• Aaron J Dawes, Ganesh Rajasekar, Katherine D Arnow, Amber W Trickey, HarrisAlex H SAHSStanford-Surgery Policy Improvement Research and Education Center, Stanford, CA.Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA., Arden M Morris, and Todd H Wagner.
• Section of Colon & Rectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
• Ann. Surg. 2024 Feb 26.

ObjectiveTo compare access, quality, and clinical outcomes between Latino and non-Latino White Californians with colon cancer.Summary Background DataRacial and ethnic disparities in cancer care remain understudied, particularly among patients who identify as Latino. Exploring potential mechanisms, including differential utilization of high-volume hospitals, is an essential first step to designing evidence-based policy solutions.MethodsWe identified all adults diagnosed with colon cancer between January 1, 2010 and December 31, 2020 from a statewide cancer registry linked to hospital administrative records. We compared survival, access (stage at diagnosis, receipt of surgical care, treatment at a high-volume hospital), and quality of care (receipt of adjuvant chemotherapy, adequacy of lymph node resection) between patients who identified as Latino and as non-Latino White.Results75,543 patients met inclusion criteria, including 16,071 patients who identified as Latino (21.3%). Latino patients were significantly less likely to undergo definitive surgical resection (marginal difference [MD] -0.72 percentage points, 95% CI -1.19,-0.26), have an operation in a timely fashion (MD -3.24 percentage points, 95% CI -4.16,-2.32), or have an adequate lymphadenectomy (MD -2.85 percentage points, 95% CI -3.59,-2.12) even after adjustment for clinical and sociodemographic factors. Latino patients treated at high-volume hospitals were significantly less likely to die and more likely to meet access and quality metrics.ConclusionsLatino colon cancer patients experienced delays, segregation, and lower receipt of recommended care. Hospital-level colectomy volume appears to be strongly associated with access, quality, and survival--especially for patients who identify as Latino--suggesting that directing at-risk cancer patients to high-volume hospitals may improve health equity.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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