Disparities in Surgical Oncologic Care
Amy Y. Li, MD
Fellow Physician
University of California, Irvine, Department of Surgery, United States
Amy Y. Li, MD
Fellow Physician
University of California, Irvine, Department of Surgery, United States
.jpg "Shaina Sedighim, MD photo")
Shaina Sedighim, MD
Resident Physician
University of California, Irvine, Department of Surgery
Irvine, California, United States
.jpg "Aaqil Khan, BS photo")
Aaqil Khan, BS
Master's Student
University of California, Irvine, United States
Selma Masri, PhD
Associate Professor
University of California, Irvine, United States
Nicholas Pannunzio, PhD
Assistant Professor
University of California, Irvine, United States
Maheswari Senthil, MD
Professor of Surgery
University of California, Irvine, Department of Surgery
Irvine, 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
Utilization of adjuvant chemotherapy (AC) for node-positive colon cancer results in improved disease-free and overall survival (OS). Therefore, the National Comprehensive Cancer Network (NCCN) guidelines currently recommend routine AC following surgical resection for stage III colon cancer. Sociodemographic disparities are associated with barriers to treatment for colon cancer. This study aimed to evaluate disparities associated with noncompliance with receipt of recommended adjuvant chemotherapy in patients with stage III colon cancer.
Methods:
The National Cancer Database (NCDB) was queried for all adult patients between 2006 and 2019 who were diagnosed with stage III colon cancer and underwent definitive surgical resection of the primary site. The subset of patients who were recommended to undergo AC were identified and then categorized by those who received AC versus those who refused AC. Patients who were not recommended AC due to patient factors such as comorbidities and age were excluded. Descriptive statistics were performed. Demographic, socioeconomic, and hospital factors were analyzed with Cox and logistic regression analyses.
Results:
A total of 158,388 patients were identified, of whom 9.2% (n=14,518) were recommended AC but refused treatment. These patients were more likely to be female, Caucasian, older, and associated with lower-income bracket and government insurance (all p< 0.001). In a multivariable model (see Table), older age, female sex, African American race, and higher Charlson Deyo (CD) scores were independent factors associated with noncompliance (p< 0.001). Conversely, higher income quartiles (highest quartile HR 0.81, CI 0.75-0.87, p< 0.001), Hispanic ethnicity (HR 0.65, CI 0.55-0.77, p< 0.001), and having any insurance (p< 0.001) were significantly associated with compliance and subsequent receipt of recommended AC. On subset analysis of patients with CD score of 0, all independent factors continued to hold significance, except education. Noncompliance with recommended AC was associated with worse overall survival (HR 1.80, CI 1.76-1.85, p< 0.001). Median OS was 138 months versus 46 months in compliant versus noncompliant patients, respectively (p=< 0.001).
Conclusions:
Almost 10% of patients with stage III colon cancer are noncompliant with recommended adjuvant chemotherapy. There are several socioeconomic and demographic factors associated with AC noncompliance. Given the markedly worse overall survival, strategies must be implemented towards mitigating barriers in patients who are noncompliant with recommended AC.