Evaluation of Racial Disparities in Quality of Care for Patients With Gastrointestinal Tract Cancer Treated With Surgery

Importance: Racial disparities have been demonstrated in many facets of health care, but a comprehensive understanding of who is most at risk for substandard surgical care of gastrointestinal tract cancers is lacking. Objective: To examine racial disparities in quality of care of patients with gastrointestinal tract cancers. Design, Setting, and Participants: This retrospective cohort study of patients with gastrointestinal tract cancer included the US population as captured in the National Cancer Database with a diagnosis from January 1, 2004, to December 31, 2017. Participants included 565 124 adults who underwent surgical resection of gastrointestinal tract cancers. Data were analyzed from June 21 to December 23, 2021. Exposures: Race and site of cancer. Main Outcomes and Measures: Oncologic standard of care, as defined by negative resection margin, adequate lymphadenectomy, and receipt of indicated adjuvant chemotherapy and/or radiotherapy. Results: Among 565 124 adult patients who underwent surgical resection of a gastrointestinal tract cancer, 10.9% were Black patients, 83.5% were White patients, 54.7% were men, and 50.7% had Medicare coverage. The most common age range at diagnosis was 60 to 69 years (28.5%). Longer median survival was associated with negative resection margins (87.3 IQR, 28.5-161.9 months vs 22.9 IQR, 8.8-69.2 months; P < .001) and adequate lymphadenectomies (80.7 IQR, 25.6 to not reached months vs 57.6 IQR, 17.7-153.8 months; P < .001). After adjustment for covariates, Black patients were less likely than White patients to have negative surgical margins overall (odds ratio OR, 0.96 95% CI, 0.93-0.98) and after esophagectomy (OR, 0.71 95% CI, 0.58-0.87), proctectomy (OR, 0.71 95% CI, 0.66-0.76), and biliary resection (OR, 0.75 95% CI, 0.61-0.91). Black patients were also less likely to have adequate lymphadenectomy overall (OR, 0.89 95% CI, 0.87-0.91) and after colectomy (OR, 0.89 95% CI, 0.87-0.92), esophagectomy (OR, 0.72 95% CI, 0.63-0.83), pancreatectomy (OR, 0.90 95% CI, 0.85-0.96), proctectomy (OR, 0.93 95% CI, 0.88-0.98), proctocolectomy (OR, 0.90 95% CI, 0.81-1.00), and enterectomy (OR, 0.71 95% CI, 0.65-0.79). Black patients were more likely than White patients not to be recommended for chemotherapy (OR, 1.15 95% CI, 1.10-1.21) and radiotherapy (OR, 1.49 95% CI, 1.35-1.64) because of comorbidities and more likely not to receive recommended chemotherapy (OR, 1.68 95% CI, 1.55-1.82) and radiotherapy (OR, 2.18 95% CI, 1.97-2.41) for unknown reasons. Conclusions and Relevance: These findings suggest that there are significant racial disparities in surgical care of gastrointestinal tract cancers. Black patients are less likely than White patients to receive standard of care with respect to negative surgical margins, adequate lymphadenectomies, and use of adjuvant therapies. Both system- and physician-level reforms are needed to eradicate these disparities in health care.