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15-03-2017 | Gastrointestinal cancer | News | Article

Multimodal care alignment key in rectal cancer outcome

medwireNews: Patients are less likely to complete radiotherapy for rectal adenocarcinoma if treatment is performed at a different facility to their surgery, US study data show.

Incomplete surgery was also associated with increased long-term mortality, the researchers say.

This suggests that “alignment of multidisciplinary therapy within 1 health system may be important for patient longevity,” Kyle Freischlag (Duke University School of Medicine, Durham, North Carolina) and colleagues remark.

Their analysis included 17,600 adults (median age 59 years, 62% men) with stage II to III rectal adenocarcinoma from the 2006–2012 US National Cancer Database who received neoadjuvant chemoradiotherapy.

Of these, 874 (5%) received an incomplete dose of neoadjuvant radiation (<45.0 Gy), at a median level of 34.2 Gy.

As reported in JAMA Surgery, overall survival at the 5-year follow-up was significantly better among patients who received a complete course of radiotherapy (45.0–50.4 Gy) than among those who received an incomplete course, with estimated survival probabilities of 73.2% and 63.0%, respectively.

The team found that resection margin positivity, permanent colostomy rate, 30-day readmission rate, and 90-day mortality were similar regardless of whether patients had received a complete versus incomplete radiation dose.

But, after adjustment for demographic, clinical, and tumor characteristics, patients who received a complete radiation dose had a significant 30% lower risk for long-term mortality than did those who received an incomplete dose.

Women were a significant 31% less likely to complete radiotherapy than men, while patients who received radiotherapy and surgery at different facilities were 28% less likely to complete radiotherapy than those who received both treatments at the same facility.

By contrast, the type of hospital used for treatment – academic, community, or specialized cancer center – did not have any significant effect on the likelihood of completing radiotherapy, which suggests that “continuity of care in one facility, regardless of facility type, should be emphasized in radiotherapy of patients with rectal cancer,” Freischlag et al comment.

Age, race, cancer stage, Charlson-Deyo score, rurality, income, and educational level also had no significant effect on the continuity of radiotherapy, but patients who had private health insurance were a significant 60% more likely to complete the treatment regimen than those with no insurance.

The researchers say that their findings are “in concordance with the results seen in other cancers when preoperative treatment was interrupted.”

However, they caution that they were “unable to delineate between patients receiving short-course vs long-course radiotherapy,” which may affect their findings because short-course radio therapy is “less expensive and more convenient for patients, which may improve adherence.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2017 Springer Healthcare part of the Springer Nature group