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Study Finds Racial Disparities in Esophageal Cancer Surgical Rates


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A new study published by Savitch et al in the Journal of Gastrointestinal Surgery found that black patients are less likely to receive surgery for resectable esophageal cancer, which may contribute to higher rates of death.

“National guidelines suggest that early-stage esophageal cancer should be treated with surgery because data shows that it offers patients the best chances of survival, rather than chemotherapy alone,” said senior study author Nathaniel Evans, MD, Director of the Division of Thoracic Surgery at Thomas Jefferson University and Chief of Cancer Services, Center City Division at the Sidney Kimmel Cancer Center–Jefferson Health, in a statement. “Our data show that black patients are not having surgery for early-stage disease, which may contribute to higher rates of death. With this data, we can now begin to educate patients and providers to change practice.”

Study Methods

A total of 60,041 patients from 1,334 hospital across the United States were included in the analysis that drew information from the National Cancer Database; 4,402 were black and 55,639 were non-Hispanic white. In order to ensure an unbiased comparison, black and non-Hispanic white patients were matched by demographics, comorbidities, and tumor characteristics in a 1:1 fashion. The final dataset included 5,858 patients.

Findings

KEY POINTS

  • The researchers’ analysis showed that rates of surgery were significantly lower in black patients with esophageal cancer across all stages of the disease.
  • Likelihood of receiving surgery lessened as the age of black patients increased and also decreased if the patients were receiving radiation therapy.
  • Black patients were more likely to undergo surgery if they were treated at a hospital that was more than five miles from their homes.
  • Patients who were diagnosed with esophageal squamous cell carcinoma—which is more common in black patients—were less likely to receive surgery.

The researchers’ analysis showed that rates of surgery were significantly lower in black patients with esophageal cancer across all stages of the disease (stage I, odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.48–0.94; stage II, OR = 0.76, 95% CI = 0.60–0.96; and stage III, OR = 0.62, 95% CI = 0.50–0.76) after controlling for hospital random effects in single-level multivariable analysis.

In addition, the researchers noted that likelihood of receiving surgery lessened as the age of black patients increased, and also decreased if the patients were receiving radiation therapy. Black patients were more likely to undergo surgery if they were treated at a hospital that was more than five miles from their homes.

The findings also suggested that patients who were diagnosed with esophageal squamous cell carcinoma—which is more common in black patients—were less likely to receive surgery.

“Although the data doesn’t give us a reason for the observations we’re seeing, it does show us areas where we can take action,” said Dr. Evans. “Even when we control for socioeconomic status, insurance status, location, and comorbid conditions, the disparity still persists—it is quite profound. This highlights the need to educate black patients and their health-care providers on the importance of surgery in the treatment esophageal cancer.”

The study authors concluded, “Black patients with esophageal cancer are at higher risk of mortality compared to white patients. This increased risk may be influenced by decreased likelihood of receiving surgical intervention for resectable disease, in part because of between-hospital differences. Improving access to surgical care may improve disparities in esophageal cancer survival.”

Disclosure: For full disclosures of the study authors, visit link.springer.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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