Escalation of socioeconomic disparities among patients with colorectal cancer receiving advanced surgical treatment.
BACKGROUND
As tumor burden increases in colorectal cancer, treatment complexity progresses from colectomy to hepatectomy and lastly to cytoreductive surgery with heated intraperitoneal chemotherapy (CRS-HIPEC). The aim of this study was to evaluate whether disparities exist in the access to progressively more complex surgical treatment options.


METHODS
Patients undergoing surgery for colorectal cancer were grouped by treatment type: group 1 (n = 224) underwent colectomy for nonmetastatic disease, group 2 (n = 112) underwent hepatectomy for liver metastasis, and group 3 (n = 112) underwent CRS-HIPEC for carcinomatosis.


RESULTS
Whites were predominant in the HIPEC group (71.4 %) compared to the hepatectomy (67.9 %) and colectomy (57.6 %) groups (p = 0.025). The majority of the privately insured patients were in the HIPEC group (70.5 %) compared to the hepatectomy (56.2 %) and colectomy (30.4 %) groups (p < 0.0001). Distance traveled to the hospital was farthest on average in the HIPEC group (104.6 ± 258.3 km) compared to the hepatectomy (29.0 ± 28.0 km) or colectomy (26.4  ± 66.2 km) group (p < 0.0001). Mean household income also varied between the three groups, with HIPEC patients earning $56,957 (±24,124), hepatectomy patients earning $56,999 (±28,588), and colectomy patients earning ($51,518 ± 24,201) (p = 0.0503) on average per year. The HIPEC cohort contained a higher proportion of English speakers (90.2 %) than the other groups (hepatectomy 87.9 %, colectomy 85.3 %); however, this difference was not statistically significant (p = 0.43).


CONCLUSIONS
CRS-HIPEC is not accessed equally across all socioeconomic groups. Patients undergoing HIPEC were most often white, English speaking, and privately insured; had a higher mean income; and had traveled the greatest distances on average to access surgical care.
Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York, NY, USA, ptabrizian@hotmail.com.
Parissa
P
Tabrizian
Jessica
J
Overbey
Gonzalo
G
Carrasco-Avino
Emilia
E
Bagiella
Daniel M
DM
Labow
Umut
U
Sarpel
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D003082:Colectomy / Q000191:economics*; D015179:Colorectal Neoplasms / Q000191:economics / Q000208:ethnology* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006498:Hepatectomy / Q000191:economics*; D006801:Humans; D006979:Hyperthermia, Induced / Q000191:economics; D008113:Liver Neoplasms / Q000191:economics / Q000208:ethnology* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000191:economics / Q000208:ethnology* / Q000556:secondary / Q000601:surgery; D011379:Prognosis; D012959:Socioeconomic Factors