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Association between likelihood of undergoing liver metastasectomy and seeking care at more than one Commission on Cancer hospital for colorectal liver metastasis
Brittany Powell, Annabelle Jones, Thomas Clancy, Jiping Wang, Mark Fairweather, George Molina
Division of Surgical Oncology, Brigham and Women"s Hospital, Boston, Massachusetts, United States

Objective: To investigate differences in likelihood of liver metastasectomy for colorectal liver metastasis based on whether patients sought care at >1 Commission on Cancer (CoC) hospital. Design: Retrospective database review. Setting: National Cancer Database (NCDB) from 2011-2017. Patients: 25,959 patients with confirmed histology of colorectal adenocarcinoma who underwent primary tumor resection and had confirmed liver metastasis without evidence of extra-hepatic disease were identified. 23,091 (89%) patients visited 1 CoC hospital and 2,868 (11.1%) patients visited >1 CoC hospital. Main Outcome Measures: Likelihood of seeking care at >1 CoC hospital; likelihood of undergoing metastasectomy based on race and seeking care at >1 CoC hospital. Results: Black patients were less likely to seek care at >1 CoC hospital (RR 0.68, CI 0.60-0.76, p<0.001). Other factors significantly associated with lower likelihood of seeking care at >1 CoC hospital included Medicaid insurance, N1/N2 node status of the primary colorectal tumor, and all facility types (academic/research, comprehensive community cancer, and community cancer programs) compared to integrated network cancer program as the reference. Undergoing liver metastasectomy was associated with higher likelihood of seeking care at >1 CoC hospital (RR 1.27, CI 1.26-1.52, p<0.001), as was higher income based on patient zip code, and receiving systemic therapy for the primary colorectal cancer. Among patients who sought care at >1 CoC hospital, there was no significant difference between White and Black patients undergoing liver metastasectomy (RR 0.86, 95% CI 0.71-1.04, p=0.11) (Table). Conclusions: Patients with colorectal liver metastasis who sought care at >1 CoC hospital were more likely to undergo a liver metastasectomy. Robust referral systems and access to a second opinion, when appropriate, may contribute to reducing disparities in access to liver metastasectomy.

Adjusted*, Poisson Regression, Interaction Analysis to Evaluate Likelihood of Liver Metastasectomy for Colorectal Liver Metastasis According to Race and Whether Care was Sought at Multiple Commission on Cancer (CoC) Facilities
 Relative Risk (RR)95% CIP-value
Group   
White, Sought Care at More Than 1 CoCReference  
Black, Sought Care at More Than 1 CoC0.860.71-1.040.11
Black, Sought Care at Only 1 CoC0.700.64-0.76<0.001
White, Sought Care at Only 1 CoC0.820.77-0.88<0.001


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