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Nalluri H, Marmor S, Prathibha S, Jenkins A, Dindinger-Hill K, Kihara M, Sundberg MA, Day LW, Owen MJ, Lowry AC, Tuttle TM. Evaluating Disparities in Colon Cancer Survival in American Indian/Alaskan Native Patients Using the National Cancer Database. J Racial Ethn Health Disparities 2024; 11:2407-2415. [PMID: 37432562 DOI: 10.1007/s40615-023-01706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Studies demonstrate higher mortality rates from colon cancer in American Indian/Alaskan Native (AI/AN) patients compared to non-Hispanic White (nHW). We aim to identify factors that contribute to survival disparities. METHODS We used the National Cancer Database to identify AI/AN (n = 2127) and nHW (n = 527,045) patients with stage I-IV colon cancer from 2004 to 2016. Overall survival among stage I-IV colon cancer patients was estimated by Kaplan-Meier analysis; Cox proportional hazard ratios were used to identify independent predictors of survival. RESULTS AI/AN patients with stage I-III disease had significantly shorter median survival than nHW (73 vs 77 months, respectively; p < 0.001); there were no differences in survival for stage IV. Adjusted analyses demonstrated that AI/AN race was an independent predictor of higher overall mortality compared to nHW (HR 1.19, 95% CI 1.01-1.33, p = 0.002). Importantly, compared to nHW, AI/AN were younger, had more comorbidities, had greater rurality, had more left-sided colon cancers, had higher stage but lower grade tumors, were less frequently treated at an academic facility, were more likely to experience a delay in initiation of chemotherapy, and were less likely to receive adjuvant chemotherapy for stage III disease. We found no differences in sex, receipt of surgery, or adequacy of lymph node dissection. CONCLUSION We found patient, tumor, and treatment factors that potentially contribute to worse survival rates observed in AI/AN colon cancer patients. Limitations include the heterogeneity of AI/AN patients and the use of overall survival as an endpoint. Additional studies are needed to implement strategies to eliminate disparities.
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Affiliation(s)
- Harika Nalluri
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Saranya Prathibha
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Asher Jenkins
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Michelle Kihara
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Michael A Sundberg
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA
| | - Mary J Owen
- Department of Family Medicine and BioBehavioral Health, University of Minnesota, Duluth, MN, USA
- Center for American Indian and Minority Health, University of Minnesota, Duluth, MN, USA
| | - Ann C Lowry
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
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Fonseca AL, Ahmad R, Amin K, Tripathi M, Abdalla A, Hearld L, Bhatia S, Heslin MJ. Understanding Barriers to Guideline-Concordant Treatment in Foregut Cancer: From Data to Solutions. Ann Surg Oncol 2024:10.1245/s10434-024-15627-9. [PMID: 38954093 DOI: 10.1245/s10434-024-15627-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/04/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND A large proportion of patients with foregut cancers do not receive guideline-concordant treatment (GCT). This study sought to understand underlying barriers to GCT through a root cause analysis approach. METHODS A single-institution retrospective review of 498 patients with foregut (gastric, pancreatic, and hepatobiliary) adenocarcinoma from 2018 to 2022 was performed. Guideline-concordant treatment was defined based on National Comprehensive Cancer Network guidelines. The Ishikawa cause and effect model was used to establish main contributing factors to non-GCT. RESULTS Overall, 34% did not receive GCT. Root causes of non-GCT included Patient, Physician, Institutional Environment and Broader System-related factors. In decreasing order of frequency, the following contributed to non-GCT: receipt of incomplete therapy (N = 28, 16.5%), deconditioning on chemotherapy (N = 26, 15.3%), delays in care because of patient resource constraints followed by loss to follow-up (N = 19, 11.2%), physician factors (N = 19, 11.2%), no documentation of treatment plan after referral to oncologic expertise (N = 19, 11.2%), loss to follow-up before oncology referral (N = 17, 10%), nonreferral to medical oncologic expertise (N = 16, 9.4%), nonreferral to surgical oncology in patients with resectable disease (N = 15, 8.8%), and complications preventing completion of treatment (N = 11, 6.5%). Non-GCT often was a function of multiple intersecting patient, physician, and institutional factors. CONCLUSIONS A substantial percentage of patients with foregut cancer do not receive GCT. Solutions that may improve receipt of GCT include development of automated systems to improve patient follow-up; institutional prioritization of resources to enhance staffing; financial counseling and assistance programs; and development and integration of structured prehabilitation programs into cancer treatment pathways.
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Affiliation(s)
- Annabelle L Fonseca
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
- Institute for Cancer Outcomes and Survivorship, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rida Ahmad
- Department of Surgery, The University of South Alabama, Mobile, AL, USA
| | - Krisha Amin
- Department of Surgery, The University of South Alabama, Mobile, AL, USA
| | - Manish Tripathi
- Kellogg School of Management, Northwestern University, Chicago, IL, USA
| | - Ahmed Abdalla
- Department of Surgery, The University of South Alabama, Mobile, AL, USA
| | - Larry Hearld
- Department of Health Services Administration, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Martin J Heslin
- Department of Surgery, The University of South Alabama, Mobile, AL, USA
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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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Kratzer TB, Bandi P, Freedman ND, Smith RA, Travis WD, Jemal A, Siegel RL. Lung cancer statistics, 2023. Cancer 2024; 130:1330-1348. [PMID: 38279776 DOI: 10.1002/cncr.35128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 01/28/2024]
Abstract
Despite decades of declining mortality rates, lung cancer remains the leading cause of cancer death in the United States. This article examines lung cancer incidence, stage at diagnosis, survival, and mortality using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Over the past 5 years, declines in lung cancer mortality became considerably greater than declines in incidence among men (5.0% vs. 2.6% annually) and women (4.3% vs. 1.1% annually), reflecting absolute gains in 2-year relative survival of 1.4% annually. Improved outcomes likely reflect advances in treatment, increased access to care through the Patient Protection and Affordable Care Act, and earlier stage diagnosis; for example, compared with a 4.6% annual decrease for distant-stage disease incidence during 2013-2019, the rate for localized-stage disease rose by 3.6% annually. Localized disease incidence increased more steeply in states with the highest lung cancer screening prevalence (by 3%-5% annually) than in those with the lowest (by 1%-2% annually). Despite progress, disparities remain. For example, Native Americans have the highest incidence and the slowest decline (less than 1% annually among men and stagnant rates among women) of any group. In addition, mortality rates in Mississippi and Kentucky are two to three times higher than in most western states, largely because of elevated historic smoking prevalence that remains. Racial and geographic inequalities highlight longstanding opportunities for more concerted tobacco-control efforts targeted at high-risk populations, including improved access to smoking-cessation treatments and lung cancer screening, as well as state-of-the-art treatment.
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Affiliation(s)
- Tyler B Kratzer
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Priti Bandi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Neal D Freedman
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert A Smith
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - William D Travis
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Fonseca AL, Ahmad R, Amin K, Tripathi M, Vobbilisetty V, Richman JS, Hearld L, Bhatia S, Heslin MJ. Time Kills: Impact of Socioeconomic Deprivation on Timely Access to Guideline-Concordant Treatment in Foregut Cancer. J Am Coll Surg 2024; 238:720-730. [PMID: 38205919 PMCID: PMC11089897 DOI: 10.1097/xcs.0000000000000957] [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] [Indexed: 01/12/2024]
Abstract
BACKGROUND Receipt of guideline-concordant treatment (GCT) is associated with improved prognosis in foregut cancers. Studies show that patients living in areas of high neighborhood deprivation have worse healthcare outcomes; however, its effect on GCT in foregut cancers has not been evaluated. We studied the impact of the area deprivation index (ADI) as a barrier to GCT. STUDY DESIGN A single-institution retrospective review of 498 foregut cancer patients (gastric, pancreatic, and hepatobiliary adenocarcinoma) from 2018 to 2022 was performed. GCT was defined based on National Comprehensive Cancer Network guidelines. ADI, a validated measure of neighborhood disadvantage was divided into terciles (low, medium, and high) with high ADI indicating the most disadvantage. RESULTS Of 498 patients, 328 (66%) received GCT: 66%, 72%, and 59% in pancreatic, gastric, and hepatobiliary cancers, respectively. Median (interquartile range) time from symptoms to workup was 6 (3 to 13) weeks, from diagnosis to oncology appointment was 4 (1 to 10) weeks, and from oncology appointment to treatment was 4 (2 to 10) weeks. Forty-six percent were diagnosed in the emergency department. On multivariable analyses, age 75 years or older (odds ratio [OR] 0.39 [95% CI 0.18 to 0.87]), Black race (OR 0.52 [95% CI 0.31 to 0.86]), high ADI (OR 0.25 (95% CI 0.14 to 0.48]), 6 weeks or more from symptoms to workup (OR 0.44 [95% CI 0.27 to 0.73]), 4 weeks or more from diagnosis to oncology appointment (OR 0.76 [95% CI 0.46 to 0.93]), and 4 weeks or more from oncology appointment to treatment (OR 0.63 [95% CI 0.36 to 0.98]) were independently associated with nonreceipt of GCT. CONCLUSIONS Residence in an area of high deprivation predicts nonreceipt of GCT. This is due to multiple individual- and system-level barriers. Identifying these barriers and developing effective interventions, including community outreach and collaboration, leveraging telehealth, and increasing oncologic expertise in underserved areas, may improve access to GCT.
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Affiliation(s)
- Annabelle L. Fonseca
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes and Survivorship, The University of Alabama at Birmingham, AL
| | - Rida Ahmad
- Department of Surgery, The University of South Alabama, Mobile, AL
| | - Krisha Amin
- Department of Surgery, The University of South Alabama, Mobile, AL
| | - Manish Tripathi
- Kellogg School of Management, Northwestern University, Chicago, IL
| | | | - Joshua S. Richman
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes and Survivorship, The University of Alabama at Birmingham, AL
| | - Larry Hearld
- Department of Health Services Administration, The University of Alabama at Birmingham, AL
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, The University of Alabama at Birmingham, AL
| | - Martin J. Heslin
- Department of Surgery, The University of South Alabama, Mobile, AL
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Erdrich J, Cordova-Marks FM, Carson WO, Bea JW, Montfort WR, Thomson CA. Health Behavior Change Intervention Preferences Expressed by American Indian Cancer Survivors From a Southwest Tribal Community: Semistructured Interview Study. JMIR Form Res 2024; 8:e51669. [PMID: 38536214 PMCID: PMC11007609 DOI: 10.2196/51669] [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: 08/07/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND While many factors, including social determinants of health, affect cancer mortality, one modifiable risk factor that may contribute to cancer disparities is obesity. The prevalence of obesity in the American Indian/Alaska Native population is 48.1% per the Centers for Disease Control and Prevention. The overall cancer mortality for the American Indian/Alaska Native population is 18% higher than the White population as reported by the American Cancer Society. Interventions tailored to American Indian/Alaska Native communities that promote healthy lifestyle behaviors after cancer diagnosis and prior to cancer surgery (prehab) might improve cancer outcomes for this population. OBJECTIVE The aim of the study is to characterize the lifestyle behaviors of San Carlos Apache cancer survivors and identify preferences for the adaption of a prehab intervention. METHODS Semistructured interviews and validated questionnaires were completed with San Carlos Apache cancer survivors (N=4), exploring their viewpoints on healthy lifestyle and cancer risk and preferences for program development. A thematic content analysis was conducted. RESULTS Participants had an average BMI of 31 kg/m2 and walked 53 minutes daily. The majority of participants reported a high willingness to change eating habits (n=3, 75%). All 4 reported willingness to participate in a diet and exercise program. Important themes and subthemes were identified: (1) cancer is perceived as a serious health condition in the community (N=4, 100%); (2) environmental exposures are perceived as cancer-causing threats (n=3, 75%); (3) healthy diet, exercise, and avoiding harmful substances are perceived as mitigating cancer risk (n=3, 75%); (4) barriers to healthy habits include distance to affordable groceries (n=3, 75%) and lack of transportation (n=2, 50%); (5) there is high interest in a prehab program geared toward patients with cancer (N=4, 100%); and (6) standard monitoring practiced in published prehab programs showed early acceptability with participants (N=4, 100%). CONCLUSIONS Collaboration with tribal partners provided important insight that can help inform the adaptation of a culturally appropriate prehab program for San Carlos Apache patients diagnosed with cancer.
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Affiliation(s)
- Jennifer Erdrich
- Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Felina M Cordova-Marks
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - William O Carson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jennifer W Bea
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - William R Montfort
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ, United States
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Buck DiSilvestro J, Ulmer KK, Hedges M, Kardonsky K, Bruegl AS. Cervical Cancer: Preventable Deaths Among American Indian/Alaska Native Communities. Obstet Gynecol Clin North Am 2024; 51:125-141. [PMID: 38267123 DOI: 10.1016/j.ogc.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
American Indian/Alaska Native (AI/AN) individuals have twice the mortality rate of cervical cancer than the general US population. Participation in prevention programs such as cervical cancer screening and human papillomavirus (HPV) vaccination are under-utilized in this population. There are high rates of established cervical cancer risk factors among this community, with AI/AN people having a higher likelihood of infection with high-risk HPV strains not included in the 9-valent vaccine. There is a need for more robust and urgent prevention and treatment efforts in regard to cervical cancer in the AI/AN community.
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Affiliation(s)
- Jessica Buck DiSilvestro
- Brown University, Providence, RI, USA; Women & Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA.
| | - Keely K Ulmer
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | | | - Kimberly Kardonsky
- Department of Family Medicine, University of Washington School of Medicine, Heath Sciences Center, E-304 Box 356391, Seattle, WA 98195, USA
| | - Amanda S Bruegl
- Division of Gynecologic Oncology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mailstop L466, Portland, OR 97239, USA
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Zhang Q, Zhu S, Grady SC, Wang A, Hutchings H, Cox J, Popoff A, Okereke I. Spatial and spatio-temporal clusters of lung cancer incidence by stage of disease in Michigan, United States 1985-2018. GEOSPATIAL HEALTH 2024; 19. [PMID: 38357855 DOI: 10.4081/gh.2024.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024]
Abstract
Lung cancer is the most common cause of cancer-related death in Michigan. Most patients are diagnosed at advanced stages of the disease. There is a need to detect clusters of lung cancer incidence over time, to generate new hypotheses about causation and identify high-risk areas for screening and treatment. The Michigan Cancer Surveillance database of individual lung cancer cases, 1985 to 2018 was used for this study. Spatial and spatiotemporal clusters of lung cancer and level of disease (localized, regional and distant) were detected using discrete Poisson spatial scan statistics at the zip code level over the study time period. The approach detected cancer clusters in cities such as Battle Creek, Sterling Heights and St. Clair County that occurred prior to year 2000 but not afterwards. In the northern area of the lower peninsula and the upper peninsula clusters of late-stage lung cancer emerged after year 2000. In Otter Lake Township and southwest Detroit, late-stage lung cancer clusters persisted. Public and patient education about lung cancer screening programs must remain a health priority in order to optimize lung cancer surveillance. Interventions should also involve programs such as telemedicine to reduce advanced stage disease in remote areas. In cities such as Detroit, residents often live near industry that emits air pollutants. Future research should therefore, continue to focus on the geography of lung cancer to uncover place-based risks and in response, the need for screening and health care services.
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Affiliation(s)
- Qiong Zhang
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan.
| | - Shangrui Zhu
- Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, Michigan.
| | - Sue C Grady
- Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, Michigan.
| | - Anqi Wang
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan.
| | | | - Jessica Cox
- School of Medicine, University of Texas Medical Branch, Galveston, Texas.
| | - Andrew Popoff
- Department of Surgery, Henry Ford Health, Detroit, Michigan.
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health, Detroit, Michigan.
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Adamson AS, Jackson BE, Baggett CD, Thomas NE, Haynes AB, Pignone MP. Association of Receipt of Systemic Treatment for Melanoma With Insurance Type in North Carolina. Med Care 2023; 61:829-835. [PMID: 37708348 PMCID: PMC10844879 DOI: 10.1097/mlr.0000000000001921] [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] [Indexed: 09/16/2023]
Abstract
BACKGROUND Previous studies of hospital-based patients with metastatic melanoma suggest sociodemographic factors, including insurance type, may be associated with the receipt of systemic treatments. OBJECTIVES To examine whether insurance type is associated with the receipt of systemic treatment among patients with melanoma in a broad cohort of patients in North Carolina. METHODS We conducted a retrospective cohort study between 2011 and 2017 of patients with stages III-IV melanoma using data from the North Carolina Central Cancer Registry linked to Medicare, Medicaid, and private health insurance claims across the state. The primary outcome was the receipt of any systemic treatment, and the secondary outcome was the receipt of immunotherapy. RESULTS A total of 372 patients met the inclusion criteria. The average age was 68 years old (interquartile range: 56-76) and 61% were male. Within the cohort 48% had Medicare only, 29% had private insurance, 12% had both Medicare and Medicaid, and 11% had Medicaid only. A total of 186 (50%) patients received systemic treatment for melanoma, 125 (67%) of whom received immunotherapy. The use of systemic therapy, including immunotherapy, increased significantly over time. Having Medicaid-only insurance was independently associated with a 45% lower likelihood of receiving any systemic treatment [0.55 (95% CI: 0.35, 0.85)] and a 43% lower likelihood of receipt of immunotherapy [0.57 (95% CI: 0.34, 0.95)] compared with private insurance. CONCLUSIONS Stage III-IV melanoma patients with Medicaid-only insurance were less likely to receive systemic therapy or immunotherapy than patients with private insurance or Medicare insurance. This finding raises concerns about insurance-based disparities in treatment access.
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Affiliation(s)
- Adewole S. Adamson
- Department of Internal Medicine, Dell Medical School,
University of Texas at Austin, Austin, TX, USA
- LIVESTRONG Cancer Institutes, The University of Texas at
Austin, Austin, Texas, USA
- Department of Dermatology, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Bradford E. Jackson
- Lineberger Comprehensive Cancer Center, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher D. Baggett
- Lineberger Comprehensive Cancer Center, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Nancy E. Thomas
- Department of Dermatology, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alex B. Haynes
- LIVESTRONG Cancer Institutes, The University of Texas at
Austin, Austin, Texas, USA
- Department of Surgery and Perioperative Care, Dell Medical
School, The University of Texas at Austin, Austin, Texas
| | - Michael P. Pignone
- Department of Internal Medicine, Dell Medical School,
University of Texas at Austin, Austin, TX, USA
- LIVESTRONG Cancer Institutes, The University of Texas at
Austin, Austin, Texas, USA
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Herbach EL, Nash SH, Lizarraga IM, Carnahan RM, Wang K, Ogilvie AC, Curran M, Charlton ME. Patterns of Evidence-Based Care for the Diagnosis, Staging, and First-line Treatment of Breast Cancer by Race-Ethnicity: A SEER-Medicare Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1312-1322. [PMID: 37436422 PMCID: PMC10592343 DOI: 10.1158/1055-9965.epi-23-0218] [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: 03/10/2023] [Revised: 05/18/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in guideline-recommended breast cancer treatment are well documented, however studies including diagnostic and staging procedures necessary to determine treatment indications are lacking. The purpose of this study was to characterize patterns in delivery of evidence-based services for the diagnosis, clinical workup, and first-line treatment of breast cancer by race-ethnicity. METHODS SEER-Medicare data were used to identify women diagnosed with invasive breast cancer between 2000 and 2017 at age 66 or older (n = 2,15,605). Evidence-based services included diagnostic procedures (diagnostic mammography and breast biopsy), clinical workup (stage and grade determination, lymph node biopsy, and HR and HER2 status determination), and treatment initiation (surgery, radiation, chemotherapy, hormone therapy, and HER2-targeted therapy). Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (CI) for each service. RESULTS Black and American Indian/Alaska Native (AIAN) women had significantly lower rates of evidence-based care across the continuum from diagnostics through first-line treatment compared to non-Hispanic White (NHW) women. AIAN women had the lowest rates of HER2-targeted therapy and hormone therapy initiation. While Black women also had lower initiation of HER2-targeted therapy than NHW, differences in hormone therapy were not observed. CONCLUSIONS Our findings suggest patterns along the continuum of care from diagnostic procedures to treatment initiation may differ across race-ethnicity groups. IMPACT Efforts to improve delivery of guideline-concordant treatment and mitigate racial-ethnic disparities in healthcare and survival should include procedures performed as part of the diagnosis, clinical workup, and staging processes.
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Affiliation(s)
- Emma L. Herbach
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Sarah H. Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Ingrid M. Lizarraga
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Ryan M. Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Kai Wang
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA
| | - Amy C. Ogilvie
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Michaela Curran
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA
| | - Mary E. Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
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11
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Flores LE, Sargent M, Draeger B, Petereit DG, McClelland S. Validation of Navigator-Assisted Hypofractionation (NAVAH) Program Survey to Aid American Indian Breast Cancer Patients. Am J Clin Oncol 2023; 46:335-336. [PMID: 37291730 DOI: 10.1097/coc.0000000000001023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Laura E Flores
- University of Nebraska Medical Center, College of Allied Health Professions, Omaha, NE
| | | | - Beth Draeger
- Regional Health John T. Vucurevic Cancer Care Institute, Rapid City
| | - Daniel G Petereit
- Avera Walking Forward Program
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | - Shearwood McClelland
- Departments of Radiation Oncology
- Neurological Surgery, University Hospitals Cleveland Medical Center Case Western Reserve University, Cleveland, OH
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12
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Chu CE, Leapman MS, Zhao S, Cowan JE, Washington SL, Cooperberg MR. Prostate cancer disparities among American Indians and Alaskan Natives in the United States. J Natl Cancer Inst 2023; 115:413-420. [PMID: 36629492 PMCID: PMC10086629 DOI: 10.1093/jnci/djad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/25/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Americans Indians and Alaska Natives face disparities in cancer care with lower rates of screening, limited treatment access, and worse survival. Prostate cancer treatment access and patterns of care remain unknown. METHODS We used Surveillance, Epidemiology, and End Results data to compare incidence, primary treatment, and cancer-specific mortality across American Indian and Alaska Native, Asian and Pacific Islander, Black, and White patients. Baseline characteristics included prostate-specific antigen (PSA), Gleason score (GS), tumor stage, 9-level Cancer of the Prostate Risk Assessment risk score, county characteristics, and health-care provider density. Primary outcomes were first definitive treatment and prostate cancer-specific mortality (PCSM). RESULTS American Indian and Alaska Native patients were more frequently diagnosed with higher PSA, GS greater than or equal or 8, stage greater than or equal to cT3, high-risk disease overall (Cancer of the Prostate Risk Assessment risk score ≥ 6), and metastases at diagnosis than any other group. Adjusting for age, PSA, GS, and clinical stage, American Indian or Alaska Native patients with localized prostate cancer were more likely to undergo external beam radiation than radical prostatectomy and had the highest rates of no documented treatment. Five-year PCSM was higher among American Indian and Alaska Natives than any other racial group. However, after multivariable adjustment accounting for clinical and pathologic factors, county-level demographics, and provider density, American Indian and Alaska Native patient PCSM hazards were no different than those of White patients. CONCLUSIONS American Indian or Alaska Native patients have more advanced prostate cancer, lower rates of definitive treatment, higher mortality, and reside in areas of less specialty care. Disparities in access appear to account for excess risks of PCSM. Focused health policy interventions are needed to address these disparities.
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Affiliation(s)
- Carissa E Chu
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Shoujun Zhao
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Janet E Cowan
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Samuel L Washington
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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13
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Engelking M, Marmor S, Burjak M, Hinojos M, Lloyd W, Switalla KM, Tuttle TM. Use of endocrine therapy for estrogen receptor-positive breast cancer among American Indians and Alaska natives. Breast Cancer Res Treat 2023; 198:187-195. [PMID: 36689093 DOI: 10.1007/s10549-022-06826-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/30/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND American Indian/Alaska Native (AI/AN) women with estrogen receptor-positive (ER +) breast cancer have higher mortality compared to non-Hispanic whites (NHW). The purpose of this study is to compare rates of initiation of endocrine therapy (ET) between AI/AN and NHW and further determine survival outcomes for ER + breast cancer. METHODS We used the National Cancer Database to identify patients diagnosed with ER + breast cancer, stage I-III, between 2004 and 2017. Multivariable logistic regression was performed to determine factors associated with initiation of adjuvant ET. Overall survival was estimated using the Kaplan-Meier analysis and Cox proportional hazards modeling. RESULTS We identified a total of 771,619 patients (AI/AN, n = 2473; NHW, n = 769,146). Compared to NHW, AI/AN patients were more likely to live in rural areas, be younger, and have tumors that were higher grade, node positive, and larger. Initiation of adjuvant ET was high in both groups and not significantly different between AI/AN and NHW. Independent predictors of ET initiation included rural location, age, higher tumor grade, node-positive disease, larger tumor size, and progesterone receptor-positive status. Initiation of ET was significantly associated with improved overall survival among all patients. Overall survival was significantly worse among the AI/AN population. CONCLUSION AI/AN race was significantly and independently associated with worse overall survival after diagnosis of ER + breast cancer. We did not find a significant difference in the initiation of adjuvant ET between AI/AN and NHW. Exact reasons why AI/AN women with ER + breast cancer have higher mortality rates remain elusive but are probably multifactorial.
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Affiliation(s)
- Marta Engelking
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA.
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
- Center for Clinical Quality & Outcomes Discovery and Evaluation (C-QODE), Minneapolis, USA
| | - Mohamad Burjak
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
| | - Madeleine Hinojos
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
| | - Whitney Lloyd
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
| | - Kayla M Switalla
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
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14
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Steiling K, Kathuria H, Echieh CP, Ost DE, Rivera MP, Begnaud A, Celedón JC, Charlot M, Dietrick F, Duma N, Fong KM, Ford JG, Gould MK, Holguin F, Pérez-Stable EJ, Tanner NT, Thomson CC, Wiener RS, Wisnivesky J. Research Priorities for Interventions to Address Health Disparities in Lung Nodule Management: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e31-e46. [PMID: 36920066 PMCID: PMC10037482 DOI: 10.1164/rccm.202212-2216st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background: Lung nodules are common incidental findings, and timely evaluation is critical to ensure diagnosis of localized-stage and potentially curable lung cancers. Rates of guideline-concordant lung nodule evaluation are low, and the risk of delayed evaluation is higher for minoritized groups. Objectives: To summarize the existing evidence, identify knowledge gaps, and prioritize research questions related to interventions to reduce disparities in lung nodule evaluation. Methods: A multidisciplinary committee was convened to review the evidence and identify key knowledge gaps in four domains: 1) research methodology, 2) patient-level interventions, 3) clinician-level interventions, and 4) health system-level interventions. A modified Delphi approach was used to identify research priorities. Results: Key knowledge gaps included 1) a lack of standardized approaches to identify factors associated with lung nodule management disparities, 2) limited data evaluating the role of social determinants of health on disparities in lung nodule management, 3) a lack of certainty regarding the optimal strategy to improve patient-clinician communication and information transmission and/or retention, and 4) a paucity of information on the impact of patient navigators and culturally trained multidisciplinary teams. Conclusions: This statement outlines a research agenda intended to stimulate high-impact studies of interventions to mitigate disparities in lung nodule evaluation. Research questions were prioritized around the following domains: 1) need for methodologic guidelines for conducting research related to disparities in nodule management, 2) evaluating how social determinants of health influence lung nodule evaluation, 3) studying approaches to improve patient-clinician communication, and 4) evaluating the utility of patient navigators and culturally enriched multidisciplinary teams to reduce disparities.
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15
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Kratzer TB, Jemal A, Miller KD, Nash S, Wiggins C, Redwood D, Smith R, Siegel RL. Cancer statistics for American Indian and Alaska Native individuals, 2022: Including increasing disparities in early onset colorectal cancer. CA Cancer J Clin 2023; 73:120-146. [PMID: 36346402 DOI: 10.3322/caac.21757] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
American Indian and Alaska Native (AIAN) individuals are diverse culturally and geographically but share a high prevalence of chronic illness, largely because of obstacles to high-quality health care. The authors comprehensively examined cancer incidence and mortality among non-Hispanic AIAN individuals, compared with non-Hispanic White individuals for context, using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Overall cancer rates among AIAN individuals were 2% higher than among White individuals for incidence (2014 through 2018, confined to Purchased/Referred Care Delivery Area counties to reduce racial misclassification) but 18% higher for mortality (2015 through 2019). However, disparities varied widely by cancer type and geographic region. For example, breast and prostate cancer mortality rates are 8% and 31% higher, respectively, in AIAN individuals than in White individuals despite lower incidence and the availability of early detection tests for these cancers. The burden among AIAN individuals is highest for infection-related cancers (liver, stomach, and cervix), for kidney cancer, and for colorectal cancer among indigenous Alaskans (91.3 vs. 35.5 cases per 100,000 for White Alaskans), who have the highest rates in the world. Steep increases for early onset colorectal cancer, from 18.8 cases per 100,000 Native Alaskans aged 20-49 years during 1998 through 2002 to 34.8 cases per 100,000 during 2014 through 2018, exacerbated this disparity. Death rates for infection-related cancers (liver, stomach, and cervix), as well as kidney cancer, were approximately two-fold higher among AIAN individuals compared with White individuals. These findings highlight the need for more effective strategies to reduce the prevalence of chronic oncogenic infections and improve access to high-quality cancer screening and treatment for AIAN individuals. Mitigating the disparate burden will require expanded financial support of tribal health care as well as increased collaboration and engagement with this marginalized population.
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Affiliation(s)
- Tyler B Kratzer
- Surveillance and Health Services Research, American Cancer Society, Kennesaw, Georgia, USA
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Kennesaw, Georgia, USA
| | - Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Kennesaw, Georgia, USA
| | - Sarah Nash
- University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Charles Wiggins
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Diana Redwood
- Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Robert Smith
- Early Cancer Detection Science, American Cancer Society, Kennesaw, Georgia, USA
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Kennesaw, Georgia, USA
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16
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Amiri S, Greer MD, Muller CJ, Johansson P, Petras A, Allick CC, London SM, Abbey MC, Halasz LM, Buchwald DS. Disparities in Access to Radiation Therapy by Race and Ethnicity in the United States With Focus on American Indian/Alaska Native People. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1929-1938. [PMID: 35525833 DOI: 10.1016/j.jval.2022.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/24/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Striking disparities in access to radiation therapy (RT) exist, especially among racial and ethnic-minority patients. We analyzed census block group data to evaluate differences in travel distance to RT as a function of race and ethnicity, socioeconomic status, and rurality. METHODS The Directory of Radiotherapy Centers provided the addresses of facilities containing linear accelerators for RT. We classified block groups as majority (≥ 50%) American Indian/Alaska Native (AI/AN), black, white, Asian, no single racial majority, or Hispanic regardless of race. We used the Area Deprivation Index to classify deprivation and Rural-Urban Commuting Area codes to classify rurality. Generalized linear mixed models tested associations between these factors and distance to nearest RT facility. RESULTS Median distance to nearest RT facility was 72 miles in AI/AN-majority block groups, but 4 to 7 miles in block groups with non-AI/AN majorities. Multivariable models estimated that travel distances in AI/AN-majority block groups were 39 to 41 miles longer than in areas with non-AI/AN majorities. Travel distance was 1.3 miles longer in the more deprived areas versus less deprived areas and 16 to 32 miles longer in micropolitan, small town, and rural areas versus metropolitan areas. CONCLUSIONS Cancer patients in block groups with AI/AN-majority populations, nonmetropolitan location, and low socioeconomic status experience substantial travel disparities in access to RT. Future research with more granular community- and individual-level data should explore the many other known barriers to access to cancer care and their relationship to the barriers posed by distance to RT care.
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Affiliation(s)
- Solmaz Amiri
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA.
| | - Matthew D Greer
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Clemma J Muller
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Patrik Johansson
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Anthippy Petras
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Cole C Allick
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Sara M London
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Morgan C Abbey
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Lia M Halasz
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
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17
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Walker PC. INAUGURAL ADDRESS OF THE INCOMING PRESIDENT. Am J Health Syst Pharm 2022. [PMID: 35972771 DOI: 10.1093/ajhp/zxac205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Paul C Walker
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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18
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Zhong P, Yang B, Pan F, Hu F. Temporal trends in Black-White disparities in cancer surgery and cancer-specific survival in the United States between 2007 and 2015. Cancer Med 2022; 12:3509-3519. [PMID: 35968573 PMCID: PMC9939184 DOI: 10.1002/cam4.5141] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/16/2022] [Accepted: 08/02/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The American Society of Clinical Oncology (ASCO) has strived to address racial/ethnic disparities in cancer care since 2009. Surgery plays a pivotal role in cancer care; however, it is unclear whether and how racial/ethnic disparities in cancer surgery have changed over time. METHODS This cohort study included 1,113,256 White and Black cancer patients across 9 years (2007-2015) using patient data extracted from the Surveillance, Epidemiology, and End Results (SEER)-18 registries. Patient data were included from 2007 to adjust insurance status and by 2015 to obtain at least a 3-year survival follow-up (until 2018). The primary outcome was a surgical intervention. The secondary outcomes were the use of (neo)adjuvant chemotherapy and cancer-specific survival (CSS). Adjusted associations of the race (Black/White) with the outcomes were measured in each cancer type and year. RESULTS The gap between surgery rates for Black and White patients narrowed overall, from an adjusted odds ratio (aOR) of 0.621 (0.592-0.652) in 2007 to 0.734 (0.702-0.768) in 2015. However, the racial gap persisted in the surgery rates for lung, breast, prostate, esophageal, and ovarian cancers. In surgically treated patients with lymph node metastasis, Black patients with colorectal cancer (CRC) were less likely to receive (neo)adjuvant chemotherapy than White patients. Black patients undergoing surgery were more likely to have a worse CSS rate than White patients undergoing surgery. In breast cancer patients, the overall trend was narrow, but continuously present, with an adjusted hazard ratio (aHR) of 1.224 (1.278-1.173) in 2007 and 1.042 (1.132-0.96) in 2015. CONCLUSIONS Overall, progress has been made toward narrowing the Black-White gap in cancer surgical opportunity and survival. Future efforts should be directed toward those specific cancers for which the Black-White gap continues. Additionally, it is worth addressing the Black-White gap regarding the use of (neo)adjuvant chemotherapy for CRC treatment.
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Affiliation(s)
- Peijie Zhong
- Clinical Medical CollegeSouthwest Medical UniversityLuzhouChina
- Department of Gastroenterology and HepatologyHuaihe Hospital of Henan UniversityKaifengChina
| | - Bo Yang
- Department of Interventional MedicineThe Affiliated hospital of Southwest Medical UniversityLuzhouChina
| | - Feng Pan
- Department of Interventional MedicineThe Affiliated hospital of Southwest Medical UniversityLuzhouChina
| | - Fang Hu
- Department of Interventional MedicineThe Affiliated hospital of Southwest Medical UniversityLuzhouChina
- College of nursingSouthwest Medical UniversityLuzhouChina
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19
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Roubidoux MA, Kaur JS, Rhoades DA. Health Disparities in Cancer Among American Indians and Alaska Natives. Acad Radiol 2022; 29:1013-1021. [PMID: 34802904 DOI: 10.1016/j.acra.2021.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022]
Abstract
American Indians and Alaska Natives (AI/AN) are underserved populations who suffer from several health disparities, 1 of which is cancer. Malignancies, especially cancers of the breast, liver, and lung, are common causes of death in this population. Health care disparities in this population include more limited access to diagnostic radiology because of geographic and/or health system limitations. Early detection of these cancers may be enabled by improving patient and physician access to medical imaging. Awareness by the radiology community of the cancer disparities among this population is needed to support research targeted to this specific ethnic group and to support outreach efforts to provide more imaging opportunities. Providing greater access to imaging facilities will also improve patient compliance with screening recommendations, ultimately improving mortality in these populations.
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Affiliation(s)
- Marilyn A Roubidoux
- Department of Radiology, Michigan Medicine, TC 2910, 1500 E. Medical Center Drive, Ann Arbor, Mi 48109-5326.
| | - Judith S Kaur
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Dorothy A Rhoades
- Department of Internal Medicine, Stephenson Cancer Center and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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20
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Kills First CC, Sutton TL, Shannon J, Brody JR, Sheppard BC. Disparities in pancreatic cancer care and research in Native Americans: Righting a history of wrongs. Cancer 2022; 128:1560-1567. [PMID: 35132620 PMCID: PMC10257521 DOI: 10.1002/cncr.34118] [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: 08/25/2021] [Revised: 11/22/2021] [Accepted: 12/23/2021] [Indexed: 11/07/2022]
Abstract
Disparities in pancreatic cancer incidence and outcomes exist in Native American populations. These disparities are multifactorial, difficult to quantify, and are influenced by historical, socioeconomic, and health care structural factors. The objective of this article was to assess these factors and offer a call to action to overcome them. The authors reviewed published data on pancreatic cancer in Native American populations with a focus on disparities in incidence, outcomes, and research efforts. The historical context of the interactions between Native Americans and the United States health care system was also analyzed to form actionable items to build trust and collaboration. The incidence of pancreatic cancer in Native Americans is higher than that in the general US population and has the worst survival of any major racial or ethnic group. These outcomes are influenced by a patient population with often poor access to high-quality cancer care, historical trauma potentially leading to reduced care utilization, and a lack of research focused on etiologies and comorbid conditions that contribute to these disparities. A collaborative effort between nontribal and tribal leaders and cancer centers is key to addressing disparities in pancreatic cancer outcomes and research. More population-level studies are needed to better understand the incidence, etiologies, and comorbid conditions of pancreatic cancer in Native Americans. Finally, a concerted, focused effort should be undertaken between nontribal and tribal entities to increase the access of Native Americans to high-quality care for pancreatic cancer and other lethal malignancies.
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Affiliation(s)
| | | | | | - Jonathan R. Brody
- OHSU, Department of Surgery, Portland, OR, 97239
- OHSU Brenden-Colson Center for Pancreatic Care, Portland, OR, 97239
| | - Brett C. Sheppard
- OHSU, Department of Surgery, Portland, OR, 97239
- OHSU Brenden-Colson Center for Pancreatic Care, Portland, OR, 97239
- OHSU, Department of Cell, Developmental and Cancer Biology, Knight Cancer Institute, Portland, OR, 97239
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21
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Miller K, Kreis IA, Gannon MR, Medina J, Clements K, Horgan K, Dodwell D, Park MH, Cromwell DA. The association between guideline adherence, age and overall survival among women with non-metastatic breast cancer: A systematic review. Cancer Treat Rev 2022; 104:102353. [PMID: 35152157 DOI: 10.1016/j.ctrv.2022.102353] [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: 11/30/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Conformity with treatment guidelines should benefit patients. Studies have reported variation in adherence to breast cancer (BC) guidelines, particularly among older women. This study investigated (i) whether adherence to treatment guideline recommendations for women with non-metastatic BC improves overall survival (OS), (ii) whether that relationship varies by age. METHODOLOGY MEDLINE and EMBASE were systematically searched for studies on guideline adherence and OS in women with non-metastatic BC, published after January 2000, which examined recommendations on breast surgery, chemotherapy, radiotherapy or endocrine therapy. Study results were summarised using narrative synthesis. RESULTS Sixteen studies met the inclusion criteria. The recommendations for each treatment covered were similar, but studies differed in their definitions of adherence. 5-year OS rates among patients having compliant treatment ranged from 91.3% to 93.2%, while rates among patients having non-compliant treatment ranged from 75.9% to 83.4%. Six studies reported an adjusted hazard ratio (aHR) for non-compliant treatment compared with compliant treatment; all concluded OS was worse among patients whose overall treatment was non-compliant (aHR range: 1.52 [1.30-1.82] to 2.57 [1.96-3.37]), but adjustment for potential confounders was limited. Worse adherence among older women was reported in 12/16 studies, but they did not provide consistent evidence on whether OS was associated with treatment adherence and age. CONCLUSIONS Individual studies reported that better adherence to guidelines improved OS among women with non-metastatic BC, but the evidence base has weaknesses including inconsistent definitions of adherence. More precise and consistent research designs, including the evaluation of barriers to adherence across the spectrum of healthcare practice, are required to fully understand guideline compliance, as well as the relationship between compliance and OS following a BC diagnosis.
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Affiliation(s)
- Katie Miller
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Irene A Kreis
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Melissa R Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Karen Clements
- National Cancer Registration and Analysis Service, NHS Digital, 2(nd) Floor, 23 Stephenson Street, Birmingham, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Min Hae Park
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Erdrich J, Cordova-Marks F, Monetathchi AR, Wu M, White A, Melkonian S. Disparities in Breast-Conserving Therapy for Non-Hispanic American Indian/Alaska Native Women Compared with Non-Hispanic White Women. Ann Surg Oncol 2022; 29:1019-1030. [PMID: 34490527 PMCID: PMC8724083 DOI: 10.1245/s10434-021-10730-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about the surgical patterns of American Indian/Alaska Native (AI/AN) breast cancer patients. The purpose of this study is to determine whether there are disparities in breast cancer surgery and radiation therapy between non-Hispanic AI/AN (NH-AI/AN) women and non-Hispanic White (NHW) women. METHODS Data from the National Program of Cancer Registries of the Centers for Disease Control and Surveillance, Epidemiology, and End Results were used for this cross-sectional study. Female patients with invasive breast cancer diagnosed 2010-2015 were stratified by race/ethnicity, surgical procedure, radiation, and region. Percentage distributions of mastectomy and lumpectomy were compared overall and by region and stage. RESULTS From 2010 to 2015 there were 3292 NH-AI/AN women and 165,225 NHW women diagnosed with breast cancer. For early stage (AJCC stage 1 and 2), NH-AI/AN women had overall significantly higher percentage of mastectomy (41% vs 34.4%, p < 0.001) and significantly lower percentage of lumpectomy (59% vs 65.6%) compared with NHW women, without significant differences in post-lumpectomy radiation (71% vs 70%). There were regional variations, notably in the Northern Plains, where the percentage of mastectomy for early-stage disease was 48.9% for NH-AI/AN women versus 35.9% for NHW women, and in Alaska with 47% for NH-AI/AN women versus 33.3% for NHW women (p < 0.001). There were no overall significant differences in type of surgery or radiation for late-stage disease between groups. CONCLUSION This is the first study to show disparities in surgical management of NH-AI/AN women with breast cancer. For early-stage disease, NH-AI/AN women undergo a higher percentage of mastectomy. Future clinical directions could focus on the factors that drive awareness, decision-making, and access to breast conservation.
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Affiliation(s)
- Jennifer Erdrich
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA.
| | - Felina Cordova-Marks
- Department of Health Promotion Sciences, College of Public Health, University of Arizona, Tucson, USA
| | | | - Manxia Wu
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, USA
| | - Arica White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, USA
| | - Stephanie Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, USA
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Erdrich J. ASO Author Reflections: Mastectomy Versus Lumpectomy: Are There Surgical Disparities for Native American Women Compared with White Women? Ann Surg Oncol 2022; 29:1031-1032. [PMID: 34529176 DOI: 10.1245/s10434-021-10818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jennifer Erdrich
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA.
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Greer MD, Amiri S, Denney JT, Amram O, Halasz LM, Buchwald D. Disparities in Access to Radiation Therapy Facilities Among American Indians/Alaska Natives and Hispanics in Washington State. Int J Radiat Oncol Biol Phys 2022; 112:285-293. [PMID: 34715256 DOI: 10.1016/j.ijrobp.2021.08.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/29/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Racial and ethnic minorities in the state of Washington experience higher cancer mortality relative to whites. We sought to characterize differences in travel distance to radiation therapy (RT) facilities in Washington by race and ethnicity with a special focus on non-Hispanic American Indians and Alaska Natives as a contributor to limited access and cancer disparities. METHODS AND MATERIALS Geocoded mortality data from Washington Department of Health (2011-2018) were used to identify decedents with mortality related to all-causes, all cancers, and cancers likely requiring access to RT. This was determined from optimal RT usage estimates by diagnosis. RT facility locations were ascertained from the Directory of Radiation Therapy Centers and confirmed. Distance from decedents' address listed on death certificates to nearest RT facility was calculated. Generalized mixed models were used for statistical analysis. RESULTS We identified 418,754 deaths; 109,134 were cancer-related, 60,973 likely required RT. Among decedents with cancers likely requiring RT, non-Hispanic American Indians and Alaska Natives decedents would have had to travel 1.16 times (95% confidence interval [CI], 1.09-1.24) farther from their residences to reach the nearest treatment facility compared with non-Hispanic whites. This association existed in metro counties but was more pronounced in nonmetro counties (1.39 times farther; 95% CI, 1.22-1.58). In addition, Hispanics would have had to travel 1.11 times farther (95% CI, 1.06-1.16) to reach the nearest facility compared with non-Hispanic whites, primarily due to differences in urban counties. Decedents in nonmetro counties lived on average 35 miles (SD = 29) from RT centers and non-Hispanic American Indians and Alaska Natives in nonmetro counties 53 miles (SD = 38). Compared with non-Hispanic white decedents, those who were non-Hispanic black, non-Hispanic Asian, and non-Hispanic Native Hawaiian decedents lived closer to RT facilities. CONCLUSIONS We observed significant disparities in access to RT facilities in Washington, specifically for non-Hispanic American Indians and Alaska Natives and rural decedents. The findings call for initiatives to improve access to critical cancer treatment services for these underserved populations with known disparities in cancer deaths.
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Affiliation(s)
- Matthew D Greer
- Department of Radiation Oncology, University of Washington, Seattle, Washington.
| | - Solmaz Amiri
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington; Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington
| | - Justin T Denney
- Department of Sociology, Washington State University, Pullman, Washington
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Lia M Halasz
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington
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Hao S, Parikh AA, Snyder RA. Racial Disparities in the Management of Locoregional Colorectal Cancer. Surg Oncol Clin N Am 2021; 31:65-79. [PMID: 34776065 DOI: 10.1016/j.soc.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Racial disparities pervade nearly all aspects of management of locoregional colorectal cancer, including time to treatment, receipt of resection, adequacy of resection, postoperative complications, and receipt of neoadjuvant and adjuvant multimodality therapies. Disparate gaps in treatment translate into enduring effects on survivorship, recurrence, and mortality. Efforts to reduce these gaps in care must be undertaken on a multilevel basis and focus on modifiable factors that underlie racial disparity.
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Affiliation(s)
- Scarlett Hao
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Surgical Oncology Suite, 4S-24, Greenville, NC 27834, USA
| | - Alexander A Parikh
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Surgical Oncology Suite, 4S-24, Greenville, NC 27834, USA
| | - Rebecca A Snyder
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Surgical Oncology Suite, 4S-24, Greenville, NC 27834, USA.
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Surgical Services for Breast Cancer Patients in Australia, is There a Gap for Aboriginal and/or Torres Strait Islander Women? World J Surg 2021; 46:612-621. [PMID: 34557943 DOI: 10.1007/s00268-021-06310-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed cancer in Aboriginal and/or Torres Strait Islander women. When compared to other Australians, Aboriginal and/or Torres Strait Islander women have a higher breast cancer mortality rate. This systematic literature review examined disparities in breast cancer surgical access and outcomes for Aboriginal and/or Torres Strait Islander women. METHODS This systematic literature review, following the PRISMA guidelines, compared measures of breast cancer surgical care for Aboriginal and/or Torres Strait Islander people and other Australians. RESULTS The 13 included studies were largely state-based retrospective reviews of data collected prior to the year 2012. Eight studies reported more advanced breast cancer presentation among Aboriginal and/or Torres Strait Islander women. Despite the increased distance to a multidisciplinary, specialist team, there were no disparities in seeing a surgeon, or in the time from diagnosis to surgical treatment. Two studies reported disparities in the receipt of surgery and two reported no variations. Three studies reported disparities in the receipt of mastectomy versus breast conserving surgery, whilst four studies reported no variations. No studies examined postoperative surgical outcomes. CONCLUSIONS Aboriginal and/or Torres Strait Islander women present with more advanced breast cancer. There may be disparities in the receipt of surgery and the type of surgery. However, the metrics tested were not related to optimal care guidelines, and the databases utilised contain limited data on individual factors contributing to surgical care decisions. It is therefore difficult to determine whether the reported differences in the receipt of surgical care reflect disparate or appropriate care.
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Roubidoux MA, Richards B, Honey NE, Begay JA. Adherence to Screening Among American Indian Women Accessing a Mobile Mammography Unit. Acad Radiol 2021; 28:944-949. [PMID: 33896716 DOI: 10.1016/j.acra.2021.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 01/29/2023]
Abstract
RATIONALE AND OBJECTIVES Although screening mammography is essential to reducing breast cancer morbidity and mortality, barriers exist especially among underrepresented minority groups. There are few studies of mammogram screening among American Indian women, many of whom reside in rural areas where screening access is challenging. A mobile mammography unit served 24 Indian Health Service clinics during 2013-17. Screening mammography adherence was evaluated. MATERIALS AND METHODS Among mobile unit women, 'adherence to screening' was determined by the date of the most recent prior mammogram. Those having a prior mammogram 9-27 months ago were classified as 'adherent to screening'. Comparison screening data were obtained from the American College of Radiology National Mammography Database, consisting of screening cases occurring in year 2015. Additionally, among mobile unit women 'continued adherence to screening' was determined, defined as at least one repeat screening at the mobile unit within the subsequent 9-27 months after a screening there. RESULTS Among 1,615 mobile unit women, 624 (38.6%) were adherent to screening. Among 2,509,826 National Mammography Database women, 1,481,021 (59.0%) were adherent to screening. (p<0.0001) The prevalence of a >27-month interval between mammograms was 3.13 (95% CI 2.91-3.36) times greater among mobile unit women than National Mammography Database women. 'Continued adherence to screening' of mobile unit women was 428/1194 (35.9%). CONCLUSION Adherence to screening and continued adherence to screening were low among mobile unit women and time interval between screenings was longer than National Mammography Database women. Factors to improve screening adherence among these underserved women should be determined.
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Affiliation(s)
- Marilyn A Roubidoux
- Department of Radiology, Michigan Medicine, TC 2910 Box 5326; 1500 E. Ann Arbor Michigan.
| | | | | | - Joel A Begay
- Senior Research Assistant and Data Analyst Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
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Davis RE, Trickey AW, Abrahamse P, Kato I, Ward K, Morris AM. Association of Cumulative Social Risk and Social Support With Receipt of Chemotherapy Among Patients With Advanced Colorectal Cancer. JAMA Netw Open 2021; 4:e2113533. [PMID: 34106262 PMCID: PMC8190628 DOI: 10.1001/jamanetworkopen.2021.13533] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Approximately 38% of patients with advanced colorectal cancer do not receive chemotherapy. OBJECTIVE To determine whether cumulative social risk (ie, multiple co-occurring sociodemographic risk factors) is associated with lower receipt of chemotherapy among patients with advanced colorectal cancer and whether social support would moderate this association. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, population-based, mailed survey study was conducted from 2012 to 2014. Participants were recruited between 2011 and 2014 from all adults within 1 year after diagnosis of stage III colorectal cancer in the Detroit, Michigan, and State of Georgia Surveillance, Epidemiology, End-Results cancer registries. Patients were eligible if they were aged 18 years or older, had undergone surgery 4 or more months ago, did not have stage IV cancer, and resided in the registry catchment areas. Data analyses were conducted from March 2017 to April 2021. MAIN OUTCOMES AND MEASURES The primary outcome was receipt of chemotherapy. Cumulative social risk represented a sum of 8 risk factors with the potential to drain resources from participants' cancer treatment (marital status, employment, annual income, health insurance, comorbidities, health literacy, adult caregiving, and perceived discrimination). Social support was operationalized as emotional support related to colorectal cancer diagnosis. RESULTS Surveys were mailed to 1909 eligible patients; 1301 completed the survey (response rate, 68%). A total of 1087 participants with complete data for key variables were included in the sample (503 women [46%]; mean [SD] age, 64 [13] years). Participants with 3 or more risk factors were less likely to receive chemotherapy than participants with 0 risk factors (3 factors, odds ratio [OR], 0.48 [95% CI, 0.26-0.87]; 4 factors, OR, 0.41 [95% CI, 0.21-0.78]; 5 factors, OR, 0.42 [95% CI, 0.20-0.87]; ≥6 factors, OR, 0.22 [95% CI, 0.09-0.55]). Participants with 2 or more support sources had higher odds of undergoing chemotherapy than those without social support (2 sources, OR, 3.05 [95% CI, 1.36-6.85]; 3 sources, OR, 3.24 [95% CI, 1.48-7.08]; 4 sources, OR, 3.69 [95% CI, 1.71-7.97]; 5 sources, OR, 4.40 [95% CI, 1.98-9.75]; ≥6 sources, OR 5.95 [95% CI, 2.58-13.74]). Within each social support level, participants were less likely to receive chemotherapy as cumulative social risk increased. CONCLUSIONS AND RELEVANCE Cumulative social risk was associated with reduced receipt of chemotherapy. These associations were mitigated by social support. Assessing cumulative social risk may identify patients with colorectal cancer who are at higher risk for omitting chemotherapy who can be targeted for support programs to address social disadvantage and increase social support.
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Affiliation(s)
- Rachel E. Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
| | - Amber W. Trickey
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Paul Abrahamse
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Ikuko Kato
- Department of Pathology, Karmanos Cancer Institute, Wayne State University, Michigan
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Arden M. Morris
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
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Mehta SJ, Morris AM, Kupfer SS. Colorectal Cancer Screening Starting at Age 45 Years-Ensuring Benefits Are Realized by All. JAMA Netw Open 2021; 4:e2112593. [PMID: 34003278 PMCID: PMC8285001 DOI: 10.1001/jamanetworkopen.2021.12593] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Shivan J Mehta
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Arden M Morris
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Sonia S Kupfer
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
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30
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Marmor S, Longacre CF, Altman AM, Hui JYC, Jensen EH, Tuttle TM. Genomic expression assay testing among American Indian and Alaska Native women with breast cancer. Cancer 2020; 126:5222-5229. [PMID: 32926435 DOI: 10.1002/cncr.33150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Breast cancer is one of the most common causes of cancer mortality for all women, including American Indian and Alaska Native (AI/AN) women. The use of the 21-gene recurrence score (RS) appears to be predictive of the benefit of chemotherapy for women with estrogen receptor (ER)-positive breast cancer. The objective of the current study was to compare RS testing between AI/AN and non-Hispanic White (NHW) women with breast cancer. METHODS The Surveillance, Epidemiology, and End Results program was used to identify women with ER-positive breast cancer from 2004 through 2015. Multivariable logistic regression was used to evaluate factors associated with RS use, with high-risk RS, and with chemotherapy use among those with a high-risk RS. RESULTS A total of 363,387 NHW patients and 1951 AI/AN patients with ER-positive breast cancer were identified. AI/AN women were found to be less likely to undergo RS testing and, when tested, were more likely to have a high-risk RS. In the multivariable logistic regression analysis, AI/AN women were found to be significantly more likely to have a high-risk RS (odds ratio,1.28; 95% confidence interval, 1.01-1.66). Among untested women, chemotherapy use was higher for AI/AN women; however, the use of chemotherapy was not found to be significantly different between the groups with a high-risk RS. Using Cox proportional hazards models, AI/AN race was found to be significantly associated with worse overall survival. CONCLUSIONS AI/AN women were less likely to undergo RS testing compared with NHW women and were more likely to have a high-risk RS. Reversing the disparity in genomic expression assay testing is critical to ensure guideline-based breast cancer treatment and improve survival rates for AI/AN women with breast cancer.
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Affiliation(s)
- Schelomo Marmor
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Colleen F Longacre
- Department of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Ariella M Altman
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jane Y C Hui
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Eric H Jensen
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
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Chen F, Wang F, Bailey CE, Murff HJ, Berlin JD, Shu XO, Zheng W. Evaluation of determinants for age disparities in the survival improvement of colon cancer: results from a cohort of more than 486,000 patients in the United States. Am J Cancer Res 2020; 10:3395-3405. [PMID: 33163278 PMCID: PMC7642646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023] Open
Abstract
Over the past two decades, elderly colon cancer patients experienced less improvement in survival than their younger counterparts, yet the contributing factors remain unknown. We aimed to evaluate factors that may contribute to the age disparity of survival improvement among patients with colon cancer. Using data from the National Cancer Database, we identified patients diagnosed with colon cancer between 2004 and 2012 with follow-up data up to 2017. The hazard ratios (HR) and 95% confidence intervals (CI) for 5-year OS associated with study variables were estimated using multivariable Cox regression. Among 486,284 patients included in this study, elderly patients (aged ≥75) had a lower adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines (% of non-adherence: 45.3%) than younger patients (aged <50, 19.3%; P<0.001). After adjusting for demographics, access to care and clinical characteristics, compared with patients diagnosed between 2004 and 2006, younger and older patients diagnosed between 2010 and 2012 experienced 16% (HR: 0.84, 95% CI: 0.81-0.88) and 6% (HR: 0.94, 95% CI: 0.93-0.95) reductions in mortality (P for interaction=1.42×10-5), respectively. After an additional adjustment for guideline adherence status, no significant difference in the improvement of survival was noted (P for interaction=0.17). The association patterns were similar regardless of tumor stage, race, and high comorbidity scores (all P for interaction>0.05). Several patient-related factors were identified in association with noncompliance to NCCN guidelines, including comorbidity status. However, over 60% of noncompliance elderly patients had a Charlson comorbidity score of 0. The observed age disparity in survival improvement among colon cancer patients was primarily explained by a slower improvement in adherence to NCCN treatment guidelines in elderly than younger patients. Many older adults were not receiving recommended therapies despite minimal comorbidities. Our findings call for measures to increase adherence to treatment guidelines among elderly patients to improve survival.
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Affiliation(s)
- Fa Chen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical CenterNashville, Tennessee, USA
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical UniversityFuzhou, Fujian, P. R. China
| | - Fei Wang
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical CenterNashville, Tennessee, USA
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong UniversityJinan, Shandong, P. R. China
| | - Christina E Bailey
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical CenterNashville, Tennessee, USA
| | - Harvey J Murff
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical CenterNashville, Tennessee, USA
| | - Jordan D Berlin
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical CenterNashville, Tennessee, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical CenterNashville, Tennessee, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical CenterNashville, Tennessee, USA
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Wu SY, Lazar AA, Gubens MA, Blakely CM, Gottschalk AR, Jablons DM, Jahan TM, Wang VEH, Dunbar TL, Wong ML, Chan JW, Guthrie W, Belkora J, Yom SS. Evaluation of a National Comprehensive Cancer Network Guidelines-Based Decision Support Tool in Patients With Non-Small Cell Lung Cancer: A Nonrandomized Clinical Trial. JAMA Netw Open 2020; 3:e209750. [PMID: 32997124 PMCID: PMC7527870 DOI: 10.1001/jamanetworkopen.2020.9750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE The association of guideline-based decision support with the quality of care in patients with non-small cell lung cancer (NSCLC) is not known. OBJECTIVE To evaluate the association of exposure to the National Comprehensive Cancer Center (NCCN) guidelines with guideline-concordant care and patients' decisional conflict. DESIGN, SETTING, AND PARTICIPANTS A nonrandomized clinical trial, conducted at a tertiary care academic institution, enrolled patients from February 23, 2015, to September 28, 2017. Data analysis was conducted from July 19, 2019, to April 22, 2020. A cohort of 76 patients with NSCLC seen at diagnosis or disease progression and a retrospective cohort of 157 patients treated before the trial were included. Adherence to 6 NCCN recommendations were evaluated: (1) smoking cessation counseling, (2) adjuvant chemotherapy for patients with stage IB to IIB NSCLC after surgery, (3) pathologic mediastinal staging in patients with stage III NSCLC before surgery, (4) pathologic mediastinal staging in patients with stage III NSCLC before nonsurgical treatment, (5) definitive chemoradiotherapy for patients with stage III NSCLC not having surgery, and (6) molecular testing for epidermal growth factor receptor and anaplastic lymphoma kinase alterations for patients with stage IV NSCLC. Subgroup analysis was conducted to compare the rates of guideline concordance between the prospective and retrospective cohorts. Secondary end points included decisional conflict and satisfaction. INTERVENTIONS An online tool customizing the NCCN guidelines to patients' clinical and pathologic features was used during consultation, facilitated by a trained coordinator. MAIN OUTCOMES AND MEASURES Concordance of practice with 6 NCCN treatment recommendations on NSCLC and patients' decisional conflict. RESULTS Of the 76 patients with NSCLC, 44 were men (57.9%), median age at diagnosis was 68 years (interquartile range [IQR], 41-87 years), and 59 patients (77.6%) had adenocarcinoma. In the retrospective cohort, 91 of 157 patients (58.0%) were men, median age at diagnosis was 66 years (IQR, 61-65 years), and 105 patients (66.9%) had adenocarcinoma. After the intervention, patients received more smoking cessation counseling (4 of 5 [80.0%] vs 1 of 24 [4.2%], P < .001) and less adjuvant chemotherapy (0 of 7 vs 7 of 11 [63.6%]; P = .012). There was no significant change in mutation testing of non-squamous cell stage IV disease (20 of 20 [100%] vs 48 of 57 [84.2%]; P = .10). There was no significant change in pathologic mediastinal staging or initial chemoradiotherapy for patients with stage III disease. After consultation with the tool, decisional conflict scores improved by a median of 20 points (IQR, 3-34; P < .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that exposure to the NCCN guidelines is associated with increased guideline-concordant care for 2 of 6 preselected recommendations and improvement in decisional conflict. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03982459.
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Affiliation(s)
- Susan Y. Wu
- Department of Radiation Oncology, University of California, San Francisco
| | - Ann A. Lazar
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Matthew A. Gubens
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
| | - Collin M. Blakely
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
| | | | | | - Thierry M. Jahan
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
| | - Victoria E. H. Wang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
| | - Taylor L. Dunbar
- Department of Radiation Oncology, University of California, San Francisco
| | - Melisa L. Wong
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
| | - Jason W. Chan
- Department of Radiation Oncology, University of California, San Francisco
| | | | - Jeff Belkora
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Sue S. Yom
- Department of Radiation Oncology, University of California, San Francisco
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Patel SH, Ebrahimi S, Northfelt DW, Mathews TE, Omar FM, Martinez ED, DeWees TA, Okamoto JM. Understanding American Indian Perceptions Toward Radiation Therapy. Cancer Control 2020; 27:1073274820945991. [PMID: 32735143 PMCID: PMC7658722 DOI: 10.1177/1073274820945991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022] Open
Abstract
Many American Indian (AI) and Alaska native (AN) patients do not complete guideline-concordant cancer care for the 4 most common cancers. Our aim was to better understand AI/AN attitudes toward radiation therapy (RT). Patients eligible for this survey study were AI/AN patients with cancer at the Phoenix Indian Medical Center who either received previous RT or were recommended to receive RT. An 18-item questionnaire was administered to each of the 50 participants from October 1, 2018, through February 15, 2019. Willingness to travel for RT was compared to respondent characteristics, concerns regarding RT, and obstacles to obtain RT. Duration of RT was important to 78% of patients: 24% would consider traveling 25 miles or more for a standard course, and 48% would travel that distance for a shorter course (P < .001). The top-ranked barriers to RT were transportation, cost of treatment, and insurance compatibility. The top-ranked concerns about RT were adverse effects, cost of treatment, and fear of RT. Concerns about adverse effects were associated with the radiation team's inability to explain the treatment (P = .05). Transportation concerns were significantly associated with accessibility (P = .02), communication with the RT team (P = .02), and fear of RT (P = .04). AI/AN patients are concerned about the adverse effects of RT and the logistics of treatment, particularly costs, transportation, and insurance compatibility. Use of culturally specific education and hypofractionation regimens may increase acceptance of RT for AI/AN patients with cancer, and this hypothesis will be tested in a future educational intervention-based study.
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Affiliation(s)
- Samir H. Patel
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Sasha Ebrahimi
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Donald W. Northfelt
- Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Timothy E. Mathews
- Oncology Center of Excellence, Phoenix Indian Medical Center, Phoenix, AZ, USA
| | - Farhia M. Omar
- Office of Health Disparities Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Erika D. Martinez
- Office of Health Disparities Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Todd A. DeWees
- Health Services Research, Mayo Clinic Scottsdale, AZ, USA
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Deuker M, Knipper S, Pecoraro A, Palumbo C, Rosiello G, Luzzago S, Tian Z, Saad F, Chun F, Karakiewicz PI. Prostate cancer characteristics and cancer-specific mortality of Native American patients. Prostate Cancer Prostatic Dis 2019; 23:277-285. [PMID: 31695139 DOI: 10.1038/s41391-019-0184-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/05/2019] [Accepted: 10/23/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Historical epidemiological data indicate that Native American patients may have worse prostate cancer (PCa) characteristics than Caucasian patients (CAP). To test for cancer-specific mortality (CSM) differences among Native American vs. CAP, the most contemporary version of the SEER database (Surveillance, Epidemiology, and End Results database [2004-2016]) was used. METHODS Descriptives and time trend analyses focused on a combined cohort of 357,289 Caucasian and Native American PCa patients of all stages. After 1:4 propensity-score (PS) matching for stage, grade, and other patient characteristics, cumulative incidence plots, and competing-risks-regression-models (CRR) were used, with further stratification according to non-metastatic (TanyN0M0) vs. metastatic (TanyN1 and/or M1) stages. RESULTS Native American patients accounted for 1804 (0.5%) of the study cohort. Native American patients had higher PSA (8 ng/ml vs. 6.3 ng/ml), higher rate of D'Amico high-risk PCa (30.8 vs. 24.8%), higher rate of T3/T4-PCa (5.5 vs. 3.7%), higher rate of N1 stage (4.5 vs. 2.8%), and higher rate of M1 stage (7.5 vs. 3.9%, all p < 0.001) than CAP. In TanyN0M0 patients after PS-matching, 10-year CSM was 5.7 vs. 6.2% in Native American vs. CAP. In TanyN1 and/or M1 patients, 10-year CSM was 64.3 vs. 63.3% in Native American vs. CAP, (both p = 0.8). In CRR, Native American race did not represent an independent predictor of CSM. CONCLUSIONS Native American patients have more unfavorable stage and grade at presentation. However, after adjustment for these characteristics, CSM in Native American patients is not higher than in CAP. In consequence, PCa prognosis does not differ between Native American and Caucasian race. Therefore, efforts should be made to diagnose PCa in Native Americans at an earlier and more favorable stage like in CAP.
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Affiliation(s)
- Marina Deuker
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. .,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
| | - Sophie Knipper
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.,Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.,Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.,Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Luzzago
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.,European Institute of Oncology, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Felix Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
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Conway AA, Gerry JM, Sacco F, Wren SM. High Prevalence of Adenomatous Polyps in Alaska Native People Aged 40-49 years. J Surg Res 2019; 243:524-530. [PMID: 31377493 DOI: 10.1016/j.jss.2019.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/02/2019] [Accepted: 07/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although colorectal cancer occurs earlier in life and at twice the frequency in Alaska Native (AN) people compared with the general population, the colorectal polyp burden in this group has not been quantified. In addition, an appropriate age for initial screening in ANs has not been defined. MATERIALS AND METHODS A retrospective chart review of 766 AN people who had screening colonoscopy from 2015 to 2016 was performed. The polyp burden in patients aged 40-49 y was compared with that in those aged 50-59 y in both the AN and the general US populations. RESULTS In total, 345 adenomas were removed: 121 (35%) from 40- to 49-year-olds and 224 (65%) from 50- to 59-year-olds. Twenty-six percent of AN people aged 40 y to 49 y and 40% of AN people aged 50 to 59 y had at least one adenoma. Low- and high-risk adenomas were significantly less frequent in the younger group (22% versus 29%, P = 0.048; 9.2% versus 15%, P = 0.035; respectively). Advanced adenomas were also less frequent in the younger group, although not statistically significant. Polyp histology, size, location, and morphology did not differ significantly between groups. CONCLUSIONS The adenoma and advanced adenoma prevalence in 40- to 49-year-old AN people is high, suggesting colorectal cancer screening should begin at age 40 y in ANs.
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Affiliation(s)
- Alison A Conway
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Jon M Gerry
- Department of Surgery, Alaska Native Medical Center, Anchorage, Alaska
| | - Frank Sacco
- Department of Surgery, Alaska Native Medical Center, Anchorage, Alaska
| | - Sherry M Wren
- Department of Surgery, Stanford University School of Medicine, Stanford, California; Department of Surgery, Palo Alto Veterans Health Care System, Palo Alto, California.
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Burnette CE, Roh S, Liddell J, Lee YS. American Indian Women Cancer Survivor's Needs and Preferences: Community Support for Cancer Experiences. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:592-599. [PMID: 29546486 PMCID: PMC6139076 DOI: 10.1007/s13187-018-1346-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Cancer (the focus of this inquiry) is the leading cause of death among American Indian and Alaska Native women. The purpose of this study was to identify American Indian women cancer survivors' needs and preferences related to community supports for their cancer experience. This qualitative study examined female American Indian cancer survivors' needs and preferences about community support. The sample included 43 American Indian women cancer survivors (the types of cancer survivors included cervical cancer: n = 14; breast cancer: n = 14; and colon and other types: n = 15) residing in the Northern Plains region, in the state of South Dakota. Data were analyzed using qualitative content analysis and were collected between June of 2014 and February of 2015. When asked about their needs and preferences, 82% of participants (n = 35) of female American Indian cancer survivors reported at least one of the following most commonly reported themes: cancer support groups (n = 31, 72%), infrastructure for community support (n = 17, 40%), and cancer education (n = 11, 26%). In addition to the aforementioned themes, 33% of participants (n = 14) indicated the need for an improved healthcare system, with 11% (n = 5) of participants expressly desiring the integration of spirituality and holistic healing options. The majority of American Indian women cancer survivor participants of this study identified a need for more community-based support systems and infrastructures to aid with the cancer survivor experience. Results warrant a community approach to raise awareness, education, and support for American Indian cancer survivors.
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Affiliation(s)
- Catherine E. Burnette
- School of Social Work, Tulane University, 127 Elk Place, #8906, New Orleans, LA 70112, USA
| | - Soonhee Roh
- Department of Social Work, 365 Health Science Center, University of South Dakota, 1400 West 22nd Street, Sioux Falls, SD 57105, USA
| | - Jessica Liddell
- School of Social Work, Tulane University, 127 Elk Place, #8906, New Orleans, LA 70112, USA
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, USA
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Ho-Huynh A, Tran A, Bray G, Abbot S, Elston T, Gunnarsson R, de Costa A. Factors influencing breast cancer outcomes in Australia: A systematic review. Eur J Cancer Care (Engl) 2019; 28:e13038. [PMID: 30919536 DOI: 10.1111/ecc.13038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/18/2019] [Accepted: 03/03/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE This systematic review evaluates factors influencing breast cancer outcomes for women treated in Australia, facilitating the exploration of disparities in breast cancer outcomes for certain groups of women in Australia. METHOD A systematic literature search was performed using MEDLINE and Scopus focusing on breast cancer in Australia with outcome measures being breast cancer survival and recurrence with no restrictions on date. Risk of bias was assessed using Cairns Assessment Scale for Observational studies of Risk factors (CASOR). RESULTS Fifteen quantitative studies were included: two were high quality, 11 were intermediate quality, and two were low quality. Traditional risk factors such as invasive tumour type, larger size, higher grade and stage, lymph node involvement and absence of hormone receptors were found to be associated with breast cancer mortality. Being younger (<40 years old) and older (>70 years old), having more comorbidities, being of lower socioeconomic status, identifying as Aboriginal or Torres Strait Islander, living in more rural areas or having a mastectomy were factors found to be associated with poorer breast cancer outcomes. CONCLUSION Despite the heterogeneity of the studies, this review identified significant risk factors for breast cancer mortality and recurrence. The use of this data would be most useful in developing evidence-based interventions and in optimising patient care through creation of a prediction model. PROSPERO REGISTRATION CRD42017072857.
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Affiliation(s)
- Albert Ho-Huynh
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Alex Tran
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Gerard Bray
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Samuel Abbot
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Timothy Elston
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Ronny Gunnarsson
- Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Alan de Costa
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Toubat O, Farias AJ, Atay SM, McFadden PM, Kim AW, David EA. Disparities in the surgical management of early stage non-small cell lung cancer: how far have we come? J Thorac Dis 2019; 11:S596-S611. [PMID: 31032078 DOI: 10.21037/jtd.2019.01.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
It is currently estimated that nearly one-third of patients with newly diagnosed non-small cell lung cancer (NSCLC) have stage I-II disease on clinical evaluation. Curative-intent surgical resection has been a cornerstone of the therapeutic management of such patients, offering the best clinical and oncologic outcomes in the long-term. In 1999, Peter Bach and colleagues brought attention to racial disparities in the receipt of curative-intent surgery in the NSCLC population. In the time since this seminal study, there is accumulating evidence to suggest that disparities in the receipt of definitive surgery continue to persist for patients with early stage NSCLC. In this review, we sought to provide an up-to-date assessment of 20 years of surgical disparities literature in the NSCLC population. We summarized common and unrecognized disparities in the receipt of surgical resection for early stage NSCLC and demonstrated that demographic and socioeconomic factors such as race/ethnicity, special patient groups, income and insurance continue to impact the receipt of definitive resection. Additionally, we found that discrepancies in patient and provider perceptions of and attitudes toward surgery, access to invasive staging, distance to treatment centers and negative stigmas about lung cancer that patients experience may act to perpetuate disparities in surgical treatment of early stage lung cancer.
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Affiliation(s)
- Omar Toubat
- Keck School of Medicine of USC, Los Angeles, CA, USA.,Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Scott M Atay
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - P Michael McFadden
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth A David
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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Delavar A, Feng Q, Johnson KJ. Rural/urban residence and childhood and adolescent cancer survival in the United States. Cancer 2018; 125:261-268. [PMID: 30311635 DOI: 10.1002/cncr.31704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND To the authors' knowledge, no previous study has examined the relationship between rural/urban residence and childhood or adolescent cancer survival in the United States. Using the Surveillance, Epidemiology, and End Results 18 registries database, the authors examined childhood and adolescent cancer survival by rural/urban residence as defined by Rural-Urban Continuum Codes (RUCCs). METHODS The authors obtained data from Surveillance, Epidemiology, and End Results 18 registries for individuals diagnosed at ages birth to 19 years with a first primary malignant cancer from 2000 through 2010. Rural/urban residence at the time of diagnosis was defined using both metropolitan/nonmetropolitan county classifications and individual RUCC categories. Cox proportional hazards regression was used to compute adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association between rural/urban residence and cancer survival. The authors also examined effect modification by age group, sex, race/ethnicity, and cancer type. RESULTS Among 41,879 cancer cases, approximately 54.7% were non-Hispanic white, 54.3% were male, and 90.4% lived in a metropolitan county. Individuals living in nonmetropolitan counties versus metropolitan counties had a similar risk of cancer death (HR, 1.03; 95% CI, 0.94-1.13) as did those living in nonmetropolitan rural counties with <2500 individuals nonadjacent to a metropolitan area versus those living in metropolitan counties of ≥1 million individuals (HR, 0.98; 95% CI, 0.71-1.37). Evidence for effect modification largely was absent. CONCLUSIONS The results of the current study suggest that childhood and adolescent cancer survival in the United States does not vary by rural/urban residence at the time of diagnosis as defined by RUCCs. The widespread availability of public health insurance for children and adolescents and a nationwide network of pediatric cancer providers may explain this finding.
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Affiliation(s)
- Arash Delavar
- Master of Public Health Program, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Qianxi Feng
- Master of Public Health Program, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Kimberly J Johnson
- Master of Public Health Program, Brown School, Washington University in St. Louis, St. Louis, Missouri.,Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
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Liddell JL, Burnette CE, Roh S, Lee YS. Healthcare barriers and supports for American Indian women with cancer. SOCIAL WORK IN HEALTH CARE 2018; 57:656-673. [PMID: 29775173 PMCID: PMC6108540 DOI: 10.1080/00981389.2018.1474837] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Although American Indian (AI) women continue to experience cancer at higher rates and have not seen the same decline in cancer prevalence as the general U.S. population, little research examines how interactions with health care providers may influence and exacerbate these health disparities. The purpose of the study was to understand the experiences of AI women who receive cancer treatment, which is integral for eradication of AI cancer disparities among women. A qualitative descriptive methodology was used with a sample of 43 AI women with breast, cervical, colon, and other types of cancer from the Northern Plains region of South Dakota. Interviews were conducted from June 2014 to February 2015. Qualitative content analysis revealed that women experienced: (a) health concerns being ignored or overlooked; (b) lack of consistent and qualified providers; (c) inadequate healthcare infrastructure; (d) sub-optimal patient-healthcare provider relationships; (e) positive experiences with healthcare providers; and (f) pressure and misinformation about treatment. Results indicate the types of support AI women may need when accessing healthcare. Culturally informed trainings for healthcare professionals may be needed to provide high-quality and sensitive care for AI women who have cancer, and to support those providers already providing proper care.
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Affiliation(s)
- Jessica L. Liddell
- City, Community and Culture PhD Program, School of Social Work, Tulane University, New Orleans, LA, USA
| | | | - Soonhee Roh
- Department of Social Work, University of South Dakota, Sioux Falls, SD, USA
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, CA, USA
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Improving cancer care for American Indians with cervical cancer in the Indian Health Service (IHS) system - Navigation may not be enough. Gynecol Oncol 2018; 149:89-92. [PMID: 29605056 DOI: 10.1016/j.ygyno.2017.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/10/2017] [Accepted: 10/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patient navigation programs have been shown to positively impact cancer outcomes for minority populations. Little is known regarding the effects of these programs on American Indian (AI) populations. The purpose of this study is to characterize the impact of a patient navigation program on AI cervical cancer patients at a tertiary care center. METHODS A retrospective review of all AI cervical cancer patients receiving navigation services and a cohort of AI patients treated prior to navigation services was performed. Additional comparisons were made between those with and without Indian Health Service (IHS) funding. Summary statistics were used to describe demographic, clinical characteristics, treatment, and survivorship across groups. RESULTS Of 55 patients identified, 34 received navigation and 21 did not. In navigated patients, median age was 46years (27-80years) compared with 42years (17-68years) in pre-navigation patients (p=0.53). There was no difference between stage at diagnosis (p=0.73). No difference was noted in treatment received between groups (p=0.48). Distance traveled for treatment between groups did not differ (p=0.46). Median time to initiation of treatment was not different between groups, 30.5days vs. 27.5days (p=0.18). Among patients with IHS funding, navigation services did not alter time to initiation of treatment (p=0.57), and there was no difference in completion of prescribed therapy between groups (92% navigated vs 100% pre-navigation). CONCLUSIONS Navigation services for AI cervical cancer patients did not alter initiation or completion of treatment. Navigation programs may provide less tangible benefits to AI cervical cancer patients and further study is warranted.
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Prieto D, Soto-Ferrari M, Tija R, Peña L, Burke L, Miller L, Berndt K, Hill B, Haghsenas J, Maltz E, White E, Atwood M, Norman E. Literature review of data-based models for identification of factors associated with racial disparities in breast cancer mortality. Health Syst (Basingstoke) 2018; 8:75-98. [PMID: 31275571 PMCID: PMC6598506 DOI: 10.1080/20476965.2018.1440925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 01/03/2023] Open
Abstract
In the United States, early detection methods have contributed to the reduction of overall breast cancer mortality but this pattern has not been observed uniformly across all racial groups. A vast body of research literature shows a set of health care, socio-economic, biological, physical, and behavioural factors influencing the mortality disparity. In this paper, we review the modelling frameworks, statistical tests, and databases used in understanding influential factors, and we discuss the factors documented in the modelling literature. Our findings suggest that disparities research relies on conventional modelling and statistical tools for quantitative analysis, and there exist opportunities to implement data-based modelling frameworks for (1) exploring mechanisms triggering disparities, (2) increasing the collection of behavioural data, and (3) monitoring factors associated with the mortality disparity across time.
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Affiliation(s)
- Diana Prieto
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - Milton Soto-Ferrari
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Department of Marketing and Operations, Scott College of Business, Terre Haute, IN, USA
| | - Rindy Tija
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Lorena Peña
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Leandra Burke
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Lisa Miller
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Kelsey Berndt
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Brian Hill
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jafar Haghsenas
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Ethan Maltz
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Evan White
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Maggie Atwood
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Earl Norman
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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McClelland S, Leberknight J, Guadagnolo BA, Coleman CN, Petereit DG. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 2: American Indian patients. Adv Radiat Oncol 2018; 3:3-7. [PMID: 29556572 PMCID: PMC5856975 DOI: 10.1016/j.adro.2017.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION American Indian/Alaska Native (AI/AN) patients with cancer disproportionally present with more advanced stages of disease and have the worst cancer-specific survival rates of any racial/ethnic group in the United States. The presence of disparities in radiation therapy (RT) access for AI/AN patients has rarely been examined. METHODS AND MATERIALS National Cancer Institute (NCI) initiatives toward addressing AI/AN disparities were examined. Additionally, an extensive PubMed literature search for studies investigating RT access disparities in AI/AN patients was performed. RESULTS Literature describing RT access disparities for the AI/AN patient population is sparse, revealing only 3 studies, each of which described initiatives from the Walking Forward program, the NCI Cancer Disparity Research Partnership initiative to address barriers to cancer screening among AI populations in the Northern Plains region (eg, geographic remoteness and mistrust of health care providers). This program has used patient navigation, community education, and access to clinical trials for more than 4000 AI/AN patients to combat high cancer mortality rates. Over the course of its 15-year existence, the program has resulted in patients presenting with earlier stages of disease and experiencing higher cure rates. Lung cancer, the most common cause of cancer-related mortality in AI/AN patients, is the most recent and ongoing focus of the program. CONCLUSION The amount of information regarding RT access in AI/AN patients is limited, with nearly all peer-reviewed published progress in this area being associated with the Walking Forward program. Further initiatives from this program will hopefully inspire similar initiatives throughout the country to reduce the barriers to optimized cancer care that these patients face. Given the similarities with cancer disparities of populations worldwide, the AI/AN experience should be included within the broad issue of a global shortage of cancer care among underserved populations.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - B. Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Daniel G. Petereit
- Walking Forward Program, Rapid City, South Dakota
- International Cancer Expert Corps, Washington, DC
- Rapid City Regional Cancer Care Institute, Rapid City, South Dakota
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Guadagnolo BA, Petereit DG, Coleman CN. Cancer Care Access and Outcomes for American Indian Populations in the United States: Challenges and Models for Progress. Semin Radiat Oncol 2017; 27:143-149. [PMID: 28325240 PMCID: PMC5363281 DOI: 10.1016/j.semradonc.2016.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Low socioeconomic and health care access realities of being American Indian/Alaskan Native (AI/AN) in the United States combined with decades of data documenting poor cancer outcomes for this population provide a population nested within the United States that is analogous to the cancer care landscape of low- and middle-income countries internationally. We reviewed the medical literature with respect to cancer prevention, access to cancer treatment, and access to effective supportive and palliative care for AI/AN populations in the United States. Research confirms poorer cancer outcomes, suboptimal cancer screening, and high-risk cancer behaviors among AI/AN communities. AI/AN cancer patients are less likely to undergo recommended cancer surgeries, adjuvant chemotherapy, and radiation therapy than their White counterparts. Studies including both rural and urban survivors with AI cancer revealed barriers to receipt of optimal cancer symptom management and proportionally lower hospice use among AI/AN populations. Culturally tailored programs in targeted communities have been shown to mitigate the observed cancer-related health disparities among AI/AN communities. There is still much work to be done to improve cancer-related health outcomes in AI/AN communities, and the goals of the providers serving them corresponds with those propelling the growing interest in global oncology equity. Policy work and more funding are needed to continue to build upon the work that the Indian Health Service and established cancer-related health programs have begun in AI/AN communities.
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Affiliation(s)
- B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
| | | | - C Norman Coleman
- International Cancer Expert Corps, New York, NY; Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
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45
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Ginsburg O, Bray F, Coleman MP, Vanderpuye V, Eniu A, Kotha SR, Sarker M, Huong TT, Allemani C, Dvaladze A, Gralow J, Yeates K, Taylor C, Oomman N, Krishnan S, Sullivan R, Kombe D, Blas MM, Parham G, Kassami N, Conteh L. The global burden of women's cancers: a grand challenge in global health. Lancet 2017; 389:847-860. [PMID: 27814965 PMCID: PMC6191029 DOI: 10.1016/s0140-6736(16)31392-7] [Citation(s) in RCA: 574] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 07/19/2016] [Accepted: 08/05/2016] [Indexed: 12/15/2022]
Abstract
Every year, more than 2 million women worldwide are diagnosed with breast or cervical cancer, yet where a woman lives, her socioeconomic status, and agency largely determines whether she will develop one of these cancers and will ultimately survive. In regions with scarce resources, fragile or fragmented health systems, cancer contributes to the cycle of poverty. Proven and cost-effective interventions are available for both these common cancers, yet for so many women access to these is beyond reach. These inequities highlight the urgent need in low-income and middle-income countries for sustainable investments in the entire continuum of cancer control, from prevention to palliative care, and in the development of high-quality population-based cancer registries. In this first paper of the Series on health, equity, and women's cancers, we describe the burden of breast and cervical cancer, with an emphasis on global and regional trends in incidence, mortality, and survival, and the consequences, especially in socioeconomically disadvantaged women in different settings.
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Affiliation(s)
- Ophira Ginsburg
- Women's College Research Institute, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; World Health Organization, Geneva, Switzerland.
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Verna Vanderpuye
- National Center for Radiotherapy, Korlebu Teaching Hospital, Accra, Ghana
| | | | - S Rani Kotha
- Institute for Global Health Equity and Innovation, University of Toronto, Toronto, ON, Canada
| | - Malabika Sarker
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Tran Thanh Huong
- Hanoi Medical University and National Institute for Cancer Control, Hanoi, Vietnam
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Allison Dvaladze
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Centre, University of Washington, Seattle, WA, USA
| | - Julie Gralow
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Centre, University of Washington, Seattle, WA, USA
| | - Karen Yeates
- Queen's University Faculty of Health Sciences, Office of Global Health, Queen's University, Kingston, ON, Canada
| | | | - Nandini Oomman
- Independent Global Health Specialist, Washington, DC, USA
| | - Suneeta Krishnan
- Research Triangle Institute Global India Pvt Ltd, New Delhi, India; St John's Research Institute, Bengarulu, India
| | - Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, UK
| | | | - Magaly M Blas
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Groesbeck Parham
- Department of Obstetrics and Gynecology University of North Carolina, Chapel Hill, NC, USA; University of Zambia, Lusaka, Zambia
| | - Natasha Kassami
- Health Economics Group, School of Public Health, Imperial College London, London, UK
| | - Lesong Conteh
- Health Economics Group, School of Public Health, Imperial College London, London, UK
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Dasgupta P, Baade P, Youlden D, Garvey G, Aitken J, Wallington I, Chynoweth J, Zorbas H, Roder D, Youl P. Variations in outcomes for Indigenous women with breast cancer in Australia: A systematic review. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12662] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2016] [Indexed: 02/06/2023]
Affiliation(s)
- P. Dasgupta
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
| | - P.D. Baade
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- School of Mathematical Sciences; Queensland University of Technology; Brisbane QLD Australia
- Menzies Health Institute Queensland; Griffith University; Southport QLD Australia
| | - D.R. Youlden
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
| | - G. Garvey
- Menzies School of Health Research; Charles Darwin University; Brisbane Queensland Australia
| | - J.F. Aitken
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- School of Public Health and Social Work; Queensland University of Technology; Kelvin Grove Queensland Australia
- School of Population Health; University of Queensland; Brisbane Australia
- Institute for Resilient Regions; University of Southern Queensland; Toowoomba Australia
| | | | - J. Chynoweth
- Cancer Australia; Sydney New South Wales Australia
| | - H. Zorbas
- Cancer Australia; Sydney New South Wales Australia
| | - D. Roder
- Centre for Population Health Research; Samson Institute; University of South Australia; Adelaide SA Australia
| | - P.H. Youl
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University; Southport QLD Australia
- School of Public Health and Social Work; Queensland University of Technology; Kelvin Grove Queensland Australia
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47
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Rodin D, Longo J, Sherertz T, Shah MM, Balagun O, Wendling N, Van Dyk J, Coleman CN, Xu MJ, Grover S. Mobilising Expertise and Resources to Close the Radiotherapy Gap in Cancer Care. Clin Oncol (R Coll Radiol) 2016; 29:135-140. [PMID: 27955997 DOI: 10.1016/j.clon.2016.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
Closing the gap in cancer care within low- and middle-income countries and in indigenous and geographically isolated populations in high-income countries requires investment and innovation. This is particularly true for radiotherapy, for which the global disparity is one of the largest in healthcare today. New models and paradigms and non-traditional collaborations have been proposed to improve global equity in cancer control. We describe recent initiatives from within the radiation oncology community to increase access to treatment, build the low- and middle-income countries' radiation oncology workforce, mobilise more professionals from within high-income countries and raise awareness of the global need for equitable cancer care.
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Affiliation(s)
- D Rodin
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - J Longo
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - T Sherertz
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - M M Shah
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - O Balagun
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Cornell University Medical School, New York, New York, USA
| | - N Wendling
- International Cancer Expert Corps (ICEC), New York, New York, USA
| | - J Van Dyk
- International Cancer Expert Corps (ICEC), New York, New York, USA; Departments of Oncology and Medical Biophysics, Western University, London, Ontario, Canada; Medical Physics for World Benefit (MPWB), Canada
| | - C N Coleman
- International Cancer Expert Corps (ICEC), New York, New York, USA
| | - M J Xu
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - S Grover
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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48
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Harris R, Van Dyke ER, Ton TGN, Nass CA, Buchwald D. Assessing Needs for Cancer Education and Support in American Indian and Alaska Native Communities in the Northwestern United States. Health Promot Pract 2016; 17:891-898. [PMID: 26507742 DOI: 10.1177/1524839915611869] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
American Indians and Alaska Natives (AI/ANs) experience significant cancer disparities. To inform future public health efforts, a web-based needs assessment survey collected quantitative and qualitative data from AI/AN community health workers and cancer survivors in the northwestern United States. Content analysis of qualitative responses identified themes to contextualize quantitative results. Seventy-six AI/AN respondents (93% female) described substantial unmet needs for education and resources to assist cancer survivors, including a shortage of patient navigators, support groups, and home health care workers. Fear of negative outcomes, a culturally rooted avoidance of discussing illness, and transportation difficulties were cited as major barriers to participation in cancer education and receipt of health services. Face-to-face contact was overwhelmingly preferred for community education and support, but many respondents were receptive to other communication channels, including e-mail, social media, and webinars. Survey results highlight the importance of culturally sensitive approaches to overcome barriers to cancer screening and education in AI/AN communities. Qualitative analysis revealed a widespread perception among respondents that available financial and human resources were insufficient to support AI/AN cancer patients' needs.
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Affiliation(s)
| | | | | | | | - Dedra Buchwald
- College of Medical Sciences, Washington State University, Seattle, WA
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Morris AM, Doorenbos AZ, Haozous E, Meins A, Javid S, Flum DR. Perceptions of cancer treatment decision making among American Indians/Alaska Natives and their physicians. Psychooncology 2016; 25:1050-6. [PMID: 27279001 PMCID: PMC5014590 DOI: 10.1002/pon.4191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/03/2016] [Accepted: 06/06/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE American Indian/Alaska Native (AI/AN) patients are significantly less likely than non-Hispanic whites to receive guideline-concordant cancer care. Our objective was to examine cancer treatment decision making among AI/AN patients and their providers. METHODS From 2011 to 2014, AI/AN cancer patients and their surgeons were identified through a hospital registry in Washington State. Patients were invited to participate in a mailed survey that queried socio-demographics, cultural affiliation, everyday perceived discrimination, and trust in providers. Both patients and surgeons were queried about decision-making quality (collaboration and satisfaction). The primary outcome was association between patient and provider assessments of decision-making quality. The secondary outcome was non-adherence to treatment. RESULTS Forty-nine patients (62% response rate) and 14 surgeons (37% response rate) returned surveys. Half of patients had not completed high school; 41% were living in poverty. Half of patients reported a strong tribal affiliation and most reported experiencing some form of discrimination. Patients endorsed high trust in surgeons and a high quality decision-making process; and surgeons' rated decision-making quality even more highly than patients did in every domain. Non-adherence to treatment recommendations was common (26%) and was significantly associated with lower patient-reported collaboration and satisfaction with decision making. CONCLUSIONS Given the importance of adherence to cancer treatment for survival, the many non-clinical reasons for non-adherence, and the currently demonstrated association between decision-making quality and adherence, it would be worthwhile to investigate how to increase AI/AN patient satisfaction with decision making and whether improving satisfaction yields improved adherence to the cancer treatment plan. Copyright © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Arden M Morris
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Ardith Z Doorenbos
- University of Washington School of Nursing, Department of Biobehavioral Nursing and Health Systems, Seattle, WA, USA
| | - Emily Haozous
- University of New Mexico College of Nursing, Albuquerque, NM, USA
| | - Alexa Meins
- University of Washington School of Nursing, Department of Biobehavioral Nursing and Health Systems, Seattle, WA, USA
| | - Sara Javid
- University of Washington, School of Medicine Department of Surgery, Seattle, WA, USA
| | - David R Flum
- University of Washington, School of Medicine Department of Surgery, Seattle, WA, USA
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50
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Chen YW, Muralidhar V, Mahal BA, Nezolosky MD, Beard CJ, Choueiri TK, Hoffman KE, Martin NE, Orio PF, Sweeney CJ, Feng FY, Trinh QD, Nguyen PL. Factors associated with the omission of androgen deprivation therapy in radiation-managed high-risk prostate cancer. Brachytherapy 2016; 15:695-700. [PMID: 27528590 DOI: 10.1016/j.brachy.2016.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/03/2016] [Accepted: 07/08/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Androgen deprivation therapy (ADT) has been shown to improve survival for men with unfavorable-risk prostate cancer (PCa). We investigated the utilization and factors associated with the omission of ADT in radiation-managed high-risk PCa. METHODS AND MATERIALS We used the National Cancer Database to identify men with National Comprehensive Cancer Network high-risk PCa treated with external beam radiation therapy (EBRT) with or without brachytherapy boost from 2004 to 2012. Multivariable logistic regression adjusting for clinical and sociodemographic factors was used to identify independent predictors for ADT use. RESULTS A total of 57,968 radiation-treated high-risk PCa men were included in our analysis. There were 49,363 patients (85.2%) treated with EBRT alone and 8605 patients (14.8%) treated with EBRT plus brachytherapy boost. Overall, 77% of men received ADT. In multivariable regression analysis, the use of brachytherapy boost was associated with a significantly lower utilization of ADT (70% vs. 78%; adjusted odds ratio [AOR]: 0.65; 95% CI: 0.62-0.69; p-Value <0.0001), as was treatment at an academic vs. nonacademic center (AOR: 0.90; 95% CI: 0.86-0.95; p-Value <0.0001) and treatment in 2010-2012 compared to 2004-2006 (AOR: 0.85; 95% CI: 0.81-0.90; p-Value <0.0001). Conversely, greater ADT use was seen with higher Gleason scores, PSA, and T-category (all p-Values <0.001). CONCLUSIONS Approximately one in four men with radiation-managed high-risk PCa do not receive ADT, which may reflect concerns about its toxicity profile despite known improvements in overall survival. Practice patterns suggest that some providers believe dose escalation through brachytherapy boost may obviate the need for ADT in some high-risk patients, but this hypothesis requires further testing.
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Affiliation(s)
- Yu-Wei Chen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Vinayak Muralidhar
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Brandon A Mahal
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michelle D Nezolosky
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Clair J Beard
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Karen E Hoffman
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Neil E Martin
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Peter F Orio
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Christopher J Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Felix Y Feng
- Department of Radiation Oncology, University of California, San Francisco, CA; Department of Urology, University of California, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA
| | - Quoc-Dien Trinh
- Department of Surgery, Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.
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