Real-world treatment patterns, healthcare resource utilization (HCRU), and costs in newly diagnosed patients with rectal cancer (RC) in the United States (US).
Authors: Laura Moore-Schiltz, Caitlyn T Solem, Joseph Tkacz, Sean O’Donnell
Journal: Journal of Clinical Oncology (2025)

295 Background: RC constitutes 30% of colorectal cancer cases, the fourth most common cancer in the US, and is associated with a substantial economic burden. This retrospective claims analysis examined patient (pt) characteristics, all-cause and RC-related HCRU, and costs in pts who received surgery, radiotherapy (RT), or systemic therapy (ST) for RC. Methods: Medicare Fee-for-Service and MORE 2 Registry claims data were used to select pts with RC (RC cohort) and matched, non-RC controls (non-RC cohort). Pts with RC were required to have a diagnosis of RC in the primary position of ≥1 inpatient claim or in any position of ≥2 outpatient claims between Jan 1, 2016, and Dec 1, 2021, and ≥1 claim for an RC surgery, RT, or ST after diagnosis. Pts (aged ≥18 y) also needed to have continuous enrollment for 12 months preceding and minimum 30 days following the treatment index date (earliest RC treatment claim). Non-RC controls were matched to pts with RC on birth year, sex, payer type, and Deyo-Charlson Comorbidity Index (DCI). All-cause HCRU and costs (per pt per month [PPPM]) were compared for the RC and non-RC cohorts. Results: A total of 20,953 pts were included in each cohort (median age, 70 y; 52.5% male; median DCI, 1.0 in both cohorts). Median follow-up time was 24 months. In the RC cohort, 88.5% of pts underwent ≥1 surgery after RC diagnosis and 51.3% had ≥4 surgeries during follow-up. Colonoscopy and biopsies (59.4%), total mesorectal excision (47.7%), and proctectomy (45.2%) were the most frequent surgeries/procedures. RT was used as neoadjuvant and adjuvant therapies in 21% and 15.7% of pts, respectively; 5-fluorouracil was the most common neoadjuvant (12.7%) and adjuvant (20.9%) ST. Among nonsurgical pts (11.5%), 72.8% were treated with RT and 49.9% with 5-fluorouracil; a small proportion received immunotherapy (pembrolizumab, 1.2%; nivolumab, 0.7%). All-cause HCRU was significantly greater ( P &lt;0.001) in the RC cohort vs the non-RC cohort (proportion of pts with ≥1 claim for physician office/clinic visit, 81.3% vs 73.6%; emergency room visits, 68.7% vs 45.3%; hospitalization, 71.1% vs 25.9%). The mean all-cause costs PPPM were $6043 for the RC cohort vs $1538 for the non-RC cohort ( P &lt;0.001); mean RC-related costs PPPM were $3119. Outpatient and inpatient services were the main cost drivers in the RC cohort, accounting for 57.1% and 36.6% of all-cause expenditure, respectively, and 58.1% and 40.5% of RC-related expenditure. Conclusions: Most pts newly diagnosed with RC received standard of care surgical treatment, often with neoadjuvant or adjuvant RT or ST. All-cause HCRU was significantly greater for pts with RC vs those without RC; all-cause costs were almost 4 times higher, with about half of these costs related to RC and driven by outpatient services and hospitalizations. These results show a high economic burden and a need for additional treatments for pts with RC.