Differential Effects of Race, Socioeconomic Status, and Insurance on Disease-Specific Survival in Rectal Cancer

National Comprehensive Cancer Network guideline adherence improves cancer outcomes. In rectal cancer, guideline adherence is distributed differently by race/ethnicity, socioeconomic status, and insurance.Determine independent effects of race/ethnicity, socioeconomic status, and insurance status on rectal cancer survival after accounting for differences in guideline adherence.This was a retrospective study.Study was conducted utilizing the California Cancer Registry.Patients aged 18-79 years diagnosed with rectal adenocarcinoma between January 1, 2004 and December 31, 2017 with follow-up through November 30, 2018. Investigators determined whether patients received care with guideline adherence.Odds ratios and 95% confidence intervals were used for logistic regression to analyze patients receiving care with guideline adherence. Disease-specific survival analysis was calculated using Cox regression models.A total of 30,118 patients were analyzed. Factors associated with higher odds of guideline adherence included Asian and Hispanic race/ethnicity, managed care insurance, and high socioeconomic status. Asians and Hispanics had better disease-specific survival in the non-adherent group HR 0.80 (95% CI 0.72 - 0.88, p < 0.001) and HR 0.91 (95% CI 0.83 - 0.99, p = 0.0279). Race/ethnicity were not factors associated with disease-specific survival in the guideline adherent group. Medicaid disease-specific survival was worse in both the non-adherent group HR 1.56 (95% CI 1.40 - 1.73, p < 0.0001) and guideline adherent group HR 1.18 (95% CI 1.08 - 1.30, p = 0.0005). Lowest socioeconomic status' disease-specific survival was worse in both non-adherent group HR 1.42 (95% CI 1.27 - 1.59) guideline adherent group HR 1.20 (95% CI 1.08 - 1.34).Limitations included unmeasured confounders and retrospective nature of review.Race, socioeconomic status, and insurance are associated with guideline adherence in rectal cancer. Race/ethnicity was not associated with differences in disease specific survival in the guideline adherent group. Medicaid and lowest socioeconomic status had worse disease-specific survival in both the guideline non-adherent group and adherent groups. See Video Abstract at http://links.lww.com/DCR/B954.