© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 22, 1933-1940,
November 17, 1999
© 1999 Oxford University Press
Outcomes Among African-Americans and Caucasians in Colon Cancer Adjuvant Therapy Trials: Findings From the National Surgical Adjuvant Breast and Bowel Project
Affiliations of authors: J. J. Dignam, L. Colangelo, W. Tian, J. Jones, National Surgical Adjuvant Breast and Bowel Project (NSABP) and University of Pittsburgh, PA; R. Smith, D. L. Wickerham, N. Wolmark, NSABP and Allegheny General Hospital, Pittsburgh.
Correspondence to: James J. Dignam, Ph.D., 230 McKee Place, Suite 403, University of Pittsburgh, Pittsburgh, PA 15213 (e-mail: dignam{at}vms.cis.pitt.edu).
BACKGROUND: African-Americans generally have lower survival rates from colon cancer than Caucasian Americans. This disparity has been attributed to many sources, including diagnosis at later disease stage and other unfavorable disease features, inadequate treatment, and socioeconomic factors. The randomized clinical trial setting ensures similarity in disease stage and a uniform treatment plan between blacks and whites. In this study, we evaluated survival and related end points for African-American and Caucasian patients with colon cancer participating in randomized clinical trials of the National Surgical Adjuvant Breast and Bowel Project (NSABP) to determine whether outcomes were less favorable for African-Americans. METHODS: The study included African-American (n = 663) or Caucasian (n = 5969) patients from five serially conducted, randomized clinical trials of the NSABP. We compared recurrence-free survival, disease-free survival (recurrence, new primary cancer, or death), and survival (death from any cause) between blacks and whites by using statistical modeling to account for differences in patient and disease characteristics between the groups. Statistical tests were two-sided. RESULTS: Dukes' stage and number of positive lymph nodes were remarkably similar between African-American and Caucasian patients in each trial. Over all trials combined, an 8% (95% confidence interval [CI] = -6% to 25%; P = .27) excess risk of colon cancer recurrence that was not statistically significant was observed for blacks. A greater disparity in survival was seen, with blacks experiencing a statistically significant 21% (95% CI = 6%-37%; P = .004) greater risk of death. Treatment efficacy appeared similar between the groups. CONCLUSIONS: While the overall survival prognosis was less favorable for African-Americans compared with Caucasians in these trials, other outcomes measured were considerably more similar than those seen in the population at large, suggesting that earlier detection and adjuvant therapy could appreciably improve colon cancer prognosis for African-Americans. Continued investigations into causes of the deficits noted are warranted.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H. K. Sanoff, D. J. Sargent, E. M. Green, H. L. McLeod, and R. M. Goldberg Racial Differences in Advanced Colorectal Cancer Outcomes and Pharmacogenetics: A Subgroup Analysis of a Large Randomized Clinical Trial J. Clin. Oncol., September 1, 2009; 27(25): 4109 - 4115. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. S. Albain, J. M. Unger, J. J. Crowley, C. A. Coltman Jr, and D. L. Hershman Racial Disparities in Cancer Survival Among Randomized Clinical Trials Patients of the Southwest Oncology Group J Natl Cancer Inst, July 15, 2009; 101(14): 984 - 992. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Schwaderer, J. W. Proctor, E. F. Martz, R. J. Slack, and E. Ricci Evaluation of Patient Navigation in a Community Radiation Oncology Center Involved in Disparities Studies: A Time-to- Completion-of-Treatment Study J. Oncol. Pract, September 1, 2008; 4(5): 220 - 224. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Le, A. Ziogas, S. M. Lipkin, and J. A. Zell Effects of Socioeconomic Status and Treatment Disparities in Colorectal Cancer Survival Cancer Epidemiol. Biomarkers Prev., August 1, 2008; 17(8): 1950 - 1962. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Morris, K. G. Billingsley, A. J. Hayanga, B. Matthews, L.-M. Baldwin, and J. D. Birkmeyer Residual Treatment Disparities After Oncology Referral for Rectal Cancer J Natl Cancer Inst, May 21, 2008; 100(10): 738 - 744. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Zhang, J. Z. Ayanian, and A. M. Zaslavsky Patient characteristics and hospital quality for colorectal cancer surgery Int. J. Qual. Health Care, February 1, 2007; 19(1): 11 - 20. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. N. Polite, J. J. Dignam, and O. I. Olopade Colorectal Cancer Model of Health Disparities: Understanding Mortality Differences in Minority Populations J. Clin. Oncol., May 10, 2006; 24(14): 2179 - 2187. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Jessup, A. Stewart, F. L. Greene, and B. D. Minsky Adjuvant Chemotherapy for Stage III Colon Cancer: Implications of Race/Ethnicity, Age, and Differentiation JAMA, December 7, 2005; 294(21): 2703 - 2711. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Farooq and M. P Coleman Breast cancer survival in South Asian women in England and Wales J Epidemiol Community Health, May 1, 2005; 59(5): 402 - 406. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Sekeres, B. Peterson, R. K. Dodge, R. J. Mayer, J. O. Moore, E. J. Lee, J. Kolitz, M. R. Baer, C. A. Schiffer, A. J. Carroll, et al. Differences in prognostic factors and outcomes in African Americans and whites with acute myeloid leukemia Blood, June 1, 2004; 103(11): 4036 - 4042. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Morris, K. G. Billingsley, N. N. Baxter, and L.-M. Baldwin Racial Disparities in Rectal Cancer Treatment: A Population-Based Analysis Arch Surg, February 1, 2004; 139(2): 151 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Serna, S. J. Lee, M.-j. Zhang, K. S. Baker, M. Eapen, M. M. Horowitz, J. P. Klein, J. D. Rizzo, and F. R. Loberiza Jr Trends in Survival Rates After Allogeneic Hematopoietic Stem-Cell Transplantation for Acute and Chronic Leukemia by Ethnicity in the United States and Canada J. Clin. Oncol., October 15, 2003; 21(20): 3754 - 3760. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Glanz, R. T. Croyle, V. Y. Chollette, and V. W. Pinn Cancer-Related Health Disparities in Women Am J Public Health, February 1, 2003; 93(2): 292 - 298. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. P. Mitchell Prognosis After Rectal Cancer Treatment in Blacks and Whites: Advanced Stage at Diagnosis or Other Factors? J. Clin. Oncol., February 1, 2003; 21(3): 397 - 398. [Full Text] [PDF]
|
|
|
|
|
|
J. J. Dignam, Y. Ye, L. Colangelo, R. Smith, E. P. Mamounas, H. S. Wieand, and N. Wolmark Prognosis After Rectal Cancer in Blacks and Whites Participating in Adjuvant Therapy Randomized Trials J. Clin. Oncol., February 1, 2003; 21(3): 413 - 420. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. McCollum, P. J. Catalano, D. G. Haller, R. J. Mayer, J. S. Macdonald, A. B. Benson III, and C. S. Fuchs Outcomes and Toxicity in African-American and Caucasian Patients in a Randomized Adjuvant Chemotherapy Trial for Colon Cancer J Natl Cancer Inst, August 7, 2002; 94(15): 1160 - 1167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Wudel Jr, W. C. Chapman, Y. Shyr, M. Davidson, A. Jeyakumar, S. O. Rogers Jr, T. Allos, and S. C. Stain Disparate Outcomes in Patients With Colorectal Cancer: Effect of Race on Long-term Survival Arch Surg, May 1, 2002; 137(5): 550 - 556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Bach, D. Schrag, O. W. Brawley, A. Galaznik, S. Yakren, and C. B. Begg Survival of Blacks and Whites After a Cancer Diagnosis JAMA, April 24, 2002; 287(16): 2106 - 2113. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Bradley, C. W. Given, and C. Roberts Race, Socioeconomic Status, and Breast Cancer Treatment and Survival J Natl Cancer Inst, April 3, 2002; 94(7): 490 - 496. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. C. Earle, P. J. Neumann, R. D. Gelber, M. C. Weinstein, and J. C. Weeks Impact of Referral Patterns on the Use of Chemotherapy for Lung Cancer J. Clin. Oncol., April 1, 2002; 20(7): 1786 - 1792. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. L. Shavers and M. L. Brown Racial and Ethnic Disparities in the Receipt of Cancer Treatment J Natl Cancer Inst, March 6, 2002; 94(5): 334 - 357. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. L. Potosky, L. C. Harlan, R. S. Kaplan, K. A. Johnson, and C. F. Lynch Age, Sex, and Racial Differences in the Use of Standard Adjuvant Therapy for Colorectal Cancer J. Clin. Oncol., March 1, 2002; 20(5): 1192 - 1202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. P. Polednak Re: Association of African-American Ethnic Background With Survival in Men With Metastatic Prostate Cancer J Natl Cancer Inst, August 1, 2001; 93(15): 1174 - 1175. [Full Text] [PDF]
|
|
|
|
|
|
D. C. Hodgson, C. S. Fuchs, and J. Z. Ayanian Impact of Patient and Provider Characteristics on the Treatment and Outcomes of Colorectal Cancer J Natl Cancer Inst, April 4, 2001; 93(7): 501 - 515. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. W. Brawley and H. P. Freeman Race and Outcomes: Is This the End of the Beginning for Minority Health Research? J Natl Cancer Inst, November 17, 1999; 91(22): 1908 - 1909. [Full Text] [PDF]
|
|