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Comparison of the Financial Toxicity of Low Anterior Resection and Abdominoperineal Resection: A Prospective Cohort
Frédéric Grou-Boileau1, Tommy Lavoie-Turcotte1, Camille Gervais1
1Colon and Rectal Surgery, Department of Surgery, McGill University Health Center, Montreal, Qc, Canada.
Introduction:
Patients with colorectal cancer are often faced with two options for curative-intent resection: low anterior resection (associated with a significant risk of bowel dysfunction) and abdominoperineal resection ("APR," involving the creation of a permanent colostomy). Permanent colostomies can come with significant out-of-pocket expenses for patients, yet the amount of financial stress that patient experience because of their stoma has not been well quantified.
Method:
A prospective database of adult rectal cancer patients undergoing curative-intent proctectomy from a single high-volume university center from 09/2018 to 02/2024 was queried. Patients were excluded if they had less than 1 y of follow-up. Patients were administered a demographic questionnaire and the COmprehensive Score for financial Toxicity questionnaire at their follow-up visit or by phone.
Results:
A total of 120 patients were included (mean age, 62.27 y (standard deviation, 10.62), 62.5% male; 9.51 cm mean distance from anal verge (standard deviation, 6.51); 38% received neoadjuvant radiotherapy; 4.58 y median follow-up (interquartile range, 2.94)). There were 88 patients who underwent a low anterior resection and 32 who underwent an APR. After adjusting for age, sex, neoadjuvant and adjuvant therapy, surgical approach, tumor and node stage, ethnicity, level of education, working status, salary and insurance status, undergoing an APR remained predictive of an expected decreased COmprehensive Score for financial Toxicity score (i.e. decreased financial well-being) of 4.6 points (95% confidence interval 0.86, 8.4, P = 0.017).
Conclusions:
In this cohort, aAPRs were associated with a statistically significant decrease in financial well-being.
