key: cord-0911245-9sbehu7v
authors: Sutton, Thomas L.; Mayo, Skye C.
title: ASO Author Reflections: Geographic Disparities in Referral and Oncologic Outcomes in Intrahepatic Cholangiocarcinoma
date: 2021-08-17
journal: Ann Surg Oncol
DOI: 10.1245/s10434-021-10652-4
sha: a4414bff622510540578d8eb4852cc4443379d8e
doc_id: 911245
cord_uid: 9sbehu7v

nan

In this issue, we report an analysis of patients with ICC diagnosed within the predominately rural state of Oregon. 5 We utilized the Oregon State Cancer Registry to identify treatment patterns for patients with ICC, identifying three groups: those diagnosed and treated at referral centers, those diagnosed and treated at community centers, and those with parts of first-course therapy taking place in both settings. Referral centers were defined as programs offering multidisciplinary oncology care and clinical trials for ICC. We showed that patients treated in the combined community center plus referral center settings had improved survival compared with patients treated only at referral centers, and both of which had improved survival compared with patients who were treated only in the community without any referral center involvement. Additionally, referral center involvement in first-course treatment was associated with higher odds of receiving a curative-intent resection, radiation, and systemic chemotherapy, which were each associated with improved survival. Surprisingly, metastatic disease at diagnosis was independently associated with lower odds of referral center treatment. Finally, farther distance to the nearest referral center was independently associated with lower odds of referral center treatment. These findings are useful in characterizing the disparities in referral and treatment that exist in states with a predominately rural population, and are likely reflective of the difference in survival outcomes that may result. These disparities may be particularly pronounced for malignancies such as ICC, where novel treatments such as targeted therapeutics may be more available or appropriately utilized at referral centers.

It is incumbent upon clinicians at NCI Comprehensive Cancer Centers and other referral centers with treatment programs for rare and aggressive malignancies such as ICC to ensure that all patients within their catchment basin have access to high-quality cancer care. Prior to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, long distances often stymied outreach attempts to remote communities, and telemedicine technology was not widely available or utilized by oncologists. However, lessons learned can and should be leveraged to improve the oncologic care for patients in remote locations. Telemedicine can eliminate hours of travel across hundreds of miles for an initial evaluation, and what previously required patients to miss a day or more of work can now be accomplished during a lunch break. Even for patients who do not have a sufficient performance status to undergo a curative-intent resection, such as the major hepatectomies often required for ICC, telemedicine offers the option for referral centers to guide the care administered locally, even if that care is predominantly palliative in nature.

As increasing emphasis is placed on centralization of oncologic care due to the benefits of treatment at highvolume referral centers, the medical community is at risk of potentially overlooking patients in remote locations. If recent lessons on delivering care remotely are leveraged moving forward, the SARS-CoV-2 pandemic can be a watershed moment for oncologic care of patients in rural areas worldwide. As evidence shows, treatment at highvolume referral centers has measurable benefits, not just in the surgical population but even in patients with metastatic disease. We therefore encourage the continued use and expansion of telemedicine in the post-pandemic era to facilitate rapid evaluation and treatment planning for patients with cancer, particularly for malignancies where cutting-edge therapies promise the greatest impact to oncologic outcomes when guided by the clinical experience at cancer centers.

Trends in the incidence, treatment and outcomes of patients with intrahepatic cholangiocarcinoma in the USA: facility type is associated with margin status, use of lymphadenectomy and overall survival

Going the extra mile: improved survival for pancreatic cancer patients traveling to high-volume centers

Volume matters in the systemic treatment of metastatic pancreatic cancer: a population-based study in the Netherlands

Volume-outcome relation in palliative systemic treatment of metastatic oesophagogastric cancer

Geographic disparities in referral and oncologic outcomes in intrahepatic cholangiocarcinoma: a population-based study

FUNDING This manuscript did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.DISCLOSURES Thomas L. Sutton and Skye C. Mayo have no conflicts of interest or financial ties to disclose.