National guidelines may reduce socioeconomic disparities in treatment selection for esophageal cancer Journal Article


Authors: Nobel, T. B.; Lavery, J. A.; Barbetta, A.; Gennarelli, R. L.; Lidor, A. O.; Jones, D. R.; Molena, D.
Article Title: National guidelines may reduce socioeconomic disparities in treatment selection for esophageal cancer
Abstract: The 2011 National Comprehensive Cancer Network guidelines first incorporated the results of the landmark CROSS trial, establishing induction therapy (chemotherapy ± radiation) and surgery as the treatment standard for locoregional esophageal cancer in the United States. The effect of guideline publication on socioeconomic status (SES) inequalities in cancer treatment selection remains unknown. Patients diagnosed with Stage II/III esophageal cancer between 2004 and 2013 who underwent curative treatment with definitive chemoradiation or multimodality treatment (induction and surgery) were identified from the Surveillance, Epidemiology and End Results (SEER)-Medicare registry. Clinicopathologic characteristics were compared between the two therapies. Multivariable regression analysis was used to adjust for known factors associated with treatment selection. An interaction term with respect to guideline publication and SES was included Of the 2,148 patients included, 1,478 (68.8%) received definitive chemoradiation and 670 (31.2%) induction and surgery. Guideline publication was associated with a 16.1% increase in patients receiving induction and surgery in the low SES group (21.4% preguideline publication vs. 37.5% after). In comparison, a 4.5% increase occurred during the same period in the high SES status group (31.8% vs. 36.3%). After adjusting for factors associated with treatment selection, guideline publication was associated with a 78% increase in likelihood of receiving induction and surgery among lower SES patients (odds ratio 1.78; 95% confidence interval (CI): 1.05,3.03). Following the new guideline publication, patients living in low SES areas were more likely to receive optimal treatment. Increased dissemination of guidelines may lead to increased adherence to evidence-based treatment standards. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus 2018.
Keywords: guidelines; esophageal cancer; chemoradiation therapy; multimodality treatment
Journal Title: Diseases of the Esophagus
Volume: 32
Issue: 5
ISSN: 1120-8694
Publisher: Oxford University Press  
Date Published: 2019-05-01
Start Page: doy111
Language: English
DOI: 10.1093/dote/doy111
PUBMED: 30496376
PROVIDER: scopus
PMCID: PMC6514299
DOI/URL:
Notes: Article -- Source: Scopus
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MSK Authors
  1. David Randolph Jones
    290 Jones
  2. Daniela   Molena
    165 Molena
  3. Tamar B Nobel
    31 Nobel
  4. Jessica Ann Lavery
    46 Lavery