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22-09-2023 | Systemic Therapy | Peritoneal Surface Malignancy

Fragmentation of Care in Patients with Peritoneal Metastases Undergoing Cytoreductive Surgery

Authors: Mason Vierra, BS, Varun V. Bansal, MBBS, Ryan B. Morgan, MD, Hunter D. D. Witmer, MD, MBA, Biren Reddy, BS, Ankit Dhiman, MBBS, Frederick A. Godley IV, MD, MBA, Cecilia T. Ong, MD, Erika Belmont, MD, Blasé Polite, MD, Ardaman Shergill, MD, Kiran K. Turaga, MD, MPH, Oliver S. Eng, MD

Published in: Annals of Surgical Oncology | Issue 1/2024

Abstract

Background

The delivery of multimodal treatment at a high-volume center is known to optimize the outcomes of gastrointestinal malignancies. However, patients undergoing cytoreductive surgery (CRS) for peritoneal metastases often must ‘fragment’ their surgical and systemic therapeutic care between different institutions. We hypothesized that this adversely affects outcomes.

Patients and Methods

Adults undergoing CRS for colorectal or appendiceal adenocarcinoma at our institution between 2016 and 2022 were identified retrospectively and grouped by care network: ‘coordinated care’ patients received exclusively in-network systemic therapy, while ‘fragmented care’ patients received some systemic therapy from outside-network providers. Factors associated with fragmented care were also ascertained. Overall survival (OS) from CRS and systemic therapy-related serious adverse events (SAEs) were compared across the groups.

Results

Among 85 (80%) patients, 47 (55%) had colorectal primaries and 51 (60%) received fragmented care. Greater travel distance [OR 1.01 (CI 1.00–1.02), p = 0.02] and educational status [OR 1.04 (CI 1.01–1.07), p = 0.01] were associated with receiving fragmented care. OS was comparable between patients who received fragmented and coordinated care in the colorectal [32.5 months versus 40.8 months, HR 0.95 (CI 0.43–2.10), p = 0.89] and appendiceal [31.0 months versus 27.4 months, HR 1.17 (CI 0.37–3.74), p = 0.55] subgroups. The frequency of SAEs (7.8% versus 17.6%, p = 0.19) was also similar.

Conclusions

There were no significant differences in survival or SAEs based on the networks of systemic therapy delivery. This suggests that patients undergoing CRS at a high-volume center may safely receive systemic therapy at outside-network facilities with comparable outcomes.

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Title: Fragmentation of Care in Patients with Peritoneal Metastases Undergoing Cytoreductive Surgery
Authors: Mason Vierra, BS
Varun V. Bansal, MBBS
Ryan B. Morgan, MD
Hunter D. D. Witmer, MD, MBA
Biren Reddy, BS
Ankit Dhiman, MBBS
Frederick A. Godley IV, MD, MBA
Cecilia T. Ong, MD
Erika Belmont, MD
Blasé Polite, MD
Ardaman Shergill, MD
Kiran K. Turaga, MD, MPH
Oliver S. Eng, MD
Publication date: 22-09-2023
Publisher: Springer International Publishing
Keywords: Systemic Therapy
Care
Metastasis
Chemotherapy
Published in: Annals of Surgical Oncology / Issue 1/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-14318-1

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Fragmentation of Care in Patients with Peritoneal Metastases Undergoing Cytoreductive Surgery

Abstract

Background

Patients and Methods

Results

Conclusions

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Abstract

Background

Patients and Methods

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Conclusions

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