Language
English
Publication Date
6-1-2024
Journal
Journal of Surgical Oncology
DOI
10.1002/jso.27683
PMID
38752435
PMCID
PMC11827362
PubMedCentral® Posted Date
6-1-2025
PubMedCentral® Full Text Version
Author MSS
Abstract
Background: Disparities in gastric cancer (GC) outcomes show a higher disease burden among minorities. We aimed to evaluate the associations between sociodemographic and system-level factors and guideline-concordant treatment among GC patients.
Methods: Cohort study with GC patients in the National Cancer Data Base (2006-2018) treated with upfront resection or neoadjuvant therapy (NAT). We used logistic regression to identify associations between deviations from guideline-concordant therapy and patient- and system-level factors, and Cox regression models to assess risk of death.
Results: The cohort included 43 597 GC patients treated with endoscopic resection (8.9%), surgery only (47.1%), surgery and adjuvant therapy (20.6%), or NAT followed by surgery (23.5%). A total of 31 470 patients (72.2%) received guideline-concordant therapy. Relative to Non-Hispanic Whites (NHWs), Non-Hispanic Blacks (NHBs) (odds ratio [OR] 1.19, [95% confidence intervals 1.10-1.28]) and Asian/Pacific Islanders (APIs) (OR 1.12 [1.03-1.23]) had an increased risk of deviations from treatment guidelines. Medicare/Medicaid increased the risk of deviations while treatment at high-volume facilities decreased its risk for all races/ethnicities. Deviations from guidelines were associated with an increased risk of death (hazard ratio 1.56 [1.50-1.63].
Conclusions: Racial disparities in the delivery of guideline-concordant therapy among GC patients are affected by several sociodemographic factors at the patient- and system-level.
Keywords
Humans, Stomach Neoplasms, Female, Male, Healthcare Disparities, Aged, Middle Aged, United States, Practice Guidelines as Topic, Guideline Adherence, Cohort Studies, Follow-Up Studies, Prognosis, Gastrectomy, Survival Rate, gastric cancer, guideline-concordant therapy, health disparities
Published Open-Access
yes
Recommended Citation
da Costa, Wilson L; Tan, Mimi C; Camp, E Ramsay; et al., "Patient- and System-Level Factors Associated With Racial/Ethnic Disparities in the Delivery of Guideline-Concordant Therapy Among Us Patients With Gastric Cancer" (2024). Faculty and Staff Publications. 4449.
https://digitalcommons.library.tmc.edu/baylor_docs/4449