Disparities in rectal cancer initial staging evaluation for distant metastasis

e18589 Background: About a quarter of rectal cancer patients will present with metastasis. Since metastasis dictates prognosis and treatment, detection is crucial. NCCN guidelines recommend CT of the chest, abdomen and pelvis (CT CAP) over PET/CT. Systemic race/ethnic disparities and poor access to health care have been associated with lower utilization of radiologic imaging. Here, we set out to assess disparity in initial radiology work up for rectal cancer metastasis. Methods: We reviewed consecutive rectal cancer cases at our academic institution from 2015 to 2020. Patients with inadequate history, workup performed in foreign country, or those who may not benefit from completion of imaging evaluation were excluded. Sociodemographic data, payer information and clinical history were collected from EMR. Zip code was used to assess SES and to assess for rural-urban community area (RUCA) code. Descriptive analysis, unadjusted odds ratios, and t-tests were used for analysis. Results: Among the 421 subjects, 339 met inclusion criteria. 133 were female (39.2%) and the mean age of the group was 58.6+/-13.5 years. 214 patients (63.1%) had CT CAP performed. Subjects aged 65+ were 41% less likely to have CT CAP completed compared to patients aged 24-64 (95% CI 0.37, 0.97). Subjects with Medicare coverage are 48% less likely to have CT CAP than those with private insurance coverage (CI 0.29, 0.92). Subjects who live in zip codes with median family income below the 50th percentile were 55% less likely to have CT CAP than those who live in zip codes with higher income (CI 0.27, 0.74). Subjects who live in urbanized areas were 3.87 times more likely to have CT CAP completed than those from non-urbanized areas (CI 1.53, 10.6). Subjects who were diagnosed in 2019-2020 were 1.81 times more likely to have CT CAP imaging completed compared to patients diagnosed before 2017. Race and ethnicity and BMI were also assessed, but no disparities were observed. Conclusions: Young age, private insurance, higher SES, urban neighborhood, and more recent diagnosis are associated with receipt of NCCN recommended radiologic evaluation of metastasis in rectal cancer. [Table: see text]