Racial disparities in surgery rates for esophageal cancer

June 25, 2020

PHILADELPHIA - Black patients with esophageal cancer are at a higher risk of death compared to white patients. Although many reasons have been suggested for this, few have given physician actionable information. A new study from the Sidney Kimmel Cancer Center (SKCC) - Jefferson Health points to a different reason - Black patients were less likely to receive surgery for treatable diseases, which could have contributed to their higher rates of death.

The results were published in the Journal of Gastrointestinal Surgery.

"National guidelines suggest that early-stage esophageal cancer should be treated with surgery because data shows that it offers patients the best chances of survival, rather than chemotherapy alone," says senior author Nathaniel Evans, MD, Director of the Division of Thoracic Surgery at Thomas Jefferson University, and Chief of Cancer Services, Center City Division at the SKCC. "Our data show that Black patients are not having surgery for early-stage disease, which may contribute to higher rates of death. With this data, we can now begin to educate patients and providers to change practice."

A total of 60,041 patients were included in the analysis that drew from the National Cancer Database, of whom 4,402 were Black and 55,639 were white across over 1,334 hospitals around the country. In order to ensure an unbiased comparison, Black and white patients were matched by demographics, comorbidities, and tumor characteristics in a 1:1 fashion. The final dataset included 5,858 patients.

The analysis led by first author Samantha L. Savitch, a senior medical student and researcher working in the Department of Surgery and others showed that rates of surgery were significantly lower, 25-40% less for Black patients with esophageal cancer in stages I to III. In addition, the researchers noted that the chances of getting surgery decreased as the age of Black patients increased, and also decreased if the patients were receiving radiation therapy. Black patients were more likely to get surgery if they were treated at a hospital that was more than 5 miles from their homes.

The findings also suggested that patients who were diagnosed with a type of esophageal cancer called squamous cell carcinoma, which is more common in Black patients, were less likely to receive surgery. All this despite clear evidence that surgical resection is the best chance for survival in patients with esophageal cancer.

"Although the data doesn't give us a reason for the observations we're seeing, it does show us areas where we can take action," says Dr. Evans. "Even when we control for socioeconomic status, insurance status, location, and comorbid conditions, the disparity still persists, it is quite profound. This highlights the need to educate Black patients and their healthcare providers on the importance of surgery in the treatment esophageal cancer."

"One way we are addressing this is by developing a Multidisciplinary GI Cancer group," says Dr. Evans. "We review esophageal cancer patients and ensure their treatment plans are tailored to the individual patent and follow established guidelines."

"This important study is part of a much larger effort at the Sidney Kimmel Cancer Center to understand and mitigate cancer disparities," says Karen Knudsen, PhD, EVP of Oncology Services and Enterprise Director of SKCC. "This goal is central to our mission to improve the lives cancer patients and their families, regardless of geography, gender, or demographic. We are thankful to Dr. Evans and the entire research team for raising awareness about this critical national issue."
-end-
Article reference: Samantha L. Savitch, Tyler R. Grenda, Walter Scott, Scott W. Cowan, James Posey III, Edith P. Mitchell, Steven J. Cohen, Charles J. Yeo, Nathaniel R. Evans, "Racial Disparities in Rates of Surgery for Esophageal Cancer: a Study from the National Cancer Database," Journal of Gastrointestinal Surgery, DOI: 10.1007/s11605-020-04653-z, 2020.

Media Contact: Edyta Zielinska, 267-234-3553, edyta.zielinska@jefferson.edu.

Thomas Jefferson University

Related Esophageal Cancer Articles from Brightsurf:

Pathological regression of lymph nodes better predicts esophageal cancer survival
A team of researchers led by Osaka University established a new pathological grading system to evaluate the therapeutic effect of neoadjuvant chemotherapy (NAC) for metastatic lymph nodes (LNs) removed in esophageal cancer (EC) surgery, demonstrating that the system predicts recurrence and prognosis in EC patients better than conventional systems.

Racial disparities in surgery rates for esophageal cancer
Black patients with esophageal cancer are less likely to receive life-saving surgery for early-stage disease than white patients.

Portable 'electronic nose' can accurately pick up esophageal cancer precursor
A portable 'electronic nose' can accurately pick up the precursor condition to food pipe (esophageal) cancer, known as Barrett's esophagus, indicates a proof of principle study, published online in the journal Gut.

A new machine learning approach detects esophageal cancer better than current methods
Dartmouth scientists have proposed a new machine learning model for identification of esophageal cancer that could open new avenues for applying deep learning to digital pathology.

Lymph nodes can predict survival in patients with esophageal cancer
It is difficult for physicians to estimate recurrence and survival in patients with esophageal cancer.

New model improves staging and risk predictions for esophageal cancer patients
A new nomogram for assessing metastatic risk in esophageal cancer patients shows promise for more accurate risk-stratification, which is particularly relevant for stage T2 patients.

Combo of virotherapy and radiotherapy shows early promise in patients with esophageal cancer
The experimental oncolytic adenovirus telomelysin (OBP-301) in combination with radiotherapy was safe and showed early clinical efficacy in vulnerable patients with esophageal cancer, according to results from a phase I clinical trial presented at the AACR Annual Meeting 2019, March 29-April 3.

Drinking hot tea linked with elevated risk of esophageal cancer
Previous studies have revealed a link between hot tea drinking and risk of esophageal cancer, but until now, no study has examined this association using prospectively and objectively measured tea drinking temperature.

Test for esophageal cancer could save millions of lives
Cancer of the esophagus claims more than 400,000 lives around the world each year.

Genome offers clues to esophageal cancer disparity
A change in the genome of Caucasians could explain much-higher rates of the most common type of esophageal cancer in this population, a new study finds.

Read More: Esophageal Cancer News and Esophageal Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.