Variations in gastric cancer care

Abstract

BACKGROUND:Race is associated with patterns of presentation and survival outcomes of gastric cancer in the United States. However, the impact of race on the receipt of guideline‐recommended care is not well characterized. By using current recommendations, the authors examined the association between race and guideline‐recommended treatments and identified factors that are predictive of variations in gastric cancer care.METHODS:By using the National Cancer Database for 1998 through 2005, 106,002 patients with gastric adenocarcinoma were identified. Multivariate analysis techniques were used to examine the association between race, the receipt of guideline‐recommended care, and survival after adjusting for covariates.RESULTS:Although African‐American and Hispanic patients were more likely to undergo adequate lymphadenectomy (≥15 lymph nodes) and to receive care at comprehensive cancer centers and high‐volume facilities (for all, P ≤ .001), they were less likely to receive adjuvant multimodality therapy for American Joint Committee on Cancer stage IB through IV, lymph node‐negative (M0) disease. Up to 60% of all patients who underwent gastrectomy failed to receive adequate lymphadenectomy and adjuvant multimodality therapy. The delivery of multimodality therapy varied significantly by stage and lymph node evaluation (P ≤ .001). These findings persisted on our multivariate analyses, indicating that African‐American and Hispanic patients received adequate lymph node evaluation (P ≤ .001), whereas they were associated with receiving no adjuvant multimodality therapy (P ≤ .025).CONCLUSIONS:There were significant variations in treatment for gastric cancer among ethnic groups in the United States. It was noteworthy that, although nonwhite race was associated with improved surgical care, gastric cancer care remained suboptimal overall. Cancer programs need to identify procedures to maximize the delivery of adequate gastric cancer care to all patients. Cancer 2010. © 2010 American Cancer Society.

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

“…Second, we also observed socioeconomic and racial disparities in cancer care delivery because being nonwhite, having a low socioeconomic status, and having nonprivate insurance were each significantly associated with being less likely to receive guideline‐compliant perioperative therapy. Similar racial/ethnic disparities in the use of preoperative therapy and in the utilization of complete lymphadenectomy for patients with gastric cancer in the United States have been previously reported . Although the lack of generalizability of the guidelines to the general population may explain these findings, the lack of access to high‐quality cancer care may also play a roll.…”

“…However, less than one-third of patients had all 3 parameters met, and this is consistent with previous reports. 19 These data are an important call to action for clinicians, health care leaders, and policymakers to ensure that patients are receiving the standard of care.…”

“…Low grade was defined as a well or moderate differentiated tumor, whereas high grade was defined as a poorly differentiated or undifferentiated tumor. Surgical treatment was identified by surgery of primary site codes, and patients who underwent no surgery (site code 00) or nononcologic surgery (site code [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] or had an unknown surgery status (site code 99) were excluded to exclude those undergoing noncurative operations. Utilization of minimally invasive surgery was defined as intent to treat and included both laparoscopic and robotic-assisted approaches.…”

Association of Compliance With Process-Related Quality Metrics and Improved Survival in Oral Cavity Squamous Cell Carcinoma

“…Lymph node yield has been suggested as a quality metric for colon, 27 lung, 28 and gastric cancer 29 and endorsed as a quality metric for those cancers at a national level. 30 Single- and multi-institution retrospective studies have suggested that lymph node yield of 18 or more during elective neck dissection for OCSCC is associated with improved survival.…”

Is Laparoscopy a Risk Factor for Bile Duct Injury During Cholecystectomy?

“…This may reflect socioeconomic influences that are difficult to discern from a large database review. Despite numerous studies showing the differences in cancer 13–16 and trauma 17–20 care by socioeconomic and insurance status, there was no indication that insurance status impacted BDI rates. The increased risk of BDI in teaching institutions may be associated with the complexities of patients treated at these centers or the learning curve associated with resident training (or both).…”