Abstract
BackgroundManagement of squamous cell carcinoma of the anus (SCCA) is becoming more relevant, as its incidence increases. The purpose of this study was to investigate possible differences in patient population and care delivery for SCCA between academic and community cancer programs in the United States.MethodsA review of available data from the American College of Surgeons Committee on Cancer National Cancer DataBase focused on gender, age, race, type of health insurance, comorbidity score, distance traveled for care, stage at diagnosis, and therapy utilization (surgery, chemotherapy, and radiation therapy) as first course of treatment (FCT). The analysis included 38,766 patients treated for SCCA. Of them, 14,422 patients received treatment at Academic Cancer Programs (ACPs), while 24,344 were treated at Community Cancer Programs (CCPs) between the years 2003 and 2013.ResultsOver the 11-year study period, ACPs had significantly more male patients, of younger age, a greater non-white race population, with more Medicaid or no insurance coverage, who traveled farther for cancer center care (p < 0.001). There was no difference between ACPs and CCPs with respect to Charlson co-morbidity score and stage of SCCA at diagnosis. For stage 0 patients, use of chemotherapy was 8% for ACPs, 9% for CCPs, and use of radiotherapy was 10% for ACPs and 14% for CCPs. The incidence of stage unknown was identical at both ACPs and CCPs (11.5%). CCPs had a greater overall utilization of radiation therapy as FCT for stage 0, I, II and IV patients (p < 0.001).ConclusionsOur study indicates that gender, demographic and socio-economic differences exist in the patient population with SCCA accessing different cancer programs in the US. The high incidence of stage unknown patients reflects ongoing challenges in the pre-treatment phase. A significant percentage of stage 0 patients received systemic chemotherapy and/or radiotherapy, rather than surgery alone. Despite comparable stage at diagnosis and comorbidity scores between ACPs and CCPs, there appear to be variations in treatment choices, especially with the use of radiotherapy, with associated cost and toxicity risks. Further analysis and monitoring of SCCA management in the US may lead to improved compliance with NCCN guidelines.
Highlights
Management of squamous cell carcinoma of the anus (SCCA) is becoming more relevant, as its incidence increases
We accessed data sets on “cancer of the anus, anal canal and anorectum” from 2003 to 2013, but selected for analysis only cases listed in the database with a histologic diagnosis containing the words “squamous cell carcinoma”, to ensure that our research focused on a homogeneous patient population
The male/female ratio was greater at Academic Cancer Programs (ACP): M = 6399 (44.4%)/F = 8023 (55.6%) than at Cancer Programs (CCP): M = 8831 (36.3%)/F = 15,513 (63.7%) (p < 0.0001)
Summary
Management of squamous cell carcinoma of the anus (SCCA) is becoming more relevant, as its incidence increases. The purpose of this study was to investigate possible differences in patient population and care delivery for SCCA between academic and community cancer programs in the United States. The incidence of anal cancer has been steadily increasing in the US for approximately four decades, with an estimate by the American Cancer Society of 8080 new cases and 1080 deaths in 2016 [1, 2]. Management of SCCA represents an example of coordinated multidisciplinary involvement, often including surgery, chemotherapy and radiotherapy, in order to provide accurate diagnosis, appropriate treatment and reliable survivorship plan. Such care delivery should be best accomplished within the organized and coordinated structure of an ACS CoC accredited Cancer Program. In order to have comparable sample sizes and civilian population, we chose to limit our analysis to ACPs and CCPs
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