Socioeconomic factors in timing of esophagectomy and association with outcomes.
BACKGROUND AND OBJECTIVES
Disparities in esophageal cancer are well-established. The standard treatment for locally advanced esophageal cancer is chemoradiation followed by surgery. We sought to evaluate the association between socioeconomic factors, time to surgery, and patient outcomes.


METHODS
All patients ≥18 years old diagnosed with T2/3/4 or node-positive esophageal cancer between 2004 and 2016 and who underwent chemoradiation and esophagectomy in the National Cancer Database were included. Multivariable regression was used to assess the association between socioeconomic variables and time to surgery (grouped into <56, 56-84, and 85-112 days).


RESULTS
A total of 12 157 patients were included. Five-year overall survival was 39%, 35%, and 35% for the three groups examined. Postoperative 30- and 90-day mortality was increased in both the 56-84 days to surgery group (odds ratio [OR]: 1.30 and 1.20, respectively) and the 85-112 days group (OR: 1.37 and 1.56, respectively) when compared to <56 days. Patients of a minority race, public insurance, or lower income were more likely to have a longer time to surgery.


CONCLUSION
Longer time to surgery is associated with increased postoperative mortality and is more common in patients with lower socioeconomic status. Further research exploring reasons for delays to esophagectomy among disadvantaged patients could help target interventions to reduce disparities.
['Chen|Kevin A|KA|https://orcid.org/0000-0003-1610-5889', 'Strassle|Paula D|PD|', 'Meyers|Michael O|MO|http://orcid.org/0000-0003-3108-7279']
D000230:Adenocarcinoma D000368:Aged D002294:Carcinoma, Squamous Cell D059248:Chemoradiotherapy D004938:Esophageal Neoplasms D016629:Esophagectomy D005260:Female D054625:Healthcare Disparities D006801:Humans D007182:Income D008297:Male D008484:Medicaid D006278:Medicare D008875:Middle Aged D020360:Neoadjuvant Therapy D009657:North Carolina D000076782:Race Factors D061665:Time-to-Treatment D014481:United States
esophagectomy combined modality therapy healthcare disparities postoperative complications