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REDUCING THE IMPACT OF HISTORICAL REDLINING AND SOCIOECONOMIC STATUS ON RECTAL CANCER OUTCOMES
Moustafa Moussally
*, April Martinez, Maysoon GamalEldin, Joseph Trunzo, Champagne Bradley, Keshinro ajaratu, Kristen A. Ban, David Liska, David R. Rosen
Cleveland Clinic, Cleveland, OH
Redlining, a historical discriminatory financial practice, has left lasting socioeconomic and healthcare disparities. Studies have shown worse colorectal cancer (CRC) outcomes for patients from either redlined districts or neighborhoods with declining socioeconomic status. We hypothesized the implementation of NAPRC standards would reduce differences in rectal cancer outcomes.
We identified patients treated with rectal cancer from 2020-2024 at our NAPRC-accredited institution. ArcGIS was used to overlay historical redlining maps with current zip code maps. Zip code median income was obtained from US Census Bureau data. First, we compared outcomes for patients residing in areas from historically redlined sections A and B (considered favorable) with C and D (considered unfavorable). We then compared outcomes for patients from zip codes with a median income below the national median to those from zip codes with median income above the national median. Statistical analysis was performed using SPSS 23.0.
A total of 384 patients met inclusion criteria with median follow-up 25 months. Some 221 (58%) patients completed total neoadjuvant therapy (TNT). Overall recurrence rate was 8.6% and mortality rate 17.7%. Overall, 95% of patients were discussed at multidisciplinary tumor board, 93% of patients received treatment within 60 days of first colorectal surgery visit, and 94% of patients had a pretreatment MRI. There were 26 patients residing in historically favorable redlined sections A/B, and 106 patients residing in undesirable areas C/D. Breakdown of rectal cancer stage by district (A/B vs. C/D) showed stage similar distribution between groups, (p=0.82, Table 1). Similarly, there was no difference in TNT completion rate (54% vs. 63%), recurrence (11.5% vs. 6.6%), or disease-free survival (88.4% vs. 87.8%) between district groups. A total of 242 patients (63%) lived within zip codes with a median income less than the national median ($74,580), whereas 142 patients (37%) lived in zip codes with median income above the national median. Breakdown of rectal cancer stage by income level (above vs. below national median) showed similar stage distribution between groups (p=0.26, Table 1). There was no difference in completion rate of TNT (55% vs. 57%), recurrence (10% vs. 8%), or disease-free survival (87.3 vs 86.7%) based on income level.
Although previous work has demonstrated healthcare disparities in CRC outcomes in redlined districts and areas of poor socioeconomic status, we did not observe significant differences in rectal cancer outcomes in patients from redline districts or low-income zip codes at our NAPRC-accredited institution. This suggests a rigorous comprehensive rectal cancer treatment program, with timely initiation of care and close follow-up, may be able to overcome some disparities in rectal cancer care.
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