Sociodemographic Factors Associated With Management Of Gastric Cancer: Qrro/Cure Results

Purpose/Objective(s)Quality Research in Radiation Oncology (QRRO) surveyed US radiation therapy (RT) facilities to evaluate the quality of gastric cancer (GC) treatment in 2005-07. The specific aim of this report is to describe sociodemographic (SOC) factors that influence work-up and treatment of GC patients (pts).Materials/MethodsThe QRRO national survey used a two-stage stratified random sample of GC treated with RT: 250 cases from 45 institutions (6 facilities had no eligible pts). Eligibility: RT receipt in 2005-2007 for stomach or gastroesophageal (GE) junction tumors with stages Ib-IV (non-metastatic); histology of adenocarcinoma, squamous, adenosquamous; Karnofsky score ≥60. Exclusions: distant metastases or prior malignancy within 5 yrs. Five SOC variables based on 2000 US Census data were analyzed for association with clinical factors: pts living in urban vs. rural settings (U/R), median household income (HI), % below poverty level (POV), % unemployed (U) and % with college education (CE). U/R had three categories: 100% urban, 100% rural or urban/rural mix. HI, POV, U, and CE were defined as above or below the median values of this sample. Pts were linked to census data values by home ZIP code. Six pts did not link and were excluded from the analysis. National estimates used weighted averages.ResultsOf the 244 cases 96.2% had adenocarcinoma; 13.7% were Stage 1b, 27.4% II, 30.1% IIIA, 9.2% IIIB, 13.5% IV, 6.0% unknown. Primary location was 35.0% antrum, 14.0% corpus, 11.7% cardia, 32.9% GE junction, 6.5% unknown. Median age was 63 yrs; 64.7% were male; 17.3% African American; 14.3% Hispanic. Median RT dose was 45 Gy; median RT duration 36 days. A total of 14.7% had AP/PA technique, 14.2% 3-field, 45.9% 4-field, 19.8% >4 fields. Gastrointestinal bleeding and transfusion use (T) varied by U/R (20.8% no T, 16.4% T in urban; 7.2% No T, 13.8% T U/R mixed; 9.9% No T, 2.7% T rural; p = 0.03). Endoscopy was performed in >95% of cases in each area. Use of endoscopic ultrasound varied by U/R (16.7% in urban, 36.8% U/R mixed, 22.6% rural; p = 0.03). Chest CT was done more in lower U (85.2% vs. 63.8%; p = 0.02), PET more in lower POV (58.0% vs. 38.0%; p = 0.02) and lower U areas (58.3% vs. 37.8%; p = 0.02), MRI more in lower POV and U (both 11.4% vs. 1.7%; p = 0.03). Surgical resection was done less in lower POV (71.7% vs. 87.8%; p = 0.02). External beam technique varied by U/R with AP/PA more common in rural and ≥4-field more common in urban areas (p = 0.02). IMRT use varied by U/R (27.6% urban, 12.5% U/R mixed, 0% rural; p < 0.01).ConclusionsSociodemographic factors, which may be surrogates for multidisciplinary care and/or use of emerging RT treatment planning and delivery, are associated with variations in workup and treatment for GC pts who receive RT. Our next analysis will seek to determine if these findings represent access issues.AcknowledgmentThis project was supported by CURE- PA Dept. of Health & NCI Grant CA65435, Purpose/Objective(s)Quality Research in Radiation Oncology (QRRO) surveyed US radiation therapy (RT) facilities to evaluate the quality of gastric cancer (GC) treatment in 2005-07. The specific aim of this report is to describe sociodemographic (SOC) factors that influence work-up and treatment of GC patients (pts). Quality Research in Radiation Oncology (QRRO) surveyed US radiation therapy (RT) facilities to evaluate the quality of gastric cancer (GC) treatment in 2005-07. The specific aim of this report is to describe sociodemographic (SOC) factors that influence work-up and treatment of GC patients (pts). Materials/MethodsThe QRRO national survey used a two-stage stratified random sample of GC treated with RT: 250 cases from 45 institutions (6 facilities had no eligible pts). Eligibility: RT receipt in 2005-2007 for stomach or gastroesophageal (GE) junction tumors with stages Ib-IV (non-metastatic); histology of adenocarcinoma, squamous, adenosquamous; Karnofsky score ≥60. Exclusions: distant metastases or prior malignancy within 5 yrs. Five SOC variables based on 2000 US Census data were analyzed for association with clinical factors: pts living in urban vs. rural settings (U/R), median household income (HI), % below poverty level (POV), % unemployed (U) and % with college education (CE). U/R had three categories: 100% urban, 100% rural or urban/rural mix. HI, POV, U, and CE were defined as above or below the median values of this sample. Pts were linked to census data values by home ZIP code. Six pts did not link and were excluded from the analysis. National estimates used weighted averages. The QRRO national survey used a two-stage stratified random sample of GC treated with RT: 250 cases from 45 institutions (6 facilities had no eligible pts). Eligibility: RT receipt in 2005-2007 for stomach or gastroesophageal (GE) junction tumors with stages Ib-IV (non-metastatic); histology of adenocarcinoma, squamous, adenosquamous; Karnofsky score ≥60. Exclusions: distant metastases or prior malignancy within 5 yrs. Five SOC variables based on 2000 US Census data were analyzed for association with clinical factors: pts living in urban vs. rural settings (U/R), median household income (HI), % below poverty level (POV), % unemployed (U) and % with college education (CE). U/R had three categories: 100% urban, 100% rural or urban/rural mix. HI, POV, U, and CE were defined as above or below the median values of this sample. Pts were linked to census data values by home ZIP code. Six pts did not link and were excluded from the analysis. National estimates used weighted averages. ResultsOf the 244 cases 96.2% had adenocarcinoma; 13.7% were Stage 1b, 27.4% II, 30.1% IIIA, 9.2% IIIB, 13.5% IV, 6.0% unknown. Primary location was 35.0% antrum, 14.0% corpus, 11.7% cardia, 32.9% GE junction, 6.5% unknown. Median age was 63 yrs; 64.7% were male; 17.3% African American; 14.3% Hispanic. Median RT dose was 45 Gy; median RT duration 36 days. A total of 14.7% had AP/PA technique, 14.2% 3-field, 45.9% 4-field, 19.8% >4 fields. Gastrointestinal bleeding and transfusion use (T) varied by U/R (20.8% no T, 16.4% T in urban; 7.2% No T, 13.8% T U/R mixed; 9.9% No T, 2.7% T rural; p = 0.03). Endoscopy was performed in >95% of cases in each area. Use of endoscopic ultrasound varied by U/R (16.7% in urban, 36.8% U/R mixed, 22.6% rural; p = 0.03). Chest CT was done more in lower U (85.2% vs. 63.8%; p = 0.02), PET more in lower POV (58.0% vs. 38.0%; p = 0.02) and lower U areas (58.3% vs. 37.8%; p = 0.02), MRI more in lower POV and U (both 11.4% vs. 1.7%; p = 0.03). Surgical resection was done less in lower POV (71.7% vs. 87.8%; p = 0.02). External beam technique varied by U/R with AP/PA more common in rural and ≥4-field more common in urban areas (p = 0.02). IMRT use varied by U/R (27.6% urban, 12.5% U/R mixed, 0% rural; p < 0.01). Of the 244 cases 96.2% had adenocarcinoma; 13.7% were Stage 1b, 27.4% II, 30.1% IIIA, 9.2% IIIB, 13.5% IV, 6.0% unknown. Primary location was 35.0% antrum, 14.0% corpus, 11.7% cardia, 32.9% GE junction, 6.5% unknown. Median age was 63 yrs; 64.7% were male; 17.3% African American; 14.3% Hispanic. Median RT dose was 45 Gy; median RT duration 36 days. A total of 14.7% had AP/PA technique, 14.2% 3-field, 45.9% 4-field, 19.8% >4 fields. Gastrointestinal bleeding and transfusion use (T) varied by U/R (20.8% no T, 16.4% T in urban; 7.2% No T, 13.8% T U/R mixed; 9.9% No T, 2.7% T rural; p = 0.03). Endoscopy was performed in >95% of cases in each area. Use of endoscopic ultrasound varied by U/R (16.7% in urban, 36.8% U/R mixed, 22.6% rural; p = 0.03). Chest CT was done more in lower U (85.2% vs. 63.8%; p = 0.02), PET more in lower POV (58.0% vs. 38.0%; p = 0.02) and lower U areas (58.3% vs. 37.8%; p = 0.02), MRI more in lower POV and U (both 11.4% vs. 1.7%; p = 0.03). Surgical resection was done less in lower POV (71.7% vs. 87.8%; p = 0.02). External beam technique varied by U/R with AP/PA more common in rural and ≥4-field more common in urban areas (p = 0.02). IMRT use varied by U/R (27.6% urban, 12.5% U/R mixed, 0% rural; p < 0.01). ConclusionsSociodemographic factors, which may be surrogates for multidisciplinary care and/or use of emerging RT treatment planning and delivery, are associated with variations in workup and treatment for GC pts who receive RT. Our next analysis will seek to determine if these findings represent access issues. Sociodemographic factors, which may be surrogates for multidisciplinary care and/or use of emerging RT treatment planning and delivery, are associated with variations in workup and treatment for GC pts who receive RT. Our next analysis will seek to determine if these findings represent access issues.