Invited Commentary

Abstract

Numerous publications have shown that a lower socioeconomic status (SES) is negatively correlated with outcome in a number of malignant tumors, including esophageal cancer. Using direct patient interviews or online surveys, the authors of the current paper [1Lineback C.M. Mervak C.M. Revels S.L. Kemp M.T. Reddy R.M. Barriers to accessing optimal esophageal cancer care for socioeconomically disadvantaged patients.Ann Thorac Surg. 2017; 103: 416-421Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar] have identified factors contributing to poor outcome in low-SES patients with esophageal cancer. Prominent among them is the extremely low rate of surgical resection in low-SES patients compared with their high-SES counterparts despite similar (albeit patient-reported) cancer stages and comorbidities. A possible explanation is that patients with low SES may frequently seek medical care without the benefit of multidisciplinary teams and surgical participation in formulation of a complex treatment plan. Distressingly, the authors also found that a high proportion of low-SES patients reported mistrust in one or more of their physicians because of poor communication and inadequate explanation of their disease and treatment plan. Compounding the tremendous financial burden imposed by their treatment, almost one third of these vulnerable patients reported loss of their jobs and livelihood. Undoubtedly, the problem of disparity in care and outcomes between high- and low-SES patients is complex and multifactorial, and discussion of its resolution is beyond the scope of this commentary. However, the question for us in the medical profession and our hospital systems is: What can we do to be part of the solution? One interesting finding identified by the patients in this study is the important role played by “medical advocates” throughout the course of a patient’s treatment. It is easy to see how these advocates could assist with the particular challenges faced by patients of low SES, such as communication assistance, navigation of a multiple-specialty and potentially multiinstitutional treatment plan and assistance with financial hardships by referral to social services. Furthermore, despite the documented positive effects of multidisciplinary management teams on patient outcomes, it remains suboptimally adopted across the board. Although the concept of regionalization of care for potentially lethal malignancies with complex treatment algorithms is attractive, it remains impractical across vast geographical distances and may even pose a greater burden for patients with low SES. Some institutions have used novel approaches, such as the concept of telemedicine, to provide virtual multidisciplinary care to patients remotely located from a specialized facility. Finally, it is imperative that we inculcate in our medical and surgical trainees that, despite time pressures and workloads, direct and compassionate patient-physician interactions is at the heart of our calling as physicians. After all, and as commonly stated, taking care of the patient is not the same as caring for the patient. Barriers to Accessing Optimal Esophageal Cancer Care for Socioeconomically Disadvantaged PatientsThe Annals of Thoracic SurgeryVol. 103Issue 2PreviewThe 5-year survival of patients with low socioeconomic status (SES) and esophageal cancer is significantly lower than that in patients with high SES. It is poorly understood what causes these worse outcomes. We hypothesized that a qualitative approach could elucidate the underlying causes of these differences. Full-Text PDF