Disparities in treatment and survival for patients with isolated colorectal liver metastases

Abstract

BackgroundSurgical resection improves survival for patients with isolated colorectal liver metastasis. National studies on the disparities related to this topic are limited; therefore, we investigated factors that affect surgical treatment and survival. MethodsWe queried the National Cancer Database (2010–2017) for patients with isolated synchronous colorectal liver metastasis. Multivariable logistic regression and Cox proportional hazard regressions were used to identify factors associated with surgical resection, treatment at high-volume facilities, and overall survival. ResultsOf 34,050 patients with isolated colorectal liver metastasis, surgical resection (n = 7,810; 23.0%) was more likely among patients who were of high socioeconomic status (odds ratio = 1.16; 95% confidence interval, 1.04–1.31), traveled long distance for treatment (odds ratio = 1.48; 95% confidence interval, 1.31–1.66), and were treated at high-volume facilities (odds ratio = 4.86; 95% confidence interval, 14.45–5.30). Black patients were less likely to undergo resection (odds ratio = 0.75; 95% confidence interval, 0.69–0.82). Treatment at high-volume facility was more common among patients who were Black (odds ratio = 1.14; 95% confidence interval, 1.07–1.21), were of high socioeconomic status (socioeconomic status index 7: odds ratio = 1.21; 95% confidence interval, 1.11–1.31), and traveled long distance (odds ratio = 4.03; 95% confidence interval, 3.63–4.48) and less likely for nonmetropolitan residents and those of low socioeconomic status (P < .05). Patients of high socioeconomic status and those who traveled long distance, were treated at high-volume facilities, underwent surgical resection, and received perioperative chemotherapy had an associated survival advantage (P < .05 for all), whereas Black race was associated with poorer overall survival (P < .05). ConclusionNonmedical patient factors, such as race, socioeconomic status, and geography, are associated with treatment and survival for isolated colorectal liver metastases. Disparities persist after adjusting for surgical resection and treatment facility. These barriers must be addressed to improve care for vulnerable cancer patients.