Impact of socioeconomic determinants of health on delays to care in gastric cancer: A national cancer database analysis

Introduction

The impact of demographic and socioeconomic backgrounds on delays to cancer care and subsequent mortality for those with resectable gastric adenocarcinoma is not well studied. We sought to investigate the relationship between sociodemographic determinants of health, delays to consensus guideline therapy, and survival outcomes for gastric cancer.

Methods

Patients with gastric cancer from the National Cancer Database (2004–2020) were partitioned into early-stage (AJCC Stage 0-I) and locoregionally advanced (Stage II-resectable stage IV) disease receiving upfront surgery and neoadjuvant therapy (NAT) followed by surgical resection, respectively. The primary outcome was odds of delay to upfront surgery or NAT initiation/post-NAT resection. Secondary outcomes were short-term (30-, 90-day) mortality and long-term survival.

Results

A total of 18,307 patients were identified; 10,623 and 7684 patients had early-stage and locoregionally advanced disease, respectively. The median [interquartile range] time to upfront surgery: 42 [22–66] days, NAT initiation: 40 [29–54] days, and post-NAT resection: 55 [44–69] days from end of NAT. In adjusted analysis, African American race, Medicaid or non-Medicare governmental insurance coverage, and lower educational and/or income status were significantly associated with delayed initiation of preoperative therapies. Delayed upfront surgery was associated with worse long-term survival (HR 1.15 [1.05–1.23], p < 0.001); delayed post-NAT surgery but not delayed NAT initiation portended worse 90-day mortality (HR 1.31 [1.02–1.69], p = 0.038) and long-term survival (HR 1.21 [1.10–1.32], p < 0.001).

Conclusion

Demographic and socioeconomic characteristics are associated with delays in receiving consensus guideline therapy for gastric cancer and translate to significantly worse survival outcomes.