Advertisement

Presentation and Survival of Gastric Cancer Patients at an Urban Academic Safety-Net Hospital

  • Ryan Morgan
  • Michael Cassidy
  • Susanna W. L. DeGeus
  • Jennifer Tseng
  • David McAneny
  • Teviah Sachs
Original Article

Abstract

Introduction

Gastric cancer is decreasing nationally but remains pervasive globally. We evaluated our experience with gastric cancer at a safety-net hospital with a substantial immigrant population.

Methods

Demographics, pathology, and treatment were analyzed for gastric adenocarcinoma at our institution (2004–2017). Chi-square analyses were performed for dependence of staging on demographics. Survival was evaluated with Kaplan-Meier and Cox regression analyses.

Results

We identified 249 patients (median age 65 years). Patients were predominantly born outside the USA or Canada (74.3%), non-white (70.7%), and federally insured (71.4%), and presented with late-stage disease (52.2%). Hispanic ethnicity, Central American birthplace, Medicaid insurance, and zip code poverty > 20% were associated with late-stage presentation (all p < 0.05). Univariate analyses showed decreased survival for patients with late-stage disease, highest zip code poverty, and age ≥ 65 (all p < 0.05). On multivariate analysis, survival was negatively associated with late-stage presentation (HR 4.45, p < 0.001), age ≥ 65 (1.80, p = 0.018), and H. pylori infection (2.02, p = 0.036).

Conclusion

Hispanic ethnicity, Central American birthplace, Medicaid insurance, and increased neighborhood poverty were associated with late-stage presentation of gastric cancer with poor outcomes. Further study of these populations may lead to screening protocols in order to increase earlier detection and improve survival.

Keywords

Gastric cancer Cancer outcomes Safety net hospital Immigrant population Health disparities 

Supplementary material

11605_2018_3898_MOESM1_ESM.docx (71 kb)
ESM 1 (DOCX 71.0 kb)
11605_2018_3898_MOESM2_ESM.docx (40 kb)
ESM 2 (DOCX 40.1 kb)
11605_2018_3898_MOESM3_ESM.docx (49 kb)
ESM 3 (DOCX 49.0 kb)
11605_2018_3898_MOESM4_ESM.docx (60 kb)
ESM 4 (DOCX 59.7 kb)

References

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30.  https://doi.org/10.3322/caac.21387.CrossRefPubMedGoogle Scholar
  2. 2.
    Anderson WF, Camargo MC, Fraumeni JF, Jr., Correa P, Rosenberg PS, Rabkin CS. Age-specific trends in incidence of noncardia gastric cancer in US adults. JAMA. 2010;303(17):1723–8.  https://doi.org/10.1001/jama.2010.496.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fitzsimmons D, Osmond C, George S, Johnson CD. Trends in stomach and pancreatic cancer incidence and mortality in England and Wales, 1951-2000. Br J Surg. 2007;94(9):1162–71.  https://doi.org/10.1002/bjs.5751.CrossRefPubMedGoogle Scholar
  4. 4.
    Cancer Stat Facts: Stomach Cancer. In: Surveillance Epidemiology and End Results. National Cancer Institute. 2017. https://seer.cancer.gov/statfacts/html/stomach.html. Accessed 22 Feb 2017
  5. 5.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.  https://doi.org/10.3322/caac.21262.CrossRefPubMedGoogle Scholar
  6. 6.
    Parsonnet J, Friedman GD, Vandersteen DP, Chang Y, Vogelman JH, Orentreich N et al. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med. 1991;325(16):1127–31.  https://doi.org/10.1056/nejm199110173251603.CrossRefPubMedGoogle Scholar
  7. 7.
    Nomura A, Stemmermann GN, Chyou PH, Kato I, Perez-Perez GI, Blaser MJ. Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med. 1991;325(16):1132–6.  https://doi.org/10.1056/nejm199110173251604.CrossRefPubMedGoogle Scholar
  8. 8.
    Schlansky B, Sonnenberg A. Epidemiology of noncardia gastric adenocarcinoma in the United States. Am J Gastroenterol. 2011;106(11):1978–85.  https://doi.org/10.1038/ajg.2011.213.CrossRefPubMedGoogle Scholar
  9. 9.
    Nassour I, Fullington H, Hynan LS, Yopp AC, Augustine MM, Polanco PM et al. The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation. Ann Surg Oncol. 2017;24(7):1787–94.  https://doi.org/10.1245/s10434-017-5805-7.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Greenlee RT, Howe HL. County-level poverty and distant stage cancer in the United States. Cancer Causes Control. 2009;20(6):989–1000.  https://doi.org/10.1007/s10552-009-9299-x.CrossRefPubMedGoogle Scholar
  11. 11.
    Park B, Shin A, Park SK, Ko KP, Ma SH, Lee EH et al. Ecological study for refrigerator use, salt, vegetable, and fruit intakes, and gastric cancer. Cancer Causes Control. 2011;22(11):1497–502.  https://doi.org/10.1007/s10552-011-9823-7.CrossRefPubMedGoogle Scholar
  12. 12.
    Ladeiras-Lopes R, Pereira AK, Nogueira A, Pinheiro-Torres T, Pinto I, Santos-Pereira R et al. Smoking and gastric cancer: systematic review and meta-analysis of cohort studies. Cancer Causes Control. 2008;19(7):689–701.  https://doi.org/10.1007/s10552-008-9132-y.CrossRefPubMedGoogle Scholar
  13. 13.
    Yang P, Zhou Y, Chen B, Wan HW, Jia GQ, Bai HL et al. Overweight, obesity and gastric cancer risk: results from a meta-analysis of cohort studies. Eur J Cancer. 2009;45(16):2867–73.  https://doi.org/10.1016/j.ejca.2009.04.019.CrossRefPubMedGoogle Scholar
  14. 14.
    Siao D, Somsouk M. Helicobacter pylori: evidence-based review with a focus on immigrant populations. J Gen Intern Med. 2014;29(3):520–8.  https://doi.org/10.1007/s11606-013-2630-y.CrossRefPubMedGoogle Scholar
  15. 15.
    Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014;311(2):183–92.  https://doi.org/10.1001/jama.2013.284692.CrossRefPubMedGoogle Scholar
  16. 16.
    Sutton JP, Washington RE, Fingar KR, Elixhauser A. Characteristics of Safety-Net Hospitals, 2014: Statistical Brief #213. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville MD 2006.Google Scholar
  17. 17.
    American Community Survey. In: American Fact Finder. United States Census Bureau. 2015. http://factfinder.census.gov. 2017.
  18. 18.
    Parikh-Patel A, Bates JH, Campleman S. Colorectal cancer stage at diagnosis by socioeconomic and urban/rural status in California, 1988-2000. Cancer. 2006;107(5 Suppl):1189–95.  https://doi.org/10.1002/cncr.22016.CrossRefPubMedGoogle Scholar
  19. 19.
    Kweon SS, Kim MG, Kang MR, Shin MH, Choi JS. Difference of stage at cancer diagnosis by socioeconomic status for four target cancers of the National Cancer Screening Program in Korea: Results from the Gwangju and Jeonnam cancer registries. J Epidemiol. 2017;27(7):299–304.  https://doi.org/10.1016/j.je.2016.07.004.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Oh CM, Won YJ, Jung KW, Kong HJ, Cho H, Lee JK et al. Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2013. Cancer Res Treat. 2016;48(2):436–50.  https://doi.org/10.4143/crt.2016.089.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Maskarinec G, Noh JJ. The effect of migration on cancer incidence among Japanese in Hawaii. Ethn Dis. 2004;14(3):431–9.PubMedGoogle Scholar
  22. 22.
    Al-Refaie WB, Tseng JF, Gay G, Patel-Parekh L, Mansfield PF, Pisters PW et al. The impact of ethnicity on the presentation and prognosis of patients with gastric adenocarcinoma. Results from the National Cancer Data Base. Cancer. 2008;113(3):461–9.  https://doi.org/10.1002/cncr.23572.CrossRefPubMedGoogle Scholar
  23. 23.
    Stessin AM, Sherr DL. Demographic disparities in patterns of care and survival outcomes for patients with resected gastric adenocarcinoma. Cancer Epidemiol Biomarkers Prev. 2011;20(2):223–33.  https://doi.org/10.1158/1055-9965.epi-10-0158.CrossRefPubMedGoogle Scholar
  24. 24.
    Nguyen DK, Maggard-Gibbons M. Age, poverty, acculturation, and gastric cancer. Surgery. 2013;154(3):444–52.  https://doi.org/10.1016/j.surg.2013.05.017.CrossRefPubMedGoogle Scholar
  25. 25.
    Bria E, De Manzoni G, Beghelli S, Tomezzoli A, Barbi S, Di Gregorio C et al. A clinical-biological risk stratification model for resected gastric cancer: prognostic impact of Her2, Fhit, and APC expression status. Ann Oncol. 2013;24(3):693–701.  https://doi.org/10.1093/annonc/mds506.CrossRefPubMedGoogle Scholar
  26. 26.
    de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D et al. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol. 2012;13(6):607–15.  https://doi.org/10.1016/s1470-2045(12)70137-7.CrossRefPubMedGoogle Scholar
  27. 27.
    Ikeda F, Doi Y, Yonemoto K, Ninomiya T, Kubo M, Shikata K et al. Hyperglycemia increases risk of gastric cancer posed by Helicobacter pylori infection: a population-based cohort study. Gastroenterology. 2009;136(4):1234–41.  https://doi.org/10.1053/j.gastro.2008.12.045.CrossRefPubMedGoogle Scholar
  28. 28.
    Gonzalez CA, Pera G, Agudo A, Palli D, Krogh V, Vineis P et al. Smoking and the risk of gastric cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). Int J Cancer. 2003;107(4):629–34.  https://doi.org/10.1002/ijc.11426.CrossRefPubMedGoogle Scholar
  29. 29.
    Singh GK, Miller BA, Hankey BF, Edwards BK. Persistent area socioeconomic disparities in U.S. incidence of cervical cancer, mortality, stage, and survival, 1975-2000. Cancer. 2004;101(5):1051–7.  https://doi.org/10.1002/cncr.20467.CrossRefPubMedGoogle Scholar
  30. 30.
    Mandelblatt J, Andrews H, Kao R, Wallace R, Kerner J. Impact of access and social context on breast cancer stage at diagnosis. J Health Care Poor Underserved. 1995;6(3):342–51.CrossRefPubMedGoogle Scholar
  31. 31.
    Mandelblatt J, Andrews H, Kao R, Wallace R, Kerner J. The late-stage diagnosis of colorectal cancer: demographic and socioeconomic factors. Am J Public Health. 1996;86(12):1794–7.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst. 2002;94(7):490–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Schwartz KL, Crossley-May H, Vigneau FD, Brown K, Banerjee M. Race, socioeconomic status and stage at diagnosis for five common malignancies. Cancer Causes Control. 2003;14(8):761–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Smith EC, Ziogas A, Anton-Culver H. Association between insurance and socioeconomic status and risk of advanced stage Hodgkin lymphoma in adolescents and young adults. Cancer. 2012;118(24):6179–87.  https://doi.org/10.1002/cncr.27684.CrossRefPubMedGoogle Scholar
  35. 35.
    Pasechnikov V, Chukov S, Fedorov E, Kikuste I, Leja M. Gastric cancer: prevention, screening and early diagnosis. World J Gastroenterol. 2014;20(38):13842–62.  https://doi.org/10.3748/wjg.v20.i38.13842.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Ford AC, Forman D, Hunt RH, Yuan Y, Moayyedi P. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ. 2014;348:g3174.  https://doi.org/10.1136/bmj.g3174.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Markar SR, Karthikesalingam A, Jackson D, Hanna GB. Long-term survival after gastrectomy for cancer in randomized, controlled oncological trials: comparison between West and East. Ann Surg Oncol. 2013;20(7):2328–38.  https://doi.org/10.1245/s10434-012-2862-9.CrossRefPubMedGoogle Scholar
  38. 38.
    Gill S, Shah A, Le N, Cook EF, Yoshida EM. Asian ethnicity-related differences in gastric cancer presentation and outcome among patients treated at a canadian cancer center. J Clin Oncol. 2003;21(11):2070–6.  https://doi.org/10.1200/jco.2003.11.054.CrossRefPubMedGoogle Scholar
  39. 39.
    McGhan LJ, Etzioni DA, Gray RJ, Pockaj BA, Coan KE, Wasif N. Underuse of curative surgery for early stage upper gastrointestinal cancers in the United States. J Surg Res. 2012;177(1):55–62.  https://doi.org/10.1016/j.jss.2012.03.013.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Ryan Morgan
    • 1
  • Michael Cassidy
    • 1
  • Susanna W. L. DeGeus
    • 1
  • Jennifer Tseng
    • 1
  • David McAneny
    • 1
  • Teviah Sachs
    • 1
  1. 1.Department of SurgeryBoston Medical CenterBostonUSA

Personalised recommendations