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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 1/2017

01-01-2017 | 2016 SSAT Plenary Presentation

Esophageal Cancer Treatment Is Underutilized Among Elderly Patients in the USA

Authors: Daniela Molena, Miloslawa Stem, Amanda L. Blackford, Anne O. Lidor

Published in: Journal of Gastrointestinal Surgery | Issue 1/2017

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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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Metadata
Title
Esophageal Cancer Treatment Is Underutilized Among Elderly Patients in the USA
Authors
Daniela Molena
Miloslawa Stem
Amanda L. Blackford
Anne O. Lidor
Publication date
01-01-2017
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 1/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3229-5

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