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05.02.2018 | Original Article | Ausgabe 6/2018

Journal of Gastrointestinal Surgery 6/2018

Underutilization of Treatment for Regional Gastric Cancer Among the Elderly in the USA

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 6/2018
Autoren:
Natalie Liu, Daniela Molena, Miloslawa Stem, Amanda L. Blackford, David B. Sewell, Anne O. Lidor
Wichtige Hinweise

Meeting Presentation Information

Presented in the Scientific Forum program at the American College of Surgeons 2016 Clinical Congress at the Walter E. Washington Convention Center, from October 16 to 20, in Washington, DC.

Abstract

Background

In the USA, a quarter of elderly patients do not receive any treatment for regional gastric cancer, which results in poorer outcomes. We sought to identify factors associated with undertreatment of regional gastric cancer in this population, as well as to assess overall survival in the undertreated population.

Methods

Elderly patients (aged ≥ 65 years) diagnosed with regional gastric cancer between 2001 and 2009 were identified from the Surveillance Epidemiology and End Results (SEER)-Medicare linked databases. Treatment was defined as receiving any medical or surgical therapy for gastric cancer. Logistic regression analysis was used to identify factors associated with failure to receive treatment. Overall survival was analyzed using the Kaplan-Meier method and Cox proportional hazard model.

Results

Of 5972 patients with regional gastric cancer, 1586 (26.5%) received no treatment. Median age was 78 years; 56.1% of patients were men. On multivariable analysis, the factors strongly associated with lack of therapy were age ≥ 80 years, black race, lower education level, and diagnosis before 2007. As expected, patients who received therapy had better overall survival (log-rank test, p < 0.001). Specifically, median survival and 5-year survival were 16.5 months and 20.5% for treated patients, compared with 9.1 months and 19.0% for untreated patients.

Conclusions

Elderly patients with gastric cancer have better overall 5-year survival after receiving treatment for their cancer. Disparities in the use of treatment for curable cancers are associated with older age, black race, lower educational level, and diagnosis before 2007.

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