Abstract
Abstract only
e14641
Background: The preferred method of care for stage II/III rectal cancer is trimodal therapy: neoadjuvant chemoradiation plus surgical resection. We aim to compare the treatment practices for patients with stage II/III rectal cancer in major insurance types. Methods: Using data from the National Cancer Database (NCDB), we analyzed the treatment patterns of 91,782 patients diagnosed with stage II/III rectal cancer from 2000-2009. The NCDB includes data from 70% of all U.S. cancer patients. This is the largest study of this kind to date. Results: In stage II/III rectal cancer, patients with private insurance received more trimodal therapy (70.3%) than patients with VA Insurance (56.6%), Medicare (46.9%), Medicaid (66.5%), or no insurance (61.7%) (p<.0001). VA patients received less trimodal therapy than Medicaid or non-insured patients (p<.0001). Medicare patients (26.9%) were treated with surgery alone more often than patients with private insurance (9.8%), Medicaid (10.4%), VAH (12.2%) or no insurance (9.4%) (p<.0001). VA (4.8%) and Medicare (4.3%) patients were more likely to not receive any “First Course Treatment” than patients with private insurance (1.3%) (p<.0001). Patients over 70yo received less trimodal therapy (42.2%) than patients under 70yo (68.9%) (p<.0001) and received more surgery without chemotherapy or radiation (29.3%) than patients less than 70yo (9.2%) (p<.0001). Conclusions: Stage II/III rectal cancer patients with private insurance received more trimodal therapy than VA, Medicare, Medicaid, or uninsured patients. VA patients received less trimodal therapy than Medicaid or uninsured patients. [Table: see text]