Socioeconomic factors in timing of esophagectomy and association with outcomes
Background and Objectives Disparities in esophageal cancer are well‐established. The standard treatment for locally advanced esophageal cancer is chemoradiation followed by surgery. We sought to evaluate the association between socioeconomic factors, time to surgery, and patient outcomes. Methods Al...
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| Veröffentlicht in: | Journal of surgical oncology 2021-12, Vol.124 (7), p.1014-1021 |
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| container_title | Journal of surgical oncology |
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| creator | Chen, Kevin A. Strassle, Paula D. Meyers, Michael O. |
| description | Background and Objectives
Disparities in esophageal cancer are well‐established. The standard treatment for locally advanced esophageal cancer is chemoradiation followed by surgery. We sought to evaluate the association between socioeconomic factors, time to surgery, and patient outcomes.
Methods
All patients ≥18 years old diagnosed with T2/3/4 or node‐positive esophageal cancer between 2004 and 2016 and who underwent chemoradiation and esophagectomy in the National Cancer Database were included. Multivariable regression was used to assess the association between socioeconomic variables and time to surgery (grouped into |
| doi_str_mv | 10.1002/jso.26606 |
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Disparities in esophageal cancer are well‐established. The standard treatment for locally advanced esophageal cancer is chemoradiation followed by surgery. We sought to evaluate the association between socioeconomic factors, time to surgery, and patient outcomes.
Methods
All patients ≥18 years old diagnosed with T2/3/4 or node‐positive esophageal cancer between 2004 and 2016 and who underwent chemoradiation and esophagectomy in the National Cancer Database were included. Multivariable regression was used to assess the association between socioeconomic variables and time to surgery (grouped into <56, 56–84, and 85–112 days).
Results
A total of 12 157 patients were included. Five‐year overall survival was 39%, 35%, and 35% for the three groups examined. Postoperative 30‐ and 90‐day mortality was increased in both the 56–84 days to surgery group (odds ratio [OR]: 1.30 and 1.20, respectively) and the 85–112 days group (OR: 1.37 and 1.56, respectively) when compared to <56 days. Patients of a minority race, public insurance, or lower income were more likely to have a longer time to surgery.
Conclusion
Longer time to surgery is associated with increased postoperative mortality and is more common in patients with lower socioeconomic status. Further research exploring reasons for delays to esophagectomy among disadvantaged patients could help target interventions to reduce disparities.</description><identifier>ISSN: 0022-4790</identifier><identifier>EISSN: 1096-9098</identifier><identifier>DOI: 10.1002/jso.26606</identifier><identifier>PMID: 34254329</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adenocarcinoma - mortality ; Adenocarcinoma - therapy ; Aged ; Carcinoma, Squamous Cell - mortality ; Carcinoma, Squamous Cell - therapy ; Chemoradiotherapy ; combined modality therapy ; Esophageal cancer ; Esophageal Neoplasms - mortality ; Esophageal Neoplasms - therapy ; Esophagectomy ; Female ; Healthcare Disparities ; Humans ; Income ; Male ; Medicaid ; Medicare ; Middle Aged ; Mortality ; Neoadjuvant Therapy ; North Carolina - epidemiology ; postoperative complications ; Race Factors ; Socioeconomic factors ; Surgery ; Time-to-Treatment ; United States</subject><ispartof>Journal of surgical oncology, 2021-12, Vol.124 (7), p.1014-1021</ispartof><rights>2021 Wiley Periodicals LLC</rights><rights>2021 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4446-3d1b579a70d11a46b15ea9376c019b391f8556c3af51e753ad3403e99884376c3</citedby><cites>FETCH-LOGICAL-c4446-3d1b579a70d11a46b15ea9376c019b391f8556c3af51e753ad3403e99884376c3</cites><orcidid>0000-0003-3108-7279 ; 0000-0003-1610-5889</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjso.26606$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjso.26606$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34254329$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Kevin A.</creatorcontrib><creatorcontrib>Strassle, Paula D.</creatorcontrib><creatorcontrib>Meyers, Michael O.</creatorcontrib><title>Socioeconomic factors in timing of esophagectomy and association with outcomes</title><title>Journal of surgical oncology</title><addtitle>J Surg Oncol</addtitle><description>Background and Objectives
Disparities in esophageal cancer are well‐established. The standard treatment for locally advanced esophageal cancer is chemoradiation followed by surgery. We sought to evaluate the association between socioeconomic factors, time to surgery, and patient outcomes.
Methods
All patients ≥18 years old diagnosed with T2/3/4 or node‐positive esophageal cancer between 2004 and 2016 and who underwent chemoradiation and esophagectomy in the National Cancer Database were included. Multivariable regression was used to assess the association between socioeconomic variables and time to surgery (grouped into <56, 56–84, and 85–112 days).
Results
A total of 12 157 patients were included. Five‐year overall survival was 39%, 35%, and 35% for the three groups examined. Postoperative 30‐ and 90‐day mortality was increased in both the 56–84 days to surgery group (odds ratio [OR]: 1.30 and 1.20, respectively) and the 85–112 days group (OR: 1.37 and 1.56, respectively) when compared to <56 days. Patients of a minority race, public insurance, or lower income were more likely to have a longer time to surgery.
Conclusion
Longer time to surgery is associated with increased postoperative mortality and is more common in patients with lower socioeconomic status. Further research exploring reasons for delays to esophagectomy among disadvantaged patients could help target interventions to reduce disparities.</description><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - therapy</subject><subject>Aged</subject><subject>Carcinoma, Squamous Cell - mortality</subject><subject>Carcinoma, Squamous Cell - therapy</subject><subject>Chemoradiotherapy</subject><subject>combined modality therapy</subject><subject>Esophageal cancer</subject><subject>Esophageal Neoplasms - mortality</subject><subject>Esophageal Neoplasms - therapy</subject><subject>Esophagectomy</subject><subject>Female</subject><subject>Healthcare Disparities</subject><subject>Humans</subject><subject>Income</subject><subject>Male</subject><subject>Medicaid</subject><subject>Medicare</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neoadjuvant Therapy</subject><subject>North Carolina - epidemiology</subject><subject>postoperative complications</subject><subject>Race Factors</subject><subject>Socioeconomic factors</subject><subject>Surgery</subject><subject>Time-to-Treatment</subject><subject>United States</subject><issn>0022-4790</issn><issn>1096-9098</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1P3DAQhq2Kqiy0h_4BZIkLHALj-CPxqaoQn0LlQHu2vI6z61XiWeKkaP89pksRVOppDu_jRzN-CfnK4IQBlKerhCelUqA-kBkDrQoNut4hs5yVhag07JK9lFYAoLUSn8guF6UUvNQz8uMeXUDvMGIfHG2tG3FINEQ6hj7EBcWW-oTrpV34HPUbamNDbUr5mR0DRvoYxiXFaXTY-_SZfGxtl_yXl7lPfl2c_zy7Km7vLq_Pvt8WTgihCt6wuay0raBhzAo1Z9JbzSvlgOk516ytpVSO21YyX0luGy6Ae63rWjxTfJ9823rX07z3jfNxHGxn1kPo7bAxaIN5n8SwNAv8bRgwyUBBNhy9GAZ8mHwaTR-S811no8cpmVJKVoIWuszo4T_oCqch5vsyVVcA-YdZpo63lBswpcG3r9swMM81mVyT-VNTZg_erv9K_u0lA6db4DF0fvN_k7m5v9sqnwCVk5xX</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Chen, Kevin A.</creator><creator>Strassle, Paula D.</creator><creator>Meyers, Michael O.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3108-7279</orcidid><orcidid>https://orcid.org/0000-0003-1610-5889</orcidid></search><sort><creationdate>20211201</creationdate><title>Socioeconomic factors in timing of esophagectomy and association with outcomes</title><author>Chen, Kevin A. ; Strassle, Paula D. ; Meyers, Michael O.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4446-3d1b579a70d11a46b15ea9376c019b391f8556c3af51e753ad3403e99884376c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - therapy</topic><topic>Aged</topic><topic>Carcinoma, Squamous Cell - mortality</topic><topic>Carcinoma, Squamous Cell - therapy</topic><topic>Chemoradiotherapy</topic><topic>combined modality therapy</topic><topic>Esophageal cancer</topic><topic>Esophageal Neoplasms - mortality</topic><topic>Esophageal Neoplasms - therapy</topic><topic>Esophagectomy</topic><topic>Female</topic><topic>Healthcare Disparities</topic><topic>Humans</topic><topic>Income</topic><topic>Male</topic><topic>Medicaid</topic><topic>Medicare</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neoadjuvant Therapy</topic><topic>North Carolina - epidemiology</topic><topic>postoperative complications</topic><topic>Race Factors</topic><topic>Socioeconomic factors</topic><topic>Surgery</topic><topic>Time-to-Treatment</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Kevin A.</creatorcontrib><creatorcontrib>Strassle, Paula D.</creatorcontrib><creatorcontrib>Meyers, Michael O.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Kevin A.</au><au>Strassle, Paula D.</au><au>Meyers, Michael O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Socioeconomic factors in timing of esophagectomy and association with outcomes</atitle><jtitle>Journal of surgical oncology</jtitle><addtitle>J Surg Oncol</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>124</volume><issue>7</issue><spage>1014</spage><epage>1021</epage><pages>1014-1021</pages><issn>0022-4790</issn><eissn>1096-9098</eissn><abstract>Background and Objectives
Disparities in esophageal cancer are well‐established. The standard treatment for locally advanced esophageal cancer is chemoradiation followed by surgery. We sought to evaluate the association between socioeconomic factors, time to surgery, and patient outcomes.
Methods
All patients ≥18 years old diagnosed with T2/3/4 or node‐positive esophageal cancer between 2004 and 2016 and who underwent chemoradiation and esophagectomy in the National Cancer Database were included. Multivariable regression was used to assess the association between socioeconomic variables and time to surgery (grouped into <56, 56–84, and 85–112 days).
Results
A total of 12 157 patients were included. Five‐year overall survival was 39%, 35%, and 35% for the three groups examined. Postoperative 30‐ and 90‐day mortality was increased in both the 56–84 days to surgery group (odds ratio [OR]: 1.30 and 1.20, respectively) and the 85–112 days group (OR: 1.37 and 1.56, respectively) when compared to <56 days. Patients of a minority race, public insurance, or lower income were more likely to have a longer time to surgery.
Conclusion
Longer time to surgery is associated with increased postoperative mortality and is more common in patients with lower socioeconomic status. Further research exploring reasons for delays to esophagectomy among disadvantaged patients could help target interventions to reduce disparities.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34254329</pmid><doi>10.1002/jso.26606</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-3108-7279</orcidid><orcidid>https://orcid.org/0000-0003-1610-5889</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adenocarcinoma - mortality Adenocarcinoma - therapy Aged Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - therapy Chemoradiotherapy combined modality therapy Esophageal cancer Esophageal Neoplasms - mortality Esophageal Neoplasms - therapy Esophagectomy Female Healthcare Disparities Humans Income Male Medicaid Medicare Middle Aged Mortality Neoadjuvant Therapy North Carolina - epidemiology postoperative complications Race Factors Socioeconomic factors Surgery Time-to-Treatment United States |
| title | Socioeconomic factors in timing of esophagectomy and association with outcomes |
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