Quality Improvement/Clinical Outcomes
Olivia Monton, MD
Research Fellow & Resident Physician
Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine; Division of General Surgery, Department of Surgery, McMaster University, United States
Olivia Monton, MD
Research Fellow & Resident Physician
Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine; Division of General Surgery, Department of Surgery, McMaster University, United States
Olivia Monton, MD
Research Fellow & Resident Physician
Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine; Division of General Surgery, Department of Surgery, McMaster University, United States
Andrei Gurau, MD, MHS, MS
Research Fellow & Resident Physician
Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine; Valley Health General Surgery Residency, The Valley Health Hospital System, United States
Kimberly Kopecky, MD, MSCI
Surgical Oncology Fellow
Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, United States
Jonathan B. Greer, MD
Assistant Professor of Surgery
Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Fabian M. Johnston, MD, MHS
Associate Professor of Surgery
Division of Gastrointestinal Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
Baltimore, Maryland, United States
Young adults (YAs) with advanced gastrointestinal (GI) malignancy have unique and complex care needs, which may be addressed through the provision of palliative therapy (PT). To date, no studies have investigated the use of PT in this population. The objectives of this study were to (1) assess whether PT was associated with improved 30- and 90-day post-operative mortality and 30-day readmissions, and (2) identify predictors of PT utilization in YAs with advanced gastrointestinal malignancy from 2004 to 2020. In this study PT is defined as care provided to palliate or alleviate symptoms, and includes palliative surgery, radiation therapy, systemic therapy, and pain management, alone or in combination.
This is a retrospective cohort study. We used the National Cancer Database (NCDB) to identify YAs (aged 18-39 years old) who were diagnosed with advanced (AJCC stages III-IV) GI cancer from 2004 to 2020. Univariable and multivariable logistic regression analyses were used to evaluate the association between the use of PT and post-operative outcomes, and describe factors associated with utilization in this patient population.
A total of 43,616 YAs with advanced GI malignancy were identified, of which only 3,820 (8.76%) received PT. Palliative therapy was associated with no difference in 30-day or 90-day mortality, however, patients who received PT had decreased odds of 30-day readmission (OR 0.96, 95 CI 0.93, 0.99). Male patients (OR 1.24, 95 CI 1.15, 1.34), of race other than White or Black (OR 1.24, 95 CI 1.1, 1.41), with no insurance (OR 1.36, 95 CI 1.21, 1.54), a median income of less than $63,000 (OR 1.20, 95 CI 1.08, 1.34), who resided in urban counties (OR 1.15, 95 CI 1.02, 1.29), and were treated in academic (OR 1.25, 95 CI 1.05, 1.50) or integrated network cancer programs (OR 1.30, 95 CI 1.07, 1.57) in the northeastern United States (OR 1.62, 95 CI 1.43, 1.85) were more likely to use PT. Multiple comorbidities (OR 1.64, 95 CI 1.27, 2.11), stage IV disease (OR 8.23, 95 CI 7.29, 9.29), and biliary (OR 2.48, 95 CI 1.87, 3.29) and esophageal (OR 2.18, 95 CI 1.63, 2.92) cancer types were found to be predictors of utilization.
This study highlights an important gap in cancer care - the provision of PT to YAs with advanced GI cancer. Work is needed to understand barriers in access among YAs and create tailored and scalable interventions to address their complex care needs.