Who Undergoes Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Appendiceal Cancer? An Analysis of the National Cancer Database

Byrne, Raphael M.; Gilbert, Erin W.; Dewey, Elizabeth; Herzig, Daniel O.; Lu, Kim C.; Billingsley, Kevin G.; Deveney, Karen E.; Tsikitis, Vassiliki L.

doi:10.1016/j.jss.2019.01.039

Cited by 14 publications

(14 citation statements)

References 23 publications

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“…However, the NCDB is not population-based as it is limited to cases diagnosed or treated at Commission-on-Cancer (CoC)-accredited institutions in the United States. In a study by Byrne et al that included 18,055 patients with AC, White patients, non-Hispanic ethnicity, and private insurance were associated with receipt of CRS/HIPEC (13). However, the study included patients without peritoneal metastasis, and neighborhood-level socioeconomic characteristics were not assessed.…”

Section: Discussionmentioning

confidence: 99%

“…Several prior studies have attempted to identify and address possible disparities related to specialty care for patients with appendiceal cancer (AC)/CRC-PM. However, these analyses were largely based on single-institution data with inherent selection bias, including pre-screening of patients prior to care, type of insurance accepted, and patients already having received care at a quaternary center (12)(13)(14)(15). As such, a better understanding of how many patients with AC/CRC-PM are receiving specialty care and which patient factors are associated with access to referral and treatment using a non-biased approach remains crucial.…”

Section: Introductionmentioning

confidence: 99%

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Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States

et al. 2022

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BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38).ConclusionAn exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States

et al. 2022

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“…This is remarkable because other studies have reported proportions of 10% or less, or race was not reported ( 7 , 8 ). In a 2019 study of the National Cancer Database characterizing the patient population undergoing cytoreductive surgery and perioperative chemotherapy (defined as receipt of HIPEC at the time of surgery or intraperitoneal chemotherapy in the perioperative period) for appendiceal cancer, only 6.60% of patients were reported as Black race, and the majority, 88.2%, were reported as White race, likely disproportionately representing the diversity of the patients with appendiceal cancer ( 27 ). There is otherwise a paucity of literature characterizing the racial distribution of patients that undergo CRS and HIPEC.…”

Section: Discussionmentioning

confidence: 99%

“…However, Byrne et al. reported that in patients with appendiceal cancer, White race and non-Hispanic ethnicity were both positive predictors for receiving CRS and HIPEC (OR: 2.00, 95% CI 1.40-2.86; OR: 1.92, 95% CI 1.21-3.05, respectively) ( 27 ). Given that CRS and HIPEC are complex and highly specialized procedures primarily conducted at tertiary care centers, the level of specialization itself may potentially be contributing to lack of access to care.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Aggressive Surgical Treatment Overcome Cancer Health Inequities?

et al. 2022

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BackgroundAdvanced cancer states perpetuate health-related disparities. Peritoneal-based cancers are clinically advanced cancers that present a significant clinical dilemma. Peritoneal cancers are managed aggressively with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). While racial and ethnic disparities are prevalent in cancer, there are no studies investigating if racial disparities exist in patients with peritoneal carcinomatosis managed with CRS and HIPEC. We hypothesized that this advanced disease state further delineates racial disparities.MethodsA retrospective chart review was conducted on patients with peritoneal carcinomatosis receiving CRS and HIPEC at a single institution from January 1, 2017-October 4, 2021. Descriptive statistics were used to compare racial groups. The Cox Proportional Hazards Model and Log Rank Test were used for multivariate and overall survival analysis.ResultsIn total, 67 patients underwent CRS and HIPEC, of which 41 (61.2%) were White, 20 (29.8%) were Black, 3 (4.5%) were Asian, and 3 (4.5%) were Other race. When compared to White patients, Black patients had lower income (p=0.0011), higher incidence of hypertension (p=0.0231), and lower performance status (p=0.0441). Cancer type, including colorectal, appendiceal, ovarian, etc., was similar between groups (p=0.8703). Despite these differences in sociodemographic and morbidity factors, when comparing Black patients to White patients, there were no differences in peritoneal cancer index score (13.2 vs. 12.3, p=0.6932), estimated blood loss (748 vs. 655 mL, p=0.6332), minor/major complication rates (1.1 vs. 1.2, p=0.7281; 0.4 vs. 0.7, p=0.3470, respectively), 30-day readmission rates (25.0% vs. 17.1%, p=0.6210), disease recurrence (40.0% vs. 51.2%, p=0.3667), or 30-day mortality (0.0% vs. 2.4%, p=1.0000). Overall survival was similar for Black and White patients (p=0.2693). The occurrence of a major complication was the only factor associated with overall survival (HR 2.188 [1.502, 3.188], p< 0.0001).ConclusionsDespite differences in patient socioeconomic factors and comorbid conditions, outcomes were similar between Black and White patients receiving CRS and HIPEC at our institution. While larger studies with more diverse patient populations are needed to confirm these findings, our data provide evidence that aggressive surgical management across diverse patient populations allows for equitable outcomes.

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“…However, there is reasonable evidence in the literature of case series to suggest independent benefit in both appendiceal adenocarcinoma and mucinous neoplasms. 35 , 37 , 39 , 42 , 47 , 52 , 55 , 57 …”

Section: Intraperitoneal Chemotherapymentioning

confidence: 99%

The role of chemotherapy in the treatment of advanced appendiceal cancers: summary of the literature and future directions

et al. 2022

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Appendiceal cancer is rare and encompasses a diverse group of tumours ranging from low-grade appendiceal mucinous neoplasms to high-grade adenocarcinomas. Appendiceal cancers often spread to the peritoneal cavity causing extensive mucinous dissemination and peritoneal metastases. Prognosis varies with histological subtype. Cytoreductive surgery and heated intraperitoneal chemotherapy is well-established as the most effective treatment achieving long-term survival in some patients. Chemotherapy regimens used to treat appendiceal cancer are extrapolated from the colorectal cancer setting, but disease biology differs and outcomes are inferior. The role of chemotherapy in the treatment of appendiceal cancer remains poorly defined. There is an urgent need to develop novel tailored treatment strategies in the perioperative and unresectable setting. This review aims to evaluate the literature for patients who received intraperitoneal and systemic chemotherapy for appendiceal cancers.

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Who Undergoes Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Appendiceal Cancer? An Analysis of the National Cancer Database

Cited by 14 publications

References 23 publications

Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States

Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States

Racial Disparities in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Aggressive Surgical Treatment Overcome Cancer Health Inequities?

The role of chemotherapy in the treatment of advanced appendiceal cancers: summary of the literature and future directions

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