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Assessment of Advanced Gastric Cancer Management in the United States

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Increasing attention is being placed on utilization of treatment for advanced malignancies. Though some suggest it is futile, recent reports have advocated noncurative surgery for advanced gastric cancer. Our objectives were to (1) assess treatment trends, (2) identify predictors of surgery, and (3) evaluate the effect of treatment on outcomes.

Methods

Patients with stage IV gastric adenocarcinoma were identified from the National Cancer Data Base (1998–2007). Patients who underwent emergent surgery were excluded. Models were developed to identify factors associated with treatment receipt and to compare adjusted overall survival by treatment group.

Results

Twenty-four percent (n = 22,430) of patients presented with stage IV gastric adenocarcinoma; 1.5 % (n = 414) underwent emergent surgery. Of the remaining 21,039 patients, 62.4 % underwent treatment (87.0 % chemotherapy with or without radiotherapy (C ± RT), 5.6 % surgery, 7.2 % combined surgery and C ± RT). Over the decade, surgery rates increased by 43 %, and C ± RT use increased by 16 % while receipt of no treatment decreased by 26 % (all p < 0.001). Patients who were younger, white, and insured, as well as those with distal tumors were more likely to undergo surgery. Reasons for receiving no treatment were multifactorial but were most strongly associated with advanced age and being uninsured. Median survival was longest for patients selected to undergo surgery and C ± RT (13.5 months) versus C ± RT alone (6.1 months), surgery alone (4.8 months), or no treatment (1.7 months, all p < 0.001).

Conclusions

Utilization of nonemergent surgical treatment and C ± RT for metastatic gastric adenocarcinoma has increased considerably over time, especially in certain patient populations; however, the true utility and cost of these treatments remain unknown.

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Acknowledgment

DJB is supported by a Career Development Award from the Health Services Research and Development Service of the Department of Veterans Affairs and the Nathan and Isabel Miller Family Foundation.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery and Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Karen L. Sherman MD, Ryan P. Merkow MD, MS, Anuj M. Shah BS, C. Edward Wang PhD, Karl Y. Bilimoria MD, MS & David J. Bentrem MD, MS

  2. Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Ryan P. Merkow MD, MS

  3. Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA

    Ryan P. Merkow MD, MS

  4. Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Karl Y. Bilimoria MD, MS & David J. Bentrem MD, MS

  5. Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL, USA

    David J. Bentrem MD, MS

Authors
  1. Karen L. Sherman MD
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  2. Ryan P. Merkow MD, MS
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  3. Anuj M. Shah BS
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  4. C. Edward Wang PhD
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  5. Karl Y. Bilimoria MD, MS
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  6. David J. Bentrem MD, MS
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Corresponding author

Correspondence to David J. Bentrem MD, MS.

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Sherman, K.L., Merkow, R.P., Shah, A.M. et al. Assessment of Advanced Gastric Cancer Management in the United States. Ann Surg Oncol 20, 2124–2131 (2013). https://doi.org/10.1245/s10434-013-2953-2

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  • DOI: https://doi.org/10.1245/s10434-013-2953-2

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