Studies in various cancer types suggest differences in treatment allocation between male and female patients, with potential impact on survival. To investigate differences in curative treatment allocation between males and females with potentially curable gastroesophageal cancer, a research team led by Prof. Mark van Berge Henegouwen studied a national cohort consisting of 27,496 patients diagnosed between 2006 and 2018.
Sex differences in tumor localization
For both types of esophageal cancer, tumors were more often located in the distal esophagus in male patients, as compared to the mid esophagus in females. For gastric cancer, tumors arising in males were more often located in the fundus, as compared to the antrum in females. Furthermore, female patients were more likely to have poorly differentiated and diffuse-type gastric cancers. This finding underscores the importance of gender-sensitive medicine and the need to conduct further research to understand the biological and molecular differences underlying sex disparities in oncology.
Concerning disparities
The researchers discovered concerning disparities in treatment allocation. Older females (>70 years) with esophageal adenocarcinoma (EAC) were less frequently allocated to curative treatment than males (62% of males vs. 50% of females). This difference remained significant even after adjusting for various confounding factors, raising questions about potential unconscious biases and stereotyping influencing treatment decisions. “It could be that stereotypes related to frailty and protection of older female patients may contribute to these disparities,” says first author Dr. Marianne Kalff, an AIOS Radiology at Amsterdam UMC Cancer Center Amsterdam.
Differences in survival outcome
The study found differences in survival outcomes as well. Female patients with EAC and esophageal squamous cell carcinoma (ESCC) who were allocated to curative treatment demonstrated superior 5-year relative survival compared to their male counterparts. However, for gastric adenocarcinoma (GAC), survival outcomes were comparable between male and female patients. Adjusted survival analysis showed that treated female patients with EAC had a relative excess risk of death of 0.88 (95% CI 0.80–0.96), and for ESCC, it was 0.82 (95% CI 0.75–0.91) compared to male patients.
“The findings of this study emphasize the need to address sex disparities in the treatment and survival of gastroesophageal cancer,” says Dr. Kalff. “One way to ensure equitable access to curative treatment would be to develop treatment algorithms that consider individual patient characteristics rather than relying on gender-based assumptions.”
Addressing sex disparities in cancer care
Addressing sex disparities requires a multidimensional approach, involving awareness, education, and evidence-based interventions aimed at eliminating unconscious biases and ensuring equitable access to care for all patients, regardless of their sex. “We also need to understand the relative contribution of both patients’ preferences and physicians’ unconscious bias better,” says Dr. Kalff. “Treatment strategies have to be improved to that assure that curative treatment options are not missed, irrespective of sex and gender.”
For more info contact Dr. Marianne Kalff, or read the publication:
Marianne C. Kalff, M.C., et a;. (2023) Sex differences in treatment allocation and survival of potentially curable gastroesophageal cancer: A population-based study. European Journal of Cancer 187,p114-123. https://doi.org/10.1016/j.ejca.2023.04.002.
People involved at Cancer Center Amsterdam
Marianne C. Kalff
Willemieke P.M. Dijksterhuis
Rob H.A. Verhoeven
Hanneke W.M. van Laarhoven
Suzanne S. Gisbertz
Mark I. van Berge Henegouwen
Text by Laura Roy.
This article was created for Cancer Center Amsterdam.
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