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Increased Rate of Nonoperative Management of Rectal Adenocarcinoma

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Key Points

  • Use of nonoperative management in patients with nonmetastatic rectal cancer increased from 2.4% in 1998 to 5.0% in 2010, according to a National Cancer Database analysis.
  • Black patients, those with no insurance or Medicaid, and those treated at low-volume facilities were more likely to receive nonoperative management.

A National Cancer Database analysis reported by Ellis et al in the Journal of Clinical Oncology indicates a doubling in the use of chemoradiation only in patients with nonmetastatic rectal cancer over recent years. However, current evidence is insufficient to support such nonoperative management.

Trends in Use

The study involved data from all incident cases of invasive, nonmetastatic rectal adenocarcinoma reported to the National Cancer Database from 1998 to 2010. Among the total of 146,135 patients included in the analysis, 5,741 had nonoperative management, and 140,394 had surgery with or without additional therapy. From 1998 to 2010, annual use of nonoperative management doubled from 2.4% to 5% of all cases.

Factors significantly associated with the use of nonoperative management consisted of black vs white race (adjusted odds ratio [AOR] = 1.71, 95% confidence interval [CI] = 1.57–1.86), uninsured vs private insurance status (AOR = 2.35, 95% CI = 2.08–2.65), Medicaid enrollment (AOR = 2.10, 95% CI = 1.90–2.33), and treatment in low- vs high-volume facilities (AOR = 1.53, 95% CI = 1.42–1.64).

The investigators concluded: “[Nonoperative management] demonstrates promise for the treatment of rectal cancer; currently, however, the most appropriate strategy is to pursue this approach with well-informed patients in the context of a clinical trial. We observed evidence of increasing…use, with this increase occurring more frequently in black and uninsured/Medicaid patients, raising concern that increased…use may actually represent increasing disparities in rectal cancer care rather than innovation. Further studies are needed to assess survival differences by treatment strategy.”

The study was supported by the Agency for Healthcare Research and Quality with sponsorship by The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.

Clayton Tyler Ellis, MD, of the University of North Carolina at Chapel Hill, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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