Race and Medicine

Race and Medicine

Disclosures: The authors report no relevant financial disclosures.
June 30, 2020
2 min read

Black patients less likely to undergo surgery for esophageal cancer

Disclosures: The authors report no relevant financial disclosures.
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Black patients with esophageal cancer had a lower likelihood of receiving surgical intervention for resectable disease than their white counterparts, according to results of a retrospective study published in Journal of Gastrointestinal Surgery.

This disparity may have contributed to the increased mortality risk observed among Black patients with esophageal cancer, researchers noted.

Diagnosis esophageal cancer written in the diagnostic form and pills.
Black patients with esophageal cancer had a lower likelihood of receiving surgical intervention for resectable disease than their white counterparts.

“National guidelines suggest that early-stage esophageal cancer should be treated with surgery because data show that it offers patients the best chance for survival, rather than chemotherapy alone,” Nathaniel Evans, MD, director of the division of thoracic surgery at Thomas Jefferson University and chief of cancer services at the Center City division of Sidney Kimmel Cancer Center, said in a press release. “Our data show that Black patients are not having surgery for early-stage disease, which may contribute to higher rates of death. With this data, we can now begin to educate patients and providers to change practice.”

Evans and colleagues sought to identify factors linked to racial disparities in surgical resection and evaluate survival differences among 60,041 patients (Black, n = 4,402) diagnosed with stage I to stage III esophageal cancer between 2004 and 2015.

Researchers gathered data from the National Cancer Database and created matched patient cohorts to reduce confounding. After 1:1 matching by demographics, tumor characteristics and comorbidities, the data set included 5,858 patients.

Results showed that, for the three stages of cancer analyzed, significantly fewer Black patients received surgery than white patients.

Single-level multivariate analysis showed Black race independently correlated with lower likelihood of receiving surgery for stage I (OR = 0.67; 95% CI, 0.48-0.94), stage II (OR = 0.76; 95% CI, 0.6-0.96) and stage III disease (OR = 0.62; 95% CI, 0.5-0.76). The effect of race on surgery odds remained significant after controlling for hospital-level random effects, which accounted for one-third of the unexplained variance in receipt of surgery.

Results also showed the odds of receiving surgery decreased with increasing age of Black patients. Other factors linked to lower likelihood of surgery included receipt of radiation therapy and squamous cell carcinoma histology, which researchers noted is more common among Black patients. Those treated at a facility more than 5 miles from their homes appeared more likely to undergo surgery.

Patients who did not undergo surgery had higher risk-adjusted 1-year, 3-year and 5-year mortality.

“The findings of this study highlight the importance of implementing changes aimed at narrowing the gap in outcomes between Black [patients] and white patients with esophageal cancer,” Evans and colleagues wrote. “Additional prospective analyses are warranted to further investigate the role of race in treatment decision-making and survival and to identify specific hospital-level factors that affect disease management.”