Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma: a review of the National Cancer Database

Gregory Vlacich, Pamela P. Samson, Stephanie M. Perkins, Michael C. Roach, Parag J. Parikh, Jeffrey D. Bradley, Albert Lockhart, Varun Puri, Bryan F. Meyers, Benjamin Kozower, Cliff G. Robinson

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

For elderly patients with locally advanced esophageal cancer, therapeutic approaches and outcomes in a modern cohort are not well characterized. Patients ≥70 years old with clinical stage II and III esophageal cancer diagnosed between 1998 and 2012 were identified from the National Cancer Database and stratified based on treatment type. Variables associated with treatment utilization were evaluated using logistic regression and survival evaluated using Cox proportional hazards analysis. Propensity matching (1:1) was performed to help account for selection bias. A total of 21,593 patients were identified. Median and maximum ages were 77 and 90, respectively. Treatment included palliative therapy (24.3%), chemoradiation (37.1%), trimodality therapy (10.0%), esophagectomy alone (5.6%), or no therapy (12.9%). Age ≥80 (OR 0.73), female gender (OR 0.81), Charlson–Deyo comorbidity score ≥2 (OR 0.82), and high-volume centers (OR 0.83) were associated with a decreased likelihood of palliative therapy versus no treatment. Age ≥80 (OR 0.79) and Clinical Stage III (OR 0.33) were associated with a decreased likelihood, while adenocarcinoma histology (OR 1.33) and nonacademic cancer centers (OR 3.9), an increased likelihood of esophagectomy alone compared to definitive chemoradiation. Age ≥80 (OR 0.15), female gender (OR 0.80), and non-Caucasian race (OR 0.63) were associated with a decreased likelihood, while adenocarcinoma histology (OR 2.10) and high-volume centers (OR 2.34), an increased likelihood of trimodality therapy compared to definitive chemoradiation. Each treatment type demonstrated improved survival compared to no therapy: palliative treatment (HR 0.49) to trimodality therapy (HR 0.25) with significance between all groups. Any therapy, including palliative care, was associated with improved survival; however, subsets of elderly patients with locally advanced esophageal cancer are less likely to receive aggressive therapy. Care should be taken to not unnecessarily deprive these individuals of treatment that may improve survival.

Original languageEnglish (US)
Pages (from-to)2886-2896
Number of pages11
JournalCancer Medicine
Volume6
Issue number12
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Databases
Carcinoma
Neoplasms
Palliative Care
Therapeutics
Esophageal Neoplasms
Esophagectomy
Survival
Histology
Adenocarcinoma
Selection Bias
Comorbidity
Logistic Models

Keywords

  • Definitive chemoradiation
  • elderly
  • locally advanced esophageal cancer
  • palliative treatment
  • trimodality

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Vlacich, G., Samson, P. P., Perkins, S. M., Roach, M. C., Parikh, P. J., Bradley, J. D., ... Robinson, C. G. (2017). Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma: a review of the National Cancer Database. Cancer Medicine, 6(12), 2886-2896. https://doi.org/10.1002/cam4.1250

Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma : a review of the National Cancer Database. / Vlacich, Gregory; Samson, Pamela P.; Perkins, Stephanie M.; Roach, Michael C.; Parikh, Parag J.; Bradley, Jeffrey D.; Lockhart, Albert; Puri, Varun; Meyers, Bryan F.; Kozower, Benjamin; Robinson, Cliff G.

In: Cancer Medicine, Vol. 6, No. 12, 01.12.2017, p. 2886-2896.

Research output: Contribution to journalArticle

Vlacich, G, Samson, PP, Perkins, SM, Roach, MC, Parikh, PJ, Bradley, JD, Lockhart, A, Puri, V, Meyers, BF, Kozower, B & Robinson, CG 2017, 'Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma: a review of the National Cancer Database', Cancer Medicine, vol. 6, no. 12, pp. 2886-2896. https://doi.org/10.1002/cam4.1250
Vlacich, Gregory ; Samson, Pamela P. ; Perkins, Stephanie M. ; Roach, Michael C. ; Parikh, Parag J. ; Bradley, Jeffrey D. ; Lockhart, Albert ; Puri, Varun ; Meyers, Bryan F. ; Kozower, Benjamin ; Robinson, Cliff G. / Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma : a review of the National Cancer Database. In: Cancer Medicine. 2017 ; Vol. 6, No. 12. pp. 2886-2896.
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