2768 - Outcomes of Curative-Intent Cancer Therapy in a Decentralized Regional Cancer Center In India
Presenter(s)
R. A. Vadgaonkar1, H. Khalil2, S. Nachu1, S. Silverwood3, V. R. Bandal1, N. Alapati1, R. Miriyala1, S. K. Kavitarapu1, N. R. N1, V. Vishwanath1, S. S. Naik1, A. Datta1, P. Vamsi1, A. S. Padhy1, V. Kapu1, K. Chiriki4, D. Fernandes1, S. Grover5, and U. M. Mahantshetty1; 1Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, India, 2University of Texas at Southwestern Medical School, Dallas, TX, 3Department of Radiation Oncology, University of Washington, Seattle, WA, 4Ruby General Hospital, Ltd, kolkata, West Benga, India, 5Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Purpose/Objective(s): Cancer burden is increasing in low- and middle-income countries (LMICs), where access to comprehensive oncologic care remains limited. Decentralized care models aim to expand access by delivering multidisciplinary treatment closer to patients. We hypothesize that decentralized regional delivery of guideline-based multimodality therapy could achieve favorable survival outcomes among patients treated with curative intent.
Materials/Methods: We conducted a retrospective cohort study of consecutive patients treated with curative intent using definitive surgery and/or radiotherapy at a regional cancer center in India between 2016 and 2020. Patients with distant metastatic disease, referral elsewhere for definitive treatment, or palliative-intent therapy were excluded. Follow-up was collected through 12/31/22. Overall survival (OS) was measured from treatment initiation to death from any cause or last contact. Clinical follow-up was available through December 31, 2022. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier methods.
Results: Of 17,706 new cancer registrations between 2016 and 2020, 1,372 patients received curative-intent treatment and were included in the analysis. Median age was 53 years (IQR 43–62), and 64.6% were female. Primary disease sites included head and neck (40.5%), breast (32.4%), gynecologic (16.2%), and gastrointestinal (11.0%). Stage at presentation varied by disease site: head and neck (50.1% stage IV), gastrointestinal (57.6% stage III), breast (52.3% stage II), and gynecologic (33.3% stage I). The median diagnosis-to-treatment interval was 17 days (IQR 9–27). Multimodality therapy was delivered in 77.6% of patients. Median follow-up was 38 months (IQR 30–49), during which 65.7% of patients were alive, 28.3% had died, and 6.0% were lost to follow-up. Three-year DFS and OS for the overall cohort were 68.4% and 72.7%, respectively. Three-year OS by disease site was highest for breast (86.2%) and gynecologic cancers (78.9%), followed by head and neck (64.2%) and gastrointestinal cancers (54.1%); corresponding three-year DFS rates were 80.7%, 69.5%, 62.2%, and 50.9%, respectively.
Conclusion: In this large single-center cohort, decentralized regional delivery of curative-intent cancer care was associated with encouraging 3-year overall and disease-free survival, high utilization of multimodality therapy, and short diagnosis-to-treatment intervals. The persistent presentation of advanced-stage disease in head and neck and gastrointestinal cancers underscores the need for earlier detection and strengthened referral pathways to fully realize the benefits of decentralized cancer care.