Colon and Rectal Surgery Fellow AdventHealth Orlando Orlando, Florida, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Participants should be aware of the following financial/non-financial relationships:
Christopher T. Aquina, MD, MPH: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Introduction: Prior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) and peritoneal metastases (PM) are limited to single-institution data with highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC-PM or CRC-PM.
Methods: Patients ≥65 years old diagnosed with AC-PM or CRC-PM were identified within the Medicare Standard Analytic File (2013-2017). Patients with distant metastases were excluded. Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a CRS/HIPEC surgeon. Cox proportional-hazards analysis compared 3-year overall survival between treatment with CRS/HIPEC versus systemic therapy alone.
Results: Among 8,155 patients, only 3.5% (N=287) underwent CRS/HIPEC. When stratified by cancer type, 23.8% (N=180) of patients with AC-PM and 1.5% (N=107) of patients with CRC-PM underwent CRS/HIPEC. Of those who did not undergo CRS/HIPEC (N=7,868), only 6.9% (N=540) had outpatient consultation with a CRS/HIPEC surgeon. Patient factors independently associated with lower odds of CRS/HIPEC or a visit with a CRS/HIPEC surgeon included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a CRS/HIPEC center (p< 0.05) (Table). CRS/HIPEC was independently associated with improved 3-year overall survival compared to systemic therapy alone (HR=0.31, 95%CI=0.24-0.40).
Conclusions: Few Medicare beneficiaries with isolated PM from AC or CRC undergo CRS/HIPEC or even receive an outpatient consultation with a CRS/HIPEC surgeon. Improving access to specialized surgical care, particularly for patients with higher levels of social vulnerability or travel distance, may improve outcomes.
Learning Objectives:
define the proportion of Medicare beneficiaries with appendiceal or colorectal cancer with peritoneal metastasis who undergo CRS/HIPEC.
define the proportion of Medicare beneficiaries with appendiceal or colorectal cancer with peritoneal metastasis who have outpatient consultation with a CRS/HIPEC surgeon.
identify current disparities in receipt of and outpatient consultation for CRS/HIPEC for appendiceal or colorectal cancer with peritoneal metastasis.
