Suriya Baskar, MD1, Chaula Desai, MD1, Anuj R. Sharma, MBBS1, Sweta Lohani, MBBS, MD1, Saigopal R. Gujjula, MD1, Adhithya Baskar, BA2, Udhayvir S. Grewal, MD3 1Brooklyn Hospital Center, Brooklyn, NY; 2Saint Matthew's University, Floral Park, NY; 3University of Iowa Hospitals & Clinics, Iowa City, IA
Introduction: Esophageal cancer is an aggressive malignancy with rising incidence globally. Despite significant therapeutic advances, overall outcomes remain sobering among patients with advanced disease. Patients with advanced esophageal cancer suffer from a heavy burden of a wide array of symptoms including dysphagia and cachexia/anorexia, necessitating the need for focused symptom management and palliative care. Studies focused on other cancer types have shown that Black patients are more likely to receive aggressive care at end-of-life (EOL) and suffer from a decline in quality of life. We sought to investigate racial differences in EOL care among patients with advanced esophageal cancer in the US.
Methods: The National Inpatient Sample (NIS) was queried to identify all hospitalizations with esophageal
cancer utilizing ICD-10 codes C15x from 2016 to 2020. Hospitalizations of White and Black
patients with documented inpatient mortality events were then extracted. Demographic and
clinical data were analyzed using chi-squared tests, independent sample t-tests, and binary
logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). Adjusted
Odds ratios (aOR) are presented with 95% Confidence intervals (CI).
Results: A total of 15,130 hospitalizations with esophageal cancer were included. 13,345 (88.2%) were
White and 1785 (11.8%) were Black. Hospitalizations with white patients recorded higher age,
more males, and higher comorbidities per CCI. Hospitalizations with black patients had longer
lengths of stay on average, higher total hospital charges, and were significantly less likely to have a Do Not Resuscitate (DNR) code status (aOR 0.81, 0.74-0.9 95% CI). Palliative care consultation at EOL was significantly less likely in hospitalizations with Black patients (aOR=0.53, 0.48-0.58 95% CI). Hospitalized Black patients were more likely to receive aggressive intervention at EOL demonstrated by rates of blood transfusion (aOR 1.9, 1.6-2.1 95% CI), mechanical ventilation (aOR 1.7, 1.5-1.8 95% CI), and vasopressor usage (aOR 1.4, 1.2-1.6 95% CI).
Discussion: Our retrospective analysis demonstrates significant racial disparities in EOL care amongst hospitalized esophageal cancer patients. Black patients had longer lengths of stay, lower rates of palliative care consultation and DNR code status, and higher rates of aggressive intervention. These findings may have implications for improving healthcare decision-making for EOL care amongst minority patients with esophageal cancer.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Suriya Baskar indicated no relevant financial relationships.
Chaula Desai indicated no relevant financial relationships.
Anuj Sharma indicated no relevant financial relationships.
Sweta Lohani indicated no relevant financial relationships.
Saigopal Gujjula indicated no relevant financial relationships.
Adhithya Baskar indicated no relevant financial relationships.
Udhayvir Grewal indicated no relevant financial relationships.
Suriya Baskar, MD1, Chaula Desai, MD1, Anuj R. Sharma, MBBS1, Sweta Lohani, MBBS, MD1, Saigopal R. Gujjula, MD1, Adhithya Baskar, BA2, Udhayvir S. Grewal, MD3. P3936 - Racial Differences in End-of-Life Care Among Patients with Esophageal Cancer in the United States, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
