Disparities of Distant Metastasis Evaluation Imaging for Rectal Cancer

The aim of this study was to determine demographic factors associated with receipt of initial distant metastasis imaging and the time delay between diagnosis and imaging among patients with rectal cancer.

Consecutive patients with rectal adenocarcinoma from a cancer registry were retrospectively reviewed for the presence of distant metastasis imaging and whether the received imaging was the first-line modality as determined by National Comprehensive Cancer Network and European Society for Medical Oncology guidelines. We obtained data for the clinical-demographic categories of ethnicity, sex, age, body mass index, census block, and insurance payer. Analyses included descriptive analysis and logistic regression analysis.

Of 329 patients, 61.4% were male, and the average age was 58 years. The average time interval from tissue diagnosis to imaging systemic staging completion was 20.6 days. In multivariable analysis, non-Hispanic patients (odds ratio [OR], 4.57; 95% confidence interval [CI], 2.27-9.19) and those who were overweight (OR, 4.55; 95% CI, 2.04-10.12) and obese (OR, 4.21; 95% CI, 1.70-10.45) were more likely to complete initial staging, with those with public insurance (P = .03) less likely to receive staging in univariable analysis. Patients with more recent year of diagnosis (OR, 1.26; 95% CI, 1.07-1.50) in multivariable analysis and those with younger age (P = .04) and urban residence (P < .01) in univariable analysis were associated with first-line imaging modality. Low body mass index was correlated with improved imaging timeliness (P = .03).

Multiple demographic factors affect the completion of imaging, receipt of recommended imaging, and the time interval to receive imaging. It is therefore necessary to ensure adequate compliance with initial workup recommendations and to improve radiologic access.