Background: Hispanic patients with esophageal cancer (EC) have racially disparate survival outcomes compared with white patients. Objectives:We explored the impact on survival of racial differences in socioeconomic factors, tumor characteristics, and rates of surgical utilization in patients with EC. Method:Using the SEER (Surveillance, Epidemiology, and End Results) registry, we identified 22,531 cases of EC in Hispanic and white patients between the ages of 18 and 65 years in 2003–2014. Of these, 6,250 cases had locoregional EC. Patients were categorized according to age, gender, education, tumor grade, histology, primary tumor site, and surgical status. Postdiagnosis survival was examined over time and compared by race and stratified by surgical status. Results: Compared with whites, Hispanics with EC had significantly higher unadjusted mortality (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.06–1.17; p < 0.001) as did Hispanics with locoregional EC (HR 1.15; 95% CI 1.03–1.29; p = 0.01). In the multivariate analysis, several socioeconomic and tumor factors were found to be independently associated with survival by race, including county of residence income and prevalence of smoking, tumor grade, stage, and primary site, and surgical utilization. After adjusting for demographic and tumor characteristics, surgical utilization in patients with locoregional EC had a significant interaction with race on overall mortality (p = 0.01). Hispanics with locoregional EC were significantly less likely to receive surgery than whites (46 vs. 60%; p < 0.001) and not receiving surgery was associated with a significantly lower overall survival (HR 2.84; 95% CI 2.65–3.04; p < 0.001). Conclusions: A lower rate of surgery among Hispanics with potentially resectable esophageal cancer was associated with a decreased survival rate when compared to whites, even when adjusting for relevant socioeconomic and tumor factors. These data support the need to better address patient barriers to surgical treatment and the systemic biases present in medical care.

No abstract

No abstract

Purpose: Retrospective studies show that high dose aspirin (ASA) during Heart Mate (HM) II support is associated with more hemorrhagic events; however, limited prospective data exist on the impact of switching to reduced antiplatelet therapy. Methods: We implemented a clinical protocol to place all patients with HM II implantation (n= 26) from November 2014 to September 2015 on low dose aspirin (ASA) 81 mg daily. Concomitant anticoagulation with warfarin (target INR: 2-2.5) was maintained. Adverse events (AEs) were compared to a historical cohort of HM II patients (n= 69) on high dose ASA 325 mg daily and warfarin therapy (target INR: 2-3). Excluding perioperative events, initial hemorrhagic (gastrointestinal, intracranial, epistaxis), thrombotic (ischemic stroke, surgically confirmed pump thrombosis) and hemolysis (LDH > 2.5x upper limit of normal) events were retrieved up to 100 days after implantation. GI bleeding was defined by requiring a blood transfusion and a drop in hemoglobin of > 2g/dL. Survival free from AEs was calculated by Kaplan-Meier curves. Results: Patients in both groups had similar distributions of major demographics including age, gender and history of hypertension. The actual INR was similar across groups throughout HM II support. Hemorrhagic events occurred in only 3 patients on ASA 81 mg daily (12%, 0.17 events/100d) in comparison to 30 patients on ASA 325 (43%, 0.64 events/100d, p= 0.02, figure 1). Thrombotic events occurred in 2 patients on ASA 81 mg (8%, 0.1 events/100d) and in 4 patients on ASA 325 mg (6%; 0.07 events/100d, p= 0.70). Hemolysis occurred in 2 patients on ASA 81 daily (8%, 0.1 events/100d) and in 4 patients on ASA 325 mg daily (6%; 0.07 events/100d, p= 0.75). Conclusion: Low dose ASA in HM II patients treated concomitantly with warfarin is associated with a reduced risk of bleeding without increased thrombotic and hemolysis events.

No abstract