Racial Disparities in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Aggressive Surgical Treatment Overcome Cancer Health Inequities?
BackgroundAdvanced cancer states perpetuate health-related disparities. Peritoneal-based cancers are clinically advanced cancers that present a significant clinical dilemma. Peritoneal cancers are managed aggressively with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HI...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.899488/full |
| _version_ | 1811243350809903104 |
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| author | Devon C. Freudenberger Xiaoyan Deng Vignesh Vudatha Andrea N. Riner Kelly M. Herremans Dipankar Bandyopadhyay Leopoldo J. Fernandez Jose G. Trevino |
| author_facet | Devon C. Freudenberger Xiaoyan Deng Vignesh Vudatha Andrea N. Riner Kelly M. Herremans Dipankar Bandyopadhyay Leopoldo J. Fernandez Jose G. Trevino |
| author_sort | Devon C. Freudenberger |
| collection | DOAJ |
| description | BackgroundAdvanced cancer states perpetuate health-related disparities. Peritoneal-based cancers are clinically advanced cancers that present a significant clinical dilemma. Peritoneal cancers are managed aggressively with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). While racial and ethnic disparities are prevalent in cancer, there are no studies investigating if racial disparities exist in patients with peritoneal carcinomatosis managed with CRS and HIPEC. We hypothesized that this advanced disease state further delineates racial disparities.MethodsA retrospective chart review was conducted on patients with peritoneal carcinomatosis receiving CRS and HIPEC at a single institution from January 1, 2017-October 4, 2021. Descriptive statistics were used to compare racial groups. The Cox Proportional Hazards Model and Log Rank Test were used for multivariate and overall survival analysis.ResultsIn total, 67 patients underwent CRS and HIPEC, of which 41 (61.2%) were White, 20 (29.8%) were Black, 3 (4.5%) were Asian, and 3 (4.5%) were Other race. When compared to White patients, Black patients had lower income (p=0.0011), higher incidence of hypertension (p=0.0231), and lower performance status (p=0.0441). Cancer type, including colorectal, appendiceal, ovarian, etc., was similar between groups (p=0.8703). Despite these differences in sociodemographic and morbidity factors, when comparing Black patients to White patients, there were no differences in peritoneal cancer index score (13.2 vs. 12.3, p=0.6932), estimated blood loss (748 vs. 655 mL, p=0.6332), minor/major complication rates (1.1 vs. 1.2, p=0.7281; 0.4 vs. 0.7, p=0.3470, respectively), 30-day readmission rates (25.0% vs. 17.1%, p=0.6210), disease recurrence (40.0% vs. 51.2%, p=0.3667), or 30-day mortality (0.0% vs. 2.4%, p=1.0000). Overall survival was similar for Black and White patients (p=0.2693). The occurrence of a major complication was the only factor associated with overall survival (HR 2.188 [1.502, 3.188], p< 0.0001).ConclusionsDespite differences in patient socioeconomic factors and comorbid conditions, outcomes were similar between Black and White patients receiving CRS and HIPEC at our institution. While larger studies with more diverse patient populations are needed to confirm these findings, our data provide evidence that aggressive surgical management across diverse patient populations allows for equitable outcomes. |
| first_indexed | 2024-04-12T14:05:53Z |
| format | Article |
| id | doaj.art-bcbd9107600541a88ba27c07311a4889 |
| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-04-12T14:05:53Z |
| publishDate | 2022-06-01 |
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| series | Frontiers in Oncology |
| spelling | doaj.art-bcbd9107600541a88ba27c07311a48892022-12-22T03:30:04ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-06-011210.3389/fonc.2022.899488899488Racial Disparities in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Aggressive Surgical Treatment Overcome Cancer Health Inequities?Devon C. Freudenberger0Xiaoyan Deng1Vignesh Vudatha2Andrea N. Riner3Kelly M. Herremans4Dipankar Bandyopadhyay5Leopoldo J. Fernandez6Jose G. Trevino7Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United StatesDepartment of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, United StatesDivision of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United StatesDepartment of Surgery, University of Florida College of Medicine, Gainesville, FL, United StatesDepartment of Surgery, University of Florida College of Medicine, Gainesville, FL, United StatesDepartment of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, United StatesDivision of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United StatesDivision of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United StatesBackgroundAdvanced cancer states perpetuate health-related disparities. Peritoneal-based cancers are clinically advanced cancers that present a significant clinical dilemma. Peritoneal cancers are managed aggressively with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). While racial and ethnic disparities are prevalent in cancer, there are no studies investigating if racial disparities exist in patients with peritoneal carcinomatosis managed with CRS and HIPEC. We hypothesized that this advanced disease state further delineates racial disparities.MethodsA retrospective chart review was conducted on patients with peritoneal carcinomatosis receiving CRS and HIPEC at a single institution from January 1, 2017-October 4, 2021. Descriptive statistics were used to compare racial groups. The Cox Proportional Hazards Model and Log Rank Test were used for multivariate and overall survival analysis.ResultsIn total, 67 patients underwent CRS and HIPEC, of which 41 (61.2%) were White, 20 (29.8%) were Black, 3 (4.5%) were Asian, and 3 (4.5%) were Other race. When compared to White patients, Black patients had lower income (p=0.0011), higher incidence of hypertension (p=0.0231), and lower performance status (p=0.0441). Cancer type, including colorectal, appendiceal, ovarian, etc., was similar between groups (p=0.8703). Despite these differences in sociodemographic and morbidity factors, when comparing Black patients to White patients, there were no differences in peritoneal cancer index score (13.2 vs. 12.3, p=0.6932), estimated blood loss (748 vs. 655 mL, p=0.6332), minor/major complication rates (1.1 vs. 1.2, p=0.7281; 0.4 vs. 0.7, p=0.3470, respectively), 30-day readmission rates (25.0% vs. 17.1%, p=0.6210), disease recurrence (40.0% vs. 51.2%, p=0.3667), or 30-day mortality (0.0% vs. 2.4%, p=1.0000). Overall survival was similar for Black and White patients (p=0.2693). The occurrence of a major complication was the only factor associated with overall survival (HR 2.188 [1.502, 3.188], p< 0.0001).ConclusionsDespite differences in patient socioeconomic factors and comorbid conditions, outcomes were similar between Black and White patients receiving CRS and HIPEC at our institution. While larger studies with more diverse patient populations are needed to confirm these findings, our data provide evidence that aggressive surgical management across diverse patient populations allows for equitable outcomes.https://www.frontiersin.org/articles/10.3389/fonc.2022.899488/fullperitoneal carcinomatosiscytoreductive surgeryHIPEC (heated intraperitoneal chemotherapy)surgical outcomesracial disparities |
| spellingShingle | Devon C. Freudenberger Xiaoyan Deng Vignesh Vudatha Andrea N. Riner Kelly M. Herremans Dipankar Bandyopadhyay Leopoldo J. Fernandez Jose G. Trevino Racial Disparities in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Aggressive Surgical Treatment Overcome Cancer Health Inequities? Frontiers in Oncology peritoneal carcinomatosis cytoreductive surgery HIPEC (heated intraperitoneal chemotherapy) surgical outcomes racial disparities |
| title | Racial Disparities in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Aggressive Surgical Treatment Overcome Cancer Health Inequities? |
| title_full | Racial Disparities in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Aggressive Surgical Treatment Overcome Cancer Health Inequities? |
| title_fullStr | Racial Disparities in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Aggressive Surgical Treatment Overcome Cancer Health Inequities? |
| title_full_unstemmed | Racial Disparities in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Aggressive Surgical Treatment Overcome Cancer Health Inequities? |
| title_short | Racial Disparities in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Aggressive Surgical Treatment Overcome Cancer Health Inequities? |
| title_sort | racial disparities in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy does aggressive surgical treatment overcome cancer health inequities |
| topic | peritoneal carcinomatosis cytoreductive surgery HIPEC (heated intraperitoneal chemotherapy) surgical outcomes racial disparities |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.899488/full |
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