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Billion T, Braaten M, Holland E, Mishra A, Kashikar R, Silberstein P, Tauseef A, Asghar N, DeVrieze B, Mirza M. Racial Disparities in Treatment and Outcomes of Pediatric Hepatoblastoma. J Pediatr Hematol Oncol 2024; 46:e381-e386. [PMID: 38980918 DOI: 10.1097/mph.0000000000002918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/30/2024] [Indexed: 07/11/2024]
Abstract
Pediatric Hepatoblastoma is a rare malignancy of the liver. This study used the National Cancer Database (NCDB) to identify 1068 patients diagnosed with hepatoblastoma from 2004 to 2020. χ 2 and Analysis of Variance testing, as well as Kaplan-Meier, Cox Regression, and multinomial logistic regression models were used. Data was analyzed using SPSS version 27, and statistical significance was set at α=0.05. Our results found Black patients experienced a significantly lower median survival rate compared with White patients, a difference which persisted after controlling for covariates. Black patients were also less likely to receive surgery and chemotherapy and more likely to be from low-income households than White patients. White patients had a significantly shorter inpatient hospital stay compared to Black patients and were more likely to receive treatment at more than 1 CoC accredited facility. There was no significant difference in grade, size of tumor, metastasis, or time of diagnosis to surgery. This study showed Black patients experienced inferior overall survival when diagnosed and treated for hepatoblastoma compared to White patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Noureen Asghar
- Creighton University Department of Internal Medicine, Omaha, NE
| | | | - Mohsin Mirza
- Creighton University Department of Internal Medicine, Omaha, NE
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Hoin JA, Carthon BC, Brown SJ, Durham LM, Garrot LC, Ghamande SA, Pippas AW, Rivers BM, Snyder CT, Gabram-Mendola SGA. Addressing disparities in cancer clinical trials: a roadmap to more equitable accrual. FRONTIERS IN HEALTH SERVICES 2024; 4:1254294. [PMID: 38523649 PMCID: PMC10957576 DOI: 10.3389/frhs.2024.1254294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024]
Abstract
The Georgia Center for Oncology Research and Education (Georgia CORE) and the Georgia Society of Clinical Oncology (GASCO) held a one-day summit exploring opportunities and evidence-based interventions to address disparities in cancer clinical trials. The purpose of the summit was to identify clear and concise recommendations aimed at decreasing clinical trial accrual disparities in Georgia for rural and minority populations. The summit included expert presentations, panel discussions with leaders from provider organizations throughout Georgia, and breakout sessions to allow participants to critically discuss the information presented. Over 120 participants attended the summit. Recognizing the need for evidence-based interventions to improve clinical trial accrual among rural Georgians and persons of color, summit participants identified four key areas of focus that included: improving clinical trial design, providing navigation for all, enhancing public education and awareness of cancer clinical trials, and identifying potential policy and other opportunities. A comprehensive list of takeaways and action plans was developed in the four key areas of focus with the expectation that implementation of the strategies that emerged from the summit will enhance cancer clinical trial accrual for all Georgians.
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Affiliation(s)
- Jon A. Hoin
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Bradley C. Carthon
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Shantoria J. Brown
- Georgia Center for Oncology Research and Education, Atlanta, CO, United States
| | - Lynn M. Durham
- Georgia Center for Oncology Research and Education, Atlanta, CO, United States
| | | | - Sharad A. Ghamande
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, United States
| | | | - Brian M. Rivers
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA, United States
| | - Cindy T. Snyder
- Georgia Center for Oncology Research and Education, Atlanta, CO, United States
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Aurora T, Bridges C, Porter A, Madni A. Pediatric sickle cell disease: A case for improved clinician-family partnerships. J Hosp Med 2024; 19:146-148. [PMID: 38017233 DOI: 10.1002/jhm.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/14/2023] [Accepted: 11/04/2023] [Indexed: 11/30/2023]
Affiliation(s)
- Tarun Aurora
- Division of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christopher Bridges
- Divison of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amy Porter
- Division of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Arshia Madni
- Division of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Meidert U, Dönnges G, Bucher T, Wieber F, Gerber-Grote A. Unconscious Bias among Health Professionals: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6569. [PMID: 37623155 PMCID: PMC10454622 DOI: 10.3390/ijerph20166569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist. METHODS We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021. RESULTS A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies. CONCLUSIONS Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.
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Affiliation(s)
- Ursula Meidert
- School of Health Sciences, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (G.D.); (T.B.); (F.W.); (A.G.-G.)
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Munnikhuysen SR, Ekpo PA, Xue W, Gao Z, Lupo PJ, Venkatramani R, Heske CM. Impact of race and ethnicity on presentation and outcomes of patients treated on rhabdomyosarcoma clinical trials: A report from the Children's Oncology Group. Cancer Med 2023; 12:12777-12791. [PMID: 37081771 PMCID: PMC10278507 DOI: 10.1002/cam4.5921] [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: 11/15/2022] [Revised: 02/17/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities have been demonstrated in pediatric and adult cancers. However, there is no consensus on whether such disparities exist in the presentation, treatment, and outcome of patients with rhabdomyosarcoma (RMS). METHODS Patient information from the seven most recent RMS clinical trials was obtained from the Children's Oncology Group (COG). Chi-squared analyses were used to compare patient, tumor, and treatment characteristics across racial and ethnic groups. Pairwise analyses comparing Non-Hispanic Black (NHB) versus Non-Hispanic White (NHW) racial groups and Hispanic versus NHW ethnic groups were conducted for significant characteristics. Kaplan-Meier method and Wilcoxon signed-rank tests were performed to analyze outcomes. RESULTS In the overall cohort (n = 2157), patients' self-identified race/ethnicity was: 0.4% American Indian/Alaska Native, 2.6% Asian, 12.6% Hispanic, 0.2% Native American/other Pacific Islander, 12.8% NHB, 61.9% NHW, and 9.6% unknown. Six characteristics differed by race/ethnicity: age, histology, IRS group, invasiveness, metastatic disease, and FOXO1 fusion partner. Five were significant in pairwise comparisons: NHB patients were more likely to present at age ≥ 10 years and with invasive tumors than NHW patients; Hispanic patients were more likely to present with alveolar histology, metastatic disease, and IRS group IV disease than NHW patients. No differences were found in event free or overall survival of the entire cohort, in risk group-based subset analyses, or among patients with high-risk characteristics significant on pairwise analysis. CONCLUSIONS While NHB and Hispanic patients enrolled in COG trials presented with higher risk features than NHW patients, there were no outcome differences by racial or ethnic group.
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Affiliation(s)
- Senna R. Munnikhuysen
- Pediatric Oncology BranchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Princess A. Ekpo
- Pediatric Oncology BranchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Zhengya Gao
- Department of Biostatistics, College of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Philip J. Lupo
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer CenterTexas Children's Hospital, Baylor College of MedicineHoustonTexasUSA
| | - Rajkumar Venkatramani
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer CenterTexas Children's Hospital, Baylor College of MedicineHoustonTexasUSA
| | - Christine M. Heske
- Pediatric Oncology BranchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
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Graetz DE. The most vulnerable pediatric cancer patients. THE LANCET REGIONAL HEALTH - AMERICAS 2023; 21:100480. [PMID: 37008198 PMCID: PMC10064219 DOI: 10.1016/j.lana.2023.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/28/2023]
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Stevenson J, DeGroote NP, Keller F, Brock KE, Bergsagel DJ, Miller TP, Cornwell P, Fasano R, Chonat S, Castellino SM. Characteristics and outcomes of pediatric oncology patients at risk for guardians declining transfusion of blood components. Cancer Rep (Hoboken) 2022; 6:e1665. [PMID: 35792092 PMCID: PMC9875642 DOI: 10.1002/cnr2.1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/01/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transfusion of blood products is a necessary part of successful delivery of myelosuppressive regimens in pediatric cancer. There is a paucity of literature characterizing outcomes or management of pediatric patients with cancer when transfusion is declined. AIMS The objective of this paper is to describe the clinical characteristics, care, and outcomes of patients with cancer at risk for declining transfusion. METHODS AND RESULTS A retrospective cohort of patients aged 0-21 years with cancer managed at Children's Healthcare of Atlanta between 2006 and 2020 and with ICD-9 codes indicating risk of "transfusion refusal" or Jehovah's witness (JW) religion was identified. Demographics, disease, and management were abstracted. Descriptive statistics were performed to examine associations with transfusion receipt. Among 35 eligible patients identified as at risk for declining transfusion, 89% had primary guardians who identified as JW, and 45.7% identified as Black, non-Hispanic. Only 40% of guardians actively declined transfusion. Transfusion recipients had significantly lower hemoglobin (g/dl) and platelet counts (1000/μl) at initial presentation (9.6 vs. 11.9, p < .002 and 116.0 vs. 406.5, p = .001, respectively) and at nadir (5.9 vs. 8.7, p < .001 and ≤ 10 vs. 154, p < .001, respectively) than non-recipients. Legal intervention was required in 36.4% of those who ultimately received a transfusion. CONCLUSION Among pediatric cancer patients whose medical record initially indicated a preference for no transfusion, 60% of guardians accepted blood products when prescribed for oncology care. Guidelines for systematic management and transfusion sparing approaches are needed to honor guardian's preferences when possible yet while maintaining equitable cancer outcomes in this population.
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Affiliation(s)
- Jason Stevenson
- Department of Pediatrics, Division of Graduate Medical EducationEmory UniversityAtlantaGeorgiaUSA
| | - Nicholas P. DeGroote
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA
| | - Frank Keller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Katharine E. Brock
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Palliative CareEmory UniversityAtlantaGeorgiaUSA
| | - D. John Bergsagel
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Tamara P. Miller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Patricia Cornwell
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA
| | - Ross Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Sharon M. Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
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Ji X, Sohn H, Sil S, Castellino SM. Moving Beyond Patient-Level Drivers of Racial/Ethnic Disparities in Childhood Cancer. Cancer Epidemiol Biomarkers Prev 2022; 31:1154-1158. [PMID: 35642393 PMCID: PMC9203027 DOI: 10.1158/1055-9965.epi-21-1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/24/2021] [Accepted: 03/03/2022] [Indexed: 01/11/2023] Open
Abstract
Racial/ethnic disparities in childhood cancer survival persist despite advances in cancer biology and treatment. Survival rates are consistently lower among non-Hispanic Black and Hispanic children as compared with non-Hispanic White children across a range of hematologic cancers and solid tumors. We provide a framework for considering complex systems and social determinants of health in research examining the drivers of racial/ethnic disparities in childhood cancer survival, given that pediatric patients' interactions with the healthcare system are filtered through their caregiver, family, and societal structure. Dismantling the multi-level (patient, family, healthcare system, and structural) barriers into modifiable drivers is critical to developing policies and interventions toward equitable health outcomes. This commentary highlights areas at the family, healthcare system, and society levels that merit closer examination and proposes actions and interventions to support improvements across these levels. See recently published article in the November issue of CEBP, Racial/Ethnic Disparities in Childhood Cancer Survival in the United States p. 2010.
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Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center,
Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Heeju Sohn
- Department of Sociology, Emory University, Atlanta,
Georgia
| | - Soumitri Sil
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center,
Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sharon M. Castellino
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center,
Children’s Healthcare of Atlanta, Atlanta, Georgia
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Graetz DE, Madni A, Gossett J, Kang G, Sabin JA, Santana VM, Russo CL. Role of implicit bias in pediatric cancer clinical trials and enrollment recommendations among pediatric oncology providers. Cancer 2020; 127:284-290. [PMID: 33119199 PMCID: PMC7790838 DOI: 10.1002/cncr.33268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Provider implicit bias can negatively affect clinician-patient communication. In the current study, the authors measured implicit bias training among pediatric oncology providers and exposure to implicit association tests (IATs). They then assessed associations between IATs for race and socioeconomic status (SES) and recommendations for clinical trial enrollment. METHODS A prospective multisite study was performed to measure implicit bias among oncology providers at St. Jude Children's Research Hospital and affiliate clinics. An IAT was used to assess bias in the domains of race and SES. Case vignettes were used to determine an association between bias and provider recommendation for trial enrollment. Data were analyzed using Student t tests or Wilcoxon tests for comparisons and Jonckheere-Terpstra tests were used for association. RESULTS Of the 105 total participants, 95 (90%) had not taken an IAT and 97 (92%) had no prior implicit bias training. A large effect was found for (bias toward) high SES (Cohen d, 1.93) and European American race (Cohen d, 0.96). The majority of participants (90%) had a vignette score of 3 or 4, indicating recommendation for trial enrollment for most or all vignettes. IAT and vignette scores did not significantly differ between providers at St. Jude Children's Research Hospital or affiliate clinics. No association was found between IAT and vignette scores for race (P = .58) or SES (P = .82). CONCLUSIONS The authors noted a paucity of prior exposure to implicit bias self-assessments and training. Although these providers demonstrated preferences for high SES and European American race, this did not appear to affect recommendations for clinical trial enrollment as assessed by vignettes.
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Affiliation(s)
- Dylan E Graetz
- Department of Oncology, St. Jude Children's Research Hospital and Comprehensive Cancer Center, Memphis, Tennessee
| | - Arshia Madni
- Department of Oncology, St. Jude Children's Research Hospital and Comprehensive Cancer Center, Memphis, Tennessee
| | - Jeffrey Gossett
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Janice A Sabin
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Victor M Santana
- Department of Oncology, St. Jude Children's Research Hospital and Comprehensive Cancer Center, Memphis, Tennessee
| | - Carolyn L Russo
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
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