EP622 - Geographic and Systemic Factors as Stronger Predictors of Fragmented Care than Patient Demographics in Locally Advanced Rectal Cancer

Sunday, May 10, 2026

4:06 PM - 4:11 PM ET

ePoster Presenter(s)

Tanay Sorathia, MPH (he/him/his)

Medical Student
Lake Erie College of Osteopathic Medicine - Bradenton
Lake Erie College of Osteopathic Medicine - Bradenton
Bradenton, FL, United States

Disclosure information not submitted.

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Author(s)

EJ

Esther Jean-Baptiste, n/a

NTRO Research Study Manager Senior
Moffitt Cancer Center and Research Institute
Tampa, Florida, United States

Disclosure information not submitted.
JL

Julaxis Love, n/a

Research Data Coordinator II
Moffitt Cancer Center and Research Institute
Tampa, Florida, United States

Disclosure information not submitted.
Seth Felder, MD

Associate Member, Department of Gastrointestinal Oncology
Moffitt Cancer Center
Moffitt Cancer Center
Tampa, FL, United States

Disclosure information not submitted.
CU

Cornelia M. Ulrich, MS, PhD

Executive Director
Huntsman Cancer Institute
Salt Lake City, Utah, United States

Disclosure information not submitted.
CL

Christopher Li, MD, PhD

Research Full Professor
Public Health Sciences Division, Fred Hutchinson Cancer Research Center
Seattle, Washington, United States

Disclosure information not submitted.
JF

Jane Figueiredo, PhD

Associate Professor
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center
Los Angeles, California, United States

Disclosure information not submitted.
AT

Adetunji Toriola, MD, PhD, MPH

Associate Professor
Department of Surgery, Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States

Disclosure information not submitted.
DS

David Shibata, MD, FACS, FASCRS

Professor and Chair of the Department of Surgery
University of Tennessee Health Science Center
Memphis, Tennessee, United States

Disclosure information not submitted.
BG

Biljana Gigic, PhD

Scientist
Department of General, Visceral and Transplantation Surgery, University of Heidelberg
Heidelberg, Baden-Wurttemberg, Germany

Disclosure information not submitted.
ES

Erin Siegel, PhD, MPH

Associate Member
Moffitt Cancer Center
Tampa, Florida, United States

Disclosure information not submitted.
DB

Doratha Byrd, PhD, MPH

Assistant Member
Department of Cancer Epidemiology, Moffitt Cancer Center
Tampa, Florida, United States

Disclosure information not submitted.

Senior Author(s)

Amalia Stefanou, MD MAS (she/her/hers)

Associate Member
Moffitt Cancer Center
Moffitt Cancer Center
Tampa, FL, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Purpose/Background: Locally advanced rectal cancer (LARC) management requires tightly coordinated trimodal therapy. Fragmented care, defined as receiving treatment components from different centers, may poorly influence outcomes. We sought to characterize the prevalence of fragmented care and identify its key predictors in stage II–III rectal cancer patients.

Methods/Interventions: A retrospective analysis of 91 stage II–III rectal cancer patients from the ColoCare prospective cohort study receiving care at a single tertiary center was conducted. Bivariate analyses were used to compare patient characteristics and sociodemographic factors. Time to surgery was defined as the time (in days) between the date of the initial colonoscopy and the date of surgery. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals for associations of patient characteristics with fragmented care.

Results/Outcomes: Of the 91 patients, 54% (49/91) experienced fragmented care. Among this group, 73% (36/49) received neoadjuvant and adjuvant therapy away from the primary surgical center. Patients traveling longer distances (≥85 km) for surgery had significantly higher odds of receiving fragmented care compared to those traveling shorter distances (aOR 7.26; 95% CI 2.46–21.41; p < 0.001). Fragmentation varied significantly by insurance status (p = 0.007), with rates highest for government-insured patients (72%), followed by managed care (53%), and lowest for those uninsured (11%). A trend toward higher fragmentation rates was observed in early-onset ( < 50) and late-onset (>65) patients (64% and 67%, respectively; p = 0.06). A longer time-to-surgery was associated with lower odds of fragmentation (aOR 0.30; 95% CI 0.10–0.93; p = 0.04).

Conclusion/Discussion: Fragmented care in LARC is common and associated with a patient's travel burden and insurance type. The long travel distances highlight potential patient challenges, such as time off work and transportation access. The influence of insurance likely reflects a combination of systemic constraints, such as plan-specific network and authorization practices, and patient-driven choice in seeking specialized surgery. The finding that integrated care is associated with a longer time-to-surgery may be characteristic of a comprehensive, multi-modal pathway that includes all diagnostic, neoadjuvant, and surgical planning steps at one institution. Efforts to improve care coordination should focus on overcoming these geographic and systemic barriers, particularly for the growing population of early-onset rectal cancer patients. Future studies must evaluate patient outcomes, recognizing that fragmented care at a tertiary center may not follow the same treatment protocols and thus lead to different outcomes than when delivered at a community center.