Examining Racial Disparities in Clinical Delay in the Colon Cancer Patterns of Care in Chicago Study

Objectives: An analysis was conducted to assess whether non-Hispanic (nH) Black and White colon cancer patients may differ in terms of their likelihoods of experiencing prolonged colon cancer clinical delay defined as lengths of ≥60 days or ≥90 days between first presentation with colon cancer symptoms or a screen-detected issue, and treatment initiation. The analysis also aimed to identify other patient-level factors that may be predictive of prolonged colon cancer clinical delay, and that may mediate observed racial differences in clinical delay timing. Methods: Data for the analysis were obtained from the multi-institutional Colon Cancer Patterns of Care in Chicago Study. Variables based on interview data from 386 colon cancer cases and pertaining to patient demographic information, socioeconomic status, healthcare access and utilization, social support, and comorbidities were included in the analysis. Multivariable logistic regression and model-based standardization were used to generate risk differences comparing prevalence of prolonged clinical delay among nH Black patients to prevalence among nH White patients. Mediation analyses were conducted to examine whether any analysis variables accounted for observed racial differences in prevalence of prolonged colon cancer clinical delay. Results: Among all analysis variables, only race was found to be a significant predictor of prolonged colon cancer clinical delay, leading to identification of a racial disparity where nH Blacks in the study sample had a 12% point greater prevalence of clinical delay of ≥60 days and a 15% point greater prevalence of delay of ≥90 days as compared to nH Whites. In mediation analyses, this disparity could not be adequately accounted for by analysis variables; however, results were suggestive of socioeconomic factors potentially playing some role in the race-prolonged clinical delay association. Conclusions: Based on the findings of this analysis, the clinical delay timeframe may be important to consider when examining strategies to help eliminate colon cancer racial disparities. Additional research is needed to assess for this racial disparity among population-based samples, to identify modifiable factors that mediate this disparity, and to investigate the potential impacts of prolonged clinical delay on patient survival.