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Differential Overall Survival and Treatment in Patients With Small Intestine Adenocarcinoma Based on Insurance Status: A National Perspective
BACKGROUND
The incidence of adenocarcinoma, the most common type of small intestine cancer, is increasing. Prior studies found a 5-year survival of about 25% even with surgical resection and lymph node dissection. A recent study found higher survival in insured versus uninsured patients, yet differential outcomes and treatments between private insurance and Medicare, along with Medicaid and no insurance, are unknown. This study aims to determine differential survival and treatment of patients with small intestine adenocarcinoma based on insurance status.
METHODS
The National Cancer Database was used to identify patients diagnosed with small intestine adenocarcinoma from 2004-2019 using the histology code 8140 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, Chi-Square, ANOVA, and Cox Proportional Hazards tests were performed. Data was analyzed using IBM SPSS version 28 and statistical significance was set at α=0.05.
RESULTS
Of the 20,933 patients included, 7,629 (32.4%) had private insurance and 13,075 (55.5%) had Medicare. Patients with private insurance had a longer median survival (28.8 months) than patients with Medicare, Medicaid, and no insurance (p<.001), while patients with Medicare had a shorter median survival (12.2 months) than other insurance statuses (p<.001). No median survival difference existed between those with Medicaid (18.9 months) and no insurance (18.0 months) (p=.882). After controlling for age, co-morbidity score, grade, tumor size, low-income, academic facility, surgery of primary site, palliative care, and days between diagnosis and treatment, private insurance was associated with an independent decrease in hazard (HR=.874; p<.001). Patients with private insurance received more surgery (67.8%) than those with Medicaid (58.6%), no insurance (54.4%), and Medicare (52.9%) (p<.001). Patients with Medicare received more adjuvant radiation, but patients with private insurance received more adjuvant chemoradiation (p<.001). While patients with Medicare presented with greater co-morbidities and age, patients with private insurance presented with fewer co-morbidities, smaller sized tumors, and shorter time between diagnosis and treatment (p<.001).
CONCLUSIONS
Since patients with private insurance received the most surgery and displayed the highest overall survival, while patients with Medicare displayed the lowest survival, future research should explore ways to alleviate this disparity in surgical resections.
BACKGROUND
The incidence of adenocarcinoma, the most common type of small intestine cancer, is increasing. Prior studies found a 5-year survival of about 25% even with surgical resection and lymph node dissection. A recent study found higher survival in insured versus uninsured patients, yet differential outcomes and treatments between private insurance and Medicare, along with Medicaid and no insurance, are unknown. This study aims to determine differential survival and treatment of patients with small intestine adenocarcinoma based on insurance status.
METHODS
The National Cancer Database was used to identify patients diagnosed with small intestine adenocarcinoma from 2004-2019 using the histology code 8140 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, Chi-Square, ANOVA, and Cox Proportional Hazards tests were performed. Data was analyzed using IBM SPSS version 28 and statistical significance was set at α=0.05.
RESULTS
Of the 20,933 patients included, 7,629 (32.4%) had private insurance and 13,075 (55.5%) had Medicare. Patients with private insurance had a longer median survival (28.8 months) than patients with Medicare, Medicaid, and no insurance (p<.001), while patients with Medicare had a shorter median survival (12.2 months) than other insurance statuses (p<.001). No median survival difference existed between those with Medicaid (18.9 months) and no insurance (18.0 months) (p=.882). After controlling for age, co-morbidity score, grade, tumor size, low-income, academic facility, surgery of primary site, palliative care, and days between diagnosis and treatment, private insurance was associated with an independent decrease in hazard (HR=.874; p<.001). Patients with private insurance received more surgery (67.8%) than those with Medicaid (58.6%), no insurance (54.4%), and Medicare (52.9%) (p<.001). Patients with Medicare received more adjuvant radiation, but patients with private insurance received more adjuvant chemoradiation (p<.001). While patients with Medicare presented with greater co-morbidities and age, patients with private insurance presented with fewer co-morbidities, smaller sized tumors, and shorter time between diagnosis and treatment (p<.001).
CONCLUSIONS
Since patients with private insurance received the most surgery and displayed the highest overall survival, while patients with Medicare displayed the lowest survival, future research should explore ways to alleviate this disparity in surgical resections.
BACKGROUND
The incidence of adenocarcinoma, the most common type of small intestine cancer, is increasing. Prior studies found a 5-year survival of about 25% even with surgical resection and lymph node dissection. A recent study found higher survival in insured versus uninsured patients, yet differential outcomes and treatments between private insurance and Medicare, along with Medicaid and no insurance, are unknown. This study aims to determine differential survival and treatment of patients with small intestine adenocarcinoma based on insurance status.
METHODS
The National Cancer Database was used to identify patients diagnosed with small intestine adenocarcinoma from 2004-2019 using the histology code 8140 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, Chi-Square, ANOVA, and Cox Proportional Hazards tests were performed. Data was analyzed using IBM SPSS version 28 and statistical significance was set at α=0.05.
RESULTS
Of the 20,933 patients included, 7,629 (32.4%) had private insurance and 13,075 (55.5%) had Medicare. Patients with private insurance had a longer median survival (28.8 months) than patients with Medicare, Medicaid, and no insurance (p<.001), while patients with Medicare had a shorter median survival (12.2 months) than other insurance statuses (p<.001). No median survival difference existed between those with Medicaid (18.9 months) and no insurance (18.0 months) (p=.882). After controlling for age, co-morbidity score, grade, tumor size, low-income, academic facility, surgery of primary site, palliative care, and days between diagnosis and treatment, private insurance was associated with an independent decrease in hazard (HR=.874; p<.001). Patients with private insurance received more surgery (67.8%) than those with Medicaid (58.6%), no insurance (54.4%), and Medicare (52.9%) (p<.001). Patients with Medicare received more adjuvant radiation, but patients with private insurance received more adjuvant chemoradiation (p<.001). While patients with Medicare presented with greater co-morbidities and age, patients with private insurance presented with fewer co-morbidities, smaller sized tumors, and shorter time between diagnosis and treatment (p<.001).
CONCLUSIONS
Since patients with private insurance received the most surgery and displayed the highest overall survival, while patients with Medicare displayed the lowest survival, future research should explore ways to alleviate this disparity in surgical resections.
Disparities Affecting Survival Outcomes of Small Intestine Leiomyosarcoma, an NCDB Analysis
BACKGROUND
Leiomyosarcoma is a rare neoplasm of smooth muscle that can originate from various organ systems. Of the gastrointestinal tract, the rarity and the difficulty of diagnosing small intestine leiomyosarcoma affect its poor prognosis. With an average age of diagnosis of 64 years and a median life expectancy of 45 months, there exists a lack of information on the disparities that exist in these patients and how patient demographics contribute to differences in survival outcomes.
METHODS
We used the National Cancer Database to identify patients diagnosed with small intestine leiomyosarcoma (ICD-O-3 histology code 8890) between 2004-2019 (N=406). General patient characteristics were assessed using descriptive statistics. Survival was evaluated using Kaplan-Meier curves and log-rank tests. Significance was set at p<0.05.
RESULTS
When analyzing race, patients diagnosed with small intestine leiomyosarcoma were predominantly White (81.8%) and African American (14.3%); however, White patients had statistically worse survival outcomes than African Americans (67 vs 97 months) (p=0.004). Patients with private insurance had statistically better outcomes when compared to Medicare (p<0.001). When compared to White patients, African Americans had a higher proportion of private insurance (53.4% vs 37.2%) and lower proportion of Medicare coverage (5.2% and 48.2%), a lower average age of diagnosis (60.5 vs 64.7 years), shorter travel distances (14.7 vs 31.1 miles) and fewer days between staging procedure and surgical diagnostics from initial diagnosis (4.54 vs 12.5 days). Patients who received surgical intervention had a statistically significant improved survival outcome than those who did not (78 vs 15 months) (p<0.001) with the majority of these procedures being partial gastrectomies (53.6%). More patients of the cohort were treated at comprehensive community cancer programs (36.2%), followed by academic research programs (32.0%), integrated network cancer programs (18.5%) and community cancer programs (8.6%).
CONCLUSIONS
Factors associated with increased survival outcomes include race, average age of diagnosis, travel distance, fewer days between diagnostic procedure and initial diagnosis, insurance status and surgical treatment. These findings make a valuable contribution to the ongoing research on disparities affecting survival in patients with small intestine leiomyosarcoma.
BACKGROUND
Leiomyosarcoma is a rare neoplasm of smooth muscle that can originate from various organ systems. Of the gastrointestinal tract, the rarity and the difficulty of diagnosing small intestine leiomyosarcoma affect its poor prognosis. With an average age of diagnosis of 64 years and a median life expectancy of 45 months, there exists a lack of information on the disparities that exist in these patients and how patient demographics contribute to differences in survival outcomes.
METHODS
We used the National Cancer Database to identify patients diagnosed with small intestine leiomyosarcoma (ICD-O-3 histology code 8890) between 2004-2019 (N=406). General patient characteristics were assessed using descriptive statistics. Survival was evaluated using Kaplan-Meier curves and log-rank tests. Significance was set at p<0.05.
RESULTS
When analyzing race, patients diagnosed with small intestine leiomyosarcoma were predominantly White (81.8%) and African American (14.3%); however, White patients had statistically worse survival outcomes than African Americans (67 vs 97 months) (p=0.004). Patients with private insurance had statistically better outcomes when compared to Medicare (p<0.001). When compared to White patients, African Americans had a higher proportion of private insurance (53.4% vs 37.2%) and lower proportion of Medicare coverage (5.2% and 48.2%), a lower average age of diagnosis (60.5 vs 64.7 years), shorter travel distances (14.7 vs 31.1 miles) and fewer days between staging procedure and surgical diagnostics from initial diagnosis (4.54 vs 12.5 days). Patients who received surgical intervention had a statistically significant improved survival outcome than those who did not (78 vs 15 months) (p<0.001) with the majority of these procedures being partial gastrectomies (53.6%). More patients of the cohort were treated at comprehensive community cancer programs (36.2%), followed by academic research programs (32.0%), integrated network cancer programs (18.5%) and community cancer programs (8.6%).
CONCLUSIONS
Factors associated with increased survival outcomes include race, average age of diagnosis, travel distance, fewer days between diagnostic procedure and initial diagnosis, insurance status and surgical treatment. These findings make a valuable contribution to the ongoing research on disparities affecting survival in patients with small intestine leiomyosarcoma.
BACKGROUND
Leiomyosarcoma is a rare neoplasm of smooth muscle that can originate from various organ systems. Of the gastrointestinal tract, the rarity and the difficulty of diagnosing small intestine leiomyosarcoma affect its poor prognosis. With an average age of diagnosis of 64 years and a median life expectancy of 45 months, there exists a lack of information on the disparities that exist in these patients and how patient demographics contribute to differences in survival outcomes.
METHODS
We used the National Cancer Database to identify patients diagnosed with small intestine leiomyosarcoma (ICD-O-3 histology code 8890) between 2004-2019 (N=406). General patient characteristics were assessed using descriptive statistics. Survival was evaluated using Kaplan-Meier curves and log-rank tests. Significance was set at p<0.05.
RESULTS
When analyzing race, patients diagnosed with small intestine leiomyosarcoma were predominantly White (81.8%) and African American (14.3%); however, White patients had statistically worse survival outcomes than African Americans (67 vs 97 months) (p=0.004). Patients with private insurance had statistically better outcomes when compared to Medicare (p<0.001). When compared to White patients, African Americans had a higher proportion of private insurance (53.4% vs 37.2%) and lower proportion of Medicare coverage (5.2% and 48.2%), a lower average age of diagnosis (60.5 vs 64.7 years), shorter travel distances (14.7 vs 31.1 miles) and fewer days between staging procedure and surgical diagnostics from initial diagnosis (4.54 vs 12.5 days). Patients who received surgical intervention had a statistically significant improved survival outcome than those who did not (78 vs 15 months) (p<0.001) with the majority of these procedures being partial gastrectomies (53.6%). More patients of the cohort were treated at comprehensive community cancer programs (36.2%), followed by academic research programs (32.0%), integrated network cancer programs (18.5%) and community cancer programs (8.6%).
CONCLUSIONS
Factors associated with increased survival outcomes include race, average age of diagnosis, travel distance, fewer days between diagnostic procedure and initial diagnosis, insurance status and surgical treatment. These findings make a valuable contribution to the ongoing research on disparities affecting survival in patients with small intestine leiomyosarcoma.