BACKGROUND: Appendiceal cancer with peritoneal metastases (ACPM) is a complex disease requiring multidisciplinary care. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS HIPEC) can significantly improve survival but requires evaluation by a surgical oncologist and significant treatment endurance. The impacts of socioeconomic status (SES) and other social determinants of health on rates of surgical evaluation and treatment have not been examined. METHODS: We conducted a retrospective cohort study examining all patients with ACPM from 2010 to 2018 in a regional healthcare system. Patient characteristics, oncologic details, treatment strategies, and survival were examined. The primary outcomes of interest were referral to Surgical Oncology, receipt of CRS HIPEC, and survival. RESULTS: Of 194 patients identified, 94% had synchronous ACPM. The majority of patients (95%) were referred to surgical oncology. Advanced age was the only predictor of nonreferral (p < 0.001). A total of 147 patients (76%) ultimately underwent CRS HIPEC. After adjusting for medical and tumor characteristics, CRS HIPEC was less likely for patients who were unmarried [odds ratio (OR) 0.253, p = 0.004] or of low SES (OR 0.372, p = 0.03). On subanalysis of patients undergoing CRS HIPEC, median overall survival was worse for patients of low SES [51 months versus not reached (NR), p = 0.05], and this disparity persisted on multivariate analysis [hazard ratio (HR) = 2.278, p = 0.001]. CONCLUSIONS: This analysis is the first to evaluate barriers to CRS HIPEC for ACPM. While most patients were evaluated by a multidisciplinary team, nonmedical factors may play a role in the treatment received and ultimate outcomes. Addressing these disparities is crucial for ensuring equitable outcomes and improving patient care.
BACKGROUND: Appendiceal cancer with peritoneal metastases (ACPM) is a complex disease requiring multidisciplinary care. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS HIPEC) can significantly improve survival but requires evaluation by a surgical oncologist and significant treatment endurance. The impacts of socioeconomic status (SES) and other social determinants of health on rates of surgical evaluation and treatment have not been examined. METHODS: We conducted a retrospective cohort study examining all patients with ACPM from 2010 to 2018 in a regional healthcare system. Patient characteristics, oncologic details, treatment strategies, and survival were examined. The primary outcomes of interest were referral to Surgical Oncology, receipt of CRS HIPEC, and survival. RESULTS: Of 194 patients identified, 94% had synchronous ACPM. The majority of patients (95%) were referred to surgical oncology. Advanced age was the only predictor of nonreferral (p < 0.001). A total of 147 patients (76%) ultimately underwent CRS HIPEC. After adjusting for medical and tumor characteristics, CRS HIPEC was less likely for patients who were unmarried [odds ratio (OR) 0.253, p = 0.004] or of low SES (OR 0.372, p = 0.03). On subanalysis of patients undergoing CRS HIPEC, median overall survival was worse for patients of low SES [51 months versus not reached (NR), p = 0.05], and this disparity persisted on multivariate analysis [hazard ratio (HR) = 2.278, p = 0.001]. CONCLUSIONS: This analysis is the first to evaluate barriers to CRS HIPEC for ACPM. While most patients were evaluated by a multidisciplinary team, nonmedical factors may play a role in the treatment received and ultimate outcomes. Addressing these disparities is crucial for ensuring equitable outcomes and improving patient care.
Authors: Carlos A Munoz-Zuluaga; Mary C King; Victor S Diaz-Sarmiento; Kimberley Studeman; Michelle Sittig; Ryan MacDonald; Carol Nieroda; Katherin Zambrano-Vera; Vadim Gushchin; Armando Sardi Journal: Ann Surg Oncol Date: 2020-07-23 Impact factor: 5.344
Authors: Konstantinos Ioannis Votanopoulos; David Bartlett; Brendan Moran; Choudry M Haroon; Greg Russell; James F Pingpank; Lekshmi Ramalingam; Chandrakumaran Kandiah; Konstantinos Chouliaras; Perry Shen; Edward A Levine Journal: Ann Surg Oncol Date: 2017-12-29 Impact factor: 5.344
Authors: Rachel M Lee; Yuan Liu; Adriana C Gamboa; Mohammad Y Zaidi; David A Kooby; Mihir M Shah; Kenneth Cardona; Maria C Russell; Shishir K Maithel Journal: J Surg Oncol Date: 2019-07-13 Impact factor: 3.454
Authors: Franchesca Arias; Fan Chen; Tamara G Fong; Haley Shiff; Margarita Alegria; Edward R Marcantonio; Yun Gou; Richard N Jones; Thomas G Travison; Eva M Schmitt; Amy J H Kind; Sharon K Inouye Journal: J Am Geriatr Soc Date: 2020-08-31 Impact factor: 5.562
Authors: Samer Tohme; Christof Kaltenmeier; Patrick Bou-Samra; Patrick R Varley; Allan Tsung Journal: Ann Surg Oncol Date: 2018-07-24 Impact factor: 5.344