Are we catching women in the safety net? Colorectal cancer outcomes by gender at a safety net hospital - 15/09/17

Doi : 10.1016/j.amjsurg.2017.07.022

Alison R. Althans ^a, Justin T. Brady ^a, Deborah S. Keller ^b, Sharon L. Stein ^a, Scott R. Steele ^c, Melissa Times ^d,^⁎
^a Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA
^b Department of Surgery, Division of Colorectal Surgery, Baylor University Medical Center, Dallas, TX, USA
^c Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
^d Department of Surgery, Division of Colorectal Surgery, MetroHealth Medical Center, Cleveland, OH, USA

^∗Corresponding author. Department of Surgery, Division of Colorectal Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.Department of SurgeryDivision of Colorectal SurgeryMetroHealth Medical CenterCase Western Reserve University School of Medicine2500 MetroHealth DriveClevelandOH44109USA

Abstract

Background

Our goal was to evaluate presentation and outcomes for colorectal cancer across gender in a safety net hospital (SNH).

Methods

An institutional Tumor Registry was reviewed for colorectal cancer resections 12/2009–2/2016. Patients were stratified into male and female cohorts. The main outcome measures were stage at presentation and oncologic outcomes across gender.

Results

170 women (48.6%) and 180 men (51.4%) were evaluated; 129 (84.1%) females and 143 (79.4%) males underwent curative resection. There were no significant differences in prior colorectal cancer screening. On presentation, there were similar rates of stage IV disease across genders (p = 0.3). After median follow-up of 26.5 months (female) and 29.9 months (male), there were no significant differences in overall survival, survival by stage, or disease-free survival by gender (all p = 0.7). The local (1.4% females vs. 2.6% males, p = 0.7) and distant recurrence (16.6% females vs. 14.9% males, p = 0.7) were similar across gender.

Conclusion

With equal access to treatment, there were no significant differences in overall survival, survival by stage, or local or distant recurrence rates by gender. These findings stress the importance of the SNH system, and need for continued support.

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Highlights

•	National studies have found disparities in colorectal cancer outcomes by gender, but few studies have centered on outcomes in a safety net hospital.
•	Reviewing oncologic outcomes in a single safety net hospital, we found similar recurrence and survival rates across genders.
•	These findings have implications for ensuring funding and support for these institutions to continue providing equal access to care.

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Keywords : Colorectal cancer, Safety net hospital, Equal access system, Gender disparities, Healthcare outcomes