Racial disparities and treatment trends in a large cohort of elderly African Americans and Caucasians with colorectal cancer, 1991 to 2002

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Abstract
BACKGROUND. Racial differences have been demonstrated in patients who receive treatment for colorectal cancer. However, little is known about whether these disparities have changed over time. The objective of this study was to determine whether racial disparities in receiving standard therapy have declined between 1991 and 2002. METHODS. The study population consisted of 59,803 Caucasians and African Americans aged ≥65 years who were diagnosed with colorectal cancer (American Joint Committee on Cancer stages I, II, and III) between 1991 and 2002 and were identified from the Surveillance, Epidemiology, and End Results Program/Medicare-linked database. Standard therapy for colorectal cancer was defined based on the Physician Data Query guidelines from the National Cancer Institute. The crude and age- and sex-adjusted percentages and the odds ratios (ORs) of receiving standard therapy were reported. RESULTS. From 1991 to 2002, the percentage of patients who did not receive standard therapy for colorectal cancer decreased for both Caucasians (from 24.5% to 22.4%) and African Americans (from 30.4% to 26.4%). Overall, African Americans were 16% less likely to receive standard therapy for colorectal cancer (OR, 0.84; 95% confidence interval [CI], 0.78-0.90) than Caucasians, but the difference was not significant after the analysis was adjusted for other factors (OR, 0.96; 95% CI, 0.88-1.05). The gap for not receiving standard therapy was relatively stable, peaked in 1997 (7.2%), and decreased from 1999 to 2002 (from 7.1% to 4%). CONCLUSIONS. The percentage of patients receiving standard therapy for colorectal cancer increased over time, but disparities remained and decreased in recent years. Future studies should include other ethnic groups and should incorporate provider and system factors that may contribute to treatment disparities. Cancer 2008. © 2008 American Cancer Society.