Delays in Gastric Cancer Treatment: Observed Disparities by Race and Insurance Status
Ian Solsky, Peter Muscarella, John McAuliffe, Haejin In
INTRODUCTION
Time from cancer diagnosis to first treatment (TimeTx) is an important quality of care indicator. Identifying predictors of delayed TimeTx for gastric adenocarcinoma (GC) patients may reveal opportunities to reduce disparities.
METHODS
National Cancer Database identified adults with GC surgically treated 2004-2014. Patients with unknown TimeTx, stage IV GC, or emergency surgery were removed. Descriptive statistics compared those with and without delayed TimeTx (>8 weeks). Logistic regression models identified predictors of delayed TimeTx for the entire cohort, those whose first treatment was surgical (Surgfirst), and those whose first treatment was chemotherapy or radiation followed by surgery (Neoadjuvant).
RESULTS
Of 30,945 patients, 19% had delayed TimeTx (22% of Surgfirst, 13% of Neoadjuvant). Predictors of delayed TimeTx for the entire cohort include: Surgfirst (OR 1.8, 95%CI 1.7-2.0), age >75 (OR 1.6, 95%CI 1.4-1.9), Black race (OR 1.3, 95%CI 1.2-1.5), low educational attainment (OR 1.4, 95%CI 1.2-1.6), Medicaid (OR 1.6, 95%CI 1.4-1.8), more comorbidities (OR 1.3, 95%CI 1.1-1.4). Among Surgfirst patients, delay was most associated with academic center treatment (OR 1.6, 95%CI 1.4-1.9). Among Neoadjuvant patients, delay was strongly associated with Black race (1.9, 95%CI 1.5-2.3), Hispanic race (OR 1.8, 95% CI 1.4-2.2), Medicaid (OR 1.7, 95%CI 1.4-2.1). Median time to treatment for non-Hispanic white patients with private insurance was 30 days (IQR: 21-41) compared to 39.5 days (IQR: 22.5-52.5) for Hispanic patients with Medicaid.
CONCLUSION
Racial and insurance disparities are prominently associated with delayed treatment, especially for neoadjuvant therapy, and must be addressed to ensure high quality GC care for all.
Email questions and comments about this abstract to isolsky@montefiore.org.
