Colorectal Cancer Disparities Across the Continuum of Cancer Care: A Systematic Review and Meta-Analysis

Abstract

Structured AbstractBackground and ObjectivesDisparate colorectal cancer outcomes persist in vulnerable populations. We aimed to examine the distribution of research across the colorectal cancer care continuum, and to determine disparities in the use of Surgery among Black patients.MethodsA systematic review and meta-analysis of colorectal cancer disparities studies was performed. The meta-analysis assessed three utilization measures in Surgery.ResultsOf 1,199 publications, 60% focused on Prevention, Screening, or Diagnosis, 20% on Survivorship, 15% on Treatment, and 1% on End-of-Life Care. A total of 16 studies, including 1,110,674 patients, were applied to three separate meta-analyses regarding utilization of Surgery. Black colorectal cancer patients were less likely to receive surgery, twice as likely to refuse surgery, and less likely to receive laparoscopic surgery when compared to White patients.ConclusionsOver the past 10 years, the majority of published research remained focused on the prevention, screening, or diagnosis domain. Given the observed treatment disparities and persistently elevated disease-specific mortality among Black patients, future efforts to reduce colorectal cancer disparities should include interventions within Surgery.SynopsisIn this systematic review on disparities along the colorectal cancer care continuum, we found that 64% of research has been focused on prevention, screening, or diagnosis while only 6% addressed surgical disparities. In the meta-analysis, Black patients were less likely to undergo surgery, more likely to refuse surgery, and less likely to undergo laparoscopic surgery, when compared to White patients. Future research should target treatment differences across populations in order to impact persistent disparities in colorectal cancer survival.