Rishindra M Reddy MD MBA FACS Professor University of Michigan Section of Thoracic Surgery Jose Jose Alvarez Professor of Thoracic Oncology Research THORACIC SURGERY Disclosures Intuitive Surgical ID: 1041125
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1. Health Disparities in Patients with Esophageal CancerRishindra M. Reddy, MD, MBA, FACSProfessor, University of Michigan, Section of Thoracic SurgeryJose Jose Alvarez Professor of Thoracic Oncology ResearchTHORACIC SURGERY
2. DisclosuresIntuitive SurgicalMedtronicAtricureGenentechOn Target LaboratoriesNone Relevant to this talkTHORACIC SURGERY
3. ObjectivesUnderstand financial barriers for some patients with esophageal cancerDiscuss Race and its relationship to socioeconomic statusReview complexity of care pathways for esophageal cancer (at all stages)THORACIC SURGERY
4. 4Racial disparities in Eso Cancer SurgeryCliff AkatehTransplant Surgery Fellow-StanfordGeneral Surgery-The Ohio State UniversityAA vs Caucasian patient outcomes after EsophagectomyAlmost 3000 esophagectomies at UmichWell kept Database on OutcomesTHORACIC SURGERY
5. 5Racial disparities in Eso Cancer Surgery2.7% of Esophagectomy patients were AA1% AsianHispanic not well recorded14.5% of Michigan is AA85% of Detroit is AADistrust of the overall health systemDistrust of University of MichiganChallenges getting care in Ann Arbor2015, <5% of UM Cancer Center referrals were AA patientsTHORACIC SURGERY
6. 6Rishindra M. Reddy MD, MBA, University of Michigan, Section of Thoracic SurgeryWhat have we found?-Akateh, et alRetrospective Review of 2000+ esophageal cancer patients in a single center database.Reviewed outcomes after esophagectomy, including long term survivalMajority of patients were treated with transhiatal esophagectomy(Never published, but presented at the Clinical Congress in 2013)THORACIC SURGERY
7. 7Rishindra M. Reddy MD, MBA, University of Michigan, Section of Thoracic SurgeryWhat have we found?-Akateh, et alNo difference in survival or other short-term outcomesIncreased Length of Stay, but unclear whySquamous cell cancer and mid-esophageal location did not increase risks associated with surgeryTHORACIC SURGERY
8. 8We have few AA patients, but why?Kemp/SarwarInterviews with 20 different esophageal cancer care physicians in SE MichiganOpen ended interviews with GI docs, Med Onc, Surgery, Rad Onc to understand where AA patients go for care, and whyPresented at Academic Surgical Congress in 2014THORACIC SURGERY
9. 9 GIMed Onc Thoracic SurgeryPCPGIER Rad OncEndoscopy THORACIC SURGERY
10. 10Socioeconomic Status > Race (95%) 1. Transportation Issues (90%)2. Fear of Surgery/Anesthesia (45%)3. Lack of understanding, follow-up, or access to primary care (85%) Overcome Issues with Social Services (75%) THORACIC SURGERY
11. 11Conclusions (Kemp/Sarwar)Some Senior physicians felt this wasn’t of valueTransportation was a key factorBus services provided by other systems in Detroit, and in MichiganSocioeconomic status was also a key factorTHORACIC SURGERY
12. Where do we go next?Lineback/Mervak-focused on low SES patients with Esophageal CancerInterviewed 80 patients/families with esophageal cancer NOT through UM’s system (through FB, Church postings, Newspaper ads)40 patients with low SES, but also 40 with high SESTHORACIC SURGERY
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15. Lineback CM, Mervak CM, Revels SL, Kemp MT, Reddy RM. Barriers to Accessing Optimal Esophageal Cancer Care for Socioeconomically Disadvantaged Patients. Ann Thorac Surg. 2017 Feb;103(2):416-421.THORACIC SURGERY
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17. 17Conclusions/Take-AwayEsophageal cancer care is complex30% of patients with limited socioeconomic means may lose their job during their treatmentAfrican American patients can have similar outcomes (from surgery), but may need more social support /transportation/flexibility, and this may be due to limited socioeconomic meansTHORACIC SURGERY
18. 18My Personal Conclusions/Take-AwayI have more empathy in helping patients get careFailure to comply with treatment (missed appointments, etc.) may be due to financial limitations, rather than apathy to care.We need a better system to help address financial (and social) inequality in patient careTHORACIC SURGERY