Poor black patients at higher risk of death following esophageal cancer surgery

Poor black patients undergoing surgery for esophageal cancer are at higher risk for death than white patients and patients with higher socioeconomic status, according to a scientific presentation at the 52nd Annual Meeting of The Society of Thoracic Surgeons.

"Prior institutional experience suggested that outcomes of some cancers might be based on socioeconomic status as well as race, so we developed this study to determine if the relationship existed in patients with esophageal cancer on a national scale," said Loretta Erhunmwunsee, MD who led the study while at Duke Health. Dr. Erhunmwunsee is now with City of Hope in Duarte, Calif.

Dr. Erhunmwunsee and colleagues used the National Cancer Data Base to gather information on 16,807 patients, of whom 6,147 were treated with esophagectomy for esophageal cancer (stages I-III) between 2003 and 2011. Patients were grouped using median income by zip code. Black patients made up 5% (293) of those who underwent esophagectomy, and 40.3% (2,476) of patients were in the lowest two income quartiles.

Before adjusting for outside factors (age, sex, other health factors, etc.), black patients had worse overall survival compared to white patients (median survival was 33 vs. 46 months, respectively), and each lower income grouping was associated with progressively worse survival.

"These results show that poorer patients are at a higher risk of death following surgery," said Dr. Erhunmwunsee. "This disparity likely is based on many factors—minority patients and patients with lower socioeconomic status often smoke more, have poor eating habits, exercise less, and are exposed to environmental hazards, all of which lead to worse health. And specifically, increased smoking and poorer eating habits can increase the risk of esophageal cancer."

After adjusting for outside factors, both black race and lower income group remained significantly associated with worse overall survival; however, there was no difference in survival rates among black and white patients in the highest two income groups. A significant difference still remained between black and white patients in the lowest income groups (median survival was 26 vs. 40 months, respectively), indicating a racial and economic disparity.

"Prior studies have shown that ethnic minority and poor patients who have access to care may still get inappropriate treatment; however, even when they do receive adequate therapy (surgery), as in this study, disparities are prevalent," said Dr. Erhunmwunsee. "These finding are important to patients because being aware of the factors that are linked to higher death rates can empower patients to be more active with their own health and medical care. We also hope that awareness of the problem among physicians and patients alike will lead to more public and professional focus on solving this disparity through strategies aimed at health policy, practices of health systems, and training of health care providers."