EP534 - Is the Grass Really Greener? Rectal Cancer Treatment Completion in Patients Treated at Multiple CoC Facilities

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Purpose/Background: Rectal cancer care has grown in complexity and requires an increasingly nuanced and experienced approach. Readily available resources have increased patient awareness of different treatments available at local hospitals and quaternary referral facilities. This may lead patients to obtain care at multiple facilities to receive what they view as the best care possible. There is currently limited data on the relationship between treatment at multiple facilities and rectal cancer outcomes. We hypothesized that treatment adherence rates of rectal cancer patients treated at multiple facilities would be higher than for those who received care at a single location.

Methods/Interventions: We performed a retrospective cohort analysis of the 2020 National Cancer Database for clinical Stage III rectal cancer patients aged 18 to 80. Patients were evaluated based upon whether they received the entirety of their treatment at a single Committee on Cancer facility or at multiple facilities. Patients were also evaluated based on the facility subtype of treatment: Community Program, Comprehensive Community Program, Academic/Research Program, or Integrated Network Cancer Program. Descriptive statistics and analyses were performed using R software.

Results/Outcomes: Patients treated at multiple facilities tended to be younger (58.1 vs 58.6 years, p< 0.01), white (86.5% vs 84.2%, p< 0.01), and non-Hispanic (8.0% vs 9.6%, p< 0.01). They were more often privately insured (53.4% vs 49.8%, p< 0.01), from areas with higher-than-average high school graduation rates (51.7 vs 47.7%, p< 0.01) and incomes (63.4% vs 59.4%, p< 0.01), and from less densely populated areas (18.6% vs 16.1%, p< 0.01).

Patients treated at multiple facilities traveled further on average to receive surgery at a separate facility than those who traveled to receive chemotherapy or radiation (52.8 miles vs 23.8 and 21.2 miles, p< 0.01). Patients treated at multiple facilities traveled further for surgery at academic centers vs all other facility subtypes (74.6 vs 27.1 mi, p< 0.01).

Patients treated at multiple facilities had fewer average days to treatment (42.0 vs 43.4, p< 0.01). They were more likely to have surgery recommended (81.4% vs 74.0%, p< 0.01) and less likely to forgo recommended surgery (2.5% vs 5.2%, p< 0.01); this remained true for all facility subtypes. This pattern remained true for chemotherapy (97.4% vs 94.9% recommended, p< 0.01; 0.7% vs 1.6% not done if recommended, p< 0.01). Patients treated at multiple facilities were also more likely to be recommended radiation (93.2% vs 89.5%, p< 0.01) and less likely to avoid radiation if recommended (0.9% vs 1.9%, p< 0.01). Patients treated at multiple facilities were more likely to be treated with radiation at academic/research facilities compared to other facility subtypes.

Conclusion/Discussion: As rectal cancer care becomes more complex, patients may begin to seek care at multiple facilities. These patients tend to be younger, from more well-to-do areas, and be willing to travel further, especially to receive surgery. Patients who seek care at multiple facilities tend to be recommended treatment more frequently and they follow through with that treatment at a higher rate. Further study is necessary to determine what factors may influence patients’ decision to travel, particularly for surgical intervention. While many factors may contribute to these differences, we must strive to standardize care across all facilities to provide equitable care for our patients. Because, at least for now, the grass does appear to be greener across town.