439 Predictors of Treatment Pathway Completion in Stage IV Rectal Cancer: A Nationwide Observational Study of 15,727 Patients

Abstract

Abstract Aim Stage IV rectal cancer carries a 10% 5-year survival rate. Curative-intent management requires treatment of both the primary and metastatic disease. This study aimed to identify patterns in stage IV rectal cancer treatment pathway at population level across the UK, and to identify predictors of treatment pathway completion. Method Patient demographics and treatment data were extracted from the UK Colorectal Cancer Intelligence Hub’s CORECT-R repository, national chemotherapy (SACT), and radiotherapy (RTDS) datasets. Treatment pathway completion was defined as receipt of intervention to the primary tumour (radiotherapy and/or surgery) in addition to metastasis-directed therapy (surgery, radiotherapy, OR ablation), or the combination alongside chemotherapy. Multivariable logistic regression analysis was performed to identify independent predictors of treatment completion. Results A total of 15,727 patients with stage IV rectal cancer diagnosed between 2010-19 were identified. Multivariable analyses showed that sex, age, number of cancer alliances (CAs) attended, ethnicity, and deprivation score were all statistically significant in predicting completion of treatment (p-values<0.02). The number of CAs attended was identified as having the strongest predictive effect of treatment completion (OR=3.9, CI: 3.5–4.3). Being male also increased the odds of completing treatment (OR=1.2, CI: 1.1-1.3), while increased deprivation reduced odds of completing treatment. Conclusions Across the UK, there is variation in Stage IV rectal cancer patients completing treatment for both their primary and metastatic disease. Further work is needed to determine whether differences in treatment pathways stem from variation in access to specialist services between alliances or whether they are due to differences in MDT decision making.