Higher poverty linked to lower rates for surgical resection in colorectal liver metastasis
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Key takeaways:
- Odds of undergoing liver metastasectomy for colorectal liver metastasis were lower in U.S. counties with higher poverty.
- County-level poverty did not correlate with surgical rates for stage I colorectal cancer.
Patients in U.S. counties with higher poverty were less likely to undergo liver metastasectomy for colorectal liver metastasis, suggesting that access to surgery for complex gastrointestinal cancers may be affected by social determinants.
“Despite its progress in prolonging survival among patients with colorectal liver metastasis (CRLM), this treatment is potentially being underutilized based on available data and estimates,” George Molina, MD, MPH, surgeon and health policy research at Brigham and Women’s Hospital, and colleagues wrote in JAMA Network Open. “It is estimated that about half of all patients with CRLM who are potentially eligible for a liver metastasectomy actually receive treatment, despite curative intent surgical resection being included in the National Comprehensive Cancer Network guidelines.”
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They continued, “The association between sociodemographic factors and receipt of cancer care has been shown previously for cancers other than CRLM. Therefore, determining if geographic differences in county-level socioeconomic characteristics may, in part, explain variability in the receipt of liver metastasectomy for CRLM is important to begin to develop interventions to address issues of access.”
In a cross-sectional and county-level analysis, Molina and colleagues used data from the Surveillance, Epidemiology and End Results Research Plus database to identify 11,348 patients (56.9% men; 71.9% white) from 194 U.S. counties diagnosed with colorectal adenocarcinoma between January 2010 and December 2018. Most of the study population was aged 50 to 64 years (38.1%) or 65 to 79 years (33.6%).
Researchers also obtained 2010 county-level poverty rates from the U.S. Census to determine odds for undergoing liver metastastectomy for CRLM compared with surgical resection of stage I CRC.
According to results, the majority of primary colorectal tumors were either T3 (40.3%) or T4 (23.1%) and the mean county-level rate for liver metastasectomy over all patients with CRLM was 23.7%. The median county-level percentage below-poverty rate was 15.6%.
Bivariable analysis showed that a 10% increase in county-level poverty rate correlated with decreased odds for undergoing liver metastasectomy in patients with CRLM (OR = 0.88; 95% CI, 0.79-0.99). Following adjustment for sociodemographic, patient and tumor characteristics, the odds remained “significantly lower” in counties with a higher poverty rate per 10% increase (OR = 0.82; 95% CI, 0.69-0.96).
Surgical resection for CRC, however, was not associated with county-level poverty rates (OR = 0.97; 95% CI, 0.9-1.04).
Researchers reported similar variance between liver metastasectomy for CRLM and surgery for stage I CRC, despite the difference in mean county-level rates of surgery (0.24 and 0.75, respectively).
“These findings may highlight that access to surgical care for complex gastrointestinal cancers, like CRLM, may be partially affected by where patients live,” Molina and colleagues concluded. “County-level poverty rates may serve as a proxy for difficult-to-measure social determinants of health that impact the care that patients with CRLM receive.”
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