B0217 - Current Trends in Endoscopic Therapy for T1a Esophageal Cancer in the United States

Calvin X. Geng, MD¹, Anuragh R. Gudur, MD¹, Alexander Podboy, MD^2
1University of Virginia Health System, Charlottesville, VA; ²University of Virginia, Charlottesville, VA

Introduction: Esophageal cancer is the 6^th leading cause of cancer mortality worldwide. Minimally invasive endoscopic therapies have become an increasingly widespread modality for early esophageal cancer treatment, with comparable outcomes to surgery. The regional variations and trends over time in the utilization of endoscopic therapies for T1a esophageal cancer have not been explored but are likely important factors in esophageal cancer care.

Methods: Patients with primary T1a esophageal cancer from 2004-2015 via the November 2018 submission of Surveillance, Epidemiology, and End Results (SEER) Program were included. 4 geographic regions comprised of 18 cancer registries covering approximately 30% of the US population were identified: South (Georgia, Louisiana), West (Hawaii, Alaska, Seattle, California, New Mexico, Utah), Northeast (Connecticut, New Jersey), and Midwest (Iowa, Kentucky). Estimates for the percentage of people living at < 150% of the poverty level were obtained using county-level data from the 2010-2014 US Census. Rates of endoscopic therapy were compared between regions over time. Chi-squared testing was used for between-region comparisons. Statistical analysis was performed using R studio (R version 3.6.1, Boston, Massachusetts). Line plots were generated using Microsoft Excel.

Results: A total of 1788 patients with primary T1a esophageal cancer from 2004-2015 were included. The majority (47%) of the patients were from the West (n=838), with 315, 352, and 283 patients from the South, the Northeast, and the Midwest regions, respectively. Rates of endoscopy differed between regions (p< 0.001) with lowest rates of endoscopy in the South (34.6%) and highest rates of endoscopy in the Northeast (50.6%). The Northeast had the lowest rate of poverty (16% of patients at < 150% poverty level) whereas the South had the highest (30%, p< 0.001). Endoscopy use increased over time in all regions. However, the South had the lowest rates of endoscopy at all time points.

Discussion: In this population level observational study, we demonstrate that rates of endoscopy for T1a esophageal cancer differ based on geographic region, and appear to be inversely related to poverty level. These findings are especially relevant considering the evolving body of evidence supporting the use of endoscopy as definitive therapy for early esophageal cancer. More research is needed to identify other factors associated with these health disparities to improve health equity and outcomes in early-stage esophageal cancer.




Disclosures:


Calvin X. Geng, MD¹, Anuragh R. Gudur, MD¹, Alexander Podboy, MD². B0217 - Current Trends in Endoscopic Therapy for T1a Esophageal Cancer in the United States, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.