title: Esophageal Cancer Treatment Is Underutilized Among Elderly Patients in the USA.
abstract: Large numbers of elderly patients in the USA receive no treatment for esophageal cancer, despite evidence that multimodality treatment can increase survival. Our goal is to identify factors that may contribute to lack of treatment.
  
  
  
  Using Surveillance Epidemiology and End Results (SEER)-Medicare Linked Database (2001-2009), we identified regional esophageal cancer patients ≥65 years old. Treatment was defined as receiving any medical or surgical therapy for esophageal cancer. Logistic regression analysis was performed to identify factors associated with failure to receive treatment. Overall survival (OS) was analyzed using the Kaplan-Meier method and Cox proportional hazard model.
  
  
  
  There were 5072 patients (median age, 75 years; interquartile range (IQR), 71-81 years). Majority were treated with definitive chemoradiation (48.49 %). Factors associated with lack of treatment included West geographic region and ≥80 years old. Patients who received therapy had better OS (log-rank, p < 0.001). Compared with treated patients, non-treated patients had worse adjusted OS (HR, 1.43; 95 % confidence interval (CI), 1.33-1.55; p < 0.001).
  
  
  
  Elderly patients with locally advanced esophageal cancer who received treatment had improved 5-year survival compared with patients without treatment. Disparities in utilization of treatment are associated with regional and socioeconomic factors, not presence of comorbidities.
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Molena
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Miloslawa
authors.initials: M
authors.lastname: Stem
authors.affiliation: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Blackford
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. lidor@surgery.wisc.edu.|Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave K4/752, Madison, WI, 53792-7375, USA. lidor@surgery.wisc.edu.
authors.forename: Anne O
authors.initials: AO
authors.lastname: Lidor
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States
keywords: Disparities in care; Elderly; Esophageal cancer; Survival; Treatment