Facilities that service economically advantaged neighborhoods perform surgical metastasectomy more often for patients with colorectal liver metastases

Cancer. 2020 Jan 15;126(2):281-292. doi: 10.1002/cncr.32529. Epub 2019 Oct 22.


Background: Metastasectomy of isolated colorectal liver metastases (CRLM) requires significant clinical expertise and may not be readily available or offered. The authors hypothesized that hospitals that treat a greater percentage of patients from higher income catchment areas are more likely to perform metastasectomies regardless of patient or tumor characteristics.

Methods: Using the National Cancer Data Base, the authors classified facilities into facility income quartiles (FIQs) based on the percentage of patients from the wealthiest neighborhoods (by zip code). Quartile 1 included facilities with <2.1% of the patients residing within the highest income zip codes, quartile 2 included facilities with 2.2% to 15.6% of patients residing within the highest income zip codes, quartile 3 included facilities with 15.7% to 40.2% of patients residing within the highest income zip codes, and quartile 4 included facilities with 40.3% to 90.5% of patients residing within the highest income ZIP codes. Patient, tumor, and facility characteristics were analyzed using a multivariate logistic regression to identify associations between metastasectomy and FIQ.

Results: Patients with CRLM were more likely to undergo metastasectomy at facilities in the highest FIQ compared with the lowest FIQ (18% vs 11% in FIQ4; P = .001). This trend was not observed in the resection of primary tumors for nonmetastatic CRLM (rates of 95% vs 93%; P = .94). After adjusting for individual insurance status, distance traveled, zip code-level individual income, tumor, and host, patients who were treated at the highest FIQ facilities were found to be more likely to undergo metastasectomy (odds ratio, 1.29; 95% CI, 1.02-1.72 [P = .03]).

Conclusions: Metastasectomy for CRLM is more likely to occur at facilities that serve a greater percentage of patients from high-income catchment areas, regardless of individual patient characteristics. This disparity uniquely affects those patients with advanced cancers for which specialized expertise for therapy is necessary.

Keywords: colorectal cancer; health care disparity; liver metastasis; treatment disparity.

MeSH terms

  • Adenocarcinoma / secondary
  • Adenocarcinoma / surgery*
  • Aged
  • Colorectal Neoplasms / pathology*
  • Databases, Factual / statistics & numerical data
  • Female
  • Healthcare Disparities / economics
  • Healthcare Disparities / statistics & numerical data*
  • Hospitals / statistics & numerical data
  • Humans
  • Income / statistics & numerical data*
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery*
  • Logistic Models
  • Male
  • Metastasectomy / statistics & numerical data*
  • Middle Aged
  • Residence Characteristics / statistics & numerical data*
  • Retrospective Studies
  • United States