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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2008

01-07-2008 | Gastrointestinal Oncology

Squamous Cell Carcinoma of the Anal Canal: Utilization and Outcomes of Recommended Treatment in the United States

Authors: Karl Y. Bilimoria, MD, MS, David J. Bentrem, MD, Clifford Y. Ko, MD, MS, MSHS, Andrew K. Stewart, MA, David P. Winchester, MD, Mark S. Talamonti, MD, Amy L. Halverson, MD

Published in: Annals of Surgical Oncology | Issue 7/2008

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Abstract

Background

Over the past two decades, recommended treatment for squamous cell carcinoma of the anal canal has shifted from surgery to primary chemoradiation. Resection is now reserved for persistent or recurrent disease. Our objectives were (1) to evaluate treatment trends over the past 20 years, (2) to assess contemporary treatment utilization, and (3) to examine the impact of recommended vs nonguideline treatment on survival.

Methods

From the National Cancer Data Base (1985–2005), 38,882 patients with anal canal cancer were identified. Regression models were used to assess factors associated with use of nonguideline treatment (vs chemoradiation ±surgery). Univariate and multivariate methods were used to assess the impact of treatment on survival.

Results

From 1985 to 2005, the use of chemoradiation increased significantly with a concomitant decrease in treatment with surgery alone (P < .0001). However, only 74.9% (5014 of 6696) of patients underwent primary chemoradiation therapy in 2003–2005. Overall, 22.7% (1523 of 6696) of patients received treatment that was not concordant with established guidelines: primary surgery (13.0%) and primary chemotherapy or radiation (9.7%). Patients were significantly less likely to receive guideline treatment if male, older, black or Hispanic, more severe comorbidities, or Stage I (vs Stage II or III). Patients undergoing chemoradiation ( ± surgery) had higher 5-year survival rates than patients who received nonguideline treatment (64% vs 58%; hazard ratio 0.82, 95% confidence interval [95% CI] 0.77–0.87; P < .0001).

Conclusion

Primary chemoradiation therapy has supplanted surgical treatment and is associated with better outcomes; however, nearly a quarter of patients are still receiving treatment that is not concordant with established guidelines.
Literature
1.
2.
Johnson LG, Madeleine MM, Newcomer LM, et al. Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973–2000. Cancer 2004; 101:281–8PubMedCrossRef
3.
Goldie SJ, Kuntz KM, Weinstein MC, et al. The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men. JAMA 1999; 281:1822–9PubMedCrossRef
4.
5.
Nigro ND, Vaitkevicius VK, Considine B Jr. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 1974; 17:354–6PubMedCrossRef
6.
Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 1996; 348:1049–54
7.
Bartelink H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 1997; 15:2040–9PubMed
8.
Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 1996; 14:2527–39PubMed
9.
Engstrom PF, Benson AB 3rd, Chen YJ, et al. Anal canal cancer clinical practice guidelines in oncology. J Natl Compr Canc Netw 2005; 3:510–5PubMed
10.
McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003; 348:2635–45PubMedCrossRef
11.
12.
Winchester DP, Stewart AK, Bura C, et al. The National Cancer Data Base: a clinical surveillance and quality improvement tool. J Surg Oncol 2004; 85:1–3PubMedCrossRef
13.
Bilimoria KY, Stewart AK, Winchester DP, et al. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 2008; 15:683–90PubMedCrossRef
14.
International Classification of Disease for Oncology, 3rd ed. Geneva: World Health Organization, 2000
15.
Facility Oncology Registry Data Standards. Chicago: Commission on Cancer, 2004
16.
Department of Health and Human Services. The International Classification of Diseases, 9th revised. clinical modification: ICD-9-CM. Washington, DC: Government Printing Office, 1998
17.
Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40:373–83PubMedCrossRef
18.
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992; 45:613–9PubMedCrossRef
19.
20.
Hosmer J, Lemeshow S. Applied logistic regression. New York: John Wiley & Sons, 1999
21.
Kaplan E, Meier P. Non parametric estimation from incomplete observations. J Am Stat Assoc 1958; 53:457–81CrossRef
22.
Cox D. Regression models and life tables. J R Stat Soc 1972; 34:187–220
23.
Myerson RJ, Karnell LH, Menck HR. The National Cancer Data Base report on carcinoma of the anus. Cancer 1997; 80:805–15PubMedCrossRef
24.
25.
Cummings BJ, Thomas GM, Keane TJ, et al. Primary radiation therapy in the treatment of anal canal carcinoma. Dis Colon Rectum 1982; 25:778–82PubMedCrossRef
26.
Touboul E, Schlienger M, Buffat L, et al. Epidermoid carcinoma of the anal canal. Results of curative-intent radiation therapy in a series of 270 patients. Cancer 1994; 73:1569–79PubMedCrossRef
27.
Cummings BJ, Keane TJ, O’Sullivan B, et al. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C. Int J Radiat Oncol Biol Phys 1991; 21:1115–25PubMed
28.
Chiao EY, Krown SE, Stier EA, et al. A population-based analysis of temporal trends in the incidence of squamous anal canal cancer in relation to the HIV epidemic. J Acquir Immune Defic Syndr 2005; 40:451–5PubMedCrossRef
29.
Maggard MA, Beanes SR, Ko CY. Anal canal cancer: a population-based reappraisal. Dis Colon Rectum 2003; 46:1517–23; discussion 1523–4; author reply 1524PubMedCrossRef
30.
Bilimoria KY, Stewart AK, Palis BE, et al. Adequacy and importance of nodal examination for colon cancer in the elderly. J Am Coll Surg 2008; 206:247–54PubMedCrossRef
31.
Bilimoria KY, Talamonti MS, Ko CY, et al. Effect of hospital volume on lymph node evaluation for gastrointestinal malignancies. Arch Surg 2007; In press
32.
Bilimoria KY, Balch C, Bentrem DJ, et al. Complete lymph node dissection for sentinel node-positive melanoma: assessment of practice patterns in the United States. Ann Surg Onc 2008; In press
33.
Bilimoria KY, Bentrem DJ, Ko CY, et al. Multimodality therapy for pancreatic cancer in the U.S.: utilization, outcomes, and the effect of hospital volume. Cancer 2007; 110:1227–34PubMedCrossRef
34.
Bilimoria KY, Bentrem DJ, Linn JG, et al. Utilization of total thyroidectomy for papillary thyroid cancer in the United States. Surgery 2007; 142:906–13PubMedCrossRef
35.
Reid-Lombardo KM, Gay G, Patel-Parekh L, et al. Treatment of gastric adenocarcinoma may differ among hospital types in the United States, a report from the National Cancer Data Base. J Gastrointest Surg 2007; 11:410–9; discussion 419–20PubMedCrossRef
36.
Morris AM, Billingsley KG, Baxter NN, et al. Racial disparities in rectal cancer treatment: a population-based analysis. Arch Surg 2004; 139:151–5; discussion 156PubMedCrossRef
37.
Hershman D, McBride R, Jacobson JS, et al. Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol 2005; 23:6639–46PubMedCrossRef
38.
Eloubeidi MA, Desmond RA, Wilcox CM, et al. Prognostic factors for survival in pancreatic cancer: a population-based study. Am J Surg 2006; 192:322–9PubMedCrossRef
39.
Unequal Treatment: Confronting Racial, Ethnic Disparities in Health Care. Vol. xvi. Washington DC: National Academies Press, 2003
40.
Liu JH, Zingmond DS, McGory ML, et al. Disparities in the utilization of high-volume hospitals for complex surgery. JAMA 2006; 296:1973–80PubMedCrossRef
41.
Margolis ML, Christie JD, Silvestri GA, et al. Racial differences pertaining to a belief about lung cancer surgery: results of a multicenter survey. Ann Intern Med 2003; 139:558–63PubMed
42.
43.
Wexler A, Berson AM, Goldstone SE, et al. Invasive anal squamous-cell carcinoma in the HIV-positive patient: outcome in the era of highly active antiretroviral therapy. Dis Colon Rectum 2008; 51:73–81PubMedCrossRef
44.
Edelman S, Johnstone PA. Combined modality therapy for HIV-infected patients with squamous cell carcinoma of the anus: outcomes and toxicities. Int J Radiat Oncol Biol Phys 2006; 66:206–11PubMed
45.
Blazy A, Hennequin C, Gornet JM, et al. Anal carcinomas in HIV-positive patients: high-dose chemoradiotherapy is feasible in the era of highly active antiretroviral therapy. Dis Colon Rectum 2005; 48:1176–81PubMedCrossRef
46.
Graf R, Wust P, Hildebrandt B, et al. Impact of overall treatment time on local control of anal cancer treated with radiochemotherapy. Oncology 2003; 65:14–22PubMedCrossRef
47.
Nilsson PJ, Svensson C, Goldman S, et al. Epidermoid anal cancer: a review of a population-based series of 308 consecutive patients treated according to prospective protocols. Int J Radiat Oncol Biol Phys 2005; 61:92–102PubMed
48.
Mangione-Smith R, DeCristofaro AH, Setodji CM, et al. The quality of ambulatory care delivered to children in the United States. N Engl J Med 2007; 357:1515–23PubMedCrossRef
Metadata
Title
Squamous Cell Carcinoma of the Anal Canal: Utilization and Outcomes of Recommended Treatment in the United States
Authors
Karl Y. Bilimoria, MD, MS
David J. Bentrem, MD
Clifford Y. Ko, MD, MS, MSHS
Andrew K. Stewart, MA
David P. Winchester, MD
Mark S. Talamonti, MD
Amy L. Halverson, MD
Publication date
01-07-2008
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-008-9905-2

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