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Van Haren RM, Kovacic MB, Delman AM, Pratt CG, Griffith A, Arbili L, Harvey K, Kohli E, Pai A, Topalian A, Rai SN, Shah SA, Kues J. Disparities Associated with Decision to Undergo Oncologic Surgery: A Prospective Mixed-Methods Analysis. Ann Surg Oncol 2024; 31:5757-5764. [PMID: 38869765 PMCID: PMC11300547 DOI: 10.1245/s10434-024-15610-4] [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: 01/26/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Underrepresented minority patients with surgical malignancies experience disparities in outcomes. The impact of provider-based factors, including communication, trust, and cultural competency, on outcomes is not well understood. This study examines modifiable provider-based barriers to care experienced by patients with surgical malignancies. METHODS A parallel, prospective, mixed-methods study enrolled patients with lung or gastrointestinal malignancies undergoing surgical consultation. Surveys assessed patients' social needs and patient-physician relationship. Semi-structured interviews ascertained patient experiences and were iteratively analyzed, identifying key themes. RESULTS The cohort included 24 patients (age 62 years; 63% White and 38% Black/African American). The most common cancers were lung (n = 18, 75%) and gastroesophageal (n = 3, 13%). Survey results indicated that food insecurity (n = 5, 21%), lack of reliable transportation (n = 4, 17%), and housing instability (n = 2, 8%) were common. Lack of trust in their physician (n = 3, 13%) and their physician's treatment recommendation (n = 3, 13%) were identified. Patients reported a lack of empathy (n = 3, 13%), lack of cultural competence (n = 3, 13%), and inadequate communication (n = 2, 8%) from physicians. Qualitative analysis identified five major themes regarding the decision to undergo surgery: communication, trust, health literacy, patient fears, and decision-making strategies. Five patients (21%) declined the recommended surgery and were more likely Black (100% vs. 21%), lower income (100% vs. 16%), and reported poor patient-physician relationship (40% vs. 5%; all p < 0.05). CONCLUSIONS Factors associated with declining recommended cancer surgery were underrepresented minority race and poor patient-physician relationships. Interventions are needed to improve these barriers to care and racial disparities.
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Affiliation(s)
- Robert M Van Haren
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Melinda Butsch Kovacic
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Aaron M Delman
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Catherine G Pratt
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Azante Griffith
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lana Arbili
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Krysten Harvey
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Eshika Kohli
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ahna Pai
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alique Topalian
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Shesh N Rai
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Shimul A Shah
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John Kues
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Geng CX, Gudur AR, Kadiyala J, Strand DS, Shami VM, Wang AY, Podboy A, Le TM, Reilley M, Zaydfudim V, Buerlein RCD. Associations between income and survival in cholangiocarcinoma: A comprehensive subtype-based analysis. Ann Hepatobiliary Pancreat Surg 2024; 28:144-154. [PMID: 38356257 PMCID: PMC11128791 DOI: 10.14701/ahbps.23-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Backgrounds/Aims Socioeconomic determinants of health are incompletely characterized in cholangiocarcinoma (CCA). We assessed how socioeconomic status influences initial treatment decisions and survival outcomes in patients with CCA, additionally performing multiple sub-analyses based on anatomic location of the primary tumor. Methods Observational study using the 2018 submission of the Surveillance, Epidemiology, and End Results (SEER)-18 Database. In total, 5,476 patients from 2004-2015 with a CCA were separated based on median household income (MHI) into low income (< 25th percentile of MHI) and high income (> 25th percentile of MHI) groups. Seventy-three percent of patients had complete follow up data, and were included in survival analyses. Survival and treatment outcomes were calculated using R-studio. Results When all cases of CCA were included, the high-income group was more likely than the low-income to receive surgery, chemotherapy, and local tumor destruction modalities. Initial treatment modality based on income differed significantly between tumor locations. Patients of lower income had higher overall and cancer-specific mortality at 2 and 5 years. Non-cancer mortality was similar between the groups. Survival differences identified in the overall cohort were maintained in the intrahepatic CCA subgroup. No differences between income groups were noted in cancer-specific or overall mortality for perihilar tumors, with variable differences in the distal cohort. Conclusions Lower income was associated with higher rates of cancer-specific mortality and lower rates of surgical resection in CCA. There were significant differences in treatment selection and outcomes between intrahepatic, perihilar, and distal tumors. Population-based strategies aimed at identifying possible etiologies for these disparities are paramount to improving patient outcomes.
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Affiliation(s)
- Calvin X. Geng
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Anuragh R. Gudur
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Jagannath Kadiyala
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Daniel S. Strand
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Vanessa M. Shami
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Andrew Y. Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Alexander Podboy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Tri M. Le
- Division of Hematology and Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Matthew Reilley
- Division of Hematology and Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Victor Zaydfudim
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Ross C. D. Buerlein
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
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Valdera FA, O'Shea AE, Smolinsky TR, Carpenter EL, Adams AA, McCarthy PM, Tiwari A, Chick RC, Kemp-Bohan PM, Van Decar S, Thomas KK, Bader JO, Peoples GE, Clifton GT, Stojadinovic A, Nelson DW, Vreeland TJ. Predictors and benefits of multiagent chemotherapy for pancreatic adenocarcinoma: Timing matters. J Surg Oncol 2024; 129:244-253. [PMID: 37800378 DOI: 10.1002/jso.27466] [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: 05/02/2023] [Revised: 09/11/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Adjuvant (A) multiagent chemotherapy (MC) is the standard of care for patients with pancreatic adenocarcinoma (PDAC). Tolerating MC following a morbid operation may be difficult, thus neoadjuvant (NA) treatment is preferable. This study examined how the timing of chemotherapy was related to the regimen given and ultimately the overall survival (OS). METHODS The National Cancer Database was queried from 2006 to 2017 for nonmetastatic PDAC patients who underwent surgical resection and received MC or single-agent chemotherapy (SC) pre- or postresection. Predictors of receiving MC were determined using multivariable logistic regression. Five-year OS was evaluated using the Kaplan-Meier and Cox proportional hazards model. RESULTS A total of 12,440 patients (NA SC, n = 663; NA MC, n = 2313; A SC, n = 6152; A MC, n = 3312) were included. MC utilization increased from 2006-2010 to 2011-2017 (33.1%-49.7%; odds ratio [OR]: 0.59; p < 0.001). Younger age, fewer comorbidities, higher clinical stage, and larger tumor size were all associated with receipt of MC (all p < 0.001), but NA treatment was the greatest predictor (OR 5.18; 95% confidence interval [CI]: 4.63-5.80; p < 0.001). MC was associated with increased median 5-year OS (26.0 vs. 23.9 months; hazard ratio [HR]: 0.92; 95% CI: 0.88-0.96) and NA MC was associated with the highest survival (28.2 months) compared to NA SC (23.3 months), A SC (24.0 months), and A MC (24.6 months; p < 0.001). CONCLUSION Use and timing of MC contribute to OS in PDAC with an improved 5-year OS compared to SC. The greatest predictor of receiving MC was being given as NA therapy and the greatest survival benefit was the NA MC subgroup. Randomized studies evaluating the timing of effective MC in PDAC are needed.
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Affiliation(s)
- Franklin A Valdera
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, Texas, USA
| | - Anne E O'Shea
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, Texas, USA
| | - Todd R Smolinsky
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, Texas, USA
| | | | - Alexandra A Adams
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, Texas, USA
| | - Patrick M McCarthy
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, Texas, USA
| | - Ankur Tiwari
- Department of Surgery, University of Texas San Antonio Health Science Center, San Antonio, Texas, USA
| | - Robert C Chick
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, Texas, USA
| | | | - Spencer Van Decar
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, Texas, USA
| | - Katryna K Thomas
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, Texas, USA
| | | | | | - Guy T Clifton
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, Texas, USA
| | | | - Daniel W Nelson
- Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Timothy J Vreeland
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, Texas, USA
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Ortiz Rueda B, Endo Y, Tsilimigras DI, Araujo Lima H, Munir MM, Woldesenbet S, Dillhoff M, Ejaz A, Cloyd J, Pawlik TM. Impact of Medicaid expansion on the multimodal treatment of biliary tract cancer. J Surg Oncol 2024; 129:233-243. [PMID: 37795657 DOI: 10.1002/jso.27478] [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: 08/23/2023] [Revised: 09/16/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION The impact of Medicaid expansion (ME) on the treatment of patients with cancer remains controversial, especially individuals requiring complex multidisciplinary care. We sought to evaluate the impact of Medicaid expansion (ME) on receipt of multimodal care, including surgical resection, for Stage I-III biliary tract cancer (BTC). METHODS Patients diagnosed with BTC between 40 and 65 years of age were identified from the National Cancer Database and divided into pre- (2008-2012) and post- (2015-2018) ME cohorts. Difference-in-difference (DID) analysis was used to determine the impact of ME on the utilization of surgery and multimodal chemotherapy and/or radiotherapy treatment for BTC. RESULTS Among 12,415 patients with BTC (extrahepatic, n = 5622, 45.3%; intrahepatic, n = 4352, 35.1%; gallbladder, n = 1944, 15.7%; overlapping, n = 497, 4.0%), 5835 (47.0%) and 6580 (53.0%) patients were diagnosed before versus after ME, respectively. Overall utilization of surgery (OR 1.13, 95% CI 1.02-1.26) and multimodality therapy (OR 1.13, 95% CI 1.01-1.27) increased in states that adopted ME. Utilization of surgery among uninsured/Medicaid patients in ME states increased relative to patients living in non-ME states (∆+10.1%, p = 0.01). Similarly, the use of multimodal treatment increased among uninsured/Medicaid patients living in ME versus non-ME states (∆+6.4%, p = 0.04); in contrast, there were no difference among patients with other insurance statuses (overall: ∆+1.5%, private: ∆-2.0%, other: ∆+3.9%, all p > 0.5). Uninsured/Medicaid patients with BTC who lived in a ME state had a lower risk of long-term death in the post-ME era (HR 0.81, 95% CI 0.67-0.98; p = 0.03). CONCLUSIONS Implementation of ME positively impacted survival among patients who underwent surgical and multimodal treatment for Stage I-III BTC.
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Affiliation(s)
- Belisario Ortiz Rueda
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Henrique Araujo Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Surgery, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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Munir MM, Woldesenbet S, Endo Y, Lima HA, Alaimo L, Moazzam Z, Shaikh C, Cloyd J, Ejaz A, Azap R, Azap L, Pawlik TM. Racial Segregation Among Patients with Cholangiocarcinoma-Impact on Diagnosis, Treatment, and Outcomes. Ann Surg Oncol 2023; 30:4238-4246. [PMID: 36695990 DOI: 10.1245/s10434-023-13122-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Racial segregation, an effect of historical marginalization, may impact cancer care and outcomes. We sought to examine the impact of racial segregation on the diagnosis, treatment, and outcomes of patients with cholangiocarcinoma (CCA). PATIENTS AND METHODS Data on Black and White patients with CCA were obtained from the linked SEER-Medicare database (2004-2015) and 2010 Census data. The index of dissimilarity (IoD), a validated measure of segregation, was used to assess Black-White disparities in stage disease presentation, surgery for localized disease, and cancer-specific mortality. Multivariable Poisson regression was performed, and competing risk regression analysis was used to determine cancer-specific survival. RESULTS Among 7480 patients with CCA, 90.2% (n = 6748) were White and 9.8% (n = 732) were Black. Overall, Black patients were more likely to reside in segregated areas compared with White patients (IoD, 0.42 vs. 0.38; p < 0.05). On multivariable Poisson regression, Black patients were more likely to present with advanced-stage disease [relative risk (RR) 1.17, 95% confidence interval (CI) 1.08-1.27; p < 0.001] and were less likely to undergo surgery for localized disease (RR 0.62, 95% CI 0.51-0.76; p < 0.001). Black patients also had worse cancer-specific survival (CSS) compared with White patients (median CSS: 4 vs. 8 months; p < 0.01). Black patients living in the highest areas of segregation had 40% increased hazard of mortality versus White patients residing in the lowest IoD areas (hazard ratio 1.40, 95% CI 1.10-1.80; p < 0.01). CONCLUSION Racial segregation, as a proxy for structural racism, had a marked effect on Black-White disparities among patients with CCA.
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Affiliation(s)
- Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Chanza Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Rosevine Azap
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lovette Azap
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA.
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Huang G, Song W, Zhang Y, Ren B, Lv Y, Liu K. Prognostic nomogram for cancer-specific survival in patients with intrahepatic cholangiocarcinoma after hepatectomy: A population study of 919 patients. Front Surg 2023; 9:1025521. [PMID: 36684170 PMCID: PMC9852639 DOI: 10.3389/fsurg.2022.1025521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background and Aims Intrahepatic cholangiocarcinoma has an increasing global incidence and mortality rate. Hepatectomy is still the most effective curative treatment for patients with ICC, but the prognosis of patients with ICC is still poor even after curative resection. This study aimed to incorporate important factors obtained from SEER database to construct and validate a nomogram for predicting the cancer-specific survival of patients with ICC after hepatectomy. Methods We obtained patient data from SEER database. The nomogram was constructed base on six prognostic factors for predicting CSS rates in ICC patients. The nomogram was validated by C-index, ROC curve and calibration curves. Results A total of 919 patients with ICC after hepatectomy between 2000 and 2018 were included in this study. A nomogram based on six independent prognostic factors (Black race, AJCC T, AJCC N, AJCC M, chemotherapy and PLNR ≥ 0.15) was developed for the prediction of CSS at 3 and 5 years. The C-index of the nomogram and AJCC stage system were 0.709 and 0.657 in the training cohort respectively. The 3- and 5-year AUCs of nomogram were 0.744 and 0.75 in the training cohort. The calibration plots indicated that there was good agreement between the actual observations and predictions. Conclusions In conclusion, we constructed and validated a nomogram for predicting the 3- and 5-year CSS in ICC patients after hepatectomy. We have confirmed the precise calibration and acceptable discrimination power of our nomogram. The predictive power of this nomogram may be improved by considering other potential important factors and also by external validation.
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Affiliation(s)
- Gaobo Huang
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Department of Oncology, Xi'an No.3 Hospital, Xi'an, China
| | - Weilun Song
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanchao Zhang
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bingyi Ren
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kang Liu
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Correspondence: Kang Liu
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Rieser C, Phelos H, Zureikat A, Pingpank J, Ongchin M, Lee A, Brown J, Choudry MH, Hoehn RS. Socioeconomic Barriers to CRS HIPEC for Appendiceal Cancer within a Regional Academic Hospital System. Ann Surg Oncol 2022; 29:6593-6602. [PMID: 35639293 PMCID: PMC9547669 DOI: 10.1245/s10434-022-11949-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/12/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Appendiceal cancer with peritoneal metastases (ACPM) is a complex disease requiring multidisciplinary care. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS HIPEC) can significantly improve survival but requires evaluation by a surgical oncologist and significant treatment endurance. The impacts of socioeconomic status (SES) and other social determinants of health on rates of surgical evaluation and treatment have not been examined. METHODS We conducted a retrospective cohort study examining all patients with ACPM from 2010 to 2018 in a regional healthcare system. Patient characteristics, oncologic details, treatment strategies, and survival were examined. The primary outcomes of interest were referral to Surgical Oncology, receipt of CRS HIPEC, and survival. RESULTS Of 194 patients identified, 94% had synchronous ACPM. The majority of patients (95%) were referred to surgical oncology. Advanced age was the only predictor of nonreferral (p < 0.001). A total of 147 patients (76%) ultimately underwent CRS HIPEC. After adjusting for medical and tumor characteristics, CRS HIPEC was less likely for patients who were unmarried [odds ratio (OR) 0.253, p = 0.004] or of low SES (OR 0.372, p = 0.03). On subanalysis of patients undergoing CRS HIPEC, median overall survival was worse for patients of low SES [51 months versus not reached (NR), p = 0.05], and this disparity persisted on multivariate analysis [hazard ratio (HR) = 2.278, p = 0.001]. CONCLUSIONS This analysis is the first to evaluate barriers to CRS HIPEC for ACPM. While most patients were evaluated by a multidisciplinary team, nonmedical factors may play a role in the treatment received and ultimate outcomes. Addressing these disparities is crucial for ensuring equitable outcomes and improving patient care.
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Affiliation(s)
- Caroline Rieser
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Heather Phelos
- Division of Trauma and Acute Care Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amer Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James Pingpank
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Melanie Ongchin
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew Lee
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joshua Brown
- Division of Trauma and Acute Care Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M Haroon Choudry
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Richard S Hoehn
- Division of Surgical Oncology, University Hospitals, Cleveland, OH, USA.
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8
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Huang LF, Hong A, Cioffi G, Alahmadi A, Tang TY, Ocuin LM, Patil N, Bajor DL, Saltzman JN, Mohamed A, Selfridge E, Webb Hooper M, Barnholtz-Sloan J, Lee RT. Associations of Racial and Ethnic Category, Age, Comorbidities, and Socioeconomic Factors on Concordance to NCCN Guidelines for Patients With High-Risk Biliary Tract Cancers After Surgery. Front Oncol 2022; 12:771688. [PMID: 35273909 PMCID: PMC8901570 DOI: 10.3389/fonc.2022.771688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022] Open
Abstract
Background Biliary tract cancers (BTC) have a limited prognosis even for localized cancers, emphasizing the importance of multidisciplinary management. NCCN guidelines recommend adjuvant chemotherapy (CT) +/- radiotherapy (RT) for high-risk disease. We analyzed the association between racial and ethnic category along with other demographic factors and concordance to NCCN guidelines among patients following surgery for high-risk BTC. Methods Subjects were identified from the National Cancer Database (NCDB) for BTC patients who underwent surgery and found to have metastatic lymph nodes (LN+) or positive surgical margins (M+) from 2004 to 2015. We defined concordance to NCCN guidelines as receiving surgery + CT +/- RT and non-concordance to the guidelines as surgery +/- RT. Descriptive studies and multivariate logistic regression analysis was performed. Results A total of 3,792 patients were identified with approximately half being female (55.4%) and between the ages of 50-69 (52.8%). Most were White (76.3%) followed by Black (10.6%), Hispanic (8.5%), and Asian (5.3%). The BTC included extrahepatic cholangiocarcinoma (CCA) (48.6%), gallbladder cancer (43.5%), and intrahepatic CCA (7.9%). Most patients had an M- resection (71.9%) but also had LN+ disease (88.0%). There were no significant differences between racial groups in disease presentation (histological grade, tumor stage) and surgical outcomes (LN+, M+, hospital readmission, and 90 day post-surgery mortality). Hispanic patients as compared to White patients were less likely to be insured (85.7% vs 96.3%, p<0.001) and less likely to be treated at an academic facility (42.1% vs 52.1%, p=0.008). Overall, almost one-third (29.7%) of patients received non-concordant NCCN guideline care with Hispanic patients having the highest proportion of non-concordance as compared to Whites patients (36.1% vs 28.7%, p=0.029). On multivariate analysis, Hispanic ethnicity (HR=1.51, 95% CI: 1.15-1.99) remained significantly associated with non-concordance to NCCN guidelines. Conclusion This study indicates that Hispanic patients with high-risk BTC are significantly less likely to receive NCCN-concordant treatment in comparison to White patients. More research is needed to confirm and understand the observed disparities and guide targeted interventions at the system-level.
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Affiliation(s)
- Lauren F Huang
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Augustine Hong
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Gino Cioffi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Asrar Alahmadi
- Department of Internal Medicine, Ohio State University James Thoracic Oncology Center, Comprehensive Cancer Center, Columbus, OH, United States
| | - Tin-Yun Tang
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lee M Ocuin
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Nirav Patil
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - David L Bajor
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Joel N Saltzman
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Amr Mohamed
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Eva Selfridge
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Monica Webb Hooper
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.,Department of Psychology, Case Comprehensive Cancer Center, Cleveland, OH, United States
| | - Jill Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Richard T Lee
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.,Department of Medicine, Case Western Reserve University Comprehensive Cancer Center, Cleveland, OH, United States
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9
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Cantos A, Eguia E, Wang X, Abood G, Knab LM. Impact of sociodemographic factors on outcomes in patients with peritoneal malignancies following cytoreduction and chemoperfusion. J Surg Oncol 2022; 125:1285-1291. [PMID: 35253223 PMCID: PMC9314066 DOI: 10.1002/jso.26843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives Sociodemographic factors have been shown to impact surgical outcomes. However, the effects of these factors on patients undergoing cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) are not well known. This study aims to evaluate the impact of sociodemographic factors on patients undergoing CRS/HIPEC. Methods Adult patients at a tertiary center who underwent CRS/HIPEC were evaluated. Perioperative variables were collected and analyzed. A national database was also used to evaluate patients undergoing CRS/HIPEC. Results There were 90 patients who underwent CRS/HIPEC (32% non‐White). There was no statistically significant difference in postoperative complications, length of stay, or discharge disposition based upon race (white vs. non‐White patients), socioeconomic status (SES), or insurance type. Nationally, we found that Black and Hispanic patients were less likely to undergo CRS/HIPEC than Non‐Hispanic white patients (Black: odds ratio [OR]: 0.60, [confidence interval {CI}: 0.39–0.94]; Hispanic: OR: 0.52, [CI: 0.28–0.98]). However, there were no significant differences in postoperative complications based upon race/ethnicity. Conclusion Sociodemographic factors including race, SES, and insurance status did not impact postoperative outcomes in patients undergoing CRS/HIPEC at our single institution. On a national level, Black and Hispanic patients underwent CRS/HIPEC at lower rates compared to white patients.
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Affiliation(s)
- Adriana Cantos
- Department of Surgery Loyola University Chicago Stritch School of Medicine Maywood Illinois USA
| | - Emanuel Eguia
- Department of Surgery Loyola University Medical Center Maywood Illinois USA
| | - Xuanji Wang
- Department of Surgery Loyola University Medical Center Maywood Illinois USA
| | - Gerard Abood
- Department of Surgery Loyola University Medical Center Maywood Illinois USA
| | - Lawrence M. Knab
- Department of Surgery Loyola University Medical Center Maywood Illinois USA
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10
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Kumar D, Bansal V, Raza SA, Thrift AP, Malaty HM, Sealock RJ. Widening Health Disparities: Increasing Cholangiocarcinoma Incidence in an Underserved Population. GASTRO HEP ADVANCES 2022; 1:180-185. [PMID: 39131132 PMCID: PMC11308073 DOI: 10.1016/j.gastha.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/03/2021] [Indexed: 08/13/2024]
Abstract
Background and Aims Cholangiocarcinoma is a relatively rare malignancy with high mortality. In the U.S., incidence rates of cholangiocarcinoma have increased, particularly affecting younger age groups and Hispanic and Asian individuals. We investigated the incidence of cholangiocarcinoma in a largely under-represented, minority population. Methods We performed a retrospective cohort study from 2005 to 2017 among adults in a county-funded healthcare system in Harris County, Texas. Incidence rate ratios were computed to compare age-standardized rates using U.S. standard population between 2 time periods: 2005-2011 and 2012-2017. Results We identified 139 cholangiocarcinoma cases (64% intrahepatic, 36% extrahepatic). The median age at diagnosis was 57 years; 62% were Hispanic, and 56% were born outside the U.S. The incidence rate increased from 1.2 to 2.4 per 100,000 person-years (rate ratio 2.1 [95% confidence interval {CI}: 1.5, 3.0]). Hispanic individuals and those aged 40-69 years had the highest rate of incidence increase (respectively, rate ratio: 2.5 [95% CI: 1.6, 4.0] and rate ratio: 2.0 [95% CI: 1.2, 3.0]) between time periods. In 2012-2017, the risk of cholangiocarcinoma among patients with diabetes was 1.4 times relative to those without (relative risk: 1.4; 95% CI: 1.1, 1.5) and 1.2 times among those who were overweight/obese relative to those who were not (relative risk: 1.2; 95% CI: 1.1, 1.6). Conclusion Incidence of cholangiocarcinoma doubled during the 12-year study period, with Hispanic and middle-aged individuals disproportionately affected. Individuals with diabetes mellitus and those who were overweight or obese had a high risk of being diagnosed with cholangiocarcinoma in the later time period. Further studies should focus on preventing and improving earlier diagnosis of cholangiocarcinoma among Hispanics.
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Affiliation(s)
- Disha Kumar
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Varun Bansal
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, Florida
| | - Syed A. Raza
- Section of Epidemiology and Population Sciences, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Aaron P. Thrift
- Section of Epidemiology and Population Sciences, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Hoda M. Malaty
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Robert J. Sealock
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
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11
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Rieser CJ, Hoehn RS, Zenati M, Hall LB, Kang E, Zureikat AH, Lee A, Ongchin M, Holtzman MP, Pingpank JF, Bartlett DL, Choudry MHA. Impact of Socioeconomic Status on Presentation and Outcomes in Colorectal Peritoneal Metastases Following Cytoreduction and Chemoperfusion: Persistent Inequalities in Outcomes at a High-Volume Center. Ann Surg Oncol 2021; 28:3522-3531. [PMID: 33687614 PMCID: PMC8184539 DOI: 10.1245/s10434-021-09627-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS HIPEC) can offer significant survival advantage for select patients with colorectal peritoneal metastases (CRPM). Low socioeconomic status (SES) is implicated in disparities in access to care. We analyze the impact of SES on postoperative outcomes and survival at a high-volume tertiary CRS HIPEC center. PATIENTS AND METHODS We conducted a retrospective cohort study examining patients who underwent CRS HIPEC for CRPM from 2000 to 2018. Patients were grouped according to SES. Baseline characteristics, perioperative outcomes, and survival were examined between groups. RESULTS A total of 226 patients were analyzed, 107 (47%) low-SES and 119 (53%) high-SES patients. High-SES patients were younger (52 vs. 58 years, p = 0.01) and more likely to be White (95.0% vs. 91.6%, p = 0.06) and privately insured (83% vs. 57%, p < 0.001). They traveled significantly further for treatment and had lower burden of comorbidities and frailty (p = 0.01). Low-SES patients more often presented with synchronous peritoneal metastases (48% vs. 35%, p = 0.05). Following CRS HIPEC, low-SES patients had longer length of stay and higher burden of postoperative complications, 90-day readmission, and 30-day mortality. Median overall survival following CRS HIPEC was worse for low-SES patients (17.8 vs. 32.4 months, p = 0.02). This disparity persisted on multivariate survival analysis (low SES: HR = 1.46, p = 0.03). CONCLUSIONS Despite improving therapies for CRPM, low-SES patients remain at a significant disadvantage. Even patients who overcome barriers to care experience worse short- and long-term outcomes. Improving access and addressing these disparities is crucial to ensure equitable outcomes and improve patient care.
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Affiliation(s)
- Caroline J Rieser
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, UPMC Cancer Pavilion, Pittsburgh, PA, USA.
| | - Richard S Hoehn
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, UPMC Cancer Pavilion, Pittsburgh, PA, USA
| | - Mazen Zenati
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, UPMC Cancer Pavilion, Pittsburgh, PA, USA
| | - Lauren B Hall
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, UPMC Cancer Pavilion, Pittsburgh, PA, USA
| | - Eliza Kang
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, UPMC Cancer Pavilion, Pittsburgh, PA, USA
| | - Amer H Zureikat
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, UPMC Cancer Pavilion, Pittsburgh, PA, USA
| | - Andrew Lee
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, UPMC Cancer Pavilion, Pittsburgh, PA, USA
| | - Melanie Ongchin
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, UPMC Cancer Pavilion, Pittsburgh, PA, USA
| | - Matthew P Holtzman
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, UPMC Cancer Pavilion, Pittsburgh, PA, USA
| | - James F Pingpank
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, UPMC Cancer Pavilion, Pittsburgh, PA, USA
| | - David L Bartlett
- AHN Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - M Haroon A Choudry
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, UPMC Cancer Pavilion, Pittsburgh, PA, USA
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12
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Sempokuya T, Wien EA, Pattison RJ, Ma J, Wong LL. Factors associated with 5-year survival of combined hepatocellular and cholangiocarcinoma. World J Hepatol 2020; 12:1020-1030. [PMID: 33312426 PMCID: PMC7701962 DOI: 10.4254/wjh.v12.i11.1020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/25/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Combined hepatocellular and cholangiocarcinoma (HCC/CC) is a rare primary hepatic malignancy which carries a poor prognosis due to its aggressive nature. Few centers have enough cases to draw definitive conclusions and there is limited understanding of prognosis. Given the rarity of HCC/CC, an analysis of large national cancer database was needed to obtain larger number of HCC/CC cases.
AIM To identify associated factors for 5-year survival of HCC/CC.
METHODS We conducted a retrospective study of The Surveillance, Epidemiology, and End Results (SEER) database obtained from SEER*Stat 8.3.6 software. Previously defined histology code 8180 for the International Classification of Disease for Oncology, 3rd edition was used to identify HCC/CC cases from 2004 to 2015. We collected demographics, American Joint Committee on Cancer (AJCC) stage, treatment, tumor size, and survival data. These data were converted to categorical variables. The Shapiro-Wilk normality test was used to assess normal distribution. Mann-Whitney U test was used to compare continuous variables without normal distribution, and t-test was used to compare continuous variables with a normal distribution. The Kaplan-Meier survival curve analyzed 5-year survival. Univariate and multivariate logistic regression model was used to analyze factors associated with 5-year survival. Multivariate Cox proportional hazard regression was done on 5-year survival. We defined P < 0.05 was statistically significant.
RESULTS We identified 497 patients with the following characteristics: Mean age 62.4 years (SD: 11.3), 149 (30.0%) were female, racial distribution was: 276 (55.5%) white, 53 (10.7%) black, 84 (16.9%) Asian and Pacific Islander (API), 77 (15.5%) Hispanic, and 7 (1.4%) others or unknown. Stage I/II disease occurred in 41.5% and tumor size < 50 mm was seen in 35.6% of patients. Twenty-four (4.8%) received locoregional therapy (LRT), 119 (23.9%) underwent resection, and 50 (10.1%) underwent liver transplantation. The overall median survival was 6 mo [Interquartile range (IQR): 1-22]. After multivariate logistic regression, tumor size < 50 mm [Odds ratios (OR): 2.415, P = 0.05], resection (OR: 12.849, P < 0.01), and transplant (OR: 27.129, P < 0.01) showed significance for 5-year survival. Age > 60, sex, race, AJCC stages, metastasis, and LRT were not significant. However, API vs white showed significant OR of 2.793 (CI: 1.120-6.967). Cox proportional hazard regression showed AJCC stages, tumor size < 50 mm, LRT, resection, and transplant showed significant hazard ratio.
CONCLUSION HCC/CC patients with tumor size < 50 mm, resection, and transplant were associated with an increase in 5-year survival. API showed advantageous OR and hazard ratios over white, black.
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Affiliation(s)
- Tomoki Sempokuya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Eric A Wien
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States
| | - Robert J Pattison
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States
| | - Jihyun Ma
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Linda L Wong
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96817, United States
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13
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Gadkaree SK, McCarty JC, Feng AL, Siu JM, Burks CA, Deschler DG, Richmon JD, Varvares MA, Bergmark RW. Role of physician density in predicting stage and survival for head and neck squamous cell carcinoma. Head Neck 2020; 43:438-448. [PMID: 33015935 DOI: 10.1002/hed.26495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/17/2020] [Accepted: 09/22/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Identifying and linking barriers to access to head and neck cancer care, specifically provider density, to stage of diagnosis and survival outcomes is important to serve as a foundation for policy interventions. METHODS Retrospective cohort study using patients with head and neck squamous cell (HNSCC) in the Surveillance, Epidemiology, and End Results (SEER) database from 2007 to 2016 and Area Resource File. Primary outcomes included stage of presentation and cancer-specific 5-year survival and relation to provider density. RESULTS The initial cohort consisted of 18 342 patients with oral cavity, 21 809 oropharyngeal, 15 860 laryngeal, and 2887 patients with hypopharyngeal malignancy. Non-Hispanic Black race and being uninsured increased the odds of presenting with advanced stage HNSCC and increased hazard of death. There was no significant and consistent association identified between Health Service Areas provider density and advanced stage at diagnosis or cancer-specific 5-year mortality. CONCLUSIONS Provider density of otolaryngologists and primary care physicians and dentists was not significantly associated with stage of presentation or cancer-specific survival for HNSCC while race and insurance status remained independent predictors for worse outcomes.
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Affiliation(s)
- Shekhar K Gadkaree
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Justin C McCarty
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jennifer M Siu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology, University of Toronto, Toronto, Ontario, USA
| | - Ciersten A Burks
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Regan W Bergmark
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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14
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Zhu MX, Li Y. The correlations between socioeconomic status and intrahepatic cholangiocarcinoma in the United States: a population-based study. Transl Cancer Res 2020; 9:4931-4942. [PMID: 35117855 PMCID: PMC8798916 DOI: 10.21037/tcr-20-2506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND The incidence and mortality rates of intrahepatic cholangiocarcinoma (ICC) continue to increase in the United States (US). To our knowledge, the associations between socioeconomic factors (SES) and ICC-associated incidence and survival are still unclear. METHODS We identified patients with ICC in the US Surveillance, Epidemiology, and End Results (SEER) database between 2011 and 2015. ICC incidence rates were calculated by directly age-adjusted to the 2000 US population. Univariate and multivariate Cox regression analyses were performed to find the influence of SES on ICC cause-specific survival (CSS) and overall survival (OS). Using disadvantageous SES, we generated a prognostic score model for risk stratification, then Kaplan-Meier analysis was performed to find the influence of SES on for ICC CSS/OS. RESULTS A total of 3,456 ICC patients were included. Rates ratios (RR) for ICC incidence rates increased monotonically with ages and decreased with increasing county education levels. From three disadvantageous socioeconomic factors (i.e., unmarried status, uninsured status, median household income CONCLUSIONS Low county education levels may be associated with increased ICC risk. Median household income, insurance status, and marital status were significant predictors of survival outcomes. Low-risk socioeconomic status (SES) confers protective effects in ICC.
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Affiliation(s)
- Ming-Xi Zhu
- Department of Anatomy, School of Basic Medicine and Life Science, Hainan Medical University, Haikou, China
| | - Yan Li
- Department of Anesthesiology, the 4th Affiliated Hospital of Harbin Medical University, Harbin, China
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