It's Not About the Money: Continued Treatment and Survival Outcome Disparities in Minority Rectal Cancer Patients After Controlling for Socioeconomic Factors.

BACKGROUND: While the disparities for minority patients with cancer have been well established, few studies have illustrated disparities in cancer outcomes while controlling for potential confounding factors. The current study was designed to address these confounding variables and how they influence the treatment and survival time for patients with rectal cancer. METHODS: Using the Surveillance, Epidemiology, and End Results database, black and Hispanic patients were compared with white patients with rectal cancer for the rates of chemotherapy, radiation, and surgery in addition to survival time after diagnosis. Following this analysis, confounding variables were controlled for and analysis was repeated with groups of comparable demographic variables. RESULTS: Before controlling for confounding variables, there were significant differences in treatment and survival for both Hispanic and black patients compared with white. Following matching, black patients continued to have lower rates of treatment and shorter survival times. CONCLUSIONS: These differences in treatment methods and survival outcomes for minorities, particularly black patients, highlight the need for more advocacy and focus on these underrepresented populations with rectal cancer.

An update on surgical treatment of hemorrhoidal disease: a systematic review and meta-analysis.

BACKGROUND: Pathologic hemorrhoids are common among adults age 45-65. Hemorrhoids are characterized as internal or external, and grades 1-4 based on severity. The type and grade dictate treatment, with surgical treatment reserved for grades 3/4. The aim of this study is to compare clinical outcomes of various surgical treatments. METHODS: A systematic review was conducted to identify randomized clinical trials that compare surgical treatments for grade 3/4 hemorrhoids. A Bayesian network meta-analysis was done using NetMetaXL and WinBUGS. RESULTS: A total of 26 studies with 3137 participants and 14 surgical treatments for grade 3/4 hemorrhoids were included. Pain was less in patients with techniques such as laser (OR 0.34, CI 0.01-6.51), infrared photocoagulation (OR 0.38, CI 0.02-5.61), and stapling (OR 0.48, CI 0.19-1.25), compared to open and closed hemorrhoidectomies. There was less recurrence with Starion (OR 0.01, CI 0.00-0.46) and harmonic scalpel (OR 0.00, CI 0.00-0.49), compared to infrared photocoagulation and transanal hemorrhoidal dearterialization. Fewer postoperative clinical complications were seen with infrared photocoagulation (OR 0.04, CI 0.00-2.54) and LigaSure (OR 0.16, CI 0.03-0.79), compared to suture ligation and open hemorrhoidectomy. With Doppler-guided (OR 0.26, CI 0.05-1.51) and stapled (OR 0.36, CI 0.15-0.84) techniques, patients return to work earlier when compared to open hemorrhoidectomy and laser. CONCLUSION: There are multiple favorable techniques without a clear "gold standard" based on current literature. Open discussion should be had between patients and physicians to guide individualized care.