Gender, racial, and socioeconomic disparities in the management and survival of patients with locally advanced esophageal cancer: a SEER-based study.

BACKGROUND

Esophageal cancer is the sixth most common gastrointestinal cancer in the United States. Treatment for esophageal cancer depends on the extent of the disease but often includes surgery with or without chemoradiation. The aim of this study is to identify possible gender, racial, and socioeconomic disparities in treatment decisions and survival outcomes for patients with locally advanced esophageal cancer.

METHODS

Locally advanced (stage IIA-IVA) esophageal cancer cases in adults (age ≥ 20 years) diagnosed between 2012 and 2021 were identified from the Surveillance, Epidemiology, and End Results database. Data regarding patient demographics, treatment strategies, and survival outcomes was collected. Multivariate logistic and Cox regression analyses were performed to evaluate the association between various patient characteristics and management patterns and survival.

RESULTS

A total of 10,823 cases were included in this study. Female (OR: 0.71, p < 0.001), Black (OR 0.33, p < 0.001), and Hispanic (OR: 0.75, p < 0.001) patients were less likely to be recommended surgery for their esophageal cancer. Among patients who were recommended surgery, Black race (OR: 0.062, p = 0.006) and Low SES (OR: 0.662, p = 0.007) were associated with a lower likelihood of surgery being performed. Female (OR: 0.74, p = 0.007) and Hispanic (OR 0.64, p = 0.003) patients were less likely to receive neoadjuvant therapy. Female (OR: 0.82, p = 0.040), Black (OR: 0.63, p = 0.018), and Low SES (OR: 0.734, p = 0.008) patients were less likely to receive adjuvant therapy. Female patients had improved OS (HR: 0.88, p < 0.001) and CSS (HR: 0.85, p = 0.003) whereas Black race (OS-HR: 1.32, p < 0.001, CSS-HR: 1.31, p < 0.001) and Low SES (OS-HR: 1.15, p < 0.001, CSS-HR: 1.17, p < 0.001) were associated with worse OS and CSS.

CONCLUSIONS

Significant differences in surgical management, administration of neoadjuvant and adjuvant therapy, OS, and CSS exist based on gender, race/ethnicity, and SES. Further research is needed to elucidate and ameliorate the possible causes of these disparities.