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Journal of Gastrointestinal Surgery

, Volume 23, Issue 2, pp 239–246 | Cite as

Presentation and Survival of Gastric Cancer Patients at an Urban Academic Safety-Net Hospital

  • Ryan Morgan
  • Michael Cassidy
  • Susanna W. L. DeGeus
  • Jennifer Tseng
  • David McAneny
  • Teviah SachsEmail author
Original Article
  • 117 Downloads

Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Gastric cancer Cancer outcomes Safety net hospital Immigrant population Health disparities 

Supplementary material

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Ryan Morgan
    • 1
  • Michael Cassidy
    • 1
  • Susanna W. L. DeGeus
    • 1
  • Jennifer Tseng
    • 1
  • David McAneny
    • 1
  • Teviah Sachs
    • 1
    Email author
  1. 1.Department of SurgeryBoston Medical CenterBostonUSA

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