Proportion of Early-Onset Gastric and Esophagus Cancers Has Changed Over Time With Disproportionate Impact on Black and Hispanic Patients

Abstract

PURPOSE: The proportion of gastroesophageal junction adenocarcinoma is increasing. This study evaluated trends in early-onset gastric and esophageal cancers and compared socioeconomic and clinical characteristics between early-onset versus late-onset disease. MATERIALS AND METHODS: We included all patients with gastric and esophageal cancer from 2004 to 2015 from the National Cancer Database. Patients were categorized by age < 50, 50-69, and ≥ 70 years. Differences in pathologic and socioeconomic factors between early-onset and late-onset cancers were assessed by using chi-square test. The effects of demographic and socioeconomic factors on overall survival (OS) were assessed using Cox models. RESULTS: The proportion of patients with early-onset gastric cancer increased from 23.9% in 2004-2006 to 26.2% in 2013-2015, whereas the proportion of early-onset esophageal cancer decreased from 27.3% in 2004-2006 to 23.1% in 2013-2015. For both malignancies, the early-onset group was more likely to be Black or Hispanic and more likely to be diagnosed with stage IV cancer. Black patients had the worst median OS in both malignancies. In gastric cancer, within the Black patient group, patients experienced worse OS if they had government insurance versus private insurance (hazard ratio 1.2; 95% CI, 1.1 to 1.3; P value < .0001) or if they were in the lowest community median income category versus the highest category (hazard ratio 1.2; 95% CI, 1.1 to 1.3; P value < .0001). CONCLUSION: Early-onset gastric cancer is increasing, whereas early-onset esophageal cancer is declining. Early-onset gastric cancer disproportionately affects non-White patients, particularly Hispanic patients. Black patients have worse outcomes compared with other races for both gastric and esophageal cancer.

Variation in Treatment Patterns of Patients with Early-Onset Gastric Cancer

“…We found that patients with EOGC were more likely to be female, Asian/PI, AA, Hispanic, uninsured, and present with stage IV disease versus patients with AOGC and LOGC. Our analysis was consistent with others that showed EOGC is more common in females, more likely to be diagnosed at an advanced stage and have a disproportionate effect on uninsured patients, African Americans, and Hispanic patients [ 13 , 14 , 15 , 16 ]. Others have shown that EOGC displays unique genomic features.…”

Are Quality Cancer Prevention and Treatment Along the Texas US-Mexico Border Achievable?

“…These findings can broaden disparities in outcomes of patients with gastric cancer. Further, in this special series, the manuscript by Torrejon et al 7 adds to the body of evidence reporting increasing trends in early-onset gastric cancer (ie, diagnosed in young adults age < 50 years) over time using a national sample of patients with cancer. Specifically, Torrejon et al 7 highlighted the disproportionate burden of gastric cancer among Hispanic patients, who are known to have two times the risk of being diagnosed with gastric cancer compared with non-Hispanic White patients and are more commonly diagnosed with advanced cancer stages.…”

“…Further, in this special series, the manuscript by Torrejon et al 7 adds to the body of evidence reporting increasing trends in early-onset gastric cancer (ie, diagnosed in young adults age < 50 years) over time using a national sample of patients with cancer. Specifically, Torrejon et al 7 highlighted the disproportionate burden of gastric cancer among Hispanic patients, who are known to have two times the risk of being diagnosed with gastric cancer compared with non-Hispanic White patients and are more commonly diagnosed with advanced cancer stages. 8,9 In the South Texas region, younger patients have significantly higher odds of advanced gastric cancer stage at diagnosis; specifically, patients age 20-29 years are nearly 4 times more likely to be diagnosed with advanced stage compared with those age 65 years or older.…”

Disparities in Cancer Care and Scientific Knowledge in Hispanic/Latinx People in the United States

“…Similarly, in their paper on evaluating access and resources, Franco et al 3 note the impact of Affordable Care Act in reducing health care access barriers but with disproportionate and continuous chronic health problems in the Hispanic/Latinx patient population. Access to care was also noted as a challenge in the manuscript by Torrejon et al and was underlined for the patients who live in the border counties as reported by LaPelusa et al and Ju et al 4-6 In their papers, gaps in care for patients with colorectal and gastric cancer were noted with higher incidence, lower likelihood to receive guideline-concordant care, and worse survival for Hispanic/Latinx patients who live in the border counties. The editorial by Nodora and Velazquez 7 summarized the efforts and resources in Texas to evaluate and address the potential ways that we can achieve quality care in border counties.…”

“…City of Hope, Duarte, CA2 Dana Farber Community Cancer Care-Lawrence, Boston, MA3 University of Miami, Coral Gables, FL4 Gilead Sciences, Clinical Development, Foster City, CA CORRESPONDING AUTHOR Linda D. Bosserman, MD, City of Hope, c/o 3803 Seashore Dr, Newport Beach, CA; e-mail: lbosserman@coh.org.…”