Race, ethnicity, and socioeconomic factors in cholangiocarcinoma: What is driving disparities in receipt of treatment?

• Type of Material: Article
• Authors: Rachel M. Lee, Emory University; Yuan Liu, Emory University; Adriana C. Gamboa, Emory University; Mohammad Y. Zaidi, Emory University; David Kooby, Emory University; Mihir Shah, Emory University; Kenneth Cardona, Emory University; Maria Russell, Emory University; Shishir Maithel, Emory University
• Language: English
• Date: 2019-09-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 John Wiley & Sons, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1002/jso.25632
• Title of Journal or Parent Work: Journal of Surgical Oncology
• Volume: 120
• Issue: 4
• Start Page: 611
• End Page: 623
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.
• Keywords: Delays; treatment; Oncology; Survival; Cancer; cholangiocarcinoma; Care; Science & Technology; disparities; Life Sciences & Biomedicine; Maternal mortality; multimodality; Surgery; race; ethnicity; socioeconomic factors
• Research Categories: Biology, Biostatistics; Biology, Bioinformatics; Health Sciences, Oncology; Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery

Abstract

Background and Objectives: Race/ethnicity and socioeconomic factors are associated with worse cancer outcomes. Our aim was to determine the association of these factors with receipt of surgery and multimodality therapy for cholangiocarcinoma. Methods: Patients with cholangiocarcincoma in the National Cancer Database were identified. Racial/ethnic groups were defined as non-Hispanic White, non-Hispanic Black, Asian, and Hispanic. Socioeconomic factors were insurance status, income, and education. Results: Of 12 095 patients with non-metastatic cholangiocarcinoma, 42% received surgery. Black race was associated with decreased odds of receiving surgery (odds ratio [OR]: 0.66l; P < .001) compared to White patients. Socioeconomic factors accounted for 21% of this disparity. Accounting for socioeconomic and clinicopathologic variables, Black race (OR: 0.73; P < .001), uninsured status (OR: 0.43; P < .001), and Medicaid insurance (OR: 0.63; P < .001) were all associated with decreased receipt of surgery. Of 4808 patients who received surgery, 47% received multimodality therapy. There were no racial/ethnic or socioeconomic differences in receipt of multimodality therapy once patients accessed surgical care. Similar results were seen in patients with advanced disease who received chemotherapy as primary treatment. Conclusion: Racial/ethnic and socioeconomic disparities exist in treatment for cholangiocarcinoma, however only for primary treatment. In patients who received surgery or chemotherapy, there were no disparities in receipt of multimodality therapy. This emphasizes the need to improve initial access to health care for minority and socioeconomical disadvantaged patients.