Variations in gastric cancer care

A trend beyond racial disparities

Authors

  • Waddah B. Al-Refaie MD,

    Corresponding author
    1. Departments of Surgery and Health Care Policy, University of Minnesota and Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
    • Division of Surgical Oncology, Department of Surgery, University of Minnesota and Minneapolis VAMC, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN 55455
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    • Fax: (612) 625-4406

  • Greer Gay PhD,

    1. National Cancer Data Base, American College of Surgeons, Commission on Cancer, Chicago, Illinois
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  • Beth A. Virnig MPH, PhD,

    1. Departments of Surgery and Health Care Policy, University of Minnesota and Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
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  • Jennifer F. Tseng MD, MPH,

    1. Division of Surgical Oncology and Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Andrew Stewart MA,

    1. National Cancer Data Base, American College of Surgeons, Commission on Cancer, Chicago, Illinois
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  • Selwyn M. Vickers MD, FACS,

    1. Departments of Surgery and Health Care Policy, University of Minnesota and Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
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  • Todd. M. Tuttle MD, FACS, MS,

    1. Departments of Surgery and Health Care Policy, University of Minnesota and Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
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  • Barry W. Feig MD, FACS

    1. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Presented at the American College of Surgeons 94th Annual Clinical Congress, San Francisco, California, October 12-16, 2008.

  • The authors contributed to this article as follows: study conception and design, Drs. Al-Refaie and Gay, Feig; acquisition of data, Drs. Al-Refaie and Gay; analysis and interpretation of data, Drs. Al-Refaie, Gay, Virnig, and Feig; drafting of the article, Drs. Al-Refaie, Gay, Virnig, Tuttle, and Feig; critical revision, Drs. Al-Refaie, Gay, Virnig, Tseng, Stewart, Tuttle, Vickers, and Feig.

Abstract

BACKGROUND:

Race is associated with patterns of presentation and survival outcomes of gastric cancer in the United States. However, the impact of race on the receipt of guideline-recommended care is not well characterized. By using current recommendations, the authors examined the association between race and guideline-recommended treatments and identified factors that are predictive of variations in gastric cancer care.

METHODS:

By using the National Cancer Database for 1998 through 2005, 106,002 patients with gastric adenocarcinoma were identified. Multivariate analysis techniques were used to examine the association between race, the receipt of guideline-recommended care, and survival after adjusting for covariates.

RESULTS:

Although African-American and Hispanic patients were more likely to undergo adequate lymphadenectomy (≥15 lymph nodes) and to receive care at comprehensive cancer centers and high-volume facilities (for all, P ≤ .001), they were less likely to receive adjuvant multimodality therapy for American Joint Committee on Cancer stage IB through IV, lymph node-negative (M0) disease. Up to 60% of all patients who underwent gastrectomy failed to receive adequate lymphadenectomy and adjuvant multimodality therapy. The delivery of multimodality therapy varied significantly by stage and lymph node evaluation (P ≤ .001). These findings persisted on our multivariate analyses, indicating that African-American and Hispanic patients received adequate lymph node evaluation (P ≤ .001), whereas they were associated with receiving no adjuvant multimodality therapy (P ≤ .025).

CONCLUSIONS:

There were significant variations in treatment for gastric cancer among ethnic groups in the United States. It was noteworthy that, although nonwhite race was associated with improved surgical care, gastric cancer care remained suboptimal overall. Cancer programs need to identify procedures to maximize the delivery of adequate gastric cancer care to all patients. Cancer 2010. © 2010 American Cancer Society.

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