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Less surgery among blacks linked to worse esophageal cancer survival
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Black patients with esophageal cancer have shorter survival times compared with other patients, which could be due to the underuse of surgery in the population, according to research published in Clinical Gastroenterology and Hepatology.
Aaron P. Thrift, PhD, of the Dan L. Duncan Comprehensive Cancer Center at the Baylor College of Medicine, and colleagues wrote that black patients have poorer survival and are more likely to be diagnosed with later-stage disease than non-Hispanic white patients.
“We conducted this updated analysis with the most recent data from the [Surveillance Epidemiology and End Results (SEER)]-Medicare database to examine the extent of the racial disparities in esophageal cancer survival in the U.S., with the added objective to understand the nature of the disparity,” they wrote. “We asked whether [non-Hispanic whites] with esophageal cancer who present like blacks with esophageal cancer are treated in the same way as blacks are treated, and if not, to what extent does a difference in treatment explain the disparity in survival.”
To address these questions while avoiding limitation of conventional model-based methods, Thrift and colleagues used a matching analysis system to compare the entire black population with esophageal cancer with three matched non-Hispanic white populations.
Using the SEER-Medicare database, researchers identified 1,900 black and 15,523 non-Hispanic white patients diagnosed with either esophageal squamous cell carcinoma or esophageal adenocarcinoma from 1994 to 2011. All the patients were aged at least 65 years.
Investigators matched three sets of 1,900 non-Hispanic white patients sequentially to the same set of 1,900 black patients based on demographics, presentation and treatment.
Black patients had a shorter median survival compared with non-Hispanic white patients (8 months vs. 10 months; P < .001), as well as a 5.1% lower 5-year survival rate (13.3% vs. 18.4%; 95% CI, 2.3–7.7).
The difference in 5-year survival decreased to 2.3% (95% CI, 0.3–4.8) when investigators matched for presentation, and additional matching for treatment-related factors eliminated the racial difference in 5-year survival.
Thrift and colleagues found that just 10.8% of black patients underwent surgery compared with 22.8% of non-Hispanic white patients (P < .001). While histology, tumor location, socioeconomic status, chemotherapy and radiation therapy were all associated with the receipt of surgery, researchers found that none of them could explain the racial difference in surgery rates.
“We confirmed striking differences in the receipt of surgery between blacks and [non-Hispanic whites], which was the major contributor to the survival disparity. Even among patients matched for stage, grade and comorbidities, blacks were less likely to receive surgery than [non-Hispanic whites],” the researchers wrote. “Although we cannot explain the racial disparities in the receipt of surgery due to the nature of the data, we believe that histology and tumor location play a role. These racial disparities in treatment and survival may be from the histopathological, epidemiologic and molecular distinctions between [esophageal squamous cell carcinoma] and [esophageal adenocarcinoma].” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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