Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC.
Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA-Kaiser Permanente Center for Health Equity, and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, CA.
Am Soc Clin Oncol Educ Book. 2021 Mar;41:108-117. doi: 10.1200/EDBK_321071.
Colorectal cancer mortality has decreased considerably following the adoption of national screening programs, yet, within at-risk subgroups, there continue to be measurable differences in clinical outcomes from variations in screening, receipt of chemotherapy, radiation or surgery, access to clinical trials, research participation, and survivorship. These disparities are well-described and some have worsened over time. Disparities identified have included race and ethnicity, age (specifically young adults), socioeconomic status, insurance access, geography, and environmental exposures. In the context of the COVID-19 pandemic, colorectal cancer care has necessarily shifted dramatically, with broad, immediate uptake of telemedicine, transition to oral medications when feasible, and considerations for sequence of treatment. However, it has additionally marginalized patients with colorectal cancer with historically disparate cancer-specific outcomes; among them, uninsured, low-income, immigrant, and ethnic-minority patients-all of whom are more likely to become infected, be hospitalized, and die of either COVID-19 or colorectal cancer. Herein, we outline measurable disparities, review implemented solutions, and define strategies toward ensuring that all have a fair and just opportunity to be as healthy as possible.
结直肠癌死亡率在全国筛查计划实施后大幅下降，但在高危亚组中，由于筛查、接受化疗、放疗或手术、获得临床试验、参与研究和生存的差异，临床结局仍存在可衡量的差异。这些差异已经得到了很好的描述，而且有些差异随着时间的推移而恶化。已确定的差异包括种族和民族、年龄（特别是年轻人）、社会经济地位、保险覆盖范围、地理位置和环境暴露。在 COVID-19 大流行的背景下，结直肠癌的治疗已经发生了重大转变，广泛、立即采用远程医疗，在可行的情况下转为口服药物治疗，以及考虑治疗顺序。然而，它还使结直肠癌患者边缘化，这些患者的癌症特异性结局历来存在差异；其中包括没有保险、低收入、移民和少数民族患者——所有这些患者更有可能感染、住院，并死于 COVID-19 或结直肠癌。在此，我们概述了可衡量的差异，回顾了已实施的解决方案，并定义了确保所有人都有公平公正的机会尽可能健康的策略。
