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March 21, 2023

Troubling Disparities Found in Esophageal Cancer Outcomes

Illustration depicting esophageal cancer

Lower-income people are significantly less likely to receive a potentially lifesaving treatment for the fastest-increasing type of esophageal cancer – and are more likely to die from the disease, new research from UVA Cancer Center reveals.

The study highlights troubling socioeconomic disparities in treatment access for early stage esophageal adenocarcinoma, an increasingly common cancer of the food tube that can be cured if treated early but can be fatal if treated too late. UVA researchers found that patients from lower-income households were more likely to die than those from higher-income brackets.

“These findings are alarming,” said researcher Alexander Podboy, MD, of UVA Health’s Division of Gastroenterology and Hepatology. “Population-based strategies aimed at identifying and rectifying possible etiologies [causes] for our findings are paramount to improving patient outcomes in early esophageal cancer.”

Improving Esophageal Cancer Care

Podboy and his collaborators used anonymized data collected in the national Surveillance Epidemiology and End-Results (SEER) cancer database to examine treatments and outcomes for more than 1,500 patients across the country with the T1a subtype of early stage esophageal adenocarcinoma. The researchers classified the patients by median household income and found stark disparities.

Patients in the lowest household income bracket ($20,000-$54,390) had the highest death rate of the three groups and were less likely to receive an increasingly common endoscopic treatment. In that nonsurgical approach, a thin, lighted tube is threaded into the throat to let doctors view and remove the cancerous cells. Endoscopic treatment is less invasive and associated with similar outcomes compared with traditional surgery.

The use of the endoscopic intervention increased across the United States during the 10-year period the researchers reviewed. Patients in the South were the least likely to receive endoscopic treatment, and the region had the slowest adoption of the procedure. The South also had the worst overall survival and cancer-specific mortality, the researchers found.

Patients in higher income brackets across the country were more likely to receive endoscopic treatment, and they enjoyed significantly higher survival rates at both two and five years, the study found. 

The researchers say the disparities likely stem, in part, from the fact that endoscopic treatment requires technical expertise typically only found at advanced specialty centers such as UVA Cancer Center. So one barrier to care may be the distance many patients must travel to access the treatment. But the researchers say there are likely other factors contributing to the higher death rates seen in the lower income group, such as the possibility that the patients may have other health conditions that lead to poor outcomes.

To address the disparities, the researchers are calling for efforts to increase screening for esophageal cancer and to improve access to advanced centers where patients can receive care from multidisciplinary teams.

“Access to the very best in cancer-related care should not be predicated on your socioeconomic status,” Podboy said. “We hope that our research helps shine a spotlight on this problem and leads to actions that help eliminate any barriers to care.”

Finding ways to improve cancer care is a key mission of UVA Cancer Center, which is one of only 53 cancer centers in the country designated as a Comprehensive Cancer Center by the National Cancer Institute. The designation recognizes elite cancer centers with the most outstanding cancer programs in the nation. Comprehensive Cancer Centers must meet rigorous standards for innovative research and leading-edge clinical trials.

UVA Cancer Center is the only Comprehensive Cancer Center in Virginia.

Findings Published

The researchers have published their findings in the scientific journal Clinical Gastroenterology and Hepatology. The team consisted of Calvin X. Geng, Anuragh R. Gudur, Mark Radlinski, Ross C.D. Buerlein, Daniel S. Strand, Bryan G. Sauer, Vanessa M. Shami, Andrew Y. Wang and Podboy. 

To keep up with the latest medical research news from UVA, subscribe to the Making of Medicine blog.

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