Disparities in access and outcomes in advanced malignancies encompass, result from, and are interlinked with a host of dimensions, including genetic factors, racial and gender inequities, and socioeconomic status (SES). There are limited data on the existing disparities in patients with peritoneal carcinomatosis (PC) undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Our review aims to discuss these disparities, highlighting the role of race, gender, SES, and distance from healthcare facilities in the utilization of these crucial therapies. Although equal access to treatment for PC remains a hurdle, there are no disparities in the severity and extent of peritoneal cancer, the aggressiveness of cancer, or its response to treatment between White and African American individuals. Males are more likely to undergo CRS and HIPEC for peritoneal metastasis despite a lower prevalence compared to females. Females, however, have increased overall survival and lower 30-day mortality. There is an association between higher SES and private insurance with better access to such therapeutic modalities. Patients with lower SES have an increased number of comorbidities, delays in diagnosis, and significantly lower overall survival. Lower SES patients are at a further disadvantage, as CRS and HIPEC are complex procedures that require specialized expertise and infrastructure, which is typically concentrated in urban areas. These disparities can be addressed by providing equal access, education, and virtual care solutions, which are essential to bridge these gaps and ensure that all patient populations have the opportunity to benefit from advancements in CRS and HIPEC.
Sohail et al. (Mon,) studied this question.