Abstract
ObjectivesThe impact of insurance status on oncological outcome in patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is poorly understood.MethodsRetrospective study on 31 patients having undergone 36 CRS-HIPEC at a single institution (safety-net hospital) between 2012 and 2018. Patients were categorized as insured or underinsured. Demographics and perioperative events were compared. Primary outcome was overall survival (OS).ResultsA total of 20 patients were underinsured and 11 were insured. There were less gynecologic malignancies in the underinsured (p=0.02). On univariate analysis, factors linked to poor survival included gastrointestinal (p=0.01) and gynecologic malignancies (p=0.046), treatment with neoadjuvant chemotherapy (p=0.03), CC1 (p=0.02), abdominal wall resection (p=0.01) and Clavien–Dindo 3-4 (p=0.01). Treatment with neoadjuvant chemotherapy and abdominal wall resections, but not insurance status, were independently associated with OS (p=0.01, p=0.02 respectively). However, at the end of follow-up, six patients were alive in the insured group vs. zero in the underinsured group.ConclusionsIn this small, exploratory study, there was no statistical difference in OS between insured and underinsured patients after CRS-HIPEC. However, long-term survivors were observed only in the insured group.
Highlights
Peritoneal metastasis (PM) is a late presentation of malignancies that is characterized by the spread of disease throughout the peritoneum
Factors linked to poor survival included gastrointestinal (p=0.01) and gynecologic malignancies (p=0.046), treatment with neoadjuvant chemotherapy (p=0.03), CC1 (p=0.02), abdominal wall resection (p=0.01) and Clavien–Dindo 3-4 (p=0.01)
The focus on access and disparities in cancer care has revolved around the presence or absence of medical insurance coverage
Summary
Peritoneal metastasis (PM) is a late presentation of malignancies that is characterized by the spread of disease throughout the peritoneum. The cancer subtypes typically seen in this kind of spread are appendiceal, mesothelioma, primary peritoneal, gastrointestinal, and gynecologic malignancies. Amongst diseases with this manner of spread, the survival has shown to be poor without treatment [1]. Operations for PM are available in highly specialized centers that have the surgical expertise to manage these complex patients. With increasing data supporting CRS-HIPEC and many more centers providing training in the US for these procedures, this has become more widely available.
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