Abstract
Abstract only
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Background: The current standard of care for stage II/III esophageal carcinoma for patients who can withstand aggressive therapy is chemotherapy, radiotherapy and surgery (tri-modality therapy). This is the largest study of its kind to date. Methods: Using the National Cancer Database (NCDB) 46,758 patients diagnosed with stage II/III esophageal carcinoma between 2000 and 2009 were identified. The NCDB database includes data from 70% of cancer patients in the US. Results: In stage II/III esophageal cancer private insurance holders received more tri-modality therapy (39%) than VA insurance (18%), Medicaid (22%), Medicare (18%), and the uninsured (19%) (p<0.0001). There was no statistically significant difference in the amount of tri-modality therapy received in patients with VA, Medicare, or no insurance. Medicaid patients received more tri-modality therapy than Medicare, uninsured, and VA patients (p<0.05). VA and uninsured patients received no treatment more frequently (13%) than those with private insurance (5%), Medicare (10%), and Medicaid (9%) (p<0.0003). Patients over 70 less frequently underwent tri-modality therapy (13%) as compared to those under 70 (34%, p<0.0001). Conclusions: Although VA, Medicare, and the uninsured patients received similar rates of tri-modality therapy (18-19%), it was much less than private insurance holders (39%). Medicaid patients received less tri-modality therapy than private insurance holders despite similar ages. Uninsured patients received a similar amount of tri-modality therapy as those with VA and Medicare. [Table: see text]