Understanding differences in the receipt of chemotherapy between African-American (AA) and white (W) patients with stage III colon cancer

6568 Background: Even when stage is controlled for, AA are more likely to die from colon cancer than are W. Previous research suggests that AA are less likely to receive adjuvant chemotherapy for Stage III colon cancer than W. This study examines the differences in the receipt of chemotherapy for stage III colon cancer and the reasons behind those differences. Methods: The records of patients diagnosed with and/or receiving their first-course of treatment for Stage III colon cancer at the University of Chicago between 1995–2004 were examined. Specifically, patient charts were audited to determine whether the patients had received chemotherapy, and if not, the documented reasons for the non-receipt of therapy. In the case of incomplete records, the patients’ outside physicians were contacted to ascertain the chemotherapy history. Chemotherapy information was unavailable for only 13 patients (5 AA and 8 W). Results: A total of 186 patients (110 AA and 76 W) were diagnosed with stage III colon cancer at the University of Chicago between 1995–2004. No significant differences were seen with respect to age, sex or tumor location between AA and W. In total, 65% of AA versus 82% of W received chemotherapy (OR 0.43; 95% CI: 0.20–0.86). AA were more likely to not undergo chemotherapy because of comorbidities (OR 3.80; 95%CI 1.35–10.50). Those pts not receiving therapy because of comorbidities had a poorer overall survival than those who received therapy (HR 5.9; 95%CI 3.4–10.3). This effect held for both AA and W pts (p=0.65 for race and comorbidity interaction). Among the 146 pts (86AA, 63W) for whom it is known that chemotherapy was recommended, AA were over 9 times as likely to have a documented refusal (OR 9.5; 95% CI 1.19–75.4). These findings were robust to adjustments for age, sex, insurance status and marital status. Conclusions: AA were significantly less likely than W to receive chemotherapy for stage III colon cancer. The reasons for the difference include both refusal of therapy and the presence of comorbidities that the treating physicians felt were a contraindication to therapy. Future research should be directed at better understanding the reasons behind the higher refusal rates for AA patients. No significant financial relationships to disclose.