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Race, treatment, and survival among colorectal carcinoma patients in an equal‐access medical system
Author(s) -
Dominitz Jason A.,
Samsa Gregory P.,
Landsman Pamela,
Provenzale Dawn
Publication year - 1998
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19980615)82:12<2312::aid-cncr3>3.0.co;2-u
Subject(s) - medicine , veterans affairs , odds ratio , confidence interval , colorectal cancer , retrospective cohort study , comorbidity , cancer , surgery , oncology
BACKGROUND The aim of this study was to assess the influence of race on the treatment and survival of patients with colorectal carcinoma. METHODS This retrospective cohort study included all white or black male veterans given a new diagnosis of colorectal carcinoma in 1989 at Veterans Affairs Medical Centers nationwide. After adjusting for patient demographics, comorbidity, distant metastases, and tumor location, the authors determined the likelihood of surgical resection, chemotherapy, radiation therapy, and death in each case. RESULTS Of the 3176 veterans identified, 569 (17.9%) were black. Bivariate analyses and logistic regression revealed no significant differences in the proportions of patients undergoing surgical resection (70% vs. 73%, odds ratio 0.92, 95% confidence interval 0.74‐1.15), chemotherapy (23% vs. 23%, odds ratio 0.99, 95% confidence interval 0.78‐1.24), or radiation therapy (17% vs. 16%, odds ratio 1.10, 95% confidence interval 0.85‐1.43) for black versus white patients. Five‐year relative survival rates were similar for black and white patients (42% vs. 39%, respectively; P = 0.16), though the adjusted mortality risk ratio was modestly increased (risk ratio 1.13, 95% confidence interval 1.01‐1.28). CONCLUSIONS Overall, race was not associated with the use of surgery, chemotherapy, or radiation therapy in the treatment of colorectal carcinoma among veterans seeking health care at Veterans Affairs Medical Centers. Although mortality from all causes was higher among black veterans with colorectal carcinoma, this finding may be attributed to underlying racial differences associated with survival. This study suggests that when there is equal access to care, there are no differences with regard to race. Cancer 1998;82:2312‐2320. © 1998 American Cancer Society.