Ciara R Huntington1, Kendall Walsh2, Yimei Han2, Jonathan Salo2, Joshua Hill3. 1. Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd., Charlotte, NC, 28204, USA. 2. Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, 1021 Morehead Medical Drive #6100, Charlotte, NC, 28204, USA. 3. Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, 1021 Morehead Medical Drive #6100, Charlotte, NC, 28204, USA. Joshua.hill@carolinas.org.
Abstract
INTRODUCTION: Accurate preoperative staging is important for patients with gastric cancer. This study identifies the rate of utilization of endoscopic ultrasound (EUS) and its associated factors in Medicare patients with gastric adenocarcinoma. METHODS: The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was queried from 1996 to 2009 for patients with gastric cancer who underwent gastric resection. Analysis with univariate, multivariate, and Cochran-Armitage trend tests were performed. RESULTS: In 5826 patients with gastric cancer with an average age of 76.9 ± 6.62 years, 59.1% had regionalized spread of cancer. EUS utilization increased significantly during the study period from 2.6% to 22% (p < 0.0001). EUS patients were more likely to be male, white, married, have higher education and income quartiles, and live in large metropolitan areas compared to non-EUS patients (p < 0.0001). Even after controlling for confounding factors, patients who underwent EUS were more likely to have >15 lymph nodes examined (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.04-1.53) and have the administration of both pre- and postoperative chemotherapy (OR 1.27, 95% CI 1.03-1.57). CONCLUSION: EUS is currently under-utilized but increasing. Patients who underwent EUS (12.9%) were more likely to receive other NCCN-recommended care, including perioperative chemotherapy and adequate nodal retrieval.
INTRODUCTION: Accurate preoperative staging is important for patients with gastric cancer. This study identifies the rate of utilization of endoscopic ultrasound (EUS) and its associated factors in Medicare patients with gastric adenocarcinoma. METHODS: The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was queried from 1996 to 2009 for patients with gastric cancer who underwent gastric resection. Analysis with univariate, multivariate, and Cochran-Armitage trend tests were performed. RESULTS: In 5826 patients with gastric cancer with an average age of 76.9 ± 6.62 years, 59.1% had regionalized spread of cancer. EUS utilization increased significantly during the study period from 2.6% to 22% (p < 0.0001). EUS patients were more likely to be male, white, married, have higher education and income quartiles, and live in large metropolitan areas compared to non-EUS patients (p < 0.0001). Even after controlling for confounding factors, patients who underwent EUS were more likely to have >15 lymph nodes examined (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.04-1.53) and have the administration of both pre- and postoperative chemotherapy (OR 1.27, 95% CI 1.03-1.57). CONCLUSION: EUS is currently under-utilized but increasing. Patients who underwent EUS (12.9%) were more likely to receive other NCCN-recommended care, including perioperative chemotherapy and adequate nodal retrieval.
Authors: Sung Wook Hwang; Dong Ho Lee; Sang Hyub Lee; Young Soo Park; Jin Hyeok Hwang; Jin Wook Kim; Sook Hyang Jung; Na Young Kim; Young Hoon Kim; Kyoung Ho Lee; Hyung-Ho Kim; Do Joong Park; Hye Seung Lee; Hyun Chae Jung; In Sung Song Journal: J Gastroenterol Hepatol Date: 2010-03 Impact factor: 4.029
Authors: Deirdre P Cronin-Fenton; Margaret M Mooney; Limin X Clegg; Linda C Harlan Journal: World J Gastroenterol Date: 2008-05-28 Impact factor: 5.742