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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.
Survival and Treatment in Older Patients With Ewing Sarcoma
BACKGROUND
Ewing sarcoma (EWS) is a malignancy which primarily arises in adolescence and has been studied extensively in this population. Much less is www.mdedge.com/fedprac/avaho SEPTEMBER 2023 • S23 known about the rare patient cohort over the age of 40 at diagnosis. In this study, we describe the survival outcomes and clinical characteristics of this population.
METHODS
This retrospective cohort study utilized the National Cancer Database (NCDB) to identify 4600 patients diagnosed between 2004 through 2019. Of these patients, 4058 were under the age of 40 and 542 were over 40. Multivariate Cox regression models and Kaplan- Meier curves were used to estimate survival from diagnosis to death between age groups. Chi-square tests were used to compare demographic and socioeconomic patient characteristics. IBM SPSS version 27.0 was used. p<0.05 was used to indicate statistical significance.
RESULTS
EWS patients older than 40 experienced worse survival outcomes compared to patients under the age of 40. 5-year survival was 43.5% for older patients vs. 64.5% for younger patients (p<0.05). A multivariate Cox proportional hazards model showed that age was independently associated with inferior survival. (HR 2.23; p<0.05). EWS patients over the age of 40 were more likely to have tumors originating from the vertebral column (16.2% vs. 9.6%; p<0.05), cranium (5.5% vs. 4.7%; p<0.05), and had a higher rate of axial tumors (43.3% vs. 32.4%; p<0.05) compared to patients under 40. Additionally, patients older than 40 experienced a significantly longer delay between the date of diagnosis and initiation of systemic treatment (29.85 days vs. 19.37 days; p<0.05). Despite presenting with larger tumors , older patients were less likely to undergo a surgical procedure of the primary site (47.6% vs. 52.2%; p<0.05) and had higher rates of micro- and macroscopic residual tumor following surgical resection.
CONCLUSIONS
An age over 40 is associated with decreased survival for patients with EWS. Due to the rarity of EWS in this cohort, the optimal role of systemic treatment remains unknown and has yet to be clearly elucidated. Consequently, our findings suggest that older patients receive disparities in treatment which may be contributing to decreased survival rates.
BACKGROUND
Ewing sarcoma (EWS) is a malignancy which primarily arises in adolescence and has been studied extensively in this population. Much less is www.mdedge.com/fedprac/avaho SEPTEMBER 2023 • S23 known about the rare patient cohort over the age of 40 at diagnosis. In this study, we describe the survival outcomes and clinical characteristics of this population.
METHODS
This retrospective cohort study utilized the National Cancer Database (NCDB) to identify 4600 patients diagnosed between 2004 through 2019. Of these patients, 4058 were under the age of 40 and 542 were over 40. Multivariate Cox regression models and Kaplan- Meier curves were used to estimate survival from diagnosis to death between age groups. Chi-square tests were used to compare demographic and socioeconomic patient characteristics. IBM SPSS version 27.0 was used. p<0.05 was used to indicate statistical significance.
RESULTS
EWS patients older than 40 experienced worse survival outcomes compared to patients under the age of 40. 5-year survival was 43.5% for older patients vs. 64.5% for younger patients (p<0.05). A multivariate Cox proportional hazards model showed that age was independently associated with inferior survival. (HR 2.23; p<0.05). EWS patients over the age of 40 were more likely to have tumors originating from the vertebral column (16.2% vs. 9.6%; p<0.05), cranium (5.5% vs. 4.7%; p<0.05), and had a higher rate of axial tumors (43.3% vs. 32.4%; p<0.05) compared to patients under 40. Additionally, patients older than 40 experienced a significantly longer delay between the date of diagnosis and initiation of systemic treatment (29.85 days vs. 19.37 days; p<0.05). Despite presenting with larger tumors , older patients were less likely to undergo a surgical procedure of the primary site (47.6% vs. 52.2%; p<0.05) and had higher rates of micro- and macroscopic residual tumor following surgical resection.
CONCLUSIONS
An age over 40 is associated with decreased survival for patients with EWS. Due to the rarity of EWS in this cohort, the optimal role of systemic treatment remains unknown and has yet to be clearly elucidated. Consequently, our findings suggest that older patients receive disparities in treatment which may be contributing to decreased survival rates.
BACKGROUND
Ewing sarcoma (EWS) is a malignancy which primarily arises in adolescence and has been studied extensively in this population. Much less is www.mdedge.com/fedprac/avaho SEPTEMBER 2023 • S23 known about the rare patient cohort over the age of 40 at diagnosis. In this study, we describe the survival outcomes and clinical characteristics of this population.
METHODS
This retrospective cohort study utilized the National Cancer Database (NCDB) to identify 4600 patients diagnosed between 2004 through 2019. Of these patients, 4058 were under the age of 40 and 542 were over 40. Multivariate Cox regression models and Kaplan- Meier curves were used to estimate survival from diagnosis to death between age groups. Chi-square tests were used to compare demographic and socioeconomic patient characteristics. IBM SPSS version 27.0 was used. p<0.05 was used to indicate statistical significance.
RESULTS
EWS patients older than 40 experienced worse survival outcomes compared to patients under the age of 40. 5-year survival was 43.5% for older patients vs. 64.5% for younger patients (p<0.05). A multivariate Cox proportional hazards model showed that age was independently associated with inferior survival. (HR 2.23; p<0.05). EWS patients over the age of 40 were more likely to have tumors originating from the vertebral column (16.2% vs. 9.6%; p<0.05), cranium (5.5% vs. 4.7%; p<0.05), and had a higher rate of axial tumors (43.3% vs. 32.4%; p<0.05) compared to patients under 40. Additionally, patients older than 40 experienced a significantly longer delay between the date of diagnosis and initiation of systemic treatment (29.85 days vs. 19.37 days; p<0.05). Despite presenting with larger tumors , older patients were less likely to undergo a surgical procedure of the primary site (47.6% vs. 52.2%; p<0.05) and had higher rates of micro- and macroscopic residual tumor following surgical resection.
CONCLUSIONS
An age over 40 is associated with decreased survival for patients with EWS. Due to the rarity of EWS in this cohort, the optimal role of systemic treatment remains unknown and has yet to be clearly elucidated. Consequently, our findings suggest that older patients receive disparities in treatment which may be contributing to decreased survival rates.