Objective: We sought to compare long-term healthcare dependency and time-at-home between older adults undergoing minimally invasive surgery (MIS) for colorectal cancer (CRC) and those undergoing open resection. Background: Although the benefits of MIS for CRC resection are established, data specific to older adults are lacking. Long-term functional outcomes, central to decision-making in the care for older adults, are unknown. Methods: We performed a population-based analysis of patients ≥70years old undergoing CRC resection between 2007 to 2017 using administrative datasets. Outcomes were receipt of homecare and “high” time-at-home, which we defined as years with ≤14 institution-days, in the 5years after surgery. Homecare was analyzed using time-to-event analyses as a recurrent dichotomous outcome with Andersen-Gill multivariable models. High timeat-home was assessed using Cox multivariable models. Results: Of 16,479 included patients with median follow-up of 4.3 (interquartile range 2.1–7.1) years, 7822 had MIS (47.5%). The MIS group had lower homecare use than the open group with 22.3% versus 31.6% at 6 months and 14.8% versus 19.4% at 1 year [hazard ratio 0.87,95% confidence interval (CI) 0.83–0.92]. The MIS group had higher probability ofhigh time-at-home than open surgery with 54.9% (95% CI 53.6%–56.1%) versus 41.2% (95% CI 40.1%–42.3%) at 5years (hazard ratio 0.71, 95% CI 0.68–0.75). Conclusions: Compared to open surgery, MIS for CRC resection was associated with lower homecare needs and higher probability of high time-at-home in the 5 years after surgery, indicating reduced long-term functional dependence. These are important patient-centered endpoints reflecting the overall long-term treatment burden to be taken into consideration in decision-making.
# 01: Iron deficiency in bariatric surgery patients — a single-centre experience over 5 years {#article-title-2} As the prevalence and severity of obesity have increased in Canada, so too has the demand for bariatric surgery. The objective of this study was to determine the incidence of
351 Background: Pancreas cancer is expensive to treat, and the effectiveness of adjuvant chemotherapy (CT) and chemoradiation (CRT) following resection is debated. We compared both survival and healthcare costs by adjuvant therapy after curative-intent pancreaticoduodenectomy (PD) for pancreas adenocarcinoma (PC). Methods: All patients with resected PC in Ontario, Canada diagnosed 2004 to 2014 were identified and linked to administrative healthcare databases. Stratified Kaplan—Meier survival curves and log-rank test compared survival across treatment groups. Costs were assessed from the perspective of Ontario’s single-payer healthcare system and compared between CT and CRT. A one-year time horizon was used from the date of surgery. Results: 677 PC patients met all inclusion/exclusion criteria and underwent curative-intent PD with 77% receiving CT and 23% CRT. Median survival after resection was 21.7 and 18.9 months for CT and CRT groups, respectively. Patients receiving CRT were less likely to have high comorbidity burden (ADG ≥ 10), but were similar across other demographics. CRT patients were more likely to have margin positive disease. In a subgroup of 489 patients with margin negative disease, median survival in the node negative patients (n = 156) was 28.0 months for CRT and 24.7 months for CT (p = 0.8297, logrank). Median survival in the node positive patients (n = 333) was 20.6 months and 21.8 months for the CRT and CT patients, respectively (p = 0.9856, logrank). The median total one-year cost for CT was $52,575 (USD); CRT was $68,216 (Table 1). Conclusions: Patients who underwent adjuvant CT and CRT after PD for PC had similar overall survival, but healthcare expenditures were significantly higher in the CRT group. [Table: see text]
854 Background: The efficacy of routine administration of adjuvant chemotherapy following sequential neoadjuvant chemoradiotherapy and surgery for rectal cancer is uncertain. This uncertainty may lead to practice pattern variations, with significant downstream discrepancies in oncological outcomes, patient-centered outcomes, and healthcare costs. The objective of this study, therefore, was to evaluate patient, disease, and health system factors associated with receipt of adjuvant chemotherapy following neoadjuvant radiotherapy and proctectomy. Methods: A retrospective cohort study of patients diagnosed with rectal cancer undergoing preoperative radiotherapy prior to proctectomy from January 1, 2010 to December 31, 2014 was performed using linked administrative healthcare databases. We compared the rate of chemotherapy administration (≥ 1 billing record) within 180 days of index rectal resection by healthcare administrative region in Ontario, Canada (2014 population: 13.4 million). Multivariable logistic regression models were constructed to assess patient, disease, and health system factors associated with differences in receipt of adjuvant chemotherapy. Results: We studied 1668 patients treated with preoperative radiotherapy and proctectomy, of whom 67% received chemotherapy within 180 days after surgery. The rate of adjuvant chemotherapy administration varied among health regions from 54% to 93%. On multivariable analysis, health region of residence, younger patient age, lower baseline comorbidity burden, and pathological nodal involvement were significant predictors of receipt of adjuvant chemotherapy. Conclusions: There is significant variation in receipt of adjuvant chemotherapy for patients receiving preoperative radiotherapy followed by proctectomy in Ontario. This variability is associated with patient, disease, and health system-related factors. Identifying the drivers of variability in cancer care practice may help to provide a basis for understanding and addressing discrepancies in clinical, patient-centered, and economic outcomes in healthcare systems.
