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Hong JS, Kim A, Layrisse Landaeta V, Patrón R, Foglia C, Saldinger P, Chu DI, Chao SY. Uncommon Sociodemographic Factors Are Associated With Racial Disparities in Length of Stay Following Oncologic Elective Colectomy. J Surg Res 2024; 300:287-297. [PMID: 38833755 DOI: 10.1016/j.jss.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Although outcome disparities by race have been identified in colorectal cancer, these patterns are challenging to explain using variables that are commonly available in databases. In a single institution serving a diverse community, length of stay (LOS) varies by race following elective oncologic colectomy. We investigated previously unexplored variables that may explain the relationship between race and LOS following elective resection of colorectal neoplasms. METHODS Retrospective, single institution cohort study from January 2015 to December 2020 for adult patients undergoing elective colorectal cancer resections. Baseline demographic variables and intraoperative factors were analyzed for changes in LOS following elective colorectal resection. Additional retrospective chart review was carried out to determine household member composition and distance from home to hospital. Bivariate analysis was conducted to determine which variables should be included in multivariable analyses. All analyses were conducted using SAS Academic. RESULTS Most patients (n = 383) were Asian (40%), Black (12%), or Hispanic (26%). Race and LOS were associated with age (P = 0.001 and P < 0.001 for race and LOS, respectively), American Society of Anesthesiologists class (P = 0.004 and P < 0.001), enhanced recovery after surgery protocols (P = 0.006 and P < 0.001), household members (P = 0.009 and P = 0.002), and discharge disposition (P = 0.049 and P < 0.001). In multivariable analysis, household members (P = 0.021) independently remained associated with LOS after controlling for race (P = 0.008) and discharge disposition (P < 0.001). CONCLUSIONS Household member composition varies with LOS, suggesting that level of support at home may influence decisions regarding discharge disposition, which lead to differences in LOS.
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Affiliation(s)
- Julie S Hong
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York.
| | - Angelina Kim
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York
| | | | - Roger Patrón
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Christopher Foglia
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Pierre Saldinger
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Steven Y Chao
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
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Gupta A, Chant ED, Mohile S, Vogel RI, Parsons HM, Blaes AH, Booth CM, Rocque GB, Dusetzina SB, Ganguli I. Health Care Contact Days Among Older Cancer Survivors. JCO Oncol Pract 2024:OP2300590. [PMID: 38452315 DOI: 10.1200/op.23.00590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/10/2023] [Accepted: 12/13/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Health care contact days-days spent receiving health care outside the home-represent an intuitive, practical, and person-centered measure of time consumed by health care. METHODS We linked 2019 Medicare Current Beneficiary Survey and traditional Medicare claims data for community-dwelling older adults with a history of cancer. We identified contact days (ie, spent in a hospital, emergency department, skilled nursing facility, or inpatient hospice or receiving ambulatory care including an office visit, procedure, treatment, imaging, or test) and described patterns of total and ambulatory contact days. Using weighted Poisson regression models, we identified factors associated with contact days. RESULTS We included 1,168 older adults representing 4.51 million cancer survivors (median age, 76.4 years, 52.8% women). The median (IQR) time from cancer diagnosis was 65 (27-126) months. In 2019, these adults had mean (standard deviation) total contact days of 28.4 (27.6) and ambulatory contact days of 24.2 (23.6). These included days for tests (8.0 [8.8]), imaging (3.6 [4.1]), visits with any clinicians (12.4 [11.5]), and visits with primary care clinicians (4.4 [4.7]), and nononcology specialists (7.1 [9.4]) specifically. Sixty-four percent of days with a nonvisit ambulatory service (eg, a test) were not on the same day as a clinician visit. Factors associated with more total contact days included younger age, lower income, more chronic conditions, poor self-rated health, and tendency to "go to doctor as soon as feel bad." CONCLUSION Older adult cancer survivors spent nearly 1 month of the year receiving health care outside the home. This care was largely ambulatory, often delivered by nononcologists, and varied by factors beyond clinical characteristics. These results highlight the need to recognize patient burdens and improve survivorship care delivery, including through care coordination.
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Affiliation(s)
| | - Emma D Chant
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
| | - Supriya Mohile
- Department of Medicine, University of Rochester, Rochester, NY
| | | | | | | | | | | | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Ishani Ganguli
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
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Faro JM, Dressler EV, Kittel C, Beeler DM, Bluethmann SM, Sohl SJ, McDonald AM, Weaver KE, Nightingale C. Availability of cancer survivorship support services across the National Cancer Institute Community Oncology Research Program network. JNCI Cancer Spectr 2024; 8:pkae005. [PMID: 38268476 PMCID: PMC10868389 DOI: 10.1093/jncics/pkae005] [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: 10/17/2023] [Revised: 11/30/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND National cancer organizations recommend provision of nutrition, physical activity, and mental health supportive services to cancer survivors. However, the availability of these services across diverse community oncology settings remains unclear. METHODS The National Cancer Institute Community Oncology Research Program (NCORP) is a national network of community oncology practices engaged in cancer research. The 2022 NCORP Landscape Assessment (5UG1CA189824) assessed individual practices' establishment of survivorship clinics and nutrition, physical activity, and mental health services, resources, and/or referrals. Descriptive statistics summarized and logistic regression quantified the association between services, practice, and patient characteristics. RESULTS Of 46 NCORP community sites, 45 (98%) responded to the survey, representing 259 adult practice groups. A total of 41% had a survivorship clinic; 96% offered mental health, 94% nutrition, and 53% physical activity services, resources, and/or referrals. All 3 services were offered in various formats (eg, in-house, referrals, education) by 51% and in-house only by 25% of practices. Practices with advanced practice providers were more likely to have a survivorship clinic (odds ratio [OR] = 3.19, 95% confidence interval [CI] = 1.04 to 9.76). Practices with at least 30% Medicare patients (OR = 2.54, 95% CI = 1.39 to 4.66) and more oncology providers (OR = 1.02, 95% CI = 1.01 to 1.04) were more likely to have all 3 services in any format. Practices with at least 30% Medicare patients (OR = 3.41, 95% CI = 1.50 to 7.77) and a survivorship clinic (OR = 2.84, 95% CI = 1.57 to 5.14) were more likely to have all 3 services in-house. CONCLUSIONS Larger oncology practices and those caring for more survivors on Medicare provided more supportive services, resources, and/or referrals. Smaller practices and those without survivorship clinics may need strategies to address potential gaps in supportive services.
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Affiliation(s)
- Jamie M Faro
- Department of Population and Quantitative Health Science, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Carol Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Dori M Beeler
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Shirley M Bluethmann
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Stephanie J Sohl
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Andrew M McDonald
- Department of Radiation Oncology, The University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Chandylen Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Communicating is analogous to caring: A systematic review and thematic synthesis of the patient-clinician communication experiences of individuals with ovarian cancer. Palliat Support Care 2022; 21:515-533. [PMID: 35582975 DOI: 10.1017/s1478951522000621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To systematically review and synthesize the patient-clinician communication experiences of individuals with ovarian cancer. METHODS The CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science databases were reviewed for articles that described (a) original qualitative or mixed methods research, (b) the experiences of individuals with ovarian cancer, and (c) findings related to patient-clinician communication. Relevant data were extracted from study results sections, then coded for descriptive and analytical themes in accordance with Thomas and Harden's approach to thematic synthesis. Data were coded by two authors and discrepancies were resolved through discussion. RESULTS Of 1,390 unique articles, 65 met criteria for inclusion. Four descriptive themes captured participants' experiences communicating with clinicians: respecting me, seeing me, supporting me, and advocating for myself. Findings were synthesized into three analytical themes: communication is analogous to caring, communication is essential to personalized care, and communication may mitigate or exacerbate the burden of illness. SIGNIFICANCE OF RESULTS Patient-clinician communication is a process by which individuals with ovarian cancer may engage in self-advocacy and appraise the extent to which they are seen, respected, and supported by clinicians. Strategies to enhance patient-clinician communication in the ovarian cancer care setting may promote patient perceptions of patient-centered care.
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Brown ZJ, Labiner HE, Shen C, Ejaz A, Pawlik TM, Cloyd JM. Impact of care fragmentation on the outcomes of patients receiving neoadjuvant and adjuvant therapy for pancreatic adenocarcinoma. J Surg Oncol 2022; 125:185-193. [PMID: 34599756 PMCID: PMC9113396 DOI: 10.1002/jso.26706] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/25/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Neoadjuvant therapy (NT) is increasingly used for localized pancreatic ductal adenocarcinoma (PDAC). The impact of care fragmentation during NT on the outcomes of patients with PDAC is unknown. METHODS Adult patients with Stage I-III PDAC who received NT and patients who underwent surgery first followed by adjuvant therapy (AT) between 2004 and 2016 were queried from the National Cancer Database. Short- and long-term outcomes were compared between patients who received fragmented care (FC; care provided at >1 hospital) versus integrated care (IC; care at a single institution). RESULTS Among 6522 patients who underwent NT before pancreatectomy, 3755 (57.6%) received FC and 2767 (42.4%) received IC. While patients who received FC had a longer time to initiation of treatment (33.2 vs. 29.7 days, p < 0.001), there was no difference in median overall survival (OS) (26.7 vs. 26.5 months, p = 0.6). Among patients who underwent upfront surgery followed by AT (n = 15 291), patients who received FC had a longer time from diagnosis to undergoing surgery but less time from surgery to AT and no difference in OS (24.0 vs. 24.0 months, p = 0.910). CONCLUSION Although care fragmentation was associated with slightly longer times to initiate and complete treatment among patients with localized PDAC, long-term survival outcomes were similar.
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Affiliation(s)
- Zachary J. Brown
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Hanna E. Labiner
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Chengli Shen
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Aslam Ejaz
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Timothy M. Pawlik
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Jordan M. Cloyd
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
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Mullins MA, Ruterbusch JJ, Clarke P, Uppal S, Cote ML, Wallner LP. Continuity of care and receipt of aggressive end of life care among women dying of ovarian cancer. Gynecol Oncol 2021; 162:148-153. [PMID: 33931242 DOI: 10.1016/j.ygyno.2021.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the association between post-diagnosis continuity of care and receipt of aggressive end of life care among women dying of ovarian cancer. METHODS This retrospective claims analysis included 6680 Medicare beneficiaries over age 66 with ovarian cancer who survived at least one year after diagnosis, had at least 4 outpatient evaluation and management visits and died between 2000 and 2016. We calculated the Bice-Boxerman Continuity of Care Index (COC) for each woman, and split COC into tertiles (high, medium, low). We compared late or no hospice use, >1 emergency department (ED) visit, intensive care unit (ICU) admission, >1 hospitalization, terminal hospitalization, chemotherapy, and invasive and/or life extending procedures among women with high or medium vs. low COC using multivariable adjusted logistic regression. RESULTS In this sample, 49.8% of women received aggressive care in the last month of life. Compared to women with low COC, women with high COC had 66% higher odds of chemotherapy (adjusted OR 1.66 CI 1.23-2.24) in the last two weeks of life. Women with high COC also had 16% greater odds of not enrolling in hospice compared to women with low COC (adjusted OR 1.16 CI 1.01-1.33). COC was not associated with late enrollment in hospice, hospital utilization, or aggressive procedures. CONCLUSIONS COC at the end of life is complicated and may pose unique challenges in providing quality end of life care. Future work exploring the specific facets of continuity associated with quality end of life care is needed.
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Affiliation(s)
- Megan A Mullins
- Center for Improving Patient and Population Health and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States of America.
| | - Julie J Ruterbusch
- Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Philippa Clarke
- Department of Epidemiology and Institute for Social Research, University of Michigan, Ann Arbor, MI, United States of America
| | - Shitanshu Uppal
- Department of Gynecologic Oncology, University of Michigan, Ann Arbor, MI, United States of America
| | - Michele L Cote
- Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Lauren P Wallner
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
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Pinheiro LC, Reshetnyak E, Safford MM, Nanus D, Kern LM. Healthcare fragmentation and cardiovascular risk control among older cancer survivors in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Cancer Surviv 2020; 15:325-332. [PMID: 32901370 PMCID: PMC7937763 DOI: 10.1007/s11764-020-00933-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023]
Abstract
Purpose: Cardiovascular disease (CVD) is the number one cause of death among 5-year cancer survivors. Survivors see many providers and poor coordination may contribute to worse CVD risk factor control. We sought to determine associations between fragmentation and CVD risk factor control among survivors overall and by self-rated health. Methods: We included REGARDS participants aged 66+ years who: 1) had a cancer history; 2) reported diabetes, hypertension or hyperlipidemia; and 3) had continuous Medicare coverage. Twelve month ambulatory care fragmentation was calculated using the Bice-Boxerman Index (BBI). We determined associations between fragmentation and CVD risk factors, defining “control” as fasting glucose <126 mg/dL or non-fasting glucose <200 mg/dL for diabetes; blood pressure <140/90 mm Hg for hypertension; and total cholesterol <240 mg/dL, low-density lipoprotein cholesterol <160 mg/dL, or high-density lipoprotein cholesterol >40 mg/dL for hyperlipidemia. Results: The 1,002 cancer survivors (2+ years since cancer treatment) had mean age of 75 years, 39% were women, and 23% were Black. Among individuals with diabetes (N=225), hypertension (N=660), and hyperlipidemia (N=516), separately, approximately 60% had CVD risk factor control. Overall, more fragmented care was not associated with worse control. However, among cancer survivors with excellent, very good or good health, more fragmentation was associated with a decreased likelihood of diabetes control (OR 0.78, 95% CI 0.61–0.99), adjusting for confounders. Conclusions: More fragmented care was associated with worse glycemic control among cancer survivors with diabetes who reported excellent, very good, or good health. Associations were not observed for control of hypertension or hyperlipidemia. Implications for cancer survivors: Reducing fragmentation may support glucose control among survivors with diabetes.
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Affiliation(s)
- Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 E 70th Street, Box 331, New York, NY, 10065, USA.
| | - Evgeniya Reshetnyak
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 E 70th Street, Box 331, New York, NY, 10065, USA
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 E 70th Street, Box 331, New York, NY, 10065, USA
| | - David Nanus
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lisa M Kern
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 E 70th Street, Box 331, New York, NY, 10065, USA
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