SSO 2022 Press Release – Disparities in Care Access to Liver-directed Therapy Among Medicare Beneficiaries with Colorectal Cancer Liver Metastasis
(Dallas—March 12, 2022; 8:30 a.m.) — Despite the well accepted role of liver-directed therapies (LDT) for colorectal cancer liver metastases (CRLM), only a small proportion of Medicare beneficiaries with CRLM undergo LDT or receive an outpatient consultation with a hepatobiliary surgeon, according to research presented at the Society of Surgical Oncology 2022 International Conference on Surgical Care.
Liver-directed therapies are important components of the multidisciplinary care of patients with colorectal cancer liver metastases that contribute to improved long-term outcomes. However, factors associated with receipt of LDT are poorly understood. To better understand this gap in oncology practice, Christopher T. Aquina, MD, MPH from the Ohio State University Wexner Medical Center, Columbus, OH, analyzed Medicare data of these patients.
Dr. Aquina identified 23,484 patients over age 65 years old diagnosed with CRLM. Patients with extrahepatic metastatic disease were excluded. Dr Aquina assessed patient factors associated with LDT, defined as hepatectomy, ablation, and/or hepatic artery infusion chemotherapy (HAIC), and outpatient consultation with a hepatobiliary surgeon.
Of 23,484 patients with isolated CRLM, only 2,004 (8.5 percent) received LDT and of those who received LDT, 61.7 percent underwent hepatectomy alone, 28.1 percent received ablation alone, 8.5 percent underwent hepatectomy and ablation, and 1.8 percent received HAIC either alone (0.8 percent) or in combination with hepatectomy and/or ablation (0.8 percent).
Of those who did not undergo LDT, only 4.7 percent had outpatient consultation with a hepatobiliary surgeon. Only 114 hospitals were considered high-volume hepatobiliary centers (defined as performing more than 20 annual hepatectomies for malignancy), and the estimated median distance to the nearest high-volume hepatobiliary center for patients was 40.4 miles (IQR=13.7-83.6). Furthermore, only 23 hospitals were identified as providing HAIC, and the median distance to the nearest HAIC center for patients was 130.2 miles (IQR=68.7-247.3). Patient factors independently associated with lower odds of LDT included older age, female sex, Black race, greater comorbidity burden, higher social vulnerability index, primary rectal cancer, synchronous liver metastasis, and further distance from a high-volume hepatobiliary center (p < 0.05).
“Despite the well accepted role of liver-directed therapies for colorectal cancer liver metastases, only a small proportion of Medicare beneficiaries with CRLM undergo LDT or receive an outpatient consultation with a hepatobiliary surgeon,” Dr. Aquina said. “Increasing access to specialized centers with expertise in LDT, particularly for Black patients, those with higher levels of social vulnerability, and long travel distances, may improve outcomes for patients with CRLM.”