efforts are needed to uncover the root causes underlying these observations and optimize treatment of rectal cancer.

Key Words: Rectal cancer • NCDB • Age • Race • Surgery • Adjuvant therapy