Quality of care in patients with colorectal cancer at University of Pittsburgh Medical Center - Is there a racial disparity? Free

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Introduction - Colorectal cancer (CRC) is the third most common cancer in African Americans (AA) in the United States. Estimated 5 - year relative survival is 55 % in AA as compared to 65% in whites. Lower survival in AA with CRC may reflect differences in tumor biology as well as disparities in access to and receipt of high-quality medical care, which could lead to late diagnosis and disparities in treatment. Our study was aimed at detecting potential disparities in care received by AA with CRC in a large university medical system.
 Method - 2454 patients diagnosed at University of Pittsburgh Medical Center (UPMC) with CRC from 1994 - 2005 were identified through tumor registry. Corresponding data were extracted on age, sex, disease stage at diagnosis, tumor grade, number of regional lymph nodes examined and number of positive lymph nodes, time from diagnosis to start of treatment and chemotherapy received by these patients.
 Results - Among the 1800 patients for whom complete data were available (181 AA, 1619 whites), the average age at diagnosis was 68 years in AA vs 69 years in whites. The ratio of male to female patients was 43:57 in AA vs 52:48 in whites. The distribution of disease stage at diagnosis in AA vs whites was: 22% vs 18% (stage I), 27% vs 34% (stage II), 32% vs 29% (stage III), and 19% vs 19% (stage IV). Median time from diagnosis to initiation of treatment was 8 days in AA vs 11 days in whites. Tumor grade was similar in both groups: well differentiated 2% vs 3%, moderately differentiated 83% vs 76%, poorly differentiated 14% vs 20%, and undifferentiated 1% vs. 1% in AA and whites, respectively. Median number of lymph nodes examined was 12 in AA vs 14 in whites. Overall, 36% of AA patients received chemotherapy as compared to 45% of whites (p = 0.03).
 Conclusions - AA patients diagnosed at UPMC with CRC did not have higher stage of disease, worse tumor grade or longer time to start treatment after diagnosis as compared to white patients. Fewer number of AA patients received chemotherapy as compared to white patients. The reason for lower rates of chemotherapy administration in AA patients may depend on co-morbidities. Further analysis to detect any survival differences in the two groups and the contributing factors, if any is ongoing.