301
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Schlottmann F, Gaber C, Strassle PD, Charles AG, Patti MG. Health care disparities in colorectal and esophageal cancer. Am J Surg 2020; 220:415-420. [PMID: 31898942 DOI: 10.1016/j.amjsurg.2019.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND We aimed to identify differences in disparities among patients with a cancer in which screening is widely recommended (colorectal cancer [CRC]) and one in which it is not (esophageal cancer). METHODS A retrospective analysis was performed using 2004-2015 data from the National Cancer Database. Multivariable generalized logistic regression was used to identify potential differences in the effect of disparities in stage at diagnosis. RESULTS A total of 96,524 esophageal cancer patients and 361,187 CRC patients were included. Black patients, longer travel distances, and lower educational attainment were only associated with increased odds of stage IV CRC. While both Medicaid and uninsured patients were more likely to be diagnosed with stage IV esophageal and CRC, the effect was larger among CRC patients. From 2004 to 2015, the rates of stage IV esophageal cancer decreased from 42.0% to 38.2%, while the rates of stage IV CRC increased from 36.9% to 40.8% (p < 0.0001). CONCLUSIONS Disparities are more pronounced in CRC, compared to esophageal cancer. Equity in access to screening and cancer care should be prioritized.
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Affiliation(s)
- Francisco Schlottmann
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA; Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
| | - Charles Gaber
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paula D Strassle
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony G Charles
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Marco G Patti
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA; Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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302
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Beebe-Dimmer JL, Ruterbusch JJ, Harper F, Baird TM, Finlay DG, Rundle A, Pandolfi S, Hastert T, Schwartz KL, Bepler G, Simon MS, Mantey J, Abrams J, Albrecht T, Schwartz AG. Physical activity and quality of life in African American cancer survivors: The Detroit Research on Cancer Survivors study. Cancer 2020; 126:1987-1994. [PMID: 32090322 PMCID: PMC8293666 DOI: 10.1002/cncr.32725] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The benefit of regular exercise in improving cancer outcomes is well established. The American Cancer Society (ACS) released a recommendation that cancer survivors should engage in at least 150 minutes of moderate to vigorous physical activity (PA) per week; however, few report meeting this recommendation. This study examined the patterns and correlates of meeting ACS PA recommendations in the Detroit Research on Cancer Survivors (ROCS) cohort of African American cancer survivors. METHODS Detroit ROCS participants completed baseline and yearly follow-up surveys to update their health and health behaviors, including PA. This study examined participation in PA by select characteristics and reported health-related quality of life (HRQOL) as measured with the Functional Assessment of Cancer Therapy and Patient-Reported Outcomes Measurement Information System instruments. RESULTS Among the first 1500 ROCS participants, 60% reported participating in regular PA, with 24% reporting ≥150 min/wk. Although there were no differences by sex, prostate cancer survivors were the most likely to report participating in regular PA, whereas lung cancer survivors were the least likely (P = .022). Survivors who reported participating in regular PA reported higher HRQOL (P < .001) and lower depression (P = .040). CONCLUSIONS Just 24% of African American cancer survivors reported meeting the ACS guidelines for PA at the baseline, but it was encouraging to see increases in activity over time. Because of the established benefits of regular exercise observed in this study and others, identifying and reducing barriers to regular PA among African American cancer survivors are critical for improving outcomes and minimizing disparities.
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Affiliation(s)
- Jennifer L. Beebe-Dimmer
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - Julie J. Ruterbusch
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - Felicity Harper
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - Tara M. Baird
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - David G. Finlay
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
| | - Andrew Rundle
- Columbia University Mailman School of Public Health, New York New York 10032
| | - Stephanie Pandolfi
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - Theresa Hastert
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - Kendra L. Schwartz
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - Gerold Bepler
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - Michael S. Simon
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - Julia Mantey
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - Judy Abrams
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - Teri Albrecht
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
| | - Ann G. Schwartz
- Barbara Ann Karmanos Cancer Institute, Detroit Michigan 48201
- Wayne State School of Medicine, Detroit Michigan 48201
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303
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Zahnd WE, McLafferty SL, Eberth JM. Multilevel analysis in rural cancer control: A conceptual framework and methodological implications. Prev Med 2019; 129S:105835. [PMID: 31520673 PMCID: PMC7136953 DOI: 10.1016/j.ypmed.2019.105835] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/19/2019] [Accepted: 09/06/2019] [Indexed: 12/22/2022]
Abstract
Rural populations experience a myriad of cancer disparities ranging from lower screening rates to higher cancer mortality rates. These disparities are due in part to individual-level characteristics like age and insurance status, but the physical and social context of rural residence also plays a role. Our objective was two-fold: 1) to develop a multilevel conceptual framework describing how rural residence and relevant micro, macro, and supra-macro factors can be considered in evaluating disparities across the cancer control continuum and 2) to outline the unique considerations of multilevel statistical modeling in rural cancer research. We drew upon several formative frameworks that address the cancer control continuum, population-level disparities, access to health care services, and social inequities. Micro-level factors comprised individual-level characteristics that either predispose or enable individuals to utilize health care services or that may affect their cancer risk. Macro-level factors included social context (e.g. domains of social inequity) and physical context (e.g. access to care). Rural-urban status was considered a macro-level construct spanning both social and physical context, as "rural" is often characterized by sociodemographic characteristics and distance to health care services. Supra-macro-level factors included policies and systems (e.g. public health policies) that may affect cancer disparities. Our conceptual framework can guide researchers in conceptualizing multilevel statistical models to evaluate the independent contributions of rural-urban status on cancer while accounting for important micro, macro, and supra-macro factors. Statistically, potential collinearity of multilevel model predictive variables, model structure, and spatial dependence should also be considered.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Suite 204, Columbia, SC 29210, United States of America.
| | - Sara L McLafferty
- Department of Geography and Geographic Information Science, University of Illinois Urbana-Champaign, 1301 W. Green Street Urbana, IL 61801, United States of America.
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Suite 204, Columbia, SC 29210, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America; Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America.
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304
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Borno HT, Bakke BM, Kaplan C, Hebig-Prophet A, Chao J, Kim YJ, Yeager J, Cinar P, Small E, Boscardin C, Gonzales R. A step towards equitable clinical trial recruitment: a protocol for the development and preliminary testing of an online prostate cancer health information and clinical trial matching tool. Pilot Feasibility Stud 2019; 5:123. [PMID: 31720002 PMCID: PMC6839161 DOI: 10.1186/s40814-019-0516-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022] Open
Abstract
Background Recruitment of a diverse participant pool to cancer clinical trials is an essential component of clinical research as it improves the generalizability of findings. Investigating and piloting novel recruitment strategies that take advantage of ubiquitous digital technologies has become an important component of facilitating broad recruitment and addressing inequities in clinical trial participation. Equitable and inclusive recruitment improves generalizability of clinical trial outcomes, benefiting patients, clinicians, and the research community. The increasing prevalence of online connectivity in the USA and use of the Internet as a resource for medical information provides an opportunity for digital recruitment strategies in cancer clinical trials. This study aims to measure the acceptability, preliminary estimates of efficacy, and feasibility of the Trial Library intervention, an Internet-based cancer clinical trial matching tool. This study will also examine the extent to which the Trial Library website, designed to address the linguistic and literacy needs of broader patient populations, influences patient-initiated conversations with physicians about clinical trial participation. Methods This is a study protocol for a non-randomized, single-arm pilot study. This is a mixed methods study design that utilizes the statistical analysis of quantitative survey data and the qualitative analysis of interview data to assess the participant experience with the Trial Library intervention. This study will examine (1) acceptability as a measure of participant satisfaction with this intervention, (2) preliminary measure of efficacy as a measure of proportion of participants with documented clinical trial discussion in the electronic medical record, and (3) feasibility of the intervention as a measure of duration of clinical visit. Discussion The principles that informed the design of the Trial Library intervention aim to be generalizable to clinical trials across many disease contexts. From the ground up, this intervention is built to be inclusive of the linguistic, literacy, and technological needs of underrepresented patient populations. This study will collect essential preliminary data prior to a multi-site randomized clinical trial of the Trial Library intervention. Trial registration This study has received institutional approval from the Committee of Human Subjects Research at the University of California, San Francisco.
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Affiliation(s)
- Hala T Borno
- 1Department of Medicine, Division of Hematology/Oncology, University of California at San Francisco, 550 16th Street, 6th Floor, Box 3211, Office 6554, San Francisco, CA 94158 USA
| | - Brian M Bakke
- 2School of Medicine, University of California at San Francisco, San Francisco, USA
| | - Celia Kaplan
- 3Department of Medicine, Division of General Internal Medicine, University of California at San Francisco, San Francisco, USA
| | - Anke Hebig-Prophet
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
| | - Jessica Chao
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
| | - Yoon-Ji Kim
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
| | - Jan Yeager
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
| | - Pelin Cinar
- 1Department of Medicine, Division of Hematology/Oncology, University of California at San Francisco, 550 16th Street, 6th Floor, Box 3211, Office 6554, San Francisco, CA 94158 USA
| | - Eric Small
- 1Department of Medicine, Division of Hematology/Oncology, University of California at San Francisco, 550 16th Street, 6th Floor, Box 3211, Office 6554, San Francisco, CA 94158 USA.,3Department of Medicine, Division of General Internal Medicine, University of California at San Francisco, San Francisco, USA
| | - Christy Boscardin
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
| | - Ralph Gonzales
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
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305
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Rajeshuni N, Whittemore AS, Ludwig CA, Mruthyunjaya P, Moshfeghi DM. Racial, Ethnic, and Socioeconomic Disparities in Retinoblastoma Enucleation: A Population-Based Study, SEER 18 2000-2014. Am J Ophthalmol 2019; 207:215-223. [PMID: 31077666 DOI: 10.1016/j.ajo.2019.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/12/2019] [Accepted: 04/26/2019] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the effect of race, ethnicity, and census tract-level composite socioeconomic status (SES) on retinoblastoma enucleation. This study augments Truong and associates, providing multivariate analyses combining sociodemographic and clinical characteristics with more accurate SES measures. We hypothesized that children from nonwhite, Hispanic, and lower socioeconomic backgrounds would have increased adjusted odds of enucleation. DESIGN Retrospective cohort analysis. SETTING Multicenter population-based study using the Surveillance, Epidemiology, and End Results (SEER) 18 Registries. STUDY POPULATION Children aged 18 years and younger diagnosed with retinoblastoma between 2000 and 2014. Subjects were identified using International Classification of Diseases-Oncology (ICD-O) site and morphology codes. MAIN OUTCOME MEASURES Enucleation odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Analysis of 959 retinoblastoma patients revealed that 70.8% were enucleated. Adjusted analyses showed associations between enucleation and Asian (OR 2.00, CI 1.08-3.71) or black (2.42, 1.41-4.16) race, Hispanic ethnicity (1.69, 1.16-2.46), and low SES (1.68, 1.09-2.58). Significantly increased enucleation risk was associated with older age at diagnosis (age 1-2 years 2.55, 1.80-3.61; >2 years 4.88, 2.57-9.25), unilateral disease (5.00, 3.45-7.14), and advanced stage (regional 4.71, 2.51-8.84; distant 3.15, 1.63-6.08). No interactions were observed between race, ethnicity, SES, and stage at diagnosis. Enucleation rates decreased over time across all racial, ethnic, and socioeconomic groups. CONCLUSIONS Children from nonwhite, Hispanic, and lower socioeconomic backgrounds are more likely to receive enucleation. These associations are independent of stage of diagnosis, suggesting larger systemic disparities in retinoblastoma care. The origin of these differences requires further study and attention by clinicians and policy makers.
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Affiliation(s)
- Nitya Rajeshuni
- Stanford University School of Medicine, Stanford, California
| | - Alice S Whittemore
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Cassie A Ludwig
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Darius M Moshfeghi
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California.
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306
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Wiese D, Stroup AM, Crosbie A, Lynch SM, Henry KA. The Impact of Neighborhood Economic and Racial Inequalities on the Spatial Variation of Breast Cancer Survival in New Jersey. Cancer Epidemiol Biomarkers Prev 2019; 28:1958-1967. [PMID: 31649136 DOI: 10.1158/1055-9965.epi-19-0416] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/17/2019] [Accepted: 09/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mapping breast cancer survival can help cancer control programs prioritize efforts with limited resources. We used Bayesian spatial models to identify whether breast cancer survival among patients in New Jersey (NJ) varies spatially after adjusting for key individual (age, stage at diagnosis, molecular subtype, race/ethnicity, marital status, and insurance) and neighborhood measures of poverty and economic inequality [index of concentration at the extremes (ICE)]. METHODS Survival time was calculated for all NJ women diagnosed with invasive breast cancer between 2010 and 2014 and followed to December 31, 2015 (N = 27,078). Nonlinear geoadditive Bayesian models were used to estimate spatial variation in hazard rates and identify geographic areas of higher risk of death from breast cancer. RESULTS Significant geographic differences in breast cancer survival were found in NJ. The geographic variation of hazard rates statewide ranged from 0.71 to 1.42 after adjustment for age and stage, and were attenuated after adjustment for additional individual-level factors (0.87-1.15) and neighborhood measures, including poverty (0.9-1.11) and ICE (0.92-1.09). Neighborhood measures were independently associated with breast cancer survival, but we detected slightly stronger associations between breast cancer survival, and the ICE compared to poverty. CONCLUSIONS The spatial models indicated breast cancer survival disparities are a result of combined individual-level and neighborhood socioeconomic factors. More research is needed to understand the moderating pathways in which neighborhood socioeconomic status influences breast cancer survival. IMPACT More effective health interventions aimed at improving breast cancer survival could be developed if geographic variation were examined more routinely in the context of neighborhood socioeconomic inequalities in addition to individual characteristics.
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Affiliation(s)
- Daniel Wiese
- Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania.
| | - Antoinette M Stroup
- New Jersey State Cancer Registry, Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey.,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey.,Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, Piscataway, New Jersey
| | - Amanda Crosbie
- New Jersey State Cancer Registry, Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey
| | | | - Kevin A Henry
- Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania.,Fox Chase Cancer Center, Philadelphia, Pennsylvania
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307
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Blair CK, Wiggins CL, Nibbe AM, Storlie CB, Prossnitz ER, Royce M, Lomo LC, Hill DA. Obesity and survival among a cohort of breast cancer patients is partially mediated by tumor characteristics. NPJ Breast Cancer 2019; 5:33. [PMID: 31602394 PMCID: PMC6775111 DOI: 10.1038/s41523-019-0128-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/30/2019] [Indexed: 01/03/2023] Open
Abstract
Obesity exerts adverse effects on breast cancer survival, but the means have not been fully elucidated. We evaluated obesity as a contributor to breast cancer survival according to tumor molecular subtypes in a population-based case-cohort study using data from the Surveillance Epidemiology and End Results (SEER) program. We determined whether obese women were more likely to be diagnosed with poor prognosis tumor characteristics and quantified the contribution of obesity to survival. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated via Cox multivariate models. The effect of obesity on survival was evaluated among 859 incident breast cancers (subcohort; 15% random sample; median survival 7.8 years) and 697 deaths from breast cancer (cases; 100% sample). Obese women had a 1.7- and 1.8-fold increased risk of stage III/IV disease and grade 3/4 tumors, respectively. Obese women with Luminal A- and Luminal B-like breast cancer were 1.8 (95% CI 1.3-2.5) and 2.2 (95% CI 0.9-5.0) times more likely to die from their cancer compared to normal weight women. In mediation analyses, the proportion of excess mortality attributable to tumor characteristics was 36.1% overall and 41% and 38% for Luminal A- and Luminal B-like disease, respectively. Obesity was not associated with breast cancer-specific mortality among women who had Her2-overexpressing or triple-negative tumors. Obesity may influence hormone-positive breast cancer-specific mortality in part through fostering poor prognosis tumors. When tumor biology is considered as part of the causal pathway, the public health impact of obesity on breast cancer survival may be greater than previously estimated.
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Affiliation(s)
- Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM USA
| | - Charles L. Wiggins
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM USA
| | - Andrea M. Nibbe
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM USA
| | - Curt B. Storlie
- Department of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Eric R. Prossnitz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM USA
| | - Melanie Royce
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM USA
| | - Lesley C. Lomo
- Department of Pathology, University of Utah, Salt Lake City, UT USA
| | - Deirdre A. Hill
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM USA
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308
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Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, Jemal A, Kramer JL, Siegel RL. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin 2019; 69:363-385. [PMID: 31184787 DOI: 10.3322/caac.21565] [Citation(s) in RCA: 2858] [Impact Index Per Article: 571.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.
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Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | - Ahmedin Jemal
- Surveillance Research, American Cancer Society, Atlanta, Georgia
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Joan L Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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309
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The Effect of Socioeconomic Status on Treatment and Mortality in Non-Small Cell Lung Cancer Patients. Ann Thorac Surg 2019; 109:225-232. [PMID: 31472134 DOI: 10.1016/j.athoracsur.2019.07.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/10/2019] [Accepted: 07/05/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Treatment decisions for patients with non-small cell lung cancer (NSCLC) are based on patient and tumor characteristics, including socioeconomic status (SES) factors. The objective was to assess the contribution of SES factors to treatment and outcomes among patients with stage I NSCLC. METHODS The National Cancer Database was queried for operable patients with stage I NSCLC. Patients were divided into three treatment groups: primary resection (ie, surgery only); nonstandard treatments consisting of chemotherapy with or without radiation; and no therapy. The SES of patients who made up the treatment groups was assessed, and the 5-year survival of all groups was analyzed. RESULTS The cohort included 69,168 patients with stage I NSCLC. Each of these patients had between zero and five SES risk factors. The factors associated with no surgery were low income, nonwhite race, low high school graduation rate, Medicaid or no insurance, rural residence, and distance less than 12.5 miles from treatment facility. Patients with several SES risk factors have linearly increasing odds of undergoing nonstandard treatments and quadratically increasing odds of having no therapy (for patients with five factors, to odds ratio 4.7; 95% confidence interval, 3.44 to 6.30). Surgery alone was associated with significantly longer 5-year survival (71.8%) compared with nonstandard treatments (22.7%) and no therapy (21.8%; P < .001). CONCLUSIONS Socioeconomic status factors increase the risk of undergoing guideline discordant therapy for stage I NSCLC. As the number of SES factors increases, the odds of no therapy rises quadratically whereas the odds of nonstandard treatments rises constantly. The surgery only group had significantly longer survival than the nonstandard treatment and no therapy groups.
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310
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Coughlin SS. A review of social determinants of prostate cancer risk, stage, and survival. Prostate Int 2019; 8:49-54. [PMID: 32647640 PMCID: PMC7335972 DOI: 10.1016/j.prnil.2019.08.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/15/2019] [Indexed: 11/15/2022] Open
Abstract
Social determinants of health that have been examined in relation to prostate cancer incidence, stage at diagnosis, and survival include socioeconomic status (income, education), neighborhood disadvantage, immigration status, social support, and social network. Other social determinants of health include geographic factors such as neighborhood access to health services. Socioeconomic factors influence risk of prostate cancer. Prostate cancer incidence rates tend to be positively associated with socioeconomic status. On the other hand, low socioeconomic status is associated with increased risk of poorer survival. There are well-documented disparities in prostate cancer survival by socioeconomic status, race, education, and census tract-level poverty. The results of this review indicate that social determinants such as poverty, lack of education, immigration status, lack of social support, and social isolation play an important role in prostate cancer stage at diagnosis and survival. To address these social determinants and eliminate cancer disparities, effective interventions that account for the social and environmental contexts in which patients with cancer live and are treated are needed.
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Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
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311
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Yu XQ, Goldsbury D, Yap S, Yap ML, O'Connell DL. Contributions of prognostic factors to socioeconomic disparities in cancer survival: protocol for analysis of a cohort with linked data. BMJ Open 2019; 9:e030248. [PMID: 31427338 PMCID: PMC6825410 DOI: 10.1136/bmjopen-2019-030248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Socioeconomic disparities in cancer survival have been reported in many developed countries, including Australia. Although some international studies have investigated the determinants of these socioeconomic disparities, most previous Australian studies have been descriptive, as only limited relevant data are generally available. Here, we describe a protocol for a study to use data from a large-scale Australian cohort linked with several other health-related databases to investigate several groups of factors associated with socioeconomic disparities in cancer survival in New South Wales (NSW), Australia, and quantify their contributions to the survival disparities. METHODS AND ANALYSIS The Sax Institute's 45 and Up Study participants completed a baseline questionnaire during 2006-2009. Those who were subsequently diagnosed with cancer of the colon, rectum, lung or female breast will be included. This study sample will be identified by linkage with NSW Cancer Registry data for 2006-2013, and their vital status will be determined by linking with cause of death records up to 31 December 2015. The study cohort will be divided into four groups based on each of the individual education level and an area-based socioeconomic measure. The treatment received will be obtained through linking with hospital records and Medicare and pharmaceutical claims data. Cox proportional hazards models will be fitted sequentially to estimate the percentage contributions to overall socioeconomic survival disparities of patient factors, tumour and diagnosis factors, and treatment variables. ETHICS AND DISSEMINATION This research is covered by ethical approval from the NSW Population and Health Services Research Ethics Committee. Results of the study will be disseminated to different interest groups and organisations through scientific conferences, social media and peer-reviewed articles.
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Affiliation(s)
- Xue Qin Yu
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Goldsbury
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Sarsha Yap
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Mei Ling Yap
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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312
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Saini G, Ogden A, McCullough LE, Torres M, Rida P, Aneja R. Disadvantaged neighborhoods and racial disparity in breast cancer outcomes: the biological link. Cancer Causes Control 2019; 30:677-686. [PMID: 31111277 PMCID: PMC7043809 DOI: 10.1007/s10552-019-01180-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
Neighborhoods encompass complex environments comprised of unique economic, physical, and social characteristics that have a profound impact on the residing individual's health and, collectively, on the community's wellbeing. Neighborhood disadvantage (ND) is one of several factors that prominently contributes to racial breast cancer (BC) health disparities in American women. African American (AA) women develop more aggressive breast cancer features, such as triple-negative receptor status and more advanced histologic grade and tumor stage, and suffer worse clinical outcomes than European American (EA) women. While the adverse effects of neighborhood disadvantage on health, including increased risk of cancer and decreased longevity, have recently come into focus, the specific molecular mechanisms by which neighborhood disadvantage increases BC risk and worsens BC outcomes (survivorship, recurrence, mortality) are not fully elucidated. This review illuminates the probable biological links between neighborhood disadvantage and predominantly BC risk, with an emphasis on stress reactivity and inflammation, epigenetics and telomere length in response to adverse neighborhood conditions.
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Affiliation(s)
- Geetanjali Saini
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Angela Ogden
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Mylin Torres
- Department of Radiation Oncology, Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Padmashree Rida
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA.
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313
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Disparities among racial/ethnic groups of patients diagnosed with ependymoma: analyses from the Surveillance, Epidemiology and End Results (SEER) registry. J Neurooncol 2019; 144:43-51. [DOI: 10.1007/s11060-019-03214-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
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314
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Sung JM, Martin JW, Jefferson FA, Sidhom DA, Piranviseh K, Huang M, Nguyen N, Chang J, Ziogas A, Anton-Culver H, Youssef RF. Racial and Socioeconomic Disparities in Bladder Cancer Survival: Analysis of the California Cancer Registry. Clin Genitourin Cancer 2019; 17:e995-e1002. [PMID: 31239240 DOI: 10.1016/j.clgc.2019.05.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/01/2019] [Accepted: 05/20/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE To examine the California Cancer Registry (CCR) for bladder cancer survival disparities based on race, socioeconomic status (SES), and insurance in California patients. PATIENTS AND METHODS The CCR was queried for bladder cancer cases in California from 1988 to 2012. The primary outcome was disease-specific survival (DSS), defined as the time interval from date of diagnosis to date of death from bladder cancer. Survival analyses were performed to determine the prognostic significance of racial and socioeconomic factors. RESULTS A total of 72,452 cases were included (74.5% men, 25.5% women). The median age was 72 years (range, 18-109 years). The racial distribution among the patients was 81% white, 3.8% black, 8.8% Hispanic, 5.2% Asian, and 1.2% from other races. In black patients, tumors presented more frequently with advanced stage and high grade. Medicaid patients tended to be younger and had more advanced-stage, higher-grade tumors compared to patients with Medicare or managed care (P < .0001). Kaplan-Meier analysis demonstrated significantly poorer 5-year DSS in black, low SES, and Medicaid patients (P < .0001). When controlling for stage, grade, age, and gender, multivariate analysis revealed that black race (DSS hazard ratio = 1.295; 95% confidence interval, 1.212-1.384), low SES (DSS hazard ratio = 1.325; 95% confidence interval, 1.259-1.395), and Medicaid insurance (DSS hazard ratio = 1.349; 95% confidence interval, 1.246-1.460) were independent prognostic factors (P < .0001). CONCLUSION An analysis of the CCR demonstrated that black race, low SES, and Medicaid insurance portend poorer DSS. These findings reflect a multifaceted socioeconomic and public health conundrum, and efforts to reduce inequalities should be pursued.
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Affiliation(s)
- John M Sung
- Department of Urology, University of California, Irvine, CA.
| | | | | | | | | | - Melissa Huang
- Department of Urology, University of California, Irvine, CA
| | - Nobel Nguyen
- Department of Urology, University of California, Irvine, CA
| | - Jenny Chang
- Department of Epidemiology, University of California, Irvine, CA
| | - Argyrios Ziogas
- Department of Epidemiology, University of California, Irvine, CA
| | | | - Ramy F Youssef
- Department of Urology, University of California, Irvine, CA
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315
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Rodriguez-Torres SA, McCarthy AM, He W, Ashburner JM, Percac-Lima S. Long-Term Impact of a Culturally Tailored Patient Navigation Program on Disparities in Breast Cancer Screening in Refugee Women After the Program's End. Health Equity 2019; 3:205-210. [PMID: 31106287 PMCID: PMC6524343 DOI: 10.1089/heq.2018.0104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: To examine the long-term effects of a patient navigation (PN) program for mammography screening tailored to refugee women and to assess screening utilization among these women after PN ended. Methods: We assessed the proportion of patients completing mammography screening during the prior 2 years during 2012–2016 for refugee women who had previously received PN compared with that of English-speaking women cared for at the same health center during the same period, both overall and stratifying by age. We used logistic regression to compare screening completion between refugees and English speakers, adjusting for age, race, insurance status, number of clinic visits, and clustering by primary care physician and to test trends in screening over time. Results: In 2012, the year when the funding for PN ceased, among 126 refugee women eligible for breast cancer screening, mammography screening rates were significantly higher among refugees (90.5%, 95% confidence interval [CI]: 83.5–94.7%) than among English speakers (81.9%, 95% CI: 76.2–86.5%, p=0.006). By 2016, screening rates decreased among refugee women (76.5%, 95% CI: 61.6–86.9%, p=0.023) but were not statistically significantly different from those among English-speaking women (80.5%, 95% CI: 74.4–85.3%, p=0.460). Screening prevalence for refugee women remained above the pre-PN program screening levels, and considerably so in women <50 years. Conclusion: The culturally and language-tailored PN program for refugee women appeared to have persistent effects, with refugee women maintaining similar levels of mammography screening to English-speaking patients 5 years after the PN program's end.
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Affiliation(s)
| | - Anne Marie McCarthy
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Wei He
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey M Ashburner
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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316
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Yabroff KR, Gansler T, Wender RC, Cullen KJ, Brawley OW. Minimizing the burden of cancer in the United States: Goals for a high-performing health care system. CA Cancer J Clin 2019; 69:166-183. [PMID: 30786025 DOI: 10.3322/caac.21556] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Between 1991 and 2015, the cancer mortality rate declined dramatically in the United States, reflecting improvements in cancer prevention, screening, treatment, and survivorship care. However, cancer outcomes in the United States vary substantially between populations defined by race/ethnicity, socioeconomic status, health insurance coverage, and geographic area of residence. Many potentially preventable cancer deaths occur in individuals who did not receive effective cancer prevention, screening, treatment, or survivorship care. At the same time, cancer care spending is large and growing, straining national, state, health insurance plans, and family budgets. Indeed, one of the most pressing issues in American medicine is how to ensure that all populations, in every community, derive the benefit from scientific research that has already been completed. Addressing these questions from the perspective of health care delivery is necessary to accelerate the decline in cancer mortality that began in the early 1990s. This article, part of the Cancer Control Blueprint series, describes challenges with the provision of care across the cancer control continuum in the United States. It also identifies goals for a high-performing health system that could reduce disparities and the burden of cancer by promoting the adoption of healthy lifestyles; access to a regular source of primary care; timely access to evidence-based care; patient-centeredness, including effective patient-provider communication; enhanced coordination and communication between providers, including primary care and specialty care providers; and affordability for patients, payers, and society.
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Affiliation(s)
- K Robin Yabroff
- Strategic Director, Surveillance and Health Services Research Program, American Cancer Society Inc, Atlanta, GA
| | - Ted Gansler
- Strategic Director of Pathology Research, American Cancer Society Inc, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society Inc, Atlanta, GA
| | - Kevin J Cullen
- Director, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Otis W Brawley
- Chief Medical and Scientific Officer and Executive Vice President-Research, American Cancer Society Inc, Atlanta, GA
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317
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DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin 2019; 69:211-233. [PMID: 30762872 DOI: 10.3322/caac.21555] [Citation(s) in RCA: 480] [Impact Index Per Article: 96.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the United States, African American/black individuals bear a disproportionate share of the cancer burden, having the highest death rate and the lowest survival rate of any racial or ethnic group for most cancers. To monitor progress in reducing these inequalities, every 3 years the American Cancer Society provides the estimated number of new cancer cases and deaths for blacks in the United States and the most recent data on cancer incidence, mortality, survival, screening, and risk factors using data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics. In 2019, approximately 202,260 new cases of cancer and 73,030 cancer deaths are expected to occur among blacks in the United States. During 2006 through 2015, the overall cancer incidence rate decreased faster in black men than in white men (2.4% vs 1.7% per year), largely due to the more rapid decline in lung cancer. In contrast, the overall cancer incidence rate was stable in black women (compared with a slight increase in white women), reflecting increasing rates for cancers of the breast, uterine corpus, and pancreas juxtaposed with declining trends for cancers of the lung and colorectum. Overall cancer death rates declined faster in blacks than whites among both males (2.6% vs 1.6% per year) and females (1.5% vs 1.3% per year), largely driven by greater declines for cancers of the lung, colorectum, and prostate. Consequently, the excess risk of overall cancer death in blacks compared with whites dropped from 47% in 1990 to 19% in 2016 in men and from 19% in 1990 to 13% in 2016 in women. Moreover, the black-white cancer disparity has been nearly eliminated in men <50 years and women ≥70 years. Twenty-five years of continuous declines in the cancer death rate among black individuals translates to more than 462,000 fewer cancer deaths. Continued progress in reducing disparities will require expanding access to high-quality prevention, early detection, and treatment for all Americans.
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Affiliation(s)
- Carol E DeSantis
- Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Kimberly D Miller
- Senior Associate Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ann Goding Sauer
- Senior Associate Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Scientific Director, Surveillance Research, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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318
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Dasgupta P, Baade PD, Aitken JF, Ralph N, Chambers SK, Dunn J. Geographical Variations in Prostate Cancer Outcomes: A Systematic Review of International Evidence. Front Oncol 2019; 9:238. [PMID: 31024842 PMCID: PMC6463763 DOI: 10.3389/fonc.2019.00238] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/18/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Previous reviews of geographical disparities in the prostate cancer continuum from diagnosis to mortality have identified a consistent pattern of poorer outcomes with increasing residential disadvantage and for rural residents. However, there are no contemporary, systematic reviews summarizing the latest available evidence. Our objective was to systematically review the published international evidence for geographical variations in prostate cancer indicators by residential rurality and disadvantage. Methods: Systematic searches of peer-reviewed articles in English published from 1/1/1998 to 30/06/2018 using PubMed, EMBASE, CINAHL, and Informit databases. Inclusion criteria were: population was adult prostate cancer patients; outcome measure was PSA testing, prostate cancer incidence, stage at diagnosis, access to and use of services, survival, and prostate cancer mortality with quantitative results by residential rurality and/or disadvantage. Studies were critically appraised using a modified Newcastle-Ottawa Scale. Results: Overall 169 studies met the inclusion criteria. Around 50% were assessed as high quality and 50% moderate. Men from disadvantaged areas had consistently lower prostate-specific antigen (PSA) testing and prostate cancer incidence, poorer survival, more advanced disease and a trend toward higher mortality. Although less consistent, predominant patterns by rurality were lower PSA testing, prostate cancer incidence and survival, but higher stage disease and mortality among rural men. Both geographical measures were associated with variations in access and use of prostate cancer-related services for low to high risk disease. Conclusions: This review found substantial evidence that prostate cancer indicators varied by residential location across diverse populations and geographies. While wide variations in study design limited comparisons across studies, our review indicated that internationally, men living in disadvantaged areas, and to a lesser extent more rural areas, face a greater prostate cancer burden. This review highlights the need for a better understanding of the complex social, environmental, and behavioral reasons for these variations, recognizing that, while important, geographical access is not the only issue. Implementing research strategies to help identify these processes and to better understand the central role of disadvantage to variations in health outcome are crucial to inform the development of evidence-based targeted interventions.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Nicholas Ralph
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,St Vincent's Private Hospital, Toowoomba, QLD, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Suzanne Kathleen Chambers
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, WA, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Jeff Dunn
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
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319
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Borno HT, Lichtensztajn DY, Gomez SL, Palmer NR, Ryan CJ. Differential use of medical versus surgical androgen deprivation therapy for patients with metastatic prostate cancer. Cancer 2019; 125:453-462. [PMID: 30444526 PMCID: PMC6340740 DOI: 10.1002/cncr.31826] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/27/2018] [Accepted: 10/01/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Surgical and medical androgen deprivation therapy (ADT) strategies are comparable in their ability to suppress serum testosterone levels as treatment in patients with metastatic prostate cancer but differ with regard to cost and impact on quality of life. Medical ADT is associated with better long-term quality of life due to the flexibility of possible therapy interruption but comes with a higher cumulative cost. In the current study, the authors examined whether surgical ADT (ie, bilateral orchiectomy) was used differentially by race/ethnicity and other social factors. METHODS The authors identified patients with metastatic disease at the time of diagnosis through the California Cancer Registry. The association between race/ethnicity and receipt of surgical ADT was modeled using multivariable Firth logistic regression adjusting for age, Gleason score, prostate-specific antigen level, clinical tumor and lymph node classification, neighborhood socioeconomic status (SES), insurance, marital status, comorbidities, initial treatment (radiotherapy, chemotherapy), location of care, rural/urban area of residence, and year of diagnosis. RESULTS The authors examined a total of 10,675 patients with metastatic prostate cancer, 11.4% of whom were non-Hispanic black, 8.4% of whom were Asian/Pacific Islander, 18.5% of whom were Hispanic/Latino, and 60.5% of whom were non-Hispanic white. In the multivariable model, patients found to be more likely to receive surgical ADT were Hispanic/Latino (odds ratio [OR], 1.32; 95% confidence interval [95% CI], 1.01-1.72), were from a low neighborhood SES (OR, 1.96; 95% CI, 1.34-2.89) or rural area (OR, 1.49; 95% CI, 1.15-1.92), and had Medicaid/public insurance (OR, 2.21; 95% CI, 1.58-3.10). Patients with military/Veterans Affairs insurance were significantly less likely to receive surgical ADT compared with patients with private insurance (OR, 0.34; 95% CI, 0.13-0.88). CONCLUSIONS Race/ethnicity, neighborhood SES, and insurance status appear to be significantly associated with receipt of surgical ADT. Future research will need to characterize other differences in initial treatments among men with advanced prostate cancer based on race/ethnicity and aim to better understand what factors drive the association between surgical ADT among men of Hispanic origin or those from areas with low neighborhood SES.
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Affiliation(s)
- Hala T. Borno
- University of California at San Francisco, Division of Hematology/Oncology
| | | | - Scarlett L. Gomez
- University of California at San Francisco, Department of Epidemiology and Biostatistics
- Cancer Prevention Institute of California
| | - Nynikka R. Palmer
- University of California at San Francisco, Division of General Internal Medicine
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320
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Ren JX, Gong Y, Ling H, Hu X, Shao ZM. Racial/ethnic differences in the outcomes of patients with metastatic breast cancer: contributions of demographic, socioeconomic, tumor and metastatic characteristics. Breast Cancer Res Treat 2019; 173:225-237. [PMID: 30293212 PMCID: PMC6394580 DOI: 10.1007/s10549-018-4956-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 09/03/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE Population-based estimates of racial disparities in metastatic breast cancer are lacking. We quantified the contributions of demographic, socioeconomic, tumor, and metastatic characteristics to racial differences in metastatic breast cancer and characterized the most disproportional subgroup. METHODS Patients diagnosed with metastatic breast cancer between 2010 and 2014 were identified using the Surveillance, Epidemiology, and End Results database. A multivariable Cox proportional hazards model was used to adjust each set of variables. The excess relative risk of cancer-specific and all-cause death in non-Hispanic black (NHB) versus non-Hispanic white women diagnosed with metastatic breast cancer was expressed as a percentage and was stratified by the age at diagnosis. RESULTS We identified 13,066 female patients. NHB women exhibited substantially higher morbidity and mortality than women of other races/ethnicities. The greatest excess mortality risk for NHB women was observed in the young-onset group (18-49 years; hazard ratio: 1.57), followed by the middle-age group (50-64 years; hazard ratio: 1.42); the trend was not significant among the elderly group. Socioeconomic factors stably explained one-half of the excess risk, whereas the contribution of tumor characteristics obviously decreased with age (18-49 years, 40.7%; 50-64 years, 33.9%), and the metastatic pattern accounted for approximately one-tenth of the excess risk. Additionally, the disproportional death burden of NHB women persisted in less aggressive subgroups. CONCLUSIONS By providing a comprehensive assessment of racial differences in the incidence and outcomes of patients with metastatic breast cancer, we urge the implementation of targeted preventive efforts in both the public health and clinical arenas.
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Affiliation(s)
- Jin-Xiao Ren
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Cancer Institute, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong-An Road, Shanghai, 200032, China
| | - Yue Gong
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Cancer Institute, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong-An Road, Shanghai, 200032, China
| | - Hong Ling
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Cancer Institute, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China
| | - Xin Hu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Cancer Institute, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China.
| | - Zhi-Ming Shao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Cancer Institute, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong-An Road, Shanghai, 200032, China.
- Institutes of Biomedical Science, Fudan University, Shanghai, 200032, China.
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321
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Borno H, George DJ, Schnipper LE, Cavalli F, Cerny T, Gillessen S. All Men Are Created Equal: Addressing Disparities in Prostate Cancer Care. Am Soc Clin Oncol Educ Book 2019; 39:302-308. [PMID: 31099647 DOI: 10.1200/edbk_238879] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. By 2030, the number of cancer cases is projected to increase to 24.6 million and the number of cancer deaths, to 13 million. Global data mask the social and health disparities that influence cancer incidence and survival. Inequality in exposure to carcinogens, education, access to quality diagnostic services, and affordable treatments all affect the probability of survival. Worryingly, despite the fact that many cancers could be prevented by stronger public health actions and many others could be largely cured by better access to diagnostics and affordable treatments, the international community has yet to make a substantial move to tackle this challenge. In prostate cancer, studies show that there are geographic and racial/ethnic distribution differences as well as a number of other variables, including environmental factors, limited access to standard cancer treatments, reduced probability to be included in trials, and the financial burden of cancer treatments. Financial burden for the patients can result in poor adherence, increased debt, and poor long-term outcomes. The following article will discuss some of the important causes for disparity in prostate cancer and prostate cancer care, focused on the current situation in the United States, as well as possible remedies to address these causes.
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Affiliation(s)
- Hala Borno
- 1 University of California, San Francisco, CA
| | | | | | - Franco Cavalli
- 4 Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Thomas Cerny
- 5 Kantonsspital St. Gallen, St. Gallen, Switzerland
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322
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Neighborhoods and Breast Cancer Survival: The Case for an Archetype Approach. ENERGY BALANCE AND CANCER 2019. [DOI: 10.1007/978-3-030-18408-7_10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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323
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Examination of a paradox: recurrent metastatic breast cancer incidence decline without improved distant disease survival: 1990-2011. Breast Cancer Res Treat 2018; 174:505-514. [PMID: 30560462 PMCID: PMC6422972 DOI: 10.1007/s10549-018-05090-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/06/2018] [Indexed: 11/24/2022]
Abstract
Purpose Distant relapse metastatic breast cancer (rMBC) incidence and survival are vital measures of breast cancer diagnosis and treatment progress over time. Methods We conducted a retrospective cohort study of stage I–III invasive breast cancer, 1990–2011, follow-up through 2016 [N = 8292, rMBC = 964 (12%)] at a community-based institution. Patient and tumor characteristics (treatment, distant recurrence, vital status) from BC registry data were evaluated. Survival analysis and Cox proportional hazards (HzR) with 95% confidence intervals (95% CI) were calculated using distant recurrence and distant disease-specific survival (DDSS) endpoints. Results Both 5- and 10-year distant relapse (rMBC) declined over time from 1990–1998 to 2005–2011 [11% to 5%, 16% to 8% (p < 0.001)]. Proportionately, HER2 + BC distant relapse decreased 9% and triple negative (HR−/HER2−) increased 8% (p = 0.011). In the Cox model, lower stage [stage I: HzR = 0.08 (0.07, 0.10), stage II: 0.29 (0.25, 0.33)], more recent diagnosis years [1999–2004: HzR = 0.60 (0.51, 0.70), 2005–2011: HzR = 0.44 (0.38, 0.52)], HR+ [HzR = 0.62 (0.53, 0.72)], and age 40+ [HzR = 0.81 (0.67, 0.98)] had decreased rMBC risk. Compared to HR+/HER2− BC, triple-negative BC had increased rMBC risk [HzR = 2.02 (1.61, 2.53)] but HER2+ subtypes did not. HR−, age 70+, > 1, or visceral metastases and stage III disease were associated with worse DDSS. DDSS did not improve over time. Conclusion rMBC incidence declined over time with decreased HER2-positive distant recurrence, a shift to more triple-negative BC and consistently poor distant disease survival.
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Muller C, Lee SM, Barge W, Siddique SM, Berera S, Wideroff G, Tondon R, Chang J, Peterson M, Stoll J, Katona BW, Sussman DA, Melson J, Kupfer SS. Low Referral Rate for Genetic Testing in Racially and Ethnically Diverse Patients Despite Universal Colorectal Cancer Screening. Clin Gastroenterol Hepatol 2018; 16:1911-1918.e2. [PMID: 30130624 PMCID: PMC6866232 DOI: 10.1016/j.cgh.2018.08.038] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/07/2018] [Accepted: 08/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Guidelines recommend that all colorectal tumors be assessed for mismatch repair deficiency, which could increase identification of patients with Lynch syndrome. This is of particular importance for minority populations, in whom hereditary syndromes are under diagnosed. We compared rates and outcomes of testing all tumor samples (universal testing) collected from a racially and ethnically diverse population for features of Lynch syndrome. METHODS We performed a retrospective analysis of colorectal tumors tested from 2012 through 2016 at 4 academic centers. Tumor samples were collected from 767 patients with colorectal cancer (52% non-Hispanic white [NHW], 26% African American, and 17% Hispanic patients). We assessed rates of tumor testing, recommendations for genetic evaluation, rates of attending a genetic evaluation, and performance of germline testing overall and by race/ethnicity. We performed univariate and multivariate regression analyses. RESULTS Overall, 92% of colorectal tumors were analyzed for mismatch repair deficiency without significant differences among races/ethnicities. However, minority patients were significantly less likely to be referred for genetic evaluation (21.2% for NHW patients vs 16.9% for African American patients and 10.9% for Hispanic patients; P = .02). Rates of genetic testing were also lower among minority patients (10.7% for NHW patients vs 6.0% for AA patients and 3.1% for Hispanic patients; P < .01). On multivariate analysis, African American race, older age, and medical center were independently associated with lack of referral for genetic evaluation and genetic testing. CONCLUSION In a retrospective analysis, we found that despite similar rates of colorectal tumor analysis, minority patients are less likely to be recommended for genetic evaluation or to undergo germline testing for Lynch syndrome. Improvements in institutional practices in follow up after tumor testing could reduce barriers to diagnosis of Lynch diagnosis in minorities.
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Affiliation(s)
- Charles Muller
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sang Mee Lee
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | - William Barge
- Division of Digestive Diseases and Nutrition, Rush University, Chicago, Illinois
| | - Shazia M Siddique
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shivali Berera
- Gastroenterology Division, University of Miami, Miami, Florida
| | - Gina Wideroff
- Gastroenterology Division, University of Miami, Miami, Florida
| | - Rashmi Tondon
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy Chang
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Meaghan Peterson
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jessica Stoll
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Bryson W Katona
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Joshua Melson
- Division of Digestive Diseases and Nutrition, Rush University, Chicago, Illinois
| | - Sonia S Kupfer
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois.
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325
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Hall MJ, Morris AM, Sun W. Precision Medicine Versus Population Medicine in Colon Cancer: From Prospects of Prevention, Adjuvant Chemotherapy, and Surveillance. Am Soc Clin Oncol Educ Book 2018; 38:220-230. [PMID: 30231337 DOI: 10.1200/edbk_200961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
With the advances of technologic revolution that provides new insights into human biology, genetics and cancer, as well as advantages of big data which amasses large amounts of information for us to approach cancer treatment and prevention, we are facing challenges of organically combining data from studies based on general population and information from individual testing and setting out precisional recommendations in cancer diagnosis, prevention, and treatment. We are obligated to accelerate the adaptation of new scientific discoveries into effective treatments and prevention for cancer. In this review, we introduce our opinions on bringing knowledge of precision and population medicine together to guide our clinical practice from the prospects of colorectal cancer prevention, stage III colon cancer adjuvant therapy, and postsurgery surveillance.
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Affiliation(s)
- Michael J Hall
- From the Fox Chase Cancer Center, Philadelphia, PA; Stanford University, Stanford, CA; University of Kansas, Kansas City, KS
| | - Arden M Morris
- From the Fox Chase Cancer Center, Philadelphia, PA; Stanford University, Stanford, CA; University of Kansas, Kansas City, KS
| | - Weijing Sun
- From the Fox Chase Cancer Center, Philadelphia, PA; Stanford University, Stanford, CA; University of Kansas, Kansas City, KS
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326
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Miller KD, Goding Sauer A, Ortiz AP, Fedewa SA, Pinheiro PS, Tortolero-Luna G, Martinez-Tyson D, Jemal A, Siegel RL. Cancer Statistics for Hispanics/Latinos, 2018. CA Cancer J Clin 2018; 68:425-445. [PMID: 30285281 DOI: 10.3322/caac.21494] [Citation(s) in RCA: 282] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.8% (57.5 million) of the total population in the continental United States and Hawaii in 2016. In addition, more than 3 million Hispanic Americans live in the US territory of Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanics in the United States based on data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the Centers for Disease Control and Prevention. For the first time, contemporary incidence and mortality rates for Puerto Rico, which has a 99% Hispanic population, are also presented. An estimated 149,100 new cancer cases and 42,700 cancer deaths will occur among Hispanics in the continental United States and Hawaii in 2018. For all cancers combined, Hispanics have 25% lower incidence and 30% lower mortality compared with non-Hispanic whites, although rates of infection-related cancers, such as liver, are up to twice as high in Hispanics. However, these aggregated data mask substantial heterogeneity within the Hispanic population because of variable cancer risk, as exemplified by the substantial differences in the cancer burden between island Puerto Ricans and other US Hispanics. For example, during 2011 to 2015, prostate cancer incidence rates in Puerto Rico (146.6 per 100,000) were 60% higher than those in other US Hispanics combined (91.6 per 100,000) and 44% higher than those in non-Hispanic whites (101.7 per 100,000). Prostate cancer is also the leading cause of cancer death among men in Puerto Rico, accounting for nearly 1 in 6 cancer deaths during 2011-2015, whereas lung cancer is the leading cause of cancer death among other US Hispanic men combined. Variations in cancer risk are driven by differences in exposure to cancer-causing infectious agents and behavioral risk factors as well as the prevalence of screening. Strategies for reducing cancer risk in Hispanic populations include targeted, culturally appropriate interventions for increasing the uptake of preventive services and reducing cancer risk factor prevalence, as well as additional funding for Puerto Rico-specific and subgroup-specific cancer research and surveillance.
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Affiliation(s)
- Kimberly D Miller
- Senior Associate Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Ann Goding Sauer
- Senior Associate Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Ana P Ortiz
- Professor, Epidemiology and Biostatistics, University of Puerto Rico School of Public Health, San Juan, PR
| | - Stacey A Fedewa
- Senior Principal Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Paulo S Pinheiro
- Research Associate Professor, Miller School of Medicine, University of Miami, Miami, FL
| | | | | | - Ahmedin Jemal
- Scientific Vice President, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Scientific Director, Surveillance Research, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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327
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Mehta AJ, Stock S, Gray SW, Nerenz DR, Ayanian JZ, Keating NL. Factors contributing to disparities in mortality among patients with non-small-cell lung cancer. Cancer Med 2018; 7:5832-5842. [PMID: 30264921 PMCID: PMC6246958 DOI: 10.1002/cam4.1796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 08/02/2018] [Accepted: 08/28/2018] [Indexed: 12/31/2022] Open
Abstract
Historically, non-small-cell lung cancer (NSCLC) patients who are non-white, have low incomes, low educational attainment, and non-private insurance have worse survival. We assessed whether differences in survival were attributable to sociodemographic factors, clinical characteristics at diagnosis, or treatments received. We surveyed a multiregional cohort of patients diagnosed with NSCLC from 2003 to 2005 and followed through 2012. We used Cox proportional hazard analyses to estimate the risk of death associated with race/ethnicity, annual income, educational attainment, and insurance status, unadjusted and sequentially adjusting for sociodemographic factors, clinical characteristics, and receipt of surgery, chemotherapy, and radiotherapy. Of 3250 patients, 64% were white, 16% black, 7% Hispanic, and 7% Asian; 36% of patients had incomes <$20 000/y; 23% had not completed high school; and 74% had non-private insurance. In unadjusted analyses, black race, Hispanic ethnicity, income <$60 000/y, not attending college, and not having private insurance were all associated with an increased risk of mortality. Black-white differences were not statistically significant after adjustment for sociodemographic factors, although patients with patients without a high school diploma and patients with incomes <$40 000/y continued to have an increased risk of mortality. Differences by educational attainment were not statistically significant after adjustment for clinical characteristics. Differences by income were not statistically significant after adjustment for clinical characteristics and treatments. Clinical characteristics and treatments received primarily contributed to mortality disparities by race/ethnicity and socioeconomic status in patients with NSCLC. Additional efforts are needed to assure timely diagnosis and use of effective treatment to lessen these disparities.
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Affiliation(s)
- Anish J. Mehta
- Department of MedicineBrigham and Women's HospitalBostonMassachusetts
| | - Shannon Stock
- Department of Mathematics and Computer ScienceCollege of the Holy CrossWorcesterMassachusetts
| | - Stacy W. Gray
- Department of Population SciencesCity of Hope Cancer CenterDuarteCalifornia
| | - David R. Nerenz
- Center for Health Policy and Health Services ResearchHenry Ford Health SystemDetroitMichigan
| | - John Z. Ayanian
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichigan
| | - Nancy L. Keating
- Department of MedicineBrigham and Women's HospitalBostonMassachusetts
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusetts
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Ramamoorthy A, Knepper TC, Merenda C, Mendoza M, McLeod HL, Bull J, Zhang L, Pacanowski M. Demographic Composition of Select Oncologic New Molecular Entities Approved by the FDA Between 2008 and 2017. Clin Pharmacol Ther 2018; 104:940-948. [PMID: 30218447 PMCID: PMC6220929 DOI: 10.1002/cpt.1180] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/06/2018] [Indexed: 01/13/2023]
Abstract
Race, ethnicity, sex, and age are demographic factors that can influence drug exposure and/or response, and can consequently affect treatment outcome. We evaluated demographic subgroup enrollment patterns in new therapeutic products approved by the US Food and Drug Administration (FDA) for the treatment of select cancers-breast, colorectal, lung, and prostate-that have comparative differences in morbidity and/or mortality among some demographic subgroups. In submissions of products approved between 2008 and 2013, participants (n = 22,481) were white (80%), from outside the United States (74%), between 17 and 64 years old (59%), and men (56% and 53%, including and excluding sex-specific indications, respectively). In pivotal trials of products approved between2014 and 2017, participants (n = 3,612) were white (71%), between 17 and 64 years old (61%), and men (48% and 63%, including and excluding sex-specific indications, respectively). The US-relevant minority populations were under-represented. A broader representation of patient subgroups in clinical trials may contribute to better understanding of exposure and/or response variability, and consequently help personalize drug therapy.
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Affiliation(s)
- Anuradha Ramamoorthy
- Office of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and Research (CDER)U.S. Food and Drug Administration (FDA)Silver SpringMarylandUSA
| | | | - Christine Merenda
- Office of Minority HealthOffice of the CommissionerFDASilver Spring, MarylandUSA
| | - Martin Mendoza
- Office of Minority HealthOffice of the CommissionerFDASilver Spring, MarylandUSA
| | | | - Jonca Bull
- Office of Minority HealthOffice of the CommissionerFDASilver Spring, MarylandUSA
- Pharmaceutical Product Development (PPD)LLCBethesdaMarylandUSA
| | - Lei Zhang
- Office of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and Research (CDER)U.S. Food and Drug Administration (FDA)Silver SpringMarylandUSA
- Office of Research and StandardsOffice of Generic DrugsCDERFDASilver Spring, MarylandUSA
| | - Michael Pacanowski
- Office of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and Research (CDER)U.S. Food and Drug Administration (FDA)Silver SpringMarylandUSA
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Nogueira MC, Guerra MR, Cintra JRD, Corrêa CSL, Fayer VA, Bustamante-Teixeira MT. Disparidade racial na sobrevivência em 10 anos para o câncer de mama: uma análise de mediação usando abordagem de respostas potenciais. CAD SAUDE PUBLICA 2018; 34:e00211717. [DOI: 10.1590/0102-311x00211717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/02/2018] [Indexed: 01/23/2023] Open
Abstract
Os objetivos foram investigar a associação entre raça/cor e a sobrevivência em 10 anos de mulheres com câncer de mama e o papel do estadiamento como mediador. Coorte hospitalar com 481 mulheres com câncer invasivo de mama, diagnosticadas entre 2003 e 2005. Foram feitas comparações entre mulheres brancas e negras quanto às características sociodemográficas e ao estadiamento, usando o teste qui-quadrado, e à sobrevivência em 10 anos, usando os métodos de Kaplan-Meier e regressão de Cox. Foram estimados para a variável raça/cor efeitos diretos e indiretos, mediados pelo estadiamento, com ajuste para a condição social da área de residência e idade, utilizando o modelo de respostas potenciais (contrafactual) e regressão múltipla de Cox. As mulheres negras residiam em setores censitários de menor renda, eram usuárias do setor público em maior proporção e foram diagnosticadas com estadiamentos mais avançados. A sobrevivência específica em 10 anos foi de 64,3% (IC95%: 60,0; 68,9), com diferença significativa entre brancas (69,5%; IC95%: 64,8; 74,6) e negras (44%; IC95%: 35,2; 55,1). Nos modelos múltiplos, ajustados para renda e idade, as negras tiveram pior prognóstico (HR = 2,09; IC95%: 1,76; 2,51), e a proporção mediada pelo estadiamento foi de 40% (IC95%: 37; 42). Há disparidade racial na sobrevivência do câncer de mama em 10 anos, mediada principalmente pelo estadiamento mais avançado da doença nas mulheres negras. Isso aponta para a necessidade de ampliar a cobertura e a qualidade do programa de rastreamento dessa doença e facilitar o acesso ao diagnóstico e tratamento precoces, com vistas à redução da iniquidade racial.
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330
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Ren X, Ghassemi P, Kanaan YM, Naab T, Copeland RL, Dewitty RL, Kim I, Strobl JS, Agah M. Kernel-Based Microfluidic Constriction Assay for Tumor Sample Identification. ACS Sens 2018; 3:1510-1521. [PMID: 29979037 DOI: 10.1021/acssensors.8b00301] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A high-throughput multiconstriction microfluidic channels device can distinguish human breast cancer cell lines (MDA-MB-231, HCC-1806, MCF-7) from immortalized breast cells (MCF-10A) with a confidence level of ∼81-85% at a rate of 50-70 cells/min based on velocity increment differences through multiconstriction channels aligned in series. The results are likely related to the deformability differences between nonmalignant and malignant breast cells. The data were analyzed by the methods/algorithms of Ridge, nonnegative garrote on kernel machine (NGK), and Lasso using high-dimensional variables, including the cell sizes, velocities, and velocity increments. In kernel learning based methods, the prediction values of 10-fold cross-validations are used to represent the difference between two groups of data, where a value of 100% indicates the two groups are completely distinct and identifiable. The prediction value is used to represent the difference between two groups using the established algorithm classifier from high-dimensional variables. These methods were applied to heterogeneous cell populations prepared using primary tumor and adjacent normal tissue obtained from two patients. Primary breast cancer cells were distinguished from patient-matched adjacent normal cells with a prediction ratio of 70.07%-75.96% by the NGK method. Thus, this high-throughput multiconstriction microfluidic device together with the kernel learning method can be used to perturb and analyze the biomechanical status of cells obtained from small primary tumor biopsy samples. The resultant biomechanical velocity signatures identify malignancy and provide a new marker for evaluation in risk assessment.
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Affiliation(s)
- Xiang Ren
- The Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, Virginia 24061, United States
| | - Parham Ghassemi
- The Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, Virginia 24061, United States
| | | | | | | | - Robert L. Dewitty
- Howard University
Hospital, Providence Hospital, Washington, DC 20017, United States
| | - Inyoung Kim
- Department of Statistics, Virginia Tech, Blacksburg, Virginia 24061, United States
| | - Jeannine S. Strobl
- The Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, Virginia 24061, United States
| | - Masoud Agah
- The Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, Virginia 24061, United States
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331
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McDonagh PR, Slade AN, Anderson J, Burton W, Fields EC. Racial differences in responses to the NCCN Distress Thermometer and Problem List: Evidence from a radiation oncology clinic. Psychooncology 2018; 27:2513-2516. [PMID: 30067307 DOI: 10.1002/pon.4846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Philip Reed McDonagh
- Massey Cancer Center, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Justin Anderson
- Massey Cancer Center, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Whitney Burton
- Massey Cancer Center, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Emma C Fields
- Massey Cancer Center, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
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332
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Wang MX, Ren JT, Tang LY, Ren ZF. Molecular features in young vs elderly breast cancer patients and the impacts on survival disparities by age at diagnosis. Cancer Med 2018; 7:3269-3277. [PMID: 29761914 PMCID: PMC6051220 DOI: 10.1002/cam4.1544] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/03/2018] [Accepted: 04/15/2018] [Indexed: 01/02/2023] Open
Abstract
Young and elderly breast cancer patients are more likely to have a poorer outcome than middle‐aged patients. The intrinsic molecular features for this disparity are unclear. We obtained data from the Cancer Genome Atlas (TCGA) on May 15, 2017 to test the potential mediation effects of the molecular features on the association between age and prognosis with a four‐step approach. The relative contributions of the molecular features (PAM50 subtype, risk stratification, DNAm age, and mutations in TP53,PIK3CA,MLL3,CDH1,GATA3, and MAP3K1) to age disparities in survival were estimated by Cox proportional hazard models with or without the features. Young patients were significantly more likely to have basal‐like subtype, GATA3 mutations, and younger DNA methylation (DNAm) age than middle‐aged patients (P < .05). Both the young and elderly patients had a significantly increased risk of breast cancer recurrence after adjusted by race, tumor size, and node status (Hazard ratio [HR] (95% confidence interval [CI]): 2.81 [1.44, 5.45], 2.37 [1.45, 3.89], respectively). This increased risk was weakened in the young patients after further adjustments in the molecular features, particularly basal‐like subtype, GATA3 mutations, and DNAm age (HR [95%CI]: 1.87 [0.81, 4.32]), resulting in 33.5% decreased risk of recurrence. Meanwhile, the adjustments of the molecular features did not alter the recurrence risk for the elderly patients. Compared with middle‐aged patients of breast cancer, poorer prognosis of elderly patients may be caused by aging, while poorer prognosis of young patients was probably mediated through intrinsic characteristics, such as basal‐like subtype, GATA3 mutations, and DNAm age of the cancerous tissues.
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Affiliation(s)
- Mei-Xia Wang
- The School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jun-Ting Ren
- The School of Public Health, Sun Yat-sen University, Guangzhou, China.,Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lu-Ying Tang
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ze-Fang Ren
- The School of Public Health, Sun Yat-sen University, Guangzhou, China
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333
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Wallner LP, Griggs JJ. Advancing the Science of Cancer Health Disparities Research. J Clin Oncol 2018; 36:1-3. [DOI: 10.1200/jco.2017.76.0496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lauren P. Wallner
- Lauren P. Wallner and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI
| | - Jennifer J. Griggs
- Lauren P. Wallner and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI
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334
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Active Surveillance in African-Americans. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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