In a recent publication in the journal Clinical Gastroenterology and Hepatology, researchers sought to evaluate the impact of socioeconomic status on treatment decisions and survival outcomes in patients with the T1a subtype of early-stage esophageal adenocarcinoma.
In this observational study, researchers gathered anonymized data from the Surveillance, Epidemiology, and End Results cancer database. The study included 1,526 patients with a primary T1aN0M0 esophageal adenocarcinoma who were divided into three socioeconomic groups based on their average household income.
The researchers calculated endoscopic trends over time, rates of endoscopic and surgical treatment, 2- and 5-year overall survival, cancer-specific mortality, and noncancer-specific mortality, and, using R-studio software, a statistical analysis was performed.
The results revealed that patients within the lowest average household income ($20,000-$54,390) were associated with higher cancer-specific mortality at 2 years (P <.01) and 5 years (P <.02) and lower overall survival at 2 and 5 years (P <.01) compared with patients in higher income groups.
The researchers also indicated that patients with a higher income had a diminished hazard ratio (HR) for cancer-specific mortality (HR 0.66; 95% CI, 0.45-0.99) in a multivariate Cox proportional hazards regression model. Patients within the higher income group were more likely to obtain the endoscopic intervention (P <.001), which was correlated with improved cancer-specific mortality compared with patients who received the primary surgical intervention (P = .001). Geographically, the South had lower rates of endoscopy compared with other regions.
Based on their findings, the authors concluded, “Lower median household income was associated with higher rates of cancer-specific mortality and lower rates of endoscopic resection in T1aN0M0 esophageal adenocarcinoma. Population-based strategies aimed at identifying and rectifying possible etiologies for these socioeconomic and geographic disparities are paramount to improving patient outcomes in early esophageal cancer.”
In a press release, the researchers indicated that the study highlights disconcerting socioeconomic disparities in treatment access for early-stage esophageal adenocarcinoma. One of the authors, Alexander Podboy, MD, of the University of Virginia Health’s division of gastroenterology and hepatology, stated, “These findings are alarming. Population-based strategies aimed at identifying and rectifying possible etiologies [causes] for our findings are paramount to improving patient outcomes in early esophageal cancer.”
Dr. Podboy also stated, “Access to the very best in cancer-related care should not be predicated on your socioeconomic status. We hope that our research helps shine a spotlight on this problem and leads to actions that help eliminate any barriers to care.”
To identify and address disparities, the researchers indicated that greater efforts are needed to increase esophageal cancer screening and expand access to advanced centers where patients can receive care from multidisciplinary teams.
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Published May 9, 2023