Vulnerable Populations Are Treated Less Frequently for GI Cancers

Safety net hospitals exist to offer care to vulnerable populations, such as those on Medicaid or who are uninsured. However, these patients still face barriers to care that affect survival outcomes.

The safety-net hospital approach typically tries to address the three-delays model for vulnerable and minority populations to receive care — which includes delays in seeking medical help because of cost, poor education or lack of access to information; a delay in reaching an appropriate facility because of distance or transport; and a delay in receiving adequate care at a facility because of staff shortages or medical supplies.

It is unknown what the primary reason is for delay of care for vulnerable patients with gastric adenocarcinoma.

Therefore, researchers from Emory University Winship Cancer Institute and Emory University Hospital aimed to define these groups of patients who reached care at a safety-net hospital versus an academic institution, and to compare survival outcomes.

To do this, they compared outcomes between Grady-Memorial Hospital (GMH), a safety net hospital, and Emory University Hospital (EUH), a quaternary referral hospital — both of which are within the same health care system. Specifically, the researchers compared treatment and survival outcomes between the two hospitals for patients with gastric adenocarcinoma (GAC).

Results were then presented at the 2018 Gastrointestinal Cancers Symposium.

The racial makeup of patients treated at each hospital differed, for example, 17.2 percent of those treated at EUH were black compared to 85.1 percent at GMH. Further, patients at GMH were much more likely to be uninsured (30.5 percent versus 4.7 percent), have stage 4 disease (43.5 percent versus 30.1 percent) and received no treatment (40.3 percent versus 18.4 percent).

However, it should be noted that the 23 patients at GMH who underwent curative-intent resection had similar median overall survival (OS) to the 137 patients who received the same or similar treatment at EUH.

The researchers noted that more efforts need to be made in order to address these findings.

“Efforts must be made to identify and overcome the barriers in seeking and reaching care for this vulnerable patient population, as it appears that outcomes are acceptable in those who receive care,” the authors wrote.