Survival disparities among non-elderly American adults with locally advanced gastric cancer undergoing gastrectomy by health insurance status

Fang, Wenjia; Hu, Honglian; Li, Jia; Zhang, Jing; Huang, Congyang; Hu, Suyun

doi:10.1016/j.amjms.2022.03.004

Cited by 4 publications

(6 citation statements)

References 42 publications

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“… 6 , 7 , 8 , 9 , 10 , 11 , 12 A previous study reported that locally advanced gastric cancer patients undergoing gastrectomy who have limited or no insurance have a lower overall survival rate. 13 Similar results were reported in esophageal cancer and lung cancer. 14 , 15 However, it is still unknown whether public health insurance status affects the prognosis of HCC patients after liver resection.…”

Section: Introductionsupporting

confidence: 77%

“…The provision of health insurance is vital to achieving universal health coverage and health equity in a nation because it can significantly reduce the financial burden on patients and positively impact the diagnosis and prognosis of diseases 6–12 . A previous study reported that locally advanced gastric cancer patients undergoing gastrectomy who have limited or no insurance have a lower overall survival rate 13 . Similar results were reported in esophageal cancer and lung cancer 14,15 .…”

Section: Introductionmentioning

confidence: 79%

“…Similar results have been reported in other cancers. Fang et al demonstrated that locally advanced gastric cancer patients undergoing gastrectomy with limited or no insurance had a worse OS 13 . Deol et al found that robotic‐assisted lobectomy patients with private insurance had a better prognosis than those with combined and public insurance 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Fang et al demonstrated that locally advanced gastric cancer patients undergoing gastrectomy with limited or no insurance had a worse OS. 13 Deol et al found that robotic‐assisted lobectomy patients with private insurance had a better prognosis than those with combined and public insurance. 15 In the Korean research on esophageal cancer, patients in the Medicare group had a lower 5‐year survival compared to those in the health insurance group.…”

Section: Discussionmentioning

confidence: 99%

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Insurance status impacts survival of hepatocellular carcinoma patients after liver resection

Qiu

et al. 2023

Cancer Medicine

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BackgroundThis study intends to examine the effect of public insurance status on survival outcomes of HCC patients after liver resection in China.MethodsWe divided 2911 HCC patients after liver resection included in our study into the Urban Employed‐based Medical Insurance group (UEBMI group, n = 1462) and the non‐Urban Employed‐based Medical Insurance group (non‐UEBMI group, n = 1449). A propensity score matching (PSM) analysis was used to control confounding factors. Overall survival (OS) was estimated by Kaplan–Meier curves and Cox proportional hazard models based on variables screened by Lasso regression. Competing risk analysis was used to analyze cancer‐specific survival (CSS).ResultsUEBMI group had more male patients (p = 0.031), patients in the UEBMI group were older (p < 0.001) and had lower Charlson Comorbidity Index scores (CCI score, p < 0.001). Meanwhile, patients in the UEBMI group had better liver function (albumin‐bilirubin grade I [ALBI I], p < 0.001) and lower tumor burden (α‐fetoprotein [AFP], p = 0.009; Barcelona Clinic Liver Cancer stage [BCLC], p = 0.026; Milan criteria, p < 0.001; tumor size, p < 0.001; microvascular invasion [MVI], p = 0.030; portal vein tumor thrombosis [PVTT], p = 0.002). More patients in the UEBMI group received laparoscopic surgery (p = 0.024) and adjuvant transarterial chemoembolization (TACE, p < 0.001). After PSM, patients in the two matched groups had similar characteristics. Patients with recurrent HCC in the UEBMI were more likely to receive curative therapy (p < 0.001) and less likely to receive supportive care (p < 0.001). HCC patients after liver resection in the non‐UEBMI group had a worse OS before (p < 0.0001) and after PSM (p = 0.0031). In our Lasso‐Cox risk regression model, public health insurance status was an independent factor linked with OS (non‐UEBMI vs. UEBMI, hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 1.12–1.46; p < 0.001). In the competing risk analysis, patients in the UEBMI group had a lower cumulative incidence of CSS before (p < 0.001) and after PSM (p = 0.001), and public insurance status of HCC patients after liver resection remained independently associated with CSS (non‐UEBMI vs. UEBMI; HR:1.36; 95% CI: 1.18–1.58; p < 0.001).ConclusionsUnderinsured HCC patients after liver resection had worse survival outcomes. Less access to care for underinsured patients may explain the difference in survival, but the corresponding conclusions need to be further explored.

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Section: Introductionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Insurance status impacts survival of hepatocellular carcinoma patients after liver resection

Qiu

et al. 2023

Cancer Medicine

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“…Finally, Our study can add more useful information to the studies of survival analysis of LAGC. Previous studies have been relatively restrictive regarding the conditions of LAGC patients, such as non-elderly LAGC patients undergoing gastrectomy, LAGC patients over 75 years of age, and patients with locally advanced gastric signet-ring cell carcinoma ( 29 , 41 – 43 ). Meanwhile, our study included more treatment modalities, a larger age range, and more histological types.…”

Section: Discussionmentioning

confidence: 99%

Developing and validating nomograms for predicting the survival in patients with clinical local-advanced gastric cancer

2022

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BackgroundMany patients with gastric cancer are at a locally advanced stage during initial diagnosis. TNM staging is inaccurate in predicting survival. This study aims to develop two more accurate survival prediction models for patients with locally advanced gastric cancer (LAGC) and guide clinical decision-making.MethodsWe recruited 2794 patients diagnosed with LAGC (2010–2015) from the Surveillance, Epidemiology, and End Results (SEER) database and performed external validation using data from 115 patients with LAGC at Yantai Affiliated Hospital of Binzhou Medical University. Univariate and multifactorial survival analyses were screened for meaningful independent prognostic factors and were used to build survival prediction models. Concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were evaluated for nomograms. Finally, the differences and relationships of survival and prognosis between the three different risk groups were described using the Kaplan–Meier method.ResultsCox proportional risk regression model analysis identified independent prognostic factors for patients with LAGC, and variables associated with overall survival (OS) included age, race, marital status, T-stage, N-stage, grade, histologic type, surgery, and chemotherapy. Variables associated with cancer-specific survival (CSS) included age, race, T-stage, N-stage, grade, histological type, surgery, and chemotherapy. In the training cohort, C-index of nomogram for predicting OS was 0.722 (95% confidence interval [95% CI]: 0.708–0.736] and CSS was 0.728 (95% CI: 0.713–0.743). In the external validation cohort, C-index of nomogram for predicted OS was 0.728 (95% CI:0.672–0.784) and CSS was 0.727 (95% CI:0.668–0.786). The calibration curves showed good concordance between the predicted and actual results. C-index, ROC, and DCA results indicated that our nomograms could more accurately predict OS and CSS than TNM staging and had a higher clinical benefit. Finally, to facilitate clinical use, we set up two web servers based on nomograms.ConclusionThe nomograms established in this study have better risk assessment ability than the clinical staging system, which can help clinicians predict the individual survival of LAGC patients more accurately and thus develop appropriate treatment strategies.

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Social determinants of health and upper gastrointestinal cancer outcomes in the United States: a systematic review

Santellano,

Agrawal,

Duchesne

et al. 2024

Front. Public Health

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IntroductionSocial determinants of health (SDOH) are the conditions in which individuals are born, grow, work, live, and age.MethodsWe examined the literature on the association between SDOH and survival of patients with gastrointestinal (GI) cancer [esophageal, duodenal and gastric cancer (GC)] in the United States from 2001 to 2022.ResultsFrom 38,654 studies across COCHRANE, EMBASE, SCOPUS, WEB OF SCIENCE, and PubMed, we identified 14 relevant studies focusing on GI cancer using the PRISMA flowchart. Eight of the 12 GC studies specifically focused on gastric adenocarcinoma (GAC), the most common histologic subtype. Uninsured patients had a significantly worse overall survival probability. For patients with GI cancer, the highest income level (i.e., in the highest quartile) was associated with improved survival. Being unmarried had a negative impact on overall survival. Overall, people with insurance, higher incomes, and who were married had better overall survival rates.DiscussionOur findings suggest a clear association between SDOH and survival for patients with GI cancers. However, there is great variability in the factors studied and how these are measured and reported. A better understanding of SDOH is needed to design strategies with an aim to improve patient outcomes.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42022346854).

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Survival disparities among non-elderly American adults with locally advanced gastric cancer undergoing gastrectomy by health insurance status

Cited by 4 publications

References 42 publications

Insurance status impacts survival of hepatocellular carcinoma patients after liver resection

Insurance status impacts survival of hepatocellular carcinoma patients after liver resection

Developing and validating nomograms for predicting the survival in patients with clinical local-advanced gastric cancer

Social determinants of health and upper gastrointestinal cancer outcomes in the United States: a systematic review

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