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Evaluating disparities in delivery of neoadjuvant guideline‐based chemoradiation for rectal cancer: A multicenter, propensity score‐weighted cohort study
Author(s) -
Lau Lung W.,
Kethman William C.,
Bingmer Katherine E.,
Ofshteyn Asya,
Steinhagen Emily,
Charles Ronald,
Dietz David,
Stein Sharon L.
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26572
Subject(s) - medicine , guideline , colorectal cancer , propensity score matching , cancer , radiation therapy , stage (stratigraphy) , oncology , neoadjuvant therapy , cohort , breast cancer , pathology , paleontology , biology
Background Despite guideline recommendations, some patients still receive care inappropriate for their clinical stage of disease. Identification of factors that contribute to variation in guideline base care may help eradicate disparities in the treatment of early and locally advanced rectal cancer. Methods The American College of Surgeons National Cancer Database from 2010 to 2015 was analyzed with propensity score weighting to identify factors associated with delivery and omission of neoadjuvant guideline‐based chemoradiation (GBC) for those with early and locally advanced rectal cancer. Results Only 74% of patients with rectal cancer received stage‐appropriate neoadjuvant chemoradiation; 4544 (88%) of those with early stage disease and 8675 (68%) in locally advanced disease. Chemotherapy and radiotherapy were not planned in 27% and 34% respectively, of those who did not receive GBC. Factors associated with receipt of non‐guideline‐based neoadjuvant chemoradiation were age >65 years, Medicare insurance, treatment at a community facility, West‐South‐Central geography, having locally advanced disease, and Charlson–Deyo score >3. Receipt of ideal guideline‐based neoadjuvant chemoradiation conferred a survival benefit at 5 years. Conclusion Patient and non‐patient factors contribute to disparities in guideline‐based delivery of neoadjuvant chemoradiation in the treatment of rectal cancer. Identification of these risk factors are important to help standardize care and improve survival outcomes