Do Socioeconomic Factors Impair Uptake of Neoadjuvant Therapy for Patients With Locoregional Oesophageal Cancer?

This study aimed to explore the impact of socioeconomic disparities on the uptake of neoadjuvant therapy in patients with locally advanced esophageal cancer. Using data from the American National Cancer Database, 19,748 patients were identified with clinical stage II-III esophageal cancer who underwent surgical resection between 2006 and 2020. Overall, 85 percent received neoadjuvant therapy, while the remaining patients underwent upfront surgery. In a propensity-matched cohort, neoadjuvant therapy was associated with improved five-year overall survival compared to upfront surgery. Over time, the uptake of neoadjuvant therapy increased, but lower uptake was associated with factors such as age (≥70), female sex, Black race, increased comorbidities (as measured by the Charlson Comorbidity Index), and government insurance compared to private insurance. This study highlights the potential inequities in cancer care delivery.