Disparities in Surgical Oncologic Care
.jpg "Shaina Sedighim, MD photo")
Shaina Sedighim, MD
Resident Physician
University of California, Irvine, Department of Surgery
Irvine, California, United States
Shaina Sedighim, MD
Resident Physician
University of California, Irvine, Department of Surgery
Irvine, California, United States
Rhami Khorfan, MD
Fellow Physician
Loma Linda University, Department of Surgery, United States
Amy Y. Li, MD
Fellow Physician
University of California, Irvine, Department of Surgery, United States
Jordan Shin, N/A
Student
University of California, Irvine, United States
Yixuan Irene Tang, N/A
Student
University of California, Irvine, United States
.jpg "Aaqil Khan, BS photo")
Aaqil Khan, BS
Master's Student
University of California, Irvine, United States
Maheswari Senthil, MD
Professor of Surgery
University of California, Irvine, Department of Surgery
Irvine, California, United States
Michael P. O’Leary, MD (he/him/his)
Attending Surgeon
Loma Linda University, Department of Surgery
Loma Linda, California, United States
.jpg "Oliver Eng, MD (he/him/his) photo")
Oliver Eng, MD (he/him/his)
Associate Professor of Surgery
University of California, Irvine
Orange, California, United States
Patients with metastatic colorectal cancer (mCRC) present with symptoms which require multidisciplinary interventions. Utilization of palliative treatment in patients with advanced cancers can be associated with many benefits, including improved quality of life. Sociodemographic disparities exist in the treatment of mCRC, but such disparities remain understudied in palliative treatment. This study aimed to characterize disparities in palliative treatment utilization nationally in patients with mCRC.
Methods:
Utilizing data from the National Cancer Database, we identified patients diagnosed with mCRC 2016 and 2020. Patients were categorized by metastatic site: peritoneal, liver, lung, or bone/brain/lymph node. Patients with multiple metastatic sites were excluded. Palliative treatment rates were compared across metastatic sites. Patient and hospital factors influencing palliative treatment were analyzed using multivariable logistic regression models.
Results:
A total of 88,048 patients were identified, 14,684 (16.7%) of whom received palliative treatment. When comparing palliative treatment by metastatic site, patients with peritoneal metastases (PM) had the lowest rate of palliative treatment (14.3%), compared to bone/brain/lymph node (23.4%), liver (15.3%), and lung (16.4%) (p< 0.001). On univariate analysis, patients in the lowest age-group (< 55) received palliative care treatment at a significantly lower rate (16.0%) compared to the other cohorts (p=0.0124); however, this association was no longer significant in a multivariable model (p=0.102). Hispanic patients received palliative treatment at a lower rate (13.7%) compared to Asian (14.5%), non-Hispanic Black (16.0%), and non-Hispanic White (17.3%) patients (p< 0.001). Patients with private insurance had lower palliative care involvement (15.2%) compared to those with no insurance (19.05%), Medicaid (18.6%), and Medicare (17.3%) (p< 0.001). The lowest education quartile received slightly lower rates of palliative care (15.5%) compared to highest education quartile (16.7%) (p< 0.001).
Conclusions:
Among patients with oligometastatic mCRC, those with PM were associated with the lowest rate of receiving palliative treatment. In addition, lower rates of palliative treatment were observed among Hispanic patients, as well as patients in the lowest education quartile. Demographic and socioeconomic differences associated with palliative treatment reflect the need for future research to better understand disparities in palliative treatment strategies for mCRC patients.