Abstract B58: Limited esophageal cancer care access among African American patients in Michigan.
Authors: Revels Sha'Shonda L. , Mouch Charles A. , Reddy Rishindra M. 
Published: August 2014

Background: The incidence of esophageal cancer (EC) in Michigan (MI) is among the highest in the nation. Moreover, even higher rates are observed among the state's most vulnerable minority populations. The purpose of this study was to quantify the utilization of resources by African-American (AA) EC patients at the University of Michigan Medical Center (UMMC), a state sponsored hospital tasked with providing cancer care for all MI residents.

Methods: All patients presenting with a diagnosis of stage I-III EC from April 2007 to April 2012 were identified using the UMMC information technology department. A retrospective chart review was performed eliciting information on demographics, comorbid conditions and treatments received. We used multivariable logistic regression to examine patient demographics, comorbid conditions and tumor specific characteristics as predictors of receipt of neoadjuvant chemoradiation and esophagectomy. Patients with cervical esophageal cancers and stage IV disease were excluded.

Results: A total of 718 patient charts (95.1% white, 2.26% AA, 2.64% asian/hispanic/other) were reviewed. Overall, only 14 of the 16 AA patients were MI residents. White patients were more likely to travel greater distances compared with AA patients (median distance in miles 242.1 vs. 81.0, respectively, p&lt;0.001). Although UMMC is approximately 30 miles from Metro Detroit, only 5 AA patients from this area sought care at UMMC. AA patients were more likely to report current tobacco use (56.3% vs. 23.4%, p&lt;0.01) at the time of diagnosis, have squamous cell histology (62.5% vs. 7.82%, p&lt;0.001) and have tumors located in the mid-esophagus (43.8% vs. 6.1%, p&lt;0.001), compared with white patients. AA and white patients were largely indistinguishable in terms of age at the time of diagnosis, the number of comorbid conditions, insurance status and stage at diagnosis. After adjusting for patient factors, comorbid conditions and tumor characteristics, AA patients (OR 0.12, 95%CI 0.02-0.55), patients with congestive heart failure (OR 0.21, 95%CI 0.08-0.60) and pulmonary disease (OR 0.45, 95%CI 0.23-0.91) were significantly less likely to undergo esophagectomy. There were no race-related differences in the use of neoadjuvant chemoradiation.

Conclusions: Racial disparities in the treatment of EC are widely recognized and considered an important public health and policy concern. UMMC provides care for more than 50% of all EC patients in MI. However, relatively few AA patients seek care at UMMC, a high volume regional center. Our ability to estimate racial differences in care within UMMC was limited by sample size constraints among the AA population. Efforts to reduce racial disparities in treatment and ultimately improve EC outcomes will require providers to assure that patients are referred for the appropriate treatments and have assistance navigating the cancer care system.

Citation Format: Sha'Shonda L. Revels, Charles A. Mouch, Rishindra M. Reddy. Limited esophageal cancer care access among African American patients in Michigan. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B58.