Outcomes of Patients With Esophageal and Gastric Carcinoma at a Safety-net Health Care System: A Juncture to Explore Disparities in Diverse Socioeconomic Cohorts and Ethnicities

Kalyani Narra; Sachita Guthula; Kari J Teigen; Susmita Potti; Jolonda C Bullock; Timothy J Brown

doi:10.1097/COC.0000000000001287

Outcomes of Patients With Esophageal and Gastric Carcinoma at a Safety-net Health Care System: A Juncture to Explore Disparities in Diverse Socioeconomic Cohorts and Ethnicities

Am J Clin Oncol. 2025 Dec 23. doi: 10.1097/COC.0000000000001287. Online ahead of print.

Authors

Kalyani Narra^{1

2}, Sachita Guthula³, Kari J Teigen⁴, Susmita Potti⁵, Jolonda C Bullock¹, Timothy J Brown^{6

7}

Affiliations

¹ JPS Oncology and Infusion Center, JPS Health Network, Fort Worth, TX.
² Department of Internal Medicine, Burnett School of Medicine at Texas Christian University, Fort Worth, TX.
³ Texas College of Osteopathic Medicine, Fort Worth, TX.
⁴ Office of Clinical Research, JPS Health Network, Fort Worth, TX.
⁵ AdventHealth Cancer Institute, Orlando, FL.
⁶ Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, TX.
⁷ Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX.

PMID: 41430541
DOI: 10.1097/COC.0000000000001287

Abstract

Objectives: Outcomes for upper gastrointestinal (UGI) cancers are poor except for those patients whose cancers are diagnosed at a very early stage. Unique socioeconomic factors may result in worse outcomes in the safety-net setting given that these patients often seek care later in the disease course. This study aims to understand the survival outcomes of patients with UGI cancers in a safety-net health care (SNH) setting.

Methods: Patients diagnosed with esophageal squamous (ES), esophageal adenocarcinoma (EA), and gastric carcinomas (G) at JPS Health Network in Fort Worth, Texas from January 1, 2018, to December 31, 2022, were identified in the tumor registry database. The electronic health record was queried for clinical characteristics, pathology variables, and management outcomes. Kaplan-Meier curve was used to illustrate the difference in survival time across cancer stages from an index date of diagnosis with censoring at date of last contact.

Results: A total of 171 patients were included: the median age was 57 years, but 15 patients were under 40 years. By ethnicity, 40% were Hispanic. The majority were male (71%) and uninsured (65%). G was the most common primary site (n = 92, 54%), followed by EA (n = 58, 34%) and ES (n = 21, 12%). Of the 125 stage 4B patients, 69 (55%) did not receive any treatment, 6 received only palliative radiation, and the remainder received systemic therapy. In patients with stage 4B, the median overall survival for patients with systemic treatment was 7.9 months (95% CI: 6.7-11), compared with 2.1 months (95% CI: 1.5-3.0) without treatment.

Conclusions: In an urban safety-net population with a high percentage of Hispanic population, most patients with advanced UGI cancers did not receive systemic therapy. Interventions to improve outcomes must consider the unique socioeconomic needs of this vulnerable population to translate clinical trial results into improved outcomes.

Keywords: safety-net setting; survival; upper gastrointestinal.

Grants and funding

RP220542/CPRIT