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Jalili F, Hajizadeh M, Mehrabani S, Ghoreishy SM, MacIsaac F. The association between neighborhood socioeconomic status and the risk of incidence and mortality of colorectal cancer: A systematic review and meta-analysis of 1,678,582 participants. Cancer Epidemiol 2024; 91:102598. [PMID: 38878681 DOI: 10.1016/j.canep.2024.102598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis to evaluate the association between neighborhood socioeconomic status (n-SES) and the risk of incidence and mortality in colorectal cancer (CRC). SETTING A comprehensive literature search was performed using PubMed/MEDLINE, ISI Web of Science and Scopus without any limitation until October 11, 2023. Inclusion criteria consisted of observational studies in adult subjects (≥18 years) which provided data on the association between n-SES and CRC-related incidence and mortality. Relative risk (RR) and 95 % confidence interval (CI) were pooled by employing a random-effects model. We employed validated methods to assess study quality and publication bias, utilizing the Newcastle-Ottawa Scale for quality evaluation, subgroup analysis to find possible sources of heterogeneity, Egger's regression asymmetry and Begg's rank correlation tests for bias detection and sensitivity analysis. RESULTS Finally, 24 studies (21 cohorts and 3 cross-sectional studies) from seven different countries with 1678,582 participants were included. The analysis suggested that a significant association between lower n-SES and an increased incidence of CRC (RR=1.11; 95 % CI: 1.08, 1.14; I2=64.4 %; p<0.001; n=46). The analysis also indicated a significant association between lower n-SES and an increased risk of mortality of CRC (RR=1.21; 95 % CI: 1.16, 1.26; I2=76.4 %; p<0.001; n=23). Furthermore, subgroup analysis revealed that there was a significant association between lower n-SES and an increased risk of incidence of CRC in colon location (RR=1.06; 95 % CI: 1.02, 1.10; I2=0.0 %; p=0.001; n=8), but not rectal location. In addition, subgroup analysis for covariates adjustment suggested that body mass index, smoking, physical activity, alcohol intake, or sex adjustment may influence the relationship between n-SES and the risk of incidence and mortality in CRC. CONCLUSION Lower n-SES was found to be a contributing factor to increased incidence and mortality rates associated with CRC, highlighting the substantial negative impacts of lower n-SES on cancer susceptibility and health outcomes.
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Affiliation(s)
- Faramarz Jalili
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Sanaz Mehrabani
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mojtaba Ghoreishy
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Fernandez-Rodriguez EJ, Taboada-Taboada R, Garcia-Martin A, Sanchez-Gomez C, Saez-Gutierrez S, Rihuete-Galve MI, Fonseca-Sánchez E. Study on the additional financial burden of breast cancer disease on cancer patients and their families. Financial toxicity in cancer. Front Public Health 2024; 12:1324334. [PMID: 39022422 PMCID: PMC11251982 DOI: 10.3389/fpubh.2024.1324334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Breast cancer is among the most frequently diagnosed cancers worldwide, with 2.3 million new cases reported annually. The condition causes a social and economic impact known as financial toxicity of cancer. The study aims to explore the extra expenses borne by patients and their families on being diagnosed with breast cancer. Methodology An observational, descriptive, cross-sectional study was conducted. The data was collected between November 2021 and March 2022 at the Medical Oncology Service in Complejo Asistencial Universitario de Salamanca, Spain. The variables under investigation were additional economic costs, physical disability (as measured by the Barthel Index), instrumental activities of daily living (as measured by the Lawton-Brody Scale), and caregiver burden (measured using the ZARIT scale). Results The final sample size was N = 107. The study yielded the following outcomes: the median age was 55 years old and the majority of participants were female, with a proportion of 99.1%. The incidence rates for stage I and II were 31.8 and 35.5%, respectively. The median Barthel score was 100 points, while the Lawton and Brody score were 8 points and the ECOG score was 2 points. The analysis of primary caregiver burden resulted in a median ZARIT score of 15 points. The expenses related solely to the cancer diagnosis totaled 1511.22 euros per year (316.82 euros for pharmaceuticals; 487.85 euros for orthopedic equipment; 140.19 euros for home help; and 566.36 euros for housing adaptation or transfer to a hospital). The average annual income before diagnosis was 19962.62 euros. However, after being diagnosed with breast cancer, there is a significant income decrease of 15.91%, resulting in a reduced average annual income of 16785.98 euros. Additionally, a significant correlation was found between total expenditure and the level of dependency (p = 0.032) and functional status (p = 0.045). Conclusion These findings indicate that breast cancer patients experience a considerable economic burden, which worsens as their functional status deteriorates. Therefore, we believe policies should be implemented to help control this economic deterioration resulting from a serious health condition.
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Affiliation(s)
- Eduardo J. Fernandez-Rodriguez
- Deparment of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
- Institute of Biomedical Research (IBSAL), Salamanca, Spain
| | | | | | - Celia Sanchez-Gomez
- Institute of Biomedical Research (IBSAL), Salamanca, Spain
- Deparment of Evolutionary and Educational Psychology, University of Salamanca, Salamanca, Spain
| | | | - Maria I. Rihuete-Galve
- Deparment of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
- Institute of Biomedical Research (IBSAL), Salamanca, Spain
- Deparment of Medicine, University of Salamanca, Salamanca, Spain
| | - Emilio Fonseca-Sánchez
- Institute of Biomedical Research (IBSAL), Salamanca, Spain
- Deparment of Medicine, University of Salamanca, Salamanca, Spain
- Medical Oncology Unit, University Hospital of Salamanca, Salamanca, Spain
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Mulligan KM, Kakish H, Pawar O, Ahmed FA, Elshami M, Rothermel LD, Bordeaux JS, Sheng IY, Mangla A, Hoehn RS. Disparities in Receipt of Adjuvant Immunotherapy among Stage III Melanoma Patients. Am J Clin Oncol 2024:00000421-990000000-00207. [PMID: 38937882 DOI: 10.1097/coc.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Melanoma survival has greatly improved with the advent of immunotherapy, but unequal access to these medications may exist due to nonmedical patient factors such as insurance status, educational background, and geographic proximity to treatment. METHODS We used the National Cancer Database to assess patients with nonmetastatic cutaneous melanoma who underwent surgical resection and sentinel lymph node biopsy (SLNB) with tumor involvement from 2015 to 2020. We evaluated rates of adjuvant immunotherapy among this patient population based on patient, tumor, and facility variables, including insurance status, socioeconomic status, pathologic stage (IIIA-IIID), and treatment facility type and volume. RESULTS Adjuvant immunotherapy was associated with improved survival for stage III melanoma, with a slight increase in 5-year OS for stage IIIA (87.9% vs. 85.9%, P=0.044) and a higher increase in stages IIIB-D disease (70.3% vs. 59.6%, P<0.001). Receipt of adjuvant immunotherapy was less likely for patients who were older, low socioeconomic status, or uninsured. Low-volume and community cancer centers had higher rates of adjuvant immunotherapy overall for all stage III patients, whereas high-volume and academic centers used adjuvant immunotherapy much less often for stage IIIA patients compared with those in stages IIIB-D. CONCLUSIONS Our results demonstrate inconsistent use of adjuvant immunotherapy among patients with stage III melanoma despite a significant association with improved survival. Notably, there was a lower use of adjuvant immunotherapy in patients of lower SES and those treated at high-volume centers. Equity in access to novel standards of care represents an opportunity to improve outcomes for patients with melanoma.
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Affiliation(s)
| | - Hanna Kakish
- Department of Surgery, Division of Surgical Oncology
| | | | | | | | | | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center
| | - Iris Y Sheng
- Division of Hematology and Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Ankit Mangla
- Division of Hematology and Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH
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Guram K, Huang J, Mouchati C, Abdallah N, Jani C, Navani V, Xie W, El Zarif T, Adib E, Gebrael G, Agarwal N, Li H, Labaki C, Labban M, Ruiz Morales JM, Choueiri TK, Chin Heng DY, Mittal A, Hansen AR, Rose BS, McKay RR. Comparison of outcomes for Hispanic and non-Hispanic patients with advanced renal cell carcinoma in the International Metastatic Renal Cell Carcinoma Database. Cancer 2024; 130:2003-2013. [PMID: 38297953 DOI: 10.1002/cncr.35216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/03/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Existing data on the impact of Hispanic ethnicity on outcomes for patients with renal cell carcinoma (RCC) is mixed. The authors investigated outcomes of Hispanic and non-Hispanic White (NHW) patients with advanced RCC receiving systemic therapy at large academic cancer centers using the International Metastatic Renal Cell Carcinoma Database (IMDC). METHODS Eligible patients included non-Black Hispanic and NHW patients with locally advanced or metastatic RCC initiating systemic therapy. Overall survival (OS) and time to first-line treatment failure (TTF) were calculated using the Kaplan-Meier method. The effect of ethnicity on OS and TTF were estimated by Cox regression hazard ratios (HRs). RESULTS A total of 1563 patients (181 Hispanic and 1382 NHW) (mostly males [73.8%] with clear cell RCC [81.5%] treated with tyrosine kinase inhibitor [TKI] monotherapy [69.9%]) were included. IMDC risk groups were similar between groups. Hispanic patients were younger at initial diagnosis (median 57 vs. 59 years, p = .015) and less likely to have greater than one metastatic site (60.8% vs. 76.8%, p < .001) or bone metastases (23.8% vs. 33.4%, p = .009). Median OS and TTF was 38.0 months (95% confidence interval [CI], 28.1-59.2) versus 35.7 months (95% CI, 31.9-39.2) and 7.8 months (95% CI, 6.2-9.0) versus 7.5 months (95% CI, 6.9-8.1), respectively, in Hispanic versus NHW patients. In multivariable Cox regression analysis, no statistically significant differences were observed in OS (adjusted hazard ratio [HR], 1.07; 95% CI, 0.86-1.31, p = .56) or TTF (adjusted HR, 1.06; 95% CI, 0.89-1.26, p = .50). CONCLUSIONS The authors did not observe statistically significant differences in OS or TTF between Hispanic and NHW patients with advanced RCC. Receiving treatment at tertiary cancer centers may mitigate observed disparities in cancer outcomes.
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Affiliation(s)
- Kripa Guram
- University of California, San Diego Health, La Jolla, California, USA
| | - Jiaming Huang
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christian Mouchati
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nour Abdallah
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Chinmay Jani
- Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
- University of Miami-Sylvester Comprehensive Cancer Center/Jackson Health System, Miami, Florida, USA
| | - Vishal Navani
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Wanling Xie
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Talal El Zarif
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elio Adib
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Georges Gebrael
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Haoran Li
- Department of Medical Oncology, University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Chris Labaki
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Muhieddine Labban
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel Yick Chin Heng
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Abhenil Mittal
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aaron R Hansen
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brent S Rose
- University of California, San Diego Health, La Jolla, California, USA
| | - Rana R McKay
- University of California, San Diego Health, La Jolla, California, USA
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Olafimihan A, Obomanu E, Cuartas-Mesa MC, Turk E, Fawehinmi P, Olatunji G, Kokori E, Aderinto N, Shaka H, Mba B, Mullane M. Trends and disparities in colorectal cancer hospitalizations and outcomes: a 10-year joinpoint trend study. Proc AMIA Symp 2024; 37:535-542. [PMID: 38910805 PMCID: PMC11188818 DOI: 10.1080/08998280.2024.2346404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/11/2024] [Indexed: 06/25/2024] Open
Abstract
Background Colorectal cancer (CRC) poses a significant burden on healthcare systems globally. Sociodemographic factors intricately influence CRC epidemiology, yet their impact on inpatient care remains underexplored. This study aimed to assess trends in CRC hospitalization and the effect of sociodemographic factors on outcomes of CRC patients. Methods A retrospective longitudinal analysis was conducted using data from the Healthcare Cost and Utilization Project National Inpatient Sample. Trends in CRC admissions were assessed, stratified by sociodemographic variables. Disparities in hospital-associated outcomes were examined. Statistical methods included multivariable regression and joinpoint regression analysis. Results The prevalence of CRC hospitalizations uptrended from 760 per 100,000 hospitalizations in 2010 to 841 per 100,000 hospitalizations in 2019 (P trend < 0.001). The mean age decreased from 67 to 66 years (P < 0.001). Male gender and White race were predominant across the study period. Inpatient mortality decreased from 4.5% in 2010 to 4.16% in 2019 (P trend = 0.033). On sex subgroup analysis, men had a significantly higher mortality rate (P = 0.034). Racially, Blacks had the highest mortality rate (P = 0.550) and only Whites showed a significant decline in mortality over the study period (P = 0.003). Hospitalization length decreased while total hospital charges increased. Conclusion Our study highlights sociodemographic disparities in CRC outcomes, emphasizing the need for targeted interventions to address inequity in screening, diagnosis, and treatment. Continued research is needed to inform effective healthcare practices in mitigating these disparities and improving survival outcomes.
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Affiliation(s)
- Ayobami Olafimihan
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Elvis Obomanu
- Department of Internal Medicine, Jefferson-Einstein Hospital, Philadelphia, Pennsylvania, USA
| | | | - Ekrem Turk
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Praise Fawehinmi
- Department of Pharmaceutical Sciences, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
| | - Hafeez Shaka
- Department of General Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Benjamin Mba
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Mullane
- Department of Hematology and Oncology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
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Cirulli GO, Corsi N, Rakic I, Stephens A, Chiarelli G, Finati M, Davis M, Tinsley S, Sood A, Buffi N, Lughezzani G, Carrieri G, Salonia A, Briganti A, Montorsi F, Rogers C, Abdollah F. Impact of lymphovascular invasion on survival in surgically treated upper tract urothelial carcinoma: a nationwide analysis. BJU Int 2024; 133:555-563. [PMID: 38097533 DOI: 10.1111/bju.16258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVES To assess the prognostic ability of lymphovascular invasion (LVI) in upper tract urothelial carcinoma (UTUC) as a predictor of overall survival (OS) using a large North American cohort. PATIENTS AND METHODS Our cohort included 5940 patients with clinical M0 UTUC who underwent a radical nephroureterectomy (RNU), between 2010 and 2016, within the National Cancer Database. The main variable of interest was LVI status, and its interaction with pathological nodal (pN) status. Kaplan-Meier curves were used to depict the OS also stratifying patients on LVI status. Cox regression analysis tested the impact of LVI status on OS after accounting for the available covariates. RESULTS The median (interquartile range [IQR]) age at diagnosis was 71 (63-78) years and most patients had pathological T1 stage disease (48.6%). Nodal status was pN0, pN1 and pNx in 45.8%, 6.3% and 47.9%, respectively. Overall, 22.1% had LVI. The median (IQR) follow-up time was 32.6 (16.0-53.3) months. At the 5-year postoperative follow-up, the estimated OS rate was 28% in patients with LVI vs 66% in those without LVI (P < 0.001). When patients were stratified based on nodal status those rates were 32% vs 68% in pN0 patients (P < 0.001), 23% vs 30% in pN1 patients (P = 0.8), and 28% vs 65% in pNx patients (P < 0.001). On multivariable analysis, the presence of LVI was associated with less favourable OS (hazard ratio 1.79, 95% confidence interval 1.60-1.99; P < 0.001). CONCLUSION Our study assessed the impact of LVI on OS in patients with UTUC in a large North American nationwide cohort. Our series, as the largest to date, indicate that LVI is associated with less favourable survival outcomes in patients with UTUC after RNU, and this variable could be used in counselling patients about their prognosis and might be a useful tool for future trials to risk-stratify patients.
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Affiliation(s)
- Giuseppe Ottone Cirulli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicholas Corsi
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Ivan Rakic
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Alex Stephens
- Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Giuseppe Chiarelli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Marco Finati
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Matthew Davis
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Shane Tinsley
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Akshay Sood
- Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicolò Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Andrea Salonia
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Craig Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
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VanLandingham HB, Ellison RL, Turchmanovych-Hienkel N, Alfonso D, Oh A, Kaseda ET, Basurto K, Tse PKY, Khan H. Neuropsychological assessment, intervention, and best practices for women with non-Central nervous system cancer: A scoping review of current standards. Clin Neuropsychol 2024:1-32. [PMID: 38641949 DOI: 10.1080/13854046.2024.2343147] [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: 07/24/2023] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
Objective: Existing literature has sought to characterize the broad cognitive impact of non-central nervous system cancer and its treatment, including chemotherapy, radiation, surgery, and hormonal regulation. However, despite the frequency of women that are diagnosed with breast and gynecological cancer, there is limited research on the specific cognitive experiences of women undergoing cancer treatment. Presently, the current literature lacks concise guidance for neuropsychologists to support the cognitive health of women facing cancer, despite the acknowledged impact of cancer interventions and chronic illness on cognitive outcomes. Method: Applying scoping review criteria outlined by Peters et al. (2015) and adhering to Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a comprehensive examination of literature spanning multiple databases (Google Scholar, PubMed, PsychINFO) with a focus on the cognitive impact of cancer treatment on women. Conclusions: Women are subject to unique treatment-related outcomes due to the impact of hormonal alterations, differences in metabolization of certain chemotherapies, and psychosocial risk factors. Despite the known impact of cancer intervention, chronic illness, and cancer-related sequelae on cognitive outcomes, the current literature does not parsimoniously outline best practices for neuropsychologists to promote the health of women experiencing cancer. The current paper (1) provides an overview of the cognitive implications of cancer treatment with an intentional focus on cancers that are more prevalent in women versus men, (2) addresses the characteristics of this impact for women undergoing cancer intervention(s), and (3) provides possible intervention and treatment strategies for mental health providers and neuropsychologists.
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Affiliation(s)
- Hannah B VanLandingham
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Rachael L Ellison
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Demy Alfonso
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Alison Oh
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Erin T Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Karen Basurto
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Phoebe K Y Tse
- Department of Psychology, The Chicago School, Chicago, IL, USA
| | - Humza Khan
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
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Sun D, Fang H, Wang J, Wu J. Group-based trajectory modeling for fear of cancer recurrence in cancer survivors: a systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01582-7. [PMID: 38584241 DOI: 10.1007/s11764-024-01582-7] [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: 12/08/2023] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE We aimed to systematically review studies that used a group-based trajectory modeling approach to explore the categories of fear of cancer recurrence (FCR) trajectories and their predictors in cancer survivors. METHODS MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science were searched. Three authors independently reviewed the literature for predefined eligibility criteria. The Joanna Briggs Institute critical appraisal tools for Cohort Studies and the Guidelines for Reporting on Latent Trajectory Studies were used to assess the quality of included studies. A qualitative synthesis of the included studies was performed. RESULTS Ninety-eight studies were retrieved after removing duplicates, and 11 studies met the criteria for inclusion. There are four types of FCR trajectories: stable, decreasing, increasing, and stable-then-decreasing-then-increasing. The following factors were considered significant predictors of FCR trajectory category in at least one of the included studies: age, race, income, education, employment, cancer stage, physical symptoms, depression, anxiety, satisfaction with medical care, and selected cognitive and behavioral factors. CONCLUSIONS There was considerable heterogeneity among the studies included in study design and FCR trajectory results. Factors that significantly predicted FCR trajectory categories mostly focused on psychological characteristics. The correlation of sociodemographic and disease-related predictors with FCR trajectory categories was not consistent among the included studies. IMPLICATIONS FOR CANCER SURVIVORS We suggest that future scholars should incorporate more psychological factors when identifying cancer survivors who persistently maintain a high level of FCR and developing FCR mitigation measures.
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Affiliation(s)
- Dandan Sun
- Huadong Hospital Affiliated to Fudan University, Shanghai, China
- School of Nursing, Fudan University, Shanghai, China
| | - Huaying Fang
- Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jin Wang
- Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinqiu Wu
- Huadong Hospital Affiliated to Fudan University, Shanghai, China.
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9
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Lin L, Chen Q, Lai F, Guo D, Wang J, Tian L. The interaction of financial toxicity and social support on social functioning in post-chemotherapy breast cancer patients: a cross-sectional study. Support Care Cancer 2023; 31:583. [PMID: 37728783 DOI: 10.1007/s00520-023-08048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To explore the correlation between financial toxicity, social support, and social functioning in post-chemotherapy breast cancer patients, as well as any possible interaction of financial toxicity and social support on social functioning. METHODS Post-chemotherapy breast cancer patients admitted to the thyroid and breast surgery departments of three first-class general hospitals in East China from December 2020 to January 2022 were recruited by convenience sampling for a cross-sectional survey. The survey instruments included the general information form, the comprehensive scores for financial toxicity based on the patient-reported outcome measures (COST-PROM), the social roles and activity participation subscale from the patient-reported outcomes measurement system-breast-chemotherapy (PROMS-B-C) (score range: 8-40), and the social support subscale from PROMS-B-C (score range: 16-80). RESULTS The results showed that low social functioning (low score) in post-chemotherapy breast cancer patients was positively correlated with high financial toxicity (low score) as well as poor economic resources (low score) and poor psychosocial responses (low score) (P<0.01) and negatively correlated with low economic expenditures (low score) (P<0.01); high social functioning (high score) was positively correlated with high social support (high score) (P<0.01). The interaction analysis results showed an additive interaction between financial toxicity and social support in social functioning. CONCLUSION There was an additive interaction of financial toxicity and social support in the social functioning of post-chemotherapy breast cancer patients. Those patients with high financial toxicity and low social support are the most likely to benefit from relevant intervention measures compared to other breast cancer populations.
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Affiliation(s)
- Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Road, Suzhou, 215006, People's Republic of China
| | - Qiuyun Chen
- Department of Nursing, Dushu Lake Hospital Affiliated to Soochow University, No. 9 Chongwen Road, Suzhou, 215006, People's Republic of China
| | - Fengxia Lai
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Road, Suzhou, 215006, People's Republic of China
| | - Daoxia Guo
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Road, Suzhou, 215006, People's Republic of China
| | - Jie Wang
- Department of Nursing, Dushu Lake Hospital Affiliated to Soochow University, No. 9 Chongwen Road, Suzhou, 215006, People's Republic of China.
| | - Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China.
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Road, Suzhou, 215006, People's Republic of China.
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10
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Zhang B, Li J, Tang M, Cheng C. Reduced Racial Disparity as a Result of Survival Improvement in Prostate Cancer. Cancers (Basel) 2023; 15:3977. [PMID: 37568792 PMCID: PMC10417437 DOI: 10.3390/cancers15153977] [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: 05/13/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Prostate cancer is a cancer type associated with a high level of racial and socioeconomic disparities as reported by many previous studies. However, the changes in these disparities in the past two decades have not been systematically studied. In this study, we investigated the Surveillance Epidemiology End Results (SEER) data for prostate cancer patients diagnosed during 2004-2018. African Americans and Asians showed significantly better and worse cancer-specific survival (CSS), respectively, compared to non-Hispanic white individuals after adjusting for confounding factors such as age and cancer stage. Importantly, the data indicated that racial disparities fluctuated and reached the highest level during 2009-2013, and thereafter, it showed a substantial improvement. Such a change cannot be explained by the improvement in early diagnosis but is mainly driven by the differential improvement in CSS between races. Compared with Asians and non-Hispanic whites, African American patients achieved a more significant survival improvement during 2014-2018, while no significant improvement was observed for Hispanics. In addition, the SEER data showed that high-income patients had significantly longer CSS than low-income patients. Such a socioeconomic disparity was continuously increasing during 2004-2018, which was caused by the increased survival benefits of the high-income patients with respect to the low-income patients. Our study suggests that more efforts and resources should be allocated to improve the treatment of patients with low socioeconomic status.
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Affiliation(s)
- Baoyi Zhang
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX 77030, USA;
| | - Jianrong Li
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Mabel Tang
- Department of Biosciences, Rice University, Houston, TX 77030, USA;
| | - Chao Cheng
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
- The Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX 77030, USA
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11
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Johnson G, Miquel-Chambers C, Blas Y, Lowery S, Guerra L, Gonzalez E. Women's Health Maintenance Efforts at a Student-Run Free Clinic in South Florida Exceeded National Trends During the COVID-19 Pandemic. J Community Health 2023; 48:501-507. [PMID: 36719533 PMCID: PMC9887570 DOI: 10.1007/s10900-023-01190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic posed a setback to health maintenance screenings worldwide. These delays have impacted minorities and those of low socioeconomic status in the same way that disparities in cancer screenings have historically trended. Here, we evaluated the performance of a student-run free clinic in maintaining women up-to-date with cancer screenings before, during, and after the pandemic in relation to national trends. We identified all women eligible for screening mammography and cervical cancer screenings between 2018 and 2022 at the clinic (N = 185). Adequate adherence to screening was defined according to the American Cancer Society (ACS) recommendations for breast mammography, and the United States Preventive Services Task Force (USPSTF) guidelines for cervical cancer screenings. For cervical cancer screening, 166 female patients seen between 2018 and 2022 were eligible, and up-to-date proportions were as follows: 81.3% in 2018; 90.9% in 2019; 83.3% in 2020; 93.3% in 2021; 93.8% in 2022. For breast surveillance, 143 women were eligible for screening mammography, and up-to-date proportions were as follows: 66.7% in 2018; 62.5% in 2019; 91.7% in 2020; 73.1% in 2021; 84.1% in 2022. These proportions were higher than or near national averages.In conclusion, adherence remained steady during the pandemic and was not subject to the declines seen nationally. Our clinic represents an effective model for promoting women's health maintenance and tempering the disparities seen among women of low socioeconomic status.
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Affiliation(s)
- Grace Johnson
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | | | - Yohancie Blas
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Sylea Lowery
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Lucy Guerra
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Eduardo Gonzalez
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
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12
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Ottman R, Ganapathy K, Lin HY, Osterman CD, Dutil J, Matta J, Ruiz-Deya G, Wang L, Yamoah K, Berglund A, Chakrabarti R, Park JY. Differential Expression of miRNAs Contributes to Tumor Aggressiveness and Racial Disparity in African American Men with Prostate Cancer. Cancers (Basel) 2023; 15:cancers15082331. [PMID: 37190259 DOI: 10.3390/cancers15082331] [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: 03/10/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Prostate cancer is the leading cancer in incidence and second leading cause of cancer mortality in US men. African American men have significantly higher incidence and mortality rates from prostate cancer than European American men. Previous studies reported that the disparity in prostate cancer survival or mortality can be explained by different biological backgrounds. microRNAs (miRNAs) regulate gene expression of their cognate mRNAs in many cancers. Therefore, miRNAs may be a potentially promising diagnostic tool. The role of miRNAs in prostate cancer aggressiveness and racial disparity has not been fully established. The goal of this study is to identify miRNAs associated with aggressiveness and racial disparity in prostate cancer. Here we report miRNAs that are associated with tumor status and aggressiveness in prostate cancer using a profiling approach. Further, downregulated miRNAs in African American tissues were confirmed by qRT-PCR. These miRNAs have also been shown to negatively regulate the expression of the androgen receptor in prostate cancer cells. This report provides a novel insight into understanding tumor aggressiveness and racial disparities of prostate cancer.
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Affiliation(s)
- Richard Ottman
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL 32816, USA
| | - Kavya Ganapathy
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL 32816, USA
| | - Hui-Yi Lin
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Carlos Diaz Osterman
- Department of Basic Sciences, Ponce Research Institute, School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA
| | - Julie Dutil
- Department of Basic Sciences, Ponce Research Institute, School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA
| | - Jaime Matta
- Department of Basic Sciences, Ponce Research Institute, School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA
| | - Gilberto Ruiz-Deya
- Department of Basic Sciences, Ponce Research Institute, School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA
| | - Liang Wang
- Department of Tumor Biology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Anders Berglund
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Ratna Chakrabarti
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL 32816, USA
| | - Jong Y Park
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
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13
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Mantz CA, Thaker NG, Deville C, Hubbard A, Pendyala P, Mohideen N, Kavadi V, Winkfield KM. A Medicare Claims Analysis of Racial and Ethnic Disparities in the Access to Radiation Therapy Services. J Racial Ethn Health Disparities 2023; 10:501-508. [PMID: 35064522 DOI: 10.1007/s40615-022-01239-0] [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: 09/01/2021] [Revised: 12/20/2021] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Reduced access and utilization of radiation therapy (RT) is a well-documented healthcare disparity observed among racial and ethnic minority groups in the USA and a contributor to the inferior health outcomes observed among Black, Hispanic, and Native American patient groups. What is less understood are the points during the process of care following RT consultation at which patients either fail to complete their prescribed treatment or encounter delays. Identification of those points where significant differences exist among different patient groups may help identify opportunities to close gaps in the access of clinically indicated RT. METHODS AND MATERIALS This analysis examines 261,559 RT episodes abstracted from Medicare claims and beneficiary data between 2016 and 2018 to determine rates of treatment initiation following planning and timeliness of treatment completion for different racial groups. RESULTS Failure to initiate treatment was observed to be 29.3% relatively greater for Black, Hispanic, and Native American patients than for White and Asian patients. Among episodes for which treatment was initiated, Black and Hispanic patients were observed to require a significantly greater number of calendar days (when adjusted for fraction number) for completion than for White, Asian, and Native American patients. CONCLUSIONS There appears to be a patient cohort for which RT disparities may be more marginal in their effects-allowing for access to consultation and treatment prescription but not for treatment initiation or timely completion of treatment-and may therefore permit effective solutions to help address current differences in cancer outcomes.
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Affiliation(s)
| | | | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Hubbard
- American Society for Radiation Oncology, Fairfax, VA, USA
| | - Praveen Pendyala
- Rutgers Cancer Institute of New Jersey, North Brunswick, NJ, USA
| | | | | | - Karen M Winkfield
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
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14
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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Relationship between intersectionality and cancer inequalities: a scoping review protocol. BMJ Open 2023; 13:e066637. [PMID: 36707112 PMCID: PMC9884887 DOI: 10.1136/bmjopen-2022-066637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Persistent inequalities in cancer care and cancer outcomes exist within and between countries. However, the evidence pertaining to the root causes driving cancer inequalities is mixed. This may be explained by the inadequate attention paid to experiences of patients with cancer living at the intersection of multiple social categories (eg, social class, ethnicity). This is supported by the intersectionality framework. This framework offers an alternative lens through which to analyse and understand how these interlocking systems of oppression uniquely shape the experiences of patients with cancer and drive inequalities. In this protocol, we outline a scoping review that will systematically map what is known about the relationship between intersectionality and inequalities in care experience and cancer outcomes of patients with cancer; and to determine how the intersectionality framework has been applied in studies across the cancer care pathway and across countries. METHODS AND ANALYSIS This study will be guided by Arksey and O'Malley's, and Levac et al's frameworks for scoping reviews. We will identify and map the evidence on cancer inequalities and intersectionality from 1989 to present date. Electronic databases (EMBASE, PsychINFO, CINAHL, Medline, Web of Science, ProQuest) and a systematic search strategy using a combination of keywords and Boolean operators AND/OR will be used to identify relevant studies. Screening of eligible papers and data extraction will be conducted by two independent reviewers, and disagreements resolved by discussion with the research team. We will use an iterative process to data charting using a piloted form. Findings will be collated into a narrative report. ETHICS AND DISSEMINATION Ethical approval is not required since data used are from publicly available secondary sources. Findings will be disseminated through peer-reviewed journals, conferences and stakeholder meetings. Further, findings will inform the next phases of a multistage research project aimed at understanding inequalities among patients with breast cancer.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, UK
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15
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Suryanegara FDA, Rokhman MR, Ekaputra E, de Jong LA, Setiawan D, de Bock GH, Postma MJ. Facing problems in radiotherapy for breast cancer patients in Yogyakarta, Indonesia: A cohort retrospective study. Cancer Med 2023; 12:8851-8859. [PMID: 36680328 PMCID: PMC10134354 DOI: 10.1002/cam4.5634] [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: 09/10/2022] [Revised: 12/15/2022] [Accepted: 01/08/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aim of this study is to explore problems in radiotherapy for breast cancer patients in Yogyakarta, Indonesia, focusing on overall treatment time (OTT) and completion rate. METHODS A retrospective cohort study was conducted based on data from the Insurance Unit at a tertiary hospital in Yogyakarta, Indonesia. The study included all female outpatients with breast cancer who were treated with radiotherapy from January to December 2017 and met the inclusion criteria. The primary outcomes were OTT and completion rate. The secondary outcomes included the number of radiotherapy fractions, radiotherapy doses, number of radiotherapy interruption days, and reasons for radiotherapy interruption. The chi-squared and Mann-Whitney U tests were used to assess the differences in outcomes between two insurance schemes (JKN-PBI (Beneficiaries of Health Insurance Contribution Assistance) and JKN-NON-PBI (Non-Beneficiaries of Health Insurance Contribution Assistance)). RESULTS The sample included 285 breast cancer patients (mean age: 53 years). The median OTT was 38 days (IQR: 17-48 days), with 123 (43.2%) patients having prolonged OTT. The completion rate was 57.9%. No significant differences in OTT (44.4% vs. 35.7%, p = 0.445) and completion rate (57.2% vs. 61.9%, p = 0.569) were found between the JKN-NON-PBI and JKN-PBI groups, respectively. In all, the data reported 3,022 interrupted days of radiotherapy across a total of 227 patients. The most common reason for radiotherapy interruption was unknown. CONCLUSION There are problems in timely delivery and low completion rate of radiotherapy among breast cancer patients in Indonesia. There are no significant differences in OTT and completion rate between the insurance schemes.
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Affiliation(s)
- Fithria Dyah Ayu Suryanegara
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Pharmacy, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - M Rifqi Rokhman
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ericko Ekaputra
- Dr. Sardjito General Hospital, Yogyakarta, Indonesia.,Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Lisa Aniek de Jong
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Didik Setiawan
- Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten Jacobus Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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16
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Varshavsky JR, Rayasam SDG, Sass JB, Axelrad DA, Cranor CF, Hattis D, Hauser R, Koman PD, Marquez EC, Morello-Frosch R, Oksas C, Patton S, Robinson JF, Sathyanarayana S, Shepard PM, Woodruff TJ. Current practice and recommendations for advancing how human variability and susceptibility are considered in chemical risk assessment. Environ Health 2023; 21:133. [PMID: 36635753 PMCID: PMC9835253 DOI: 10.1186/s12940-022-00940-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A key element of risk assessment is accounting for the full range of variability in response to environmental exposures. Default dose-response methods typically assume a 10-fold difference in response to chemical exposures between average (healthy) and susceptible humans, despite evidence of wider variability. Experts and authoritative bodies support using advanced techniques to better account for human variability due to factors such as in utero or early life exposure and exposure to multiple environmental, social, and economic stressors.This review describes: 1) sources of human variability and susceptibility in dose-response assessment, 2) existing US frameworks for addressing response variability in risk assessment; 3) key scientific inadequacies necessitating updated methods; 4) improved approaches and opportunities for better use of science; and 5) specific and quantitative recommendations to address evidence and policy needs.Current default adjustment factors do not sufficiently capture human variability in dose-response and thus are inadequate to protect the entire population. Susceptible groups are not appropriately protected under current regulatory guidelines. Emerging tools and data sources that better account for human variability and susceptibility include probabilistic methods, genetically diverse in vivo and in vitro models, and the use of human data to capture underlying risk and/or assess combined effects from chemical and non-chemical stressors.We recommend using updated methods and data to improve consideration of human variability and susceptibility in risk assessment, including the use of increased default human variability factors and separate adjustment factors for capturing age/life stage of development and exposure to multiple chemical and non-chemical stressors. Updated methods would result in greater transparency and protection for susceptible groups, including children, infants, people who are pregnant or nursing, people with disabilities, and those burdened by additional environmental exposures and/or social factors such as poverty and racism.
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Affiliation(s)
- Julia R Varshavsky
- Department of Health Sciences and Department of Civil and Environmental Engineering Northeastern University, Boston, MA, 02115, USA.
| | - Swati D G Rayasam
- Department of Obstetrics, Program on Reproductive Health and the Environment, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Carl F Cranor
- Department of Philosophy, University of California, Riverside, Riverside, CA, USA
- Environmental Toxicology Graduate Program, College of Natural and Agricultural Sciences, University of California, Riverside, Riverside, CA, USA
| | - Dale Hattis
- The George Perkins Marsh Institute, Clark University, Worcester, MA, USA
| | - Russ Hauser
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Patricia D Koman
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Rachel Morello-Frosch
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Department of Environmental Science, Policy and Management, University of California, Berkeley, Berkeley, CA, USA
| | - Catherine Oksas
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Joshua F Robinson
- Department of Obstetrics, Program on Reproductive Health and the Environment, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
- Center for Reproductive Sciences and Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Seattle Children's Research Institute, Seattle, WA, USA
| | | | - Tracey J Woodruff
- Department of Obstetrics, Program on Reproductive Health and the Environment, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
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17
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Farzaneh CA, Pigazzi A, Duong WQ, Carmichael JC, Stamos MJ, Dekhordi-Vakil F, Dayyani F, Zell JA, Jafari MD. Analysis of delay in adjuvant chemotherapy in locally advanced rectal cancer. Tech Coloproctol 2023; 27:35-42. [PMID: 36042105 DOI: 10.1007/s10151-022-02676-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/27/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Adjuvant chemotherapy (AC) after neoadjuvant chemoradiation and surgical resection has been the standard of care for locally advanced rectal cancer. However, there are no evidence-based guidelines regarding the optimal timing of AC for rectal cancer. The objective of this study was to evaluate the effect of AC timing on overall survival for rectal cancer. METHODS The National Cancer Database (NCDB) from 2004 to 2016 was queried for primary clinical stage II or III rectal cancer patients who had undergone neoadjuvant chemoradiation followed by surgery and AC. Patients were grouped based on AC initiation: early ≤ 4 weeks, intermediate 4-8 weeks, and delayed ≥ 8 weeks. The primary outcome was overall survival. RESULTS We identified 8722 patients, of which 905 (10.4%) received early AC, 4621 (53.0%) intermediate AC, and 3196 (36.6%) delayed AC. Pathological lymph-node metastasis (ypN +) was positive in 73% of early AC, 74% intermediate AC, and 63% delayed AC (p < 0.05). The 5-year survival probability was 71.1% (95% CI 68-74%) for early AC, 73.2% (95% CI 72-75%) intermediate AC, and 65.8% (95% CI 64-68%) delayed AC (p < 0.001). Using Cox proportional hazard modeling, patients undergoing delayed AC had an associated decreased survival compared to patients receiving early AC (HR 1.18; 95% CI 1.028-1.353, p = 0.018) or intermediate AC (HR 1.28; 95% CI 1.179-1.395, p < 0.01). CONCLUSIONS Delay in AC administration may be associated with decreased 5-year survival. Compared to early or intermediate AC, patients in the delayed AC group were observed to have increased risk of death, despite having lower proportions with ypN + disease. Patients with higher socioeconomic and education status were more likely to receive early chemotherapy.
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Affiliation(s)
- C A Farzaneh
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA
| | - A Pigazzi
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell College of Medicine, 525 E 68th Street, Box #172, New York, NY, 10065, USA
| | - W Q Duong
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA
| | - J C Carmichael
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA
| | - M J Stamos
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA
| | - F Dekhordi-Vakil
- Department of Statistics, University of California, Irvine, Irvine, CA, USA
| | - F Dayyani
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Orange, CA, USA
| | - J A Zell
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Orange, CA, USA
| | - M D Jafari
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell College of Medicine, 525 E 68th Street, Box #172, New York, NY, 10065, USA.
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18
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Azizoddin DR, Allsop M, Farah S, Salim F, Hauser J, Baltazar AR, Molokie R, Weber J, Weldon C, Feldman L, Martin JL. Oncology distress screening within predominately Black Veterans: Outcomes on supportive care utilization, hospitalizations, and mortality. Cancer Med 2022; 12:8629-8638. [PMID: 36573460 PMCID: PMC10134375 DOI: 10.1002/cam4.5560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We evaluated whether patients' initial screening symptoms were related to subsequent utilization of supportive care services and hospitalizations, and whether patient-level demographics, symptoms, hospitalizations, and supportive care service utilization were associated with mortality in primarily low-income, older, Black Veterans with cancer. METHODS This quality improvement project created collaborative clinics to conduct cancer distress screenings and refer to supportive care services at an urban, VA medical center. All patients completed a distress screen with follow-up screening every 3 months. Supportive care utilization, hospitalization rates, and mortality were abstracted through medical records. Poisson regression models and cox proportional hazard models were utilized. RESULTS Five hundred and eighty five screened patients were older (m = 72), mostly Black 70% (n = 412), and had advanced cancer 54%. Fifty-eight percent (n = 340) were screened only once with 81% (n = 470) receiving ≥1 supportive care service and 51.5% (n = 297) being hospitalized ≥1 time 18 months following initial screen. Symptom severity was significantly related to number of hospitalizations. Low mood was significantly related to higher supportive services (p < 0.001), but not hospitalizations (p ≥ 0.52). Pain, fatigue, physical function, nutrition, and physical symptoms were significantly associated with more supportive services and hospitalizations (p < 0.01). Twenty percent (n = 168) died; Veterans who were Black, had lower stage cancers, better physical health, and utilized less supportive care services had lower odds of mortality (p ≤ 0.01). CONCLUSION Individuals with elevated distress needs and those reporting lower physical function utilized more supportive care services and had higher hospitalization rates. Lower physical function, greater supportive care use, higher stage cancer, and being non-Black were associated with higher odds of death.
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Affiliation(s)
- Desiree R. Azizoddin
- Health Promotion Research Center, Stephenson Cancer Center University of Oklahoma Health Sciences Center Oklahoma City Oklahoma USA
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Matthew Allsop
- Academic Unit of Palliative Care Leeds Institute of Health Sciences, University of Leeds Leeds UK
| | - Subrina Farah
- Center for Clinical Investigation Brigham and Women's Hospital Boston Massachusetts USA
| | - Farah Salim
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
| | - Joshua Hauser
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Ashton R. Baltazar
- Health Promotion Research Center, Stephenson Cancer Center University of Oklahoma Health Sciences Center Oklahoma City Oklahoma USA
| | - Robert Molokie
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- University of Illinois Hospital and Health Sciences System Chicago Illinois USA
| | - Jane Weber
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
| | | | - Lawrence Feldman
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- University of Illinois Hospital and Health Sciences System Chicago Illinois USA
| | - Joanna L. Martin
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- Northwestern University Feinberg School of Medicine Chicago Illinois USA
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19
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Nezu K, Yamashita S, Kakimoto K, Uemura M, Kishida T, Kawai K, Nakamura T, Goto T, Osawa T, Nishimura K, Nonomura N, Negoro H, Shiraishi T, Ukimura O, Ogawa O, Shinohara N, Suzukamo Y, Ito A, Arai Y. Association of financial toxicity with quality of life in testicular cancer survivors. Int J Urol 2022; 29:1526-1534. [PMID: 36102302 DOI: 10.1111/iju.15039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Most testicular cancer (TC) survivors have long-term survival. However, the association between financial toxicity (FT), which is an economic side effect of cancer treatment, and the quality of life (QOL) of TC survivors is still unclear. Thus, the impact of FT on the QOL of TC survivors was examined in a multi-institutional cross-sectional study. METHODS We recruited TC survivors from eight high-volume institutions in Japan between January 2018 and March 2019. A total of 562 participants completed the EORTC QLQ-C30, EORTC QLQ-TC26 and the questionnaires on demographics, including annual income. Financial difficulty in the EORTC QLQ-C30 and low income were used to assess financial distress (FD) and financial burden (FB), respectively. FT was defined as FD and FB. The QOL scores were compared, and a multivariate logistic regression analysis for FT was performed. RESULTS With severe FD, TC survivors had more treatment side effects, physical limitations, and anxiety concerning employment and future. The TC survivors who reported low income were worried about their jobs and the future. The QOL of the survivors with FT exhibited high impairment, except for sexual activity. In particular, the TC survivors with FT were physically limited and anxious concerning the future. The multivariate logistic regression analysis revealed that four or more chemotherapy cycles were substantial risk factors for FT (4 cycles, odds ratio (OR) = 4.17; ≥5 cycles, OR = 6.96). CONCLUSIONS TC survivors who received multi-cycle chemotherapy were prone to experience FT, resulting in a decline in their health-related QOL.
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Affiliation(s)
- Kunihisa Nezu
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichi Yamashita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichi Kakimoto
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | - Koji Kawai
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Terukazu Nakamura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Urology, Saiseikai Imperial Gift Foundation Inc. Saiseikai Suita Hospital, Suita, Japan
| | - Takayuki Goto
- Department of Urology, Graduate School of Medicine and Faculty of Medicine Kyoto University, Kyoto, Japan
| | - Takahiro Osawa
- Department of Urology, Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine and Faculty of Medicine Kyoto University, Kyoto, Japan
| | - Nobuo Shinohara
- Department of Urology, Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Yoshimi Suzukamo
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Urology, Miyagi Cancer Center, Natori, Japan
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20
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Yang X, Deng L, Li M, Zhou Y, Wang G. Impact of socioeconomic status on cancer staging, survival in non-small cell lung cancer. Front Public Health 2022; 10:992944. [PMID: 36424960 PMCID: PMC9679653 DOI: 10.3389/fpubh.2022.992944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose We performed this study to evaluate the association of socioeconomic status (SES) factors with cancer-specific survival (CSS) of patients with non-small cell lung cancer (NSCLC). We further assessed the predictive value of a novel Tumor Node Metastasis (TNM)-SES staging system, combining the TNM stage with the SES stage. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, we selected 40,378 patients diagnosed with NSCLC from 2012 to 2016. Cox regression method and Harrell's concordance index (C-index) were performed to select the SES factors related to CSS and evaluate the predictive ability of the novel TNM-SES stage. We used Kaplan-Meier curves and a log-rank test to conduct a survival analysis. Results We identified four SES factors (marriage, insurance, education, and household income) associated with CSS and constructed the SES stage (SES-1 and SES-2). NSCLC patients with SES-2 stage (low SES) was associated with young adult, black race, male, squamous carcinoma, upper lobe site, and advanced stage. SES-2 stage patients were significantly associated with a dismal prognosis of patients with NSCLC, with a 21.0% increased risk (HR = 1.21, 95%CI (1.18-1.24), p < 0.001). The C-index of our novel TNM-SES stage was 0.732 [95% CI (0.728-0.736)], higher than the traditional TNM stage [0.717, 95% CI (0.715-0.719)], indicating superior predictive value. Conclusion Our population-based study indicated that SES was significantly associated with cancer staging and SCC in patients with NSCLC. Our novel TNM-SES staging system showed a superior predictive value to the traditional TNM stage. The impact of SES on patients with NSCLC should receive more concern in clinical management.
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Affiliation(s)
- Xianghui Yang
- Department of Oncology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China,*Correspondence: Guihua Wang
| | - Liyong Deng
- Department of Oncology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Min Li
- Interventional Treatment Room, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Yongjie Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guihua Wang
- Department of Oncology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China,Xianghui Yang
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21
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Chu AK, Mutsaers B, Lebel S. The Association between Survivorship Care Plans and Patient-Reported Satisfaction and Confidence with Follow-Up Cancer Care Provided by Primary Care Providers. Curr Oncol 2022; 29:7343-7354. [PMID: 36290854 PMCID: PMC9600139 DOI: 10.3390/curroncol29100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/15/2022] Open
Abstract
Survivorship care plans aim to facilitate a smooth transition from tertiary to primary care settings after primary cancer treatment is completed. This study sought to identify the sociodemographic factors associated with receiving a survivorship care plan and examine the relationship between receiving a plan and confidence in follow-up care delivered by primary care providers. A cross-sectional analysis of the Canadian Partnership Against Cancer's Experiences of Cancer Patients in Transition Study was conducted (n = 9970). Separate adjusted multinomial logistic regression models assessed the relationship between survivorship care plans and follow-up care outcomes. Proportion of survivors more likely to receive a survivorship care plan varied by numerous sociodemographic and medical factors, such as cancer type (colorectal and prostate), gender (male), and education (high school or less). In unadjusted and adjusted models, individuals who received a Survivorship Care Plan had significantly higher odds of: having felt their primary care providers were involved; agreeing that their primary care providers understood their needs, knew where to find supports and services, and were able to refer them directly to services; and were confident that their primary care provider could meet their follow-up care needs.
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22
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Nayak SS, Borkar R, Ghozy S, Agyeman K, Al-Juboori MT, Shah J, Ulrich MT. Social vulnerability, medical care access and asthma related emergency department visits and hospitalization: An observational study. Heart Lung 2022; 55:140-145. [PMID: 35588567 DOI: 10.1016/j.hrtlng.2022.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Social Vulnerability Index (SVI) is a publicly available dataset to identify communities in greatest need of resources. OBJECTIVE To examine the utility of using the county-level SVI as predictors of asthma-related outcomes. METHODS We used the American Community Survey-derived SVI and the National Environmental Public Health Tracking Network - Query Tool to retrieve data for all counties with available SVI data and at least one matched outcome of interest. Then, we tested SVI as a predictor for emergency department visits (EDV) and hospitalizations, with investigating disparities in primary care physician (PCP) density and emergency department physicians (EDP) density. Linear and logistic regression models were used. RESULTS Compared to counties of the lowest SVI quartile, counties of mid-low, mid-high, and highest SVI quartiles had 1%, 4%, and 5% higher odds of asthma-related EDV per 10,000 population, respectively, and 4%, 21%, and 24% higher odds of asthma-related hospitalization per 10,000 population, respectively. Moreover, the data showed an apparent resources mismatch between the EDP densities per 10,000 populations and the SVI quartiles, and the effect of the county level SVI on the asthma-related EDV and hospitalization is not strongly affected by PCP or EDP densities. CONCLUSION The counties with the highest SVI -and the most vulnerable to asthma hazards- have a lower coverage of PCP and EDP. Interventions directed to address persistent social vulnerability would offer the opportunity of primary prevention with less exhaustion for the medical resources.
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Affiliation(s)
- Sandeep S Nayak
- Department of Internal Medicine, NYC Health + Hospitals/Metropolitan, NY 10029, USA; Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, CT 06610, USA.
| | - Rachana Borkar
- Department of Internal Medicine, NYC Health + Hospitals/Metropolitan, NY 10029, USA.
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC program), Oxford University, UK.
| | - Kwame Agyeman
- Department of Internal Medicine, Loma Linda University Medical Center, CA 92354, USA.
| | - Mohammed T Al-Juboori
- Department of Internal Medicine, NYC Health + Hospitals/Metropolitan, NY 10029, USA.
| | - Jaffer Shah
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
| | - Michael T Ulrich
- Department of Internal Medicine, Loma Linda University Medical Center, CA 92354, USA; Department of Internal Medicine, Riverside University Health System, CA 92555, USA.
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23
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Conti B, Bochaton A, Charreire H, Kitzis-Bonsang H, Desprès C, Baffert S, Ngô C. Influence of geographic access and socioeconomic characteristics on breast cancer outcomes: A systematic review. PLoS One 2022; 17:e0271319. [PMID: 35853035 PMCID: PMC9295987 DOI: 10.1371/journal.pone.0271319] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Socio-economic and geographical inequalities in breast cancer mortality have been widely described in European countries and the United States. To investigate the combined effects of geographic access and socio-economic characteristics on breast cancer outcomes, a systematic review was conducted exploring the relationships between: (i) geographic access to healthcare facilities (oncology services, mammography screening), defined as travel time and/or travel distance; (ii) breast cancer-related outcomes (mammography screening, stage of cancer at diagnosis, type of treatment and rate of mortality); (iii) socioeconomic status (SES) at individuals and residential context levels. In total, n = 25 studies (29 relationships tested) were included in our systematic review. The four main results are: The statistical significance of the relationship between geographic access and breast cancer-related outcomes is heterogeneous: 15 were identified as significant and 14 as non-significant. Women with better geographic access to healthcare facilities had a statistically significant fewer mastectomy (n = 4/6) than women with poorer geographic access. The relationship with the stage of the cancer is more balanced (n = 8/17) and the relationship with cancer screening rate is not observed (n = 1/4). The type of measures of geographic access (distance, time or geographical capacity) does not seem to have any influence on the results. For example, studies which compared two different measures (travel distance and travel time) of geographic access obtained similar results. The relationship between SES characteristics and breast cancer-related outcomes is significant for several variables: at individual level, age and health insurance status; at contextual level, poverty rate and deprivation index. Of the 25 papers included in the review, the large majority (n = 24) tested the independent effect of geographic access. Only one study explored the combined effect of geographic access to breast cancer facilities and SES characteristics by developing stratified models.
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Affiliation(s)
- Benoit Conti
- LVMT, Université Gustave Eiffel, Ecole des Ponts, Champs-sur-Marne, France
- * E-mail:
| | - Audrey Bochaton
- Université Paris Nanterre, UMR 7533 LADYSS, Nanterre, France
| | - Hélène Charreire
- Université Paris-Est, Lab’Urba, France
- Institut Universitaire de France (IUF), Paris, France
| | | | - Caroline Desprès
- Centre de recherche des Cordeliers, Sorbonne Université, Université de Paris, INSERM, Equipe Etres, France
| | | | - Charlotte Ngô
- Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
- Centre de recherche des Cordeliers, Sorbonne Université, Université de Paris, INSERM, Equipe Etres, France
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24
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Sanchez JI, Shankaran V, Unger JM, Madeleine MM, Espinoza N, Thompson B. Disparities in post-operative surveillance testing for metastatic recurrence among colorectal cancer survivors. J Cancer Surviv 2022; 16:638-649. [PMID: 34031803 PMCID: PMC10424733 DOI: 10.1007/s11764-021-01057-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Among colorectal cancer (CRC) survivors, treatment for metastatic recurrence is most effective when malignancies are detected early through surveillance with carcinoembryonic antigen (CEA) level test and computer tomography (CT) imaging. However, utilization of these tests is low, and many survivors fail to meet the recommended guidelines. This population-based study assesses individual- and neighborhood-level factors associated with receipt of CEA and CT surveillance testing. METHODS We used the Surveillance, Epidemiology and End Results (SEER)-Medicare data to identify Medicare beneficiaries diagnosed with CRC stages II-III between 2010 and 2013. We conducted multivariate logistic regression to estimate the effect of individual and neighborhood factors on receipt of CEA and CT tests within 18 months post-surgery. RESULTS Overall, 78% and 58% of CRC survivors received CEA and CT testing, respectively. We found significant within racial/ethnic differences in receipt of these surveillance tests. Medicare-Medicaid dual coverage was associated with 39% lower odds of receipt of CEA tests among non-Hispanic Whites, and Blacks with dual coverage had almost two times the odds of receiving CEA tests compared to Blacks without dual coverage. CONCLUSIONS Although this study did not find significant differences in receipt of initial CEA and CT surveillance testing across racial/ethnic groups, the assessment of the factors that measure access to care suggests differences in access to these procedures within racial/ethnic groups. IMPLICATIONS FOR CANCER SURVIVORS Our findings have implications for developing targeted interventions focused on promoting surveillance for the early detection of metastatic recurrence among colorectal cancer survivors and improve their health outcomes.
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Affiliation(s)
- Janeth I Sanchez
- School of Public Health, Department of Health Services, University of Washington, Box 357230, Seattle, WA, 98195, USA.
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA, 98166, USA.
| | - Veena Shankaran
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA, 98166, USA
| | - Joseph M Unger
- School of Public Health, Department of Health Services, University of Washington, Box 357230, Seattle, WA, 98195, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA, 98166, USA
| | - Margaret M Madeleine
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA, 98166, USA
- School of Public Health, Department of Epidemiology, University of Washington, Box 357236, Seattle, WA, 98195, USA
| | - Noah Espinoza
- Clinical Analytics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Beti Thompson
- School of Public Health, Department of Health Services, University of Washington, Box 357230, Seattle, WA, 98195, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA, 98166, USA
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25
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Abu-Quider A, Asleh M. Ethnic and socioeconomic disparities in survival of children and adolescents with CNS tumors in Southern Israel. Neurooncol Pract 2022; 9:441-448. [DOI: 10.1093/nop/npac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This study sought to evaluate survival of pediatric and adolescent patients with central nervous system (CNS) cancer in southern Israel, outline disparities between ethnic and socioeconomic groups (Bedouin Arabs compared to Jews) and evaluate the role of socioeconomic status (SES) in ethnic disparities.
Methods
A retrospective study was conducted among 91 patients aged one to 20 years, who were diagnosed with CNS tumors between 2001 and 2017, and followed-up through 2020. Ethnic differences in survival were measured by age, sex, stage, histology and SES. One and 3-year survival rates were calculated. Multivariable regression analysis was used to estimate adjusted ethnic differences in survival rates.
Results
Ethnic differences in survival existed within all studied variables. All Bedouin patients lived in low SES settlements (All Bedouin settlement in Southern Israel are ranked in lower socioeconomic deciles). Twenty-eight patients had medulloblastoma. Seven (25%) presented with leptomeningeal disease or distant metastases. Medulloblastoma molecular subgroups were not assessed for logistic reasons. Three-year overall survival of Bedouins was 50% compared to 92.3% for Jews. Adjusted risk of death at 3 years was significantly higher for Bedouin patients (aHR 3.36, 95% CI 1.41–7.98, P = .006).
Conclusions
We conclude that Bedouin children with CNS tumors have significantly lower survival rates compared to Jewish children, and SES seems to play a major part in these disparities. Factors influencing these disparities should be addressed and public health interventions to eliminate these disparities should be developed.
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Affiliation(s)
- Abed Abu-Quider
- Pediatric Hemato-Oncology Department, Saban Pediatric Medical Center, Soroka University Medical Center , Israel
| | - Mahdi Asleh
- Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
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26
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Sorice KA, Fang CY, Wiese D, Ortiz A, Chen Y, Henry KA, Lynch SM. Systematic review of neighborhood socioeconomic indices studied across the cancer control continuum. Cancer Med 2022; 11:2125-2144. [PMID: 35166051 PMCID: PMC9119356 DOI: 10.1002/cam4.4601] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is extensive interest in understanding how neighborhood socioeconomic status (nSES) may affect cancer incidence or survival. However, variability regarding items included and approaches used to form a composite nSES index presents challenges in summarizing overall associations with cancer. Given recent calls for standardized measures of neighborhood sociodemographic effects in cancer disparity research, the objective of this systematic review was to identify and compare existing nSES indices studied across the cancer continuum (incidence, screening, diagnosis, treatment, survival/mortality) and summarize associations by race/ethnicity and cancer site to inform future cancer disparity studies. METHODS Using PRISMA guidelines, peer-reviewed articles published between 2010 and 2019 containing keywords related to nSES and cancer were identified in PubMed. RESULTS Twenty-four nSES indices were identified from 75 studies. In general, findings indicated a significant association between nSES and cancer outcomes (n = 64/75 studies; 85.33%), with 42/64 (65.63%) adjusting for highly-correlated individual SES factors (e.g., education). However, the direction of association differed by cancer site, race/ethnicity, and nSES index. CONCLUSIONS This review highlights several methodologic and conceptual issues surrounding nSES measurement and potential associations with cancer disparities. Recommendations pertaining to the selection of nSES measures are provided, which may help inform disparity-related disease processes and improve the identification of vulnerable populations in need of intervention.
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Affiliation(s)
- Kristen A. Sorice
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Carolyn Y. Fang
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Daniel Wiese
- Geography and Urban StudiesTemple UniversityPhiladelphiaPAUSA
| | - Angel Ortiz
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Yuku Chen
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Kevin A. Henry
- Geography and Urban StudiesTemple UniversityPhiladelphiaPAUSA
| | - Shannon M. Lynch
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
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27
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Hofmann A, Liu H, Copeland E, Ang D. Impact on Breast Cancer Survival by Surgical Facility Type Secondary to the ACOSOG Z0011 Trial. Am Surg 2022; 88:2141-2147. [PMID: 35486590 DOI: 10.1177/00031348221093761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies have reported differences between age, socioeconomic status, treatment facility, and tumor burden based on survival outcomes for breast cancer (BC). The goal of this study is to evaluate BC survival and mortality outcomes by facility type. To examine likely influence of evidence-based practices, these groups were then sub stratified by pre- and post-Z0011 trial. METHODS This is a population-based study using the National Cancer Database of Commission on Cancer (CoC) designated centers. Intergroup comparisons of demographics were performed using chi-square test. Kaplan-Meier curve and Cox Hazard Ratios were used to evaluate survival differences. Multivariable regression methods were used to evaluate risk-adjusted 30- and 90-day mortality among BC patients. A difference-in-difference (DiD) analysis was used to evaluate the change of treatment over time pre- and post-Z0011 trial. RESULTS Median survival was highest among comprehensive community facilities at 63.2 months and integrated community facilities at 62.7 months, while the lowest for community and academic facilities at 60.6 months and 61 months. Academic facilities had the lowest 30- and 90-day mortality. Community centers saw the largest improvement in overall mortality post-Z0011 trial. The benefit after the Z0011 trial was evident among community centers at the 90-day mortality period as their decrease in mortality (-1.7%) was significantly lower than the decrease of mortality among academic centers (-1.3%), P-value = .01. CONCLUSION While the Z0011 trial had a positive influence in both community and academic facilities, community programs benefited the most. Z0011 trial showed the most change in practice for the community centers.
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Affiliation(s)
- Alana Hofmann
- College of Medicine, 124506University of Central Florida/HCA Consortium- Ocala, Ocala, FL, USA
| | - Huazhi Liu
- 23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Edward Copeland
- Department of Surgery, 3463University of Florida, Gainesville, FL, USA
| | - Darwin Ang
- College of Medicine, 124506University of Central Florida/HCA Consortium- Ocala, Ocala, FL, USA
- Department of Surgery, University of South Florida, Ocala Regional Medical Center, Ocala, FL, USA
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28
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van Maaren MC, Rachet B, Sonke GS, Mauguen A, Rondeau V, Siesling S, Belot A. Socioeconomic status and its relation with breast cancer recurrence and survival in young women in the Netherlands. Cancer Epidemiol 2022; 77:102118. [PMID: 35131686 PMCID: PMC9422085 DOI: 10.1016/j.canep.2022.102118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/06/2022] [Accepted: 01/27/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Associations between socioeconomic status (SES) and breast cancer survival are most pronounced in young patients. We further investigated the relation between SES, subsequent recurrent events and mortality in breast cancer patients < 40 years. Using detailed data on all recurrences that occur between date of diagnosis of the primary tumor and last observation, we provide a unique insight in the prognosis of young breast cancer patients according to SES. METHODS All women < 40 years diagnosed with primary operated stage I-III breast cancer in 2005 were selected from the nationwide population-based Netherlands Cancer Registry. Data on all recurrences within 10 years from primary tumor diagnosis were collected directly from patient files. Recurrence patterns and absolute risks of recurrence, contralateral breast cancer (CBC) and mortality - accounting for competing risks - were analysed according to SES. Relationships between SES, recurrence patterns and excess mortality were estimated using a multivariable joint model, wherein the association between recurrent events and excess mortality (expected mortality derived from the general population) was included. RESULTS We included 525 patients. The 10-year recurrence risk was lowest in high SES (18.1%), highest in low SES (29.8%). Death and CBC as first events were rare. In high, medium and low SES 13.2%, 15.3% and 19.1% died following a recurrence. Low SES patients had shorter median time intervals between diagnosis, first recurrence and 10-year mortality (2.6 and 2.7 years, respectively) compared to high SES (3.5 and 3.3 years, respectively). In multivariable joint modeling, high SES was significantly related to lower recurrence rates over 10-year follow-up, compared to low SES. A strong association between the recurrent event process and excess mortality was found. CONCLUSIONS High SES is associated with lower recurrence risks, less subsequent events and better prognosis after recurrence over 10 years than low SES. Breast cancer risk factors, adjuvant treatment adherence and treatment of recurrence may possibly play a role in this association.
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Affiliation(s)
- Marissa C van Maaren
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, United States.
| | - Virginie Rondeau
- INSERM U1219, Biostatistics team, University of Bordeaux, Bordeaux, France.
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Aurélien Belot
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Crown A, Ramiah K, Siegel B, Joseph KA. The Role of Safety-Net Hospitals in Reducing Disparities in Breast Cancer Care. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11576-3. [PMID: 35357616 DOI: 10.1245/s10434-022-11576-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 12/22/2022]
Abstract
Advances in breast cancer screening and systemic therapies have been credited with profound improvements in breast cancer outcomes; indeed, 5-year relative survival rate approaches 91% in the USA (U.S. National Institutes of Health NCI. SEER Training Modules, Breast). While breast cancer mortality has been declining, oncologic outcomes have not improved equally among all races and ethnicities. Many factors have been implicated in breast cancer disparities; chief among them is limited access to care which contributes to lower rates of timely screening mammography and, once diagnosed with breast cancer, lower rates of receipt of guideline concordant care (Wu, Lund, Kimmick GG et al. in J Clin Oncol 30(2):142-150, 2012). Hospitals with a safety-net mission, such as the essential hospitals, historically have been dedicated to providing high-quality care to all populations and have eagerly embraced the role of caring for the most vulnerable and working to eliminate health disparities. In this article, we review landmark articles that have evaluated the role safety-net hospitals have played in providing equitable breast cancer care including to those patients who face significant social and economic challenges.
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Affiliation(s)
- Angelena Crown
- Breast Surgery, True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA
| | | | - Bruce Siegel
- America's Essential Hospitals, Washington, DC, USA
| | - Kathie-Ann Joseph
- Department of Surgery, New York University School of Medicine, NYC Health and Hospitals, Bellevue, New York, NY, USA.
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30
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Zhou Y, Zhang W, Ma J, Zhang Z, Yang M, Luo J, Yan Z. The Impact of Socioeconomic Status on Staging, Prognosis in Hepatocellular Carcinoma. Int J Gen Med 2022; 15:1459-1469. [PMID: 35210820 PMCID: PMC8858014 DOI: 10.2147/ijgm.s353402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We conducted this large population-based study to evaluate the impact of socioeconomic status (SES) factors on cancer-specific survival (CSS) of patients with hepatocellular carcinoma (HCC). We further assessed the value of a novel TNM-SES staging system, which incorporated these SES factors with TNM stage on staging and prognosis. Methods A total of 13,791 patients diagnosed with HCC from 2012 to 2016 were retrieved from one large population database. Cox proportional hazards regression model and Harrell’s concordance index (C-index) were used to identify the SES factors associated with CSS and analyze the prognostic value of TNM-SES stage. Kaplan–Meier curves and Log rank test were performed to evaluate CSS. Results Four SES factors (marital status, insurance status, education, household income) were identified as the prognostic factors associated with CSS. The SES-2 (lower SES) stage was significantly correlated to unfavorable CSS of the patients with HCC, with a 32.0% increased risk (HR = 1.32, 95% CI (1.26–1.39), P < 0.001), after adjusting for several confounders. The C-index of the TNM-SES stage was 0.735 (95% CI (0.729–0.741)) which was higher than that of the TNM stage (0.718, 95% CI (0.712–0.724)), indicating a high accuracy of prognostic prediction. Conclusion Our comprehensive study revealed that SES was significantly associated with prognosis of patients with HCC after adjusting several confounders. The novel TNM-SES staging system which combined TNM stage and SES stage had more superior predictive value than the traditional TNM stage. Disparity on SES should receive more attention for patients with HCC in clinical management.
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Affiliation(s)
- Yongjie Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institution of Medical Imaging, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institution of Medical Imaging, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jingqin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institution of Medical Imaging, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Zihan Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institution of Medical Imaging, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Minjie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institution of Medical Imaging, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jianjun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institution of Medical Imaging, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Jianjun Luo; Zhiping Yan, Department of Interventional Radiology, Zhongshan Hospital, Fudan UniversityNo. 180 Fenglin Road, Shanghai, 200032, People’s Republic of China, Email ;
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institution of Medical Imaging, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, People’s Republic of China
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31
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Williams AD, Buckley M, Ciocca RM, Sabol JL, Larson SL, Carp NZ. Racial and socioeconomic disparities in breast cancer diagnosis and mortality in Pennsylvania. Breast Cancer Res Treat 2022; 192:191-200. [PMID: 35064367 DOI: 10.1007/s10549-021-06492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Many studies have demonstrated disparities in breast cancer (BC) incidence and mortality among Black women. We hypothesized that in Pennsylvania (PA), a large economically diverse state, BC diagnosis and mortality would be similar among races when stratified by a municipality's median income. METHODS We collected the frequencies of BC diagnosis and mortality for years 2011-2015 from the Pennsylvania Cancer Registry and demographics from the 2010 US Census. We analyzed BC diagnoses and mortalities after stratifying by median income, municipality size, and race with univariable and multivariable logistic regression models. RESULTS In this cohort, of 5,353,875 women there were 54,038 BC diagnoses (1.01% diagnosis rate) and 9,828 BC mortalities (0.18% mortality rate). Unadjusted diagnosis rate was highest among white women (1.06%) but Black women had a higher age-adjusted diagnosis rate (1.06%) than white women (1.02%). Race, age and income were all significantly associated with BC diagnosis, but there were no differences in BC diagnosis between white and Black women across all levels of income in the multivariable model. BC mortality was highest in Black women, a difference which persisted when adjusted for age. Black women 35 years and older had a higher mortality rate in all income quartiles. CONCLUSION We found that in PA, age, race and income are all associated with BC diagnosis and mortality with noteworthy disparities for Black women. Continued surveillance of differences in both breast cancer diagnosis and mortality, and targeted interventions related to education, screening and treatment may help to eliminate these socioeconomic and racial disparities.
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Affiliation(s)
| | - Meghan Buckley
- Main Line Health Center for Population Health Research at Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Robin M Ciocca
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Jennifer L Sabol
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Sharon L Larson
- Main Line Health Center for Population Health Research at Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Ned Z Carp
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
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Socioeconomic Status and Inflammation in Women with Early-stage Breast Cancer: Mediation by Body Mass Index. Brain Behav Immun 2022; 99:307-316. [PMID: 34673177 PMCID: PMC9802182 DOI: 10.1016/j.bbi.2021.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Breast cancer is the most common cancer among women in the US, and women of low socioeconomic status (SES) show markedly poorer outcomes than those of high SES. SES may influence health through inflammation, although links between SES and inflammatory biomarkers have not been investigated in women with breast cancer. This study tested the hypothesis that breast cancer patients of lower SES would show higher levels of inflammation than those of higher SES. BMI was examined as a mediator of this association. METHODS Women recently diagnosed with early-stage breast cancer (N = 194) were recruited before neoadjuvant or adjuvant therapy. Participants completed questionnaires and provided blood samples for immune assessment. SES was indexed by participants' self-reported education and annual household income, BMI was determined by height and weight measurements, and blood was assayed for inflammatory biomarkers linked with cancer outcomes: IL-6, CRP, TNF-α, and sTNF-RII. General linear models tested associations between SES and inflammation, and mediation models examined indirect effects through BMI. RESULTS Consistent with hypotheses, education status was associated with CRP, (F(2,185) = 4.72, p = 0.001), and sTNF-RII, (F(2,185) = 4.19, p = 0.02), such that lower education was associated with higher levels of both biomarkers. Further, BMI mediated the associations between education and CRP, (95% CIs [-0.62, -0.11; -0.76, -0.21]), sTNF-RII, (95% CIs [-0.09, -0.01; -0.10, -0.02]), and IL-6, (95% CIs [-0.32, -0.05; -0.38, -0.09]). Annual household income was not significantly associated with inflammation (ps > 0.25), and indirect effects on inflammation through BMI were not significant. CONCLUSIONS Lower education was associated with higher levels of inflammation in this sample, which may presage poor breast cancer-related and clinical outcomes. SES should inform the development of interventions targeting BMI and inflammation in breast cancer.
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Fiebig DG, van Gool K, Hall J, Mu C. Health care use in response to health shocks: Does socio-economic status matter? HEALTH ECONOMICS 2021; 30:3032-3050. [PMID: 34510621 DOI: 10.1002/hec.4427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/20/2021] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
We investigate how utilization of primary care, specialist care, and emergency department (ED) care (and the mix across the three) changes in response to a change in health need. We determine whether any changes in utilization are impacted by socio-economic status. The use of a unique Australian data set that consists of a large survey linked to multiple years of detailed administrative records enables us to better control for individual heterogeneity and allows us to exploit changes in health that are related to the onset of two health shocks: a new diagnosis of diabetes and heart disease. We extend the analysis by also examining changes to patient out-of-pocket costs. We find significant differences in the mix between primary and specialist care use according to income and type of health shock but no evidence of using ED as a substitute for other care. Our results indicate that low- and high-income patients navigate very different pathways for their care following the onset of diabetes and to a lesser extent heart disease. These pathways appear to be chosen on the basis of ability to pay, rather than the most effective or efficient bundle of care delivered through a combination of GP and specialist care.
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Affiliation(s)
- Denzil G Fiebig
- School of Economics, University of New South Wales, Sydney, New South Wales, Australia
| | - Kees van Gool
- Center for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Broadway, New South Wales, Australia
| | - Jane Hall
- Center for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Broadway, New South Wales, Australia
| | - Chunzhou Mu
- Center for Quantitative Economics, Jilin University, Changchun, China
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Kaur M, Joshu CE, Visvanathan K, Connor AE. Trends in breast cancer incidence rates by race/ethnicity: Patterns by stage, socioeconomic position, and geography in the United States, 1999-2017. Cancer 2021; 128:1015-1023. [PMID: 34731501 DOI: 10.1002/cncr.34008] [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: 06/10/2021] [Revised: 09/16/2021] [Accepted: 10/11/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The incidence rate of breast cancer has been increasing over time across race/ethnicity in the United States. It is unclear whether these trends differ among stage, poverty, and geography subgroups. METHODS Using data from the North American Association of Central Cancer Registries, this study estimated trends in age-adjusted breast cancer incidence rates among women aged 50 to 84 years from 1999 to 2017 by race/ethnicity (non-Hispanic Black, non-Hispanic White, and Hispanic) and across subgroups (stage, county-level poverty, county urban/rural status, and geographic region [West, Midwest, South, and Northeast]). RESULTS From 2004 to 2017, breast cancer incidence rates increased across race/ethnicity and subgroups, with the greatest average annual percent increases observed for non-Hispanic Black women, overall (0.9%) and those living in lower poverty areas (0.8%), rural areas (1.2%), and all regions except the West (0.8%-1.0%). Stronger increases among non-Hispanic Black women were observed for local-stage disease and for some subgroups of distant-stage disease. Non-Hispanic Black women had the smallest decrease in regional-stage disease across most subgroups. Similarly, Hispanic women had the strongest increases in some subgroups, including areas with higher poverty (0.6%-1.2%) and in the West (0.8%), for local- and distant-stage disease. CONCLUSIONS These trends highlight concerns for an increasing burden of breast cancer among subpopulations, with some already experiencing disparate breast cancer mortality rates, and they highlight the need for targeted breast cancer prevention and efforts to reduce mortality disparities in areas with increasing incidence.
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Affiliation(s)
- Maneet Kaur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Avonne E Connor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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35
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Auer RC, Balaa FK. Textbook Oncologic Outcome Summarizes the Perioperative Cancer Journey, but Should it be used to Judge Hospitals? Ann Surg Oncol 2021; 28:8025-8027. [PMID: 34609646 DOI: 10.1245/s10434-021-10714-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Rebecca C Auer
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
| | - Fady K Balaa
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
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36
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Peponis T, Stafford C, Cusack J, Cauley C, Goldstone R, Berger D, Bordeianou L, Kunitake H, Francone T, Ricciardi R. The growing trend for no primary surgery in colorectal cancer. Colorectal Dis 2021; 23:2659-2670. [PMID: 34288327 DOI: 10.1111/codi.15828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/13/2021] [Accepted: 07/12/2021] [Indexed: 02/08/2023]
Abstract
AIM In colorectal cancer (CRC), surgery of the primary site is commonly curative. Our aim was to determine estimates of 'no surgery' for primary CRC while identifying common reasons for no surgery. METHOD We identified all patients with a diagnosis of colorectal adenocarcinoma from the National Cancer Database between January 2004 and December 2016. Then, we identified patients who did not undergo surgery on the primary tumour and their demographic, tumour and institutional characteristics. Kaplan-Meier and logistic regression analyses were used to evaluate specific factors associated with overall survival as related to no surgery and recommendations against operative management. RESULTS A total of 1,208,878 patients with CRC were identified, 14.5% of whom had no surgery of the primary cancer. No surgery was more common in rectal cancer than in colon cancer. Despite a steady incidence of CRC diagnoses, the likelihood of no surgery grew by 170% over the study period. Metastatic disease was noted in 53.7% of the no surgery cohort. Nine per cent of the no surgery patient cohort received a recommendation against surgery despite the absence of metastatic disease, 7.5% refused surgery and only 2% underwent palliative surgery. On multivariable analysis, patients who were not recommended to have surgery were more likely to be older, uninsured, comorbid and receive care at a single hospital. The no surgery patients had significantly lower overall survival. CONCLUSION A substantial proportion of patients with CRC do not have surgery. Interventions aimed at expanding access and promoting second opinions at other cancer hospitals might reduce the growing rate of no surgery in CRC.
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Affiliation(s)
- Thomas Peponis
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Caitlin Stafford
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James Cusack
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christy Cauley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert Goldstone
- Department of Surgery, Newton Wellesley Hospital, Newton, Massachusetts, USA
| | - David Berger
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Todd Francone
- Department of Surgery, Newton Wellesley Hospital, Newton, Massachusetts, USA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Rowley J, Richards N, Carduff E, Gott M. The impact of poverty and deprivation at the end of life: a critical review. Palliat Care Soc Pract 2021; 15:26323524211033873. [PMID: 34541536 PMCID: PMC8442481 DOI: 10.1177/26323524211033873] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/01/2021] [Indexed: 11/22/2022] Open
Abstract
This critical review interrogates what we know about how poverty and deprivation impact people at the end of life and what more we need to uncover. While we know that people in economically resource-rich countries who experience poverty and deprivation over the life course are likely to die younger, with increased co-morbidities, palliative care researchers are beginning to establish a full picture of the disproportionate impact of poverty on how, when and where we die. This is something the Covid-19 pandemic has further illustrated. Our article uses a critical social science lens to investigate an eclectic range of literature addressing health inequities and is focused on poverty and deprivation at the end of life. Our aim was to see if we could shed new light on the myriad ways in which experiences of poverty shape the end of people's lives. We start by exploring the definitions and language of poverty while acknowledging the multiple intersecting identities that produce privilege. We then discuss poverty and deprivation as a context for the nature of palliative care need and overall end-of-life circumstances. In particular, we explore: total pain; choice at the end of life; access to palliative care; and family caregiving. Overall, we argue that in addressing the effects of poverty and deprivation on end-of-life experiences, there is a need to recognise not just socio-economic injustice but also cultural and symbolic injustice. Too often, a deficit-based approach is adopted which both 'Others' those living with poverty and renders invisible the strategies and resilience they develop to support themselves, their families and communities. We conclude with some recommendations for future research, highlighting in particular the need to amplify the voices of people with lived experience of poverty regarding palliative and end-of-life care.
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Affiliation(s)
- Jane Rowley
- End of Life Studies Group, School of
Interdisciplinary Studies, University of Glasgow, Glasgow, UK
| | - Naomi Richards
- End of Life Studies Group, School of
Interdisciplinary Studies, University of Glasgow, Glasgow, UK
| | | | - Merryn Gott
- Professor, Te Ārai Palliative Care and End of
Life Research Group, School of Nursing, The University of Auckland, Private
Bag 92019, Auckland 1142, New Zealand
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38
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Chan HC, Huang CC, Huang CC, Chattopadhyay A, Yeh KH, Lee WC, Chiang CJ, Lee HY, Cheng SHC, Lu TP. Predicting Colon Cancer-Specific Survival for the Asian Population Using National Cancer Registry Data from Taiwan. Ann Surg Oncol 2021; 29:853-863. [PMID: 34427821 DOI: 10.1245/s10434-021-10646-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Colon cancer is the third most incident and life-threatening cancer in Taiwan. A comprehensive survival prediction system would greatly benefit clinical practice in this area. This study was designed to develop an accurate prognostic model for colon cancer patients by using clinicopathological variables obtained from the Taiwan Cancer Registry database. METHODS We analyzed 20,218 colon cancer patients from the Taiwan Cancer Registry database, who were diagnosed between 2007 and 2015, were followed up until December 31, 2017, and had undergone curative surgery. We proposed two prognostic models, with different combinations of predictors. The first model used only traditional clinical features. The second model included several colon cancer site-specific factors (circumferential resection margin, perineural invasion, obstruction, and perforation), in addition to the traditional features. Both prediction models were developed by using a Cox proportional hazards model. Furthermore, we investigated whether race is a significant predictor of survival in colon cancer patients by using Model 1 on the Surveillance, Epidemiology, and End Results (SEER) cancer registry dataset. RESULTS The proposed models displayed a robust prediction performance (all Harrell's c-index >0.8). For both the calibration and validation steps, the differences between the predicted and observed mortality were mostly less than 5%. CONCLUSIONS The prediction model (Model 1) is an effective predictor of survival regardless of the ethnic background of patients and can potentially help to provide better prediction of colon cancer-specific survival outcomes, thus allowing physicians to improve treatment plans.
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Affiliation(s)
- Han-Ching Chan
- Institute of Epidemiology and Preventive Medicine, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chi-Cheng Huang
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Chieh Huang
- Institute of Epidemiology and Preventive Medicine, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Amrita Chattopadhyay
- Institute of Epidemiology and Preventive Medicine, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuan-Hung Yeh
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Taiwan Cancer Registry, Taipei, Taiwan
| | - Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Taiwan Cancer Registry, Taipei, Taiwan
| | - Hsin-Ying Lee
- Institute of Epidemiology and Preventive Medicine, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Skye Hung-Chun Cheng
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Mathew A, George PS, Kunnambath R, Mathew BS, Kumar A, Syampramod R, Booth CM. Educational Status, Cancer Stage, and Survival in South India: A Population-Based Study. JCO Glob Oncol 2021; 6:1704-1711. [PMID: 33156718 PMCID: PMC7713566 DOI: 10.1200/go.20.00259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Lower socioeconomic status is associated with more advanced cancer at the time of cancer diagnosis. It is unknown whether this leads to inferior survival in low- and middle-income countries. Here, we explore the association between educational level and survival in South India. METHODS The Trivandrum Cancer Registry (3.3 million population) was used to identify all cases of breast and cervical cancer (women) and oral cavity (OC) and lung cancer (men) diagnosed during 2012-2014. Educational level was classified as illiterate/primary school, middle school, and secondary school and above. Survival was measured from date of diagnosis using the Kaplan-Meier method. Cox proportional hazards regression modeling was used to describe the associations among education, stage of cancer at diagnosis, and survival. RESULTS The study population included 3,640 patients with breast (n = 1,727), cervical (n = 425), OC (n = 702), and lung (n = 786) cancer. Educational level was 27%, 23%, and 32% for illiterate/primary, middle, and secondary school and above, respectively. The 5-year survival rate for breast cancer was 59%, 68%, and 73% (P = .001); for cervical cancer, 51%, 52%, and 60% (P = .146); and for OC cancer, 42%, 35%, and 48% (P = .012) for illiterate/primary, middle school, and secondary school and above, respectively. The survival gradient across social groups was substantially attenuated when stage was added to the multivariable model. There was no observed difference in survival across educational groups for lung cancer (2%, 4%, and 3%; P = .224). CONCLUSION Data from this population-based study in South India demonstrate that patients from a lower educational background have inferior survival and that this is at least partially explained by having more advanced disease at the time of diagnosis. Public health efforts are needed to facilitate timely diagnosis and reduce disparities in cancer outcomes.
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Affiliation(s)
- Aleyamma Mathew
- Department of Cancer Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Preethi Sara George
- Department of Cancer Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Ramadas Kunnambath
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Beela Sarah Mathew
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Aswin Kumar
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Roshni Syampramod
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Department, of Oncology, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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DeRouen MC, Yang J, Jain J, Weden MM, Gomez SL, Shariff-Marco S. Disparities in Prostate Cancer Survival According to Neighborhood Archetypes, A Population-Based Study. Urology 2021; 163:138-147. [PMID: 34303761 DOI: 10.1016/j.urology.2021.05.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine survival among men with prostate cancer according to neighborhood archetypes. As an advancement beyond measures of neighborhood socioeconomic status (nSES) or specific measures of the neighborhood environment, archetypes consider interactions among many social and built environment attributes. METHODS Neighborhood archetypes for California census tracts in the year 2000 were previously developed through latent class analysis of 39 measures of social and built environment attributes. We assessed associations between archetypes and overall and prostate cancer-specific survival in this population-based study using geocoded cancer registry data for prostate cancer patients diagnosed 1996-2005 in California, followed through 2017 (n = 185,613). We used Cox proportional hazard models stratified by race/ethnicity and adjusted for age at diagnosis, year of diagnosis, tumor factors, treatment, marital status and cluster effect by census tract. Additional analyses examined associations between race/ethnicity and survival, while accounting for neighborhood archetypes. RESULTS We observed disparities in overall and prostate cancer-specific risk of death by neighborhood archetypes. Classes with the highest risk of death were defined by lower nSES, but also other domains such as rural/urban status, racial/ethnic composition or age of residents, commuting and traffic patterns, residential mobility, and food environment. Associations between archetypes and survival varied by race/ethnicity. CONCLUSION We observe interactions among several domains of neighborhood social and built environment attributes as demonstrated by the associations between neighborhood archetypes and prostate cancer survival. These results highlight opportunities for multilevel neighborhood interventions to reduce neighborhood disparities in prostate cancer survival.
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Affiliation(s)
- Mindy C DeRouen
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, California; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Juan Yang
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, California; Greater Bay Area Cancer Registry, San Francisco, California
| | - Jennifer Jain
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, California; Greater Bay Area Cancer Registry, San Francisco, California
| | | | - Scarlett L Gomez
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, California; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California; Greater Bay Area Cancer Registry, San Francisco, California
| | - Salma Shariff-Marco
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, California; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California; Greater Bay Area Cancer Registry, San Francisco, California.
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41
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Williams AD, Ciocca R, Sabol JL, Carp NZ. Institutions Treating Breast Cancer Patients of a Low Socioeconomic Status Achieve Multidisciplinary Quality Standards at Lower Rates. Ann Surg Oncol 2021; 28:5635-5647. [PMID: 34269942 DOI: 10.1245/s10434-021-10451-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The National Accreditation Program of Breast Centers (NAPBC) certifies institutions that provide quality breast care. Whereas low socioeconomic status (SES) has a negative impact on patient outcomes, it is unknown whether an institution's patient SES mix is associated with meeting NAPBC standards. METHODS All institutions submitting at least 100 breast cancer patients to the National Cancer Database (2006-2017) were ranked based on the patients' insurance status, income, and education. The 10% treating the largest proportion of low-SES patients were termed low-SES institutions (LSES). Patient cohorts were created based on the 2018 NAPBC standards. Uni- and multivariate comparisons of patient, tumor, and treatment factors were made to calculate adjusted odds of meeting each standard between low- and non-low-SES institutions. RESULTS The analysis included 1319 institutions. Both the LSES and non-LSES reached the benchmark rate of 50% lumpectomies (61.2 vs 62.9%; p < 0.001), but the unadjusted and adjusted rates of lumpectomy were lower in LSES. The rate for sentinel lymphadenectomy was lower for LSES (49.2 vs 53.7%; p < 0.001). Similarly, the unadjusted and adjusted rates of adjuvant chemotherapy and endocrine therapy were lower at LSES. Although the unadjusted rate of adjuvant radiation was higher at LSES, adjusted odds demonstrated that patients treated at LSES were less likely to undergo adjuvant radiation when appropriate. CONCLUSIONS Small but significant differences in achieving multidisciplinary standards for quality breast cancer care exist between LSES and non-LSES and may exacerbate disparities already faced by patients of low SES.
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Affiliation(s)
| | - Robin Ciocca
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Jennifer L Sabol
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Ned Z Carp
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
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Mora J, Krepline AN, Aldakkak M, Christians KK, George B, Hall WA, Erickson BA, Kulkarni N, Evans DB, Tsai S. Adjuvant therapy rates and overall survival in patients with localized pancreatic cancer from high Area Deprivation Index neighborhoods. Am J Surg 2021; 222:10-17. [DOI: 10.1016/j.amjsurg.2020.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/01/2020] [Accepted: 12/01/2020] [Indexed: 02/03/2023]
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Huang YC, Kung PT, Ho SY, Tyan YS, Chiu LT, Tsai WC. Effect of multidisciplinary team care on survival of oesophageal cancer patients: a retrospective nationwide cohort study. Sci Rep 2021; 11:13243. [PMID: 34168186 PMCID: PMC8225808 DOI: 10.1038/s41598-021-92618-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
Oesophageal cancer is the sixth leading cause of cancer death worldwide. This nationwide study analyses the survival results of oesophageal cancer under multidisciplinary team (MDT) care. We enrolled oesophageal cancer patients diagnosed between 2010 and 2015 with follow-up for at least 1 year. This study performed propensity score matching with a ratio of 1:1 between MDT participants and non-MDT participants. We performed conditional Cox proportional hazards model to research relative risk of survival and associated factors of survival. The adjusted survival curves were plotted. 8184 newly diagnosed oesophageal cancer patients were included. The favourable survival factors include participant status of MDT, gender, monthly salary, urbanization level, other catastrophic illness, stage of cancer, treatment methods, and service volume of physicians (P < 0.05). MDT participants showed lower risk of death (HR = 0.73; 95% CI 0.67–0.79). Further stratification analysis revealed that the incorporation of an MDT reduced the death risk of patients with stages 2, 3, and 4 cancer, with the greatest reduction observed in patients with stage 3 cancer (HR = 0.72; 95% CI 0.67–0.79). The risk of death was lower for oesophageal cancer patients who enrolled in MDT care.
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Affiliation(s)
- Yuan-Chun Huang
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan.,Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan.,School of Medical Imaging and Radiological Sciences, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Shang-Yun Ho
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Yeu-Sheng Tyan
- School of Medical Imaging and Radiological Sciences, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Taichung, 404060, Taiwan.
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Lai YJ, Lai HH, Chen YY, Ko MC, Chen CC, Chuang PH, Yen YF, Morisky DE. Low socio-economic status associated with increased risk of dengue haemorrhagic fever in Taiwanese patients with dengue fever: a population-based cohort study. Trans R Soc Trop Med Hyg 2021; 114:115-120. [PMID: 31688926 DOI: 10.1093/trstmh/trz103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/01/2019] [Accepted: 09/04/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence indicates that socio-economic status (SES) may affect health outcomes in patients with chronic diseases. However, little is known about the impact of SES on the prognosis of acute dengue. This nationwide cohort study determined the risk of dengue haemorrhagic fever (DHF) in Taiwanese dengue fever patients from 2000 to 2014. METHODS From 1 January 2000, we identified adult dengue cases reported in the Taiwan Centers for Disease Control Notifiable Diseases Surveillance System Database. Dengue cases were defined as positive virus isolation, nucleic acid amplification tests or serological tests. Associations between SES and incident DHF were estimated using a Cox proportional hazards model. RESULTS Of 27 750 dengue patients, 985 (3.5%) had incident DHF during the follow-up period, including 442 (4.8%) and 543 (2.9%) with low and high SES, respectively. After adjusting for age, sex, history of dengue fever and comorbidities, low SES was significantly associated with an increased risk of incident DHF (adjusted hazard ratio [AHR] 1.61 [95% confidence interval {CI} 1.42 to 1.83]). Rural-dwelling dengue patients had a higher likelihood of DHF complication than their urban counterparts (AHR 2.18 [95% CI 1.90 to 2.51]). CONCLUSIONS This study suggests low SES is an independent risk factor for DHF. Future dengue control programs should particularly target dengue patients with low SES for improved outcomes.
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Affiliation(s)
- Yun-Ju Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan.,Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Hsin-Hao Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, No.145, Zhengzhou Road, Datong District, Taipei City 10341, Taipei, Taiwan
| | - Yu-Yen Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Chung Ko
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Department of Urology, Taipei City Hospital, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taipei, Taiwan
| | - Yung-Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, No.145, Zhengzhou Road, Datong District, Taipei City 10341, Taipei, Taiwan.,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Donald E Morisky
- Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
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Njoku K, Barr CE, Hotchkies L, Quille N, Wan YL, Crosbie EJ. Impact of socio-economic deprivation on endometrial cancer survival in the North West of England: a prospective database analysis. BJOG 2021; 128:1215-1224. [PMID: 33289967 PMCID: PMC8248174 DOI: 10.1111/1471-0528.16618] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the impact of socio-economic deprivation on endometrial cancer survival. DESIGN Single-centre prospective database study. SETTING North West England. POPULATION Women with endometrial cancer treated between 2010 and 2015. METHODS Areal-level socio-economic status, using the English indices of multiple deprivation from residential postcodes, was analysed in relation to survival using Kaplan-Meier estimation and multivariable Cox regression. MAIN OUTCOME MEASURES Overall survival, cancer-specific survival and patterns and rates of recurrence. RESULTS A total of 539 women, with a median age of 66 years (interquartile range, IQR 56-73 years) and a body mass index (BMI) of 32 kg/m2 (IQR 26-39 kg/m2 ), were included in the analysis. Women in the most deprived social group were younger (median 64 years, IQR 55-72 years) and more obese (median 34 kg/m2 , IQR 28-42 kg/m2 ) than women in the least deprived group (median age 68 years, IQR 60-74 years; BMI 29 kg/m2 , IQR 25-36 kg/m2 ; P = 0.002 and <0.001, respectively). There were no differences in endometrial cancer type, stage or grade between social groups. There was no difference in recurrence rates, however, women in the middle and most deprived social groups were more likely to present with distant/metastatic recurrence (80.6 and 79.2%, respectively) than women in the least deprived group (43.5%, P < 0.001). Women in the middle and most deprived groups had a two-fold (adjusted hazard ratio, HR = 2.00, 95% CI 1.07-3.73, P = 0.030) and 53% (adjusted HR = 1.53, 95% CI 0.77-3.04, P = 0.221) increase in cancer-specific mortality compared with women in the least deprived group. There were no differences in overall survival. CONCLUSIONS We found that socio-economically deprived women with endometrial cancer were more likely to develop fatal recurrence. Larger studies are needed to confirm these findings and to identify modifiable contributing factors. TWEETABLE ABSTRACT Socio-economic deprivation is linked to an increased risk of death from endometrial cancer in the North West of England.
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Affiliation(s)
- K Njoku
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
- Division of Cancer SciencesFaculty of Biology, Medicine and HealthStoller Biomarker Discovery CentreUniversity of ManchesterManchesterUK
- Department of Obstetrics and GynaecologyManchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - CE Barr
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
- Department of Obstetrics and GynaecologyManchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - L Hotchkies
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
| | - N Quille
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
| | - YL Wan
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
- Department of Obstetrics and GynaecologyManchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - EJ Crosbie
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
- Department of Obstetrics and GynaecologyManchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
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McNeill D, Karapetis CS, Price TJ, Meagher P, Piantadosi C, Quinn S, Roder D, Padbury R, Maddern G, Townsend A, Jayawardana MW, Roy AC. Treatment and outcomes of metastatic colorectal cancer patients in public and private hospitals: results from the South Australian Metastatic Colorectal Cancer Registry. Intern Med J 2021; 51:69-77. [PMID: 31985128 DOI: 10.1111/imj.14765] [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: 09/03/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies have reported significant differences in baseline characteristics and outcomes of metastatic colorectal cancer (mCRC) patients when managed in private versus public hospitals. AIMS To compare disease, treatment and survival outcomes of patients with mCRC in public versus private hospitals in South Australia (SA). METHODS Analysis of prospectively collected data from the SA mCRC Registry. Patterns of care and outcome data according to location of care and socioeconomic status based on Index of Relative Socio-Economic Advantage and Disadvantage were analysed. RESULTS A total of 3470 patients' data was analysed during February 2006-January 2015. The majority (70%) of patients received treatment in public hospitals. Patients in the upper 50% for Index of Relative Socio-Economic Advantage and Disadvantage score were more likely to receive treatment at a private hospital (41.2% vs 21.56%) compared to <50%. Public patients had higher burden of disease (10.49% vs 7.41%, P = 0.005). Public patients received less treatment compared to the private patients (odds ratio = 0.48 (0.38-0.61), P = 0.01) and rates of surgical resections were lower in public patients. After adjusting for the covariates, public patients survive 1.33 months (P = 0.025) shorter than private patients with follow-up time of 5 years. Patients receiving metastasectomy and more than three lines of treatment were shown to have the greatest survival benefit. CONCLUSION Public patients have a higher burden of disease and in comparison are less likely to receive systemic therapy and have lower survival than patients treated in private hospitals.
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Affiliation(s)
- David McNeill
- Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Christos S Karapetis
- Department of Medical Oncology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
| | - Timothy J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Philip Meagher
- Engineering and Materials Science Centre, University College Dublin, Dublin, Ireland
| | - Cynthia Piantadosi
- Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Rob Padbury
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Guy Maddern
- Department of Surgery, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda Townsend
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Madawa W Jayawardana
- Office of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amitesh C Roy
- Department of Medical Oncology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
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Kakarla M, ChallaSivaKanaka S, Hayward SW, Franco OE. Race as a Contributor to Stromal Modulation of Tumor Progression. Cancers (Basel) 2021; 13:cancers13112656. [PMID: 34071280 PMCID: PMC8197868 DOI: 10.3390/cancers13112656] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 02/07/2023] Open
Abstract
Stromal cells play crucial roles in tumor development and are increasingly attractive targets for therapy. There are considerable racial disparities in the incidence and progression of many tumors, reflecting both environmental exposure and genetic differences existing between races. Tumorigenesis and tumor progression are linked to both the propensity to suffer an initiating event and the host response to such an event once it occurs, contributing to incidence and outcomes. In this review, we focused on racial disparities in the tumor microenvironment (TME) of different cancers as potential modulators of growth, metastasis, and response to treatment. Several studies suggest that the TME in AA has a distinct tumor biology and may facilitate both early onset and aggressive tumor growth while inhibiting anti-tumorigenic properties. The TME of AA patients often exhibits an immunosuppressive microenvironment with a substantial enrichment of immune inflammatory pathways and genes. As a result, AA patients can potentially benefit more from treatment strategies that modulate the immune system. Focusing on TME components for diagnostic and therapeutic purposes to address racial disparities is a promising area of investigation. Future basic and clinical research studies on personalized cancer diagnosis and treatment should acknowledge the significance of TME in racial disparities.
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Shah R, Chan KKW. The impact of socioeconomic status on stage at presentation, receipt of diagnostic imaging, receipt of treatment and overall survival in colorectal cancer patients. Int J Cancer 2021; 149:1031-1043. [PMID: 33950515 DOI: 10.1002/ijc.33622] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/11/2021] [Accepted: 04/26/2021] [Indexed: 11/12/2022]
Abstract
Socioeconomic factors influence patterns of care in colorectal cancer. Our study investigates the impact of socioeconomic status (SES) on stage at presentation, receipt of diagnostic imaging, receipt of treatment and overall survival (OS) in a universal healthcare system. The Ontario Cancer Registry (OCR) was accessed to identify a cohort of patients diagnosed with colorectal adenocarcinoma from 2007 to 2016 in Ontario, Canada. SES was measured using median neighborhood income divided into quintiles (Q1-Q5; Q1 = lowest income). Logistic regression analyses were used to evaluate stage, imaging and treatment. Cox proportional hazards models were used to evaluate OS. All endpoints were adjusted for demographics and comorbidities with OS models also adjusting for stage, imaging and treatment. In total, 39 802 colon and 13 164 rectal patients were identified. Lower SES was associated with advanced stage at presentation in both cohorts (Q1 vs Q5: Colon odds ratio [OR] = 1.08, P = .046, rectal OR = 1.25, P < .0001). Lower SES colon patients were less likely to receive adjuvant oxaliplatin (Q1 vs Q5: OR = 0.78, P < .001) and all palliative chemotherapies studied including oxaliplatin (Q1 vs Q5: OR = 0.60, P < 0.0001), irinotecan (Q1 vs Q5: OR = 0.65, P < .0001), bevacizumab (Q1 vs Q5: OR = 0.70, P < .001), cetuximab (Q1 vs Q5: OR = 0.40, P = .0053) and panitumumab (Q1 vs Q5: OR = 0.54, P = .0036). In rectal patients, lower SES was associated with decreased receipt of rectal cancer resection for stages I-III (Q1 vs Q5: OR = 0.78, P < .001), adjuvant oxaliplatin (Q1 vs Q5: OR = 0.72, P = .0020) and palliative chemotherapies including oxaliplatin (Q1 vs Q5: OR = 0.59, P < .001), irinotecan (Q1 vs Q5: OR = 0.53, P < .001) and bevacizumab (Q1 vs Q5: OR = 0.71, P = .046). All survival models identified poorer OS for lower SES patients (total colorectal; Q1 vs Q5: Hazard ratio [HR] = 1.25, P < .0001). These findings suggest disparities persist even within universal healthcare.
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Affiliation(s)
- Rajan Shah
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
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49
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Song S, Duan Y, Huang J, Wong MCS, Chen H, Trisolini MG, Labresh KA, Smith SC, Jin Y, Zheng ZJ. Socioeconomic Inequalities in Premature Cancer Mortality Among U.S. Counties During 1999 to 2018. Cancer Epidemiol Biomarkers Prev 2021; 30:1375-1386. [PMID: 33947656 DOI: 10.1158/1055-9965.epi-20-1534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/06/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study investigated socioeconomic inequalities in premature cancer mortality by cancer types, and evaluated the associations between socioeconomic status (SES) and premature cancer mortality by cancer types. METHODS Using multiple databases, cancer mortality was linked to SES and other county characteristics. The outcome measure was cancer mortality among adults ages 25-64 years in 3,028 U.S. counties, from 1999 to 2018. Socioeconomic inequalities in mortality were calculated as a concentration index (CI) by income (annual median household income), educational attainment (% with bachelor's degree or higher), and unemployment rate. A hierarchical linear mixed model and dominance analyses were used to investigate SES associated with county-level mortality. The analyses were also conducted by cancer types. RESULTS CIs of SES factors varied by cancer types. Low-SES counties showed increasing trends in mortality, while high-SES counties showed decreasing trends. Socioeconomic inequalities in mortality among high-SES counties were larger than those among low-SES counties. SES explained 25.73% of the mortality. County-level cancer mortality was associated with income, educational attainment, and unemployment rate, at -0.24 [95% (CI): -0.36 to -0.12], -0.68 (95% CI: -0.87 to -0.50), and 1.50 (95% CI: 0.92-2.07) deaths per 100,000 population with one-unit SES factors increase, respectively, after controlling for health care environment and population health. CONCLUSIONS SES acts as a key driver of premature cancer mortality, and socioeconomic inequalities differ by cancer types. IMPACT Focused efforts that target socioeconomic drivers of mortalities and inequalities are warranted for designing cancer-prevention implementation strategies and control programs and policies for socioeconomically underprivileged groups.
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Affiliation(s)
- Suhang Song
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York
| | - Yuqi Duan
- Department of Global Health, School of Public Health, Peking University, Beijing, P.R. China.,Institute for Global Health, Peking University, Beijing, P.R. China
| | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, P.R. China
| | - Martin C S Wong
- Department of Global Health, School of Public Health, Peking University, Beijing, P.R. China.,Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, P.R. China
| | - Hongda Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | | | | | - Sidney C Smith
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, P.R. China. .,Institute for Global Health, Peking University, Beijing, P.R. China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, P.R. China.,Institute for Global Health, Peking University, Beijing, P.R. China
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50
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Shariff-Marco S, DeRouen MC, Yang J, Jain J, Nelson DO, Weden MM, Gomez SL. Neighborhood archetypes and breast cancer survival in California. Ann Epidemiol 2021; 57:22-29. [PMID: 33577928 PMCID: PMC8133764 DOI: 10.1016/j.annepidem.2021.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Previous studies on neighborhoods and breast cancer survival examined neighborhood variables as unidimensional measures (e.g. walkability or deprivation) individually and thus cannot inform how the multitude of highly correlated neighborhood domains interact to impact breast cancer survival. Neighborhood archetypes were developed that consider interactions among a broad range of neighborhood social and built environment attributes and examine their associations with breast cancer survival. METHODS Archetypes were measured using latent class analysis (LCA) fit to California census tract-level data. Thirty-nine social and built environment attributes relevant to eight neighborhood domains (socioeconomic status (SES), urbanicity, demographics, housing, land use, commuting and traffic, residential mobility, and food environment) were included. The archetypes were linked to cancer registry data on breast cancer cases (diagnosed 1996-2005 with follow-up through Dec 31, 2017) to evaluate their associations with overall and breast cancer-specific survival using Cox proportional hazards models. Analyses were stratified by race/ethnicity. RESULTS California neighborhoods were best described by nine archetypal patterns that were differentially associated with overall and breast cancer-specific survival. The lowest risk of overall death was observed in the upper middle class suburb (reference) and high status neighborhoods, while the highest was observed among inner city residents with a 39% greater risk of death (95% CI = 1.35 to 1.44). Results were similar for breast cancer-specific survival. Stratified analyses indicated that differences in survival by neighborhood archetypes varied according to individuals' race/ethnicity. CONCLUSIONS By describing neighborhood archetypes that differentiate survival following breast cancer diagnosis, the study provides direction for policy and clinical practice addressing contextually-rooted social determinants of health including SES, unhealthy food environments, and greenspace.
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Affiliation(s)
- Salma Shariff-Marco
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA.
| | - Mindy C DeRouen
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Juan Yang
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA
| | - Jennifer Jain
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA
| | | | | | - Scarlett L Gomez
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA
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