Outcomes of patients with esophageal and gastric carcinomas at a safety-net healthcare system.

Abstract

e23080 Background: Outcomes for esophageal squamous (ES), esophageal (EA) and gastric adenocarcinomas (G) are poor except for those patients whose cancers are diagnosed at a very early stage. Prior studies in the real-world setting have demonstrated that only 76% of patients with advanced upper gastrointestinal (GI) adenocarcinomas received first line systemic therapy. Unique socioeconomic factors may result in worse outcomes in the safety-net setting given that these patients (pts) often seek care later in the disease course, complicating candidacy for therapy due to poor nutritional status or performance status. Methods: Pts diagnosed with ES, EA, G at John Peter Smith Health Network (JPS) in Fort Worth, Texas from January 1, 2018, to December 31, 2022, were identified in the tumor registry database. Gastroesophageal junction adenocarcinomas were grouped under EA or G based on clinical notes. Epic EHR was queried for pathology variables and to verify survival. Kaplan Meier curve was used to assess the difference in survival time across cancer stages from an index date of diagnosis with censoring at date of last contact. The log rank test was then performed to assess the survival distributions across exposures of interest. This study was approved by the North Texas IRB. Results: A total of 171 pts were included: 15 pts were under 40 and the median age was 57 years. 40% were Hispanic, 33% were non-Hispanic (NH) White, and 20% were NH Black. The majority were male (71%) and uninsured (65%). G was the most common primary site (n = 92, 54%), followed by EA (n = 58, 34%) and ES (n = 21, 12%). The majority of patients (n = 125, 73%) were stage 4B. Of these pts, 69 (55%) did not receive any treatment (50 pts went on hospice), 6 received only palliative radiation, the remainder received systemic therapy. One-year survival probability by stage is shown in Table. The overall log-rank test showed a statistical difference between the survival curves (p < .0001). Stage 4B was stratified by receipt of treatment. Of note, in patients with 4B the median overall survival for patients with treatment was 7.6 months (95% CI: (6.1-10), compared to 2.0 months (95% CI: (1.4-3.0) without treatment. Conclusions: In an urban safety-net population of JPS, several concerning trends in upper GI cancers were noteworthy. First, the majority of patients with advanced upper GI cancers did not receive systemic therapy, likely due to advanced stage and symptoms at diagnosis. Second, a concerning proportion of patients were young and Hispanic, highlighting an under-studied population of patients. Finally, outcomes appear worse stage-for-stage than in the previously published literature. Interventions to improve outcomes for these patients must consider their unique socioeconomic needs. Survival probability at 1 year by stage. Stage 1 (n=7) 2-4A (n=39) 4B treated (n=56) 4B untreated (n=69) Survival probability (95% CI) 69% (21%-91%) 72% (55%-83%) 32% (20%-44%) 9.2% (3.8%-18%)