title: National Trends in Utilization of Endoscopic Ultrasound for Gastric Cancer: a SEER-Medicare Study.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd., Charlotte, NC, 28204, USA.
authors.forename: Ciara R
authors.initials: CR
authors.lastname: Huntington
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, 1021 Morehead Medical Drive #6100, Charlotte, NC, 28204, USA.
authors.forename: Kendall
authors.initials: K
authors.lastname: Walsh
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, 1021 Morehead Medical Drive #6100, Charlotte, NC, 28204, USA.
authors.forename: Yimei
authors.initials: Y
authors.lastname: Han
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, 1021 Morehead Medical Drive #6100, Charlotte, NC, 28204, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Salo
authors.affiliation: 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.
authors.forename: Joshua
authors.initials: J
authors.lastname: Hill
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000368:Aged; D019160:Endosonography / Q000706:statistics & numerical data*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging / Q000379:methods; D016017:Odds Ratio; D012189:Retrospective Studies; D018426:SEER Program; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014481:United States
keywords: EUS; Endoscopic ultrasound; Gastric cancer; NCCN guidelines; SEER-Medicare