Disparities in the Treatment of Latino Patients with Colorectal Cancer
Latino patients with colorectal cancer experience significant disparities in access, quality of care, and clinical outcomes compared to non-Latino White patients, primarily driven by inequities in healthcare access, utilization, and quality of treatment rather than biological differences. 1
Key Disparities Affecting Latino Patients
Access to Care
- Latino patients are significantly less likely to undergo definitive surgical resection for colorectal cancer compared to non-Latino White patients 1
- Latino patients experience greater delays in receiving timely surgical intervention, with a marginal difference of -3.24 percentage points compared to non-Latino White patients 1
- Latino patients face structural barriers including economic limitations, inadequate health insurance coverage, and limited health educational resources that impede timely diagnosis and treatment 2
- Lack of Spanish-speaking providers creates significant communication barriers that affect the quality of care and patient understanding 3
Quality of Treatment
- Latino patients are less likely to receive adequate lymphadenectomy during surgical treatment (-2.85 percentage points compared to non-Latino White patients), which can affect staging accuracy and treatment planning 1
- Latino patients are less likely to be treated at high-volume hospitals, which is strongly associated with poorer access, quality, and survival outcomes 1
- Latino patients experience lower rates of next-generation sequencing genetic testing for metastatic colorectal cancer compared to White patients, limiting access to targeted therapies 4
Screening and Early Detection
- Mexican Americans in particular have significantly lower colorectal cancer screening rates (28%) compared to non-Latino Whites (47%), non-Latino Blacks (42%), and Puerto Ricans (40%) 5
- Even after adjusting for education, income, and insurance coverage, Mexican Americans remain significantly less likely to receive endoscopy or any CRC screening compared to non-Latino Whites 5
- Language barriers, cost concerns, and lack of understanding about screening procedures are frequently cited barriers to colorectal cancer screening among Latino patients 3
Contributing Factors
Structural and System-Level Barriers
- Limited insurance coverage and high costs are major barriers, with both patients and providers citing lack of funding and referral sources for colonoscopy as key obstacles 3
- Fragmented care is more common among Latino patients, who are more likely to be uninsured and face greater obstacles to receiving continuous care 4
- Geographic location and distance from treatment facilities can limit access to specialized care for Latino patients 4
Patient-Level Factors
- Misunderstanding of symptoms by patients and misdiagnosis by physicians contribute to delayed diagnosis 2
- Cultural beliefs about illness and health, including reliance on faith or self-care when symptoms develop, may delay seeking medical attention 2
- Embarrassment, fear, and concerns about maintaining masculinity can prevent Latino patients from seeking care for colorectal symptoms 2
- Limited health literacy and knowledge about colorectal cancer screening procedures affect screening participation 3
Provider and System Interactions
- Confusing interactions with physicians who may not be culturally or linguistically competent can impede effective communication about symptoms and treatment options 2
- Perceived discrimination within the healthcare system creates barriers to seeking care 2
- Issues related to being a new immigrant, including unfamiliarity with the healthcare system, create additional barriers 3
Evidence-Based Interventions
- Patient navigation programs that include culturally tailored education have shown promise, with one clinic-based intervention achieving 76% screening completion rates among Latino patients 6
- Directing Latino patients to high-volume hospitals appears to significantly improve access, quality metrics, and survival outcomes 1
- Targeted interventions that address barriers across multiple levels (structural, personal, healthcare system) are needed to effectively reduce disparities 2
- Providing Spanish-language materials and Spanish-speaking health educators can help overcome language barriers 3
Clinical Implications
- Healthcare providers should recognize that Latino patients may present with more advanced disease due to screening and treatment delays 4
- A targeted approach that meets the specific needs of Latino populations is recommended to address healthcare disparities 4
- Providers should be aware that equalizing access to care for Latino patients with colorectal cancer may result in outcomes comparable to those seen in clinical trials 4
- Clinicians should advocate for systems that ensure Latino patients receive recommended colorectal cancer screening, follow-up, and treatment 4