1 / 22

Treatment of Stage IV Colon Cancer in the US: A Patterns of Care Analysis

This study analyzes the treatment patterns for Stage IV colon cancer in the US, examining patient, tumor, hospital factors influencing regimens. Results show variations by region, demographics, and tumor characteristics.

lalbert
Download Presentation

Treatment of Stage IV Colon Cancer in the US: A Patterns of Care Analysis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Treatment of Stage IV Colon Cancer in the US: A Patterns of Care Analysis Xiang Gao1, Amanda Kahl2 ,Paolo Goffredo1, Imran Hassan1, Mary Charlton2 1University of Iowa, Department of Surgery; 2University of Iowa, College of Public Health NAACCR/IACR Combined Annual Conference 2019

  2. Disclosures • The authors have nothing to disclose

  3. Background - Colon Cancer • 3rd most common cancer diagnosis • 3rd leading cause of cancer-related deaths • Lifetime risk • Men: 1 in 22 • Women: 1 in 24 • Stage IV 5-year survival: 14% • 77-90% present with unresectable disease Source: American Cancer Society. https://www.cancer.org/cancer/colon-rectal-cancer.html

  4. Background - SEER POC 2014

  5. Background - Stage IV Treatment Tumor resection, metastasectomy, neo/adjuvant chemotherapy Chemotherapy + biologics, then re-evaluate Chemotherapy + biologics Chemotherapy + biologics Colon resection if: imminent risk of obstruction, significant bleeding, perforation, or other significant tumor symptoms

  6. Objective Examine the patient, tumor, and hospital factors associated with treatment regimens in stage IV colon cancer.

  7. Methods - Study Population • Patients aged >20 years • Diagnosed in 2014 • Stage IV colon- first and only cancer • Sampling proportionate to registry size • Connecticut, New Jersey, Iowa, Detroit, Kentucky, Louisiana, Atlanta, California, Hawaii, New Mexico, Seattle, Utah • Oversampling of racial minorities

  8. Methods - Treatment Variables Treatment variables: • Primary tumor resection (PTR, yes/no) • Radiation (yes/no) • Chemotherapy • Targeted biologic agents Treatment groups: • Resection plus chemotherapy • Chemotherapy only • Given within 7 weeks of diagnosis • Resection only • No treatment

  9. Methods - Additional Variables • Charlson Index • SEER Registry region: • Northeast: Connecticut, New Jersey • North Central: Iowa, Detroit • South: Kentucky, Louisiana, Atlanta • West: California, Hawaii, New Mexico, Seattle, Utah

  10. Methods - Statistical Analysis • Treatment patterns by SEER region • Chi-square tests • Patient, tumor, hospital/region characteristics by treatment • Multinomial logistic regression • Patient, tumor, hospital/region characteristics by treatment with chemotherapy only as reference group • Overall survival • Kaplan-Meier • Cox proportional hazards

  11. Results SEER 18 Registry POC patients diagnosed with stage IV colon cancer in 2014 (N=1445) Exclude histologies that are not malignant neoplasm, carcinoma, adenocarcinona, mucinous adenocarcinoma, or signet ring cell carcinoma N=38 Stage IV adenocarcinoma of colon (N=1407)

  12. Results - Overall Population Surgery to metastasis 28%

  13. Results - Patterns of Treatment by Region

  14. Results - Univariable Analysis by Treatment Group Patient Demographics Age at diagnosis Sex Race Insurance status Marital status Hospital/registry characteristics Registry Region Hospital bed size Residency program status Clinical characteristics Charlson Index Perforation Obstruction Treatment variables PTR and chemotherapy sequence Surgery to metastasis Radiation Chemotherapy VEGF inhibitor EGFR inhibitor Tumor characteristics Histology Grade T, N, M stages KRAS, BRAF status MSI

  15. Results - Multinomial Regression Factors associated with PTR + Chemotherapy (vs chemotherapy only)

  16. Results- Results - Multinomial Regression Factors associated with PTR only (vs chemotherapy only)

  17. Results - Multinomial Regression Factors associated with no treatment (vs chemotherapy only)

  18. Results - Kaplan Meier Overall Survival Median survival PTR + Chemotherapy: >24 months Chemotherapy Only: 14 months PTR only: 5 months No treatment:2 months

  19. Results - Cox Proportional Hazards Adjusted for: Age, sex, race, insurance status, marital status, Charlson Index, SEER region, hospital bed size, hospital residency status, tumor histology, grade, T, N, and M stages, KRAS, BRAF, MSI, perforation, obstruction, surgery to metastasis

  20. Summary PTR + Chemo • Node positive • Lower metastatic burden • + perforation • + obstruction • Married • Small, non-academic hospitals PTR only • Advanced T, N • Lower metastatic burden • + perforation • + obstruction • Older • Medicaid • Small hospitals No treatment • Unknown genetic markers • Older • African American 57% of patients received PTR (+/- chemotherapy)

  21. Conclusions • Resection is frequently used in treatment of stage IV colon cancer • Resection should be reserved to severe symptoms or curative intent • Variation in treatment patterns by hospital factors • Support for guideline implementation may be particularly beneficial in small, non-academic hospitals • Variation in treatment patterns by race, insurance status, age • Efforts that identify/address barriers to care, patient education

  22. Thank you

More Related