Disparities in chemotherapy utilization among urban upper GI malignancy cancer patients at a safety-net hospital.

Abstract

e23170 Background: Urban underserved populations face barriers to cancer treatment. Safety-net hospitals, serving vulnerable groups, often reveal disparities in care. This study examines chemotherapy utilization, cancer staging, demographics, and insurance status among upper gastrointestinal (GI) malignancy patients at a safety-net hospital in Newark, NJ. Methods: Data from 109 patients treated at University Hospital, Newark, NJ, from 2014–2024 were analyzed. Patients had upper GI malignancies, including gastric adenocarcinoma, esophageal cancer, cholangiocarcinoma, gallbladder cancer, and metastatic adenocarcinoma of gastric origin. Variables included cancer staging, chemotherapy status, language, ethnicity, race, age, sex, and insurance type. Patients were categorized by chemotherapy receipt: “Yes” for treatment or “No” for non-treatment. Of the cohort, 61 patients did not receive chemotherapy. Descriptive and subgroup analyses identified treatment disparities. Results: Of the 61 patients who did not receive chemotherapy, 46 had upper GI malignancies: gastric adenocarcinoma (n=28), esophageal cancer (n=5), cholangiocarcinoma (n=3), gallbladder cancer (n=1), and metastatic adenocarcinoma (n=8). Non-treatment patients were predominantly Hispanic/Latino (n=20) and Black/African American (n=13), with smaller numbers identifying as non-Hispanic White (n=1), Asian American (n=4), or other ethnicities (n=7). Uninsured or underinsured patients, including those on Medicaid, Medicare, or charity care, accounted for 76% (n=35) of this group. Among chemotherapy recipients (n=32), most had Medicaid/Medicare (n=21), charity care (n=7), or private insurance (n=4). Advanced-stage disease was more common among non-treatment patients, reflecting delayed diagnoses and systemic barriers. Language barriers disproportionately impacted non-English speakers, reducing chemotherapy initiation. Conclusions: This study reveals significant disparities in chemotherapy utilization among urban cancer patients at a safety-net hospital. Hispanic/Latino and Black/African American patients were disproportionately affected, with gaps in insurance and language services compounding inequities. Advanced-stage disease at diagnosis further reduced treatment options. Efforts to address disparities should prioritize expanding insurance coverage, improving language services, and enhancing outreach to promote earlier diagnosis. Structural reforms in safety-net hospitals are critical to improving equity and outcomes for underserved urban populations with upper GI malignancies.