FOLFOX and FOLFIRI Use in Stage IV Colon Cancer: Analysis of SEER-Medicare Data

e18062 Background: Evidence suggests that resection of synchronous hepatic metastases (SHM) in Stage IV colon cancer is safe and can improve survival in select patients. Little is known, however, about the use of hepatic resection in this setting on a population level. Methods: A retrospective cohort study was performed of Stage IV colon cancer patients during 2000-2011 in SEER-Medicare data who had diagnosis codes confirming SHM. Univariate and multivariate logistic regression were used to identify patient factors related to receipt of hepatic resection. Results: There were 11,351 patients with colon cancer and SHM. 465 (4.1%) underwent surgical hepatic resection. The proportion increased steadily over time from 2000-2003 (3.5%) to 2009-2011 (5.1%) (p = 0.03). Patients who were older with higher comorbidity burden were less likely to undergo hepatic resection (Table 1). Additionally, the odds of hepatic resection were 30% lower for African-American patients than for white patients (OR 0.70, p = 0.05). Odds of hepatic resection were 44% lower for patients from ZIP Codes with > 20% poverty than for patients from areas with < 5% poverty (OR 0.56, p < 0.001). Interestingly, among patients who underwent no surgical treatment at all, only 12% saw a surgeon after diagnosis. This number increased over time from 7.7% in 2000 to 15.9% in 2011 (p < 0.001). Similar disparities noted above were seen with regard to being evaluated by a surgeon. Conclusions: Despite evidence supporting the safety and efficacy of hepatic resection in the setting of SHM, few patients are seen by surgeons and go on to receive hepatic surgery. Additionally, access to hepatic resection is notably lower for African Americans and patients from areas with higher poverty rates. [Table: see text]

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Medical oncology referral and systemic therapy of patients with advanced stage urothelial carcinoma

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2020-0093 ◽

2020 ◽

Vol 9 (13) ◽

pp. 945-957

Author(s):

Abdalla Aly ◽

Courtney Johnson ◽

Yunes Doleh ◽

Rahul Shenolikar ◽

Marc F Botteman ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Medical Oncology ◽

Stage Iv ◽

Care Physician ◽

Older Age ◽

Medical Oncologist ◽

Negatively Associated ◽

Medicare Data ◽

Adjusted Model ◽

Timely Referral

Aim: To understand physician visit patterns among patients with stage IV (including nonmetastatic [M0] and metastatic [M1] disease) urothelial carcinoma (UC) and understand factors associated with a timely referral to a medical oncologist and systemic treatment. Patients & methods: Retrospective analysis of Surveillance, Epidemiology and End Results-Medicare data. Results: First physician encounter was with a urologist (M0: 69%; M1: 53%) or primary care physician ([PCP]; M0: 19%, M1: 25%) for the majority of patients around UC diagnosis. After the index urologist encounter, most patients had a subsequent medical oncologist visit at a median of 52 days (M0: 69.5 days, M1: 33 days). In an adjusted model, older age, index PCP visit, higher comorbidities and M0 disease were negatively associated with a medical oncologist referral. Among those referred to a medical oncologist, older age, Hispanic or non-Hispanic Black race and not being married were negatively associated with subsequent chemotherapy receipt (p < 0.05). Conclusion: Many patients with advanced UC encounter multiple specialists during their disease course. Older patients or those with a first UC-related encounter with a PCP are less likely to be referred to medical oncology. Once referred to medical oncology, social determinants, including race and marital status, are relevant predictors of receiving chemotherapy.

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Comparative effectiveness of primary tumor resection in patients with stage IV colon cancer

Cancer ◽

10.1002/cncr.30230 ◽

2016 ◽

Vol 123 (7) ◽

pp. 1124-1133 ◽

Cited By ~ 26

Author(s):

Zeinab Alawadi ◽

Uma R. Phatak ◽

Chung-Yuan Hu ◽

Christina E. Bailey ◽

Y. Nancy You ◽

...

Keyword(s):

Colon Cancer ◽

Primary Tumor ◽

Comparative Effectiveness ◽

Tumor Resection ◽

Stage Iv ◽

Primary Tumor Resection

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Metastatic patterns and survival outcomes in patients with stage IV colon cancer: A population‐based analysis

Cancer Medicine ◽

10.1002/cam4.2673 ◽

2019 ◽

Vol 9 (1) ◽

pp. 361-373 ◽

Cited By ~ 7

Author(s):

Jiwei Wang ◽

Song Li ◽

Yanna Liu ◽

Chunquan Zhang ◽

Honglang Li ◽

...

Keyword(s):

Colon Cancer ◽

Stage Iv ◽

Population Based ◽

Survival Outcomes ◽

Metastatic Patterns

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Spending for Advanced Cancer Diagnoses: Comparing Recurrent Versus De Novo Stage IV Disease

Journal of Oncology Practice ◽

10.1200/jop.19.00004 ◽

2019 ◽

Vol 15 (7) ◽

pp. e616-e627 ◽

Cited By ~ 1

Author(s):

Michael J. Hassett ◽

Matthew Banegas ◽

Hajime Uno ◽

Shicheng Weng ◽

Angel M. Cronin ◽

...

Keyword(s):

Advanced Cancer ◽

Cancer Diagnosis ◽

De Novo ◽

Stage Iv ◽

Absolute Difference ◽

Medicare Data ◽

Stage Iv Disease ◽

De Novo Cancer ◽

Payment Models ◽

Diagnosis Age

PURPOSE: Spending for patients with advanced cancer is substantial. Past efforts to characterize this spending usually have not included patients with recurrence (who may differ from those with de novo stage IV disease) or described which services drive spending. METHODS: Using SEER-Medicare data from 2008 to 2013, we identified patients with breast, colorectal, and lung cancer with either de novo stage IV or recurrent advanced cancer. Mean spending/patient/month (2012 US dollars) was estimated from 12 months before to 11 months after diagnosis for all services and by the type of service. We describe the absolute difference in mean monthly spending for de novo versus recurrent patients, and we estimate differences after controlling for type of advanced cancer, year of diagnosis, age, sex, comorbidity, and other factors. RESULTS: We identified 54,982 patients with advanced cancer. Before diagnosis, mean monthly spending was higher for recurrent patients (absolute difference: breast, $1,412; colorectal, $3,002; lung, $2,805; all P < .001), whereas after the diagnosis, it was higher for de novo patients (absolute difference: breast, $2,443; colorectal, $4,844; lung, $2,356; all P < .001). Spending differences were driven by inpatient, physician, and hospice services. Across the 2-year period around the advanced cancer diagnosis, adjusted mean monthly spending was higher for de novo versus recurrent patients (spending ratio: breast, 2.39 [95% CI, 2.05 to 2.77]; colorectal, 2.64 [95% CI, 2.31 to 3.01]; lung, 1.46 [95% CI, 1.30 to 1.65]). CONCLUSION: Spending for de novo cancer was greater than spending for recurrent advanced cancer. Understanding the patterns and drivers of spending is necessary to design alternative payment models and to improve value.

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Single-Incision Laparoscopic Colectomy for Colon Cancer: Experiences with 308 Consecutive Cases

The American Surgeon ◽

10.1177/000313481808400432 ◽

2018 ◽

Vol 84 (4) ◽

pp. 565-569 ◽

Cited By ~ 1

Author(s):

Yasumitsu Hirano ◽

Masakazu Hattori ◽

Kenji Douden ◽

Chikashi Hiranuma ◽

Yasuo Hashizume ◽

...

Keyword(s):

Colon Cancer ◽

Single Incision ◽

Survival Rates ◽

Stage Iv ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Oncologic Outcomes ◽

Single Incision Laparoscopic Surgery ◽

Intention To Treat

Single-incision laparoscopic surgery (SILS) has been developed with the aim to further reduce the invasiveness of conventional laparoscopy. Our experiences with more than 300 consecutive patients with SILS for colon cancer are reviewed, and its outcomes are evaluated to determine the midterm clinical and oncologic safety of SILS for colon cancer in a community hospital. A single surgeon's consecutive experience of SILS for colon cancer is presented. Three hundred and eight patients were treated with the SILS procedure for colon cancer between December 2010 and March 2015. Data were analyzed according to intention to treat. Of these 308 patients, 19 (6.2%) were converted to laparotomy. Intraoperative injury occurred in five patients. Postoperative complications occurred in 19 patients (6.2%). The 2-year relapse-free survival rates of patients with Stage I, Stage II, and Stage III were 97.8, 92.2, and 80.4 per cent, respectively, and the 2-year overall survival rates of patients with Stage I, Stage II, Stage III, and Stage IV were 100, 95.7, 93.0, and 74.4 per cent, respectively. Our initial experiences showed that SILS colectomy for cancer can be performed safely and with good short-term oncologic outcomes by a skilled surgeon.

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Is primary tumor location an independent prognostic factor in stage IV colon cancer?

Journal of the Anus Rectum and Colon ◽

10.23922/jarc.2019-006 ◽

2019 ◽

Vol 3 (4) ◽

pp. 196-202

Author(s):

Sachio Yokoyama ◽

Hideo Baba

Keyword(s):

Colon Cancer ◽

Prognostic Factor ◽

Primary Tumor ◽

Stage Iv ◽

Tumor Location ◽

Independent Prognostic Factor ◽

Primary Tumor Location

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Utilization and outcomes of primary tumor surgery for stage IV colon cancer in the United States: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.3542 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 3542-3542

Author(s):

Yvonne Sada ◽

Zhigang Duan ◽

Hashem El-Serag ◽

Jessica Davila

Keyword(s):

Colon Cancer ◽

Logistic Regression ◽

Primary Tumor ◽

Proportional Hazards ◽

Stage Iv ◽

The United States ◽

Cox Proportional Hazards ◽

Tumor Surgery ◽

Cancer Specific Survival ◽

Co Morbidity

3542 Background: Stage IV colon cancer treatment may include resection of the primary tumor. Current use of primary tumor surgery (PTS) in clinical practice is unknown. This study examined utilization and determinants of PTS and evaluated its effect on survival. Methods: Using national Surveillance, Epidemiology, and End Results registry data, stage IV colon cancer patients diagnosed from 1998-2008 were identified. Data on demographics, PTS, and tumor features were collected. Temporal changes in receipt of PTS were examined over 3 periods (1998-2000, 2001-2004, 2005-2008). Multiple logistic regression was used to identify significant determinants of PTS. 1- and 3-year cancer-specific survival was calculated in PTS and non-PTS patients. Cox proportional hazards models examined the effect of PTS on mortality risk. Results: 16,029 patients were identified. Median age was 69 (IQR: 57-78), and 50% were male. Approximately 67% of patients received PTS. Receipt of PTS significantly declined from 72% in 1998-2000 to 68% in 2001-2004, and 63% in 2005-2008 (p<0.01). Results from the logistic regression analysis showed that patients who were younger, white, married, had right sided cancer and higher tumor grade were more likely to receive PTS (all p<0.01). The 1- and 3-year survival was higher in patients who received PTS compared with those who did not (1-year: 55% (95% CI: 54-56) vs. 24% (95% CI: 23-26); 3-year: 19% (95% CI: 19-20) vs. 4% (95%CI: 3.4-4.9)). Adjusted for demographics and tumor features, risk of mortality was 54% (HR=0.46; 95% CI: 0.44-0.48) lower in patients who received PTS than those without PTS. Recent year of diagnosis (HR=0.88; 95% CI: 0.75-0.80) and being married (HR=0.90, 95% CI: 0.86-0.95) were associated with lower mortality. Older age (HR=1.48; 95% CI: 1.39-1.56), black race (HR=1.09; 95% CI: 1.03-1.15), right sided cancer (HR=1.21; 95% CI: 1.17-1.26), and poorly differentiated tumors (HR= 1.62; 95% CI: 1.46-1.80) were associated with increased mortality. Conclusions: PTS utilization for stage IV colon cancer has significantly declined, yet survival was higher in patients who received PTS. However, these findings are limited by the absence of co-morbidity and chemotherapy data.

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Choice of therapy and time to first treatment for patients with colon cancer: A National Cancer Database analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e14642 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e14642-e14642

Author(s):

David C. Olson ◽

Khaled Mohamed Abou El-Ezz ◽

Peter T. Silberstein

Keyword(s):

Colon Cancer ◽

Stage Iv ◽

Standard Of Care ◽

Insurance Status ◽

National Cancer Database ◽

Veteran Affairs ◽

Treatment Data ◽

Medicare Patients ◽

Time To First Treatment ◽

To Receive

e14642 Background: Insurance status has been shown to affect adherence to guidelines in the treatment of colon cancer1. This study aims to investigate trends in management of colon cancer and time to first treatment in patients with various insurance types using the National Cancer Database (NCDB). Methods: Treatment data for 845,121 patients and time to first treatment data for 497,993 patients diagnosed with colon cancer between 2000 and 2010 were identified using the NCDB. Reported utilization of treatment and time to first treatment were analyzed by insurance status. Results: Among all stages of colon cancer, no treatment was received more often by Veteran Affairs (10.5%) and Medicare (10.9%) patients than uninsured (8.8%), managed care (4.5%), private insurance (4.7%), Medicaid (8.4%) or Medicare with supplement (7.7%). Among stage I colon cancer, surgery was received less often by uninsured (90.9%) than other insurance types. Stage III colon cancer patients enrolled in Medicare with/without supplement received chemotherapy less often than other insurance types (49.9% and 46%). Stage IV Medicare patients with/without supplement also received chemotherapy less than other insurance types (59.5% and 52.9%). Surgery as monotherapy was the most common treatment received among all insurance types and stages. More uninsured patients received treatment within 3 days than any other insurance types (61%). A delay of at least 17days occurred more in Veteran Affairs patients than other insurance types (40.6%). Conclusions: This is the largest study to date to have examined treatment trends and time to first treatment. Among all insurance types, Medicare without supplement and Veteran Affairs patients were most likely to receive no treatment. Uninsured were less likely to receive the standard of care treatment with stage I cancers. Medicare patients were less likely to receive the standard of care for stage III and stage IV cancers than other insurance types. Veteran Affairs patients had treatment delayed significantly more than other insurance types. Future studies are needed to assess factors leading to receipt of substandard care.

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