Is there a difference in utilization of a perioperative treatment approach for gastric cancer between safety net hospitals and tertiary referral centers?

Abstract

Background and Objectives Perioperative therapy is a favored treatment strategy for gastric cancer. We sought to assess utilization of this approach at safety net hospitals (SNH) and tertiary referral centers (TRC). Materials and Methods Patients in the US Safety Net Collaborative (2012–2014) with resectable gastric cancer across five SNH and their sister TRC were included. Primary outcomes were receipt of neoadjuvant chemotherapy (NAC) and perioperative therapy. Results Of 284 patients, 36% and 64% received care at SNH and TRC. The distribution of Stage II/III resectable disease was similar across facilities. Receipt of NAC at SNH and TRC was similar (56% vs. 46%, p = 0.27). Compared with overall clinical stage, 38% and 36% were pathologically downstaged at SNH and TRC, respectively. Among patients who received NAC, those who also received adjuvant chemotherapy at SNH and TRC were similar (66% vs. 60%, p = 0.50). Asian race and higher clinical stage were associated with receipt of perioperative therapy (both p < 0.05) while treatment facility type was not. Conclusions There was no difference in utilization of a perioperative treatment strategy between facility types for patients with gastric cancer. Pathologic downstaging from NAC was similar across treatment facilities, suggesting similar quality and duration of therapy. Treatment at an SNH is not a barrier to receiving standard‐of‐care perioperative therapy for gastric cancer.

Patient‐ and system‐level factors associated with racial/ethnic disparities in the delivery of guideline‐concordant therapy among US patients with gastric cancer

“…However, a national study identified that utilization of NAT for GC patients with stage II–III disease remains under 50% in the United States 19 . In addition, studies have shown racial and socioeconomic disparities in access to MMT among GC patients that are associated with worse survival outcomes 20–22 . The association of higher incidence among minorities and complex interdisciplinary management might increase the risk of treatment and outcomes inequalities among GC patients across their cancer care continuum.…”