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Time Period of Treatment’s Effect on the Association Between Race and Survival in Patients With Malignant Colorectal Adenocarcinoma
Background: Colorectal cancer is one of the most common malignancies diagnosed in the United States, with 126,240 new cases diagnosed in 2020. Past studies have shown that disparities may exist between certain patient populations, but it is unknown how they are affected over time as treatments evolv...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10589074/ https://www.ncbi.nlm.nih.gov/pubmed/37868544 http://dx.doi.org/10.7759/cureus.45641 |
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author | Ramirez, Juan C Alvarez, Juan C Cifuentes, Phillip Castro, Grettel Barengo, Noel C |
author_facet | Ramirez, Juan C Alvarez, Juan C Cifuentes, Phillip Castro, Grettel Barengo, Noel C |
author_sort | Ramirez, Juan C |
collection | PubMed |
description | Background: Colorectal cancer is one of the most common malignancies diagnosed in the United States, with 126,240 new cases diagnosed in 2020. Past studies have shown that disparities may exist between certain patient populations, but it is unknown how they are affected over time as treatments evolve. The purpose of this study was to determine whether the decade of treatment modifies the association between race and five-year survival in adults diagnosed and treated for malignant colorectal adenocarcinomas since the 1970s. Methods: This was a non-concurrent retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. The inclusion criteria involved patients with primary malignant colorectal adenocarcinoma between the years 1975 and 2018. Exclusion criteria included previous malignancies or missing information on any of the variables. The exposure variable was the patient’s race, and the main outcome variable was average five-year survival rates. The effect modifier was the time period in which the patient received treatment. The covariates of the study included age, sex, Hispanic status, surgical intervention recommendation, and disease stage. Unadjusted and adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated using Cox regression models. Results: As the interaction term between race/ethnicity and year of diagnosis was statistically significant, the data were stratified according to year of diagnosis. Black patients in both time periods had a higher mortality rate from malignant colorectal carcinoma after adjustment for the covariates (1975-1990: HR 1.10, 95% CI 1.06-1.15; 1991-2018: HR 1.19, 95% CI 1.16-1.23) when compared with White patients. American Indian, Alaskan Native, and Asian patients were found to have lower mortality in both time periods when compared with White patients (1975-1990: HR 0.90, 95% CI 0.85-0.95; 1991-2018: HR 0.93, 95% CI 0.89-0.96). Conclusion: Our data found that despite the evolution in the standard of care treatment for malignant colorectal adenocarcinoma since the year 1975, Black patients had lower five-year survival rates when compared with their White counterparts as well as increased rates of being diagnosed with this disease. Overall, addressing these disparities in colorectal cancer outcomes is critical for improving public health and reducing healthcare costs. |
format | Online Article Text |
id | pubmed-10589074 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-105890742023-10-22 Time Period of Treatment’s Effect on the Association Between Race and Survival in Patients With Malignant Colorectal Adenocarcinoma Ramirez, Juan C Alvarez, Juan C Cifuentes, Phillip Castro, Grettel Barengo, Noel C Cureus Epidemiology/Public Health Background: Colorectal cancer is one of the most common malignancies diagnosed in the United States, with 126,240 new cases diagnosed in 2020. Past studies have shown that disparities may exist between certain patient populations, but it is unknown how they are affected over time as treatments evolve. The purpose of this study was to determine whether the decade of treatment modifies the association between race and five-year survival in adults diagnosed and treated for malignant colorectal adenocarcinomas since the 1970s. Methods: This was a non-concurrent retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. The inclusion criteria involved patients with primary malignant colorectal adenocarcinoma between the years 1975 and 2018. Exclusion criteria included previous malignancies or missing information on any of the variables. The exposure variable was the patient’s race, and the main outcome variable was average five-year survival rates. The effect modifier was the time period in which the patient received treatment. The covariates of the study included age, sex, Hispanic status, surgical intervention recommendation, and disease stage. Unadjusted and adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated using Cox regression models. Results: As the interaction term between race/ethnicity and year of diagnosis was statistically significant, the data were stratified according to year of diagnosis. Black patients in both time periods had a higher mortality rate from malignant colorectal carcinoma after adjustment for the covariates (1975-1990: HR 1.10, 95% CI 1.06-1.15; 1991-2018: HR 1.19, 95% CI 1.16-1.23) when compared with White patients. American Indian, Alaskan Native, and Asian patients were found to have lower mortality in both time periods when compared with White patients (1975-1990: HR 0.90, 95% CI 0.85-0.95; 1991-2018: HR 0.93, 95% CI 0.89-0.96). Conclusion: Our data found that despite the evolution in the standard of care treatment for malignant colorectal adenocarcinoma since the year 1975, Black patients had lower five-year survival rates when compared with their White counterparts as well as increased rates of being diagnosed with this disease. Overall, addressing these disparities in colorectal cancer outcomes is critical for improving public health and reducing healthcare costs. Cureus 2023-09-20 /pmc/articles/PMC10589074/ /pubmed/37868544 http://dx.doi.org/10.7759/cureus.45641 Text en Copyright © 2023, Ramirez et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Epidemiology/Public Health Ramirez, Juan C Alvarez, Juan C Cifuentes, Phillip Castro, Grettel Barengo, Noel C Time Period of Treatment’s Effect on the Association Between Race and Survival in Patients With Malignant Colorectal Adenocarcinoma |
title | Time Period of Treatment’s Effect on the Association Between Race and Survival in Patients With Malignant Colorectal Adenocarcinoma |
title_full | Time Period of Treatment’s Effect on the Association Between Race and Survival in Patients With Malignant Colorectal Adenocarcinoma |
title_fullStr | Time Period of Treatment’s Effect on the Association Between Race and Survival in Patients With Malignant Colorectal Adenocarcinoma |
title_full_unstemmed | Time Period of Treatment’s Effect on the Association Between Race and Survival in Patients With Malignant Colorectal Adenocarcinoma |
title_short | Time Period of Treatment’s Effect on the Association Between Race and Survival in Patients With Malignant Colorectal Adenocarcinoma |
title_sort | time period of treatment’s effect on the association between race and survival in patients with malignant colorectal adenocarcinoma |
topic | Epidemiology/Public Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10589074/ https://www.ncbi.nlm.nih.gov/pubmed/37868544 http://dx.doi.org/10.7759/cureus.45641 |
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