EP821 - Association between Distance Traveled by Patients to Hospital and Receipt of Neoadjuvant Radiation Therapy in Stage II-III Rectal Adenocarcinomas

Monday, May 12, 2025

1:20 PM – 1:25 PM PT

ePoster Presenter(s)

Sameh H. Emile, MBBCh, MSc, MD, FACS

Project Scientist
Cleveland Clinic Florida
Cleveland Clinic Florida
Plantation , FL, United States

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

Author(s)

Nir Horesh, MD

Resident Physician
Cleveland Clinic Florida
Cleveland Clinic Florida
Weston, FL, United States

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This individual has no financial relationships with ineligible companies.
Zoe Garoufalia, MD (she/her/hers)

Colorectal Surgery Fellow
Cleveland Clinic Florida
Cleveland Clinic Florida
Weston, FL, United States

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

Michal Perets, MD

Clinical Fellow
Cleveland Clinic Florida
Weston, Florida, United States

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

Giovanna DaSilva, MD

Colorectal Surgeon
Cleveland Clinic Florida

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

Senior Author(s)

Steven D. Wexner, MD, PhD (Hon), MD, PhD (Hon), FACS, FRCS, FRCSI, MAMSE

Emeritus Chair, Department of Colorectal Surgery
Cleveland Clinic Florida
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
Weston, Florida, United States

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

All of the relevant financial relationships listed below have been mitigated.

Sameh H. Emile, MBBCh, MSc, MD, FACS: This individual has no relevant relationships with ineligible companies.

Nir Horesh, MD: This individual has no financial relationships with ineligible companies.

Zoe Garoufalia, MD: This individual has no financial relationships with ineligible companies.

Michal Perets, MD: This individual has no financial relationships with ineligible companies.

Giovanna DaSilva, MD: This individual has no financial relationships with ineligible companies.

Steven D. Wexner, MD, PhD (Hon), FACS, FRCS, FRCSI, MAMSE, MD, PhD (Hon): This individual has no relevant relationships with ineligible companies.

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Purpose/Background: Neoadjuvant radiation therapy (NART) is an essential pillar of treatment for stage II-III rectal cancers. However, previous studies showed that some patients who should by guideline receive neoadjuvant radiation do not receive it. The present study examined the association between the distance traveled by patients to the hospital and receipt of NART.

Methods/Interventions: This study was a retrospective observational study on patients with stage II-III rectal adenocarcinomas from the National Cancer Database (2015 - 2021). The main outcome was receipt of NART. Patients were divided into two groups; patients who received or did not receive NART. A case-control analysis was conducted to examine the association between receiving NART and the distance traveled to the hospital and other factors. A multivariable binary logistic regression analysis was performed to assess factors associated with receipt of NART.

Results/Outcomes: The study included 40,216 patients (61.7% male) with a mean age of 60.1± 12.4 years. Stage II and III accounted for 35.1% and 64.9% of patients, respectively. NART was given to 85.5% of patients. The median distance between the patient’s residence and the hospital was 13 (IQR: 5.7, 31.4) miles. The distance traveled to the hospital was not associated with receipt of NART (OR=1, p=0.477). Factors independently associated with a decreased likelihood of receiving NART were age (OR= 0.97, 95%CI: 0.97-0.98, p< 0.001), Black race (OR: 0.81, 95%CI: 0.72-0.90, p< 0.001), Hispanic ethnicity (OR= 0.89, 95%CI: 0.79-0.99, p=0.038), Charlson score of 3 (OR= 0.80, 95%CI: 0.68-0.94, p=0.006), and mucinous adenocarcinomas (OR= 0.75, 95%CI: 0.64-0.87, p< 0.001). Conversely, the likelihood of receiving NART increased with stage III disease (OR= 1.86, 95%CI: 1.75- 1.97, p< 0.001), urban residence (OR= 1.20, 95%CI: 1.10- 1.31, p< 0.001), lower household income ( < $38,000: OR= 1.18, p< 0.001 and $38,000-47,999: OR= 1.10, p=0.037), and undergoing surgery at community cancer programs (OR= 1.42, 95%CI: 1.24- 1.63, p< 0.001), comprehensive community cancer programs (OR= 1.34, 95%CI: 1.24- 1.43, p< 0.001), and integrated network cancer programs (OR: 1.18, 95%CI: 1.09-1.28, < 0.001) compared to Academic/research programs. Sex and type of insurance were not significantly associated with receipt of neoadjuvant radiation. Subgroup regression analysis of stage III disease only showed that age, Black race, urban residence, facility type, and insurance type were associated with receipt of NART whereas sex, ethnicity, household income, and tumor histology were not associated with decreased odds of receiving NART (Figure).

Conclusion/Discussion: The distance traveled by patients with rectal cancer to the hospital was not significantly associated with the receipt of NART. Older, Black and Hispanic patients with advanced medical comorbidities and mucinous carcinomas were less likely to receive NART for stage II-III rectal cancer. Further studies should focus on the patient discrepancies for Black and Hispanic patients.