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. 2022 Oct;29(11):6593-6602.
doi: 10.1245/s10434-022-11949-8. Epub 2022 May 31.

Socioeconomic Barriers to CRS HIPEC for Appendiceal Cancer within a Regional Academic Hospital System

Caroline Rieser  1 , Heather Phelos  2 , Amer Zureikat  1 , James Pingpank  1 , Melanie Ongchin  1 , Andrew Lee  1 , Joshua Brown  2 , M Haroon Choudry  1 , Richard S Hoehn  3
Affiliations

Socioeconomic Barriers to CRS HIPEC for Appendiceal Cancer within a Regional Academic Hospital System

Caroline Rieser et al. Ann Surg Oncol. 2022 Oct.

Abstract

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.

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Conflict of interest statement

Conflict of Interest: There are no conflicts of interest for the authors of this manuscript.

Figures

Figure 1:
Figure 1:
Study flow diagram. SES: Socioeconomic Status; CRS HIPEC: Cytoreductive Surgery Hyperthermic Intraperitoneal Chemoperfusion; PM: Peritoneal Metastases.
Figure 2:
Figure 2:. 2 Hour Drive Time Analysis Cohort:
Map of facilities and patients. CRS HIPEC facility (dark purple heart) and other facilities (purple heart) are shown in relation to patient zip code (black diamond). 1-, 2-, and 3-hour driving distance from CRS HIPEC facility depicted by areas shown in purple.
Figure 3:
Figure 3:
Survival Analysis by Socioeconomic Status (SES). A) Overall survival for the whole cohort. B) Overall survival for patients who underwent CRS HIPEC.
See this image and copyright information in PMC

Comment in

References

    1. Kirkegård J, Ladekarl M, Fristrup CW, Hansen CP, Sall M, Mortensen FV. Urban versus rural residency and pancreatic cancer survival: A Danish nationwide population-based cohort study. PLoS One. 2018;13(8):e0202486. doi: 10.1371/journal.pone.0202486 - DOI - PMC - PubMed
    1. Lee RM, Liu Y, Gamboa AC, et al. Race, ethnicity, and socioeconomic factors in cholangiocarcinoma: What is driving disparities in receipt of treatment? J Surg Oncol. Sep 2019;120(4):611–623. doi: 10.1002/jso.25632 - DOI - PMC - PubMed
    1. Lutfi W, Zenati MS, Zureikat AH, Zeh HJ, Hogg ME. Health Disparities Impact Expected Treatment of Pancreatic Ductal Adenocarcinoma Nationally. Ann Surg Oncol. Jul 2018;25(7):1860–1867. doi: 10.1245/s10434-018-6487-5 - DOI - PubMed
    1. Shapiro M, Chen Q, Huang Q, et al. Associations of Socioeconomic Variables With Resection, Stage, and Survival in Patients With Early-Stage Pancreatic Cancer. JAMA Surg. Apr 2016;151(4):338–45. doi: 10.1001/jamasurg.2015.4239 - DOI - PubMed
    1. Hoehn RS, Rieser CJ, Winters S, et al. A Pancreatic Cancer Multidisciplinary Clinic Eliminates Socioeconomic Disparities in Treatment and Improves Survival. Ann Surg Oncol. Feb 1 2021;doi: 10.1245/s10434-021-09594-8 - DOI - PMC - PubMed

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