Association of Insurance Status and Extent of Organ Involvement With Survival Among Patients With Stage IV Cancer

Abstract

This cohort study examines the association of insurance status and extent of metastatic organ involvement with survival among patients with stage IV cancer to better understand outcome disparities in the US.

Utilization and Outcomes of Radiation in Stage IV Esophageal Cancer

“…These categories were chosen to represent ranges for palliative and definitive dosing of external beam radiation therapy. 3 , 4 , 5 , 13 , 14 , 15 , 16 In a manner consistent with previous studies, 17 , 18 age was included as a categorical variable (18–34, 35–49, 50–64, 65–79, ≥80 y). Survival models with age as a continuous variable were created as sensitivity analyses, yielding similar results (data available on request).…”

Nonregional Lymph Nodes as the Only Metastatic Site in Stage IV Esophageal Cancer

“… a The three groups were chosen as a surrogate for oligometastatic versus multiorgan metastatic disease; the prognostic significance of single-organ and multiorgan metastases has been revealed previously. 11 …”

“…In a manner consistent with previous studies, 11 , 12 age was included as a categorical variable (18–34, 35–49, 50–64, 65–79, ≥80 y). Other independent variables included sex (female, male), race (white, black, other), ethnicity (Hispanic, non-Hispanic), median household income of the patient’s ZIP code of residence (categorized as quartiles: <$40,227, $40,227–$50,353, $50,354–$63,332, ≥$63,333), insurance status (private, uninsured, Medicaid, Medicare, other government), modified Charlson-Deyo Comorbidity Index (CCI) (0, 1, 2, 3+), U.S. Census Division (New England, Middle Atlantic, South Atlantic, East North Central, East South Central, West North Central, West South Central, Mountain, Pacific), facility type (nonacademic, academic), area of residence (metropolitan, urban, rural), year of diagnosis, histology (adenocarcinoma, SCC), and tumor location (cervical esophagus, upper esophagus, midesophagus, lower esophagus, overlapping lesion, unspecified).…”

“…These variables were selected because they have been associated with prognosis in the literature and are most often included in NCDB analysis. 11 , 13 , 14 A comprehensive definition of NCDB variables is available online. 15…”