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Session: ePoster: Rectal Cancer 6 (Mon8)

EP667 - Social Vulnerability Index and the Utilization of Short Course Radiation for Locally Advanced Rectal Cancer

Monday, May 12, 2025
8:32 AM – 8:37 AM PT
Location: Monitor 9, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • PR

    Pavan K. Rao, MD

    Colon and Rectal Surgery Fellow
    Geisinger Medical Center
    Danville, Pennsylvania, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • KL

    Kevin C. Long, MD, FACS, FASCRS

    Program Director, Geisinger Colon and Rectal Surgery Fellowship Program
    Geisinger Medical Center
    Danville, Pennsylvania, United States

    Disclosure information not submitted.

  • Brittney A. Ehrlich, MD (she/her/hers)

    General Surgery Resident
    Geisinger Medical Center
    Danville, PA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • SW

    Shengxuan Wang, n/a

    Biostatistician
    Geisinger Medical Center
    Danville, Pennsylvania, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • RH

    Rebecca L. Hoffman, MD MSCE

    Assistant Professor
    Geisinger Medical Center
    Danville, Pennsylvania, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Pavan K. Rao, MD: This individual has no financial relationships with ineligible companies.
Brittney A. Ehrlich, MD: This individual has no financial relationships with ineligible companies.
Rebecca L. Hoffman, MD MSCE: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Socially vulnerable populations experience significant disparities in healthcare access and outcomes. Social Vulnerability Index (SVI) was designed to delineate factors, such as socioeconomic status, transportation barriers, etc., to identify at risk populations requiring greater support. With more restricted access to care and transportation, these patients may be less able to complete a prolonged course of radiation treatment (LC-RT), which has traditionally been a staple of neoadjuvant therapy for locally advanced rectal cancer. Utilizing the National Cancer Database (NCDB) to obtain surrogate markers for the SVI, the following study aimed to assess the utilization of short course radiation (SC-RT) according to SVI-surrogate for stage II/III rectal cancer.

Methods/Interventions: A retrospective cohort study of patients with locally advanced rectal cancer who received neoadjuvant radiation therapy was performed using the NCDB (2018-2021). Radiation was defined as either long course (LC-RT; 45-50 Gy) or short course (SC-RT; 25 Gy over 5 fractions). The SVI-surrogate was created using the following variables: Age > 65, non-white ethnicity, distance from treatment center >75th percentile, insurance status, percentage of people within the residential area that have obtained high school equivalence degrees, Charlson co-morbidity score, and median household income. Univariate and multivariate analyses were performed to determine the impact (influence) of SVI on utilization of short course radiation. The multivariate analysis was performed by assigning weights to the components of the SVI-surrogate derived from a Cox regression model that evaluated the impact of each variable on survival outcomes.

Results/Outcomes: A total of 12,434 patients were reviewed for this study, 1,508 (12.1%) of whom received SC-RT. The median age was 59yrs (IQR 51,68), 7,803(62.8% were male, and 10,415 (83.8% were white. The majority of patients in both cohorts completed their radiation therapy (99% vs 99.8%). Recipients of SC-RT traveled significantly longer distances (16.0 miles vs, 12.1, p< 0.001) and significantly more likely to be treated at an academic/research program (57.6% vs. 33.6%). The use of SC-RT was significantly higher as SVI-surrogate increased (Figure; p< 0.001). SVI was significantly higher in the SC-RT cohort [ 0.36 (0.04,0.67), p< 0.01]. Multivariate analysis demonstrated that patients with a high SVI were significantly more likely to receive SC-RT (OR1.45;95% CI1.26-1.66, ).Patients treated at academic institutions were also 3 times as likely to receive SC-RT (OR 3.37, 95%CI 2.47-4.61).

Conclusion/Discussion: The use of SC-RT is positively impacted by components of social vulnerability, such that clinicians recognize the importance of therapy completion and the difficulties that some patients may face with a longer treatment course. Providers, particularly at academic institutions, are more likely to use SC-RT in the treatment of locally advanced rectal cancer in patients