Effect of Health Disparities on Refusal of Trimodality Therapy in Localized Esophageal Adenocarcinoma: A Propensity Score Matched Analysis of the National Cancer Database.

Autor:	Salti I; Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, IL, USA., Petesch T; Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA., Naffouje SA; Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA., Kamarajah SK; Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, IL, USA.; Department of Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, UK., Dahdaleh F; Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, IL, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2023 Nov; Vol. 89 (11), pp. 4644-4653. Date of Electronic Publication: 2022 Sep 16.
DOI:	10.1177/00031348221117040
Abstrakt:	Background: Factors associated with refusal of multimodality therapy in patients with localized esophageal adenocarcinoma (EA) remain unknown. We hypothesized that sociodemographic disparities affect decision to pursue optimal trimodally therapy for patients with EA. Methods: NCDB for esophageal cancer (2004-2017) was utilized. Included were patients diagnosed with cT3-T4 cN0 or cTany N1-3 EA of the mid-lower esophagus. Annual institutional esophagectomy volumes were categorized as low (<20/year) and high (≥20/year). Conditional logistic regression was used to identify predictors of refusal of offered treatment. Kaplan Meier method was used to compare survival. Results: 13 091 patients met selection criteria, mean age was 62.4 ± 9.6 years and 11 581 (88.5%) were males. 633 (4.8%) patients refused at least one component of recommended treatment (chemotherapy, radiation, and esophagectomy), most commonly refusal of surgery (N = 554, 4.2%). On multivariable analysis, factors predictive of treatment refusal included older age, female gender, black race, no insurance, low income (below poverty), mid-esophageal tumors, and treatment at low-volume centers. Patients who were recommended treatment but refused had significantly worse survival than those who adhered to treatment (median 23.1 ± 1.1 vs. 32.1 ± 1.2 months; P < .001). Conclusions: In this study, sociodemographic disparities and center volume were among factors predictive of therapy refusal in patients with localized esophageal adenocarcinoma. While understanding potential reasons for treatment refusal is critical, this data suggests that socioeconomic variables may drive patient decisions. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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