Overall survival differences in small intestine adenocarcinoma patients treated at academic vs non-academic facilities: A national perspective.

Abstract

180 Background: Adenocarcinoma is a malignancy of glands lining organs in the human body. It is commonly found in the breast, lung, pancreas and throughout the digestive track. Prior research shows that common treatments include a combination of surgery, chemotherapy, and radiation. It also demonstrates that socioeconomic factors (such as income, insurance status, facility type) impact a patients’ survival. Thus, using the National Cancer Database (NCDB), this study aimed to evaluate the differential survival of patients treated at Academic or Non-Academic facilities for small intestine adenocarcinoma. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with small intestine adenocarcinoma from 2004 to 2019 using the histology code 8140 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: Of the 20,791 patients queried, 38% were treated at an academic/research facility (AF). Patients treated at an AF had an improved median survival compared to a non-academic facility (NA) (58 months versus 47 months; p < 0.001). After controlling for income level, age, sex, race, adjuvant therapy and surgery, patients treated at an AF was associated with an independent decrease in hazard (HR=0.85, p<0.001). AF patients disproportionately presented with a lower stage, had fewer lymph node metastases, had lower comorbidity scores, were more likely to receive chemotherapy, were more likely to receive surgery and come from a higher income bracket (p<0.001). They were also more likely to have no residual tumor after surgery, have private insurance and receive palliative care (p<0.001). There were no significant differences in grade/differentiation at presentation, 30-day surgical readmission rates, or phases of radiation treatment between patients treated at AF and NA. Conclusions: Patients treated at AF survived longer than patients treated at NA. While patients treated at AF were more likely to receive chemotherapy and surgery, controlling for those factors and others still resulted in a decreased hazard. It is a concerning finding that confirms prior research and underscores the need for further research to alleviate health care disparities.