EP126 - Demographic Dilemmas: Treatment Decision-Making Biases May Contribute to Disparities in Multimodal Therapy for Colon Cancer

Saturday, May 10, 2025

3:31 PM – 3:36 PM PT

Location: Monitor 4, Sails Pavilion, Upper Level

ePoster Presenter(s)

Carson T. Herbert (he/him/his)

Medical Student
University of North Dakota School of Medicine & Health Sciences
Reynolds, ND, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

SE

Samuel Eisenstein, MD

Associate Professor
UC San Diego Health
La Jolla, California, United States

All of the relevant financial relationships listed below have been mitigated.
Takeda: Consultant (Ongoing)
Shanglei Liu, MD (he/him/his)

Assistant Professor
UCSD Department of Survery
San Diego, California, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Sonia Ramamoorthy, MD (she/her/hers)

Professor
UCSD
La Jolla, California, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.

Senior Author(s)

Nicole Lopez, MD

Associate Professor
UCSD Department of Surgery
San Diego, California, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Carson T. Herbert, n/a: This individual has no financial relationships with ineligible companies.

Samuel Eisenstein, MD: Takeda: Consultant (Ongoing)

Shanglei Liu, MD: This individual has no financial relationships with ineligible companies.

Sonia Ramamoorthy, MD: This individual has no relevant relationships with ineligible companies.

Nicole Lopez, MD: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Background and

Objectives: Combination therapy is known to improve outcomes in colorectal cancer. We hypothesized that demographic factors may influence the recommendation of surgery and chemotherapy for treatment of patients with colon cancer.

Methods/Interventions:

Methods: Using the National Cancer Database (2004-2020), we examined factors associated adult patients with Stage I-IV colon adenocarcinoma who received recommendations for or against treatment of colon cancer with surgery or chemotherapy. Factors associated with treatment recommendation were assessed using multivariable analysis.

Results/Outcomes:

Results: Data regarding treatment recommendation was available for 932,871 surgical and 431,290 chemotherapy patients. Over the course of the study, recommendation for surgery decreased 0.5%, while recommendation for chemotherapy increased 1.6%. Compared to White patients, Black patients were less likely to have a recommendation for surgery (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.73-0.82), while Black (OR: 1.12, 95% CI: 1.08-1.16) and Asian/Pacific Islander (OR: 1.58, 95% CI: 1.46-1.72) patients were more likely to be recommended for chemotherapy. Private insurance holders were more likely have a recommendation for surgery compared to government insured patients (OR: 0.40, 95% CI: 0.38-0.43) and uninsured (OR: 0.46, 95% CI: 0.41-0.52) patients. Private insurance holders were also more likely to be recommended for chemotherapy compared to government insured (OR: 0.23, 95% CI: 0.22-0.24) and uninsured (OR: 0.85, 95% CI: 0.77-0.94) patients.

Conclusion/Discussion:

Conclusions: We found differences in treatment recommendations among vulnerable groups who traditionally experience discrimination and among patients without private insurance suggesting bias in treatment related decision-making. Further work must be dedicated to developing strategies to avoid bias in medical decision making.