Lower-Income Patients With Early-Stage Esophageal Adenocarcinoma May Face Disparities in Cancer Care and Higher Mortality Rates

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Patients with early-stage esophageal adenocarcinoma from lower-income households may be significantly less likely to receive a potentially life-saving treatment and may be more likely to die from the disease, according to a new study published by Geng et al in Clinical Gastroenterology and Hepatology. The new findings highlight troubling socioeconomic disparities in treatment access for this patient population.

“These findings are alarming,” said senior study author Alexander Podboy, MD, Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology at the University of Virginia Health. “Population-based strategies aimed at identifying and rectifying possible etiologies for our findings are paramount to improving patient outcomes in early-[stage] esophageal [adenocarcinoma],” he emphasized.

Study Methods and Results

In the new study, the investigators used anonymized data collected in the National Cancer Institute’s Surveillance, Epidemiology, and End Results database to examine treatments and patient outcomes in 1,526 patients with stage T1a esophageal adenocarcinoma—who they classified by median household income—and found stark disparities. The investigators discovered that patients in the lowest household income bracket, with an annual income of $20,000 to $54,390, had a higher rate of cancer-specific mortality and were less likely to undergo endoscopic intervention than the other two income groups involved in the study.

The use of the endoscopic intervention increased across the United States during the 10-year study period. The investigators explained that patients in the South—a region that has had the slowest uptake of endoscopic intervention—were least likely to undergo the procedure and demonstrated the worst overall survival and cancer-specific mortality rates among the patients in the study population. However, patients in higher-income households were more likely to receive endoscopic intervention, and had significantly higher survival rates at both 2 and 5 years of follow-up.


The investigators deduced that the disparities likely stem, in part, from the fact that endoscopic intervention requires technical expertise typically only found at advanced specialty centers. As a result, a barrier to patient care may be the distance many patients are expected to travel to access the treatment. Nevertheless, the investigators noted that there may be other factors contributing to the higher mortality rates seen among patients in lower-income households— such as the possibility that the patients may have comorbidities that contribute to poorer outcomes.

To address the disparities, the investigators stressed the need for increased esophageal adenocarcinoma screenings and improved access to advanced centers where patients can receive care from multidisciplinary teams.

“Access to the very best in cancer-related care should not be predicated on your socioeconomic status. We hope that our research helps shine a spotlight on this problem and leads to actions that help eliminate any barriers to care,” Dr. Podboy concluded.

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