Racial and Ethnic Differences in Colon Cancer Surgery Type Performed and Delayed Treatment Among People 45 Years Old and Older in the USA Between 2007-2017: Mediating Effect on Survival

Introduction: The study examined the impact of race/ethnicity and socioeconomic status on colon cancer treatment and outcomes in the US. Patients' race/ethnicity and SES significantly influenced surgery type and delayed treatment. Non-Hispanic Black patients were more likely to receive more aggressive surgery than Non-Hispanic White patients. Patients with delayed treatment had higher mortality rates than those with timely treatment underscoring the necessity of implementing multidisciplinary interventions that target both treatment and social factors responsible for perpetuating racial inequalities in mortality rates from colon cancer. Methods: We studied 111,789 adult patients ≥ 45 years old who were diagnosed with colon cancer between 2007 to 2017, identified from the SEER database. We performed logistic regression models to examine the association of SES and race/ethnicity with surgery type and first course of treatment delays. We also performed mediation analysis to quantify the extent to which treatment, sociodemographic and clinicopathologic factors mediated racial/ethnic differences in survival. Results: Non-Hispanic (NH) Blacks [adjusted Odds Ratio (aOR) = 1.19, 95% CI:1.13-1.25] were significantly more likely to undergo subtotal colectomy and to experience treatment delays [aOR = 1.39, 95% CI: 1.31-1.48] compared to NH Whites. Hispanics [aOR = 1.59, 95% CI: 1.49-1.69] were more likely to experience treatment delays than NH Whites. Delayed first course of treatment explained 23.56 % and 56.73% of the lower survival among NH Blacks and Hispanics, respectively, compared to their NH White counterparts. Conclusion: This population-based study found that race/ethnicity, SES, age, tumor grade, tumor stage, and location were significant predictors of surgery treatment type and treatment delays experienced by patients. The study reinforces the need for healthcare providers to consider socio-cultural and clinicopathological factors when managing colon cancer patients. It also highlights the importance of reducing treatment delays, as they can have significant implications for health outcomes, including increased AcM rates except in cases where patients present with comorbidities which may require some delay to ensure proper perioperative investigation and/or stabilization. Overall, the findings of this study offer valuable insights into the disparities in colon cancer treatment and outcomes, which can be used to guide the development of targeted interventions to improve health equity.