Abstract
36 Background: Studies have demonstrated disparities in health care driven by socioeconomic factors. Patients with metastatic cancer represent the most vulnerable group of cancer patients. We hypothesized that these factors impact timeliness to chemotherapy in patients with metastatic colon cancer and their treatment outcomes. Methods: We queried the National Cancer Database (NCDB) for patients with metastatic colon cancer (AJCC pathologic stage4) diagnosed from 2004-2016. We selected patients treated with chemotherapy as first line treatment within 90 days of diagnosis. Time to initiation (TTI) was defined as time in days (d) from diagnosis of cancer to initiation of systemic chemotherapy and survival was measured in terms of months (m) from the day of diagnosis. Stepwise negative binomial regression and Cox proportional hazard models were used for analysis. Results: We identified 11,764 patients meeting the eligibility criteria. Median age was 62 (range 18-90) years and included 51% males. Median TTI was 9d (range 1-89) and median overall survival was 24.3m. TTI was significantly associated with race - Caucasian 26.4d (95% CI 25.6-27.1) vs. African American 28.9d (26.9-31.0) p-value=0.021, Median income - ≥ $63,000 23.5d (95% CI 22.4 – 24.5) vs.< $38,000 29.2d (27.3 – 31.0) p-value < 0.0001, Facility type – Community cancer center 23.6d (95% CI 21.6-25.6) vs. Academic/research program 26.5d (95% CI 25.5 – 27.4) p-value=0.014. Factors impacting survival in a multivariate model included time to chemotherapy initiation – 24.7m with TTI ≤ 9d vs. 23.8m with TTI > 9d (p-value <0.0001), type of facility – Academic/research program 26.4m vs. community cancer center 21.3 (p-value <0.0001), age (p-value <0.001), comorbidities (p-value <0.0001) and site of primary. Conclusions: Patients with metastatic cancer are not free from disparities driven by social determinants of health that impact their outcomes. The findings suggest that further studies to identify barriers to healthcare access and continued efforts to improve them are warranted.
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