Identifying the barriers to gastric cancer care at safety‐net hospitals: A novel comparison of a safety‐net hospital to a neighboring quaternary referral academic center in the same healthcare system

Abstract

Background:The three-delays model describes delays in seeking, reaching, and receiving care for vulnerable populations needing treatment. The dominant delay for patients with gastric adenocarcinoma (GAC) is unknown. We aimed to define patients with GAC who reached and received care at our regional safety-net hospital (Grady Memorial Hospital [GMH]) and our neighboring quaternary referral hospital (Emory University Hospital [EUH]). Methods: Clinicopathologic data from National Cancer Database (NCDB) participating academic centers were compared with GMH from 2004 to 2014. Outcomes of patients undergoing surgery at GMH were compared to those at EUH. Results: At presentation, compared to NCDB centers (n = 69 662), GMH patients (n = 154) were more often black (85.1 vs 17.2%; P < 0.001), uninsured (30.5 vs 4.7%; P < 0.001), have stage IV disease (43.5 vs 30.1%; P = 0.017), and received no treatment (40.3 vs 18.4%; P < 0.001). When only comparing patients who underwent curative-intent resection at GMH (n = 23) to EUH (n = 137), median overall survival was similar between both groups (GMH: median not reached; EUH: 59.8 mos; P = 0.785). Conclusion: Although vulnerable patients with GAC within a safety-net hospital present with later stages of the disease, those who received surgery have acceptable outcomes. Thus, efforts should be made to overcome barriers in seeking care. K E Y W O R D S disparty, gastric cancer, safety-net

The impact of race and socioeconomic status on the presentation, management and outcomes for gastric cancer patients: Analysis from a metropolitan area in the southeast United States

“…Furthermore, one of the hospitals within this system could be considered a “safety‐net hospital” as it traditionally services the most indigent population in our community. The results of the current study are in line with recent findings by Zaidi et al who found that when socioeconomically disadvantaged patients make it “into the system” and receive care, oncologic outcomes are equivalent to more affluent groups.…”

Influence of race and sociodemographic factors on declining resection for gastric cancer: A national study

“…8 Patients treated at non-academic centers tend to have less comprehensive insurance compared to those treated at academic centers, so financial issues could be a barrier to receiving appropriate care. 31 This emphasizes the important role that surgeons can play in advocating for their less fortunate patients who might encounter issues with access to surgery. Previous work at our institution identified 88 gastric cancer patients with early stage disease, of which 6 patients (6.8%) declined surgical resection.…”

Is there a difference in utilization of a perioperative treatment approach for gastric cancer between safety net hospitals and tertiary referral centers?

“…This was consistent with our study as a higher clinical stage was a predictor for receiving neoadjuvant chemotherapy or perioperative therapy. In a prior study from our group, patients with gastric cancer at safety net hospitals were more likely to present with more advanced disease, which may lead to worse clinical outcomes 7 . Nevertheless, when patients at safety net hospitals received appropriate care, their long‐term outcomes were equivalent to those of their peers at tertiary referral centers.…”