Is there a difference in utilization of a perioperative treatment approach for gastric cancer between safety net hospitals and tertiary referral centers?

• Type of Material: Article
• Authors: Michael K Turgeon, Emory University; Rachel M Lee, Emory University; Jessica M Keilson, Emory University; Michelle R Ju, University of Texas Southwestern Medical School; Matthew R Porembka, University of Texas Southwestern Medical School; Rodrigo E Alterio, University of Texas Southwestern Medical School; Joshua Kronenfeld, University of Miami; Jashodeep Datta, University of Miami; Neha Goel, University of Miami; Annie Wang, NYU Langone Health; Ann Y Lee, NYU Langone Health; Manuel Fernandez, University of Illinois at Chicago; Harry Richter, University of Illinois at Chicago; Ajay V Maker, University of California San Francisco; Shishir Maithel, Emory University; Maria Russell, Emory University
• Language: English
• Date: 2021-06-01
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Wiley Periodicals LLC
• Final Published Version (URL): http://dx.doi.org/10.1002/jso.26554
• Title of Journal or Parent Work: JOURNAL OF SURGICAL ONCOLOGY
• Volume: 124
• Issue: 4
• Start Page: 551
• End Page: 559
• Grant/Funding Information: National Center for Advancing Translational Science, Grant/Award Number: UL1TR002378/TL1TR002382; Abraham J. and Phyllis Katz Foundation
• Keywords: Surgery; health disparities; MORTALITY; perioperative therapy; RACE; Life Sciences & Biomedicine; Oncology; Science & Technology; gastric cancer; HEALTH; POSTOPERATIVE MORBIDITY; SURVIVAL; PREVALENCE; safety net hospitals; RACIAL DISPARITIES

Abstract

Background and Objectives: Perioperative therapy is a favored treatment strategy for gastric cancer. We sought to assess utilization of this approach at safety net hospitals (SNH) and tertiary referral centers (TRC). Materials and Methods: Patients in the US Safety Net Collaborative (2012–2014) with resectable gastric cancer across five SNH and their sister TRC were included. Primary outcomes were receipt of neoadjuvant chemotherapy (NAC) and perioperative therapy. Results: Of 284 patients, 36% and 64% received care at SNH and TRC. The distribution of Stage II/III resectable disease was similar across facilities. Receipt of NAC at SNH and TRC was similar (56% vs. 46%, p = 0.27). Compared with overall clinical stage, 38% and 36% were pathologically downstaged at SNH and TRC, respectively. Among patients who received NAC, those who also received adjuvant chemotherapy at SNH and TRC were similar (66% vs. 60%, p = 0.50). Asian race and higher clinical stage were associated with receipt of perioperative therapy (both p < 0.05) while treatment facility type was not. Conclusions: There was no difference in utilization of a perioperative treatment strategy between facility types for patients with gastric cancer. Pathologic down-staging from NAC was similar across treatment facilities, suggesting similar quality and duration of therapy. Treatment at an SNH is not a barrier to receiving standard-of-care perioperative therapy for gastric cancer.