Black Patients Experience Lower OS With CRC Liver Metastases Than Others

Compared to other racial and ethnic groups, Black patients were the least likely to receive chemotherapy or surgical resection for colorectal liver metastases and experienced worse survival, according to a research paper published by JAMA Network Open.¹

In an analysis of 16,382 patients, Black patients had the lowest median survival at 11 months compared with Asian and Hispanic patients at 14 months, Middle Eastern patients at 18 months, and White patients at 12 months. Black patients were also the least likely to receive chemotherapy compared with White and Hispanic patients at 59% versus 65% and 68%, respectively (P <.001) and less likely to undergo liver resection, at 6.2% versus 10.3% and 9.5%, respectively.

“The unfortunate reality is that minorities, especially Black people, have a much lower chance of getting lifesaving cancer treatment,” Mustafa Raoof, MD, surgical oncologist at City of Hope and senior author of the study said in a statement. “Health care works within a social construct, and to change health disparities, we need social change.”²

Compared with White patients, Black patients had a 17% higher hazard of death after the investigators controlled for age, sex, comorbidities, and extrahepatic metastases (HR, 1.17; 95% CI, 1.10-1.24; P <.001). For Black and White patients who underwent liver resection for colorectal liver metastases, there was no difference in survival (HR, 1.01; 95% Ci, 0.94-1.08; P =.84).

“The decreased health outcomes in Black patients could be attributed to factors such as lower rate of referral to cancer specialists, late detection of colorectal cancer metastases and patient-reported barriers, including fear of cancer and its treatment, costs, and the burdens of transportation and childcare during therapy,” Lucas Thornblade, MD, a City of Hope surgical oncology fellow and first author of the study, said in a press release.

According to Yuman Fong, MD, the Sangiacomo Family Chair in Surgical Oncology at City of Hope and co-author of the study, the rate of liver resection in the United States is only about 10%, but that percentage is about 40% at City of Hope.

“There is a vast under-utilization of liver resection as a potentially curative treatment for colorectal liver metastases,” Fong said in a statement. “This missed opportunity is even more common for Black patients than for the general population.”

The study was a retrospective cohort analysis of adult patients enrolled in the California Cancer Registry with synchronous colorectal liver metastases from January 1, 2000 to December 31, 2012 and analyzed from August 15, 2019 to January 25, 2020. The race and ethnicity of patients were recorded by institutional trained abstractors.

To improve survival for patients in minority populations, the authors of the study suggest optimizing chances of receiving state-of-the-art surgical therapy, maximizing opportunities to visit a cancer specialist, and ensuring these patients receive adjuvant therapy when appropriate.

“These troubling statistics are the result of a disparity in access to health care,” Raoof said in a press release. “We observed that if Black people with metastatic colorectal cancer had access to subspecialists with expertise in liver resection, they would not experience higher numbers of unnecessary deaths due to underutilization of lifesaving therapies.”

_References:

_{1. Thornblade LW, Warner S, Melstrom L, Singh G, Fong Y, Raoof M. Association of race/ethnicity with overall survival among patients with colorectal liver metastasis. JAMA Netw Open. 2020;3(9):e2016019. doi:10.1001/jamanetworkopen.2020.16019}

_{2. Black people more likely than others to die from colorectal cancer spreading to the liver. News release. City of Hope. September 9, 2020. Accessed September 11, 2020. https://bit.ly/2Fy5Xm4​}