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Medientyp:
E-Artikel
Titel:
Presenting characteristics of insured and uninsured patients with anorectal malignancy referred for radiotherapy at an urban safety net hospital
Beteiligte:
Nichols, Romaine Charles;
Morris, Christopher G.;
Zaiden, Robert Anthony;
Awad, Ziad;
Colaco, Rovel;
Hoppe, Bradford S.;
Mendenhall, William M.;
Mendenhall, Nancy Price
Erschienen:
American Society of Clinical Oncology (ASCO), 2013
Beschreibung:
<jats:p> 363 </jats:p><jats:p> Background: This retrospective study compares: presenting characteristics; time intervals between symptom emergence, tissue diagnosis and initiation of therapy; and survival, for insured (IP) and uninsured patients (UP) with anal (22) or rectal (39) malignancy referred for radiotherapy at University of Florida Shands Hospital in Jacksonville. Methods: From 5/2002 to 8/2012, 63 newly diagnosed patients were evaluated. 2 patients were excluded due to mental illness. Records were reviewed to capture: 1.) Patient demographics; 2.) Stage at diagnosis; 3.) Weight loss at diagnosis; 4.) Patient reported date of symptom onset; 5.) Date of tissue confirmation of malignancy; 6.) Date of first therapeutic intervention (i.e. surgery, chemotherapy or radiotherapy); 7.) Insurance status at each of the above time points; and 8.) Survival data. Results: At the time of symptom emergence, 32 patients were uninsured and 29 were insured. Median age of UP was 52 years vs. 64 years for IP (P=0.0005). UP experienced median intervals of 258.5 days between symptom emergence and tissue confirmation of malignancy vs. 58 days for IP (P=0.0013). UP experienced median intervals of 314.5 days between symptom emergence and treatment initiation vs. 120 days for IP (P=0.0024). UP presented with T4 primary tumors in 41% of cases vs. 7% for IP (P=0.0027). UP presented with a median weight loss of 10 lbs vs. 0 lbs for IP (P=0.0158). UP presented with lymph node metastasis in 66% of cases vs. 45% for IP (P=0.1264). With a median follow up of 22 months for UP and 32 months for IP, 2 year actuarial overall survival was 87% for UP and 74% for IP (P=0.5503). Conclusions: UP presented at a younger age than IP (P=0.0005) and demonstrated:1.) Longer intervals between symptom emergence and tissue confirmation of malignancy (P=0.0013); 2.) Longer intervals between symptom emergence and treatment initiation (P=0.0024); 3.) Greater likelihood of presenting with a T4 tumor (P=0.0027); 4.) Greater weight loss at presentation (P=0.0158); 5.) A trend toward a greater likelihood of presenting with lymph node metastasis (P=0.1264); 6.) No difference in actuarial 2 year survival from date of diagnosis compared to IP. (P=0.54). </jats:p>