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Keirns DL, Verplancke K, McMahon K, Eaton V, Silberstein P. Demographic differences in early vs. late-stage laryngeal squamous cell carcinoma. Am J Otolaryngol 2024; 45:104282. [PMID: 38604102 DOI: 10.1016/j.amjoto.2024.104282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE This study aims to evaluate how various demographic factors impact the stage at diagnosis and, therefore, prognosis of laryngeal cancer. MATERIALS AND METHODS Using the National Cancer Database, 96,409 patients were diagnosed with laryngeal squamous cell carcinoma between 2004 and 2020. Early (stage 0 or I) vs. late-stage (stage IV) cancers were compared based on demographic variables utilizing Chi-square and multivariate analysis with a significance of p < 0.05. RESULTS Female, Black, and generally older patients were more likely to have late-stage cancer than their counterparts. When compared with a community cancer program, patients treated at other facility types were more likely to be diagnosed late. Patients with private insurance, Medicare, or other government insurance were all less likely to have late-stage cancer compared to patients without insurance. Compared to patients in the lowest median household income quartile, patients in the third quartile and fourth quartile were diagnosed earlier. Patients living in an area with the lowest level of high school degree attainment were most likely to be diagnosed late. Living in a more populous area was associated with a lower chance of being diagnosed late. Increasing Charlson-Deyo Score was associated with a stronger likelihood of being diagnosed at a later stage. CONCLUSION Patients who are female, Black, uninsured, have a low household income, live in less populated and less educated areas, are treated at non-community cancer programs, and have more comorbid conditions have later stage diagnoses. This data contributes to understanding inequities in healthcare.
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Affiliation(s)
- Darby L Keirns
- Creighton University School of Medicine, Omaha, NE, USA.
| | | | - Kevin McMahon
- Creighton University School of Medicine, Omaha, NE, USA
| | - Vincent Eaton
- Creighton University School of Medicine, Omaha, NE, USA
| | - Peter Silberstein
- Department of Medicine, Hematology and Oncology, School of Medicine, Creighton University, Omaha, NE, USA
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Cho S, Lee K. Association between insurance type and suicide-related behavior among US adults: The impact of the Affordable Care Act. Psychiatry Res 2024; 333:115714. [PMID: 38219348 DOI: 10.1016/j.psychres.2024.115714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024]
Abstract
This study examined the association between insurance type and suicidal ideation and attempts among adults in the United States, incorporating a comparative analysis of the pre- and post-Affordable Care Act (ACA) periods. We used a nationally representative, cross-sectional, population-based survey of individuals aged 18 years and older from the 2010-2019 National Survey on Drug Use and Health. The higher rates of suicidal ideation and attempts among Medicaid and uninsured groups compared with those with private insurance. After implementation of the ACA policy, the difference-in-differences analysis showed a significantly reduced risk of suicide in the Medicare group compared with the privately insured group, with no significant differences observed in the other groups. These findings highlight the importance of improving access to mental health services, particularly for those with lower levels of insurance coverage, such as Medicaid and Medicare.
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Affiliation(s)
- Seungwon Cho
- Department of Psychiatry, Hanyang Universtiy Medical Center, Seoul, Republic of Korea; Department of Health Policy and Management, Graduate School of Public Health, Hanyang University, Seoul, Republic of Korea
| | - Kounseok Lee
- Department of Psychiatry, Hanyang Universtiy Medical Center, Seoul, Republic of Korea; Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Republic of Korea.
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Baek JW, Nam AR, Kim K, Kim PH. Dualistic Effects of PRKAR1A as a Potential Anticancer Target in Cancer Cells and Cancer-Derived Stem Cells. Int J Mol Sci 2024; 25:2876. [PMID: 38474121 DOI: 10.3390/ijms25052876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
The integration of innovative medical technologies and interdisciplinary collaboration could improve the treatment of cancer, a globally prevalent and often deadly disease. Despite recent advancements, current cancer therapies fail to specifically address recurrence and target cancer stem cells (CSCs), which contribute to relapse. In this study, we utilized three types of cancer cells, from which three types of CSCs were further derived, to conduct a proteomic analysis. Additionally, shared cell surface biomarkers were identified as potential targets for a comprehensive treatment strategy. The selected biomarkers were evaluated through short hairpin RNA treatment, which revealed contrasting functions in cancer cells and CSCs. Knockdown of the identified proteins revealed that they regulate the epithelial-mesenchymal transition (EMT) and stemness via the ERK signaling pathway. Resistance to anticancer agents was consequently reduced, ultimately enhancing the overall anticancer effects of the treatment. Additionally, the significance of these biomarkers in clinical patient outcomes was confirmed using bioinformatics. Our study suggests a novel cancer treatment strategy that addresses the limitations of current anticancer therapies.
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Affiliation(s)
- Joong-Won Baek
- Department of Biomedical Laboratory Science, Konyang University, Daejeon 35365, Republic of Korea
| | - A-Reum Nam
- Department of Veterinary Medicine, Seoul National University, Seoul 08826, Republic of Korea
| | - Kyunggon Kim
- Department of Convergence Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Pyung-Hwan Kim
- Department of Biomedical Laboratory Science, Konyang University, Daejeon 35365, Republic of Korea
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Fuzzell L, Lake P, Brownstein NC, Fontenot HB, Whitmer A, Michel A, McIntyre M, Rossi SL, Kajtezovic S, Vadaparampil ST, Perkins R. Examining the perceived impact of the COVID-19 pandemic on cervical cancer screening practices among clinicians practicing in Federally Qualified Health Centers: A mixed methods study. eLife 2023; 12:e86358. [PMID: 37664989 PMCID: PMC10476963 DOI: 10.7554/elife.86358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Background The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed methods study we explored perceived pandemic-related practice changes to cervical cancer screenings in federally qualified health centers (FQHCs). Methods Between October 2021 and June 2022, we conducted a national web survey of clinicians (physicians and advanced practice providers) who performed cervical cancer screening in FQHCs in the United States during the post-acute phase of the COVID-19 pandemic, along with a sub-set of qualitative interviews via video conference, to examine perceived changes in cervical cancer screening practices during the pandemic. Results A total of 148 clinicians completed surveys; a subset (n=13) completed qualitative interviews. Most (86%) reported reduced cervical cancer screening early in the pandemic, and 28% reported continued reduction in services at the time of survey completion (October 2021- July 2022). Nearly half (45%) reported staff shortages impacting their ability to screen or track patients. Compared to clinicians in Obstetrics/Gynecology/Women's health, those in family medicine and other specialties more often reported reduced screening compared to pre-pandemic. Most (92%) felt that screening using HPV self-sampling would be very or somewhat helpful to address screening backlogs. Qualitative interviews highlighted the impacts of staff shortages and strategies for improvement. Conclusions Findings highlight that in late 2021 and early 2022, many clinicians in FQHCs reported reduced cervical cancer screening and of pandemic-related staffing shortages impacting screening and follow-up. If not addressed, reduced screenings among underserved populations could worsen cervical cancer disparities in the future. Funding This study was funded by the American Cancer Society, who had no role in the study's design, conduct, or reporting.
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Affiliation(s)
- Lindsay Fuzzell
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Paige Lake
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Naomi C Brownstein
- Medical University of South Carolina, Public Health SciencesCharlestonUnited States
| | - Holly B Fontenot
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - Ashley Whitmer
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Alexandra Michel
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - McKenzie McIntyre
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Sarah L Rossi
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| | - Sidika Kajtezovic
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
- H. Lee Moffitt Cancer Center & Research Institute, Office of Community Outreach, Engagement, and EquityTampaUnited States
| | - Rebecca Perkins
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
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Phillips JD, Fay KA, Wakeam E, Graham NJ, Godfrey CM, Marmor HN, Grogan EL, Meguid RA, Madsen HJ, Stuart CM, Sachdeva UM, Wang D, Abou Chaar MK, Blackmon SH, Maeder ME, Emond JA, Hasson RM, Millington TM, Finley DJ. Food Deserts Increase Readmission After Esophagectomy for Cancer: A Multi-institutional Study. Ann Thorac Surg 2023; 116:246-253. [PMID: 37080374 PMCID: PMC10631468 DOI: 10.1016/j.athoracsur.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/24/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Food deserts are low-income census tracts with poor access to supermarkets and are associated with worse outcomes in breast, colon, and a small number of esophageal cancer patients. This study investigated residency in food deserts on readmission rates in a multi-institutional cohort of esophageal cancer patients undergoing trimodality therapy. METHODS A retrospective review of patients who underwent trimodality therapy at 6 high-volume institutions from January 2015 to July 2019 was performed. Food desert status was defined by the United States Department of Agriculture by patient ZIP Code. The primary outcome was 30-day readmission after esophagectomy. Multilevel, multivariable logistic regression was used to model readmission on food desert status adjusted for diabetes, insurance type, length of stay, and any complication, treating the institution as a random factor. RESULTS Of the 453 records evaluated, 425 were included in the analysis. Seventy-three patients (17.4%) resided in a food desert. Univariate analysis demonstrated food desert patients had significantly increased 30-day readmission. No differences were seen in length of stay, complications, or 30-day mortality. In the adjusted logistic regression model, residing in a food desert remained a significant risk factor for readmission (odds ratio, 2.11; 95% CI, 1.07-4.15). There were no differences in 30-day, 90-day, or 1-year mortality based on food desert status, although readmission was associated with worse 90-day and 1-year mortality. CONCLUSIONS Food desert residence was associated with 30-day readmission after esophagectomy in patients undergoing trimodality treatment for esophageal cancer in this multi-institutional population. Identification of patients residing in a food desert may allow surgeons to focus preventative interventions during treatment and postoperatively to improve outcomes.
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Affiliation(s)
- Joseph D Phillips
- Section of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Kayla A Fay
- Section of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Elliot Wakeam
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Caroline M Godfrey
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hannah N Marmor
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric L Grogan
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A Meguid
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Helen J Madsen
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Christina M Stuart
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Uma M Sachdeva
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Danny Wang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Matthew E Maeder
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jennifer A Emond
- Department of Biomedical Data Sciences, Geisel School of Medicine, Hanover, New Hampshire
| | - Rian M Hasson
- Section of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Timothy M Millington
- Section of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - David J Finley
- Section of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Verplancke KB, Keirns DL, McMahon K, Creech ZA, Truong GT, Silberstein PT, Dahl MB. Association Between Demographic and Socioeconomic Factors and Diagnosis of Advanced Non-small Cell Lung Cancer: An Analysis of the National Cancer Database. Cureus 2023; 15:e44351. [PMID: 37779816 PMCID: PMC10540479 DOI: 10.7759/cureus.44351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Lung cancer is a prevalent and potentially lethal cancer. The stage at initial presentation for diagnosis predicts mortality and helps to guide treatment options. Thus, it is critical to determine what factors impact the stage of cancer at diagnosis. This study sought to determine if certain socioeconomic and demographic factors are associated with receiving an early (Stage 0-I) or advanced (Stage IV) diagnosis of non-small cell lung cancer (NSCLC). Methods Using the National Cancer Database (NCDB), 1,149,539 patients were identified as having an NCDB Analytic Stage Group diagnosis of Stage 0-I (early) versus Stage IV (advanced) NSCLC between 2004 and 2018. Patients with early and delayed diagnoses were compared based on specific characteristics including sex, race, ethnicity, number of comorbid conditions, insurance status, median annual income, level of education, geographic location, and reporting facility. Using IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York, United States), the data underwent analysis using binary multivariate logistic regression, chi-square analyses, and one-way ANOVA. Results Factors associated with an advanced diagnosis of NSCLC include being male, Black, Native American, or Hispanic. Compared to patients with at least one comorbid condition, those without comorbid conditions are more likely to present with advanced disease. Patients with private insurance, Medicaid, Medicare, or other government insurance are all less likely to present with advanced-stage cancer than patients without insurance. Compared to patients in the lowest median household income quartile, those in the second and fourth quartiles are diagnosed earlier. Patients living in areas where a higher proportion of residents lack a high school diploma are more likely to present with advanced NSCLC. Additionally, living in the Midwest and Western United States and presenting to Community Cancer programs are associated with advanced disease at initial presentation. Conclusions Factors that were associated with the advanced presentation of NSCLC included being male, Black, Native American, or Hispanic, having a lack of comorbid conditions or insurance, earning a lower median annual income, and living in a zip code where a higher proportion of residents lack a high school diploma. Additionally, residing in the Midwest and Western United States and seeking care at Community Cancer programs were associated with advanced disease at initial presentation. Understanding that certain socioeconomic and demographic factors impact the stage at initial diagnosis of NSCLC can allow for targeted intervention strategies aimed at the most at-risk individuals, areas, and facilities.
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Affiliation(s)
| | | | - Kevin McMahon
- School of Medicine, Creighton University, Omaha, USA
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Asare M, Elizondo A, Dwumfour-Poku M, Mena C, Gutierrez M, Mamudu HM. Intervention to Increase Cervical Cancer Screening Behavior among Medically Underserved Women: Effectiveness of 3R Communication Model. Healthcare (Basel) 2023; 11:healthcare11091323. [PMID: 37174865 PMCID: PMC10178119 DOI: 10.3390/healthcare11091323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Human Papillomavirus (HPV) self-sampling has the potential to increase Cervical Cancer Screening (CCS) and reduce the cervical cancer burden in Medically Underserved Women (MUW). However, interventions promoting self-sampling are limited. We examined the effectiveness of an intervention study in increasing CCS among MUW. We conducted a quasi-experimental intervention study. A face-to-face verbal approach was used to recruit MUW (n = 83, mean age 48.57 ± 11.02) living in a small city in the US. Behavioral intervention based on reframing, reprioritizing, and reforming (3R model) was used to educate the women about CCS in a group format. The women (n = 83) completed pre-and post-intervention assessments, and 10 of them were invited for follow-up interviews. The primary outcome was CCS uptake. Mixed methods analyses were conducted using a t-test for the primary outcome, PROCESS for mediation analysis, and NVivo for interview data. The majority of women (75%) completed self-testing. High-risk HPV among women was 11%, and of those, 57% followed up with physicians for care. We found that the significant increase in the women's post-intervention screening behaviors was mediated by the increase in knowledge (Indirect Effect [IE] = 0.1314; 95% CI, 0.0104, 0.4079) and attitude (IE = 0.2167; 95% CI, 0.0291, 0.6050) scores, (p < 0.001). Interview analyses offered further explanations why MUW found the intervention messages acceptable (encourages proactive behavior), feasible (simple and easy to understand), and appropriate (helpful and informative). Barriers, including lack of trust and fear of results, were identified. The findings suggest that an intervention that combines the 3R model and self-sampling may increase CCS among MUW.
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Affiliation(s)
- Matthew Asare
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Anjelica Elizondo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Mina Dwumfour-Poku
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Carlos Mena
- North American University, Stafford, TX 77477, USA
| | - Mariela Gutierrez
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Hadii M Mamudu
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson City, TN 37614, USA
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Mohammed S, Awan OA. Fostering Cultural Diversity in Radiology Departments: Tips and Insights. Acad Radiol 2023; 30:1007-1009. [PMID: 37059493 DOI: 10.1016/j.acra.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 04/16/2023]
Affiliation(s)
- Sharon Mohammed
- Memorial Sloan Kettering Cancer Center (S.M.), West Harrison, New York
| | - Omer A Awan
- University of Maryland School of Medicine (O.A.A.), 655 W Baltimore Street, Baltimore, Maryland 21201.
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Kim G. Examining Diversity: a Content Analysis of Cancer Depictions on Primetime Scripted Television. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1842-1848. [PMID: 34142356 PMCID: PMC9681682 DOI: 10.1007/s13187-021-02050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Abstract
Entertainment programming provides a unique opportunity for cancer education, particularly for higher risk racial and ethnic minority groups. Cultural relevancy is key to quality narrative cancer communication, and minorities often prefer media content produced by and featuring members of their own cultural in-group. However, little is known about whether cancer depictions or the television programs they appear in are culturally diverse. Using media content analysis, this study aims to assess the cultural diversity of cancer depictions on primetime scripted television to reveal opportunities to improve cancer education through entertainment. Indicators used to assess cultural diversity at the program level and depiction levels were collected. Out of 111 television programs, 10 (9.01%) programs mentioned cancer, from which 37 cancer depictions were identified. However, the majority of cancer depictions involved White patients and White health providers. Depictions of coping and treatment also dominated with less than 10% of depictions discussing cancer prevention. These patterns reveal a missed opportunity in existing cancer narratives on primetime scripted television and a lack of representation of cultural, social, and environmental factors that affect the health of minority communities, who need to hear these messages the most.
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Affiliation(s)
- Grace Kim
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles Young Drive South, Los Angeles, CA, 90095, USA.
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Kazzi B, Chino F, Kazzi B, Jain B, Tian S, Paguio JA, Yao JS, Muralidhar V, Mahal BA, Nguyen PL, Sanford NN, Dee EC. Shared burden: the association between cancer diagnosis, financial toxicity, and healthcare cost-related coping mechanisms by family members of non-elderly patients in the USA. Support Care Cancer 2022; 30:8905-8917. [PMID: 35877007 DOI: 10.1007/s00520-022-07234-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/14/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE There has been little research on the healthcare cost-related coping mechanisms of families of patients with cancer. Therefore, we assessed the association between a cancer diagnosis and the healthcare cost-related coping mechanisms of participant family members through their decision to forego or delay seeking medical care, one of the manifestations of financial toxicity. METHODS Using data from the National Health Interview Survey (NHIS) between 2000 and 2018, sample weight-adjusted prevalence was calculated and multivariable logistic regressions defined adjusted odds ratios (aORs) for participant family members who needed but did not get medical care or who delayed seeking medical care due to cost in the past 12 months, adjusting for relevant sociodemographic covariates, including participant history of cancer (yes vs. no) and participant age (18-45 vs. 46-64 years old). The analysis of family members foregoing or delaying medical care was repeated using a cancer diagnosis * age interaction term. RESULTS Participants with cancer were more likely than those without a history of cancer to report family members delaying (19.63% vs. 16.31%, P < 0.001) or foregoing (14.53% vs. 12.35%, P = 0.001) medical care. Participants with cancer in the 18 to 45 years old age range were more likely to report family members delaying (pinteraction = 0.028) or foregoing (pinteraction < 0.001) medical care. Other factors associated with cost-related coping mechanisms undertaken by the participants' family members included female sex, non-married status, poorer health status, lack of health insurance coverage, and lower household income. CONCLUSION A cancer diagnosis may be associated with familial healthcare cost-related coping mechanisms, one of the manifestations of financial toxicity. This is seen through delayed/omitted medical care of family members of people with a history of cancer, an association that may be stronger among young adult cancer survivors. These findings underscore the need to further explore how financial toxicity associated with a cancer diagnosis can affect patients' family members and to design interventions to mitigate healthcare cost-related coping mechanisms.
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Affiliation(s)
- Bahaa Kazzi
- Department of Biology, Emory University, Atlanta, GA, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 02446, USA
| | - Brigitte Kazzi
- Department of Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bhav Jain
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sibo Tian
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph A Paguio
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - J Seth Yao
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, 2280 Inwood Road, Dallas, TX, 75235, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 02446, USA.
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Cherston C, Yoh K, Huang Y, Melamed A, Gamble CR, Prabhu VS, Li Y, Hershman DL, Wright JD. Relative importance of individual insurance status and hospital payer mix on survival for women with cervical cancer. Gynecol Oncol 2022; 166:552-560. [PMID: 35787803 DOI: 10.1016/j.ygyno.2022.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the relative contributions of individual insurance status and hospital payer mix (safety net status) to quality of care and survival for patients with cervical cancer. METHODS We used the National Cancer Database to identify patients with cervical cancer diagnosed from 2004 to 2017. Patients were classified by insurance (uninsured/Medicaid/private/Medicare/other) and hospitals were grouped into quartiles based on the proportion of uninsured/Medicaid patients (payer mix) (top quartile defined as safety-net hospital (SNHs) and lowest as Q1 hospitals). Quality-of-care was assessed by adherence to evidence-based metrics. Individual contributions of insurance status and payer mix to survival was assessed with a proportional hazards Cox model. RESULTS A total of 124,339 patients including 11,338 uninsured (9.1%) and 27,281 Medicaid (21.9%) recipients treated at 1156 hospitals were identified. Quality-of-care was not significantly different across hospital quartiles. Adjusting for patients' clinical/demographic characteristics, treatment at a SNH was associated with a 14% higher mortality (HR = 1.14; 95% CL, 1.08-1.20) than at Q1 hospitals. Testing for individual insurance, uninsured patients had 32% increased mortality (HR = 1.32; 95% CI,1.26-1.38) and Medicaid recipients 40% increased (HR = 1.40; 95%CI,1.35-1.44) compared to privately insured patients. Examining both payer mix and insurance, only individual insurance retained a significant impact on mortality. CONCLUSIONS Individual insurance may be a more important predictor of survival than site-of-care and hospital payer mix for women with cervical cancer. There is substantial variation in outcomes within hospitals based on individual insurance, regardless of hospital payer mix.
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Affiliation(s)
- Caroline Cherston
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Katherine Yoh
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Yongmei Huang
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Alexander Melamed
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Charlotte R Gamble
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | | | - Yeran Li
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Dawn L Hershman
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Jason D Wright
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA.
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Fay KA, Maeder ME, Emond JA, Hasson RM, Millington TM, Finley DJ, Phillips JD. Residing in a food desert is associated with an increased risk of readmission following esophagectomy for cancer. J Thorac Dis 2022; 14:1854-1868. [PMID: 35813712 PMCID: PMC9264063 DOI: 10.21037/jtd-21-1637] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/19/2022] [Indexed: 11/06/2022]
Abstract
Background Nutritional status is related to treatment outcomes for esophageal cancer. Residing in a food desert (FD) has been associated with worse outcomes in breast and colon cancer. We assessed the association of residing in a FD on 30-day outcomes of esophageal cancer patients who received tri-modality therapy. Methods A retrospective review of patients who underwent esophagectomy (1/2015 to 7/2020, in New Hampshire, USA) was performed. Patients were excluded if they did not undergo neo-adjuvant treatment, required treatment outside of standard Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) protocol, or lacked both pre and post neo-adjuvant treatment computed tomography (CT) scans for review. Demographics, nutrition parameters, treatment characteristics, 30-day complications and 90-day mortality were reviewed. FD status was defined by the United States Department of Agriculture (USDA) Food Access Research Atlas and cross-referenced with patients' home zip code. Readmission was defined as readmission to any hospital for any reason within 30-day of discharge. Univariable analysis was conducted using Student's t-test or Wilcoxon rank-sum for continuous variables, and Fisher's exact test for categorical variables. Multivariable logistic regression was then used to model readmission status on FD status adjusted for measures statistically associated with readmission status at the P<0.10 in univariable analyses. Results Seventy-eight patients were included in the analysis. Overall pre-treatment prevalence of sarcopenia was 11.5% (9/78) and did not vary by FD status. Univariable analysis, demonstrated few significant differences between those who were readmitted and those who were not. On unadjusted analysis, patients who lived in a FD were 5 times more likely to be readmitted [5.16; 95% confidence interval (CI): 1.70-15.67] compared to those who did not. Residing in a FD remained a significant risk factor for readmission after adjustment for operative time, discharge to a rehabilitation facility and development of a grade III/IV complication [adjusted odds ratio (OR): 6.38; 95% CI: 1.45-28.08]. Conclusions Our data suggest that residing in a FD is a prognostic factor for readmission after tri-modality therapy for esophageal cancer. Clinicians need to be aware that previously established nutritional markers may not completely capture nutritional status and living in a FD may significantly increase the risk of readmission in these patients.
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Affiliation(s)
- Kayla A Fay
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Matthew E Maeder
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jennifer A Emond
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Rian M Hasson
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Timothy M Millington
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - David J Finley
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Joseph D Phillips
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Fonseca AL, Khan H, Mehari KR, Cherla D, Heslin MJ, Johnston FM. Disparities in Access to Oncologic Care in Pancreatic Cancer: A Systematic Review. Ann Surg Oncol 2022; 29:3232-3250. [PMID: 35067789 DOI: 10.1245/s10434-021-11258-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/06/2021] [Indexed: 12/17/2023]
Abstract
BACKGROUND Pancreatic cancer care is complex, and multiple disparities in receipt of therapies have been documented. The authors aimed to conduct a systematic review of the literature to critically assess and summarize disparities in access to oncologic therapies for pancreatic cancer. METHODS A search of PubMed, Scopus, Web of Science, and Cochrane databases were performed for studies reporting disparities in access to oncologic care for pancreatic cancer. Primary research articles published in the United States from 2000 to 2020 were included. Data were independently extracted, and risk of bias was assessed using the modified Newcastle-Ottawa scale. RESULTS The inclusion criteria were met by 47 studies. All the studies used retrospective data, with 70 % involving national database studies, 41 assessing the impact of race/ethnicity, 22 assessing the impact of socioeconomic status, 18 assessing the impact of insurance status, 23 assessing the impact of gender, 26 assessing the impact of age, and 3 assessing the impact of location on the delivery of cancer-directed therapies. Race, socioeconomic status, insurance status, gender, and age- based disparities in receipt of surgical resection, treatment at high-volume facilities and multimodal therapy for resectable pancreatic cancer, receipt of systemic chemotherapy for metastatic cancer, and receipt of expected standard-of-care treatment are reported. CONCLUSION Significant sociodemographic disparities in access to equitable oncologic care exist along the continuum of pancreatic cancer care. Multiple patient, provider, and systemic factors contribute to these disparities. The ongoing study of these disparities is important to elucidate processes that may be targeted to improve access to equitable oncologic care for patients with pancreatic cancer.
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Affiliation(s)
| | - Hamza Khan
- Division of Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Krista R Mehari
- Department of Psychology, The University of South Alabama, Mobile, AL, USA
| | - Deepa Cherla
- Department of Surgery, The University of South Alabama, Mobile, AL, USA
| | - Martin J Heslin
- Department of Surgery, The University of South Alabama, Mobile, AL, USA
| | - Fabian M Johnston
- Division of Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Dhawan S, Alattar AA, Bartek J, Ma J, Bydon M, Venteicher AS, Chen CC. Racial disparity in recommendation for surgical resection of skull base chondrosarcomas: A Surveillance, Epidemiology, and End Results (SEER) analysis. J Clin Neurosci 2021; 94:186-191. [PMID: 34863436 DOI: 10.1016/j.jocn.2021.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/09/2021] [Accepted: 09/26/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION There is increased appreciation of racial disparities in the delivery of neurosurgical care. Here, we explore whether race influences surgical recommendations in the management of skull base chondrosarcomas. METHODS We identified 493 patients with skull base chondrosarcoma using the Surveillance, Epidemiology, and End Results (SEER) registry (November 2017 submission). Regression analyses were performed to identify demographic variables associated with recommendation against surgery. Univariate and multivariate cox proportional hazards models were used for survival analysis. RESULTS In a univariate analysis, we found that the African-American race was associated with an increased likelihood of surgeon recommendation against surgery (OR = 4.416, 95% CI = 1.893-10.302, p = 0.001). This association remained robust in the multivariate model that controlled for other covariates, including age of diagnosis (OR = 5.091, 95% CI = 2.127-12.187, p < 0.001). For patients who received a recommendation against surgery, the likelihood of dying from non-chondrosarcoma causes was comparable between Caucasian and African-American patients, suggesting that the prevalence and severity of medical conditions that increase the risk of death were comparable between these cohorts (HR = 0.466, 95% CI = 0.057-3.802, p = 0.475). The likelihood of dying from chondrosarcoma was comparable between Caucasian and African-American patients who underwent surgery (HR = 0.982, 95% CI = 0.353-2.732, p = 0.973), suggesting absence of race-specific surgical benefits. CONCLUSION We identified a racial disparity against African-Americans in recommendations for surgical resection of skull base chondrosarcomas.
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Affiliation(s)
- Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Ali A Alattar
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jun Ma
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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Abstract
Significant disparities exist in lung cancer incidence and screening. Geographic, racial, gender, and socioeconomic disparities affect lung cancer incidence. As the leading cause of lung cancer, smoking varies among different racioethnic groups, genders, and socioeconomic statuses. In addition, environmental pollutants, such as radon, industrial toxins, and air pollution, are significant risk factors for lung cancer development that is disproportionately seen in working-class communities, as well as underserved and disabled populations. Lung cancer incidence depends on diagnosis. Literature examining lung cancer incidence and screening disparities have its limitations, as most studies are methodologically limited and do not adjust for important risk factors.
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Affiliation(s)
- Vignesh Raman
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Valeda Yong
- Surgery, Temple University Hospital, 3401 N. Broad Street, Zone C, 4th Floor, Philadelphia, PA 19140, USA. https://twitter.com/ValedaYongMD
| | - Cherie P Erkmen
- Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Betty C Tong
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA
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16
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van den Broek-Altenburg EM, Atherly AJ, Hess S, Benson J. The effect of unobserved preferences and race on vaccination hesitancy for COVID-19 vaccines: implications for health disparities. J Manag Care Spec Pharm 2021; 27:S4-S13. [PMID: 34534008 DOI: 10.18553/jmcp.2021.27.9-a.s4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Reducing the extra burden COVID-19 has on people already facing disparities is among the main national priorities for the COVID-19 vaccine rollout. Early reports from states releasing vaccination data by race show that White residents are being vaccinated at significantly higher rates than Black residents. Public health efforts are being targeted to address vaccine hesitancy among Black and other minority populations. However, health care interventions intended to reduce health disparities that do not reflect the underlying values of individuals in underrepresented populations are unlikely to be successful. OBJECTIVE: To identify key factors underlying the disparities in COVID-19 vaccination. METHODS: Primary data were collected from an online survey of a representative sample of the populations of the 4 largest US states (New York, California, Texas, and Florida) between August 10 and September 3, 2020. Using latent class analysis, we built a model identifying key factors underlying the disparities in COVID-19 vaccination. RESULTS: We found that individuals who identify as Black had lower rates of vaccine hesitancy than those who identify as White. This was true overall, by latent class and within latent class. This suggests that, contrary to what is currently being reported, Black individuals are not universally more vaccine hesitant. Combining the respondents who would not consider a vaccine (17%) with those who would consider one but ultimately choose not to vaccinate (11%), our findings indicate that more than 1 in 4 (28%) persons will not be willing to vaccinate. The no-vaccine rate is highest in White individuals and lowest in Black individuals. CONCLUSIONS: Results suggest that other factors, potentially institutional, are driving the vaccination rates for these groups. Our model results help point the way to more effective differentiated policies. DISCLOSURES: No funding was received for this study. The authors have nothing to disclose.
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Affiliation(s)
| | - Adam J Atherly
- Larner College of Medicine, University of Vermont, Burlington
| | - Stephane Hess
- Choice Modelling Centre and Institute for Transport Studies, University of Leeds, United Kingdom
| | - Jamie Benson
- Larner College of Medicine, University of Vermont, Burlington
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17
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van den Broek-Altenburg EM, Atherly AJ, Hess S, Benson J. Valuing diversity in value assessment: introducing the PhRMA Foundation Health Disparities Challenge Award. J Manag Care Spec Pharm 2021; 27:S2-S3. [PMID: 34534009 PMCID: PMC10408392 DOI: 10.18553/jmcp.2021.27.9-a.s2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
DISCLOSURES:: No funding supported the writing of this article. The author has received grants from BeiGene, Ltd., and Pfizer, Inc., and advisory board fees from PhRMA Foundation.
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Affiliation(s)
| | - Adam J Atherly
- Larner College of Medicine, University of Vermont, Burlington
| | - Stephane Hess
- Choice Modelling Centre and Institute for Transport Studies, University of Leeds, United Kingdom
| | - Jamie Benson
- Larner College of Medicine, University of Vermont, Burlington
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18
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Black KZ, Lightfoot AF, Schaal JC, Mouw MS, Yongue C, Samuel CA, Faustin YF, Ackert KL, Akins B, Baker SL, Foley K, Hilton AR, Mann-Jackson L, Robertson LB, Shin JY, Yonas M, Eng E. 'It's like you don't have a roadmap really': using an antiracism framework to analyze patients' encounters in the cancer system. ETHNICITY & HEALTH 2021; 26:676-696. [PMID: 30543116 PMCID: PMC6565499 DOI: 10.1080/13557858.2018.1557114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
Background: Cancer patients can experience healthcare system-related challenges during the course of their treatment. Yet, little is known about how these challenges might affect the quality and completion of cancer treatment for all patients, and particularly for patients of color. Accountability for Cancer Care through Undoing Racism and Equity is a multi-component, community-based participatory research intervention to reduce Black-White cancer care disparities. This formative work aimed to understand patients' cancer center experiences, explore racial differences in experiences, and inform systems-level interventions.Methods: Twenty-seven breast and lung cancer patients at two cancer centers participated in focus groups, grouped by race and cancer type. Participants were asked about what they found empowering and disempowering regarding their cancer care experiences. The community-guided analysis used a racial equity approach to identify racial differences in care experiences.Results: For Black and White patients, fear, uncertainty, and incomplete knowledge were disempowering; trust in providers and a sense of control were empowering. Although participants denied differential treatment due to race, analysis revealed implicit Black-White differences in care.Conclusions: Most of the challenges participants faced were related to lack of transparency, such that improvements in communication, particularly two-way communication could greatly improve patients' interaction with the system. Pathways for accountability can also be built into a system that allows patients to find solutions for their problems with the system itself. Participants' insights suggest the need for patient-centered, systems-level interventions to improve care experiences and reduce disparities.
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Affiliation(s)
- Kristin Z. Black
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA,
| | - Alexandra F. Lightfoot
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, ,
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | | | - Mary S. Mouw
- Division of Geriatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | - Christina Yongue
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA,
| | - Cleo A. Samuel
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | - Yanica F. Faustin
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | | | - Barbara Akins
- Behavioral Health, Cone Health System, Greensboro, North Carolina, USA,
| | - Stephanie L. Baker
- Public Health Studies Program, Elon University, Elon, North Carolina, USA,
| | - Karen Foley
- University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,
| | - Alison R. Hilton
- Durham County Department of Public Health, Durham, North Carolina, USA,
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA,
| | - Linda B. Robertson
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA,
| | - Janet Y. Shin
- Georgia Department of Public Health, Atlanta, Georgia, USA,
| | - Michael Yonas
- Social Innovation, Research and Special Initiatives, The Pittsburgh Foundation, Pittsburgh, Pennsylvania, USA,
| | - Eugenia Eng
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, ,
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19
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Janeway MG, Sanchez SE, Rosen AK, Patts G, Allee LC, Lasser KE, Dechert TA. Disparities in Utilization of Ambulatory Cholecystectomy: Results From Three States. J Surg Res 2021; 266:373-382. [PMID: 34087621 DOI: 10.1016/j.jss.2021.03.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inpatient cholecystectomy is associated with higher cost and morbidity relative to ambulatory cholecystectomy, yet the latter may be underutilized by minority and underinsured patients. The purpose of this study was to examine the effects of race, income, and insurance status on receipt of and outcomes following ambulatory cholecystectomy. MATERIALS AND METHODS Retrospective observational cohort study of patients 18-89 undergoing cholecystectomy for benign indications in Florida, Iowa, and New York, 2011-2014 using administrative databases. The primary outcome of interest was odds of having ambulatory cholecystectomy; secondary outcomes included intraoperative and postoperative complications, and 30-day unplanned admissions following ambulatory cholecystectomy. RESULTS Among 321,335 cholecystectomies, 190,734 (59.4%) were ambulatory and 130,601 (40.6%) were inpatient. Adjusting for age, sex, insurance, income, residential location, and comorbidities, the odds of undergoing ambulatory versus inpatient cholecystectomy were significantly lower in black (aOR = 0.71, 95% CI [0.69, 0.73], P< 0.001) and Hispanic (aOR = 0.71, 95% CI [0.69, 0.72], P< 0.001) patients compared to white patients, and significantly lower in Medicare (aOR = 0.77, 95% CI [0.75, 0.80] P < 0.001), Medicaid (aOR = 0.56, 95% CI [0.54, 0.57], P< 0.001) and uninsured/self-pay (aOR = 0.28, 95% CI [0.27, 0.28], P< 0.001) patients relative to privately insured patients. Patients with Medicaid and those classified as self-pay/uninsured had higher odds of postoperative complications and unplanned admission as did patients with Medicare compared to privately insured individuals. CONCLUSIONS Racial and ethnic minorities and the underinsured have a higher likelihood of receiving inpatient as compared to ambulatory cholecystectomy. The higher incidence of postoperative complications in these patients may be associated with unequal access to ambulatory surgery.
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Affiliation(s)
- Megan G Janeway
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Sabrina E Sanchez
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Amy K Rosen
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
| | - Gregory Patts
- Boston University School of Public Health, Boston, Massachusetts
| | - Lisa C Allee
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Karen E Lasser
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Crosstown Center, Boston, Massachusetts
| | - Tracey A Dechert
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
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Association between Moving to a High-Volume Hospital in the Capital Area and the Mortality among Patients with Cancer: A Large Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073812. [PMID: 33917393 PMCID: PMC8061764 DOI: 10.3390/ijerph18073812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to identify the association between moving to a high-volume hospital and the mortality of patients with cancer living in the district. The study population comprised participants diagnosed with cancer within the past nine years (2004-2012). The final sample included 8197 patients with cancer, 3939 were males (48.1%), and 4258 were females (51.9%). A Cox proportional hazard model was used to estimate the hazard ratio (HR) for death. Confounding variables including sex, age, type of social security, income level, disability, and utilization volume were incorporated into the model. Among patients with cancer living in the district, 2874 (35.1%) used healthcare services in Seoul. About 10% (n = 834) of patients died during the follow-up period. The HR for death in females (HR: 0.68, 95% CI: 0.58-0.81) was lower than that in males. Additionally, the HR for the death of patients using healthcare services in Seoul (HR: 1.30, 95% CI: 1.11-1.53) was higher than those patients who did not use healthcare services in Seoul. Among patients utilizing services in the province, wealthier patients' survival probability was significantly higher than that of others. The cause of income differences should be identified, and accessibility to medical use of low-income families should be enhanced to prevent mortality of patients from cancer disparities.
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Suh W, Master S, Liu L, Mills G, Shi R. The Effect of Payer Status on Survival of Patients With Prostate Cancer. Cureus 2021; 13:e13329. [PMID: 33738172 PMCID: PMC7959411 DOI: 10.7759/cureus.13329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Disparities in access to care and proper treatment can have significant implications in patient survival outcome and mortality. This retrospective study of prostate cancer patients from the National Cancer Database (NCDB) between the years 2004 and 2014 and follow-up to the end of 2015 analyzed such effects that variation in payer status might have on outcome. Methods This study used the data of 696,321 diagnosed prostate cancer patients from the NCDB for the years 2004 to 2014 and follow-up to the end of 2015 to analyze the effect that payer status would have on prostate cancer survival. Multivariable cox regression was used to study the hazard ratios (HRs) of payer status and other variables along with the Charlson Comorbidity Index to analyze their associated increased risk of death. Statistical software SAS 9.4 for Windows was used to analyze the overall survival (OS) of patients on different insurance plans along with variations in prostate-specific antigen (PSA) levels and treatment type. Results When looking at OS, those with private insurance had the greatest overall survivability while those on Medicare were the only ones who reached the median OS. In contrast to those who had private insurance, those who had Medicare, the uninsured, and those with Medicaid demonstrated significantly greater risks of death at 43%, 58%, and 69% increased risk of death, respectively. In addition to payer status, other variables were also significant predictors of OS, including demographic factors (age, race), comorbidities, socioeconomic status (income, education), distance traveled to facility, type of facility, treatment delay, treatment modality, PSA levels at diagnosis, and cancer stage at diagnosis. Conclusion Payer status is intricately linked to a number of other variables that might affect survival. Even after adjustment for a number of these factors, insurance status was shown to have a significant effect on prostate cancer survivorship. In contrast to those who had private insurance, those who had Medicare, the uninsured, and those with Medicaid demonstrated significantly greater risks of death at 43%, 58%, and 69% increased risk of death, respectively. Studies have suggested that those without insurance or on Medicaid are less likely to undergo screening and have worse health-related quality of life, while those on Medicare may be deterred from continuing treatment due to high out-of-pocket costs. However, the complete mechanism behind the improved survivorship of those on private insurance is unclear. The effect of payer status on quality of life may be an interest that needs to be further studied. Further research will be required to provide definite reasons for these observations and mediation analysis of other factors could prove to be valuable.
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Affiliation(s)
- Winston Suh
- Hematology-Oncology, Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
| | - Samip Master
- Hematology-Oncology, Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
| | - Lihong Liu
- Hematology-Oncology, Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
| | - Glenn Mills
- Hematology-Oncology, Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
| | - Runhua Shi
- Hematology-Oncology, Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, USA
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22
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Overcoming disparities: Multidisciplinary breast cancer care at a public safety net hospital. Breast Cancer Res Treat 2021; 187:197-206. [PMID: 33495917 DOI: 10.1007/s10549-020-06044-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Public safety net hospitals (SNH) serve a disparate patient population; however, little is known about long-term oncologic outcomes of patients receiving care at these facilities. This study is the first to examine overall survival (OS) and the initiation of treatment in breast cancer patients treated at a SNH. METHODS Patients presenting to a SNH with stage I-IV breast cancer from 2005 to 2017 were identified from the local tumor registry. The hospital has a weekly breast tumor board and a multidisciplinary approach to breast cancer care. Kaplan-Meier survival analysis was performed to identify patient, tumor, and treatment characteristics associated with OS. Factors with a p < 0.1 were included in the Cox proportional hazards model. RESULTS 2709 breast cancer patients were evaluated from 2005 to 2017. The patient demographics, tumor characteristics, and treatments received were analyzed. Five-year OS was 78.4% (93.9%, 87.4%, 70.9%, and 23.5% for stages I, II, III, and IV, respectively). On multivariable analysis, higher stage, age > 70 years, higher grade, and non-Hispanic ethnicity were associated with worse OS. Patients receiving surgery (HR = 0.33, p < 0.0001), chemotherapy (HR = 0.71, p = 0.006), and endocrine therapy (HR = 0.61, p < 0.0001) had better OS compared to those who did not receive these treatments. CONCLUSION Despite serving a vulnerable minority population that is largely poor, uninsured, and presenting with more advanced disease, OS at our SNH approaches national averages. This novel finding indicates that in the setting of multidisciplinary cancer care and with appropriate initiation of treatment, SNHs can overcome socioeconomic barriers to achieve equitable outcomes in breast cancer care.
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Effects of socioeconomic status on cancer patient survival: counterfactual event-based mediation analysis. Cancer Causes Control 2020; 32:83-93. [PMID: 33211220 DOI: 10.1007/s10552-020-01361-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 10/22/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE This study investigated the direct and indirect effects of socioeconomic status (SES) on the survival time of cancer patients by using cancer stage to create a pathway from SES to health outcomes and facilitate a mechanistic inference. METHODS Both a traditional mediation analysis and a counterfactual event-based mediation analysis were applied to SEER (The Surveillance, Epidemiology, and End Results) data from the National Cancer Institute of the United States. A Cox proportional hazards model for survival analysis was performed in the mediation analysis. RESULTS The counterfactual event-based mediation analysis showed that the effect of SES on survival time was partially mediated by stage at diagnosis in lung (12%), liver (14.33%), and colorectal (9%) cancers. Investigation of the fundamental mechanism involved thus established the direct effect of SES on survival time and the indirect effect of SES on survival time through stage at diagnosis. Moreover, the mediation analysis also revealed that the disparity in timely diagnosis (i.e., stage at diagnosis) caused by SES was slightly significant. CONCLUSIONS SES can either affect cancer survival directly or indirectly through stage at diagnosis. Opportunities to reduce cancer disparity exist in the design of early detection policies or mechanisms for patients with varying resources.
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Schröder S, Beller J, Golpon H, Geyer S. Are there social gradients in the occurrence of lung cancer and in the survival of lung cancer patients? Findings from an observational study using German claims data of Lower Saxony. BMJ Open 2020; 10:e036506. [PMID: 32878756 PMCID: PMC7470500 DOI: 10.1136/bmjopen-2019-036506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Only a few studies on health inequalities in terms of lung cancer are available. We examined whether social inequalities are present for the occurrence of lung cancer. Confining the analyses to patients, it was also examined whether survival over the observation period and over a standardised period of 18 months differed by occupational position and income. METHODS Our findings are based on claims data from a German statutory health insurance covering 2005-2016. The database comprised N=3 163 211 women (50.7%) and men (49.3%) aged 18 years and older. Diagnoses (International Statistical Classification of Diseases and Related Health Problems 10th Revision: C34.0 to C34.9) were hospital-based, and income and occupational position were used as indicators of socioeconomic position. Analyses on social gradients were performed for employed and retired insured, but only for employed insured information on occupation and on income were available, for retired women and men only income was available. Analyses were performed by means of proportional hazard regression. RESULTS In employed women, social gradients for the occurrence emerged for occupational position, but not for income. In men, social differences were found for both indicators. For retired insured, income gradients were found in men. Looking at overall survival, neither in women nor in men social gradients emerged. CONCLUSIONS The reported social inequalities in the occurrence of lung cancer are pointing towards social differences in smoking behaviour, exposition to hazardous occupation-related substances and differences in preventive strategies. The absence of social inequalities in survival after lung cancer suggests equality in medical treatment of the disease.
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Affiliation(s)
| | - Johannes Beller
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | - Heiko Golpon
- Pneumology, Hannover Medical School, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology, Hannover Medical School, Hannover, Germany
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Costello S, Chen K, Picciotto S, Lutzker L, Eisen E. Metalworking fluids and cancer mortality in a US autoworker cohort (1941-2015). Scand J Work Environ Health 2020; 46:525-532. [PMID: 32406514 PMCID: PMC7737797 DOI: 10.5271/sjweh.3898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives This report describes the extended follow-up (1941-2015) of a cohort of 38 549 automobile manufacturing workers with potential exposure to metalworking fluids (MWF). The outcomes of interest were mortality from cancers of the esophagus, stomach, intestine, rectum, bladder, liver, pancreas, larynx, lung, skin, prostate, brain, and female breast, as well as leukemia. This report includes 5472 deaths from cancer, more than ten times the numbers of deaths in our last summary report published 20 years ago. Methods Standardized mortality ratios were computed for the entire study period. Adjusted hazard ratios (HR) were estimated in Cox proportional hazard models with categorical variables for cumulative exposure to each type of MWF. Results Exposure-response patterns are consistent with prior mortality reports from this cohort. We found increased risk of skin and female breast cancer with straight fluids. For the first time, we found elevated risk of stomach cancer mortality. Overall, many of the exposure-response results did not suggest an association with MWF. Conclusions Mortality is a poor proxy for cancer diagnosis for treatable cancers and not the optimal outcome measure in etiological studies. Although the HR presented here handle bias from the healthy worker hire effect and left truncation, they do not handle bias from healthy worker survivor effect, which likely results in underestimates of the health impacts of MWF. Although this updated summary provides some information on the risk of cancer from MWF, targeted future analyses will help clarify associations.
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Affiliation(s)
- Sadie Costello
- Environmental Health Science, School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA.
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Iezzoni LI, Rao SR, Agaronnik ND, El-Jawahri A. Cross-Sectional Analysis of the Associations Between Four Common Cancers and Disability. J Natl Compr Canc Netw 2020; 18:1031-1044. [PMID: 32755976 DOI: 10.6004/jnccn.2020.7551] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Approximately 61 million Americans have a disability. Little research has explored whether disability is associated with subsequent diagnosis of cancer, the second-leading cause of death in the United States. The objective of this study was to explore associations between cancer and disability, focusing on 4 cancers that may present with nonspecific symptoms that could be conflated with aspects of disability, thus delaying cancer diagnoses. An analysis of a nationally representative survey using sampling weights to produce national estimates was performed. METHODS Civilian, noninstitutionalized US residents responding to the 2010-2017 National Health Interview Surveys totaling 259,392 Sample Adult Core survey respondents were included. We used self-reported functional status limitations to identify persons with movement difficulties (MD), complex activity limitations (CAL), and no disability. Multivariable regressions predicting cancer diagnosis included sociodemographic characteristics, tobacco use, body mass index, access to care indicators, and disability status. RESULTS Persons with preexisting disability had significantly higher rates of cancer (ranging from 0.40 [SE, 0.05] for ovarian to 3.38 [0.14] for prostate) than did those without disability (0.20 [0.02] and 1.26 [0.04] for the same cancers; all P<.0001). Multivariable analyses found strong associations of preexisting MD and CAL with colorectal cancer, with adjusted odds ratios (aORs) of 1.5 (95% CI, 1.2-1.9) and 1.9 (1.5-2.4), respectively. For non-Hodgkin's lymphoma, the aOR for CAL was 1.5 (1.1-2.1). For prostate cancer, aORs for MD were 1.2 (1.0-1.3) and 1.1 (1.0-1.3) for CAL. Using cross-sectional survey data, we could only identify statistical associations, not causality. CONCLUSIONS Our population-based analyses suggest that persons with disability may constitute a high-risk population, with higher cancer incidence. Optimizing appropriate screening and fully investigating new signs and symptoms are therefore critical for patients with disability.
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Affiliation(s)
- Lisa I Iezzoni
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital.,Department of Medicine, Harvard Medical School
| | - Sowmya R Rao
- Massachusetts General Hospital Biostatistics Center; and.,Boston University School of Public Health, Boston, Massachusetts
| | - Nicole D Agaronnik
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital
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Singh S, Armenia SJ, Merchant A, Livingston DH, Glass NE. Treatment of Acute Cholecystitis at Safety-Net Hospitals: Analysis of the National Inpatient Sample. Am Surg 2020. [DOI: 10.1177/000313482008600116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence supports index cholecystectomy as the quality of care for patients admitted with acute cholecystitis. We sought to examine the role of hospital safety-net status on whether patients received appropriate index procedures for cholecystitis. The National Inpatient Sample was queried for patients with acute cholecystitis. Proportion of Medicaid and uninsured discharges were used to define safety-net hospitals (SNHs). Multivariate logistic regression was used to calculate associations between the frequency of index cholecystectomy and prolonged length of stay (LOS), and the effect of SNH designation. SNHs and non-SNHs had similar rates of index cholecystectomy in all geographic regions, except in the northeast, where the likelihood of having an index cholecystectomy was lower at SNHs. Patients at SNHs had longer LOS for acute cholecystitis, regardless of index or delayed cholecystectomy. When controlling for insurance status, patients at SNHs had longer LOS than those at non-SNHs. There was also increased LOS in SNHs in the Midwest, in urban hospitals, and in large hospitals. Our data showed no difference in the frequency of index cholecystectomy overall between SNHs and non-SNHs, except in the northeast. The variability and increased LOS at SNHs highlight potential opportunities to improve quality and decrease cost of care at our most vulnerable hospitals.
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Affiliation(s)
- Supreet Singh
- From the Department of Surgery, New Jersey Medical School, Newark, New Jersey
| | - Sarah J. Armenia
- From the Department of Surgery, New Jersey Medical School, Newark, New Jersey
| | - Aziz Merchant
- From the Department of Surgery, New Jersey Medical School, Newark, New Jersey
| | - David H. Livingston
- From the Department of Surgery, New Jersey Medical School, Newark, New Jersey
| | - Nina E. Glass
- From the Department of Surgery, New Jersey Medical School, Newark, New Jersey
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Garranzo-Asensio M, Guzmán-Aránguez A, Povedano E, Ruiz-Valdepeñas Montiel V, Poves C, Fernandez-Aceñero MJ, Montero-Calle A, Solís-Fernández G, Fernandez-Diez S, Camps J, Arenas M, Rodríguez-Tomàs E, Joven J, Sanchez-Martinez M, Rodriguez N, Dominguez G, Yáñez-Sedeño P, Pingarrón JM, Campuzano S, Barderas R. Multiplexed monitoring of a novel autoantibody diagnostic signature of colorectal cancer using HaloTag technology-based electrochemical immunosensing platform. Theranostics 2020; 10:3022-3034. [PMID: 32194852 PMCID: PMC7053203 DOI: 10.7150/thno.42507] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose: The humoral immune response in cancer patients can be used for early detection of the disease. Autoantibodies raised against tumor-associated antigens (TAAs) are promising clinical biomarkers for reliable cancer diagnosis, prognosis, and therapy monitoring. In this study, an electrochemical disposable multiplexed immunosensing platform able to integrate difficult- and easy-to-express colorectal cancer (CRC) TAAs is reported for the sensitive determination of eight CRC-specific autoantibodies. Methods: The electrochemical immunosensing approach involves the use of magnetic microcarriers (MBs) as solid supports modified with covalently immobilized HaloTag fusion proteins for the selective capture of specific autoantibodies. After magnetic capture of the modified MBs onto screen-printed carbon working electrodes, the amperometric responses measured using the hydroquinone (HQ)/H2O2 system were related to the levels of autoantibodies in plasma. Results: The biosensing platform was applied to the analysis of autoantibodies against 8 TAAs described for the first time in this work in plasma samples from healthy asymptomatic individuals (n=3), and patients with high-risk of developing CRC (n=3), and from patients already diagnosed with colorectal (n=3), lung (n=2) or breast (n=2) cancer. The developed bioplatform demonstrated an improved discrimination between CRC patients and controls (asymptomatic healthy individuals and breast and lung cancer patients) compared to an ELISA-like luminescence test. Conclusions: The proposed methodology uses a just-in-time produced protein in a simpler protocol, with low sample volume, and involves cost-effective instrumentation, which could be used in a high-throughput manner for reliable population screening to facilitate the detection of early CRC patients at affordable cost.
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Affiliation(s)
- María Garranzo-Asensio
- Departamento de Bioquímica y Biología Molecular, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, 28037 Madrid, Spain
- UFIEC, Chronic Disease Programme, Instituto de Salud Carlos III, Majadahonda 28220, Madrid, Spain
| | - Ana Guzmán-Aránguez
- Departamento de Bioquímica y Biología Molecular, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, 28037 Madrid, Spain
| | - Eloy Povedano
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Víctor Ruiz-Valdepeñas Montiel
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Carmen Poves
- Gastroenterology Unit, Hospital Universitario Clínico San Carlos, E-28040, Madrid, Spain
| | | | - Ana Montero-Calle
- UFIEC, Chronic Disease Programme, Instituto de Salud Carlos III, Majadahonda 28220, Madrid, Spain
| | | | | | - Jordi Camps
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d´Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus (Spain)
| | - Meritxell Arenas
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d´Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus (Spain)
| | - Elisabeth Rodríguez-Tomàs
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d´Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus (Spain)
- Department of Radiation Oncology, Hospital Universitari Sant Joan, Institut d´Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus (Spain)
| | - Jorge Joven
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d´Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus (Spain)
| | | | - Nuria Rodriguez
- Medical Oncology Department, Hospital Universitario La Paz, E-28046, Madrid, Spain
| | - Gemma Dominguez
- Departamento de Medicina, Facultad de Medicina, Instituto de Investigaciones Biomédicas "Alberto Sols", CSIC-UAM, E-28029, Madrid, Spain
| | - Paloma Yáñez-Sedeño
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - José Manuel Pingarrón
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Susana Campuzano
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Rodrigo Barderas
- UFIEC, Chronic Disease Programme, Instituto de Salud Carlos III, Majadahonda 28220, Madrid, Spain
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Adams SA, Haynes VE, Brandt HM, Choi SK, Young V, Eberth JM, Hébert JR, Friedman DB. Cervical cancer screening behaviors and proximity to federally qualified health centers in South Carolina. Cancer Epidemiol 2020; 65:101681. [PMID: 32035294 DOI: 10.1016/j.canep.2020.101681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/18/2019] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Lack of participation in cervical cancer screening in underserved populations has been attributed to access to care, particularly among women in rural areas. Federally Qualified Health Centers (FQHCs) were created to address this need in medically underserved populations. This study observed proximity to three health centers in relation to cervical cancer screening rates in South Carolina. METHODS Data were obtained from FQHC patient visits (from 3 centers) between 2007-2010 and were limited to women eligible for cervical cancer screening (n = 24,393). ArcGIS was used to geocode patients addresses and FQHC locations, and distance was calculated. Modified Poisson regression was used to estimate relative risk of obtaining cervical cancer screening within one yearor ever, stratified by residential area. RESULTS Findings differed markedly by center and urban/rural status. At two health clinics, rural residents living the furthest away from the clinic (∼9 miles difference between quartile 4 and quartile 1) were more likely to be ever screened (RRs = 1.05 and 1.03, p-values < 0.05), while urban residents living the furthest away were less likely to be ever screened (RR = 0.85, p-value < 0.05). At the third center, only urban residents living the furthest away were more likely to be ever screened (RR = 1.02, p-value < 0.05). CONCLUSIONS Increased travel distance significantly increased the likelihood of cervical cancer screening at two FQHC sites while significantly decreasing the likelihood of screening at the 3rd site. These findings underscore the importance of contextual and environmental factors that impact use of cervical cancer screening services.
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Affiliation(s)
- Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; College of Nursing, University of South Carolina, 1601 Greene Street Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Venice E Haynes
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Seul Ki Choi
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States; Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, South Korea.
| | - Vicki Young
- South Carolina Primary Care Association, 3 Technology Circle Columbia, SC, 29203, United States.
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
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Obeng-Gyasi S, Kircher SM, Lipking KP, Keele BJ, Benson AB, Wagner LI, Carlos RC. Oncology clinical trials and insurance coverage: An update in a tenuous insurance landscape. Cancer 2019. [PMID: 31251394 DOI: 10.1002/cncr.32360.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Samilia Obeng-Gyasi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sheetal M Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Kelsey P Lipking
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Benjamin J Keele
- Robert H. McKinney School of Law, Indiana University, Indianapolis, Indiana
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Lynne I Wagner
- Social Sciences and Health Policy Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ruth C Carlos
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan
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Ahmad TR, Chen LM, Chapman JS, Chen LL. Medicaid and Medicare payer status are associated with worse surgical outcomes in gynecologic oncology. Gynecol Oncol 2019; 155:93-97. [DOI: 10.1016/j.ygyno.2019.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 11/16/2022]
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Obeng-Gyasi S, Kircher SM, Lipking KP, Keele BJ, Benson AB, Wagner LI, Carlos RC. Oncology clinical trials and insurance coverage: An update in a tenuous insurance landscape. Cancer 2019; 125:3488-3493. [PMID: 31251394 DOI: 10.1002/cncr.32360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Samilia Obeng-Gyasi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sheetal M Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Kelsey P Lipking
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Benjamin J Keele
- Robert H. McKinney School of Law, Indiana University, Indianapolis, Indiana
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Lynne I Wagner
- Social Sciences and Health Policy Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ruth C Carlos
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan
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Snider JT, Duncan ME, Gore MR, Seabury S, Silverstein AR, Tebeka MG, Goldman DP. Association Between State Medicaid Eligibility Thresholds and Deaths Due to Substance Use Disorders. JAMA Netw Open 2019; 2:e193056. [PMID: 31026034 PMCID: PMC6487569 DOI: 10.1001/jamanetworkopen.2019.3056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The United States is currently facing an epidemic of deaths related to substance use disorder (SUD), with totals exceeding those due to motor vehicle crashes and gun violence. The epidemic has led to decreased life expectancy in some populations. In recent years, Medicaid eligibility has expanded in some states, and the association of this expansion with SUD-related deaths is yet to be examined. OBJECTIVE To examine the association between eligibility thresholds for state Medicaid coverage and SUD-related deaths. DESIGN, SETTING, AND PARTICIPANTS Economic evaluation study using a retrospective analysis of state-level data between 2002 and 2015 to determine the association between the Medicaid eligibility threshold and SUD-related deaths, controlling for other relevant policies, state socioeconomic characteristics, fixed effects, and a time trend. Policy variables were lagged by 1 year to allow time for associations to materialize. Data were collected and analyzed from 2016 to 2017. EXPOSURES The policy of interest was the state Medicaid eligibility threshold, ie, the highest allowed income that qualifies a person for Medicaid, expressed as a percentage of the federal poverty level. State policies related to mental health, overdose treatment, and law enforcement of drug crimes were included as controls. MAIN OUTCOMES AND MEASURES The primary outcome was number of SUD-related deaths, obtained from data provided by the Centers for Disease Control and Prevention. RESULTS Across 700 state-year observations, the mean (SD) number of SUD-related deaths was 21.15 (6.05) per 100 000 population. Between 2002 and 2015, the national SUD-related death rate increased from 16.0 to 27.5 per 100 000, while the average Medicaid eligibility threshold increased from 87.2% to 97.1% of the federal poverty level. Over this period, every 100-percentage point increase in the Medicaid eligibility threshold (eg, from 50% to 150% of the federal poverty level) was associated with 1.373 (95% CI, -2.732 to -0.014) fewer SUD-related deaths per 100 000 residents, a reduction of 6.50%. In the 22 states with net contractions in eligibility thresholds between 2005 and 2015, an estimated increase of 570 SUD-related deaths (95% CI, -143 to 1283) occurred. In the 28 states that increased eligibility thresholds, an estimated 1045 SUD-related deaths (95% CI, -209 to 2299) may have been prevented. CONCLUSIONS AND RELEVANCE These findings suggest that the overall increase in SUD-related deaths between 2002 and 2015 may have been greater had the average eligibility threshold for Medicaid not increased over this period. Broader eligibility for Medicaid coverage may be one tool to help reduce SUD-related deaths.
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Affiliation(s)
| | | | | | - Seth Seabury
- Precision Health Economics, Los Angeles, California
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
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Santamaría-Ulloa C, Valverde-Manzanares C. Inequality in the Incidence of Cervical Cancer: Costa Rica 1980-2010. Front Oncol 2019; 8:664. [PMID: 30687639 PMCID: PMC6335361 DOI: 10.3389/fonc.2018.00664] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/17/2018] [Indexed: 01/17/2023] Open
Abstract
Introduction: Cervical cancer is the third most incident and the fourth most lethal cancer among Costa Rican women. The purpose of this study was to quantify incidence inequality along three decades and to explore its determinants. Materials and Methods: This is a population-based study. Main data sources were the National Tumor Registry (1980-2010), CRELES (Costa Rican Longevity and Healthy Aging Study) longitudinal survey (2013), and published indices of economic condition (2007) and access to healthcare (2000). Cartography was made with QGIS software. Inequality was quantified using the Theil-T index. With the purpose of detecting differences by tumor's behavior, inequality was estimated for "in situ" and invasive incidence. In Situ/Invasive Ratios were estimated as an additional marker of inequality. Poisson and spatial regression analyses were conducted with Stata and ArcMap software, respectively, to assess the association between incidence and social determinants such as economic condition, access to healthcare and sub-utilization of Papanicolaou screening. Results: As measured by Theil-T index, incidence inequality has reached high (83 to 87%) levels during the last three decades. For invasive cervical cancer, inequality has been rising especially in women aged 50-59; increasing from 58% in the 1980's to 66% in 2000's. Poisson regression models showed that sub-utilization of Papanicolaou smear was associated with a significant decrease in the probability of early diagnosis. Costa Rican guidelines establish a Pap smear every 2 years; having a Pap smear every 3 years or longer was associated with a 36% decrease in the probability of early "in situ" diagnosis (IRR = 0.64, p = 0.003) in the last decade. Spatial regression models allowed for the detection of specific areas where incidence of invasive cervical cancer was higher than expected. Conclusion: Results from this study provide evidence of inequality in the incidence of cervical cancer, which has been high over three decades, and may be explained by sub-utilization of Papanicolaou smear screening in certain regions. The reasons why women do not adequately use screening must be addressed in future research. Interventions should be developed to stimulate the utilization of screening especially among women aged 50 to 59 where inequality has been rising.
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Segreto FA, Beyer GA, Grieco P, Horn SR, Bortz CA, Jalai CM, Passias PG, Paulino CB, Diebo BG. Vertebral Osteomyelitis: A Comparison of Associated Outcomes in Early Versus Delayed Surgical Treatment. Int J Spine Surg 2018; 12:703-712. [PMID: 30619674 DOI: 10.14444/5088] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The recommended timing of surgical intervention for vertebral osteomyelitis (VO) is controversial; however, most studies are not sufficiently powered. Our goal was to investigate the associated effects of delaying surgery in VO patients on in-hospital complications, neurologic deficits, and mortality. Methods Retrospective review of the National Inpatient Sample. Patients who underwent surgery for VO from 1998 to 2013 were identified using codes from the International Classification of Disease, Ninth Revision, Clinical Modification. Patients were stratified into groups based on incremental delay of surgery: 0-day delay (same-day surgery), 1-day delay, 2-day delay, 3- to 6-day delay, 7- to 14-day delay, and 14- to 30-day delay. Univariate analysis compared demographics and outcomes between groups. Multivariate logistic regression models calculated independent predictors of any complication, mortality, and neurologic deficits. A 0-day delay was the reference group. Results A total of 34 465 patients were identified. Delayed groups were older (same day: 53.5 vs. 7-14-day delay: 61.1) and had a higher Deyo-Charlson score (same day: 0.4901 vs. 14-30-day delay: 1.66), length of stay (same day: 4.2 vs. 14-30-day delay: 34.04 days), and total charges (same day: $63,390.78 vs. 14-30-day delay: $245,752.4), all P < .001. Delayed groups had higher surgical combined-approach rates (same day: 9.1% vs. 14-30-day delay: 31.5%) and lower anterior-approach rates (same day: 42.4% vs. 14-30-day delay: 24.2%). Delayed groups had increased mortality and complication rates. Regressions showed delayed groups as the strongest independent indicators of any complication (14-30-day delay: odds ratio [OR] 3.384), mortality (14-30-day delay: OR 10.658), and neurologic deficits (14-30-day delay: OR 3.464), all P < .001. Conclusion VO patients who operate within 24 hours of admission are more likely to have desirable outcomes. Patients with delayed surgery had a significantly increased risk of developing any complication, mortality, and discharging with neurologic deficits. Level of Evidence III. Clinical Relevance Medically fit patients may benefit from earlier surgical management in order to reduce risk of postoperative complications, improve outcomes, and reduce overall hospital costs.
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Affiliation(s)
- Frank A Segreto
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | | | - Preston Grieco
- Department of Orthopaedic Surgery, SUNY Downstate, Brooklyn, New York
| | - Samantha R Horn
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Cole A Bortz
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Cyrus M Jalai
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Peter G Passias
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Carl B Paulino
- Department of Orthopaedic Surgery, SUNY Downstate, Brooklyn, New York
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate, Brooklyn, New York
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Tsui J, DeLia D, Stroup AM, Nova J, Kulkarni A, Ferrante JM, Cantor JC. Association of Medicaid enrollee characteristics and primary care utilization with cancer outcomes for the period spanning Medicaid expansion in New Jersey. Cancer 2018; 125:1330-1340. [DOI: 10.1002/cncr.31824] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/30/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Jennifer Tsui
- Cancer Institute of New Jersey Rutgers, the State University of New Jersey New Brunswick New Jersey
- School of Public Health Rutgers, the State University of New Jersey Piscataway New Jersey
| | - Derek DeLia
- MedStar Health Research Institute Hyattsville Maryland
| | - Antoinette M. Stroup
- Cancer Institute of New Jersey Rutgers, the State University of New Jersey New Brunswick New Jersey
- School of Public Health Rutgers, the State University of New Jersey Piscataway New Jersey
- New Jersey State Cancer Registry New Jersey Department of Health Trenton New Jersey
| | - Jose Nova
- Center for State Health Policy Rutgers, the State University of New Jersey New Brunswick New Jersey
| | - Aishwarya Kulkarni
- Cancer Institute of New Jersey Rutgers, the State University of New Jersey New Brunswick New Jersey
- New Jersey State Cancer Registry New Jersey Department of Health Trenton New Jersey
| | - Jeanne M. Ferrante
- Department of Family Medicine, Robert Wood Johnson Medical School Rutgers, the State University of New Jersey New Brunswick New Jersey
| | - Joel C. Cantor
- Center for State Health Policy Rutgers, the State University of New Jersey New Brunswick New Jersey
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Assessing the Quality of Microvascular Breast Reconstruction Performed in the Urban Safety-Net Setting: A Doubly Robust Regression Analysis. Plast Reconstr Surg 2018; 143:361-370. [PMID: 30489498 DOI: 10.1097/prs.0000000000005191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Safety-net hospitals serve vulnerable populations; however, care delivery may be of lower quality. Microvascular immediate breast reconstruction, relative to other breast reconstruction subtypes, is sensitive to the performance of safety-net hospitals and an important quality marker. The authors' aim was to assess the quality of care associated with safety-net hospital setting. METHODS The 2012 to 2014 National Inpatient Sample was used to identify patients who underwent microvascular immediate breast reconstruction after mastectomy. Primary outcomes of interest were rates of medical complications, surgical inpatient complications, and prolonged length of stay. A doubly-robust approach (i.e., propensity score and multivariate regression) was used to analyze the impact of patient and hospital-level characteristics on outcomes. RESULTS A total of 858 patients constituted our analytic cohort following propensity matching. There were no significant differences in the odds of surgical and medical inpatient complications among safety-net hospital patients relative to their matched counterparts. Black (OR, 2.95; p < 0.001) and uninsured patients (OR, 2.623; p = 0.032) had higher odds of surgical inpatient complications. Safety-net hospitals (OR, 1.745; p = 0.005), large bedsize hospitals (OR, 2.170; p = 0.023), and Medicaid patients (OR, 1.973; p = 0.008) had higher odds of prolonged length of stay. CONCLUSIONS Safety-net hospitals had comparable odds of adverse clinical outcomes but higher odds of prolonged length of stay, relative to non-safety-net hospitals. Institution-level deficiencies in staffing and clinical processes of care might underpin the latter. Ongoing financial support of these institutions will ensure delivery of needed breast cancer care to economically disadvantaged patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Neal CD, Weaver DT, Raphel TJ, Lietz AP, Flores EJ, Percac-Lima S, Knudsen AB, Pandharipande PV. Patient Navigation to Improve Cancer Screening in Underserved Populations: Reported Experiences, Opportunities, and Challenges. J Am Coll Radiol 2018; 15:1565-1572. [DOI: 10.1016/j.jacr.2018.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 02/06/2023]
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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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Bastian K, Hollinger A, Mebazaa A, Azoulay E, Féliot E, Chevreul K, Fournier MC, Guidet B, Michel M, Montravers P, Pili-Floury S, Sonneville R, Siegemund M, Gayat E. Association of social deprivation with 1-year outcome of ICU survivors: results from the FROG-ICU study. Intensive Care Med 2018; 44:2025-2037. [PMID: 30353380 PMCID: PMC7095041 DOI: 10.1007/s00134-018-5412-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/10/2018] [Indexed: 11/25/2022]
Abstract
Purpose Intensive care unit survivors suffer from prolonged impairment, reduced quality of life, and higher mortality rates after discharge compared to the general population. Socioeconomic status may play a partial but important role in mortality and recovery. Therefore, the detection of factors that are responsible for poor long-term outcomes would be beneficial in designing targeted interventions for at-risk populations. Methods For an endpoint analysis, 1834 intensive care unit patients with known French Deprivation Index (FDep) scores were included from the French and euRopean Outcome reGistry in Intensive Care Units (FROG-ICU) study, which was a prospective, observational, multicenter cohort study performed in 20 French intensive care units in 13 different hospitals. Socioeconomic status was defined by using the FDep score [represented as quintiles when referring to the general French population, as quintiles when referring to the FROG-ICU cohort, or as dichotomized data (which was defined as a FDep ≤ 0 for nondeprived patients)] and by using a detailed social questionnaire that was completed 3 months after discharge. The primary outcome included an all-cause, 1-year mortality after ICU discharge when regarding socioeconomic status. The secondary outcomes included both ICU and hospital lengths of stay, both short- and medium-term mortality, and the quality of life, as assessed during the 1-year follow-up by using the Medical Outcome Survey Short Form-36 (SF-36). The Revised Impact of Event Scale (IES-R) was used to evaluate the symptoms of post-traumatic stress disorder, and the Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depression. Results Of the 1447 patients who were discharged alive from the ICU, 19.2% died over the following year. No association was found between 1-year mortality and socioeconomic status, regardless of whether this association was analyzed in quintiles (p = 0.911 in the quintiles of the general French population; p = 0.589 in the quintiles of the FROG-ICU cohort itself) or as dichotomized data [nondeprived (n = 177; 1-year mortality of 18.2%) versus deprived (n = 97; 1-year mortality of 20.5%; p = 0.304)]. Moreover, no differences were found between the nondeprived and the deprived patients in the ICU and hospital lengths of stay, ICU mortalities, in-hospital mortalities, or 28-day mortalities. The SF-36 was below the score for the normal French population throughout the follow-up period. Socially deprived patients showed significantly lower median scores in the physical function subscale [55, interquartile range (IQR) (28.8–80) vs. 65, IQR (35–90); p = 0.014], the physical role subscale [25, IQR (0–75) vs. 33.3, IQR (0–100); p = 0.022], and the overall physical component scale [47.5, IQR (30–68.8) vs. 54.4, IQR (35–78.8); p = 0.010]. Up to 31.6% of survivors presented symptoms that indicated post-traumatic stress disorder, and up to 31.5% of survivors reported clinically meaningful symptoms of anxiety or depression. Conclusions A lower socioeconomic status was associated with lower self-reported physical component scores in the nondeprived patients. Psychiatric symptoms are frequently reported after an ICU stay, and subsequent interventions should target those fields. Trial registration ClinicalTrials.gov NCT01367093; registered on June 6, 2011. Electronic supplementary material The online version of this article (10.1007/s00134-018-5412-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathleen Bastian
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Alexa Hollinger
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
| | - Elie Azoulay
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
| | - Elodie Féliot
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Karine Chevreul
- INSERM UMR1123, Paris, France
- Unité de Recherche Clinique en Économie de la Santé d’Ile-de-France, Paris, France
| | - Marie-Céline Fournier
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
| | - Bertrand Guidet
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Morgane Michel
- Unité de Recherche Clinique en Économie de la Santé d’Ile-de-France, Paris, France
| | - Philippe Montravers
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
- Department of Anesthesiology and Intensive Care, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sébastien Pili-Floury
- Department of Anesthesiology and Intensive Care Medicine, Besançon University Hospital, Besançon, France
- EA 3920, University of Bourgogne Franche-Comté, Besançon, France
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude, Paris, France
| | - Martin Siegemund
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Etienne Gayat
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
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Annie FH, Uejio CK, Bhagat A, Kochar T, Embrey S, Tager A. Survival Analysis of Cancer Patients of Differing Payer Type in South West Virginia, Between 2000 and 2013. Cureus 2018; 10:e3022. [PMID: 30254811 PMCID: PMC6150748 DOI: 10.7759/cureus.3022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The effect of insurance coverage on the health of at-risk populations is poorly understood in the Appalachian region of the United States. The goal of this study is to examine how different types of insurance coverage (Private Insurance, Medicare under 65, Medicare 65 or over, Medicaid and Self Pay) may influence cancer survival over time. This study analyzes colon, bladder, as well as combines anal, rectal, and esophageal cancers. Methods We systematically analyzed all West Virginia Cancer Registry patients between the years of 2000 and 2013 who was diagnosed with colon, bladder, anal, rectal, and esophageal cancers. Separate analysis examined colon (n = 927), bladder (n = 269), and combined anal, rectum, and esophageal cancers (n = 398). Cox proportional hazards models investigated the effect of insurance types on survival while controlling for age, sex, tobacco use, alcohol use, and cancer stage. Results Overall, tobacco use marginally significantly decreased colon cancer survival. Tobacco use had a suggestive relationship at hazards ratio at 1.150, 95% confidence interval: 0.9990-1.235, p = 0.052. The type of payer group did not alter survival. Older individuals tend to have a lower survival rate compared to those that are younger at the time of diagnosis. Also, late-stage cancer faced lower survival compared to those with early-stage cancer. Other results within stage groups corresponded to existing literature. Conclusion For the three differing cancer groupings, there was no significant survival difference for patients by insurance type. The effect of tobacco usage on colon cancer survival merits further research. The study design could be improved by considering more risk factors such as patient comorbidities that might affect patient care and survival.
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Affiliation(s)
- Frank H Annie
- Cardiology, Charleston Area Medical Center/Health Education and Research Institute, Charleston, USA
| | - Chris K Uejio
- Geography, Florida State Universiy, Charleston , USA
| | - Abhishek Bhagat
- Internal Medicne, Charleston Area Medical Center, Charleston, USA
| | - Tanureet Kochar
- Internal Medicine, West Virginia University/Charleston Area Medical Center, Charleston, USA
| | - Sarah Embrey
- University of Charleston, School of Pharmacy, Charleston, USA
| | - Alfred Tager
- Emergence Medicine, Charleston Area Medical Center, Charleston, USA
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Li X, Zhou Q, Wang X, Su S, Zhang M, Jiang H, Wang J, Liu M. The effect of low insurance reimbursement on quality of care for non-small cell lung cancer in China: a comprehensive study covering diagnosis, treatment, and outcomes. BMC Cancer 2018; 18:683. [PMID: 29940893 PMCID: PMC6019825 DOI: 10.1186/s12885-018-4608-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background The insurance reimbursement rate of medical cost affects the quality and quantity of health services provided in China. The nature of this relationship, however, has not been reliably described in the field of non-small cell lung cancer (NSCLC). The objective of the current study was to examine the impact of low reimbursement rates of medical costs on diagnosis, treatment and outcomes among patients with NSCLC. Methods We examined care of 2643 NSCLC patients and we divided the study cohort into a high reimbursement rate group and a low reimbursement rate group. The impact of reimbursement rates of medical costs on quality of care of NSCLC patients were examined using logistic regression and generalized linear models. Results Compared with patients insured with high reimbursement rate, patients insured through lower reimbursement rate programs were less likely to benefit from early detection and treatment services. Delayed detection was more common in low reimbursement group and they were less likely to be recommended for adjuvant chemotherapy, or to receive adjuvant chemotherapy and postoperative radiation therapy and they had lower odds to receipt chemotherapy response assessment. However, low reimbursement rate group had lower rate of in-hospital mortality and metastases. Conclusions Low reimbursement rate mainly negatively influenced the diagnosis and treatment of NSCLC. Reducing the gap in reimbursement rate between the three health insurance schemes should be a focus of equalizing access to care and improving the level of medical compliance and finally improving quality of care of NSCLC. Electronic supplementary material The online version of this article (10.1186/s12885-018-4608-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xi Li
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Qi Zhou
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Xinyu Wang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Shaofei Su
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Meiqi Zhang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Hao Jiang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Jiaying Wang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Meina Liu
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China. .,School of Public Health, Harbin Medical University, No.157 Baojian Road, Harbin, 150081, China.
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Moore JX, Royston KJ, Langston ME, Griffin R, Hidalgo B, Wang HE, Colditz G, Akinyemiju T. Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics. Cancer Causes Control 2018; 29:737-750. [PMID: 29922896 DOI: 10.1007/s10552-018-1051-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 06/13/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The goals of this study were to identify geographic and racial/ethnic variation in breast cancer mortality, and evaluate whether observed geographic differences are explained by county-level characteristics. METHODS We analyzed data on breast cancer deaths among women in 3,108 contiguous United States (US) counties from years 2000 through 2015. We applied novel geospatial methods and identified hot spot counties based on breast cancer mortality rates. We assessed differences in county-level characteristics between hot spot and other counties using Wilcoxon rank-sum test and Spearman correlation, and stratified all analysis by race/ethnicity. RESULTS Among all women, 80 of 3,108 (2.57%) contiguous US counties were deemed hot spots for breast cancer mortality with the majority located in the southern region of the US (72.50%, p value < 0.001). In race/ethnicity-specific analyses, 119 (3.83%) hot spot counties were identified for NH-Black women, with the majority being located in southern states (98.32%, p value < 0.001). Among Hispanic women, there were 83 (2.67%) hot spot counties and the majority was located in the southwest region of the US (southern = 61.45%, western = 33.73%, p value < 0.001). We did not observe definitive geographic patterns in breast cancer mortality for NH-White women. Hot spot counties were more likely to have residents with lower education, lower household income, higher unemployment rates, higher uninsured population, and higher proportion indicating cost as a barrier to medical care. CONCLUSIONS We observed geographic and racial/ethnic disparities in breast cancer mortality: NH-Black and Hispanic breast cancer deaths were more concentrated in southern, lower SES counties.
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Affiliation(s)
- Justin Xavier Moore
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. .,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA. .,Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA. .,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, TAB 2nd Floor Suite East, 7E, Saint Louis, MO, 63110-1093, USA.
| | - Kendra J Royston
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marvin E Langston
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA
| | - Russell Griffin
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bertha Hidalgo
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Henry E Wang
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Graham Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA
| | - Tomi Akinyemiju
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Epidemiology, University of Kentucky, Lexington, KY, USA
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Preliminary Results of Lung Cancer Screening in a Socioeconomically Disadvantaged Population. AJR Am J Roentgenol 2018; 210:489-496. [DOI: 10.2214/ajr.17.18853] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Roche AM, Fedewa SA, Shi LL, Chen AY. Treatment and survival vary by race/ethnicity in patients with anaplastic thyroid cancer. Cancer 2018; 124:1780-1790. [DOI: 10.1002/cncr.31252] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Ansley M. Roche
- Division of Otolaryngology-Head and Neck Surgery; Hofstra Northwell School of Medicine; Staten Island New York
| | - Stacey A. Fedewa
- Surveillance and Health Services Research, American Cancer Society; Atlanta Georgia
| | - Lucy L. Shi
- Department of Otolaryngology-Head and Neck Surgery; The Ohio State University; Columbus Ohio
| | - Amy Y. Chen
- Department of Otolaryngology-Head and Neck Surgery; Emory University; Atlanta Georgia
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Stevenson JK, Cheung MC, Earle CC, Fischer HD, Camacho X, Saskin R, Shah BR, Austin PC, Singh S. Chinese and South Asian ethnicity, immigration status, and clinical cancer outcomes in the Ontario Cancer System. Cancer 2018; 124:1473-1482. [DOI: 10.1002/cncr.31231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 01/01/2023]
Affiliation(s)
| | - Matthew C. Cheung
- Division of Hematology, Department of Medicine; University of Toronto; Toronto Ontario Canada
- Odette Cancer Centre; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | - Craig C. Earle
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Odette Cancer Centre; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Ontario Institute for Cancer Research; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Hadas D. Fischer
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Ximena Camacho
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Baiju R. Shah
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Division of Endocrinology, Department of Medicine; University of Toronto; Toronto Ontario Canada
| | - Peter C. Austin
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Institute for Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
| | - Simron Singh
- Odette Cancer Centre; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Division of Medical Oncology, Department of Medicine; University of Toronto; Toronto Ontario Canada
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Mukherjee A, Mazumder K, Ghoshal S. Impact of Different Sociodemographic Factors on Mental Health Status of Female Cancer Patients Receiving Chemotherapy for Recurrent Disease. Indian J Palliat Care 2018; 24:426-430. [PMID: 30410253 PMCID: PMC6199836 DOI: 10.4103/ijpc.ijpc_64_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context: Deterioration in mental health and poor quality of life (QOL) among women suffering from breast and ovarian cancer is not a direct result of the illness but mediated by many other psychosocial variables. Aims: The study intended to examine if there was any effect of educational level, residential status, family type, duration of treatment, and income level of family on anxiety, depression, and QOL among the breast and ovarian cancer patients, undergoing second- or subsequent-line chemotherapy. Subjects and Methods: Forty married female cancer patients with breast and ovarian cancer, aging between 40 and 60 years, education level ranges from no formal education to postgraduate degree, income level ranges from Rs. 1000 per month to Rs. 20000 per month, and undergoing second- or subsequent-line chemotherapy for the past 1–10 years were studied. Levels of anxiety and depression were determined by Hospital Anxiety and Depression Scale. The QOL was measured by using WHO QOLBREF scale. Statistical Analysis Used: Mean and standard deviation and Levene's F values were calculated. If Levene's F value was significant, then Mann–Whitney U-test was done or else independent samples t-test was used. Results: Among all the variables, education, residential status, and income affect significantly on anxiety, depression, and QOL. Conclusions: Early detection of psychosocial variables is essential for better screening of the cancer patients undergoing chemotherapy, and therefore, further psychological intervention can be planned accordingly.
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Affiliation(s)
- Anindita Mukherjee
- Department of Radiotherapy and Oncology, Postgraduate Medical Education and Research, Chandigarh, India
| | - Koustav Mazumder
- Department of Radiotherapy and Oncology, Postgraduate Medical Education and Research, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiotherapy and Oncology, Postgraduate Medical Education and Research, Chandigarh, India
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Kooistra L, Chiang K, Dawes S, Gittleman H, Barnholtz-Sloan J, Bordeaux J. Racial disparities and insurance status: An epidemiological analysis of Ohio melanoma patients. J Am Acad Dermatol 2017; 78:998-1000. [PMID: 29138060 DOI: 10.1016/j.jaad.2017.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/27/2017] [Accepted: 11/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Laura Kooistra
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Katherine Chiang
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sean Dawes
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Haley Gittleman
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jill Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeremy Bordeaux
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Nazha A, Al-Issa K, Przychodzen B, Abuhadra N, Hirsch C, Maciejewski JP, Sekeres MA. Differences in genomic patterns and clinical outcomes between African-American and White patients with myelodysplastic syndromes. Blood Cancer J 2017; 7:e602. [PMID: 28862700 PMCID: PMC5709751 DOI: 10.1038/bcj.2017.82] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- A Nazha
- Department of Translation Hematology and Oncology Research, Leukemia Program, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | - K Al-Issa
- Department of Translation Hematology and Oncology Research, Leukemia Program, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | - B Przychodzen
- Department of Translation Hematology and Oncology Research, Leukemia Program, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | - N Abuhadra
- Department of Translation Hematology and Oncology Research, Leukemia Program, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | - C Hirsch
- Department of Translation Hematology and Oncology Research, Leukemia Program, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | - J P Maciejewski
- Department of Translation Hematology and Oncology Research, Leukemia Program, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | - M A Sekeres
- Department of Translation Hematology and Oncology Research, Leukemia Program, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
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Srour SA, Machiorlatti M, Pierson NT, Bhutta UZ, Cherry M, Selby GB, Thompson DM, Vesely SK, Kurkjian CD. Impact of Health Care Insurance Status on Treatment Outcomes of Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017. [DOI: 10.1016/j.clml.2017.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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