Presentation and Survival of Gastric Cancer Patients at an Urban Academic Safety-Net Hospital
- 38 Downloads
Gastric cancer is decreasing nationally but remains pervasive globally. We evaluated our experience with gastric cancer at a safety-net hospital with a substantial immigrant population.
Demographics, pathology, and treatment were analyzed for gastric adenocarcinoma at our institution (2004–2017). Chi-square analyses were performed for dependence of staging on demographics. Survival was evaluated with Kaplan-Meier and Cox regression analyses.
We identified 249 patients (median age 65 years). Patients were predominantly born outside the USA or Canada (74.3%), non-white (70.7%), and federally insured (71.4%), and presented with late-stage disease (52.2%). Hispanic ethnicity, Central American birthplace, Medicaid insurance, and zip code poverty > 20% were associated with late-stage presentation (all p < 0.05). Univariate analyses showed decreased survival for patients with late-stage disease, highest zip code poverty, and age ≥ 65 (all p < 0.05). On multivariate analysis, survival was negatively associated with late-stage presentation (HR 4.45, p < 0.001), age ≥ 65 (1.80, p = 0.018), and H. pylori infection (2.02, p = 0.036).
Hispanic ethnicity, Central American birthplace, Medicaid insurance, and increased neighborhood poverty were associated with late-stage presentation of gastric cancer with poor outcomes. Further study of these populations may lead to screening protocols in order to increase earlier detection and improve survival.
KeywordsGastric cancer Cancer outcomes Safety net hospital Immigrant population Health disparities
- 4.Cancer Stat Facts: Stomach Cancer. In: Surveillance Epidemiology and End Results. National Cancer Institute. 2017. https://seer.cancer.gov/statfacts/html/stomach.html. Accessed 22 Feb 2017
- 9.Nassour I, Fullington H, Hynan LS, Yopp AC, Augustine MM, Polanco PM et al. The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation. Ann Surg Oncol. 2017;24(7):1787–94. https://doi.org/10.1245/s10434-017-5805-7.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Sutton JP, Washington RE, Fingar KR, Elixhauser A. Characteristics of Safety-Net Hospitals, 2014: Statistical Brief #213. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville MD 2006.Google Scholar
- 17.American Community Survey. In: American Fact Finder. United States Census Bureau. 2015. http://factfinder.census.gov. 2017.
- 19.Kweon SS, Kim MG, Kang MR, Shin MH, Choi JS. Difference of stage at cancer diagnosis by socioeconomic status for four target cancers of the National Cancer Screening Program in Korea: Results from the Gwangju and Jeonnam cancer registries. J Epidemiol. 2017;27(7):299–304. https://doi.org/10.1016/j.je.2016.07.004.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Al-Refaie WB, Tseng JF, Gay G, Patel-Parekh L, Mansfield PF, Pisters PW et al. The impact of ethnicity on the presentation and prognosis of patients with gastric adenocarcinoma. Results from the National Cancer Data Base. Cancer. 2008;113(3):461–9. https://doi.org/10.1002/cncr.23572.CrossRefPubMedGoogle Scholar
- 25.Bria E, De Manzoni G, Beghelli S, Tomezzoli A, Barbi S, Di Gregorio C et al. A clinical-biological risk stratification model for resected gastric cancer: prognostic impact of Her2, Fhit, and APC expression status. Ann Oncol. 2013;24(3):693–701. https://doi.org/10.1093/annonc/mds506.CrossRefPubMedGoogle Scholar
- 36.Ford AC, Forman D, Hunt RH, Yuan Y, Moayyedi P. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ. 2014;348:g3174. https://doi.org/10.1136/bmj.g3174.CrossRefPubMedPubMedCentralGoogle Scholar