Yale Cancer Center Study Reports Racial Disparities for Gastrointestinal Surgery

According to a large study led by researchers at Yale Cancer Center, African-American adult patients are more likely than white patients to undergo substandard gastrointestinal cancer surgery. The findings are reported today in the journal JAMA Network Open.

“The COVID-19 pandemic has brought to light previously reported racial disparities in health care, and our study unfortunately shows that patients with cancer are not immune to these disparities.” said Dr. Sajid Khan, associate professor of surgery (Oncology), division chief of Hepato-Pancreato-Biliary (HPB) and Mixed Tumors at Yale Cancer Center, and senior author of the study. “Lapse in the health care system by medical providers and hospital systems are contributing to these racial disparities and changes are needed to address and eradicate the root causes of inequalities in the treatment of gastrointestinal cancers.”

According to the American Cancer Society, gastrointestinal cancers are responsible for 35% of cancer deaths. For the new study, researchers wanted to investigate whether race-specific treatment differences exist with curative eye surgery for these patients in the United States.

For the study, scientists examined a cohort of 565,124 adult patients with gastrointestinal cancer who underwent surgery between 2004 and 2017. They found that compared to Caucasian patients, African-American patients had fewer negative surgical margins, and this was most pronounced for surgeries of the esophagus, rectum, and bile ducts (lower chance of negative margins 29%, 29%, and 25, respectively). %). They also found that African-Americans had a sufficient number of lymph nodes removed less frequently than Caucasian patients, with the greatest differences seen in surgery of the small intestine, esophagus, colon, pancreas, and rectosigmoid (lower chance of adequate lymph node removal). 29%, 28%, 11%, 10% and 10%, with due respect). Negative surgical margins and adequate lymphadenectomies are both standards of cancer surgical care and were associated with longer median survival (87.3 vs 22.9 months and 80.7 vs 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 Caucasian patients after surgery for unknown reasons.

In addition, the authors found that American Indians experienced these disparities with an 11% lower chance of negative resection margins and 23% lower chance of having adequate lymph nodes removed compared to Caucasians.

“Further research should examine both system- and physician-level causes of inequalities in cancer care and address places of bias that allow for this unequal treatment of African American and Native American patients,” Khan said. “We are currently examining our standout research findings and our areas of focus are communication tools, education, socioeconomic factors, healthcare workflows, and differences in cancer biology that exist by race and ethnicity.”

The study was funded by a research grant from the American Cancer Society and grants from the National Institutes of Health.

Baylee Bakkila is 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, MPH, and Caroline Johnson, PhD.

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