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DISPARITIES IN ADJUVANT CHEMOTHERAPY ADHERENCE AND OUTCOMES IN STAGE III COLON CANCER: INSIGHTS FROM MINORITY-SERVING HOSPITALS
Timothy Trestrail, William Scola
*, Talia R. Arcieri, Laurence R. Sands, Onur C. Kutlu, Mehmet Akcin, Daniel Sussman, Nivedh Paluvoi
General Surgery , University of Miami - Jackson Memorial Hospital, Miami, FL
Background:Adherence to adjuvant chemotherapy is recommended by National Comprehensive Cancer Network as it is a critical determinant of outcomes in Stage III colon cancer. This study examines factors influencing adherence and associated outcomes, with a focus on disparities in care at minority-serving hospitals using the NCDB.
Methods:Patients aged 18–80 years with Stage III colon cancer who underwent surgical resection were included (2010–2021).Minority serving hospitals were identified as highest decile institutions in rate of minorities. Adherence was defined as receipt of adjuvant chemotherapy following NCCN guidelines. Multivariable logistic regression assessed predictors of adherence, and short-term outcomes were compared between adherent and non-adherent patients.
Results:A total of 150,196 patients were analyzed, including 17,793 treated at minority-serving hospitals. Overall adherence was 78%, but lower at minority-serving hospitals (76% vs. 79%, p<0.001, figure). Non-adherence was mainly low for patients receiving care at minority-serving hospitals (OR 0.85, 95% CI 0.82–0.89). Significant predictors also included older age (OR 0.59 per Z-score, 95% CI 0.58–0.60), Black (OR 0.80, 95% CI 0.77–0.83) and Hispanic ethnicity (OR 0.86, 95% CI 0.82–0.91), Medicaid/uninsured status (OR 0.57, 95% CI 0.54–0.60). However, minimally invasive surgery was associated with higher adherence (OR 1.79, 95% CI 1.74–1.83). Institutions which were adherent had significantly improved outcomes, with lower 30-day readmission (5.5% vs. 8.2%, p<0.001) and reduced 90-day mortality (0.3% vs. 1.1%, p<0.001).
Conclusions:Adherence to chemotherapy is suboptimal at minority-serving hospitals, with associated disparities in outcomes. Interventions targeting socioeconomic and institutional barriers are needed to improve chemotherapy adherence and optimize outcomes in these populations.
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