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Nyame YA, Cooperberg MR, Cumberbatch MG, Eggener SE, Etzioni R, Gomez SL, Haiman C, Huang F, Lee CT, Litwin MS, Lyratzopoulos G, Mohler JL, Murphy AB, Pettaway C, Powell IJ, Sasieni P, Schaeffer EM, Shariat SF, Gore JL. Deconstructing, Addressing, and Eliminating Racial and Ethnic Inequities in Prostate Cancer Care. Eur Urol 2022; 82:341-351. [PMID: 35367082 DOI: 10.1016/j.eururo.2022.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Men of African ancestry have demonstrated markedly higher rates of prostate cancer mortality than men of other races and ethnicities around the world. In fact, the highest rates of prostate cancer mortality worldwide are found in the Caribbean and Sub-Saharan West Africa, and among men of African descent in the USA. Addressing this inequity in prostate cancer care and outcomes requires a focused research approach that creates durable solutions to address the structural, social, environmental, and health factors that create racial disparities in care and outcomes. OBJECTIVE To introduce a conceptual model for evaluating racial inequities in prostate cancer care to facilitate the development of translational research studies and interventions. EVIDENCE ACQUISITION A collaborative review of literature relevant to racial inequities in prostate cancer care and outcomes was performed. Existing literature was used to highlight various components of the conceptual model to inform future research and interventions toward equitable care and outcomes. EVIDENCE SYNTHESIS Racial inequities in prostate cancer outcomes are driven by a series of structural and social determinants of health that impact exposures, mediators, and outcomes. Social determinants of equity, such as laws/policies, economic systems, and structural racism, affect the inequitable access to environmental and neighborhood exposures, in addition to health care access. Although the incidence disparity remains problematic, various studies have demonstrated parity in outcomes when social and health factors, such as access to equitable care, are normalized. Few studies have tested interventions to reduce inequities in prostate cancer among Black men. CONCLUSIONS Worldwide, men of African ancestry demonstrate worse outcomes in prostate cancer, a phenomenon driven largely by social factors that inform biologic, environmental, and health care risks. A conceptual model was presented that organizes the many factors that influence prostate cancer incidence and mortality. Within that framework, we must understand the current state of inequities in clinical prostate cancer practice, the optimal state of what equitable practice would be, and how achieving equity in prostate cancer care balances costs, benefits, and harms. More robust characterization of the sources of prostate cancer inequities should inform testing of ambitious and innovative interventions as we work toward equity in care and outcomes. PATIENT SUMMARY Men of African ancestry demonstrate the highest rates of prostate cancer mortality, which may be reduced through social interventions. We present a framework for formalizing the identification of the drivers of prostate cancer inequities to facilitate the development of interventions and trials to eradicate them.
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Affiliation(s)
- Yaw A Nyame
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Scott E Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christopher Haiman
- Department of Preventive Medicine, Center for Genetic Epidemiology, University of Southern California, Los Angeles, CA, USA
| | - Franklin Huang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Cheryl T Lee
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Mark S Litwin
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes, Institute of Epidemiology & Health Care, University College London, London, UK
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Adam B Murphy
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Curtis Pettaway
- Department of Urology, M.D. Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Isaac J Powell
- Department of Urology, Wayne State University, Detroit, MI, USA
| | - Peter Sasieni
- Cancer Research UK & King's College London Cancer Prevention Trials Unit, King's College London, London, UK
| | - Edward M Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - John L Gore
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Nie J, Hsiang W, Marks V, Laditi F, Varghese A, Umer W, Haleem A, Mothy D, Wang H, Patel R, Pan W, Shah R, Khan S, Singh R, Golla V, Cavallo J, Breyer BN, Leapman MS. Access to Urological Care for Medicaid-Insured Patients at Urology Practices Acquired by Private Equity Firms. Urology 2022; 164:112-117. [PMID: 35276202 DOI: 10.1016/j.urology.2022.01.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize appointment access for Medicaid-insured patients seeking care at urology practices affiliated with private equity firms in light of the recent national trends in practice consolidation. METHODS We identified 214 urology offices affiliated with private equity firms that were geographically matched with 231 non-private equity affiliated urology offices. Using a standardized script, researchers posed as an adult patient with either Medicaid or commercial insurance in the clinical setting of new onset, painless hematuria. The primary outcome was whether the patient's insurance was accepted for an appointment. The secondary outcome was appointment wait time. RESULTS We conducted 815 appointment inquiry calls to 214 PE and 231 non-PE-affiliated urology offices across 12 states. Appointment availability was higher for commercially-insured patients (99.0%; 95% CI: 98.1%-99.9%) versus Medicaid-insured patients (59.8%; 95% CI: 55.0%-64.6%) (p<0.0001). Medicaid acceptance was higher at non-PE affiliated (66.8%; CI 60.4%-73.2%) than PE-affiliated practices (52.1%; 95% CI 45.0%-59.2%) (p=0.003). On multivariable logistic regression analysis, state Medicaid expansion status (OR 2.20; CI 1.14-4.28; p=0.020) was independently associated with Medicaid appointment availability, whereas PE-affiliation (OR 0.55; CI 0.37-0.83; p=0.004) was independently associated with lower Medicaid access. Appointment wait times did not differ significantly for commercially-insured versus Medicaid patients (19.2 vs 20.1 days; p=0.59), but PE-affiliated practices offered shorter mean wait times than non-PE offices (17.5 vs 21.4 days; p=0.017). CONCLUSIONS Access disparities for urologic evaluation in patients with Medicaid insurance at urology practices and were more pronounced at private equity acquired practices.
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Affiliation(s)
- James Nie
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Walter Hsiang
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Victoria Marks
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Folawiyo Laditi
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Adarsh Varghese
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Waez Umer
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Afash Haleem
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - David Mothy
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Hannah Wang
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Riya Patel
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - William Pan
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Rishi Shah
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Sophia Khan
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Rohan Singh
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Jaime Cavallo
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Michael S Leapman
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
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Liu X, Kang X, Lei C, Ren W, Liu C. Programming the trans-cleavage Activity of CRISPR-Cas13a by Single-Strand DNA Blocker and Its Biosensing Application. Anal Chem 2022; 94:3987-3996. [PMID: 35193353 DOI: 10.1021/acs.analchem.1c05124] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The precise and controllable programming of the trans-cleavage activity of the CRISPR-Cas13a systems is significant but challenging for fabricating high-performance biosensing systems toward various kinds of biomolecule targets. In this work, we have demonstrated that under a critical low Mg2+ concentration, a simple and short single-stranded DNA (ssDNA) probe free of any modification can efficiently prevent the assembly of crRNA and LwaCas13a only by partially binding with the crRNA repeat region, thereby blocking the trans-cleavage activity of the LwaCas13a system. Furthermore, we have demonstrated that the blocked trans-cleavage activity of the LwaCas13a system can be recovered by various kinds of biologically important substances as long as they could specifically release the blocker DNA from the crRNA in a target-responsive manner, providing a facile route for the quantification of diverse biomarkers such as enzymes, antigens/proteins, and exosomes. To the best of our knowledge, this is reported for the first time that a simple ssDNA can be employed as the switch element to control the crRNA structure and regulate the trans-cleavage activity of Cas13a, which has enriched the CRISPR-Cas13a sensing toolbox and will greatly expand its application scope.
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Affiliation(s)
- Xiaoling Liu
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education; Key Laboratory of Analytical Chemistry for Life Science of Shaanxi Province; School of Chemistry & Chemical Engineering, Shaanxi Normal University, Xi'an 710119, Shaanxi, P. R. China
| | - Xinyue Kang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education; Key Laboratory of Analytical Chemistry for Life Science of Shaanxi Province; School of Chemistry & Chemical Engineering, Shaanxi Normal University, Xi'an 710119, Shaanxi, P. R. China
| | - Chao Lei
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education; Key Laboratory of Analytical Chemistry for Life Science of Shaanxi Province; School of Chemistry & Chemical Engineering, Shaanxi Normal University, Xi'an 710119, Shaanxi, P. R. China
| | - Wei Ren
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education; Key Laboratory of Analytical Chemistry for Life Science of Shaanxi Province; School of Chemistry & Chemical Engineering, Shaanxi Normal University, Xi'an 710119, Shaanxi, P. R. China
| | - Chenghui Liu
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education; Key Laboratory of Analytical Chemistry for Life Science of Shaanxi Province; School of Chemistry & Chemical Engineering, Shaanxi Normal University, Xi'an 710119, Shaanxi, P. R. China
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Association between environmental quality and prostate cancer stage at diagnosis. Prostate Cancer Prostatic Dis 2021; 24:1129-1136. [PMID: 33947975 DOI: 10.1038/s41391-021-00370-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/16/2021] [Accepted: 04/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prostate cancer (PC) etiology is up to 57% heritable, with the remainder attributed to environmental exposures. There are limited studies regarding national level environmental exposures and PC aggressiveness, which was the focus of this study METHODS: SEER was queried to identify PC cases between 2010 and 2014. The environmental quality index (EQI) is a county-level metric for 2000-2005 combining data from 18 sources and reports an overall ambient environmental quality index, as well as 5 environmental quality sub-domains (air, water, land, built, and sociodemographic) with higher values representing lower environmental quality. PC stage at diagnosis was determined and, multivariable logistic regression models which adjusted for age at diagnosis (years) and self-reported race (White, Black, Other, Unknown) were used to test associations between quintiles of EQI scores and advanced PC stage at diagnosis. RESULTS The study cohort included 252,164 PC cases, of which 92% were localized and 8% metastatic at diagnosis. In the adjusted regression models, overall environmental quality EQI (OR 1.20, CI 1.15-1.26), water EQI (OR: 1.34, CI: 1.27-1.40), land EQI (OR: 1.35, CI: 1.29-1.42) and sociodemographic EQI (OR: 1.29, CI: 1.23-1.35) were associated with metastatic PC at diagnosis. For these domains there was a dose response increase in the OR from the lowest to the highest quintiles of EQI. Black race was found to be an independent predictor of metastatic PC at diagnosis (OR: 1.36, CI: 1.30-1.42) and in stratified analysis by race; overall EQI was more strongly associated with metastatic PC in Black men (OR: 1.53, CI: 1.35-1.72) compared to White men (OR: 1.18, CI: 1.12-1.24). CONCLUSION(S) Lower environmental quality was associated with advanced stage PC at diagnosis. The water, land and sociodemographic domains showed the strongest associations. More work should be done to elucidate specific modifiable environmental factors associated with aggressive PC.
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Javier-DesLoges JF, Yuan J, Soliman S, Hakimi K, Meagher MF, Ghali F, Hsiang W, Patel DN, Kim SP, Murphy JD, Parsons JK, Derweesh IH. Evaluation of Insurance Coverage and Cancer Stage at Diagnosis Among Low-Income Adults With Renal Cell Carcinoma After Passage of the Patient Protection and Affordable Care Act. JAMA Netw Open 2021; 4:e2116267. [PMID: 34269808 PMCID: PMC8285737 DOI: 10.1001/jamanetworkopen.2021.16267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE The association of the Patient Protection and Affordable Care Act (ACA) with insurance status and cancer stage at diagnosis among patients with renal cell carcinoma (RCC) is unknown. OBJECTIVE To test the hypothesis that the ACA may be associated with increased access to care through expansion of insurance, which may vary based on income. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort analysis included patients diagnosed with RCC from January 1, 2010, to December 31, 2016, in the National Cancer Database. Data were analyzed from July 1 to December 31, 2020. The periods from 2010 to 2013 and from 2014 to 2016 were defined as pre- and post-ACA implementation, respectively. Patients were categorized as living in a Medicaid expansion state or not. EXPOSURES Implementation of the ACA. MAIN OUTCOMES AND MEASURES The absolute percentage change (APC) of insurance coverage was calculated before and after ACA implementation in expansion and nonexpansion states. Secondary outcomes included change in stage at diagnosis, difference in the rate of insurance change, and change in localized disease between expansion and nonexpansion states. Adjusted difference-in-difference modeling was performed. RESULTS The cohort included 78 099 patients (64.7% male and 35.3% female; mean [SD] age, 54.66 [6.46] years), of whom 21.2% had low, 46.2% had middle, and 32.6% had high incomes. After ACA implementation, expansion states had a lower proportion of uninsured patients (adjusted difference-in-difference, -1.14% [95% CI, -1.98% to -1.41%]; P = .005). This occurred to the greatest degree among low-income patients through the acquisition of Medicaid (APC, 11.0% [95% CI, 8.6%-13.3%]; P < .001). Implementation of the ACA was also associated with an increase in detection of stage I and II disease (APC, 4.0% [95% CI, 1.6%-6.3%]; P = .001) among low-income patients in expansion states. CONCLUSIONS AND RELEVANCE Among patients with RCC, ACA implementation was associated with an increase in insurance coverage status in both expansion and nonexpansion states for all income groups, but to a greater degree in expansion states. The proportion of patients with localized disease increased among low-income patients in both states. These data suggest that ACA implementation is associated with earlier RCC detection among lower-income patients.
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Affiliation(s)
| | - Julia Yuan
- University of California, San Diego, School of Medicine, La Jolla
| | - Shady Soliman
- University of California, San Diego, School of Medicine, La Jolla
| | - Kevin Hakimi
- University of California, San Diego, School of Medicine, La Jolla
| | | | - Fady Ghali
- Department of Urology, University of California, San Diego, School of Medicine, La Jolla
| | - Walter Hsiang
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut
| | - Devin N. Patel
- Department of Urology, University of California, San Diego, School of Medicine, La Jolla
| | - Simon P. Kim
- Department of Urology, University of Colorado Anschutz School of Medicine, Denver
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, School of Medicine, La Jolla
| | - J. Kellogg Parsons
- Department of Urology, University of California, San Diego, School of Medicine, La Jolla
| | - Ithaar H. Derweesh
- Department of Urology, University of California, San Diego, School of Medicine, La Jolla
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Wu Q, Chen G, Qiu S, Feng S, Lin D. A target-triggered and self-calibration aptasensor based on SERS for precise detection of a prostate cancer biomarker in human blood. NANOSCALE 2021; 13:7574-7582. [PMID: 33928988 DOI: 10.1039/d1nr00480h] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Sensitive and precise detection of prostate-specific antigen (PSA) is critical for prostate cancer screening and monitoring. Herein, a target-triggered and self-calibration aptasensor based on a core-satellite nanostructure using surface-enhanced Raman spectroscopy (SERS) technology was developed for the sensitive and reliable determination of PSA protein, with a limit of detection of 0.38 ag mL-1 and a dynamic detection range of 10-2 to 10-15 mg mL-1. Furthermore, the proposed approach for the detection of PSA in patient blood samples was performed, and results showed that it is capable of providing comparable detection accuracy associated with a larger dynamic detection range and a lower detection limit as well as less sample requirement (only 5 μL) in comparison with the clinical commonly used method. Therefore, this SERS-based aptasensor for the detection of PSA in human blood samples has promising potential to be an alternative tool for clinical application in the accurate screening of prostate cancer.
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Affiliation(s)
- Qiong Wu
- Key Laboratory of OptoElectronic Science and Technology for Medicine, Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou 350007, China.
| | - Guannan Chen
- Key Laboratory of OptoElectronic Science and Technology for Medicine, Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou 350007, China.
| | - Sufang Qiu
- Fujian Medical University Cancer Hospital, Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, 350014, China
| | - Shangyuan Feng
- Key Laboratory of OptoElectronic Science and Technology for Medicine, Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou 350007, China.
| | - Duo Lin
- Key Laboratory of OptoElectronic Science and Technology for Medicine, Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou 350007, China.
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Weiner AB, Li EV, Desai AS, Press DJ, Schaeffer EM. Cause of death during prostate cancer survivorship: A contemporary, US population-based analysis. Cancer 2021; 127:2895-2904. [PMID: 33882145 DOI: 10.1002/cncr.33584] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/03/2020] [Accepted: 01/19/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND More than 3.6 million men in the United States harbor a diagnosis of prostate cancer (PCa). The authors sought to provide in-depth analyses of the causes of death for contemporary survivors. METHODS The authors performed a population-based cohort study in the United States (2000-2016) to assess causes of death for men diagnosed with PCa stratified by demographics and tumor stage. Using general population data, they calculated standardized mortality ratios (SMRs) as observed-to-expected death ratios. RESULTS In total, 752,092 men with PCa, including 200,302 who died (27%), were assessed. A total of 29,048 men with local/regional disease (17%) died of PCa, whereas more than 4-fold men died of other causes (n = 143,719 [83%]). SMRs for death from noncancer causes (0.77; 95% confidence interval [CI], 0.77-0.78) suggested that these men were less likely than the general population to die of most other causes. The most common noncancer cause of death was cardiac-related (23%; SMR, 0.76; 95% CI, 0.75-0.77). Among men with distant PCa, 90% of deaths occurred within 5 years of diagnosis. Although deaths due to PCa composed the majority of deaths (74%), SMRs suggested that men with distant PCa were at heightened risk for death from most other noncancer causes (1.50; 95% CI, 1.46-1.54) and, in particular, for cardiac-related death (SMR, 1.48; 95% CI, 1.41-1.54) and suicide (SMR, 2.32; 95% CI, 1.78-2.96). Further analyses demonstrated that causes of death varied by patient demographics. CONCLUSIONS Causes of death during PCa survivorship vary by patient and tumor characteristics. These data provide valuable information regarding health care prioritization during PCa survivorship. LAY SUMMARY Men with early-stage prostate cancer are 4-fold more likely to die of other causes, whereas those with advanced prostate cancer are at increased risk for several causes not related to prostate cancer in comparison with the general population. These findings can help guide physicians taking care of men with a diagnosis of prostate cancer.
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Affiliation(s)
- Adam B Weiner
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric V Li
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anuj S Desai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David J Press
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Weiner AB, Jan S, Jain-Poster K, Ko OS, Desai AS, Kundu SD. Insurance coverage, stage at diagnosis, and time to treatment following dependent coverage and Medicaid expansion for men with testicular cancer. PLoS One 2020; 15:e0238813. [PMID: 32936794 PMCID: PMC7494102 DOI: 10.1371/journal.pone.0238813] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/23/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction We sought to assess the impact of Affordable Care Act Dependent Care Expansion (ACA-DCE), which allowed dependent coverage for adults aged 19–25, and Medicaid expansion on outcomes for men with testicular cancer. Methods Using a US-based cancer registry, we performed adjusted difference-in-difference (DID) analyses comparing outcomes between men aged 19–25 (n = 8,026) and 26–64 (n = 33,303) pre- (2007–2009) and post-ACA-DCE (2011–2016) and between men in states that expanded Medicaid (n = 2,296) to men in those that did not (n = 2,265)pre- (2011–2013) and post-Medicaid expansion (2015–2016). Results In ACA-DCE analysis, rates of uninsurance decreased (DID -5.64, 95% confidence interval [CI] -7.23 to -4.04%, p<0.001) among patients aged 19–25 relative to older patients aged 26–64. There was no significant DID in advanced stage at diagnosis (stage≥II; p = 0.6) or orchiectomy more than 14 days after diagnosis (p = 0.6). For patients who received chemotherapy or radiotherapy as their first course of treatment, treatment greater than 60 days after diagnosis decreased (DID -4.84%, 95% CI -8.22 to -1.45%, p = 0.005) among patients aged 19–25 relative to patients aged 26–64. In Medicaid expansion states, rates of uninsurance decreased (DID -4.20%, 95% CI -7.67 to -0.73%, p = 0.018) while patients receiving chemotherapy or radiotherapy greater than 60 days after diagnosis decreased (DID -8.76, 95% CI -17.13 to -0.38%, p = 0.040) compared to rates in non-expansion states. No significant DIDs were seen for stage (p = 0.8) or time to orchiectomy (p = 0.1). Conclusions Men with testicular cancer had lower uninsurance rates and decreased time to delivery of chemotherapy or radiotherapy following ACA-DCE and Medicaid expansions. Time to orchiectomy and stage at diagnosis did not change following either insurance expansion.
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Affiliation(s)
- Adam B. Weiner
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Stephen Jan
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Ketan Jain-Poster
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Oliver S. Ko
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Anuj S. Desai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Shilajit D. Kundu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- * E-mail:
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