S. Willis1,5, D. Maurente1,4, A. Ardeljan1,3, A. Johns1, M. Bustos1,3, S. Sennhauser1,2, M. Ghali1,2, L. Ramsaran1,2, Z. Segota1,2, L. Siegel1,2, D. Drew1,2, G. Azzi1,2, D. Dammrich1,2, O. M. Rashid1,2 1Holy Cross Hospital,Michael And Dianne Bienes Comprehensive Cancer Center,Fort Lauderdale, FL, USA 2Massachusetts General Hospital,Cancer Center,Boston, MA, USA 3University Of Miami Miller School Of Medicine,Miami, FL, USA 4Charles E. Schmidt College Of Medicine At Florida Atlantic University,Boca Raton, FL, USA 5Nova Southeastern University College Of Osteopathic Medicine,Ft. Lauderdale, FL, USA
Introduction: Gastric malignancies, of which 90% are pathologically gastric adenocarcinomas, typically present at an advanced stage. Current standard of care involves a combination of chemotherapeutics, radiation therapy, antibody therapy, and surgical resection. This study reviews patient outcomes following various treatment modalities.
Methods: Data mining techniques were used to analyze the Medicare patient database from 2005-2013 for total charges, Charleston Comorbidity index (CCI), length of stay (LOS), and readmission rates at 30 days, 90 days, and 1 year for all different modalities of treatment.
Results: Statistically significant differences in charges between surgery only ($127,075), chemotherapy only ($135,969), and combination surgery with chemotherapy ($127,613) were found (P < 0.001, 95% confidence interval, or CI). CCI analysis between surgery only vs. chemotherapy only, surgery only vs. surgery with chemotherapy, and chemotherapy only versus surgery with chemotherapy was statistically significant (P < 0.001, 95% CI). Length of stay analysis was statistically significant between comparison groups (P < 0.001, 95% CI). Average lengths of stay were 14.95 days for surgery only, 16.49 days for chemotherapy only, and 13.63 for combination therapy. Readmission rates for Surgery only at 30 day, 90 day, and 1 year were 3.7%, 18.2%, and 32.0 % respectively. Combination therapy had readmission rates of 8.2%, 22.5%, and 40.7%, respectively. Chemotherapy only had readmission rates of 16.9%, 44.9%, and 59.1%, respectively.
Conclusion: Data analysis of the Medicare database demonstrated that patients treated with surgical resection only had the lowest CCI, readmission rates, and cost. Highest cost, CCI, LOS, and readmission rates were found for patients receiving chemotherapy only. Surgery may have had the lowest CCI and readmission costs, due to the fact that adenocarcinomas at earlier stages are more ideal for resection. Combination therapy may have pre-conditioned patients with chemotherapy and reduced tumor burden, resulting in a shorter hospital stay during resection.