Why Many Rectal Cancer Patients Don’t Get Enough Treatment

doctor talking to patient in hospital bed

Two studies led by American Cancer Society researchers reveal new insight about rectal cancer treatment, adding to the evidence about a disease that is commonly grouped with colon cancer.

While the colon and rectum comprise the large intestine, cancers of the colon and rectum are not exactly the same. The primary difference is where they start: The colon is roughly the first five feet of the large intestine; the rectum is the last six inches. Another difference is that colon cancer is far more common. The American Cancer Society estimates there will be 95,270 cases of colon cancer this year, compared with an estimated 39,220 new cases of rectal cancer.

Scientists at the Society and other leading institutions have been analyzing data on rectal cancer alone. Here are some of their recent findings.

Travel Distance is a Barrier to Radiation Therapy

When patients with stage II or stage III rectal cancer had to travel at least 50 miles to receive radiation therapy, they were less likely to get this important treatment, according to research published in March in the International Journal of Radiation Oncology · Biology · Physics (Red Journal).

Radiation therapy and chemotherapy, then surgery, is the standard treatment for stage II and stage III rectal cancer. Research has shown this “trimodality” regimen improves survival when compared with chemotherapy plus surgery. Radiation before surgery is also believed to improve rates of sphincter preservation.

Yet this study analyzing 26,845 patient records from the National Cancer Data Base found that approximately 30% of rectal cancer patients did not receive radiation within the recommended time frame. Travel distance – but not the availability of radiation oncologists – was a clear barrier to radiation for stages II and III rectal cancer.

“For patients who need to travel more than 50 miles, a transportation assistance program or lodging services may help to decrease travel barriers,” said lead author Chun Chieh “Anna” Lin, PhD, MBA, director of Health Services Research at the American Cancer Society.

Less Than Half of Advanced Rectal Cancer Patients Get Standard Treatment

Another study of 68,000 patients in the National Cancer Data Base analyzed treatment patterns for stages II and III rectal cancer over the past decade. One important finding: Less than half of these patients received the standard therapy (again, chemo and radiation before surgery).

The research, published in April in the journal Cancer, found that medical facilities that see fewer rectal cancer patients (“low to medium volume” facilities) were less likely to offer patients the trimodality treatment. Socioeconomic factors, including non-white race/ethnicity, lack of private medical insurance, and living in a neighborhood with a low-education background, were also associated with a lower likelihood of patients receiving this treatment.

But there is some good news. The proportion of patients receiving chemo and radiation before surgery has increased from 42.9% in 2004-2006 to 55% in 2010-2012. Meanwhile, the proportion of less-successful treatment approaches, such as surgery alone, have declined.

“Although receipt of the guideline-recommended standard of care has substantially increased over time, more concerted effort is needed to enable all locally advanced rectal cancer patients to receive the standard therapy,” said lead author Helmneh Sineshaw, MD, MPH, director of Treatment Patterns and Outcomes Research at the American Cancer Society.

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