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Do Marital Status and Race Affect the Treatment of Esophageal Cancer?


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A study using data from the Michigan state cancer registry, reported in JCO Oncology Practice by Paniagua Cruz et al, found that a higher proportion of white vs black patients with esophageal cancer were married; that single patients were less likely to receive esophagectomy and chemotherapy; and that single black patients had the lowest rate of esophagectomy.  

“Marital status differs significantly in black and white patients with esophageal cancer and may help explain racial disparities in cancer care. Further research is needed to explore reasons for care underutilization in single patients and whether these differences translate into clinical outcomes.”
— Paniagua Cruz et al

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Study Details

The study involved data on 6,809 patients identified from the state cancer registry maintained by the Michigan Department of Health and Human Services who were diagnosed with esophageal cancer between January 2000 and December 2013.

Key Findings

Overall, 88% of patients were white and 12% were black; 21% were women. A higher proportion of white vs black patients were married (62.9% vs 31.8%, P < .0001).

There was no significant difference in disease staging between white vs black patients: disease was local in 31% vs 28%, regional in 34% vs 32%, and distant in 35% vs 39% (overall P = .0671).

On multivariate analysis (including adjustment for sex, insurance status, county designation [urban vs rural], year of diagnosis, cancer morphology, cancer location, and stage at diagnosis), rates of treatment with esophagectomy (odds ratio [OR] = 0.91, 95% confidence interval [CI] = 0.55–1.50), chemotherapy (OR = 0.77, 95% CI = 0.36–1.65), and radiation therapy (OR = 1.09, 95% CI = 0.67–1.76) did not differ significantly between married white vs married black patients.

On multivariate analysis, compared with married white patients, both single white patients and single black patients had significantly lower rates of esophagectomy (OR = 0.70, 95% CI = 0.59–0.84; OR = 0.32, 95% CI = 0.19–0.56) and chemotherapy (OR = 0.54, 95% CI = 0.42–0.70; OR = 0.51, 95% CI = 0.31–0.84), but not radiation therapy. Single black patients were the least likely of all groups to receive esophagectomy. 

Compared with married white patients and married black patients, single black patients, followed by single white patients, had the higher rates of treatment refusal for esophagectomy (2.9% and 2.5%, overall P = .0083), chemotherapy (7.1% and 5.7%, overall P = .0001), and radiation therapy (5.3% and 4.3%, P = .0003).

Rates of risk factor-associated contraindications were similar across all four groups for esophagectomy, but were higher among single black patients vs other groups for chemotherapy (7.1%, overall P = .0002) and radiation therapy (4.3%, P = .0159).

The investigators concluded, “Marital status differs significantly in black and white patients with esophageal cancer and may help explain racial disparities in cancer care. Further research is needed to explore reasons for care underutilization in single patients and whether these differences translate into clinical outcomes.”

Alan Paniagua Cruz, BS, of the University of Michigan Medical School, Ann Arbor, is the corresponding author for the JCO Oncology Practice article.

Disclosure: The study was supported by a grant from the National Institutes of Health. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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