African–American rectal cancer patients wait the longest for treatment

African-American rectal cancer patients wait longer for treatment and are less likely to receive adjuvant chemotherapy than their non-African-American counterparts, results show.

However, the clinical outcomes of African-American patients did not appear to be affected by this disparity.

"African Americans and whites had similar sociodemographic characteristics, severity of disease, quality of treatment, and health outcomes in this study, which seems to support the premise that similar treatment results in similar outcomes," say Stanley Liauw (University of Chicago, Illinois, USA) and colleagues.

The study included 146 patients, 18% of whom were African-American, who underwent curative surgery for rectal adenocarcinoma.

All patients underwent preoperative chemoradiotherapy followed by low anterior resection or abdominoperineal resection. They were treated at one of two academic centers that offer "equal access" to treatment in the population.

African-American patients were more likely to present with favorable disease staging, with only 33% presenting with stage III or higher, compared with 50% of non-African Americans.

However, African-American patients waited significantly longer from diagnosis to begin treatment than non-African-American patients, at a median of 45 days compared with 35 days. They also waited significantly longer between completing chemoradiotherapy and undergoing surgery.

Furthermore, African-American patients were significantly less likely to receive adjuvant chemotherapy than non-African-American patients, at a rate of 58% compared with 89%.

Despite these inequalities in treatment, African-Americans were no more likely than non-African-Americans to experience disease recurrence during a median follow up of 34 months after chemoradiotherapy.

The authors say their findings of inequalities in treatment are surprising as the patients were all treated at high-quality academic centers by a similar group of physicians.

"We are encouraged by the lower stage presentation and equal outcome for African American patients in this study," write Liauw and colleagues in the American Journal of Clinical Oncology.

"However, further study is needed to explore the reasons underlying the delays in therapy and lower rates of adjuvant chemotherapy for African American patients and our group is actively pursuing this area of research."

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