N. Saldana-Ruiz1, A. Becerra1, C. Probst1, C. Aquina1, A. Rickles1, K. Noyes1, F. Fleming1, J. R. Monson1 1University Of Rochester,Rochester, NY, USA
Introduction: Colorectal cancer is a leading cause of U.S. cancer death. Despite decreasing national colon cancer rates in recent decades, racial disparities continue widely documented. Hispanics constitute the largest growing ethnic group, yet their trends of colon cancer remain poorly characterized. We sought to determine factors associated with U.S. Hispanics and adherence to treatment guidelines for stageIII colon cancer, for which adherence to evidence-based treatment guidelines have been proposed as measure of cancer care quality.
Methods: Patients from National Cancer Data Base (NCDB), a national registry of Commission on Cancer (CoC) accredited centers, with stageIII colon cancer patients 2003-2011 were identified(total 676,923). Adherence to National Comprehensive cancer network (NCCN) guidelines determined based on disease stage and excluded missing race and adjuvant chemotherapy data. Logistic regression analyses were preformed to identify factors predictive of receipt of adjuvant chemotherapy (p=0.05). To characterize the representativeness of our cohort we also compared colon cancer incidence in NCDB to national race-specific colon incidence rates from the Center Disease Control (CDC) utilizing census current population survey (CPS) race-specific population estimates and extrapolated absolute cancer rates for U.S. colon cancers between 1998 and 2011.
Results: We included 121,846 cases(66%) of whom were treated according to NCCN guidelines. Factors associated with receipt of adjuvant chemotherapy in logistic regression modeling included age, geographic region, race, rurality, income, education, comorbidity and facility type. Patients were less likely to receive guideline-based treatment if Black, and more likely if Asian, Cuban, or Central/South American (p<0.05). Mexicans, Puerto Ricans and Dominican Republicans, did not exhibit differences in guideline-based treatment compared to Whites (p<0.05). NCDB, CDC comparisons revealed that NCDB captures 50% of Hispanic compared to 70% cases of Whites and Blacks.
Conclusion: Our study highlights that NCDB data collected from CoC centers underrepresents Hispanics compared to Whites and Blacks. CoC-approved centers are associated with higher volume of operations and provide more cancer-related services associated with improved health outcomes, compared to non CoC-approved centers. While multivariate analyses of NCDB data demonstrates that significant U.S. variation exist in guideline-based treatment of stageIII colon cancer, our CDC rates comparison analyses highlight that NCDB underrepresents Hispanics. Lack of NCDB Hispanic data undermine information about the true state of health for this U.S. ethnic group and further study on Hispanic use of CoC centers is needed.