Fox Chase Study Finds That Non-Hispanic Black Patients With Locally Advanced Rectal Cancer Have Less Favorable Outcomes

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Sanjeevani Arora, PhD, and Shannon Lynch, PhD, MPH, led a study published in JAMA Network Open which found that Hispanic and non-Hispanic Black patients receiving neoadjuvant therapy and surgery for locally advanced rectal cancer achieve less favorable clinical outcomes than non-Hispanic White patients.

PHILADELPHIA (February 29, 2024) — While sociodemographic, clinical, and pathological factors may affect racial and ethnic disparities in outcomes of patients with locally advanced rectal cancer, non-Hispanic Black patients consistently saw less favorable treatment outcomes independent of those factors, according to a study from researchers at Fox Chase Cancer Center published today.

“There has been a substantial body of literature related to race/ethnic differences in survival outcomes for colorectal cancer, but there hasn’t really been a study looking comprehensively into the potential multitude of factors affecting racial and ethnic disparities in treatment response to neoadjuvant therapy for locally advanced rectal cancer,” said Sanjeevani Arora, PhD, co-lead author on the study and an Assistant Professor in the Cancer Prevention and Control Research Program at Fox Chase.

“We wanted to first determine if race/ethnic differences were also noted in treatment response,” added Shannon Lynch, PhD, MPH, co-lead author, Assistant Professor in the Cancer Prevention and Control Research Program, and Assistant Director of the Office of Community Outreach and Engagement at Fox Chase.

“Next, we sought to evaluate whether these differences might be explained in part by social determinants of health — like where a person lives, their education or economic circumstances, or whether or not a patient has insurance — given social determinants are generally known to contribute to race/ethnic disparities in cancer more broadly.”

The Fox Chase researchers used the National Cancer Database to examine social determinants of health, as well as demographic, clinical, and pathological factors known to predict response to neoadjuvant therapy for locally advanced rectal cancer.

Results of the study showed that treatment outcomes for locally advanced rectal cancer were less favorable for Hispanic and non-Hispanic Black patients than for non-Hispanic white patients. Additionally, non-Hispanic Black patients still experienced less favorable treatment responses, even after adjusting for social determinants and clinical factors assessed in the study. “Our findings suggest that other factors we weren’t able to measure or evaluate using this existing data resource, such as access to services or more detailed socioeconomic or clinical data, could be playing a role in differences we see in treatment response by race/ethnicity,” said Lynch.

“Apart from the above factors,” Arora added, “one thing we didn’t look at is the biological component, attributes such as gene mutations and inherited genetic conditions. This study shows that also could be a missing piece to help explain why these disparities continue to exist despite advances in treatment.”

Arora, whose lab specifically focuses on underlying cancer risk and individual responses to cancer treatment from a biologic standpoint, teamed up with Lynch, a population scientist, for this study. Lynch’s lab focuses on identifying the role of social determinants of health and the role of neighborhood or where people live on cancer outcomes.

Both agree that the study is the first step in assessing some of the sociobiological factors that may influence treatment outcomes and highlights the importance of cultivating diversity in clinical trials that assess treatment response.

The study, “Factors Associated With Racial and Ethnic Disparities in Locally Advanced Rectal Cancer Outcomes,” was published in JAMA Network Open.

Fox Chase Cancer Center (Fox Chase), which includes the Institute for Cancer Research and the American Oncologic Hospital and is a part of Temple Health, is one of the leading comprehensive cancer centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase is also one of just 10 members of the Alliance of Dedicated Cancer Centers. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence six consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. It is the policy of Fox Chase Cancer Center that there shall be no exclusion from, or participation in, and no one denied the benefits of, the delivery of quality medical care on the basis of race, ethnicity, religion, sexual orientation, gender, gender identity/expression, disability, age, ancestry, color, national origin, physical ability, level of education, or source of payment.

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