Liver-directed therapy can be much more effective than other treatments for patients with metastasized colorectal cancer. This study analyzes persistent disparities in the use of this treatment.
Colorectal cancer liver metastasis (CRCLM) affects approximately 25% of all colorectal cancer patients. Most of these patients have relatively short survival times of around 24 months when they undergo systemic chemotherapy alone. However, curative liver-directed therapy (LDT), which includes radiofrequency or microwave ablation, hepatectomy, and/or hepatic artery infusion chemotherapy, has a 5-year survival rate of up to 60%. Although LDT is effective for treating CRCLM, the number of patients who undergo this treatment varies. This study, published in the Annals of Surgical Oncology, analyzes patient factors that contribute to access to this type of specialty care.
Low LDT Use Found Among Medicare Patients With Colorectal Cancer
This study included Medicare beneficiaries over 65 years of age who received an initial diagnosis of colorectal cancer between 2013 and March 31, 2017, as well as an initial diagnosis of liver metastasis 60 days before or within 3 years after the initial diagnosis of colorectal cancer.
A total of 23,484 patients met the inclusion criteria, of which, 8.5% underwent LDT with hepatectomy, liver ablation, and/or hepatic artery infusion chemotherapy (HAIC). Lower odds of undergoing LDT were associated with older age, female sex, higher comorbidity burden, lower socioeconomic status, and Black race.
Persistent Disparities Require Additional Resources to Address
These findings show that although the overall rate of patients with CRCLM who undergo LDT is fairly low at under 10%, racial and socioeconomic disparities persist. Past studies have confirmed this disparity for other types of cancer, or for other treatment types. Additionally, past studies have suggested that the overall survival of Black and White patients who underwent hepatectomy was similar, and that access to care is the most likely reason for outcome disparities.
Future research should focus on finding ways to increase access to specialized centers with expertise in LDT treatment, as well as on eliminating barriers to care for patients with higher social vulnerability. The use of virtual multidisciplinary tumor boards can improve referral rates for LDT and may be one way of starting to address the problem.
Source:
Aquina, C. T., Brown, Z. J., Beane, J. D., Ejaz, A., Cloyd, J. M., Tsung, A., Adam, M. O., Pawlik, T. M., & Kim, A. (2022). Disparities in Care Access to Liver-Directed Therapy Among Medicare Beneficiaries with Colorectal Cancer Liver Metastasis. Annals of Surgical Oncology, 30(1), 335–344. https://doi.org/10.1245/s10434-022-12513-0
