E.F. Simon4, C. Boutros4, M. Conces2, L.E. Hanke3, E. Steinhagen1 1University Hospitals Cleveland Medical Center/Case Western Reserve Hospitals, Division Of Colorectal, Department Of Surgery, Cleveland, OH, USA 2University Hospitals Seidman Cancer Center, Department Of Medical Oncology, CLEVELAND, OH, USA 3University Hospitals Seidman Cancer Center, Department Of Radiation Oncology, CLEVELAND, OH, USA 4University Hospitals Cleveland Medical Center, Department Of Surgery, CLEVELAND, OH, USA
Introduction: Despite being a rare disease entity, the management of anal cancer (AC) is guided by well-established treatment algorithms. Although the role of chemoradiation is variable for clinical Stage I disease, it is recommended that patients with clinical Stage II-III receive chemoradiation as their initial treatment. We aim to describe factors associated with guideline concordant care (GCC) in this population.
Methods: A retrospective analysis of patients with clinical Stage II-III AC between 2004 and 2021 was conducted using the National Cancer Database (NCDB). Patients with other stages were excluded, as were those missing data regarding staging and treatment. Patients were divided into two groups: upfront chemoradiation versus nonguideline concordant care (non-GCC). Non-GCC was subdivided into surgery as the primary treatment, no treatment, or incomplete treatment (only chemotherapy, only radiation, etc.). Demographics were compared across groups. Multivariable logistic regression models were used to investigate independent predictors of GCC.
Results: Of the 99,074 patients with AC in the NCDB, 49,095 patients met study criteria. Chemoradiation was administered to 36,471 patients (74.29%) while 12,624 received non-GCC (25.71%): 8,538 received primary surgery (17.39%), 1,463 received no treatment (2.98%) and 2,623 received incomplete treatment (5.34%). Compared to women, men had lower odds of receiving chemoradiation compared to non-GCC (OR 0.67, CI 0.64-0.70). Non-Hispanic Black (NHB) and Hispanic patients both had lower odds of receiving chemoradiation compared to white patients (OR 0.74, CI 0.69-0.80; OR 0.83, CI 0.75-0.92). Charlson-Deyo Comorbidity (CDC) score >3 was correlated with decreased odds of receiving chemoradiation (OR 0.69, CI 0.62-0.76). Increasing income increased odds of receiving chemoradiation (OR 1.11, CI 1.03-1.19), whereas treatment facility type did not impact treatment type received. A second model compared receiving any treatment (chemoradiation, surgery or incomplete treatment) to receiving no treatment. Males (OR 0.81, CI 0.72-0.91), NHB patients (OR 0.73, CI 0.60-0.88), and patients with higher CDC scores (OR 0.58, CI 0.47-0.73) had lower odds of receiving any treatment. Patients with private or government insurance had increased odds of receiving some form of treatment compared to being uninsured (OR 1.84, CI 1.37-2.46; OR 2.19, CI 1.20-3.98).
Conclusion: Almost a quarter of patients with Stage II-III AC do not receive appropriate initial treatment. Our study suggests that gender and race are associated with non-GCC. Since GCC is associated with optimal outcomes, understanding the reasons for these differences may improve outcomes for patients.