Impact of palliative therapies in metastatic esophageal cancer patients not receiving chemotherapy

Table 1 Univariate and multivariable analysis of overall survival in cohort of patients with advanced esophageal cancer

Variable	n	Univariate		Multivariable
		HR (95%CI)	P value	HR (95%CI)	P value
Treatment received
No chemotherapy/received palliative therapy	407	0.94 (0.84-1.05)	0.288	0.94 (0.83-1.06)	0.290
No chemotherapy/no palliative therapy	1086	1 (Reference)		1 (Reference)
Age (yr)	1493	1.00 (1.00-1.00)	0.773	2
Gender
Female	340	0.82 (0.73-0.93)	0.002	0.81 (0.71-0.92)	0.002
Male	1153	1 (Reference)		1 (Reference)
Race1
Black	142	0.87 (0.73-1.04)	0.136	0.87 (0.72-1.05)	0.136
Other	82	0.76 (0.60-0.97)	0.026	0.72 (0.56-0.93)	0.011
White	1270	1 (Reference)		1 (Reference)
Insurance type1
Medicaid	134	1.00 (0.81-1.24)	0.977	2
Medicare	944	1.04 (0.91-1.18)	0.605
Not insured	89	0.99 (0.77-1.28)	0.963
Other government	21	1.01 (0.63-1.64)	0.956
Private	305	1 (Reference)
Income quartiles for place of residence1
$30000-$34999	291	1.03 (0.86-1.24)	0.723	1.04 (0.86-1.25)	0.710
$35000-$45999	452	1.19 (1.01-1.41)	0.034	1.21 (1.01-1.44)	0.035
$46000+	514	1.04 (0.89-1.23)	0.593	1.06 (0.89-1.26)	0.518
Less than $30000	236	1 (Reference)		1 (Reference)
Education level1,3
14%-19.9%	372	1.03 (0.90-1.18)	0.679	2
20%-28.9%	369	1.01 (0.88-1.16)	0.871
29% or more	263	0.96 (0.82-1.12)	0.580
Less than 14%	489	1 (Reference)
Treatment site1
Academic	554	0.90 (0.80-1.00)	0.047	2
Non-Academic	939	1 (Reference)
Geographic location in United States1
Midwest	487	1.10 (0.93-1.29)	0.259	1.10 (0.94-1.30)	0.232
Northeast	341	1.12 (0.94-1.32)	0.203	1.17 (0.98-1.39)	0.076
South	431	1.20 (1.02-1.42)	0.026	1.23 (1.04-1.46)	0.017
West	234	1 (Reference)		1 (Reference)
Residence area type1
Metro	1183	1.06 (0.92-1.21)	0.431	2
Rural	31	1.07 (0.73-1.57)	0.719
Urban	279	1 (Reference)
Number of comorbidities4
1	351	1.17 (1.03-1.32)	0.014	1.17 (1.03-1.32)	0.018
≥ 2	152	1.20 (1.00-1.42)	0.044	1.12 (0.94-1.35)	0.200
0	990	1 (Reference)		1 (Reference)
Year of diagnosis
2010-2014	889	1.06 (0.96-1.18)	0.249	2
2004-2009	604	1 (Reference)
Grade1,5
1	50	0.64 (0.37-1.09)	0.101	0.58 (0.33-1.01)	0.054
2	513	0.60 (0.38-0.93)	0.023	0.58 (0.37-0.92)	0.020
3	901	0.73 (0.47-1.13)	0.153	0.71 (0.45-1.11)	0.133
4	29	1 (Reference)		1 (Reference)
AJCC T stage1
T0	17	0.69 (0.35-1.35)	0.280	0.64 (0.33-1.25)	0.192
T1	335	0.89 (0.74-1.07)	0.199	0.89 (0.73-1.08)	0.223
T2	162	0.73 (0.59-0.91)	0.005	0.72 (0.58-0.90)	0.003
T3	499	0.77 (0.66-0.89)	< 0.001	0.76 (0.66-0.89)	< 0.001
T4	480	1 (Reference)		1 (Reference)
AJCC N stage1
Positive	1083	0.92 (0.81-1.04)	0.187	2
Negative	410	1 (Reference)

¹Missing data were imputed by multiple imputation.

²Dropped out of the model.

³% of adults in the patient's zip code who did not graduate from high school.

⁴Per Charlson/Deyo et al[14].

⁵Grade 1, well-differentiated; grade 2, moderately differentiated; grade 3, poorly differentiated; grade 4, undifferentiated. AJCC: American Joint Committee on Cancer; HR: Hazard ratio for mortality.

Table 2 Baseline characteristics of patients with advanced esophageal cancer who refused chemotherapy with and without receiving palliative treatment, n (%)

Variable	All patients (n = 1493)	No chemotherapy/received palliative therapy (n = 407)		No chemotherapy/no palliative therapy (n = 1086)	P value
Age (yr)					0.775
Median (IQR)	70 (62-79)	71 (62-79)		70 (62-79)
Gender					0.748
Female	340 (22.77)	95 (23.34)		245 (22.56)
Male	1153 (77.23)	312 (76.66)		841 (77.44)
Race1					0.727
Black	142 (9.50)	38 (9.36)		104 (9.58)
Other	82 (5.46)	19 (4.71)		62 (5.71)
White	1270 (85.04)	350 (85.93)		920 (84.71)
Insurance type1					0.398
Medicaid	134 (8.98)	33 (8.11)		101 (9.30)
Medicare	944 (63.30)	255 (62.65)		689 (63.45)
Not insured	89 (5.96)	19 (4.67)		70 (6.44)
Other government	21 (1.41)	7 (1.72)		14 (1.29)
Private	305 (20.43)	93 (22.85)		212 (19.52)
Income quartiles for place of residence1					0.282
Less than $30000	236 (15.79)	70 (17.20)		166 (15.29)
$30000-$34999	291 (19.51)	87 (21.38)		204 (18.78)
$35000-$45999	452 (30.29)	125 (30.71)		327 (30.11)
$46000+	514 (34.41)	125 (30.71)		389 (35.82)
Education level1,2					0.971
Less than 14%	489 (32.73)	134 (32.92)		355 (32.69)
14%-19.9%	372 (24.94)	101 (24.82)		271 (24.95)
20%-28.9%	369 (24.73)	97 (23.83)		272 (25.05)
29% or more	263 (17.60)	75 (18.43)		188 (17.31)
Treatment site1					0.118
Academic	554 (37.11)	164 (40.29)		390 (35.91)
Non-Academic	939 (62.89)	243 (59.71)		696 (64.09)
Geographic location in United States1					0.003
Midwest	487 (32.62)	128 (31.45)		359 (33.05)
Northeast	341 (22.84)	116 (28.50)		225 (20.72)
South	431 (28.87)	96 (23.59)		335 (30.85)
West	234 (15.67)	67 (16.46)		167 (15.38)
Residence area type1					0.637
Metro	1183 (79.25)	316 (77.61)		867 (79.83)
Rural	31 (2.07)	9 (2.28)		22 (2.02)
Urban	279 (18.68)	82 (20.11)		197 (18.15)
Number of comorbidities3					0.759
0	990 (66.31)	266 (65.36)		724 (66.67)
1	351 (23.51)	101 (24.82)		250 (23.02)
≥ 2	152 (10.18)	40 (9.83)		112 (10.31)
Year of diagnosis					0.753
2004-2009	604 (40.46)	162 (39.8)		442 (40.7)
2010-2014	889 (59.54)	245 (60.2)		644 (59.3)
Grade1,4					0.395
1	50 (3.35)	16 (3.93)		34 (3.13)
2	513 (34.36)	127 (31.20)		386 (35.54)
3	901 (60.35)	254 (62.41)		647 (59.58)
4	29 (1.94)	10 (2.46)		19 (1.75)
AJCC T stage1					0.091
T0	17 (1.14)	3 (0.74)		14 (1.29)
T1	335 (22.44)	80 (19.65)		255 (23.48)
T2	162 (10.85)	37 (9.09)		125 (11.51)
T3	499 (33.42)	160 (39.31)		339 (31.21)
T4	480 (32.20)	127 (31.20)		353 (32.50)
AJCC N stage1					0.006
Positive	1083 (72.54)	319 (78.38)		764 (70.35)
Negative	410 (27.46)	88 (21.62)		322 (29.65)

¹Missing data were imputed by multiple imputation.

²% of adults in the patient's zip code who did not graduate from high school.

³Per Charlson/Deyo et al[14].

⁴Grade 1, well-differentiated; grade 2, moderately differentiated; grade 3, poorly differentiated; grade 4, undifferentiated. P value is calculated by Wilcoxon rank-sum test for continuous variables and χ² test for categorical variables. AJCC: American Joint Committee on Cancer.