Influence of race and sociodemographic factors on declining resection for gastric cancer: A national study |
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| Institution: | 1. Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore – C500, Boston, MA, 02118, USA;2. University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA, 01655, USA;3. Department of Surgery, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA;1. Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA;2. Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;1. Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, United States;2. Newton Wellesley Hospital, Newton, MA, 02462, United States;3. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States;4. Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States;5. Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, United States;1. Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts;2. Department of Nephrology, Massachusetts General Hospital, Boston, Massachusetts;1. Division of Colon and Rectal Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania;2. Department of Surgery, Virginia Commonwealth University, Richmond, Virginia;3. Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia;4. Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania;1. DMD Candidate, University of Pennsylvania, Philadelphia, PA;2. Resident, Department of Surgery, Rush University Medical Center, Chicago, IL;3. Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD;4. Professor and Chief, Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL;6. Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA |
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| Abstract: | BackgroundThe purpose of this study was to determine whether racial or other demographic characteristics were associated with declining surgery for early stage gastric cancer.MethodsPatients with clinical stage I-II gastric adenocarcinoma were identified from the NCDB. Multivariable logistic models identified predictors for declining resection. Patients were stratified based on propensity scores, which were modeled on the probability of declining. Overall survival was evaluated using the Kaplan-Meier method.ResultsOf 11,326 patients, 3.68% (n = 417) declined resection. Patients were more likely to refuse if they were black (p < 0.001), had Medicaid or no insurance (p < 0.001), had shorter travel distance to the hospital (p < 0.001) or were treated at a non-academic center (p = 0.001). After stratification, patients who declined surgery had worse overall survival (all strata, p < 0.001).ConclusionsRacial and sociodemographic disparities exist in the treatment of potentially curable gastric cancer, with patients who decline recommended surgery suffering worse overall survival. |
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| Keywords: | Gastric cancer Refusal Disparity Socioeconomic Survival |
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