Socioeconomic disparities and outcomes in midgut neuroendocrine tumors.

Authors

null

Nicholas Manguso

Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA

Nicholas Manguso , Jessica Crystal , Brian Cox , Shirley C Paski , Andrew Eugene Hendifar , Jun Gong , Alexandra Gangi

Organizations

Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, Cedars Sinai Medical Center, Los Angeles, CA, Cedars-Sinai Medical Center, Division of Gastroenterology, Los Angeles, CA, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, Cedars-Sinai Medical Center, Los Angeles, CA

Research Funding

No funding received
None

Background: Demographic and socioeconomic disparities have been shown to effect cancer specific outcomes in numerous malignancies but the effect in midgut neuroendocrine tumors (mNETs) is unknown. We sought to investigate whether these factors are associated with survival in mNETs. Methods: The NCDB was queried to identify patients with mNETs between 2004 and 2015. Only patients treated at a single hospital with complete data were included. Overall Survival (OS) was compared based on demographic data, socioeconomic factors, insurance status and place of living. Results: A total of 14,083 patients were identified with a mean age of 72 years (range 18-90). The majority of patients were Caucasian (83.9%) and male (50.9%). Most patients had private insurance (50.5%) or medicare (41.3%). Patients typically lived in larger metropolitan areas (51.5%) and 60.7% lived in zip codes with median household incomes > $48,000. Only 14.7% lived in zip codes where > 20% did not graduate high school (no HSD). The majority were treated at community comprehensive cancer centers (43.8%) or academic/research centers (35.2%). Overall, 3358 (24.5%) presented with metastasis at diagnosis. The 5-year OS for the entire cohort was 78.5%. The 5-year survival was worse in patients with lower median income (73.8% [ < $38,000] vs 81.5% [ > $63,000],p < 0.0001), lower education (74.9% [ > 20% no HSD] vs 80.7% [ < 7% no HSD], p < 0.0001), those not living in proximity to a metro area (73.8% [not metro adjacent] vs 78.7% [metro/adjacent], p = 0.0004) and those treated at a community cancer center (73.6% [community] vs. 80.1% [academic], p < 0.0001). Factors predictive of worse OS were lower income ( < $38,000) (HR 1.16, 95% CI 1.04-1.28), lower education ( > 20% no HSD) (HR 1.14, 95% CI 1.02-1.26), no insurance (HR 1.66, 95% CI 1.33-2.06) and not living in proximity to a metro area (HR 1.27, 95% CI 1.10-1.47). Conclusions: Socioeconomic factors shown to have worse OS in patients with mNETs were lower median income, lower education, treatment at a community cancer center and not living in proximity to a metro area. Patient demographic and socioeconomic factors play an important role in OS for patients with mNETs and access to care must be considered in this subpopulation of cancer patients.

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Abstract Details

Meeting

2020 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Hepatobiliary Cancer, Neuroendocrine/Carcinoid, Pancreatic Cancer, and Small Bowel Cancer

Track

Hepatobiliary Cancer,Neuroendocrine/Carcinoid,Pancreatic Cancer,Small Bowel Cancer,Other GI Cancer

Sub Track

Quality of Care/Quality Improvement

Citation

J Clin Oncol 38, 2020 (suppl 4; abstr 613)

Abstract #

613

Poster Bd #

F16

Abstract Disclosures