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Presentation Patterns and Treatment Outcomes in Appendix Cancer Patients Traveling to a High-Volume Peritoneal
Vladislav Kovalik1, Armando Sardi1, Mary Caitlin King1
1Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA.
The American Surgeon
|May 5, 2025
Summary
Patients traveling for mucinous appendix cancer (MAC) treatment experience delays and more advanced disease. However, outcomes at specialized centers remain comparable, highlighting the need for early referral and travel support.
Area of Science:
- Oncology
- Surgical Oncology
- Cancer Care Delivery
Background:
- Mucinous appendix cancer (MAC) treatment is concentrated in Peritoneal Surface Malignancy Centers (PSMCs).
- Patients often require significant travel for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).
- Understanding the impact of travel distance on patient presentation and outcomes is crucial for optimizing care delivery.
Purpose of the Study:
- To compare presentation patterns and treatment outcomes between in-state (I-S) and out-of-state (O-S) patients with MAC treated at a high-volume PSMC.
- To evaluate the influence of travel distance on disease characteristics, treatment quality, and overall survival.
Main Methods:
- A cohort study analyzed 369 MAC patients with peritoneal metastases treated with CRS/HIPEC between 1998 and 2023 using a prospective database.
- Key variables included travel distance, time from diagnosis (TFD), peritoneal cancer index (PCI), prior surgery score (PSS), systemic chemotherapy (SCh), complete cytoreduction (CC-0/1), complications, and overall survival (OS).
- Cox regression was used to assess the impact of O-S travel on 10-year OS, adjusting for relevant covariates.
Main Results:
- Out-of-state (O-S) patients (60.4%) traveled a median of 180 miles compared to 29 miles for in-state (I-S) patients.
- O-S patients presented with longer TFD (4.6 vs 2.8 months), higher PCI (32 vs 24), and higher rates of PSS-2/3 (40.4% vs 28.6%) and systemic chemotherapy (31.8% vs 19.2%).
- Rates of complete cytoreduction (CC-0/1) and major complications were comparable between O-S and I-S groups, and O-S travel did not significantly impact overall survival (HR: 1.08).
Conclusions:
- Traveling to a PSMC for MAC treatment is associated with delayed presentation and more advanced disease at diagnosis.
- Despite these differences, treatment quality, including complete cytoreduction and complication rates, and overall survival outcomes are not adversely affected by O-S travel.
- Early referral to specialized centers and robust support systems for patient travel are essential for managing MAC effectively.
