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Population Bias in Anal Cancer Treatment, Finds Report From National Treatment Database: Presented at SSO

By Carole Bullock

CHICAGO -- March 19, 2008 -- Patients with anal cancer are more likely to undergo surgery as their only treatment modality if they are male, black, have comorbidities, or are treated at a low-volume hospital, said researchers presenting here on March 15 at the Society of Surgical Oncology (SSO) 61st Annual Cancer Symposium.

"Over the past 2 decades, recommended treatment for anal carcinoma has shifted from surgery to primary therapy with chemoradiation, but [this] study suggests that there are patients receiving primary surgical treatment -- which is not concordant with established guidelines," said Amy Halverson, MD, Assistant Professor, Surgical Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

The study evaluated treatment trends over the past 20 years to assess appropriate treatment utilisation and examine survival by treatment regimen.

Patients with anal carcinoma were identified from the National Cancer Data Base (1985-2005), and regression models were used to assess factors associated with utilisation of surgery as the only treatment (vs chemoradiation +- surgery) from 2003 to 2005.

Univariate and multivariate methods were used to assess survival in 38,882 patients with anal cancer who were classified as stage I (24.8%), stage II (51.6%), stage III (18.0%), or stage IV (5.6%).

From 1985 to 2005, chemoradiation increased significantly from 44.3% to 78%, with a concomitant decrease in treatment with surgery alone (P < .0001).

Of the patients receiving primary chemoradiation therapy between 2003 and 2005, 28% (n = 1,649 of 5,889) went on to have surgery. Of these patients, 3.6% (n = 60 of 1,649) required an abdominoperineal resection (APR), and 96.4% (n = 1,589 of 1,649) had a local excision (of residual disease or scar).

Surgery was the only treatment modality in 10.4% of patients (n = 853 of 8,207). Of those patients, 11.1% (n = 95 of 853) underwent APR and 88.9% (n = 747 of 853) underwent local excision.

Patients were more likely to undergo surgery as the only treatment modality if they were male, black, had a higher Charlson Index score indicating comorbidity, stage I cancer (vs stage II or III), or were treated at hospitals with low annual anal-cancer-case volume (P < .0001).

On univariate and multivariate analysis, patients selected to undergo chemoradiation (+- surgery) had better 5-year survival than patients who underwent surgery (61% vs 53%; hazard ratio 0.70; 95% confidence interval, 0.64-0.76; P < .0001).

[Presentation title: Cancer in the United States: Utilization and Outcomes of Recommended Treatment. Abstract 64]

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