Racial Disparities in Gastric Cancer Preoperative Chemotherapy Use
A National Cancer Database analysis revealed racial and ethnic disparities in patients with gastric cancer in the use of preoperative chemotherapy and in outcomes.
The study was published in Cancer (online February 2, 2018; doi:10.1002/cncr.31155).
No studies have been conducted to determine whether race and ethnicity is associated with the recommended use of preoperative chemotherapy or resulting outcomes in gastric cancer.
Brian D Bagwell, MD, MS, department of surgical oncology, University of Texas MD Anderson Cancer Center (Houston, TX), and colleagues performed an analysis of the National Cancer Database to determine whether there is such an association. Patients with clinical T2-4bN0-1M0 gastric adenocarcinoma—defined by the eighth edition of the American Joint Committee on Cancer staging manual—were identified who underwent gastrectomy from 2006 through 2014.
A total of 16,945 patients met these criteria, 49% (n = 8286) of whom received preoperative chemotherapy. Researchers utilized multiple logistic regression to examine factors associated with preoperative chemotherapy use.
Researchers noted that the use of preoperative chemotherapy increased substantially over the study period (34% in 2006 vs 65% in 2014). Preoperative chemotherapy was reportedly used more often for cardia tumors compared with non-cardia tumors (83% vs 44% in 2014, respectively).
Multivariable analysis revealed that races and ethnicities other than non-Hispanic white race were associated with less frequent use of preoperative chemotherapy compared with non-Hispanic white patients after adjustments for social, tumor, and hospital factors. Additionally, insurance status and education level were found to mediate an enhanced effect of racial and ethnic disparities in preoperative chemotherapy use.
Furthermore, preoperative chemotherapy and radiation use were associated with reduced racial and ethnic disparities in overall survival.
“Efforts to improve the access to high-quality cancer care in minority groups may reduce racial disparities in gastric cancer in the United States,” Dr Bagwell and colleagues concluded.—Zachary Bessette