Skip to main content
SSO 2024 Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Recorded for On-Demand Viewing
Recorded for On-Demand Viewing
Back

Disparities in Surgical Oncologic Care

E165: Delays in Management of Adrenocortical Carcinoma by Sociodemographic and Geographic Factors

Introduction: Adrenocortical carcinoma (ACC) is an aggressive cancer where prognosis is strongly correlated with early diagnosis and rapid intervention. Delays in the management of ACC reflective of diminished access to appropriate care resources could portend worse outcomes. In this study, we evaluate time from diagnosis to treatment of ACC as a function of sociodemographic and geographic factors.

Methods:

We performed a retrospective cohort study of all patients who received treatment for ACC (2004–2019) utilizing the National Cancer Database. The primary outcome was time from diagnosis to a composite endpoint of any medical or surgical intervention. Cox proportional hazards models were developed to evaluate the associations between sociodemographic and geographic factors and time to intervention. Sub-analysis was performed to analyze time to surgery in patients with non-metastatic disease.

Results:

We identified 2,156 subjects treated for ACC, of whom 58.3% were female and 84.7% were White. The median age was 55 years (IQR 44 – 65). Most patients were privately insured (54.3%). Across the cohort, 65.3% underwent surgical resection, 59.2% received chemotherapy, and 20.8% received radiation therapy. The median time from diagnosis to first treatment course was 27 days (95% CI 26 – 28). On multivariable analysis increasing age (HR 0.993, 95% CI 0.987 – 1.000, p=0.046), Black race (HR 0.777, 95% CI 0.647 – 0.934, p=0.007), and treatment by a low-volume facility (HR 0.769, 95% CI 0.600 – 0.986, p=0.038) were associated with longer time to receiving care, whereas female sex (HR 1.125, 95% CI 1.012 – 1.252, p=0.030) was associated with more expedient care. In patients with non-metastatic disease managed operatively, median time to surgery was 29 days (95% CI 27 – 31). On multivariable Cox analysis, only treatment at a low volume facility was associated with longer time to surgical care (HR: 0.454, 95% CI 0.272 – 0.759, p=0.003).

Conclusions: ACC is an aggressive disease process and care should be managed expediently. Advanced age, male sex, Black race, and treatment at a low volume facility were associated with longer time to care; further steps should be taken to improve expedient access to cancer care for these populations.

Learning Objectives:

  • define time to surgery in adrenocortical carcinoma by sociodemographic factors such as age, race, sex, and geography.
  • reflect on the significance of disparities in time to medical and surgical care for ACC and how they may influence overall outcomes.
  • recognize that, in ACC, oncologic care via low-volume facilities may not be delivered as expediently as through high-volume facilities.