Sociodemographic Disparities in Rectal Cancer Outcomes within Academic Cancer Centers

TL;DR

This study finds that racial and insurance-based disparities in rectal cancer outcomes persist even at top academic cancer centers, with Black patients and those without private insurance facing worse survival and longer treatment delays.

Contribution

The study reveals that sociodemographic disparities in rectal cancer outcomes persist even within academic cancer centers, where care is expected to be equitable.

Findings

Black patients had worse overall survival compared to white patients after adjustment.

Private insurance was associated with better survival and lower postoperative mortality.

Black patients experienced a 3.23-day delay in starting treatment compared to white patients.

Abstract

Sociodemographic disparities in cancer care outcomes are often related to delayed or limited care access. However, it is unknown whether outcome differences persist after establishing high-level care. This study evaluated the relationship between rectal cancer outcomes and sociodemographic status at academic cancer centers.

A retrospective cohort study of patients with rectal cancer treated at academic cancer centers was conducted utilizing the National Cancer Database. Primary outcome was overall survival, while secondary outcomes included 30- and 90-day mortality, time from diagnosis to treatments, hospital readmission rates, and hospital length of stay.

Of the 127,023 patients, median age was 62.7 years (SD 11.92), 59.3% were male, 80.3% were white, and 39.4% presented with stage III disease. After adjustment, Black patients had the worst overall survival (HR 1.10, 95% CI 1.01–1.19, p = 0.016). Private insurance status conferred overall survival benefit (HR 0.66, 95% CI 0.58–0.75, p < 0.001) as well as the best protection against 30- and 90- day postoperative mortality (30-day OR 0.31, 95% CI 0.10–0.97, p = 0.044; 90-day OR 0.37, 95% CI 0.16–0.83, p = 0.015). Black patients experienced longer time to first treatment than their white counterparts, with a delay of 3.23 days (95% CI 1.87–4.58, p < 0.001).

This study demonstrated the existence of sociodemographic disparities even within the walls of academic institutions, where care should be evidence-based, standardized, comprehensive, and equitable. When analyzing causal pathways, delays in time to treatment initiation may be contributing to these outcomes, but may be modifiable.

The online version contains supplementary material available at 10.1245/s10434-025-17085-3.

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