Presentation, Treatment, and Outcomes of Vulnerable Populations With Esophageal Cancer Treated at a Safety-Net Hospital

Social determinants of health (SDH) have been associated with poor outcomes in esophageal cancer. Primary language and immigration status have not been examined in relation to esophageal cancer outcomes. This study aims to investigate the impact of these variables on stage of presentation, treatment and outcomes of esophageal cancer patients at an urban safety-net hospital. Clinical data of patients with esophageal cancer at our institution between 2003 and 2018 was reviewed. Demographic, tumor, and treatment characteristics were obtained. Outcomes included median overall survival, stage-specific survival, and utilization of surgical and perioperative therapy. Statistical analysis was conducted using Chi-squared test, Fisher's exact tests, Kaplan-Meier method, and logistic regression. There were 266 patients; 77% were male. Mean age was 63.9 years, 23.7% were immigrants, 33.5% were uninsured/Medicaid, and 16.2% were non-English speaking. Adenocarcinoma was diagnosed in 55.3% and squamous cell in 41.0%. More patients of Non-Hispanic received esophagectomies when compared to those of Hispanic origin (64% vs 25%, p=0.012). Immigrants were less likely to undergo esophagectomy compared to US-born patients (42% vs 76%, p=0.001). Patients with adenocarcinoma were more likely than squamous cell carcinoma patients to undergo esophagectomy (OR=4.40, 95% CI [1.61-12.01], p=0.004). More commercially/privately insured patients (75%) received perioperative therapy compared to Medicaid/uninsured (54%) and Medicare (49%) patients (p=0.030). There was no association between demographic factors and the utilization of perioperative chemoradiation for patients with operable disease. Approximately 23% of patients with operable disease were too frail or declined to undergo surgical intervention. In this small single-center study, race and primary language were not associated with median survival for patients treated for esophageal cancer. US-born patients experienced higher surgical utilization and privately insured patients were more likely to receive perioperative therapy. Many patients with operable cancer were too frail to undergo a curative surgery. Studies should expand on the relationships between SDH and non-clinical services on delivery of care and survival of vulnerable populations with esophageal cancer. Ultra Mini Abstract Previously determined sociodemographic risk factors for poor outcomes in esophageal cancer in population based were examined in a safety-net center. Insurance status and immigration status are associated with disparities in delivery of care at an urban, safety-net medical center.