Treatment patterns for locoregional esophageal carcinoma according to race/ethnicity, histology, and insurance.

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128 Background: Esophageal carcinoma (EC) is a disease with a poor prognosis. There has been a rise in incidence of EC in many western countries, including the United States. African Americans (AA) have a higher mortality rate from EC than any other ethnic group in the U.S. We investigated if there were differences in treatment and clinical characteristics in AA patients with locoregional EC compared to whites. Methods: We used the National Cancer Data Base (NCDB), a national hospital-based cancer of registry to study 20,056 adults diagnosed with locoregional EC from 2004-2007. Treatment and outcome data were obtained from the NCDB. Multivariate log binomial models were used to estimate relative risk ratios (RR) and 95% confidence intervals (CI) of receiving surgery, surgery plus systemic treatment vs. surgery alone, and margin status among patients undergoing surgery. Results: Compared to whites, AA were younger, more likely to have proximal tumors and squamous cell carcinoma, and to be uninsured. AA patients had a lower likelihood of surgery compared to whites (RR = 0.71, 95% CI = 0.66-0.77). Patients who were uninsured, Medicaid insured or younger Medicare patients had a lower likelihood of surgery. Other important predictors of surgical treatment included age, tumor location, size and histology type. Facility level factors impacted surgical treatment as well. Among patients receiving surgery, there were no differences in receipt of systemic treatment by race/ethnicity and insurance status. Younger Medicare patients and uninsured patients were more likely to have positive margins while there was no difference by race/ethnicity. Conclusions: AA patients were less likely than whites with locoregional EC to receive surgery, however, there were no treatment disparities among AA receiving surgery. Tumor characteristics, patient, provider and/or institutional factors that may influence lower receipt of surgical treatment and survival among AA should be further explored. No significant financial relationships to disclose.