eP540 - Social Vulnerability and Compliance with Endoscopic Surveillance in Resected Colorectal Cancer

Purpose/Background: Postoperative endoscopic surveillance after resection of colorectal cancer enables detection of treatable, metachronous lesions, and portends reduced overall mortality. Well-described disparities in initial screening and treatment, by race and socioeconomic status, may similarly extend to subsequent follow-up care in vulnerable patients. Neighborhood-level determinants, such as social vulnerability index (SVI) capture socioeconomic, employment, household, and transportation factors at the census-tract level. SVI is implicated in lower utilization of cancer centers, and increased complications following colectomy, but its influence on compliance with endoscopic surveillance rates after resection is unknown. We therefore aimed to characterize relationships between SVI and colorectal cancer survival.Methods/Interventions: Patients aged 18 or older undergoing resection for pathologic stage I-IV colorectal adenocarcinoma January 2010 to May 2023 within a tertiary academic health system were identified. Demographics, comorbidities, tumor and treatment characteristics, complications, and endoscopic records were abstracted from electronic health records, and compared using chi-square tests. Addresses were geocoded via census tracts to obtain SVI, which was dichotomized into low (bottom three quartiles) and high (top quartile) categories. Patients with progressive disease or mortality within 12 months of resection were excluded. Nelson–Aalen cumulative hazard curves modeled time to first post-operative colonoscopy. Multivariable logistic regression evaluated factors associated with receipt of surveillance colonoscopy.Results/Outcomes: 577 patients undergoing colectomy or proctectomy were included. Patients receiving post-operative colonoscopy were more likely to originate in low-SVI areas (72% vs. 59%, p=0.01), have greater rates of stage III-IV disease (42% vs. 37%, p < 0.01), and were more likely to receive multimodal therapy (59% vs. 40%, p < 0.001). In univariate analyses, there were no significant differences by race, functional status or ASA classification, tumor location, pre-operative therapy, or post-operative complications. Median time to post-operative colonoscopy was 17.8 months (95% CI 15.0 – 23.3 months) in low-SVI patients and 20.4 months (95% CI 16.8 – 31.3 months) in high-SVI patients (log-rank p=0.04; figure 1). In a multivariable logistic regression model (table 1), high SVI remained associated with decreased receipt of post-operative colonoscopy (OR 0.48, 95% CI 0.27 – 0.86, p=0.01).Conclusion/

Discussion: High SVI was independently associated with lower rates of surveillance colonoscopy after colorectal cancer resection. Acknowledging potential missingness of endoscopy records, and need for multi-center evaluation, these findings suggest that identifying at-risk patients at the neighborhood level may help inform targeted follow-up intervention."Figure 1.Fig1_v2.tifCumulative hazard for post-operative endoscopic surveillance by SVI was evaluated using the Nelson–Aalen cumulative hazard function, and compared using the log-rank test. SVI – Social Vulnerability Index
Table 1.Table 1 ASCRS SM v2.tifMultivariable logistic regression for independent factors associated with receipt of surveillance colonoscopy among patients who underwent resection of pathologic stage I-IV colorectal adenocarcinoma."