Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
Department of Medicine, Baylor College of Medicine, Houston, TX.
Clin Colorectal Cancer. 2020 Jun;19(2):e49-e57. doi: 10.1016/j.clcc.2019.09.002. Epub 2020 Jan 2.
Metastatic colorectal cancer (CRC) outcomes continue to improve, but they vary significantly by race and ethnicity. We hypothesize that these disparities arise from unequal access to care.
The Harris Health System (HHS) is an integrated health delivery network that provides medical care to the underserved, predominantly minority population of Harris County, Texas. As the largest HHS facility and an affiliate of Baylor College of Medicine's Dan L. Duncan Comprehensive Cancer Center, Ben Taub Hospital (BTH) delivers cancer care through multidisciplinary subspecialty that prioritize access to care, adherence to evidence-based clinical pathways, integration of supportive services, and mitigation of financial toxicity. We performed a retrospective analysis of minority patients diagnosed with and treated for metastatic CRC at BTH between January 2010 and December 2012. Kaplan-Meier survival curves were compared with survival curves from randomized control trials reported during that time period.
We identified 103 patients; 40% were black, 49% were Hispanic, and 12% were Asian or Middle Eastern. Thirty-five percent reported a language other than English as their preferred language. Seventy-four percent of patients with documented coverage status were uninsured. Eighty-four percent of patients received standard chemotherapy with a clinician-reported response rate of 63%. Overall survival for BTH patients undergoing chemotherapy was superior to that of subjects enrolled in the CRYSTAL (Cetuximab Combined with Irinotecan in First-Line Therapy for Metastatic Colorectal Cancer) trial (median, 24.0 vs. 19.9 months; P = .014).
HHS provides a health delivery infrastructure through which minority patients with socioeconomic challenges experience clinical outcomes comparable with highly selected patients enrolled in randomized control trials. Efforts to resolve CRC disparities should focus on improving access of at-risk populations to high-quality comprehensive cancer care.
转移性结直肠癌（CRC）的治疗效果持续改善，但不同种族和族裔之间的差异仍然显著。我们假设这些差异源于医疗资源获取的不平等。
哈里斯健康系统（HHS）是一个提供医疗服务的综合医疗网络，服务对象是德克萨斯州哈里斯县资源匮乏的少数族裔人群。作为 HHS 中规模最大的机构，也是贝勒医学院丹 L. 邓肯综合癌症中心的附属医院，本陶布医院（BTH）通过多学科专业团队提供癌症治疗服务，重点关注医疗资源获取、遵循循证临床路径、整合支持性服务以及减轻经济毒性。我们对 2010 年 1 月至 2012 年 12 月期间在 BTH 被诊断为转移性 CRC 并接受治疗的少数族裔患者进行了回顾性分析。采用 Kaplan-Meier 生存曲线与同期报道的随机对照试验中的生存曲线进行比较。
我们共纳入 103 例患者，其中 40%为黑人，49%为西班牙裔，12%为亚洲人或中东人。35%的患者表示首选语言不是英语。有记录保险覆盖情况的患者中，74%为无保险。84%的患者接受了标准化疗，临床医生报告的缓解率为 63%。接受化疗的 BTH 患者的总体生存率优于 CRYSTAL 试验（中位，24.0 与 19.9 个月；P =.014）入组的患者。
HHS 通过提供医疗服务基础设施，使面临社会经济挑战的少数族裔患者获得与高度选择的随机对照试验患者相当的临床结果。解决 CRC 差异的努力应侧重于改善高危人群获得高质量综合癌症护理的机会。
