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Esophageal Cancer Treatment Is Underutilized Among Elderly Patients in the USA

  • 2016 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objectives

Large numbers of elderly patients in the USA receive no treatment for esophageal cancer, despite evidence that multimodality treatment can increase survival. Our goal is to identify factors that may contribute to lack of treatment.

Materials and Methods

Using Surveillance Epidemiology and End Results (SEER)-Medicare Linked Database (2001−2009), we identified regional esophageal cancer patients ≥65 years old. Treatment was defined as receiving any medical or surgical therapy for esophageal cancer. Logistic regression analysis was performed to identify factors associated with failure to receive treatment. Overall survival (OS) was analyzed using the Kaplan-Meier method and Cox proportional hazard model.

Results

There were 5072 patients (median age, 75 years; interquartile range (IQR), 71–81 years). Majority were treated with definitive chemoradiation (48.49 %). Factors associated with lack of treatment included West geographic region and ≥80 years old. Patients who received therapy had better OS (log-rank, p < 0.001). Compared with treated patients, non-treated patients had worse adjusted OS (HR, 1.43; 95 % confidence interval (CI), 1.33–1.55; p < 0.001).

Conclusions

Elderly patients with locally advanced esophageal cancer who received treatment had improved 5-year survival compared with patients without treatment. Disparities in utilization of treatment are associated with regional and socioeconomic factors, not presence of comorbidities.

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Acknowledgments

The authors thank Daren Jackson, PhD for his contribution in editing the paper.

Author Contributions

DM, MS, ALB, and AOL conceived or designed the work and acquired, analyzed, or interpreted data. DM, MS, ALB, and AOL drafted the work or revisited it critically for important intellectual content. DM, MS, ALB, and AOL approved the final version to be published.

Financial Support

Mr. Edwin Lewis provided generous support for Dr. Lidor’s Johns Hopkins Department of Surgery Research Fund.

Disclosures

The authors of this study have no relevant conflicts of interest to disclose.

Meeting Presentation

Plenary presentation at 2016 Digestive Disease Week (May 21–24, 2016) at the San Diego Convention Center in San Diego, CA.

Author information

Authors and Affiliations

  1. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Daniela Molena

  2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Daniela Molena, Miloslawa Stem & Anne O. Lidor

  3. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Amanda L. Blackford

  4. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave K4/752, Madison, WI, 53792-7375, USA

    Anne O. Lidor

Authors
  1. Daniela Molena
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  2. Miloslawa Stem
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  3. Amanda L. Blackford
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  4. Anne O. Lidor
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Corresponding author

Correspondence to Anne O. Lidor.

Appendix 1

Appendix 1

Table 5 Treatment groups
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Molena, D., Stem, M., Blackford, A.L. et al. Esophageal Cancer Treatment Is Underutilized Among Elderly Patients in the USA. J Gastrointest Surg 21, 126–136 (2017). https://doi.org/10.1007/s11605-016-3229-5

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  • DOI: https://doi.org/10.1007/s11605-016-3229-5

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