1
|
Wilson CA, Jamil TL, Velu PS, Levi JR. Patient Factors Associated with Missed Otolaryngology Appointments at an Urban Safety-Net Hospital. Laryngoscope 2024; 134:4003-4010. [PMID: 38602281 DOI: 10.1002/lary.31401] [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: 08/21/2023] [Revised: 02/21/2024] [Accepted: 03/13/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To determine if patient factors related to ethnicity, socioeconomic status (SES), medical comorbidities, or appointment characteristics increase the risk of missing an initial adult otolaryngology appointment. METHODS This study is a retrospective case control study at Boston Medical Center (BMC) in Boston, Massachusetts, that took place in 2019. Patient demographic and medical comorbidity data as well as appointment characteristic data were collected and compared between those that attended their initial otolaryngology appointment versus those who missed their initial appointment. Chi-square and ANOVA tests were used to calculate differences between attendance outcomes. Multivariate analysis was used to compare the odds of missing an appointment based on various patient- and appointment-related factors. RESULTS Patients who were more likely to miss their appointments were more often female, of lower education, disabled, not employed, Black or Hispanic, and Spanish-speaking. Spring and Fall appointments were more likely to be missed. When a multivariate regression was conducted to control for social determinants of health (SDOH) such as race, insurance status, employment, and education status, the odds of females, Spanish-speaking, students, and disabled patients missing their appointment were no longer statistically significant. CONCLUSION A majority of patients at BMC come from lower SES backgrounds and have multiple medical comorbidities. Those who reside closer to BMC, often areas of lower average income, had higher rates of missed appointments. Interventions such as decreasing lag time, providing handicap-accessible free transportation, and increasing accessibility of telemedicine for patients could help improve attendance rates at BMC. LEVEL OF EVIDENCE IV Laryngoscope, 134:4003-4010, 2024.
Collapse
Affiliation(s)
- Carolyn A Wilson
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Taylor L Jamil
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
- Boston University School of Public Health, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Preetha S Velu
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Jessica R Levi
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, U.S.A
| |
Collapse
|
2
|
Harris CS, Groman A, Sigurdson SL, Magner WJ, Singh AK, Gupta V. Retrospective Cohort Study on the Impact of Travel Distance on Late-Stage Oral Cancer Treatment and Outcomes: An NCDB Analysis. Cancers (Basel) 2024; 16:2750. [PMID: 39123477 PMCID: PMC11311623 DOI: 10.3390/cancers16152750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
The National Comprehensive Cancer Network guidelines provide evidence-based consensus for optimal individual site- and stage-specific treatments. This is a cohort study of 11,121 late-stage oral cancer patients in the National Cancer Database from 2010 to 2016. We hypothesized that patient travel distance may affect treatment choices and impact outcome. We split travel distance (miles) into quartiles (D1-4) and assessed treatment choices, type of facility, and survival outcome in relation to distance traveled. Univariate and multivariate analyses addressed contributions of specific variables. White patients were most likely to travel farthest (D4) for treatment compared to Black patients (D1). Urban area patients traveled shorter distances than those from rural areas. Greater travel distance was associated with patients undergoing surgical-based therapies and treatment at academic centers. Patients in D1 had the lowest median survival of all distance quartiles. Surgery-based multimodality treatment (surgery and radiation) had a median survival significantly greater than for non-surgical therapy. Several factors including travel distance and treatment facility were associated with survival outcomes for late-stage oral cavity cancers. Consideration of these factors may help improve the outcome for this patient population.
Collapse
Affiliation(s)
- Courtney S. Harris
- Roswell Park Summer Research Experience Program in Cancer Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
- College of Arts and Sciences, Cornell University, Ithaca, NY 14850, USA
- Weill Medical College, Cornell University, New York, NY 10065, USA
| | - Adrienne Groman
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - S. Lynn Sigurdson
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - William J. Magner
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - Anurag K. Singh
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - Vishal Gupta
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| |
Collapse
|
3
|
Fei-Zhang DJ, Chelius DC, Sheyn AM, Rastatter JC. Large-data contextualizations of social determinant associations in pediatric head and neck cancers. Curr Opin Otolaryngol Head Neck Surg 2023; 31:424-429. [PMID: 37712774 DOI: 10.1097/moo.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
PURPOSE OF REVIEW Prior investigations in social determinants of health (SDoH) and their impact on pediatric head and neck cancers are limited by the narrow scope of cancer types and SDoH being studied while lacking inquiry on the interrelational contribution of varied SDoH in real-world contexts. The purpose of this review is to discuss the current research tackling these shortcomings of SDoH-based studies in head and neck cancer and to discuss means of applying these findings in prospective initiatives and implementations. RECENT FINDINGS Through leveraging contemporary, large-data analyses measuring diverse social vulnerabilities, several studies have identified comprehensive delineations of which social disparities contribute the largest quantifiable impact on the care of head and neck cancer patients. Progressing from prior SDoH-based research of the decade, these studies contextualize the effect of social vulnerabilities and have laid the foundations to begin addressing these issues in the complex, modern-day environment of interrelatedsocial factors. SUMMARY Social determinants of health markedly affect pediatric head and neck cancer care and prognosis in complex and surprising ways. Modern-day tools and analyses derived from large-data techniques have unveiled the quantifiable underpinnings of how SDoH impact these pathologies.
Collapse
Affiliation(s)
| | - Daniel C Chelius
- Department of Otolaryngology-Head and Neck Surgery, Pediatric Thyroid Tumor Program and Pediatric Head and Neck Tumor Program, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Anthony M Sheyn
- Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center
- Department of Pediatric Otolaryngology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee
| | - Jeff C Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| |
Collapse
|
4
|
Agarwal P, Bloom J, Zhou Y, Zhao R, Huang S, Yajima M, Devaiah AK. Socioeconomic disparities in treatment and survival in patients with hypopharyngeal malignancy. Head Neck 2023; 45:2670-2679. [PMID: 37638612 DOI: 10.1002/hed.27492] [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: 03/15/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND This retrospective study utilizes The Surveillance, Epidemiology, and End Results database to investigate socioeconomic factors leading to treatment disparities in hypopharyngeal malignancy. METHODS Treatment was compared to National Cancer Care Network guidelines. Novel analyses, including logistic modeling, allowed survival analysis and identification of socioeconomic variables not previously considered in staging and management guidelines. RESULTS Black and older patients, and residence in low-income areas predict lower likelihood of standard therapy (p < 0.05). Early-stage disease and standard therapy correlate with improved survival (p < 0.001). Medicaid, advanced age, advanced disease, and treatment outside of consensus guidelines correlated with lower survival (p < 0.0001). CONCLUSIONS There are clear socioeconomic factors impacting treatment and survival in hypopharyngeal malignancies. Standard therapy affords superior survival rate. Black, low socioeconomic status, and older patients are less likely to receive standard therapy. Education and language isolation do not predict treatment or survival. Understanding these discrepancies is paramount to palliating disparities in healthcare.
Collapse
Affiliation(s)
- Pratima Agarwal
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jacob Bloom
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Runqi Zhao
- Boston University, Boston, Massachusetts, USA
| | - Simu Huang
- Boston University, Boston, Massachusetts, USA
| | | | - Anand K Devaiah
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Menezes FDS, Verzinhasse Peres S, de Castro Junior G, Antunes JLF, Latorre MDRDDO, Toporcov TN. Survival inequalities in head and neck cancers: A hospital-based cohort study. Head Neck 2023; 45:2377-2393. [PMID: 37401537 DOI: 10.1002/hed.27433] [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: 09/30/2022] [Revised: 03/23/2023] [Accepted: 06/10/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND We investigated whether the socioeconomic status (SES) influenced survival rates in oropharynx cancers (OPC), oral cavity cancers (OCC), and larynx cancers (LC) in Brazilian patients. METHODS This hospital-based cohort study assessed the age-standardized 5-year relative survival (RS) using the Pohar Perme estimator. RESULTS Overall, we identified 37 191 cases, and 5-year RS were 24.4%, 34.1%, and 44.9% in OPC, OCC, and LC, respectively. In multiple Cox regression, the highest risk of death occurred in the most vulnerable social strata for all subsites-that is, illiterates or patients relying on publicly funded healthcare services. Disparities increased over time by 34.9% in OPC due to the rising of survival rates in the highest SES, whereas they reduced by 10.2% and 29.6% in OCC and LC. CONCLUSIONS The potential inequities were more significant for OPC than for OCC and LC. It is urgent to tackle social disparities to improve prognoses in highly unequal countries.
Collapse
Affiliation(s)
- Fabrício Dos Santos Menezes
- Department of Health Education, Federal University of Sergipe, Lagarto, Brazil
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Gilberto de Castro Junior
- Instituto do Câncer do Estado de São Paulo (ICESP) and School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | | |
Collapse
|
6
|
Batool S, Burks CA, Bergmark RW. Healthcare Disparities in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023; 11:1-14. [PMID: 37362031 PMCID: PMC10247342 DOI: 10.1007/s40136-023-00459-0] [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] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review The purpose of this review is to summarize some of the recent research studies on healthcare disparities across various subspecialties within otolaryngology. This review also highlights the impact of COVID-19 pandemic on disparities and proposes potential interventions to mitigate disparities. Recent Findings Significant healthcare disparities in care and treatment outcomes have been reported across all areas of otolaryngology. Notable differences in survival, disease recurrence, and overall mortality have been noted based on race, ethnicity, socioeconomic status (SES), insurance status, etc. This is most well-researched in head and neck cancer (HNC) within otolaryngology. Summary Healthcare disparities have been identified by numerous research studies within otolaryngology for many vulnerable groups that include racial and ethnic minority groups, low-income populations, and individuals from rural areas among many others. These populations continue to experience suboptimal access to timely, quality otolaryngologic care that exacerbate disparities in health outcomes.
Collapse
Affiliation(s)
- Sana Batool
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ciersten A. Burks
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
| | - Regan W. Bergmark
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women’s Hospital and Dana Farber Cancer Institute, 45 Francis Street, Boston, MA 02115 USA
| |
Collapse
|
7
|
Beckett M, Gaudet M, Bourque JM, Dennis K, Abdel-Wahab M. Equity in adjuvant radiotherapy utilization in locally advanced head and neck cancer: A SEER-data based study. Head Neck 2023; 45:921-930. [PMID: 36797802 DOI: 10.1002/hed.27319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/19/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Not all patients with locally advanced head and neck cancer (HNC) who are eligible for adjuvant radiotherapy (RT) following upfront surgery appear to receive it. METHODS Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Selected patients from 2009 to 2018 had locally advanced HNC, underwent upfront surgery, and were eligible for adjuvant RT. Multivariable logistic regression and chi-squared test were used to analyze available patient and tumor characteristics. RESULTS Of 12 549 patients, 84.5% underwent adjuvant RT, 15.5% did not. Characteristics associated with lowest adjuvant RT utilization included cancers of the larynx (p < 0.0001) and gingivae (p < 0.0001), age 80 and above (p < 0.0001), unpartnered status (p < 0.0001), and residence within a nonmetropolitan area (p < 0.0024). CONCLUSIONS Tumor subsite, age, partnered status, and rural/urban residence correlate with omission of adjuvant RT in locally advanced HNC.
Collapse
Affiliation(s)
- Matthew Beckett
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jean-Marc Bourque
- Département Radio-Oncologie, Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| |
Collapse
|
8
|
Clausyl Plummer II, Mensah C, Kline-Quiroz C. Disparities of health impacting head and neck cancer and rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
|
9
|
Tranby EP, Heaton LJ, Tomar SL, Kelly AL, Fager GL, Backley M, Frantsve-Hawley J. Oral Cancer Prevalence, Mortality, and Costs in Medicaid and Commercial Insurance Claims Data. Cancer Epidemiol Biomarkers Prev 2022; 31:1849-1857. [PMID: 35732291 PMCID: PMC9437560 DOI: 10.1158/1055-9965.epi-22-0114] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/17/2022] [Accepted: 06/16/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This study compared prevalence, incidence, mortality rates, treatment costs, and risk factors for oral and oropharyngeal cancer (OC/OPC) between two large United States adult cohorts in 2012-2019. METHODS Medicaid and commercial claims data came from the IBM Watson Health MarketScan Database. Logistic regression analyses estimated incidence and risk factors for OC/OPC. Mortality was calculated by merging deceased individuals' files with those of the existing cancer cohort. Summing costs of outpatient and inpatient services determined costs. RESULTS Prevalence of OC/OPC in Medicaid enrollees decreased each year (129.8 cases per 100,000 enrollees in 2012 to 88.5 in 2019); commercial enrollees showed a lower, more stable prevalence (64.7 per 100,000 in 2012 and 2019). Incidence trended downward in both cohorts, with higher incidence in the Medicaid (51.4-37.6 cases per 100,000) than the commercial cohort (31.9-31.0 per 100,000). Mortality rates decreased for Medicaid enrollees during 2012-2014 but increased in the commercial cohort. OC/OPC treatment costs were higher for commercial enrollees by $8.6 million during 2016-2019. OC/OPC incidence was higher among adults who were older, male, and white; used tobacco or alcohol; or had prior human immunodeficiency virus/acquired immune deficiency syndrome diagnosis and lower among those who had seen a dentist the prior year. CONCLUSIONS Medicaid enrollees experienced higher OC/OPC incidence, prevalence, and mortality compared with commercially insured adults. Having seen a dentist within the prior year was associated with a lower risk of OC/OPC diagnosis. IMPACT Expanding Medicaid dental benefits may allow OC/OPC to be diagnosed at earlier stages through regular dental visits.
Collapse
Affiliation(s)
- Eric P. Tranby
- Analytics and Evaluation, CareQuest Institute for Oral Health, Boston, Massachusetts
| | - Lisa J. Heaton
- Analytics and Evaluation, CareQuest Institute for Oral Health, Boston, Massachusetts.,Corresponding Author: Lisa J. Heaton, Science Writer, Analytics and Evaluation, CareQuest Institute for Oral Health, 465 Medford Street, Boston, MA 02129. Phone: 617-886-1047; E-mail:
| | - Scott L. Tomar
- Division of Prevention and Public Health Sciences, College of Dentistry, University of Illinois, Chicago, Illinois
| | | | | | - Mary Backley
- Maryland Dental Action Coalition, Columbia, Maryland
| | | |
Collapse
|
10
|
Zenga J, Awan MJ, Frei A, Petrie E, Sharma GP, Shreenivas A, Shukla M, Himburg HA. Chronic stress promotes an immunologic inflammatory state and head and neck cancer growth in a humanized murine model. Head Neck 2022; 44:1324-1334. [PMID: 35261119 PMCID: PMC9081149 DOI: 10.1002/hed.27028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite the importance of immune response and environmental stress on head and neck cancer (HNC) outcomes, no current pre-clinical stress model includes a humanized immune system. METHODS We investigated the effects of chronic stress induced by social isolation on tumor growth and human immune response in subcutaneous HNC tumors grown in NSG-SGM3 mice engrafted with a human immune system. RESULTS Tumor growth (p < 0.0001) and lung metastases (p = 0.035) were increased in socially isolated versus control animals. Chronic stress increased intra-tumoral CD4+ T-cell infiltrate (p = 0.005), plasma SDF-1 (p < 0.0001) expression, and led to tumor cell dedifferentiation toward a cancer stem cell phenotype (CD44+ /ALDHhigh , p = 0.025). CONCLUSIONS Chronic stress induced immunophenotypic changes, increased tumor growth, and metastasis in HNC in a murine model with a humanized immune system. This model system may provide further insight into the immunologic and oncologic impact of chronic stress on patients with HNC.
Collapse
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI
| | - Musaddiq J. Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Anne Frei
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Ellie Petrie
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Guru Prasad Sharma
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Aditya Shreenivas
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Monica Shukla
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Heather A. Himburg
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
11
|
Lam CM, Qureshi MM, Patel PN, Park JJ, Dang RR, Rubin SJ, Salama AR, Truong MT. Oral cancer patients achieve comparable survival at high safety-net burden hospitals. Am J Otolaryngol 2022; 43:103438. [PMID: 35489110 DOI: 10.1016/j.amjoto.2022.103438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/02/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate the impact of hospital safety-net burden and social demographics on the overall survival of patients with oral cavity squamous cell carcinoma. MATERIALS AND METHODS We identified 48,176 oral cancer patients diagnosed between the years 2004 to 2015 from the National Cancer Database and categorized treatment facilities as no, low, or high safety-net burden hospitals based on the percentage of uninsured or Medicaid patients treated. Using the Kaplan Meier method and multivariate analysis, we examined the effect of hospital safety-net burden, sociodemographic variables, and clinical factors on overall survival. RESULTS Of the 1269 treatment facilities assessed, the median percentage of uninsured/Medicaid patients treated was 0% at no, 11.6% at low, and 23.5% at high safety-net burden hospitals and median survival was 68.6, 74.8, and 55.0 months, respectively (p < 0.0001). High safety-net burden hospitals treated more non-white populations (15.4%), lower median household income (<$30,000) (23.2%), and advanced stage cancers (AJCC III/IV) (54.6%). Patients treated at low (aHR = 0.97; 95% CI = 0.91-1.04, p = 0.405) and high (aHR = 1.05; 95% CI = 0.98-1.13, p = 0.175) safety-net burden hospitals did not experience worse survival outcomes compared to patients treated at no safety-net burden hospitals. CONCLUSION High safety-net burden hospitals treated more oral cancer patients of lower socioeconomic status and advanced disease. Multivariate analysis showed high safety-net burden hospitals achieved comparable patient survival to lower burden hospitals.
Collapse
|
12
|
Pan C, Rizvi Z. Oral Cancer. Surg Clin North Am 2022; 102:309-324. [DOI: 10.1016/j.suc.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Nallani R, Subramanian TL, Ferguson-Square KM, Smith JB, White J, Chiu AG, Francis CL, Sykes KJ. A Systematic Review of Head and Neck Cancer Health Disparities: A Call for Innovative Research. Otolaryngol Head Neck Surg 2022; 166:1238-1248. [PMID: 35133913 DOI: 10.1177/01945998221077197] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE (1) Describe the existing head and neck cancer health disparities literature. (2) Contextualize these studies by using the NIMHD research framework (National Institute on Minority Health and Health Disparities). (3) Explore innovative ideas for further study and intervention. DATA SOURCES Ovid MEDLINE, Embase, Web of Science, and Google Scholar. REVIEW METHODS Databases were systematically searched from inception to April 20, 2020. The PRISMA checklist was followed (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Two authors reviewed all articles for inclusion. Extracted data included health disparity population and outcomes, study details, and main findings and recommendations. Articles were also classified per the NIMHD research framework. RESULTS There were 148 articles included for final review. The majority (n = 104) focused on health disparities related to at least race/ethnicity. Greater than two-thirds of studies (n = 105) identified health disparities specific to health behaviors or clinical outcomes. Interaction between the individual domain of influence and the health system level of influence was most discussed (n = 99, 66.9%). Less than half of studies (n = 61) offered specific recommendations or interventions. CONCLUSIONS There has been extensive study of health disparities for head and neck cancer, largely focusing on individual patient factors or health care access and quality. This review identifies gaps in this research, with large numbers of retrospective database studies and little discussion of potential contributors and explanations for these disparities. We recommend shifting research on disparities upstream toward a focus on community and societal factors, rather than individual, and an evaluation of interventions to promote health equity.
Collapse
Affiliation(s)
- Rohit Nallani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | - Joshua B Smith
- Department of Otolaryngology-Head and Neck Surgery, St Louis University, St Louis, Missouri, USA
| | - Jacob White
- Research and Learning, A.R. Dykes Library, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Carrie L Francis
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
14
|
Shehan JN, Alwani T, LeClair J, Mahoney TF, Agarwal P, Chaudhry ST, Wang JJ, Noordzij JP, Tracy LF, Edwards HA, Grillone G, Salama AR, Jalisi SM, Devaiah AK. Social determinants of health and treatment decisions in head and neck cancer. Head Neck 2021; 44:372-381. [PMID: 34889486 DOI: 10.1002/hed.26931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/14/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study compares select social determinants of health (SDOH) with treatment modality selection and treatment completion in head and neck cancer (HNC) patients, to better understand disparities in health outcomes. METHODS A retrospective cohort study of HNC (n = 1428) patients was conducted. Demographic and disease-specific variables were recorded, including treatment modality selection and completion. Data were analyzed using two-sample t tests, chi-square, and Fisher's exact tests. RESULTS Primary language was significantly associated with treatment choice, where non-English speakers were less likely to choose treatment as recommended by the Tumor Board. Lower mean distance from the hospital (37.38 [48.31] vs. 16.92 [19.10], p < 0.0001) and a county-based higher mean percentage of bachelor degree or higher education (42.16 [8.82] vs. 44.95 [6.19], p < 0.0003) were associated with treatment selection. CONCLUSION Language, distance from the hospital, and education affected treatment selection in this study and may be useful in understanding how to counsel patients on treatment selection for HNC.
Collapse
Affiliation(s)
- Jennifer N Shehan
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Tooba Alwani
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jessica LeClair
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Taylor F Mahoney
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Pratima Agarwal
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Salil T Chaudhry
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Judy J Wang
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jacob Pieter Noordzij
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren F Tracy
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Heather A Edwards
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gregory Grillone
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Andrew R Salama
- Department of Oral Maxillofacial Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Scharukh M Jalisi
- Department of Otolaryngology - Head and Neck Surgery, Beth Israel Deaconess, Boston, Massachusetts, USA
| | - Anand K Devaiah
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
15
|
Entezami P, Thomas B, Mansour J, Asarkar A, Nathan C, Pang J. Targets for improving disparate head and neck cancer outcomes in the low-income population. Laryngoscope Investig Otolaryngol 2021; 6:1481-1488. [PMID: 34938891 PMCID: PMC8665427 DOI: 10.1002/lio2.698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Low-income patients have worse head and neck cancer outcomes than those with high-income. Yet, few targets have been identified to specifically improve outcomes in the low-income population. Here, we conduct a review on the current literature on head and neck cancer outcomes in the low-income population and identify targets for intervention. The degree of disparity is in the range of 20%-90% worse overall survival in the low-income population. Eliminating smoking would have the greatest effect on head and neck cancer mortality rates in the low-income population. Additionally, access to oral cancer exams, assistance with transportation, and continued expansion of telemedicine would facilitate early diagnosis and timely treatment in patients who develop head and neck cancer.
Collapse
Affiliation(s)
- Payam Entezami
- Louisiana State University Shreveport Medical Center ShreveportShreveportLouisianaUSA
| | - Bennett Thomas
- Louisiana State University Shreveport Medical Center ShreveportShreveportLouisianaUSA
| | - Jobran Mansour
- Louisiana State University Shreveport Medical Center ShreveportShreveportLouisianaUSA
| | - Ameya Asarkar
- Louisiana State University Shreveport Medical Center ShreveportShreveportLouisianaUSA
| | - Cherie‐Ann Nathan
- Louisiana State University Shreveport Medical Center ShreveportShreveportLouisianaUSA
| | - John Pang
- Louisiana State University Shreveport Medical Center ShreveportShreveportLouisianaUSA
| |
Collapse
|
16
|
Alwani T, Shehan JN, LeClair J, Mahoney TF, Agarwal P, Chaudhry ST, Wang JJ, Noordzij JP, Tracy LF, Edwards HA, Grillone G, Salama AR, Jalisi SM, Devaiah AK. Geographic Barriers Affect Follow-Up Care in Head and Neck Cancer. Laryngoscope 2021; 132:1022-1028. [PMID: 34762300 PMCID: PMC9007826 DOI: 10.1002/lary.29934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS Follow-up care in head and neck cancers (HNC) is critical in managing patient health. However, social determinants of health (SDOH) can create difficulties in maintaining follow-up care. The study goal is to explore how SDOH impacts maintenance of HNC follow-up care appointments. METHODS A systematic retrospective chart review of 877 HNC patients diagnosed in the past 10 years a safety-net tertiary care hospital with systems to help reduce care disparities. Cohort groups were identified and compared against protocols for follow-up. Data were analyzed using analysis of variance, chi-square tests, Fisher's exact tests, two-sample t-tests, and simple linear regression. RESULTS The average length of follow-up time in months and average total number of follow-ups over 5 years were 32.96 (34.60) and 9.24 (7.87), respectively. There was no significant difference in follow-up care between United States (US) versus non-US born and English versus non-English speaking patients. Race/ethnicity, county median household income, insurance status, and county educational attainment were not associated with differences in follow-up. However, living a greater distance from the hospital was associated with lower follow-up length and less frequency in follow-up (P < .0001). CONCLUSION While income, primary language, country of birth, race/ethnicity, insurance status, and markers of educational attainment do not appear to impact HNC follow-up at our safety-net, tertiary care institution, and distance from hospital remains an important contributor to disparities in care. This study shows that many barriers to care can be addressed in a model that addresses SDOH, but there are barriers that still require additional systems and resources. Laryngoscope, 2021.
Collapse
Affiliation(s)
- Tooba Alwani
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
| | | | - Jessica LeClair
- Department of Biostatistics, Boston University School of Public Health, Boston MA
| | - Taylor F. Mahoney
- Department of Biostatistics, Boston University School of Public Health, Boston MA
| | - Pratima Agarwal
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
| | | | - Judy J. Wang
- Boston University School of Medicine, Boston, MA
| | - J. Pieter Noordzij
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Lauren F. Tracy
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Heather A. Edwards
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Gregory Grillone
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Andrew R. Salama
- Department of Oral Maxillofacial Surgery Boston, Medical Center, Boston MA
| | - Scharukh M. Jalisi
- Department of Otolaryngology – Head and Neck Surgery, Beth Israel Deaconess, Boston, MA
| | - Anand K. Devaiah
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| |
Collapse
|
17
|
Khetpal S, Sasson DC, Lopez J, Steinbacher DM, Gosain AK. The Impact of Social Determinants of Health in Facial and Craniomaxillofacial Reconstruction: Can We Do Better? Cleft Palate Craniofac J 2021; 59:938-945. [PMID: 34514875 DOI: 10.1177/10556656211037510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Social determinants of health (SDOH) are integral to consider when delivering craniomaxillofacial and facial reconstructive care for patients. The American Cleft Palate-Craniofacial Association (ACPA) has instituted a formalized multidisciplinary care team model that recognizes such determinants and has aggregated patient-led organizations to strengthen patients' education and support system. This review discusses the need for all surgeons engaged in facial and craniomaxillofacial reconstruction to consider SDOH in their practice. Additionally, we explore how factors such as race, insurance status, education level, cost, and access to follow-up care, impact surgical care for craniosynostosis, facial trauma, orthognathic surgery, head and neck cancer, and facial paralysis. We propose that the ACPA team model be applied to other societies that care for the broader scope of patients in need of facial and craniomaxillofacial reconstruction to strengthen the communication, collaboration, and standardization of care delivery that is personalized to the needs of each patient.
Collapse
Affiliation(s)
| | - Daniel C Sasson
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Joseph Lopez
- 12228Yale School of Medicine, New Haven, CT, USA
| | | | - Arun K Gosain
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| |
Collapse
|
18
|
Sung WW, Hsu YC, Dong C, Chen YC, Chao YC, Chen CJ. Favorable Lip and Oral Cancer Mortality-to-Incidence Ratios in Countries with High Human Development Index and Expenditures on Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116012. [PMID: 34205053 PMCID: PMC8199886 DOI: 10.3390/ijerph18116012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The incidence rates of lip and oral cancer have continued to increase, and prognosis is associated with a country's socioeconomic status. The mortality-to-incidence ratio (MIR) is a reasonable indicator of disparities in cancer screening and treatment. In this study, we aimed to understand the association between economic status and cancer prognosis. METHODS Data were obtained from the Global Cancer Observatory (GLOBOCAN) and the World Health Organization (WHO). The MIRs were compared to evaluate the correlation with the human development index (HDI), the current health expenditure (CHE), and the ratio of CHE over gross domestic product (CHE/GDP) disparities via Spearman's rank correlation coefficient. RESULTS The results showed that Asia had the most cases and deaths. In addition, they showed a significant association (p < 0.001, p = 0.005, and p < 0.001, respectively) of the crude rate (CR) of incidence with the HDI, the CHE, and the CHE/GDP. However, their associations with mortality rate (p = 0.303, p = 0.997, and p = 0.101) were not significant. Regarding the correlation of the MIRs, the results revealed a significant association with the HDI, the CHE, and the CHE/GDP (p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSION Countries with higher HDI, CHE per capita, and CHE/GDP tend to have lower MIRs, which indicates favorable clinical outcomes.
Collapse
Affiliation(s)
- Wen-Wei Sung
- Department of Urology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.D.); (Y.-C.C.); (Y.-C.C.)
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yong-Chen Hsu
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung 40201, Taiwan;
| | - Chen Dong
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.D.); (Y.-C.C.); (Y.-C.C.)
| | - Ying-Ching Chen
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.D.); (Y.-C.C.); (Y.-C.C.)
| | - Yu-Chi Chao
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.D.); (Y.-C.C.); (Y.-C.C.)
| | - Chih-Jung Chen
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.D.); (Y.-C.C.); (Y.-C.C.)
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung 40201, Taiwan;
- Correspondence: ; Tel.: +886-4-2359-2525
| |
Collapse
|