Black Patients Are Less Likely to Receive Surgery for Esophageal Cancer

Black patients were less likely to receive surgery for esophageal cancer and therefore have a higher risk of death, according to a study published in the Journal of Gastrointestinal Surgery.

“National guidelines suggest that early-stage esophageal cancer should be treated with surgery because data shows that it offers patients the best chances of survival, rather than chemotherapy alone,” says senior author Nathaniel Evans, MD, Director of the Division of Thoracic Surgery at Thomas Jefferson University, and Chief of Cancer Services, Center City Division at the SKCC in a press release. “Our data show that Black patients are not having surgery for early-stage disease, which may contribute to higher rates of death. With this data, we can now begin to educate patients and providers to change practice.”

In this study, researchers assessed 60,041 patients from drew from the National Cancer Database, of whom 4,402 were Black and 55,639 were white across over 1,334 hospitals around the country. Subsequently, black patients and their white counterparts were matched 1:1 based on demographics, comorbidities, and tumor characteristics.

The results showed that rates of surgery were significantly lower, 25-40% less for Black patients with esophageal cancer in stages I to III. In addition, the researchers noted that the chances of getting surgery decreased as the age of Black patients increased, and also decreased if the patients were receiving radiation therapy. Black patients were more likely to get surgery if they were treated at a hospital that was more than 5 miles from their homes.

“Although the data doesn’t give us a reason for the observations we’re seeing, it does show us areas where we can take action,” says Dr. Evans. “Even when we control for socioeconomic status, insurance status, location, and comorbid conditions, the disparity still persists, it is quite profound. This highlights the need to educate Black patients and their healthcare providers on the importance of surgery in the treatment esophageal cancer.”



“This important study is part of a much larger effort at the Sidney Kimmel Cancer Center to understand and mitigate cancer disparities,” says Karen Knudsen, PhD, EVP of Oncology Services and Enterprise Director of SKCC. “This goal is central to our mission to improve the lives cancer patients and their families, regardless of geography, gender, or demographic. We are thankful to Dr. Evans and the entire research team for raising awareness about this critical national issue.”