Yale Cancer Center study reports racial disparities for gastrointestinal surgery

African-American adult patients more likely than white patients to have substandard gastrointestinal cancer surgery, says a large study conducted by researchers from Yale Cancer Center. The results are published today in the journal Open JAMA Network.

“The COVID-19 pandemic has brought to light previously reported racial disparities in the healthcare system, and our study unfortunately underscores that cancer patients are not immune to these disparities.” noted Dr. Sajid Khan, associate professor of surgery (oncology), section chief of hepato-pancreato-biliary (HPB) and mixed tumors at the Yale Cancer Center, and lead author of the study. “Health system shortcomings by medical providers and hospital systems contribute to these racial differences and changes are needed to address and eradicate the root causes of disparities in the treatment of gastrointestinal cancers.”

According to the American Cancer Society, gastrointestinal cancers account for 35% of cancer deaths. For the new study, the researchers wanted to examine whether there are race-specific treatment disparities with curative-intent surgery for these patients across the United States.

For the study, scientists looked at a cohort of 565,124 adult patients with gastrointestinal cancer undergoing surgery between 2004 and 2017. They found that compared to white patients, African American patients had lower rates of negative surgical margins, and this was more pronounced for surgeries of the oesophagus, rectum, and biliary tract (lower likelihood of negative resection margins of 29%, 29%, and 25%, respectively). They also found that African Americans had adequate numbers of lymph nodes removed less frequently than white patients, with the greatest disparities seen in surgeries of the small intestine, esophagus, colon, pancreas, and rectosigmoid (lower likelihood of adequate lymph node removal 29%, 28%, 11%, 10%, and 10%, respectively). Negative surgical margins and adequate lymphadenectomies are both standards of surgical cancer care and were associated with longer median survival (87.3 versus 22.9 months and 80.7 versus 57.6 months, respectively). African-American patients were also 68% more likely to not receive recommended chemotherapy and 118% more likely to not receive recommended radiation therapy than white patients after surgery for unknown reasons.

Further, the authors found that American Indians experienced these disparities with an 11% lower likelihood of negative resection margins and a 23% lower likelihood of adequate lymph node removal compared to whites.

“Further research should probe both system-level and physician-level drivers of disparities in cancer care and address the loci of bias that enable this inequitable treatment of African American and Native American patients,” Khan said. . “We are currently conducting a more in-depth examination of the striking results of our study, and our areas of interest are means of communication, education, socioeconomic factors, health system workflows and differences in the cancer biology that exist by race and ethnicity.”

Funding for the study was provided by a research grant from the American Cancer Society and National Institutes of Health grants.

Baylee Bakkila is the lead author of the study. Other Yale authors include: Daniel Kerekes, MD, Marcella Nunez-Smith, MD, MHS, Kevin Billingsley, MD, MBA, FACS, Nita Ahuja, MD, MBA, FACS, Karen Wang, MD, Carol Oladele, PhD, MPHand Caroline Johnson, PhD.

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