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DISPARITIES IN SURGICAL CARE OF COLORECTAL LIVER METASTASES
Ashley E. Martinez
*1, Alexis Webber
2, Sandra Dibrito
21Albany Medical College, Albany, NY; 2Albany Medical Center, Albany, NY
Background: Up to 25% of colorectal cancer patients present with liver metastases (CRLM) and 50% develop metastases over time. Surgical management of CRLM can be curative, but certain demographic and socioeconomic factors disproportionately hinder vulnerable patient populations from receiving advanced surgical care.
Methods: We queried the 2011-2021 National Cancer Database for cases of CRLM. We explored patient and facility characteristics associated with receipt of surgery vs. no surgery for metastatic liver lesions.
Results: Out of 67225 cases, 18.0% underwent hepatectomy. Surgery rates were higher among Non-Hispanic White (NHW) patients compared to Non-Hispanic Black (NHB) and Hispanic/Latino (HL) patients (Table 1, p<0.001). Surgery rates declined with lower income and education quartiles, and were lower for patients with no insurance or government insurance compared to those with private insurance (Table 1). Academic programs had higher surgery rates than community cancer programs (p<0.001). Patients receiving surgery traveled farther than non-surgery care (Table 1). Controlling for patient and center level factors, multivariable analysis showed NHB and HL patients were less likely to undergo liver surgery compared to NHW patients (OR:0.81, 95%CI [0.77-0.87]; OR:0.90, 95%CI [0.83-0.97]). Patients treated at academic programs had significantly higher odds of surgery compared to community cancer programs (OR:2.3, 95%CI [2.11-2.50]). Patients with private or government insurance had higher odds of surgery compared to uninsured patients (OR:2.0, 95%CI [1.79-2.23], OR:1.60, 95%CI [1.43-1.80]). Highest income quartile patients were more likely to have surgery than the lowest quartile (OR:1.18, 95%CI [1.09-1.28]).
Conclusion: Surgical management of CRLM is necessary to achieve cure for appropriately selected patients. However, access to surgical care is not equally distributed amongst patient populations. Significant socioeconomic and demographic disparities exist in access to surgical care amongst CRLM patients and require further exploration to improve resource allocation.
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