Impact of Treatment Coordination on Overall Survival in Rectal Cancer

Kevin Biju, George Q. Zhang, Miloslawa Stem, Rebecca Sahyoun, Bashar Safar, Chady Atallah, Jonathan E. Efron, Ashwani Rajput

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Rectal cancer treatment is often multimodal, comprising of surgery, chemotherapy, and radiotherapy. However, the impact of coordination between these modalities is currently unknown. We aimed to assess whether delivery of nonsurgical therapy within same facility as surgery impacts survival in patients with rectal cancer. Methods: A patient cohort with rectal cancer stages II to IV who received multimodal treatment between 2004 and 2016 from National Cancer Database was retrospectively analyzed. Patients were categorized into three groups: (A) surgery + chemotherapy + radiotherapy at same facility (surgery + 2); (B) surgery + chemotherapy or radiotherapy at same facility (surgery + 1); or (C) only surgery at reporting facility (chemotherapy + radiotherapy elsewhere; surgery + 0). The primary outcome was 5-year overall survival (OS), analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional-hazards models. Results: A total of 44,716 patients (16,985 [37.98%] surgery + 2, 12,317 [27.54%] surgery + 1, and 15,414 [34.47%] surgery + 0) were included. In univariate analysis, we observed that surgery+2 patients had significantly greater 5-year OS compared to surgery + 1 or surgery + 0 patients (5-year OS: 63.46% vs 62.50% vs 61.41%, respectively; P= .002). We observed similar results in multivariable Cox proportional-hazards analysis, with surgery + 0 group demonstrating increased hazard of mortality when compared to surgery + 2 group (HR: 1.09; P< .001). These results held true after stratification by stage for stage II (HR 1.10; P= .022) and stage III (HR 1.12; P< .001) but not for stage IV (P=. 474). Conclusion: Greater degree of care coordination within the same facility is associated with greater OS in patients with stage II to III rectal cancer. This finding illustrates the importance of interdisciplinary collaboration in multimodal rectal cancer therapy. The impact of treatment coordination on outcome in rectal cancer is not well understood. In this National Cancer Database retrospective analysis of a patient cohort (n = 44,716) with rectal cancer stages II to IV, we found that greater degree of care coordination is associated with better overall survival. This highlights the importance of communication between specialty teams in rectal cancer management.

Original languageEnglish (US)
JournalClinical colorectal cancer
DOIs
StateAccepted/In press - 2021

Keywords

  • Chemotherapy
  • Multidisciplinary care
  • Outcome
  • Radiotherapy
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

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