Health Barriers and Patterns of Gastric Cancer Care in Rural Central American Resource-Limited Settings

Estévez-Ordoñez, Dagoberto; Montalvan-Sanchez, Eleazar E.; Wong, Rochelle; Montalvan-Sanchez, Daniela M.; Rodriguez-Murillo, Aida A.; Domínguez, Ricardo L.; Morgan, Douglas R.

doi:10.1001/jamaoncol.2018.2570

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…Gastric cancer is a major cause of death in low and middle income countries in Central America, and is likely to become a bigger problem in the United States as the Hispanic immigrant population grows . Little progress has been made in improving outcomes for gastric cancer patients and this is likely due to the practice of assigning therapies from highly controlled prospective trials to patient populations who may not benefit.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of treatment and outcomes for Hispanic patients with gastric cancer at Commission on Cancer‐accredited centers in the United States

Zhao

Leichman

Horgan

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Gastric cancer in the Hispanic population commonly presents with poor clinical features. Characteristics of this vulnerable population and optimal therapy for these patients have not been clearly defined. Methods Using the National Cancer Database (2004‐2014), we analyzed patient demographics, clinical factors, treatment‐related factors, and outcomes for Hispanic and non‐Hispanic patients with gastric adenocarcinoma in the United States. Results A total of 129 666 patients were included in this analysis. Hispanics were younger, more often female, had larger tumors, and were more likely to present with metastatic disease (all P < 0.001). Hispanics were more likely to undergo staging laparoscopy (5.6% vs 4.9%; P = 0.037), gastrectomy (63.5% vs 56.9%; P < 0.001), and ≥ 15 lymph nodes examined (56.1% vs 50.5%; P < 0.001). Hispanics were less likely to have negative margins (91.2% vs 92.8%; P = 0.004). Hispanics with stage II/III disease were less likely to receive neoadjuvant therapy (31.7% vs 38.7%; P < 0.001), but more likely to receive multimodal therapy (48.9% vs 46.1%; P = 0.01). Predictors for improved overall survival in Hispanics included multimodal therapy, negative margins, and treatment at an academic center. Conclusions Efforts to optimize treatment of this distinct and growing population of gastric cancer patients should focus on earlier diagnosis, referral to academic centers, and high‐quality surgery.

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Section: Discussionmentioning

confidence: 99%

“…In areas such as Central America, particularly in low income countries, the picture is very different. Patients present with locally advanced or metastatic disease, and fewer than 25% of patients are eligible for or receive treatment …”

Section: Introductionmentioning

confidence: 99%

Evaluation of treatment and outcomes for Hispanic patients with gastric cancer at Commission on Cancer‐accredited centers in the United States

Zhao

Leichman

Horgan

et al. 2019

Journal of Surgical Oncology

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“…This case report exhibits multiple barriers to healthcare that were identified during the patient's prolonged disease course. First, healthcare access is difficult due to hometown being located in a mountainous region of Honduras distant to secondary or tertiary healthcare centers, despite being a known region with a high incidence of upper gastrointestinal neoplasm [18][19][20]. Additionally, in low-middle-income countries, the recommended radiological and endoscopic studies for detecting these intraabdominal conditions are not available in many hospitals and, when available, are expensive, contributing to the delay of diagnosis and treatment [19,21].…”

Section: Discussionmentioning

confidence: 99%

“…It is known that upper gastrointestinal neoplasms are the leading cause of malignancies and mortality in Central America, and impact the USA health system as Central America forms the second largest Latino immigrant population [18][19][20][21]25].…”

Section: Discussionmentioning

confidence: 99%

Upper Gastrointestinal Cancer: Delays in Diagnosis and Treatment Caused by Barriers to Healthcare in the Latino Community

et al. 2022

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We report a case of an 81-year-old male immigrant from a Latin American developing country with a high burden of upper gastrointestinal neoplasms, who presented with a small bowel gastrointestinal stromal tumor (GIST) after 2 years of delay in the diagnosis due to multiple barriers to healthcare. The patient presented with a partial intestinal obstruction in an abdominal computed tomography (CT) scan suggestive of a GIST. Surgical resection was performed, and adjuvant therapy was initiated with imatinib (a tyrosine kinase inhibitor) after the diagnosis was confirmed. The patient had a successful outcome. Due to his migratory status, the patient planned to follow up with different health providers in two different countries, which constitutes a common challenge in the immigrant population.

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“…Thus, PPL could be advantageous and worth advocating in diagnostic stating of GC in the resource‐limited settings in China. Besides China, barriers to gastric cancer care are substantial in the rural low‐ and middle‐income countries (LMICs) setting of Central America 45 . This result might contribute the cancer control in LMICs and promote the establishment of cost‐effective cancer care there.…”

Section: Discussionmentioning

confidence: 99%

A decision analysis comparing three strategies for peritoneal lavage cytology testing in staging of gastric cancer in China

Zhu²,

Wang

et al. 2020

Cancer Medicine

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Background Positive peritoneal cytology (PCY) indicates metastasis (M1) in gastric cancer (GC) patients; both the American and Chinese guidelines recommend laparoscopic peritoneal lavage (LPL) for cytology. However, relatively high costs impair the widespread use of LPL in some resource‐limited regions in China, and the cost‐effectiveness of PCY testing remains unclear. Therefore, we performed a decision analysis to evaluate the cost‐effectiveness of PCY testing by comparing the guideline‐recommended intraoperative LPL, a newly proposed preoperative percutaneous peritoneal lavage (PPL), and a third strategy of exploratory laparotomy with no cytology testing (ELNC) among GC patients. Methods We developed a decision‐analytic Markov model of the aforementioned three strategies for a hypothetical cohort of GC patients with curative intent after initial imaging, from the perspective of Chinese society. We estimated costs, quality‐adjusted life years (QALYs), and incremental cost‐effectiveness ratios (ICERs) as primary outcomes; we also conducted one‐way and probabilistic sensitivity analyses to investigate the model's robustness. Results We found that ELNC was dominated (i.e., more expensive and less effective) by PPL and LPL. LPL was the most cost‐effective method with an ICER of US$17,200/QALY compared to PPL, which was below the Chinese willingness‐to‐pay (WTP) threshold of US$29,313 per QALY gained. In sensitivity analyses, PPL was more likely to be cost‐effective with a lower WTP threshold. Conclusions Cytology testing through either LPL or PPL was less expensive and more effective than ELNC among GC patients. Moreover, LPL was the most cost‐effective modality at the current WTP threshold, while PPL could potentially be cost‐effective in lower‐income areas.

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Health Barriers and Patterns of Gastric Cancer Care in Rural Central American Resource-Limited Settings

Cited by 6 publications

References 7 publications

Evaluation of treatment and outcomes for Hispanic patients with gastric cancer at Commission on Cancer‐accredited centers in the United States

Evaluation of treatment and outcomes for Hispanic patients with gastric cancer at Commission on Cancer‐accredited centers in the United States

Upper Gastrointestinal Cancer: Delays in Diagnosis and Treatment Caused by Barriers to Healthcare in the Latino Community

A decision analysis comparing three strategies for peritoneal lavage cytology testing in staging of gastric cancer in China

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