K. A. Harden1, N. F. Fino2, C. J. Clark1 1Wake Forest University School Of Medicine,Department Of General Surgery,Winston-Salem, NC, USA 2Wake Forest University School Of Medicine,Department Of Biostatistical Sciences,Winston-Salem, NC, USA
Introduction:
With a cancer diagnosis of the gastrointestinal tract, surgery provides a potential for cure; however, not all patients with localized disease undergo an operation. The aim of the current study was to identify person and population level disparities in sociodemographic and health characteristics between patients with localized gastrointestinal malignancies treated with and without curative resection.
Methods:
Using the National Cancer Institute’s Surveillance, Epidemiology, and End-Results-Medicare Health Outcomes Survey linked database (SEER-MHOS), we identified patients diagnosed with localized adenocarcinoma of esophagus, stomach, small bowel, colon, and rectum who completed a comprehensive physical and mental health outcomes survey within two years of their diagnosis. Overall survival was summarized using Kaplan Meier methods; the log rank test was used to test for survival differences by receipt of surgery. Univariate and multivariable analyses were performed to identify disparities in sociodemographic and health characteristics between patients who were or were not treated with curative resection.
Results:
2,051 eligible patients were included in the study cohort. 20.3% of patients did not undergo surgery expected for treatment of a localized gastrointestinal cancer. Overall survival was improved for those treated with surgery (HR 0.63, 0.55-0.74 95% CI, p<0.001). Univariate analysis of sociodemographic and health characteristics showed that surgical intervention was less likely in male patients, non-homeowners, lower median household income, older age, more than two comorbid conditions, any impairment in activities of daily living, lower physical quality of life, prior history of cancer, and larger tumor size (all p<0.05). Person-level social characteristics including non-white race, less than high school education, and marriage status were not predictors of undergoing surgery. In addition, population-level social characteristics including non-metropolitan residence, non-white neighborhood, lower income neighborhood, and neighborhood with lower level of education, were not predictors of undergoing surgery. In a multivariate model using both person and population-level social characteristics, factors independently associated with curative resection were female gender, younger age, fewer comorbidities, and no prior history of cancer (all p<0.05).
Conclusion:
In the United States, patients diagnosed with early stage GI malignancies were less likely to proceed with curative resection secondary to person-level health characteristics. We did not observe population-level disparities in the treatment of early GI malignancies based on social and economic differences.