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Herbach EL, Curran M, Roberson ML, Carnahan RM, McDowell BD, Wang K, Lizarraga I, Nash SH, Charlton M. Guideline-concordant breast cancer care by patient race and ethnicity accounting for individual-, facility- and area-level characteristics: a SEER-Medicare study. Cancer Causes Control 2024; 35:1017-1031. [PMID: 38546924 DOI: 10.1007/s10552-024-01859-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/29/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE To examine racial-ethnic variation in adherence to established quality metrics (NCCN guidelines and ASCO quality metrics) for breast cancer, accounting for individual-, facility-, and area-level factors. METHODS Data from women diagnosed with invasive breast cancer at 66+ years of age from 2000 to 2017 were examined using SEER-Medicare. Associations between race and ethnicity and guideline-concordant diagnostics, locoregional treatment, systemic therapy, documented stage, and oncologist encounters were estimated using multilevel logistic regression models to account for clustering within facilities or counties. RESULTS Black and American Indian/Alaska Native (AIAN) women had consistently lower odds of guideline-recommended care than non-Hispanic White (NHW) women (Diagnostic workup: ORBlack 0.83 (0.79-0.88), ORAIAN 0.66 (0.54-0.81); known stage: ORBlack 0.87 (0.80-0.94), ORAIAN 0.63 (0.47-0.85); seeing an oncologist: ORBlack 0.75 (0.71-0.79), ORAIAN 0.60 (0.47-0.72); locoregional treatment: ORBlack 0.80 (0.76-0.84), ORAIAN 0.84 (0.68-1.02); systemic therapies: ORBlack 0.90 (0.83-0.98), ORAIAN 0.66 (0.48-0.91)). Commission on Cancer accreditation and facility volume were significantly associated with higher odds of guideline-concordant diagnostics, stage, oncologist visits, and systemic therapy. Black residential segregation was associated with significantly lower odds of guideline-concordant locoregional treatment and systemic therapy. Rurality and area SES were associated with significantly lower odds of guideline-concordant diagnostics and oncologist visits. CONCLUSIONS This is the first study to examine guideline-concordance across the continuum of breast cancer care from diagnosis to treatment initiation. Disparities were present from the diagnostic phase and persisted throughout the clinical course. Facility and area characteristics may facilitate or pose barriers to guideline-adherent treatment and warrant future investigation as mediators of racial-ethnic disparities in breast cancer care.
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Affiliation(s)
- Emma L Herbach
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Michaela Curran
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Mya L Roberson
- Department of Health Policy and Management, School of Global Public Health, University of North Carolina at Chapel Hill, Gillings, Chapel Hill, NC, USA
| | - Ryan M Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Bradley D McDowell
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Kai Wang
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Ingrid Lizarraga
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Sarah H Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Mary Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
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Puthanmadhom Narayanan S, Ren D, Oesterreich S, Lee AV, Rosenzweig MQ, Brufsky AM. Effects of socioeconomic status and race on survival and treatment in metastatic breast cancer. NPJ Breast Cancer 2023; 9:90. [PMID: 37914742 PMCID: PMC10620133 DOI: 10.1038/s41523-023-00595-2] [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: 04/01/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023] Open
Abstract
Race and socioeconomic factors affect outcomes in breast cancer. We aimed to assess the effect of race and neighborhood socioeconomic status (SES) on overall survival and treatment patterns in patients with metastatic breast cancer (MBC). This is a retrospective cohort study involving patients (N = 1246) with distant breast cancer metastases diagnosed at UPMC Magee Women's Breast Cancer Clinic from 2000-2017. Overall survival and treatment patterns were compared between races (Blacks and whites) and SES groups (defined using Area Deprivation Index). Low SES, but not tumor characteristics, was associated with Black race (P < 0.001) in the study population. Low SES (Median [Interquartile Range, IQR] survival 2.3[2.2-2.5] years vs high SES 2.7[2.5-3.1] years, P = 0.01) and Black race (Median [IQR] survival 1.8[1.3-2.3] years, vs white 2.5[2.3-2.7] years P = 0.008) separately were associated with worse overall survival in patients with MBC. In the Cox Proportional Hazard model with SES, race, age, subtype, number of metastases, visceral metastasis, and year of diagnosis as covariates, low SES (Hazard ratio 1.19[1.04-1.35], P = 0.01), but not Black race (Hazard ratio 1.19[0.96-1.49], P = 0.12), independently predicted overall survival in MBC. Moreover, patients from low SES neighborhoods and Black race received fewer lines of chemotherapy than high SES and whites. In conclusion, low neighborhood SES is associated with worse outcomes in patients with MBC. Poor outcomes in Black patients with MBC, at least in part is driven by socioeconomic factors. Future studies should delineate the interplay between neighborhood SES, race, and their effects on tumor biology in MBC.
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Affiliation(s)
| | - Dianxu Ren
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Steffi Oesterreich
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Women's Cancer Research Center (WCRC), UPMC, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Adrian V Lee
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Women's Cancer Research Center (WCRC), UPMC, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Margaret Q Rosenzweig
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
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Carbajal-Ochoa WH, Johnson D, Alvarez A, Bernal AM, Anampa JD. Racial disparities in treatment and outcomes between non-Hispanic Black and non-Hispanic White women with nonmetastatic inflammatory breast cancer. Breast Cancer Res Treat 2023:10.1007/s10549-023-07018-7. [PMID: 37442877 DOI: 10.1007/s10549-023-07018-7] [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: 04/12/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE The incidence rate of inflammatory breast cancer (IBC) is higher among non-Hispanic Black (NHB) than non-Hispanic White (NHW) women. We examined the differences in treatment and outcomes between NHB and NHW women with IBC, accounting for demographic, clinicopathological, and socioeconomic factors. METHODS We collected data from the Surveillance, Epidemiology, and End Results database for NHB and NHW women with IBC diagnosed between 2010-2016. We analyzed the odds of receiving chemotherapy, radiation, and surgery between NHB and NHW women. We evaluated overall survival (OS) with Kaplan-Meier methods and Cox proportional hazards methods. Competing risk analysis was used to compare the risk of breast cancer death between NHB and NHW women. We also evaluated the magnitude of survival disparities within the strata of demographic, socioeconomic, and treatment factors. RESULTS Among 1,652 NHW and 371 NHB women with IBC, the odds of receiving chemotherapy, surgery, and radiation were similar for NHB and NHW. After 39-month follow-up, the median OS was 40 and 81 months for NHB and NHW, respectively (p < 0.0001). The risk of breast cancer death was higher for NHB than NHW women (5-year risk of breast cancer death, 51% vs. 35%, p < 0.0001). CONCLUSION After adjustment for demographic, clinicopathological, and socioeconomic factors; NHB women with IBC had similar odds of receiving surgery, chemotherapy, and radiation therapy, but were more likely to die of the disease compared to their NHW counterparts. Our findings suggest the presence of masked tumor biology, treatment, or socioeconomic factors associated with race that can lead to worse IBC outcomes.
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Affiliation(s)
- Walter H Carbajal-Ochoa
- Department of Medical Oncology, Catalan Institute of Oncology/Josep Trueta Hospital, Girona, Spain
| | - Devin Johnson
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alvaro Alvarez
- Department of Medicine, Hematology/Oncology, Carole and Ray Neag Comprehensive Cancer Center, UCONN Health, Farmington, CT, USA
| | - Ana M Bernal
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 1695 Eastchester Rd, Bronx, NY, 10461, USA
| | - Jesus D Anampa
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 1695 Eastchester Rd, Bronx, NY, 10461, USA.
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Miller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, Kramer J, Siegel RL. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin 2022; 72:409-436. [PMID: 35736631 DOI: 10.3322/caac.21731] [Citation(s) in RCA: 883] [Impact Index Per Article: 441.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 12/12/2022] Open
Abstract
The number of cancer survivors continues to increase in the United States due to the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate triennially to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries, vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics, and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Database are presented for the most prevalent cancer types by race, and cancer-related and treatment-related side-effects are also briefly described. More than 18 million Americans (8.3 million males and 9.7 million females) with a history of cancer were alive on January 1, 2022. The 3 most prevalent cancers are prostate (3,523,230), melanoma of the skin (760,640), and colon and rectum (726,450) among males and breast (4,055,770), uterine corpus (891,560), and thyroid (823,800) among females. More than one-half (53%) of survivors were diagnosed within the past 10 years, and two-thirds (67%) were aged 65 years or older. One of the largest racial disparities in treatment is for rectal cancer, for which 41% of Black patients with stage I disease receive proctectomy or proctocolectomy compared to 66% of White patients. Surgical receipt is also substantially lower among Black patients with non-small cell lung cancer, 49% for stages I-II and 16% for stage III versus 55% and 22% for White patients, respectively. These treatment disparities are exacerbated by the fact that Black patients continue to be less likely to be diagnosed with stage I disease than White patients for most cancers, with some of the largest disparities for female breast (53% vs 68%) and endometrial (59% vs 73%). Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based strategies and equitable access to available resources are needed to mitigate disparities for communities of color and optimize care for people with a history of cancer. CA Cancer J Clin. 2022;72:409-436.
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Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Theresa Devasia
- Data Analytics Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Joan Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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5
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Chapman CH, Schechter CB, Cadham CJ, Trentham-Dietz A, Gangnon RE, Jagsi R, Mandelblatt JS. Identifying Equitable Screening Mammography Strategies for Black Women in the United States Using Simulation Modeling. Ann Intern Med 2021; 174:1637-1646. [PMID: 34662151 PMCID: PMC9997651 DOI: 10.7326/m20-6506] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Screening mammography guidelines do not explicitly consider racial differences in breast cancer epidemiology, treatment, and survival. OBJECTIVE To compare tradeoffs of screening strategies in Black women versus White women under current guidelines. DESIGN An established model from the Cancer Intervention and Surveillance Modeling Network simulated screening outcomes using race-specific inputs for subtype distribution; breast density; mammography performance; age-, stage-, and subtype-specific treatment effects; and non-breast cancer mortality. SETTING United States. PARTICIPANTS A 1980 U.S. birth cohort of Black and White women. INTERVENTION Screening strategies until age 74 years with varying initiation ages and intervals. MEASUREMENTS Outcomes included benefits (life-years gained [LYG], breast cancer deaths averted, and mortality reduction), harms (mammographies, false positives, and overdiagnoses), and benefit-harm ratios (tradeoffs) by race. Efficiency (benefits per unit resource), mortality disparity reduction, and equity in tradeoffs were evaluated. Equitable strategies for Black women were defined as those with tradeoffs closest to benchmark values for screening White women biennially from ages 50 to 74 years. RESULTS Biennial screening from ages 45 to 74 years was most efficient for Black women, whereas biennial screening from ages 40 to 74 years was most equitable. Initiating screening 10 years earlier in Black versus White women reduced Black-White mortality disparities by 57% with similar LYG per mammogram for both populations. Selection of the most equitable strategy was sensitive to assumptions about disparities in real-world treatment effectiveness: The less effective treatment was for Black women, the more intensively Black women could be screened before tradeoffs fell short of those experienced by White women. LIMITATION Single model. CONCLUSION Initiating biennial screening in Black women at age 40 years reduces breast cancer mortality disparities and yields benefit-harm ratios that are similar to tradeoffs of White women screened biennially from ages 50 to 74 years. PRIMARY FUNDING SOURCE National Cancer Institute at the National Institutes of Health.
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Affiliation(s)
- Christina Hunter Chapman
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, and University of Michigan Medical School, Ann Arbor, Michigan (C.H.C.)
| | | | - Christopher J Cadham
- Georgetown University Medical Center and Georgetown Lombardi Comprehensive Cancer Center, Washington, DC (C.J.C., J.S.M.)
| | - Amy Trentham-Dietz
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin (A.T., R.E.G.)
| | - Ronald E Gangnon
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin (A.T., R.E.G.)
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan (R.J.)
| | - Jeanne S Mandelblatt
- Georgetown University Medical Center and Georgetown Lombardi Comprehensive Cancer Center, Washington, DC (C.J.C., J.S.M.)
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Hu X, Chehal PK, Kaplan C, Krukowski RA, Lan RH, Stepanski E, Schwartzberg L, Vidal G, Graetz I. Characterization of Clinical Symptoms by Race Among Women With Early-Stage, Hormone Receptor-Positive Breast Cancer Before Starting Chemotherapy. JAMA Netw Open 2021; 4:e2112076. [PMID: 34061200 PMCID: PMC8170541 DOI: 10.1001/jamanetworkopen.2021.12076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Race disparities persist in breast cancer mortality rates. One factor associated with these disparities may be differences in symptom burden, which may reduce chemotherapy tolerance and increase early treatment discontinuation. OBJECTIVES To compare symptom burden by race among women with early-stage breast cancer before starting chemotherapy and quantify symptom differences explained by baseline characteristics. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of symptom burden differences by race among Black and White women with a diagnosis of stage I to III, hormone receptor-positive breast cancer who had a symptom report collected before chemotherapy initiation in a large cancer center in the southern region of the US from January 1, 2007, through December 31, 2015. Analyses were conducted from November 1, 2019, to March 31, 2021. Blinder-Oaxaca decomposition was used, adjusting for baseline sociodemographic and clinical characteristics. MAIN OUTCOMES AND MEASURES Four symptom composite scores with a mean (SD) of 50 (10) were reported before starting chemotherapy (baseline) and were derived from symptom items: general physical symptoms (11 items), treatment adverse effects (8 items), acute distress (4 items), and despair (7 items). Patients rated the severity of each symptom they experienced in the past week on a scale of 0 to 10 (where 0 indicates not a problem and 10 indicates as bad as possible). RESULTS A total of 1338 women (mean [SD] age, 54.6 [11.6] years; 420 Black women [31.4%] and 918 White women [68.6%]) were included in the study. Before starting chemotherapy, Black women reported a statistically significantly higher (ie, worse) symptom composite score than White women for adverse effects (44.5 vs 43.8) but a lower acute distress score (48.5 vs 51.0). Decomposition analyses showed that Black patients' characteristics were associated with higher symptom burden across all 4 scores. However, these differences were offset by relatively greater, statistically significant, unexplained physical, distress, and despair symptom reporting by White patients. CONCLUSIONS AND RELEVANCE In this study, before starting chemotherapy, Black patients with early-stage breast cancer reported significantly higher burden for symptoms that may be exacerbated with chemotherapy and lower distress symptoms compared with White patients. Future studies should explore how symptoms change before and after treatment and differ by racial/ethnic groups and how they are associated with treatment adherence and mortality disparities.
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Affiliation(s)
- Xin Hu
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Puneet K. Chehal
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cameron Kaplan
- Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine of University of Southern California, Los Angeles
| | | | - Roy H. Lan
- College of Medicine, University of Tennessee Health Science Center, Memphis
| | | | - Lee Schwartzberg
- West Cancer Center and Research Institute, Germantown, Tennessee
| | - Gregory Vidal
- West Cancer Center and Research Institute, Germantown, Tennessee
- Division of Hematology and Oncology, University of Tennessee Health Science Center, Memphis
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Xu G, Jin Y, Fang C, Yu J, Zhang Z, Sun C. Is Radical Surgery Alone Enough in T1-3N1a Colon Cancer? Front Oncol 2020; 10:1679. [PMID: 33194570 PMCID: PMC7649791 DOI: 10.3389/fonc.2020.01679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Low lymphatic tumor burden is associated with a better prognosis. However, it is uncertain whether those patients diagnosed as cN0 found to be pN+ could be a favorable subgroup in stage III disease. Radical surgery alone might avoid overtreatment in those patients. Methods: Eligible patients diagnosed with colon cancer without metastasis were recruited from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2016 using SEER*Stat 8.3.5 software (Surveillance Research Program, National Cancer Institute) and divided into two groups: surgery group (n = 3,081) and surgery followed by adjuvant chemotherapy group (n = 4,591). Overall survival (OS) and cause-specific survival (CSS) differences were assessed by Kaplan–Meier analysis, and survival differences were estimated with log-rank tests. Univariate and multivariate Cox proportional hazard regressions were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) for colon cancer patients. Results: A total of 7,672 pT1-3N1a colon cancer patients were recruited from 208,751 colon cancer patients. The 5-year CSS rates of patients without and with adjuvant chemotherapy were 80.0 and 90.7%, respectively. The receipt of adjuvant chemotherapy after the radical resection of the primary tumor was independently associated with 57.3% decreased risk of colon cancer-specific mortality compared with surgery alone (HR = 0.427, 95% CI = 0.370–0.492, P < 0.001, using surgery alone as the reference). Conclusions: Adjuvant chemotherapy was significantly associated with improved prognosis and radical surgery alone did not provide enough treatment for colon cancer with very low lymphatic tumor burden.
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Affiliation(s)
- Guoxiong Xu
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Yiqi Jin
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Changwen Fang
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Jingfan Yu
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Zhixuan Zhang
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Chunrong Sun
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
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Jayakrishnan TT, White RJ, Greenberg L, Colonias A, Wegner RE. Predictors of chemotherapy and its effects in early stage squamous cell carcinoma of the larynx. Laryngoscope Investig Otolaryngol 2020; 5:445-452. [PMID: 32596486 PMCID: PMC7314463 DOI: 10.1002/lio2.327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/21/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Squamous cell carcinoma (SCC) of larynx is a common head and neck cancer. For cases that are node negative, the role of definitive concurrent chemoradiation is unclear and not supported by guidelines but used at provider discretion. To address this knowledge gap, we examined the oncological outcomes with additional chemotherapy and factors correlated with the chemotherapy administration. METHODS We queried the National Cancer Database for patients with early stage (T2N0M0) laryngeal SCC treated nonsurgically. Multivariable logistic regression identified predictors of chemotherapy. Multivariable Cox regression evaluated predictors of survival. Propensity matching accounted for indication biases. RESULTS We identified 7181 patients meeting the eligibility criteria, of which 1568 (22%) patients received chemotherapy in addition to radiation. Predictors of chemotherapy use included younger age, Caucasian race, more remote year of treatment, higher grade, sites other than glottis, treatment at a community cancer center, and use of intensity-modulated radiation therapy. Median overall survival was not significantly different in the two arms analyzed-65 months (95% confidence interval [CI] 60, 72months) with chemotherapy compared to 70 months without chemotherapy (95% CI 66, 75 months, P<.37). Predictors for survival on propensity-matched multivariable analysis were increased age, male sex, less education, lower income, higher comorbidity score, receipt of treatment at a community center, and nonglottic sites. CONCLUSIONS This study shows no clear survival benefit with chemotherapy in early stage disease. Although this implies that chemotherapy should not be routinely delivered, individualized judgment and prospective studies are recommended as the biology behind this interesting finding is undefined. LEVEL OF EVIDENCE 2C (Outcomes Research).
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Affiliation(s)
| | - Richard J. White
- Department of Internal MedicineAllegheny Health NetworkPittsburghPA
| | - Larisa Greenberg
- Division of Medical OncologyAllegheny Health Network Cancer InstitutePittsburghPA
| | - Athanasios Colonias
- Division of Radiation OncologyAllegheny Health Network Cancer Institute, Allegheny General HospitalPittsburghPA
| | - Rodney E. Wegner
- Division of Radiation OncologyAllegheny Health Network Cancer Institute, Allegheny General HospitalPittsburghPA
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9
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The influence of race and socioeconomic status on therapeutic clinical trial screening and enrollment. J Neurooncol 2020; 148:131-139. [DOI: 10.1007/s11060-020-03503-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
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10
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Shah C, Hong YR, Bishnoi R, Jones D, Huo J. Utilization of Antineoplastic Agents and Medicare Spending in Elderly Patients With Extensive-Stage Small-Cell Lung Cancer Between 2001 and 2013. JCO Oncol Pract 2020; 16:e610-e621. [PMID: 32074011 DOI: 10.1200/jop.19.00559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Some elderly patients (≥ 65 years old) with small-cell lung cancer (SCLC) do not receive chemotherapy likely because of fear of toxicity and uncertainty regarding benefits. Thus, we aimed to study real-world trends in utilization of antineoplastics over the years and predictors of utilization, survival, and Medicare expenditure in elderly patients with extensive-stage (ES) SCLC. PATIENTS AND METHODS Using the linked SEER and Medicare database, we identified elderly patients with newly diagnosed ES-SCLC between 2001 and 2013. The Wald test was used to determine the significance of trends. Cox proportional hazards models were applied for survival analyses. We used SAS, version 9.4 (SAS Institute, Cary, NC). RESULTS We identified 15,763 patients with newly diagnosed ES-SCLC. Approximately 6,838 patients (43.38%) received antineoplastics, and 8,925 patients (56.61%) received supportive care only. Every year since 2001, the percentage of patients receiving antineoplastics has decreased (45.8% v 36.6% in 2001 and 2013, respectively; Ptrend < .0001). Patients with advanced age (P < .001), patients from high-poverty areas (P < .001) or rural areas (P = .005), patients with Charlson comorbidity index ≥ 3 (P < .001), and non-Hispanic blacks (P = .003) and Hispanics (P = .001) were less likely to receive antineoplastics. Mean Medicare spending per patient decreased over the study period for patients treated with antineoplastics ($45,998 in 2001 and $35,053 in 2013; Ptrend < .001) and for those receiving supportive care only ($34,197 in 2001 and $25,265 in 2013; Ptrend < .001). CONCLUSION Decreasing utilization of antineoplastics in elderly patients with ES-SCLC since 2001 could be partly secondary to higher comorbidities and physiologic age, leading to poor candidacy. Medicare expenditures decreased likely as a result of value-based treatment initiatives by the Centers for Medicaid and Medicare Services. However, expenditures are likely to increase with use of expensive novel agents.
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Affiliation(s)
- Chintan Shah
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Rohit Bishnoi
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL
| | - Dennie Jones
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL
| | - Jinhai Huo
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL
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Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, Jemal A, Kramer JL, Siegel RL. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin 2019; 69:363-385. [PMID: 31184787 DOI: 10.3322/caac.21565] [Citation(s) in RCA: 2816] [Impact Index Per Article: 563.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.
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Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | - Ahmedin Jemal
- Surveillance Research, American Cancer Society, Atlanta, Georgia
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Joan L Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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Thomas PS, Class CA, Gandhi TR, Bambhroliya A, Do KA, Brewster AM. Demographic, clinical, and geographical factors associated with lack of receipt of physician recommended chemotherapy in women with breast cancer in Texas. Cancer Causes Control 2019; 30:409-415. [PMID: 30868330 PMCID: PMC7239038 DOI: 10.1007/s10552-019-01151-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 02/22/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Identifying demographic, clinical, and geographical factors that contribute to disparities in the receipt of physician recommended chemotherapy in breast cancer patients. METHODS The Texas Cancer Registry was used to identify women aged ≥ 18 years with invasive breast cancer diagnosed from 2007 to 2011 who received a recommendation for chemotherapy. Multivariable logistic regression was performed to determine associations between demographic and clinical factors and the receipt of chemotherapy. Cox proportional regression was used to estimate the hazard ratio (HR) for overall survival. Spatial analysis was conducted using Poisson models for breast cancer mortality and receipt of chemotherapy. RESULTS Age ≥ 65 years, residence in areas with > 20% poverty index, and early disease stage were associated with lack of receipt of chemotherapy (all p < 0.001). Lack of receipt of chemotherapy was associated with decreased overall survival (HR 1.33, 95% CI 1.12-1.59, p = 0.001). A 38-county cluster in West Texas had lower receipt of chemotherapy (relative risk 0.88, p = 0.02) and increased breast cancer mortality (p = 0.03) compared to the rest of Texas. CONCLUSION Older age, increased poverty and rural geographical location are barriers to the receipt of chemotherapy. Interventions that target these barriers may reduce health disparities and improve breast cancer survival.
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Affiliation(s)
- Parijatham S Thomas
- Department of Clinical Cancer Prevention, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA.
| | - Caleb A Class
- Department of Biostatistics, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Tanmay R Gandhi
- Department of Biostatistics, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Arvind Bambhroliya
- Department of Neurology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Kim-Anh Do
- Department of Biostatistics, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Abenaa M Brewster
- Department of Clinical Cancer Prevention, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
- Department of Epidemiology, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
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13
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Zhang L, King J, Wu XC, Hsieh MC, Chen VW, Yu Q, Fontham E, Loch M, Pollack LA, Ferguson T. Racial/ethnic differences in the utilization of chemotherapy among stage I-III breast cancer patients, stratified by subtype: Findings from ten National Program of Cancer Registries states. Cancer Epidemiol 2018; 58:1-7. [PMID: 30415099 DOI: 10.1016/j.canep.2018.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The study aimed to examine racial/ethnic differences in chemotherapy utilization by breast cancer subtype. METHODS Data on female non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic stage I-III breast cancer patients diagnosed in 2011 were obtained from a project to enhance population-based National Program of Cancer Registry data for Comparative Effectiveness Research. Hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) were used to classify subtypes: HR+/HER2-; HR+/HER2+; HR-/HER2-; and HR-/HER2 + . We used multivariable logistic regression models to examine the association of race/ethnicity with three outcomes: chemotherapy (yes, no), neo-adjuvant chemotherapy (yes, no), and delayed chemotherapy (yes, no). Covariates included patient demographics, tumor characteristics, Charlson Comorbidity Index, other cancer treatment, and participating states/areas. RESULTS The study included 25,535 patients (72.1% NHW, 13.7% NHB, and 14.2% Hispanics). NHB with HR+/HER2- (adjusted odds ratio [aOR] 1.22, 95% CI 1.04-1.42) and Hispanics with HR-/HER2- (aOR 1.62, 95% CI 1.15-2.28) were more likely to receive chemotherapy than their NHW counterparts. Both NHB and Hispanics were more likely to receive delayed chemotherapy than NHW, and the pattern was consistent across each subtype. No racial/ethnic differences were found in the receipt of neo-adjuvant chemotherapy. CONCLUSIONS Compared to NHW with the same subtype, NHB with HR+/HER2- and Hispanics with HR-/HER2- have higher odds of using chemotherapy; however, they are more likely to receive delayed chemotherapy, regardless of subtype. Whether the increased chemotherapy use among NHB with HR+/HER2- indicates overtreatment needs further investigation. Interventions to improve the timely chemotherapy among NHB and Hispanics are warranted.
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Affiliation(s)
- Lu Zhang
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Jessica King
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Xiao-Cheng Wu
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Mei-Chin Hsieh
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Vivien W Chen
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Qingzhao Yu
- Biostatistics Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Elizabeth Fontham
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Michelle Loch
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Lori A Pollack
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tekeda Ferguson
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States.
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14
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Williams CP, Kenzik KM, Azuero A, Williams GR, Pisu M, Halilova KI, Ingram SA, Yagnik SK, Forero A, Bhatia S, Rocque GB. Impact of Guideline-Discordant Treatment on Cost and Health Care Utilization in Older Adults with Early-Stage Breast Cancer. Oncologist 2018; 24:31-37. [PMID: 30120157 DOI: 10.1634/theoncologist.2018-0076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND National Comprehensive Cancer Network (NCCN) guideline-based treatment is a marker of high-quality care. The impact of guideline discordance on cost and health care utilization is unclear. MATERIALS AND METHODS This retrospective cohort study of Medicare claims data from 2012 to 2015 included women age ≥65 with stage I-III breast cancer receiving care within the University of Alabama at Birmingham Cancer Community Network. Concordance with NCCN guidelines was assessed for treatment regimens. Costs to Medicare and health care utilization were identified from start of cancer treatment until death or available follow-up. Adjusted monthly cost and utilization rates were estimated using linear mixed effect and generalized linear models. RESULTS Of 1,177 patients, 16% received guideline-discordant treatment, which was associated with nonwhite race, estrogen receptor/progesterone receptor negative, human epidermal growth receptor 2 (HER2) positive, and later-stage cancer. Discordant therapy was primarily related to reduced-intensity treatments (single-agent chemotherapy, HER2-targeted therapy without chemotherapy, bevacizumab without chemotherapy, platinum combinations without anthracyclines). In adjusted models, average monthly costs for guideline-discordant patients were $936 higher compared with concordant (95% confidence limits $611, $1,260). For guideline-discordant patients, adjusted rates of emergency department visits and hospitalizations per thousand observations were 25% higher (49.9 vs. 39.9) and 19% higher (24.0 vs. 20.1) per month than concordant patients, respectively. CONCLUSION One in six patients with early-stage breast cancer received guideline-discordant care, predominantly related to undertreatment, which was associated with higher costs and rates of health care utilization. Additional randomized trials are needed to test lower-toxicity regimens and guide clinicians in treatment for older breast cancer patients. IMPLICATIONS FOR PRACTICE Previous studies lack details about types of deviations from chemotherapy guidelines that occur in older early-stage breast cancer patients. Understanding the patterns of guideline discordance and its impact on patient outcomes will be particularly important for these patients. This study found 16% received guideline-discordant care, predominantly related to reduced intensity treatment and associated with higher costs and rates of health care utilization. Increasing older adult participation in clinical trials should be a priority in order to fill the knowledge gap about how to treat older, less fit patients with breast cancer.
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Affiliation(s)
- Courtney P Williams
- Divisions of Hematology & Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kelly M Kenzik
- Divisions of Hematology & Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Grant R Williams
- Divisions of Hematology & Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maria Pisu
- Division of Preventive Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karina I Halilova
- Divisions of Hematology & Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stacey A Ingram
- Divisions of Hematology & Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Andres Forero
- Divisions of Hematology & Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- The University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gabrielle B Rocque
- Divisions of Hematology & Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- The University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA
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15
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Dreyer MS, Nattinger AB, McGinley EL, Pezzin LE. Socioeconomic status and breast cancer treatment. Breast Cancer Res Treat 2018; 167:1-8. [PMID: 28884392 PMCID: PMC5790605 DOI: 10.1007/s10549-017-4490-3] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/30/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE Evidence suggests substantial disparities in breast cancer survival by socioeconomic status (SES). We examine the extent to which receipt of newer, less invasive, or more effective treatments-a plausible source of disparities in survival-varies by SES among elderly women with early-stage breast cancer. METHODS Multivariate regression analyses applied to 11,368 women (age 66-90 years) identified from SEER-Medicare as having invasive breast cancer diagnosed in 2006-2009. Socioeconomic status was defined based on Medicaid enrollment and level of poverty of the census tract of residence. All analyses controlled for demographic, clinical health status, spatial, and healthcare system characteristics. RESULTS Poor and near-poor women were less likely than high SES women to receive sentinel lymph node biopsy and radiation after breast-conserving surgery (BCS). Poor women were also less likely than near-poor or high SES women to receive any axillary surgery and adjuvant chemotherapy. There were no significant differences in use of aromatase inhibitors (AI) between poor and high SES women. However, near-poor women who initiated hormonal therapy were more likely to rely exclusively on tamoxifen, and less likely to use the more expensive but more effective AI when compared to both poor and high SES women. CONCLUSIONS Our results indicate that SES disparities in the receipt of treatments for incident breast cancer are both pervasive and substantial. These disparities remained despite women's geographic area of residence and extent of disease, suggesting important gaps in access to effective breast cancer care.
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Affiliation(s)
- Marie S Dreyer
- Department of Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI, 53226, USA
| | - Ann B Nattinger
- Department of Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI, 53226, USA
| | - Emily L McGinley
- Department of Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI, 53226, USA
| | - Liliana E Pezzin
- Department of Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI, 53226, USA.
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16
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Racial and Socioeconomic Disparities Are More Pronounced in Inflammatory Breast Cancer Than Other Breast Cancers. J Cancer Epidemiol 2017; 2017:7574946. [PMID: 28894467 PMCID: PMC5574219 DOI: 10.1155/2017/7574946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/11/2017] [Indexed: 01/04/2023] Open
Abstract
Inflammatory breast cancer (IBC) is a rare yet aggressive form of breast cancer. We examined differences in patient demographics and outcomes in IBC compared to locally advanced breast cancer (LABC) and all other breast cancer patients from the Breast and Prostate Cancer Data Quality and Patterns of Care Study (POC-BP), containing information from cancer registries in seven states. Out of 7,624 cases of invasive carcinoma, IBC and LABC accounted for 2.2% (N = 170) and 4.9% (N = 375), respectively. IBC patients were more likely to have a higher number (P = 0.03) and severity (P = 0.01) of comorbidities than other breast cancer patients. Among IBC patients, a higher percentage of patients with metastatic disease versus nonmetastatic disease were black, on Medicaid, and from areas of higher poverty and more urban areas. Black and Hispanic IBC patients had worse overall and breast cancer-specific survival than white patients; moreover, IBC patients with Medicaid, patients from urban areas, and patients from areas of higher poverty and lower education had worse outcomes. These data highlight the effects of disparities in race and socioeconomic status on the incidence of IBC as well as IBC outcomes. Further work is needed to reveal the causes behind these disparities and methods to improve IBC outcomes.
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17
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Influence of comorbidity on chemotherapy use for early breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 2017; 165:17-39. [DOI: 10.1007/s10549-017-4295-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
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18
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Meresse M, Bouhnik AD, Bendiane MK, Retornaz F, Rousseau F, Rey D, Giorgi R. Chemotherapy in Old Women with Breast Cancer: Is Age Still a Predictor for Under Treatment? Breast J 2016; 23:256-266. [DOI: 10.1111/tbj.12726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mégane Meresse
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Anne-Déborah Bouhnik
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
| | - Marc-Karim Bendiane
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Frédérique Retornaz
- Departemental Geriatric Center; Polyvalent Geriatric Center; Marseille France
- Unit of Care and Research in Internal Medicine; Hôpital Européeen; Marseille France
| | - Frédérique Rousseau
- Pilot Unit of Research and Coordination in Geriatric Oncology; Department of Medicine; Institut Paoli-Calmettes; Marseille France
| | - Dominique Rey
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Roch Giorgi
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- Biostatistics & Information and Communication Technology Unit; APHM Timone hospital; Marseille France
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19
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Pollom EL, Alagappan M, Park LS, Whittemore AS, Koong AC, Chang DT. Does radiotherapy still have a role in unresected biliary tract cancer? Cancer Med 2016; 6:129-141. [PMID: 27891822 PMCID: PMC5269698 DOI: 10.1002/cam4.975] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/29/2016] [Accepted: 10/31/2016] [Indexed: 01/02/2023] Open
Abstract
The benefits of radiotherapy for inoperable biliary tract cancer remain unclear due to the lack of randomized data. We evaluated the impact of radiotherapy on survival in elderly patients using the SEER‐Medicare database. Patients in the SEER‐Medicare database with inoperable biliary tract tumors diagnosed between 1998 and 2011 were included. We used multivariate logistic regression to evaluate factors associated with treatment selection, and multivariate Cox regression and propensity score matching to evaluate treatment selection in relation to subsequent survival. Of the 2343 patients included, 451 (19%) received radiotherapy within 4 months of diagnosis. The use of radiotherapy declined over time, and was influenced by receipt of chemotherapy and patient age, race, marital status, poverty status, and tumor stage and type. Median survival was 9.3 (95% CI 8.7–9.7) months among patients who did not receive radiation and 10.0 (95% CI 9.1–11.3) months among those who received radiation, conditional on having survived 4 months. In patients who received chemotherapy (n = 1053), receipt of radiation was associated with improved survival, with an adjusted hazard ratio of 0.82 (95% 0.70–0.97, P = 0.02). In patients who did not receive chemotherapy (n = 1290), receipt of radiation was not associated with improved survival, with an adjusted hazard ratio of 1.09 (95% 0.91–1.30, P = 0.34). Propensity‐scored matched analyses showed similar results. Despite the survival benefit associated with the addition of radiotherapy to chemotherapy, the use of radiation for unresectable biliary tract cancers has declined over time.
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Affiliation(s)
- Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Muthuraman Alagappan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Lesley S Park
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Alice S Whittemore
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Albert C Koong
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
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20
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Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016; 66:271-89. [PMID: 27253694 DOI: 10.3322/caac.21349] [Citation(s) in RCA: 3404] [Impact Index Per Article: 425.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The number of cancer survivors continues to increase because of both advances in early detection and treatment and the aging and growth of the population. For the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborate to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results cancer registries. In addition, current treatment patterns for the most prevalent cancer types are presented based on information in the National Cancer Data Base and treatment-related side effects are briefly described. More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, and this number is projected to reach more than 20 million by January 1, 2026. The 3 most prevalent cancers are prostate (3,306,760), colon and rectum (724,690), and melanoma (614,460) among males and breast (3,560,570), uterine corpus (757,190), and colon and rectum (727,350) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost one-half (47%) are aged 70 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by primary care providers. Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care. CA Cancer J Clin 2016;66:271-289. © 2016 American Cancer Society.
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Affiliation(s)
- Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Strategic Director, Surveillance Information, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Chun Chieh Lin
- Director, Health Services Research, Intramural Research Department, American Cancer Society, Atlanta, GA
| | - Angela B Mariotto
- Branch Chief, Surveillance Research Program, National Cancer Institute, Bethesda, MD
| | - Joan L Kramer
- Assistant Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Julia H Rowland
- Director, Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD
| | - Kevin D Stein
- Vice President, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Rick Alteri
- Medical Editor, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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21
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Neugut AI, Hillyer GC, Kushi LH, Lamerato L, Buono DL, Nathanson SD, Bovbjerg DH, Mandelblatt JS, Tsai WY, Jacobson JS, Hershman DL. A prospective cohort study of early discontinuation of adjuvant chemotherapy in women with breast cancer: the breast cancer quality of care study (BQUAL). Breast Cancer Res Treat 2016; 158:127-138. [PMID: 27287779 PMCID: PMC5492513 DOI: 10.1007/s10549-016-3855-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
For many women with non-metastatic breast cancer, adjuvant chemotherapy prevents recurrence and extends survival. Women who discontinue chemotherapy early may reduce those benefits, but little is known about what predicts early discontinuation. We sought to determine prospectively the rate and reasons for early discontinuation of adjuvant chemotherapy in women with breast cancer. We conducted a prospective cohort study among three U.S. health care organizations. Of 1158 women with newly diagnosed non-metastatic breast cancer, 2006-2010, we analyzed 445 (38.4 %) patients who initiated standard adjuvant chemotherapy as defined by accepted guidelines. We interviewed patients at baseline and twice during treatment regarding sociodemographic/psychosocial factors and treatment decision-making and collected clinical data. They were categorized according to the number of cycles required by the chemotherapy regimen they had initiated. The outcome was early discontinuation (<80 % of planned cycles). Of patients analyzed, 392 (88.1 %) completed the prescribed therapy. The strongest predictor was receipt of a regimen entailing >4 cycles of therapy (18.1 % for longer regimens, 7.4 % for 4 cycles) (odds ratio [OR] 2.59, 95 % CI 1.32-5.08), controlling for race, age, stage, hormone receptor status, social support, optimism, spirituality, stress, and physical symptoms. Higher levels of psychological symptoms on the Memorial symptom assessment scale also increased the odds of early discontinuation (OR 1.92, 95 % CI 0.998-3.68). The large majority of patients who initiated adjuvant chemotherapy for breast cancer completed their prescribed regimens, but early discontinuation was associated with lengthier regimens and, with borderline statistical significance, for those with psychological side effects.
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Affiliation(s)
- Alfred I Neugut
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Columbia University Medical Center, 722 W 168th Street, Room 725, New York, NY, 10032, USA.
| | - Grace Clarke Hillyer
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Donna L Buono
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Dana H Bovbjerg
- Departments of Psychiatry, Psychology and Behavioral & Community Health Sciences, University of Pittsburgh, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Jeanne S Mandelblatt
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Wei-Yann Tsai
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Dawn L Hershman
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Freedman RA, Kouri EM, West DW, Lii J, Keating NL. Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment. J Oncol Pract 2016; 12:e613-25. [PMID: 27165488 PMCID: PMC4957257 DOI: 10.1200/jop.2015.008508] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Knowledge about one's breast cancer characteristics is poor, but whether this knowledge affects treatment is uncertain. Among women with breast cancer, we examined whether tumor knowledge was associated with adjuvant treatment receipt. METHODS We surveyed a population-based sample of women in Northern California with stage 0 to III breast cancer diagnosed during 2010 to 2011 (participation rate, 68.5%). Interviews were conducted between 4 months and 3 years after diagnosis. Among 414 respondents with stage I to III disease, we examined receipt of guideline-recommended chemotherapy, radiation, and hormonal therapy by reporting correct information about one's tumor, including stage, estrogen receptor, human epidermal growth factor receptor 2 (HER2), and grade (using registry data for confirmation). We performed multivariate logistic regression to assess the probability of receiving each treatment in relevant patient groups, adjusting for patient and tumor characteristics, and examined the impact of reporting correct tumor information on treatment receipt. RESULTS Among relevant treatment-eligible groups, 81% received chemotherapy, 91% received radiation, and 83% received hormonal therapy. In adjusted analyses, having correct (v incorrect) information for stage and HER2 were associated with chemotherapy receipt (odds ratio [OR], 4.45; 95% CI, 1.50 to 12.50 for stage; OR, 2.70; 95% CI, 1.02 to 7.18 for HER2). Correctly reporting estrogen receptor status was associated with hormonal therapy receipt (OR, 3.91; 95% CI, 1.73 to 8.86), and correctly reporting stage was associated with radiation receipt (OR, 2.76; 95% CI, 1.03 to 7.40). CONCLUSION Knowledge about one's tumor characteristics was strongly associated with receipt of recommended therapies. Interventions to improve patients' knowledge and understanding of their cancers should be tested as a strategy for improving receipt of care.
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Affiliation(s)
- Rachel A Freedman
- Dana-Farber Cancer Institute; Harvard Medical School; and Brigham and Women's Hospital, Boston, MA; and Public Health Institute, Sacramento, CA
| | - Elena M Kouri
- Dana-Farber Cancer Institute; Harvard Medical School; and Brigham and Women's Hospital, Boston, MA; and Public Health Institute, Sacramento, CA
| | - Dee W West
- Dana-Farber Cancer Institute; Harvard Medical School; and Brigham and Women's Hospital, Boston, MA; and Public Health Institute, Sacramento, CA
| | - Joyce Lii
- Dana-Farber Cancer Institute; Harvard Medical School; and Brigham and Women's Hospital, Boston, MA; and Public Health Institute, Sacramento, CA
| | - Nancy L Keating
- Dana-Farber Cancer Institute; Harvard Medical School; and Brigham and Women's Hospital, Boston, MA; and Public Health Institute, Sacramento, CA
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Geographic variation in the intended choice of adjuvant treatments for women diagnosed with screen-detected breast cancer in Queensland. BMC Public Health 2015; 15:1204. [PMID: 26630881 PMCID: PMC4668608 DOI: 10.1186/s12889-015-2527-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background Although early diagnosis and improved treatment can reduce breast cancer mortality, there still appears to be a geographic differential in patient outcomes. This study aims to determine and quantify spatial inequalities in intended adjuvant (radio-, chemo- and hormonal) therapy usage among women with screen-detected breast cancer in Queensland, Australia. Methods Linked population-based datasets from BreastScreen Queensland and the Queensland Cancer Registry during 1997−2008 for women aged 40−89 years were used. We adopted a Bayesian shared spatial component model to evaluate the relative intended use of each adjuvant therapy across 478 areas as well as common spatial patterns between treatments. Results Women living closer to a cancer treatment facility were more likely to intend to use adjuvant therapy. This was particularly marked for radiotherapy when travel time to the closest radiation facility was 4 + h (OR =0.41, 95 % CrI: [0.23, 0.74]) compared to <1 h. The shared spatial effect increased towards the centres with concentrations of radiotherapy facilities, in north-east (Townsville) and south-east (Brisbane) regions of Queensland. Moreover, the presence of residual shared spatial effects indicates that there are other unmeasured geographical barriers influencing women’s treatment choices. Conclusions This highlights the need to identify the additional barriers that impact on treatment intentions among women diagnosed with screen-detected breast cancer, particularly for those women living further away from cancer treatment centers. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2527-2) contains supplementary material, which is available to authorized users.
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24
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Lairson DR, Parikh RC, Cormier JN, Chan W, Du XL. Cost-Effectiveness of Chemotherapy for Breast Cancer and Age Effect in Older Women. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:1070-1078. [PMID: 26686793 DOI: 10.1016/j.jval.2015.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 07/08/2015] [Accepted: 08/03/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Previous economic evaluations compared specific chemotherapy agents using input parameters from clinical trials and resource utilization costs. Cost-effectiveness of treatment groups (drug classes) using community-level effectiveness and cost data, however, has not been assessed for elderly patients with breast cancer. OBJECTIVE To assess the cost-effectiveness of chemotherapy regimens by age and disease stage under "real-world" conditions for patients with breast cancer. METHODS The Surveillance Epidemiology and End Results-Medicare data were used to identify patients with breast cancer with American Joint Committee on Cancer stage I/II/IIIa, hormone receptor-negative (estrogen receptor-negative and progesterone receptor-negative) patients from 1992 to 2009. Patients were categorized into three adjuvant treatment groups: 1) no chemotherapy, 2) anthracycline, and 3) non-anthracycline-based chemotherapy. Median life-years and quality-adjusted life-years (QALYs) were measured using Kaplan-Meier analysis and were evaluated against average total health care costs (2013 US dollars). RESULTS A total of 4575 patients (propensity score-matched) were included for the primary analysis. The anthracycline group experienced 12.05 QALYs and mean total health care costs of $119,055, resulting in an incremental cost-effectiveness ratio of $7,688 per QALY gained as compared with the no chemotherapy group (QALYs 7.81; average health care cost $86,383). The non-anthracycline-based group was dominated by the anthracycline group with lower QALYs (9.56) and higher health care costs ($122,791). Base-case results were found to be consistent with the best-case and worst-case scenarios for utility assignments. Incremental cost-effectiveness ratios varied by age group (range $3,790-$90,405 per QALY gained). CONCLUSIONS Anthracycline-based chemotherapy was found cost-effective for elderly patients with early stage (stage I, II, IIIa) breast cancer considering the US threshold of $100,000 per QALY. Further research may be needed to characterize differential effects across age groups.
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Affiliation(s)
- David R Lairson
- Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Rohan C Parikh
- Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Janice N Cormier
- Division of Surgical Oncology and Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wenyaw Chan
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xianglin L Du
- Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA; Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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25
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Influence of patient, physician, and hospital characteristics on the receipt of guideline-concordant care for inflammatory breast cancer. Cancer Epidemiol 2015; 40:7-14. [PMID: 26605428 DOI: 10.1016/j.canep.2015.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/23/2015] [Accepted: 11/06/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Inflammatory breast cancer (IBC) is an aggressive subtype of breast cancer for which treatments vary, so we sought to identify factors that affect the receipt of guideline-concordant care. METHODS Patients diagnosed with IBC in 2004 were identified from the Breast and Prostate Cancer Data Quality and Patterns of Care Study, containing information from cancer registries in seven states. Variation in guideline-concordant care for IBC, based on National Comprehensive Cancer Network (NCCN) guidelines, was assessed according to patient, physician, and hospital characteristics. RESULTS Of the 107 IBC patients in the study without distant metastasis at the time of diagnosis, only 25.8% received treatment concordant with guidelines. Predictors of non-concordance included patient age (≥70 years), non-white race, normal body mass index (BMI 18.5-25 kg/m(2)), patients with physicians graduating from medical school >15 years prior, and smaller hospital size (<200 beds). IBC patients survived longer if they received guideline-concordant treatment based on either 2003 (p=0.06) or 2013 (p=0.06) NCCN guidelines. CONCLUSIONS Targeting factors associated with receipt of care that is not guideline-concordant may reduce survival disparities in IBC patients. Prompt referral for neoadjuvant chemotherapy and post-operative radiation therapy is also crucial.
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The Influence of Socioeconomic Status on Racial/Ethnic Disparities among the ER/PR/HER2 Breast Cancer Subtypes. J Cancer Epidemiol 2015; 2015:813456. [PMID: 26339244 PMCID: PMC4539118 DOI: 10.1155/2015/813456] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/30/2015] [Accepted: 07/08/2015] [Indexed: 01/10/2023] Open
Abstract
Background. The eight ER/PR/HER2 breast cancer subtypes vary widely in demographic and clinicopathologic characteristics and survival. This study assesses the contribution of SES to the risk of mortality for blacks, Hispanics, Asian/Pacific Islanders, and American Indians when compared with white women for each ER/PR/HER2 subtype. Methods. We identified 143,184 cases of first primary female invasive breast cancer from the California Cancer Registry between 2000 and 2012. The risk of mortality was computed for each race/ethnicity within each ER/PR/HER2 subtype. Models were adjusted for tumor grade, year of diagnosis, and age. SES was added to a second set of models. Analyses were conducted separately for each stage. Results. Race/ethnicity did not contribute to the risk of mortality for any subtype in stage 1 when adjusted for SES. In stages 2, 3, and 4, race/ethnicity was associated with risk of mortality and adjustment for SES changed the risk only in some subtypes. SES reduced the risk of mortality by over 45% for American Indians with stage 2 ER+/PR+/HER2− cancer, but it decreased the risk of mortality for blacks with stage 2 triple negative cancer by less than 4%. Conclusions. Racial/ethnic disparities do not exist in all ER/PR/HER2 subtypes and, in general, SES modestly alters these disparities.
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Sparano JA, Zhao F, Martino S, Ligibel JA, Perez EA, Saphner T, Wolff AC, Sledge GW, Wood WC, Davidson NE. Long-Term Follow-Up of the E1199 Phase III Trial Evaluating the Role of Taxane and Schedule in Operable Breast Cancer. J Clin Oncol 2015; 33:2353-60. [PMID: 26077235 DOI: 10.1200/jco.2015.60.9271] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To determine long-term outcomes in a clinical trial evaluating the role of taxane type and schedule in operable breast cancer and evaluate the impact of obesity and black race on outcome. PATIENTS AND METHODS A total of 4,954 eligible women with stage II to III breast cancer treated with four cycles of doxorubicin plus cyclophosphamide were randomly assigned to receive paclitaxel or docetaxel every 3 weeks for four doses or weekly for 12 doses using a 2 × 2 factorial design. The primary end point was disease-free survival (DFS). Results are expressed as hazard ratios (HRs) from Cox proportional hazards models. All P values are two sided. RESULTS When compared with the standard every-3-week paclitaxel arm, after a median follow-up of 12.1 years, DFS significantly improved and overall survival (OS) marginally improved only for the weekly paclitaxel (HR, 0.84; P = .011 and HR, 0.87; P = .09, respectively) and every-3-week docetaxel arms (HR, 0.79; P = .001 and HR, 0.86; P = .054, respectively). Weekly paclitaxel improved DFS and OS (HR, 0.69; P = .010 and HR, 0.69; P = .019, respectively) in triple-negative breast cancer. For hormone receptor-positive, human epidermal growth factor receptor 2-nonoverexpressing disease, no experimental arm improved OS, and black race and obesity were associated with increased risk of breast cancer recurrence and death. CONCLUSION Improved outcomes initially observed for weekly paclitaxel were qualitatively similar but quantitatively less pronounced with longer follow-up, although exploratory analysis suggested substantial benefit in triple-negative disease. Further research is required to understand why obesity and race influence clinical outcome in hormone receptor-positive disease.
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Affiliation(s)
- Joseph A Sparano
- Joseph A. Sparano, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Fengmin Zhao and Jennifer A. Ligibel, Dana-Farber Cancer Institute-Harvard University, Boston, MA; Silvana Martino, John Wayne Cancer Institute, Santa Monica, CA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Tom Saphner, Vince Lombardi Cancer Center, Two Rivers, WI; Antonio C. Wolff, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; George W. Sledge Jr, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; William C. Wood, Winship Cancer Center, Emory University, Atlanta, GA; and Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA.
| | - Fengmin Zhao
- Joseph A. Sparano, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Fengmin Zhao and Jennifer A. Ligibel, Dana-Farber Cancer Institute-Harvard University, Boston, MA; Silvana Martino, John Wayne Cancer Institute, Santa Monica, CA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Tom Saphner, Vince Lombardi Cancer Center, Two Rivers, WI; Antonio C. Wolff, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; George W. Sledge Jr, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; William C. Wood, Winship Cancer Center, Emory University, Atlanta, GA; and Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA
| | - Silvana Martino
- Joseph A. Sparano, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Fengmin Zhao and Jennifer A. Ligibel, Dana-Farber Cancer Institute-Harvard University, Boston, MA; Silvana Martino, John Wayne Cancer Institute, Santa Monica, CA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Tom Saphner, Vince Lombardi Cancer Center, Two Rivers, WI; Antonio C. Wolff, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; George W. Sledge Jr, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; William C. Wood, Winship Cancer Center, Emory University, Atlanta, GA; and Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA
| | - Jennifer A Ligibel
- Joseph A. Sparano, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Fengmin Zhao and Jennifer A. Ligibel, Dana-Farber Cancer Institute-Harvard University, Boston, MA; Silvana Martino, John Wayne Cancer Institute, Santa Monica, CA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Tom Saphner, Vince Lombardi Cancer Center, Two Rivers, WI; Antonio C. Wolff, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; George W. Sledge Jr, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; William C. Wood, Winship Cancer Center, Emory University, Atlanta, GA; and Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA
| | - Edith A Perez
- Joseph A. Sparano, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Fengmin Zhao and Jennifer A. Ligibel, Dana-Farber Cancer Institute-Harvard University, Boston, MA; Silvana Martino, John Wayne Cancer Institute, Santa Monica, CA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Tom Saphner, Vince Lombardi Cancer Center, Two Rivers, WI; Antonio C. Wolff, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; George W. Sledge Jr, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; William C. Wood, Winship Cancer Center, Emory University, Atlanta, GA; and Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA
| | - Tom Saphner
- Joseph A. Sparano, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Fengmin Zhao and Jennifer A. Ligibel, Dana-Farber Cancer Institute-Harvard University, Boston, MA; Silvana Martino, John Wayne Cancer Institute, Santa Monica, CA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Tom Saphner, Vince Lombardi Cancer Center, Two Rivers, WI; Antonio C. Wolff, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; George W. Sledge Jr, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; William C. Wood, Winship Cancer Center, Emory University, Atlanta, GA; and Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA
| | - Antonio C Wolff
- Joseph A. Sparano, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Fengmin Zhao and Jennifer A. Ligibel, Dana-Farber Cancer Institute-Harvard University, Boston, MA; Silvana Martino, John Wayne Cancer Institute, Santa Monica, CA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Tom Saphner, Vince Lombardi Cancer Center, Two Rivers, WI; Antonio C. Wolff, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; George W. Sledge Jr, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; William C. Wood, Winship Cancer Center, Emory University, Atlanta, GA; and Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA
| | - George W Sledge
- Joseph A. Sparano, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Fengmin Zhao and Jennifer A. Ligibel, Dana-Farber Cancer Institute-Harvard University, Boston, MA; Silvana Martino, John Wayne Cancer Institute, Santa Monica, CA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Tom Saphner, Vince Lombardi Cancer Center, Two Rivers, WI; Antonio C. Wolff, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; George W. Sledge Jr, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; William C. Wood, Winship Cancer Center, Emory University, Atlanta, GA; and Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA
| | - William C Wood
- Joseph A. Sparano, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Fengmin Zhao and Jennifer A. Ligibel, Dana-Farber Cancer Institute-Harvard University, Boston, MA; Silvana Martino, John Wayne Cancer Institute, Santa Monica, CA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Tom Saphner, Vince Lombardi Cancer Center, Two Rivers, WI; Antonio C. Wolff, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; George W. Sledge Jr, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; William C. Wood, Winship Cancer Center, Emory University, Atlanta, GA; and Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA
| | - Nancy E Davidson
- Joseph A. Sparano, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Fengmin Zhao and Jennifer A. Ligibel, Dana-Farber Cancer Institute-Harvard University, Boston, MA; Silvana Martino, John Wayne Cancer Institute, Santa Monica, CA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Tom Saphner, Vince Lombardi Cancer Center, Two Rivers, WI; Antonio C. Wolff, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; George W. Sledge Jr, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; William C. Wood, Winship Cancer Center, Emory University, Atlanta, GA; and Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA
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Lamont EB, Schilsky RL, He Y, Muss H, Cohen HJ, Hurria A, Meilleur A, Kindler HL, Venook A, Lilenbaum R, Niell H, Goldberg RM, Joffe S. Generalizability of trial results to elderly Medicare patients with advanced solid tumors (Alliance 70802). J Natl Cancer Inst 2015; 107:336. [PMID: 25432408 PMCID: PMC4271075 DOI: 10.1093/jnci/dju336] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/17/2014] [Accepted: 09/18/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the United States, patients who enroll in chemotherapy trials seldom reflect the attributes of the general population with cancer, as they are often younger, more functional, and have less comorbidity. We compared survival following three chemotherapy regimens according to the setting in which care was delivered (ie, clinical trial vs usual care) to determine the generalizability of clinical trial results to unselected elderly Medicare patients. METHODS Using SEER-Medicare data, we estimated survival for elderly patients (ie, age 65 years or older, n = 14097) with advanced pancreatic or lung cancer following receipt of one of three guideline-recommended first-line chemotherapy regimens. We compared their survival to that of similarly treated clinical trial enrollees, without age restrictions, with the same diagnosis and stage (n = 937). All statistical tests were two-sided. RESULTS Trial patients were 9.5 years younger than elderly Medicare patients. Medicare patients were more often white and tended to live in areas of greater educational attainment than trial enrollees. For each tumor type, Medicare patients who were 75 years or older had median survivals that were six to eight weeks shorter than those of trial patients (4.3 vs 5.8 months following treatment with single agent gemcitabine for advanced pancreatic cancer, P = .03; 7.3 vs 8.9 months following treatment with carboplatin and paclitaxel for stage IV non-small cell lung cancer, P = .91; 8.2 vs 10.2 months following treatment with CDDP/ VP16 for extensive stage small cell lung cancer, P ≤ .01), whereas younger Medicare patients had survival times that were similar to those of trial patients. CONCLUSIONS Results of clinical trials for advanced pancreatic cancer and lung cancers tended to correctly estimate survival for Medicare patients aged 65 to 74 years, but to overestimate survival for older Medicare patients by six to eight weeks. These estimates of Medicare patients' survival may aid subsequent patients and their oncologists in treatment decision-making.
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Affiliation(s)
- Elizabeth B Lamont
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ).
| | - Richard L Schilsky
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Yulei He
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Hyman Muss
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Harvey Jay Cohen
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Arti Hurria
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Ashley Meilleur
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Hedy L Kindler
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Alan Venook
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Rogerio Lilenbaum
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Harvey Niell
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Richard M Goldberg
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Steven Joffe
- Massachusetts General Hospital Cancer Center, Boston, MA (EL); Departments of Medicine, and Health Care Policy, Harvard Medical School, Boston, MA (EL, YH, AM); American Society of Clinical Oncology, Alexandria, VA (RLS); Department of Medicine, University of North Carolina, Chapel Hill, NC (HM); Department of Medicine, Duke University, Durham, NC (HJC); City of Hope, Duarte, CA (AH); Department of Medicine, University of Chicago, Chicago, IL (HLK); Department of Medicine, University of California San Francisco, San Francisco, CA (AV); Yale Cancer Center, New Haven, CT (RL); Department of Medicine, the University of Tennessee, Memphis, TN (HN); Department of Medicine, Ohio State University, Columbus, OH (RMG); Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
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Guy GP, Lipscomb J, Gillespie TW, Goodman M, Richardson LC, Ward KC. Variations in Guideline-Concordant Breast Cancer Adjuvant Therapy in Rural Georgia. Health Serv Res 2014; 50:1088-108. [PMID: 25491350 DOI: 10.1111/1475-6773.12269] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine factors associated with guideline-concordant adjuvant therapy among breast cancer patients in a rural region of the United States and to present an advancement in quality-of-care assessment in the context of multiple treatments. DATA SOURCES Chart abstraction on initial therapy received by 868 women diagnosed with primary, invasive, early-stage breast cancer in a largely rural region of southwest Georgia. STUDY DESIGN Using multivariable logistic regression, we examined predictors of adjuvant chemo-, radiation, and hormonal therapy regimens defined as guideline-concordant according to the 2000 National Institutes of Health Consensus Development Conference Statement. PRINCIPAL FINDINGS Overall, 35.2 percent of women received guideline-concordant care for all three adjuvant therapies. Higher socioeconomic status was associated with receiving guideline-concordant care for all three adjuvant therapies jointly, and for chemotherapy. Compared with private insurance, having Medicaid was associated with guideline-concordant chemotherapy. Unmarried women were more likely to be nonconcordant for chemotherapy and radiation therapy. Increased age predicted nonconcordance for adjuvant therapies jointly, for chemotherapy, and for hormonal therapy. CONCLUSIONS A number of factors were independently associated with receiving guideline-concordant adjuvant therapy. Identifying and addressing factors that lead to nonconcordance may reduce disparities in treatment and survival.
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Affiliation(s)
- Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Chamblee, GA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Theresa W Gillespie
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Michael Goodman
- Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Lisa C Richardson
- Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kevin C Ward
- Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA
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Patterns of referral for perioperative chemotherapy among patients with muscle-invasive bladder cancer: A population-based study. Urol Oncol 2014; 32:1200-8. [DOI: 10.1016/j.urolonc.2014.05.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/14/2014] [Accepted: 05/23/2014] [Indexed: 11/18/2022]
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Schinkel JK, Zahm SH, Jatoi I, McGlynn KA, Gallagher C, Schairer C, Shriver CD, Zhu K. Racial/ethnic differences in breast cancer survival by inflammatory status and hormonal receptor status: an analysis of the Surveillance, Epidemiology, and End Results data. Cancer Causes Control 2014; 25:959-68. [PMID: 24839049 PMCID: PMC5729913 DOI: 10.1007/s10552-014-0395-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/03/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Compared to non-inflammatory breast cancer (non-IBC), inflammatory breast cancer (IBC) has less favorable survival and is more likely to be estrogen receptor (ER) and progesterone receptor (PR) negative. ER-/PR- tumors, regardless of histology, have less favorable survival. While black women are more likely to have IBC and ER-/PR- tumors than white women, it is unclear whether the racial disparity in survival is explained by these factors. The objective of this study was to assess racial/ethnic differences in breast cancer survival by inflammatory status and hormone receptor status. METHODS This study examined breast cancer mortality among non-Hispanic white (NHW), Hispanic white, black, and Asian/Pacific Islander (API) women diagnosed between 1990 and 2004 using the National Cancer Institute's Surveillance, Epidemiology, and End Results data. Kaplan-Meier survival curves and Cox proportional hazard ratios (HRs) assessed the relationship between race/ethnicity and survival. RESULTS Black women had significantly poorer survival than NHW women regardless of inflammatory status and hormone receptor status. Compared to NHWs, the HRs for black women were 1.32 (95 % confidence interval (CI) 1.21-1.44), 1.43 (95 % CI 1.20-1.69), and 1.30 (95 % CI 1.16-1.47) for IBC, IBC with ER+/PR+, and with ER-/PR-, respectively. Similar HRs were found for non-IBC, non-IBC with ER+/PR-, and non-IBC with ER-/PR-. API women had significantly better survival than NHW women regardless of inflammatory status and hormone receptor status. CONCLUSION Compared to NHW women, black women had poorer survival regardless of inflammatory status and hormone receptor status and API women had better survival. These results suggest that factors other than inflammatory status and hormone receptor status may play a role in racial/ethnic disparities in breast cancer survival.
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Affiliation(s)
- Jill K Schinkel
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA,
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DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, Alteri R, Robbins AS, Jemal A. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014; 64:252-71. [PMID: 24890451 DOI: 10.3322/caac.21235] [Citation(s) in RCA: 2138] [Impact Index Per Article: 213.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 12/12/2022] Open
Abstract
The number of cancer survivors continues to increase due to the aging and growth of the population and improvements in early detection and treatment. In order for the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborated to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results (SEER) program registries. In addition, current treatment patterns for the most common cancer types are described based on information in the National Cancer Data Base and the SEER and SEER-Medicare linked databases; treatment-related side effects are also briefly described. Nearly 14.5 million Americans with a history of cancer were alive on January 1, 2014; by January 1, 2024, that number will increase to nearly 19 million. The 3 most common prevalent cancers among males are prostate cancer (43%), colorectal cancer (9%), and melanoma (8%), and those among females are cancers of the breast (41%), uterine corpus (8%), and colon and rectum (8%). The age distribution of survivors varies substantially by cancer type. For example, the majority of prostate cancer survivors (62%) are aged 70 years or older, whereas less than one-third (32%) of melanoma survivors are in this older age group. It is important for clinicians to understand the unique medical and psychosocial needs of cancer survivors and to proactively assess and manage these issues. There are a growing number of resources that can assist patients, caregivers, and health care providers in navigating the various phases of cancer survivorship.
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Affiliation(s)
- Carol E DeSantis
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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Non-initiation and early discontinuation of adjuvant trastuzumab in women with localized HER2-positive breast cancer. Breast Cancer 2014; 21:780-5. [PMID: 24902664 DOI: 10.1007/s12282-014-0543-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
One year of trastuzumab therapy is recommended for women with HER2-positive breast cancer ≥ 1.0 cm in size to increase survival and is considered for women with tumors 0.5-0.9 cm in size. We analyzed compliance with trastuzumab among women with HER2-positive breast cancer in a prospective cohort study. Of 1145 recruited patients with breast cancer, 152 were HER2-positive (13.2 %), of whom 126 had tumors ≥ 1.0 cm; 110/126 (87.3 %) of these initiated trastuzumab. Non-receipt was associated with older age, better prognosis tumors, and with non-receipt of adjuvant chemotherapy. Of the 110 who initiated treatment, 18 (15 %) did not complete treatment, 15 (83 %) of them because of cardiotoxicity. Of 20 women with tumors 0.5-0.9 cm, 5 (25 %) initiated trastuzumab. Compliance with trastuzumab was very high among those with HER2-positive breast cancer, as was the completion of the recommended therapy.
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White A, Richardson LC, Krontiras H, Pisu M. Socioeconomic disparities in breast cancer treatment among older women. J Womens Health (Larchmt) 2014; 23:335-41. [PMID: 24350590 PMCID: PMC3991993 DOI: 10.1089/jwh.2013.4460] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Racial disparities in breast cancer treatment among Medicare beneficiaries have been documented. This study aimed to determine whether racial disparities exist among white and black female Medicare beneficiaries in Alabama, an economically disadvantaged U.S. state. METHODS From a linked dataset of breast cancer cases from the Alabama Statewide Cancer Registry and fee-for-service claims from Medicare, we identified 2,097 white and black females, aged 66 years and older, who were diagnosed with stages 1-3 breast cancer from January 1, 2000, to December 31, 2002. Generalized estimating equation (GEE) models were used to determine whether there were racial differences in initiating and completing National Comprehensive Cancer Network Clinical Practice guideline-specific treatment. RESULTS Sixty-two percent of whites and 64.7% of blacks had mastectomy (p=0.27); 34.6% of whites and 30.2% of blacks had breast conserving surgery (BCS) (p=0.12). Among those who had BCS, 76.8% of whites and 83.3% of blacks started adjuvant radiation therapy (p=0.33) and they equally completed adjuvant radiation therapy (p=0.29). For women with tumors over 1 centimeter, whites and blacks were equally likely to start (16.1% of whites and 18.3% of black; p=0.34) and complete (50.6% of whites and 46.3% of black; p=0.87) adjuvant chemotherapy. There were still no differences after adjusting for confounders using GEE. However, differences were observed by area-level socioeconomic status (SES), with lower SES residents more likely to receive a mastectomy (odds ratio [OR]=1.26; 95% confidence interval [CI]: 1.01-1.57) and initiate radiation after BCS (OR=2.24; 95% CI: 1.28-3.93). CONCLUSIONS No racial differences were found in guideline-specific breast cancer treatment or treatment completion, but there were differences by SES. Future studies should explore reasons for SES differences and whether similar results hold in other economically disadvantaged U.S. states.
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Affiliation(s)
- Arica White
- Division of Cancer Prevention and Control, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C. Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Helen Krontiras
- School of Medicine, University of Alabama, Birmingham, Alabama
| | - Maria Pisu
- Division of Preventive Medicine, University of Alabama, Birmingham, Alabama
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Randén M, Helde-Frankling M, Runesdotter S, Strang P. Treatment decisions and discontinuation of palliative chemotherapy near the end-of-life, in relation to socioeconomic variables. Acta Oncol 2013; 52:1062-6. [PMID: 23438360 DOI: 10.3109/0284186x.2012.758872] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED During the last decades, the possibilities to prolong survival with chemotherapy even in metastatic disease have increased. Our aim was to study treatment decisions and treatment discontinuation decisions in the proximity of death. METHODS The medical records of 346 patients with disseminated cancer and a recorded death during 2009 were assessed in relation to demographic and clinical variables and documented treatment decisions were recorded. RESULTS Palliative chemotherapy was offered in 54% or these cases and generally one or two regimens were administered, before ending treatment. During the last month of life, 32% received treatment and much more often as an oral (instead of intravenous) treatment than in earlier stages (p < 0.001). Younger patients (p = 0.02) and those with young children (p < 0.001) were treated to a higher degree and also closer to death (p = 0.03). Other variables associated with a higher probability of treatment were high education level (p = 0.001), living with a partner (p = 0.001), female gender (p = 0.023) and ethnicity of non-European origin (p = 0.031). In a multivariate analysis, young age and high education remained as independent factors. In 57% of the cases there was no formal documentation of treatment discontinuation or end-of-life discussions with the patient. CONCLUSION Socioeconomic status (SES) is of importance for the treatment decisions. About half of the patients with disseminated disease receive palliative chemotherapy and of these, about one third are treated even during the last month of life. In a majority of cases, there is no formal documentation of treatment discontinuation or end-of-life discussions.
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Affiliation(s)
- Margareta Randén
- Karolinska Institute, Department of Oncology-Pathology, Stockholm, Sweden.
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Abstract
BACKGROUND Large health care databases are increasingly used to examine the dissemination and benefits and harms of chemotherapy treatment in routine practice, particularly among patients excluded from trials (eg, the elderly). Misclassification of chemotherapy could bias estimates of frequency and association, warranting an updated assessment. METHODS We evaluated the validity of Medicare claims to identify receipt of chemotherapy and specific agents delivered to elderly stage II/III colorectal (CRC), in situ/early-stage breast, non-small-cell lung, and ovarian cancer patients using the National Cancer Institute's Patterns of Care studies (POC) as the gold standard. The POC collected data on chemotherapy treatment by reabstracting hospital records, contacting physicians, and reviewing medical records. Patients' POC data were linked and compared with their Medicare claims for 2 to 12 months postdiagnosis. κ, sensitivity, specificity, positive and negative predictive values and 95% confidence intervals were calculated for the receipt of any chemotherapy and specific agents. RESULTS Sensitivity and specificity of Medicare claims to identify any chemotherapy were high across all cancer sites. We found substantial variation in validity across agents, by site and administration modality. Capecitabine, an oral CRC treatment, was identified in claims with high specificity (98%) but low sensitivity (47%), whereas oxaliplatin, an intravenously administered CRC agent had higher sensitivity (75%) and similar specificity (97%). CONCLUSIONS Receipt of chemotherapy and specific intravenous agents can be identified using Medicare claims, showing improvement from prior reports; yet, variation exists. Future studies should assess newly approved agents and the impact of coverage decisions for these agents under the Medicare Part D program.
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Abstract
BACKGROUND Large health care databases are increasingly used to examine the dissemination and benefits and harms of chemotherapy treatment in routine practice, particularly among patients excluded from trials (eg, the elderly). Misclassification of chemotherapy could bias estimates of frequency and association, warranting an updated assessment. METHODS We evaluated the validity of Medicare claims to identify receipt of chemotherapy and specific agents delivered to elderly stage II/III colorectal (CRC), in situ/early-stage breast, non-small-cell lung, and ovarian cancer patients using the National Cancer Institute's Patterns of Care studies (POC) as the gold standard. The POC collected data on chemotherapy treatment by reabstracting hospital records, contacting physicians, and reviewing medical records. Patients' POC data were linked and compared with their Medicare claims for 2 to 12 months postdiagnosis. κ, sensitivity, specificity, positive and negative predictive values and 95% confidence intervals were calculated for the receipt of any chemotherapy and specific agents. RESULTS Sensitivity and specificity of Medicare claims to identify any chemotherapy were high across all cancer sites. We found substantial variation in validity across agents, by site and administration modality. Capecitabine, an oral CRC treatment, was identified in claims with high specificity (98%) but low sensitivity (47%), whereas oxaliplatin, an intravenously administered CRC agent had higher sensitivity (75%) and similar specificity (97%). CONCLUSIONS Receipt of chemotherapy and specific intravenous agents can be identified using Medicare claims, showing improvement from prior reports; yet, variation exists. Future studies should assess newly approved agents and the impact of coverage decisions for these agents under the Medicare Part D program.
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Freedman RA, Hughes ME, Ottesen RA, Weeks JC, He Y, Wong YN, Theriault R, Keating NL. Use of adjuvant trastuzumab in women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer by race/ethnicity and education within the National Comprehensive Cancer Network. Cancer 2013; 119:839-46. [PMID: 23011924 PMCID: PMC3565006 DOI: 10.1002/cncr.27831] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 08/01/2012] [Accepted: 08/13/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Trastuzumab for human epidermal growth factor receptor 2 (HER2)-positive breast cancer is highly efficacious yet costly and time-intensive, and few data are available about its use. The authors of this report examined receipt and completion of adjuvant trastuzumab by race/ethnicity and education for women with HER2-positive disease. METHODS The National Comprehensive Cancer Network Breast Cancer Outcomes Database was used to identify 1109 women who were diagnosed with stage I through III, HER2-positive breast cancer during September 2005 through December 2008 and were followed for ≥1 year. The authors used multivariable logistic regression to assess the association of race/ethnicity and education with the receipt of trastuzumab and, among those women who initiated trastuzumab, with the completion of > 270 days of therapy. RESULTS The cohort was 75% white, 8% black, and 9% Hispanic; and 20% of women had attained a high school degree or less. Most women (83%) received trastuzumab, and no significant differences were observed according to race/ethnicity or socioeconomic status. Among the women who initiated trastuzumab, 73% of black women versus 87% of white women (P = .007) and 70% of women with less than a high school education versus 90% of women with a college degree completed > 270 days of therapy (P = .006). In adjusted analyses, black women (vs white women) and women without a high school degree (vs those with a college degree) had lower odds of completing therapy (black women: odds ratio, 0.45; 95% confidence interval, 0.27-074; white women: odds ratio, 0.27, 95% confidence interval, 0.14-0.51). CONCLUSIONS Differences in completing trastuzumab therapy were observed according to race and educational attainment among women who received treatment at National Comprehensive Cancer Network centers. Efforts to assure the appropriate use of trastuzumab and to understand treatment barriers are needed and may lead to improved outcomes. The authors report differences in the rate at which patients complete treatment with trastuzumab according to race and education among women who receive treatment at National Comprehensive Cancer Network centers. Efforts to assure the appropriate use of trastuzumab and to understand treatment barriers are needed and may lead to improved outcomes.
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Affiliation(s)
- Rachel A Freedman
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA.
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Jimenez R, Zhang B, Joffe S, Nilsson M, Rivera L, Mutchler J, Lathan C, Paulk ME, Prigerson HG. Clinical trial participation among ethnic/racial minority and majority patients with advanced cancer: what factors most influence enrollment? J Palliat Med 2013; 16:256-62. [PMID: 23384245 DOI: 10.1089/jpm.2012.0413] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies using administrative data report that racial/ethnic minority patients enroll in clinical trials less frequently than white patients. We studied a cohort of terminally ill cancer patients to determine a) if racial/ethnic minority patients have lower rates of drug trial enrollment than white patients once socioeconomic characteristics are accounted for and b) what factors most influence drug trial enrollment among patients with advanced canceroverall. METHODS Coping with Cancer (CwC) is a National Cancer Institute/National Institute of Mental Health (NCI/NIMH)-funded multisite, prospective, longitudinal study of patients with advanced cancer. Baseline interviews assessed drug trial enrollment as well as socioeconomic characteristics. Logistic regression models estimated associations between drug trial enrollment and baseline characteristics. Stepwise, backward, and subset model selection was applied to select the final model where characteristics significant at α=0.05 remained in the model. RESULTS At a median of 4.4 months prior to death, 35 of 358 patients (9.8%) were enrolled in a drug trial. In unadjusted analyses, race/ethnicity, health insurance, performance status, recruitment site, cancer type, preference for life-extending care, and lack of end-of-life care planning were associated (p<0.05) with enrollment. In multivariable analysis, patient race/ethnicity was not significantly associated with enrollment. Patients who reported not having an end-of-life discussion (adjusted odds ratio [AOR], 0.18; 95% confidence interval [CI] 0.04-0.83) and those not wanting to discuss life expectancy (AOR, 0.31; 95%CI 0.12-0.79) were more likely to be trial enrollees. CONCLUSION Patient race/ethnicity was not associated with clinical trial enrollment after adjustment for socioeconomic covariates. Patients with advanced cancer endorsing less engagement in end-of-life planning were more likely to be enrolled in a clinical trial.
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Affiliation(s)
- Rachel Jimenez
- Department of Radiation Oncology, Harvard Radiation Oncology Program, Boston, Massachusetts, USA
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Neugut AI, Hillyer GC, Kushi LH, Lamerato L, Leoce N, Nathanson SD, Ambrosone CB, Bovbjerg DH, Mandelblatt JS, Magai C, Tsai WY, Jacobson JS, Hershman DL. Noninitiation of adjuvant chemotherapy in women with localized breast cancer: the breast cancer quality of care study. J Clin Oncol 2012; 30:3800-9. [PMID: 23008305 DOI: 10.1200/jco.2012.43.8168] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE For some women, adjuvant chemotherapy for nonmetastatic breast cancer decreases recurrences and increases survival; however, patient-physician decisions regarding chemotherapy receipt can be influenced by medical and nonmedical factors. PATIENTS AND METHODS We used a prospective cohort design and multivariate modeling to investigate factors related to noninitiation of chemotherapy among women with newly diagnosed breast cancer recruited from three US sites. We interviewed patients at baseline and during treatment on sociodemographic, tumor, and treatment decision-making factors. Patients were categorized according to National Comprehensive Cancer Network guidelines as those for whom chemotherapy was definitely indicated, clinically discretionary, or discretionary based on age greater than 70 years. RESULTS Of 1,145 patients recruited, chemotherapy was clinically indicated for 392 patients, clinically discretionary for 459 patients, discretionary because of age for 169 patients, and not indicated for 93 patients; data were insufficient for 32 patients. Chemotherapy rates were 90% for those in whom chemotherapy was clinically indicated, 36% for those in whom it was discretionary because of clinical factors, and 19% for those in whom it was discretionary based on age greater than 70 years. Nonreceipt of chemotherapy was associated with older age, more negative beliefs about treatment efficacy, less positive beliefs about chemotherapy, and more concern about adverse effects. In the two discretionary groups, clinical predictors of worse outcome (greater tumor size, positive nodes, worse grade, and estrogen receptor- and progesterone receptor-negative status) were associated with increased chemotherapy initiation. CONCLUSION Utilization of adjuvant chemotherapy was most common among patients who, based on clinical criteria, would most likely benefit from it, patients with more positive than negative beliefs regarding treatment efficacy, and patients with few concerns about adverse effects.
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Affiliation(s)
- Alfred I Neugut
- Division of Medical Oncology, Columbia University Medical Center, 722 W 168th St, Room 725, New York, NY 10032, USA.
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Freedman RA, Virgo KS, Labadie J, He Y, Partridge AH, Keating NL. Receipt of locoregional therapy among young women with breast cancer. Breast Cancer Res Treat 2012; 135:893-906. [DOI: 10.1007/s10549-012-2156-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 06/25/2012] [Indexed: 11/28/2022]
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Lamont EB, He Y, Subramanian SV, Zaslavsky AM. Do socially deprived urban areas have lesser supplies of cancer care services? J Clin Oncol 2012; 30:3250-7. [PMID: 22869877 DOI: 10.1200/jco.2011.40.4228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Area social deprivation is associated with unfavorable health outcomes of residents across the full clinical course of cancer from the stage at diagnosis through survival. We sought to determine whether area social factors are associated with the area health care supply. PATIENTS AND METHODS We studied the area supply of health services required for the provision of guideline-recommended care for patients with breast cancer and colorectal cancer (CRC) in each of the following three distinct clinical domains: screening, treatment, and post-treatment surveillance. We characterized area social factors in 3,096 urban zip code tabulation areas by using Census Bureau data and the health care supply in the corresponding 465 hospital service areas by using American Hospital Association, American Medical Association, and US Food and Drug Administration data. In two-level hierarchical models, we assessed associations between social factors and the supply of health services across areas. RESULTS We found no clear associations between area social factors and the supply of health services essential to the provision of guideline recommended breast cancer and CRC care in urban areas. The measures of health service included the supply of physicians who facilitate screening, treatment, and post-treatment care and the supply of facilities required for the same services. CONCLUSION Because we found that the supply of types of health care required for the provision of guideline-recommended cancer care for patients with breast cancer and CRC did not vary with markers of area socioeconomic disadvantage, it is possible that previously reported unfavorable breast cancer and CRC outcomes among individuals living in impoverished areas may have occurred despite an apparent adequate area health care supply.
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Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, Cooper D, Gansler T, Lerro C, Fedewa S, Lin C, Leach C, Cannady RS, Cho H, Scoppa S, Hachey M, Kirch R, Jemal A, Ward E. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 2012; 62:220-41. [PMID: 22700443 DOI: 10.3322/caac.21149] [Citation(s) in RCA: 2039] [Impact Index Per Article: 169.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although there has been considerable progress in reducing cancer incidence in the United States, the number of cancer survivors continues to increase due to the aging and growth of the population and improvements in survival rates. As a result, it is increasingly important to understand the unique medical and psychosocial needs of survivors and be aware of resources that can assist patients, caregivers, and health care providers in navigating the various phases of cancer survivorship. To highlight the challenges and opportunities to serve these survivors, the American Cancer Society and the National Cancer Institute estimated the prevalence of cancer survivors on January 1, 2012 and January 1, 2022, by cancer site. Data from Surveillance, Epidemiology, and End Results (SEER) registries were used to describe median age and stage at diagnosis and survival; data from the National Cancer Data Base and the SEER-Medicare Database were used to describe patterns of cancer treatment. An estimated 13.7 million Americans with a history of cancer were alive on January 1, 2012, and by January 1, 2022, that number will increase to nearly 18 million. The 3 most prevalent cancers among males are prostate (43%), colorectal (9%), and melanoma of the skin (7%), and those among females are breast (41%), uterine corpus (8%), and colorectal (8%). This article summarizes common cancer treatments, survival rates, and posttreatment concerns and introduces the new National Cancer Survivorship Resource Center, which has engaged more than 100 volunteer survivorship experts nationwide to develop tools for cancer survivors, caregivers, health care professionals, advocates, and policy makers.
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Affiliation(s)
- Rebecca Siegel
- Surveillance Information, Surveillance Research, American Cancer Society, Atlanta, GA 30303, USA.
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Small but significant socioeconomic inequalities in axillary staging and treatment of breast cancer in the Netherlands. Br J Cancer 2012; 107:12-7. [PMID: 22596236 PMCID: PMC3389409 DOI: 10.1038/bjc.2012.205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The use of sentinel node biopsy (SNB), lymph node dissection, breast-conserving surgery, radiotherapy, chemotherapy and hormonal treatment for breast cancer was evaluated in relation to socioeconomic status (SES) in the Netherlands, where access to care was assumed to be equal. METHODS Female breast cancer patients diagnosed between 1994 and 2008 were selected from the nationwide population-based Netherlands Cancer Registry (N=176 505). Socioeconomic status was assessed based on income, employment and education at postal code level. Multivariable models included age, year of diagnosis and stage. RESULTS Sentinal node biopsy was less often applied in high-SES patients (multivariable analyses, ≤ 49 years: odds ratio (OR) 0.70 (95% CI: 0.56-0.89); 50-75 years: 0.85 (0.73-0.99)). Additionally, lymph node dissection was less common in low-SES patients aged ≥ 76 years (OR 1.34 (0.95-1.89)). Socioeconomic status-related differences in treatment were only significant in the age group 50-75 years. High-SES women with stage T1-2 were more likely to undergo breast-conserving surgery (+radiotherapy) (OR 1.15 (1.09-1.22) and OR 1.16 (1.09-1.22), respectively). Chemotherapy use among node-positive patients was higher in the high-SES group, but was not significant in multivariable analysis. Hormonal therapy was not related to SES. CONCLUSION Small but significant differences were observed in the use of SNB, lymph node dissection and breast-conserving surgery according to SES in Dutch breast cancer patients despite assumed equal access to health care.
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Family Interaction Patterns and Their Association With Family Support Among Women With Breast Cancer. Cancer Nurs 2012; 35:E11-21. [DOI: 10.1097/ncc.0b013e31822d4851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sparano JA, Wang M, Zhao F, Stearns V, Martino S, Ligibel JA, Perez EA, Saphner T, Wolff AC, Sledge GW, Wood WC, Davidson NE. Race and hormone receptor-positive breast cancer outcomes in a randomized chemotherapy trial. J Natl Cancer Inst 2012; 104:406-14. [PMID: 22250182 DOI: 10.1093/jnci/djr543] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The association between black race and worse outcomes in operable breast cancer reported in previous studies has been attributed to a higher incidence of more aggressive triple-negative disease, disparities in care, and comorbidities. We evaluated associations between black race and outcomes, by tumor hormone receptor and HER2 expression, in patients who were treated with contemporary adjuvant therapy. METHODS The effect of black race on disease-free and overall survival was evaluated using Cox proportional hazards models adjusted for multiple covariates in a clinical trial population that was treated with anthracycline- and taxane-containing chemotherapy. Categorical variables were compared using the Fisher exact test. All P values are two-sided. RESULTS Of 4817 eligible patients, 405 (8.4%) were black. Compared with nonblack patients, black patients had a higher rate of triple-negative disease (31.9% vs 17.2%; P < .001) and a higher body mass index (median: 31.7 vs 27.4 kg/m(2); P < .001). Black race was statistically significantly associated with worse disease-free survival (5-year disease-free survival, black vs nonblack: 76.7% vs 84.5%; hazard ratio of recurrence or death = 1.58, 95% confidence interval = 1.19 to 2.10, P = .0015) and overall survival (5-year overall survival, black vs nonblack: 87.6% vs 91.9%; hazard ratio of death = 1.49, 95% confidence interval = 1.05 to 2.12, P = .025) in patients with hormone receptor-positive HER2-negative disease but not in patients with triple-negative or HER2-positive disease. In a model that included black race, hormone receptor-positive HER2-negative disease vs other subtypes, and their interaction, the interaction term was statistically significant for disease-free survival (P = .027) but not for overall survival (P = .086). CONCLUSION Factors other than disparities in care or aggressive disease contribute to increased recurrence in black women with hormone receptor-positive breast cancer.
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Affiliation(s)
- Joseph A Sparano
- Albert Einstein College of Medicine, Montefiore Medical Center-Weiler Division, 1825 Eastchester Rd, 2S-Rm 47, Bronx, NY 10461, USA.
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Wu XC, Lund MJ, Kimmick GG, Richardson LC, Sabatino SA, Chen VW, Fleming ST, Morris CR, Huang B, Trentham-Dietz A, Lipscomb J. Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol 2011; 30:142-50. [PMID: 22147735 DOI: 10.1200/jco.2011.36.8399] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE For breast cancer, guidelines direct the delivery of adjuvant systemic therapy on the basis of lymph node status, histology, tumor size, grade, and hormonal receptor status. We explored how race/ethnicity, insurance, census tract-level poverty and education, and hospital Commission on Cancer (CoC) status were associated with the receipt of guideline-concordant adjuvant systemic therapy. METHODS Locoregional breast cancers diagnosed in 2004 (n = 6,734) were from the National Program of Cancer Registries-funded seven-state Patterns of Care study of the Centers for Disease Control and Prevention. Predictors of guideline-concordant (receiving/not receiving) adjuvant systemic therapy, according to National Comprehensive Cancer Network Guidelines, were explored by logistic regression. RESULTS Overall, 35% of women received nonguideline chemotherapy, 12% received nonguideline regimens, and 20% received nonguideline hormonal therapy. Significant predictors of nonguideline chemotherapy included Medicaid insurance (odds ratio [OR], 0.66; 95% CI, 0.50 to 0.86), high-poverty areas (OR, 0.77; 95% CI, 0.62 to 0.96), and treatment at non-CoC hospitals (OR, 0.69; 95% CI, 0.56 to 0.85), with adjustment for age, registry, and clinical variables. Predictors of nonguideline regimens among chemotherapy recipients included lack of insurance (OR, 0.47; 95% CI, 0.25 to 0.92), high-poverty areas (OR, 0.71; 95% CI, 0.51 to 0.97), and low-education areas (OR, 0.65; 95% CI, 0.48 to 0.89) after adjustment. Living in high-poverty areas (OR, 0.78; 95% CI, 0.64 to 0.96) and treatment at non-CoC hospitals (OR, 0.68; 95% CI, 0.55 to 0.83) predicted nonguideline hormonal therapy after adjustment. ORs for poverty, education, and insurance were attenuated in the full models. CONCLUSION Sociodemographic and hospital factors are associated with guideline-concordant use of systemic therapy for breast cancer. The identification of modifiable factors that lead to nonguideline treatment may reduce disparities in breast cancer survival.
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Affiliation(s)
- Xiao-Cheng Wu
- Louisiana State University Health Sciences Center, 1615 Poydras St, Suite 1400, New Orleans, LA 70112, USA.
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Sail K, Franzini L, Lairson D, Du X. Differences in treatment and survival among African-American and Caucasian women with early stage operable breast cancer. ETHNICITY & HEALTH 2011; 17:309-323. [PMID: 22066691 DOI: 10.1080/13557858.2011.628011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To examine racial disparities associated with breast cancer treatment and survival in elderly patients with early stage operable breast cancer. METHODS We studied 23,110 women with node-positive and 31,572 women with node-negative tumor who were aged ≥65 with stages I, II, or IIIA breast cancer in 1991-2002 using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked data. Logistic regression analyses were performed to assess the odds of receiving adjuvant chemotherapy and radiation after breast conserving surgery (BCS) for blacks compared to whites. Cox proportional hazard regression models were used to determine the risk of mortality in blacks compared to whites, stratified by types of treatment. RESULTS Black women with node-positive and node-negative tumors were 25% (odds ratio = 0.75, 95% CI = 0.65-0.87) and 17% (0.83, 0.70-0.99) less likely to receive chemotherapy than white women, after adjusting for patient and tumor characteristics. This relation was not attenuated and remained statistically significant even after adjustment for socioeconomic status. In women with node-negative tumor who did not receive chemotherapy, black women were significantly more likely to die than white women (hazard ratio (HR) = 1.14, 95% CI = 1.04-1.24) after adjusting for patient and tumor characteristics, and comorbidity; and (1.11, 1.01-1.22) after additionally adjusting for socioeconomic status. CONCLUSIONS There were racial disparities between black and white women in receiving adjuvant chemotherapy and radiotherapy following BCS. Higher risk of mortality in black compared to white women was found only in those receiving no chemotherapy. Future studies should explore the root causes of racial disparities beyond treatment factors.
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Affiliation(s)
- Kavita Sail
- Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, USA
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Guadagnolo BA, Dohan D, Raich P. Metrics for evaluating patient navigation during cancer diagnosis and treatment: crafting a policy-relevant research agenda for patient navigation in cancer care. Cancer 2011; 117:3565-74. [PMID: 21780091 DOI: 10.1002/cncr.26269] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Racial and ethnic minorities as well as other vulnerable populations experience disparate cancer-related health outcomes. Patient navigation is an emerging health care delivery innovation that offers promise in improving quality of cancer care delivery to these patients who experience unique health-access barriers. Metrics are needed to evaluate whether patient navigation can improve quality of care delivery, health outcomes, and overall value in health care during diagnosis and treatment of cancer. METHODS Information regarding the current state of the science examining patient navigation interventions was gathered via search of the published scientific literature. A focus group of providers, patient navigators, and health-policy experts was convened as part of the Patient Navigation Leadership Summit sponsored by the American Cancer Society. Key metrics were identified for assessing the efficacy of patient navigation in cancer diagnosis and treatment. RESULTS Patient navigation data exist for all stages of cancer care; however, the literature is more robust for its implementation during prevention, screening, and early diagnostic workup of cancer. Relatively fewer data are reported for outcomes and efficacy of patient navigation during cancer treatment. Metrics are proposed for a policy-relevant research agenda to evaluate the efficacy of patient navigation in cancer diagnosis and treatment. CONCLUSIONS Patient navigation is understudied with respect to its use in cancer diagnosis and treatment. Core metrics are defined to evaluate its efficacy in improving outcomes and mitigating health-access barriers.
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Affiliation(s)
- B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Wheeler SB, Carpenter WR, Peppercorn J, Schenck AP, Weinberger M, Biddle AK. Predictors of timing of adjuvant chemotherapy in older women with hormone receptor-negative, stages II-III breast cancer. Breast Cancer Res Treat 2011; 131:207-16. [PMID: 21842244 DOI: 10.1007/s10549-011-1717-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
Abstract
Adherence to consensus guidelines for cancer care may vary widely across health care settings and contribute to differences in cancer outcomes. For some women with breast cancer, omission of adjuvant chemotherapy or delays in its initiation may contribute to differences in cancer recurrence and mortality. We studied adjuvant chemotherapy use among women with stage II or stage III, hormone receptor-negative breast cancer to understand health system and socio-demographic correlates of underuse and delayed adjuvant chemotherapy. We used Surveillance Epidemiology and End Results (SEER)-Medicare linked data to examine the patterns of care for 6,678 women aged 65 and older diagnosed with stage II or stage III hormone receptor-negative breast cancer in 1994-2002, with claims data through 2007. Age-stratified logistic regression was employed to examine the potential role of socio-demographic and structural/organizational health services characteristics in explaining differences in adjuvant chemotherapy initiation. Overall utilization of guideline-recommended adjuvant chemotherapy peaked at 43% in this population. Increasing age, higher co-morbidity burden, and low-income status were associated with lower odds of chemotherapy initiation within 4 months, whereas having positive lymph nodes, more advanced disease, and being married were associated with higher odds (P < 0.05). Health system-related structural/organizational characteristics and race/ethnicity offered little explanatory insight. Timely initiation of guideline-recommended adjuvant chemotherapy was low, with significant variation by age, income, and co-morbidity status. Based on these findings, future studies should seek to explore the more nuanced reasons why older women do not receive chemotherapy and why delays in care occur.
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Affiliation(s)
- Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB 7411, Chapel Hill, NC 27599-7411, USA.
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