New study finds travel delays don’t impact long-term outcomes for rare cancer patients

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A new study from Mercy Medical Center reveals that patients traveling from out-of-state to receive specialized care for appendix cancer often face significant delays and arrive with more advanced disease. This discouraging yet predictable news is counteracted with a silver lining: the long-term outcomes once they begin care is similar to the results of local patients when treated at high-volume cancer centers.

The study was led by Dr. Vadim Gushchin, Director of Mercy’s heated chemotherapy (HIPEC) program and a member of the Surgical Oncology Department, as well as Armando Sardi, M.D., Medical Director of The Institute for Cancer Care at Mercy and a surgical oncologist. Gushchin and Sardi work with highly specialized and experienced clinical teams at Mercy to perform the complex surgical procedure of CRS (Cytoreductive Surgery) combined with HIPEC (Hyperthermic Intraperitoneal Chemotherapy) to treat rare and advanced cancers. HIPEC is used in conjunction with cytoreductive surgery in cases of advanced abdominal cancers.

Cytoreductive surgery is performed first to remove visible tumors from the abdominal area. Then, a heated chemotherapy solution is added to the abdominal cavity to destroy non-visible or microscopic tumor cells that may remain after surgery. Heat helps kill the cancer cells and also enhances the effect of chemotherapy. According to Sadi, this procedure has a higher success rate than any other cancer treatment.

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The research study, published in the July 2025 issue of The American Surgeon, focused on patients with mucinous appendix cancer undergoing complex surgery and heated chemotherapy (HIPEC) at Mercy, one of the nation’s leading treatment centers for peritoneal surface malignancies. The out-of-town patients studied all waited an average of 4.6 months from diagnosis to surgery, compared to 2.8 months for local patients, and presented higher peritoneal cancer index (PCi) scores. Despite these challenges, the study found that survival rates, tumor removal success, and complication rates were similar across both locals and out-of-towners, even up to 10 years.

Used in conjunction with cytoreductive surgery, HIPEC can improve survival and quality of life for patients who would have limited hope for a solution to their advanced cancer. Unfortunately, there are not many facilities around the country that offer these specialized treatments, which makes the percentage of patients who need this treatment actually getting it, very low.

“Geography is still a gatekeeper to care,” said Gushchin. “Out-of-state patients often experience delays and non-definitive treatments before reaching us — but with access to specialized treatment, their outcomes match those of local patients.”

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The percentage of patients who have to travel for personalized care simply do not do it as often, and instead of surgery, receive chemo, which does not have a similar outcome.

“Appendix cancer is rare and complex. Early, specialized intervention matters,” said Sardi. “We need to remove the barriers that keep patients from getting to the right care at the right time.”

Gushchin and Sardi use this study as a call for earlier referrals to experienced CRS/HIPEC centers and improved patient navigation, especially for those in underserved or rural areas. With the rarity of this cancer, many patients don’t have a strong support system, and many general surgeons are not adequately educated enough to refer patients to specialized centers in the time frame that is required.

Sardi commented, “I had a patient come to me who was told by their surgeon that they had months to live, and who was recommended to undergo chemotherapy during those months. However, through word of mouth and his own personal online research, he learned about HIPEC and came to Mercy for the procedure. I attended his wedding and am still in touch with him 11 years later.”

This is one of countless stories that Sardi has. In an effort to spread the word on the importance of HIPEC, he started the Abdominal Cancer Alliance, a patient-focused platform with the mission to save lives and improve quality of life by connecting patients and caregivers to the information and support that they need in their fight against advanced gastrointestinal and gynecologic cancers. Dr. Sardi, other doctors, organizations, caregivers and patients work to spread the word to provide education, resources, and medical assistance for those facing rare and advanced gastrointestinal and gynecologic cancers.

Both doctors hope that this study will educate doctors and patients around the world to the benefits of CRS/HIPEC and will refer patients to specialized centers like Mercy earlier, and provide resources for those who need it.

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