K. L. Maupin1, C. Hartupee1, H. Malinosky2, D. Danos1,3,4, O. Moaven1,3,5 1Louisiana State University (LSU) Health School of Medicine- New Orleans, Department Of Interdisciplinary Oncology, New Orleans, LOUISIANA, USA 2LSU Health Sciences Center School of Medicine, Surgical Oncology, New Orleans, LOUISIANA, USA 3LSU-LCMC Cancer Center, New Orleans, LOUISIANA, USA 4Louisiana State University (LSU) Health School of Public Health, Behavioral And Community Health Sciences, New Orleans, LOUISIANA, USA 5Louisiana State University (LSU) Health, Department Of Surgery, New Orleans, LOUISIANA, USA
Introduction: Disparities in access to prevention, screening, and the management of various cancers can significantly impact patient outcomes. Surgery is the treatment modality that can potentially provide the most significant oncologic benefit in patients with gastric cancer, and it is essential to identify inequities that affect access to surgical care and, subsequently, the outcomes of patients with gastric cancer. In this study, we aimed to investigate inequities in access to surgical management of gastric cancer and identify the associating factors and their impact on patients outcomes.
Methods: Data from the Louisiana (LA) Tumor Registry between 2010-2020 were accessed to select patients that met the inclusion criteria. Using ICD-0 codes and SEER summary staging system for inclusion, we included patients with nonmetastatic gastric cancer. Statistical analysis of categorical variables was performed by examining bivariate relationships via Chi-square tests. Receipt of surgical therapy was modeled using logistic regression. Overall survival (OS) was visualized as Kaplan Meier plots, compared via log-rank test, and modeled using a Cox proportional hazards model.
Results: We included 1,694 patients based on study criteria: 873 (51.5%) White, 720 (42.5%) Black, 59 (3.5%) Hispanic, and 42 (2.5%) documented as other races. Regarding insurance status, 4% were uninsured, 23.9% had private insurance, 9.4% had Medicaid, 52.5% had Medicare, and 10.2% were unknown. In the study cohort, 482 (28.5%) patients did not receive surgery. In the multivariable analysis (MVA), high poverty (OR=0.72; 95% CI: 0.56-0.93, p[MO1] = 0.011), no domestic partners (OR=0.68; 95% CI: 0.54-0.87, p = 0.0019), Male sex (OR=0.75; 95% CI:0.59- 0.0155), and age greater than 80 (OR=0.26, 95% CI: 0.18-0.38, p = <0.0001) were associated with not receiving surgical therapy. Patients who did not receive any surgery had a median OS of 7 months, while those who had received a subtotal gastrectomy had a median survival of 73 months, and those who received a total gastrectomy had a median survival of 35 months. [DDM2] In MVA including demographic factors, black race was associated with decreased OS (HR:1.18; 95% CI:1.03-1.34, p=0.0146). When socioeconomic factors were added to the MVA, race was no longer independently associated with OS. Male patients (HR = 1.23; 95% CI: 1.07-1.41, p = 0.003), no domestic partner (HR = 1.28; 95% CI: 1.12-1.47, p = 0.0004), and patients with either Medicaid or Medicare (HR = 1.31/1.28, 95% CI: 1.01-1.71/1.05-1.55, p = 0.0462/0.0151 respectively) were associated with lower OS.
Conclusion: A considerable portion of patients with nonmetastatic gastric cancers in LA do not receive surgical treatment. Healthcare disparities exist in receipt of surgical care, and socioeconomic inequities are associated with access to care and outcomes of patients with nonmetastatic gastric cancer. Identifying inequities is an essential step in allocating resources to improve cancer outcomes.