Racial and Socioeconomic Disparities After Surgical Resection for Rectal Cancer

• Published in: The Journal of surgical research Vol. 256; pp. 449 - 457
• Main Authors: Ghaffarpasand, Eiman, Welten, Vanessa M., Fields, Adam C., Lu, Pamela W., Shabat, Galyna, Zerhouni, Yasmin, Farooq, Ameer O., Melnitchouk, Nelya
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2020
• Subjects: African Americans - statistics & numerical data; European Continental Ancestry Group - statistics & numerical data; Health Status Disparities; Humans; Proctectomy; Racial disparities; Rectal cancer; Rectal Neoplasms - mortality; Rectal Neoplasms - surgery; Socioeconomic Factors; Socioeconomic status; Survival Rate; Rectal cancer; Racial disparities; Socioeconomic status
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2020.07.008

There are various racial, socioeconomic, and tumor-specific factors that can impact rectal cancer outcomes. The current systematic review and meta-analysis evaluate the effect socioeconomic and racial variables on overall survival of rectal cancer patients after surgical resection. A literature search was performed via electronic databases according to Systematic Reviews and Meta-Analyses and Meta-analysis Of Observational Studies in Epidemiology guidelines. All studies were evaluated by three authors and validated for data extraction. Predictive variables and survival profiles (1-, 5-, and 10-y survival and overall survival) reported by the studies were recorded for the systematic review. Hazard ratios, odds ratios, and 95% confidence intervals were extracted for meta-analysis. Forest plots were used to interpret the results. The primary outcome was the effect size of the predictive variables on overall survival after surgical resection. Of the 265 articles collected, 22 met inclusion criteria. Sixteen studies were used for the systematic review, and 17 studies were considered for meta-analysis. Overall, 662,053 subjects with rectal cancer were studied (439,766 with race reported), of which 344,193 (78.3%) were White and 60,283 (13.7%) were Black. The median survival was 56.8% for White patients and 47.9% for Black patients. Meta-analysis revealed that race, socioeconomic variables (education level, income level, and insurance status), and facility characteristics (type and volume) were significantly associated with overall survival in rectal cancer. Racial and socioeconomic disparities are present in outcomes for rectal cancer patients undergoing surgical resection. It is important to consider these disparities in the management of patients with rectal cancer to minimize any consequent disparities in surgical outcomes.