Racial Disparities in Esophageal Cancer

Summary Esophageal cancer is one of the most common cancer killers in our country. The effects of racial disparities on care for esophageal cancer patients are incompletely understood. Using the National Cancer Database, we investigated racial disparities in treatment and outcome of esophageal cancer patients. The National Cancer Database was queried from 2004 to 2017. Logistic regression and survival analysis were used to determine racial differences in access, treatment and outcome. A total of 127,098 patients were included. All minority groups were more likely to be diagnosed at advanced stages versus Caucasians after adjusting for covariates (African American OR—1.64 [95% confidence interval 1.53—1.76], Hispanic OR—1.19 [1.08—1.32], Asian OR—1.78 [1.55—2.06]). After adjustment, all minorities were less likely at every stage to receive surgery. Despite these disparities, Hispanics and Asians had improved survival compared with Caucasians. African Americans had worse survival. Racial disparities for receiving surgery were present in both academic and community institutions, and at high-volume and low-volume institutions. Surgery partially mediated the survival difference between African Americans and Caucasians (HR—1.13 [1.10–1.16] and HR—1.04 [1.02–1.07], without and with adjustment of surgery).There are racial disparities in the treatment of esophageal cancer. Despite these disparities, Hispanics and Asians have improved overall survival versus Caucasians. African Americans have the worst overall survival. Racial disparities likely affect outcome in esophageal cancer. But other factors, such as epigenetics and tumor biology, may correlate more strongly with outcome for patients with esophageal cancer.

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Racial Disparities in Esophageal Cancer Outcomes

Journal of Surgical Research ◽

10.1016/j.jss.2011.11.759 ◽

2012 ◽

Vol 172 (2) ◽

pp. 344

Author(s):

S.L. Revels ◽

A.M. Morris ◽

R.M. Reddy ◽

C. Akateh ◽

S.L. Wong

Keyword(s):

Esophageal Cancer ◽

Racial Disparities ◽

Cancer Outcomes

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Underuse of Surgery Accounts for Racial Disparities in Esophageal Cancer Survival Times: A Matched Cohort Study

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2018.07.018 ◽

2019 ◽

Vol 17 (4) ◽

pp. 657-665.e13 ◽

Cited By ~ 3

Author(s):

Jing Dong ◽

Xiangjun Gu ◽

Hashem B. El-Serag ◽

Aaron P. Thrift

Keyword(s):

Esophageal Cancer ◽

Cohort Study ◽

Racial Disparities ◽

Cancer Survival ◽

Matched Cohort ◽

Survival Times ◽

Matched Cohort Study

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Racial Differences in Surgical Evaluation, Treatment, and Outcome of Locoregional Esophageal Cancer: A Population-Based Analysis of Elderly Patients

Journal of Clinical Oncology ◽

10.1200/jco.2005.05.169 ◽

2005 ◽

Vol 23 (3) ◽

pp. 510-517 ◽

Cited By ~ 66

Author(s):

Ewout W. Steyerberg ◽

Craig C. Earle ◽

Bridget A. Neville ◽

Jane C. Weeks

Keyword(s):

Esophageal Cancer ◽

Elderly Patients ◽

Racial Disparities ◽

Racial Differences ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Curative Surgery ◽

Black Patients ◽

Surgical Evaluation ◽

White Patients

Purpose We investigated racial disparities in access to surgical evaluation, receipt of surgery, and survival among elderly patients with locoregional esophageal cancer. Methods We selected 2,946 white patients and 367 black patients who were older than 65 years and had clinically locoregional esophageal cancer in the Surveillance, Epidemiology, and End Results (SEER) registry (1991 to 1999). Treatment and outcome data were obtained from the linked SEER-Medicare databases. We used logistic regression analysis to estimate odds ratios (ORs) for being seen by a surgeon and for undergoing surgery. Cox proportional hazards analyses were performed to estimate hazard ratios (HRs) for survival adjusted for medical, nonmedical, and treatment characteristics. Results The rate of surgery for black patients was half that of white patients (25% v 46%; OR, 0.38; P < .001), which was caused by both a lower rate of seeing a surgeon (70% v 78%; OR, 0.66; P < .001) and a lower rate of surgery once seen (35% v 59%; OR, 0.38; P < .001). These racial disparities were only partly explained by differences in patient and cancer characteristics, and not by nonmedical factors, such as socioeconomic status. The 2-year survival rate was lower for black patients (18% v 25%; HR, 1.18; P = .004), but this racial difference disappeared when corrected for treatment received (adjusted HR, 1.02; P = .80). Conclusion Underuse of potentially curative surgery is an important potential explanation for the poorer survival of black patients with locoregional esophageal cancer. Barriers to surgical evaluation and treatment need to be reduced, whether related to patient or healthcare system factors.

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Racial Disparities in Esophageal Cancer Treatment and Outcomes

Annals of Surgical Oncology ◽

10.1245/s10434-007-9664-5 ◽

2007 ◽

Vol 15 (3) ◽

pp. 881-888 ◽

Cited By ~ 50

Author(s):

Alexander J. Greenstein ◽

Virginia R. Litle ◽

Scott J. Swanson ◽

Celia M. Divino ◽

Stuart Packer ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Treatment ◽

Racial Disparities

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The impact of marital status on racial disparities in esophageal cancer care.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.4056 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 4056-4056

Author(s):

Alan Paniagua Cruz ◽

Karlie L. Haug ◽

Lili Zhao ◽

Priya Wadhera ◽

Rishinda Reddy

Keyword(s):

Esophageal Cancer ◽

African American ◽

Marital Status ◽

Racial Disparities ◽

Secondary Analysis ◽

Fold Increase ◽

Categorical Variables ◽

Continuous Variables ◽

Surgery Rates ◽

The Impact

4056 Background: It is well known that racial disparities exist in cancer treatment and outcomes. The present study examined the impact of marital status as a surrogate for social support on esophageal cancer (EsC) care. Methods: We performed a secondary analysis of data collected from a state cancer registry. We included individuals with an EsC diagnosis between January 1, 2000 and December 31, 2013. A Chi-square test and Fisher’s exact test was used to analyze categorical variables and two-sample t-tests to compare continuous variables. Results: 8754 patients (Caucasian (C) or African American (AA) only) were included, with 88.4% C and 11.6% AA. Staging at diagnosis in C and AA patients revealed that 30.6% vs 28.6% had localized disease, followed by 33.8% vs 32.0% with regional, and 35.6% vs 40.0% with metastatic, respectively (p = .0155). Rates of chemotherapy (53.6% vs 53.5%) and radiation therapy (54.1% vs 56.2%) administration were found to be similar between C and AA patients. In contrast, surgery rates were significantly different between the two groups, with 29.7% of C undergoing surgical resection in comparison to only 12.0% of AA patients (p < .0001). When evaluating marital status, 63.3% of C were married, compared to 33.4% of AA patients (p < .0001). In the AA group, 20.1% of married patients underwent surgery in contrast to only 7.6% of single AAs (p < .0001). Similarly, in the C group, married patients underwent surgery at a rate of 34.5%, while single patients went to surgery at a rate of 22.2% (p < .0001). Surgery contraindication (CI) rates were found to be similar across all groups (5.6% married Cs, 5.2% married AAs, 6.6% single Cs, and 6.5% single AAs) along with surgery refusal rates (1.56% single Cs vs 2.68% married Cs (p = .052), and 1.04% single AAs vs 2.81% married AAs (p = .210)). Conclusions: African American patients receive chemotherapy and radiotherapy at comparable rates to Caucasian patients, but the rates of surgery are significantly lower. Being married was associated with an almost three-fold increase in surgery rates for AA patients, and cause a significant increase in Caucasians too.

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Racial disparities in patients with unresectable stage III/IV esophageal cancer at time of diagnosis: A National Cancer Database Analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16589 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16589-e16589

Author(s):

Meena Sadaps ◽

Neal Mehta ◽

Ran Zhao ◽

Wei Wei ◽

Amit Bhatt ◽

...

Keyword(s):

Esophageal Cancer ◽

African American ◽

Native American ◽

African Americans ◽

Racial Disparities ◽

Clinical Outcomes ◽

Locally Advanced ◽

Stage Iii ◽

National Cancer Database ◽

Unresectable Stage

e16589 Background: Significant racial disparities exist in the patterns of care and clinical outcomes for patients with early stage, non-metastatic esophageal cancer but data in advanced esophageal cancer are lacking. In this study, we aim to evaluate racial disparities in patients with locally advanced/metastatic, unresectable esophageal cancers. Methods: We identified patients in the National Cancer Database with esophageal cancer, from 2004 to 2016, with unresectable stage III/IV disease at time of diagnosis. We compared overall survival (OS) between different racial groups as well as other demographic and socioeconomic factors that may have contributed to this disparity. Secondary factors that were studied included age, sex, education, histology, and location of tumor. Results: 49,139 patients were included in this analysis. Median age was 64.5 years and 39,314 (80.0%) were male. 16,723 (34.0%) patients had stage III disease and 32,416 (66.0%) patients had stage IV disease. 16,208 patients (33.0%) had squamous cell carcinoma and 32,931 (67.0%) had adenocarcinoma. Patients were stratified into one of the following six categories for race: Caucasian (40,139; 81.7%), African American (5,571; 11.3%), Asian (907; 1.8%), Hispanic/Latino (1,793; 3.6%), Native American (145; 0.3%), and other (167; 0.3%). African Americans had worse median OS (Table) than Asians (p = 0.000), Hispanic/Latinos (p = 0.000), and Caucasians (p = 0.001) when analyzed in a pairwise comparison using log-rank testing. Within the African American subset, older age ( > 70 years) (p = 0.00), male gender (p = 0.00), and tumor location in the mid (p = 0.02) or upper third (p = 0.00) of the esophagus were associated with worse outcomes using Cox’s multivariate regression model. Conclusions: Racial disparities persist even in unresectable stage III/IV esophageal cancer patients with African Americans noted to have worse clinical outcomes as compared to most other races including Caucasian, Asian, and Hispanic/Latino patients. Further research is warranted to determine the cause for this disparity and to implement the necessary changes to improve outcomes for these patients. [Table: see text]

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Racial Disparities in Rates of Surgery for Esophageal Cancer: a Study from the National Cancer Database

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-020-04653-z ◽

2020 ◽

Author(s):

Samantha L. Savitch ◽

Tyler R. Grenda ◽

Walter Scott ◽

Scott W. Cowan ◽

James Posey ◽

...

Keyword(s):

Esophageal Cancer ◽

Racial Disparities ◽

National Cancer Database

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Association Between Marital Status and Racial Disparities in Esophageal Cancer Care

JCO Oncology Practice ◽

10.1200/jop.19.00561 ◽

2020 ◽

Vol 16 (6) ◽

pp. e498-e506

Author(s):

Alan Paniagua Cruz ◽

Karlie L. Haug ◽

Lili Zhao ◽

Rishindra M. Reddy

Keyword(s):

Esophageal Cancer ◽

Marital Status ◽

Racial Disparities ◽

Cancer Care ◽

Statistical Significance ◽

Secondary Analysis ◽

Eligibility Criteria ◽

Significant Difference ◽

The Impact ◽

White Patients

PURPOSE: This study was designed to examine the impact of marital status on racial disparities in esophageal cancer care. PATIENTS AND METHODS: We performed a secondary analysis of data collected from the state cancer registry maintained by the Michigan Department of Health and Human Services. We identified patients with an esophageal cancer diagnosis between January 1, 2000, and December 31, 2013. χ2 test and logistics regression were used to analyze 6,809 patients who met our eligibility criteria. Statistical significance was defined as P ≤ .05. RESULTS: Approximately 88.4% of our patients were White and 11.6% were Black. A significantly higher number of White patients were married when compared with Blacks (62.9% v 31.8%, respectively; P < .0001). There was no significant difference in cancer staging between the 2 groups ( P = .0671). Married Blacks had similar rates of esophagectomy, chemotherapy, and radiation as married Whites. Both single groups had lower rates of esophagectomy and chemotherapy than married Whites, but single Blacks were the least likely to undergo esophagectomy. Single patients were more likely to refuse treatment. CONCLUSION: Marital status differs significantly in Black and White patients with esophageal cancer and may help explain racial disparities in cancer care. Further research is needed to explore reasons for care underutilization in single patients and whether these differences translate into clinical outcomes.

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