D. Goldberg1,2, J. Sharpe2, S. Williams2, W. Rosenthal2, L. Maguire3, R. Kelz1,2 3Hospital Of The University Of Pennsylvania, Department Of Colorectal Surgery, Philadelphia, PA, USA 1Hospital Of The University Of Pennsylvania, Department Of Surgery, Philadelphia, PA, USA 2University Of Pennsylvania, Center For Surgery And Health Economics, Philadelphia, PA, USA
Introduction: Endoscopic stent use for obstructing colorectal (CR) cancer is inconsistently utilized within the United States, despite evidence suggesting improved time to chemotherapy and surgical outcomes compared to up front resection, in the appropriate context. We aimed to better understand utilization of CR stents in stage IV patients both at the patient and hospital level within the US to further elucidate modern colorectal cancer care patterns.
Methods: Medicare beneficiaries age > 65.5 years old were assessed for intervention following colorectal cancer admission from 2016-2018. Demographic data, cancer stage, neoadjuvant/adjuvant treatment history, procedure performed at admission (resection/ostomy/stent), and hospital characteristics were analyzed. Multinomial regression assessed the likelihood of procedure type based on patient and hospital characteristics.
Results: There were a total of 3620 patients admitted with stage IV colorectal cancer diagnosis with a median age of 75 years (IQI 70, 82), with 80% being White, 12% Black, 49% identifying as female, 21% dual eligible and 60.4% having 3 or more comorbidities. At admission, 692 (19.1%) had a malignant bowel obstruction diagnosis. 1489 (41%) underwent CR resection, 26 (0.7%) had an ostomy created and 104 (2.8%) had a CR stent placed with significant differences in cancer treatment history across procedure type (Table 1). Endoscopic stents were more often utilized within American College of Surgeons (ACS) cancer designated hospitals (71.2%, p=0.02), American Medical Association (AMA) affiliated centers (73.1%, p<0.01) and non-teaching hospitals (61.5%, p<0.01). Patients treated at ACS cancer centers were more likely to have a CR stent placed on unadjusted analysis (OR 1.44, 95% CI 1.06-1.97) but no more likely to have a CR stent (OR 1.44, 95% CI 0.94-1.89) or ostomy created (1.23, 95% CI 0.76-1.83) following adjustment.
Conclusion: CR stenting continues to be utilized at low rates for metastatic colorectal cancer patients presenting in the US. CR stenting was more frequently performed in patients admitted to ACS cancer designated centers, AMA-affiliated hospitals, and non-teaching hospitals. Patients with stage IV CR cancer treated at ACS cancer centers were similarly likely to receive palliative stent, ostomy or resection, as those treated at non-ACS designated centers.