M. Ostrowski1, M. Mora-Pinzon2, E. He2, J. Eberhardt2, T. Saclarides2, D. Hayden2 1Loyola University Chicago,Stritch College Of Medicine,Maywood, IL, USA 2Loyola University Medical Center,Department Of Surgery,Maywood, IL, USA
Purpose:
Besides the great difference in the treatment algorithm between colon and rectal cancers, some studies suggest that rectal cancer may affect different populations than colon cancer. We will examine the variation in demographic and socioeconomic factors using a population database.
Methods:
Secondary analysis of the 2011 Nationwide Inpatient Sample (NIS) was performed. Hospital discharges were identified using ICD-9 and ICD-9-CM codes for liver metastases, colon and rectal cancer and colon and rectal resections.
Results:
There were 3758 admissions for colorectal cancer metastatic to the liver in 2011. The mean age was 62 years (22-102) and the majority of patients were male (56.5%). Patients with stage IV colorectal cancer were 62.7% white, 15.5% black, 10.2% Hispanic, 2.4% Asian/Pacific Islander and 2.2% other. During these admissions, mean length of stay was 5.8 days (0-50). 31.5% (1182) of these admissions were for patients with a primary diagnosis of liver metastasis and a secondary diagnosis of rectal cancer. Patients with stage IV rectal cancer were younger than those with colon (mean age 58.9 vs. 63.6, p=0.000) and seemed more likely to be male, but the difference was not significant (58.2% vs. 55.9% male, p=0.182). Rectal cancer patients were much more likely to be white and less likely to be black than stage IV colon cancer patients (70.0% vs. 59.4%, and 8.8% vs. 18.5%, p=0.000, respectively). They were less likely to live in large metropolitan cities (p=0.000) and more likely to come from zip codes with higher income quartiles (p=0.001). Stage IV rectal cancer patients were also more likely to have private insurance and less likely to have Medicare or Medicaid when compared to colon cancer patients. Admissions were less likely to be urgent or emergent for metastatic rectal cancer (p=0.000) and the mean length of stay was slightly but significantly shorter (5.5 vs. 5.9 days, p=0.042). The majority of these patients did not have surgery during the admission (67.4%).
Conclusion:
Our study show that stage IV rectal cancer patients have varying demographics when compared to colon cancer patients. They are younger, more likely to be white, come from higher socioeconomic status and more likely to have private insurance. Their admissions are more likely to be elective. These findings suggest that patient characteristics and environmental factors may also differentiate colon and rectal cancer when stage IV disease is present and should be considered when establishing practice parameters.