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Ebrahimi A, Hosseini S, Shahabi S, Ashkani-Esfahani S, Lozano-Calderon S. The Impact of Social Determinants of Health on the Prognosis of Primary Bone Tumors: A Systematic Review. JBJS Rev 2024; 12:01874474-202409000-00004. [PMID: 39226393 DOI: 10.2106/jbjs.rvw.24.00071] [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: 09/05/2024]
Abstract
BACKGROUND Although the prevalence of primary bone tumors (PBTs) was reported to be relatively low, they represent a difficult category of tumors for appropriate prediction, prevention, diagnosis, and treatment. Among different factors contributing to the prognosis and treatment outcomes of patients with these tumors, it is assumed that social determinants of health (SDOH) have not been well investigated nor applied in the process of decision making for these patients. METHODS In this systematic review, databases including PubMed, Web of Science, Scopus, Embase, Science Direct, and CINAHL were used. To ensure the quality of the studies and assess them for bias, we used the Methodological Index for Nonrandomized Studies scaling tool. The relevant data were extracted from the included studies and reported. RESULTS Twenty-five studies were included in our review based on the inclusion criteria. Age, socioeconomic status, education, and employment status; place of living and neighborhood; race and ethnicity; and insurance coverage were found to impact the outcomes and prognosis of PBTs. CONCLUSION Literature has shown correlations of various SDOH with the outcomes of PBTs. SDOH are not independent of each other; including and interpreting them in the process of decision making should be in a multifactorial and intercalated manner. We suggest prospective studies on finding the effect of inventing with SDOH through changes in health care policies, educating patients and care providers, improving socioeconomic conditions, and providing better insurance support, on the outcomes of PBTs. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alireza Ebrahimi
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Hosseini
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Saeed Shahabi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Foot and Ankle Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Santiago Lozano-Calderon
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Dhir A, Rahul R, Liu Q, Pham D, Kronenfeld R, Koru‐Sengul T, Pinheiro PS. Disparities in incidence and survival for patients with Ewing sarcoma in Florida. Cancer Med 2024; 13:e7151. [PMID: 38650521 PMCID: PMC11036070 DOI: 10.1002/cam4.7151] [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: 10/14/2023] [Revised: 01/12/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Ewing sarcoma (ES) is a malignant bone tumor most commonly affecting non-Hispanic White (NHW) adolescent males, though recognition among Hispanic individuals is rising. Prior population-based studies in the United States (US), utilizing Surveillance, Epidemiology, and End Results (SEER) have shown higher all-cause mortality among White Hispanics, Blacks, and those of low socioeconomic status (SES). Florida is not part of SEER but is home to unique Hispanic populations including Cubans, Puerto Ricans, South Americans that contrasts with the Mexican Hispanic majority in other US states. This study aimed to assess racial/ethnic disparities on incidence and survival outcomes among this diverse Florida patient population. METHODOLOGY Our study examined all patients diagnosed with osseous ES (2005-2018) in Florida (n = 411) based on the state's population-based cancer registry dataset. Florida Age-adjusted Incidence Rates (AAIRs) were computed by sex and race-ethnicity and compared to the equivalent populations in SEER. Cause-specific survival disparities among Florida patients were examined using Kaplan-Meier analysis. Univariable and multivariable analyses using Cox regression were performed for race/ethnicity, with adjustment for age, sex, year of diagnosis, site of disease, staging, SES, and insurance type. RESULTS There was a significantly higher incidence of osseous ES in Florida Hispanic males (AAIR 2.6/1,000,000); (95% CI: 2.0-3.2 per 1,000,000; n = 84) compared to the SEER Hispanic males (AAIR 1.2/1,000,000;1.1-1.4 per 1,000,000; n = 382). Older age, distant metastasis, lack of chemotherapy or surgical resection were statistically significant determinants of poor survival while SES, insurance status and race-ethnicity were not. However, among nonmetastatic ES, Florida Hispanics had an increased risk of death compared to Florida NHW (adjusted Hazard Ratio 2.32; 95%CI: 1.20-4.46; p = 0.012). CONCLUSIONS Florida Hispanic males have a higher-than-expected incidence of osseous ES compared to the US. Hispanics of both sexes show remarkably worse survival for nonmetastatic disease compared to NHW. This disparity is likely multifactorial and requires further in-depth studies.
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Affiliation(s)
- Aditi Dhir
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Pediatric Hematology/Oncology, Department of PediatricsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Rachna Rahul
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Epidemiology & Population Health Sciences, Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Qinran Liu
- Division of Epidemiology & Population Health Sciences, Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Dan Pham
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Pediatric Hematology/Oncology, Department of PediatricsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Rachel Kronenfeld
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Pediatric Hematology/Oncology, Department of PediatricsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Tulay Koru‐Sengul
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Biostatistics, Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Paulo S. Pinheiro
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Biostatistics, Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
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McBee DB, Bentley HA, Toledanes G. Ewing's Sarcoma of the Hand: An Unusual Presentation in a Young Hispanic Male. Cureus 2023; 15:e49140. [PMID: 38130536 PMCID: PMC10733606 DOI: 10.7759/cureus.49140] [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: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Ewing's sarcoma is a neuroectodermal malignancy classically associated with innocuous and chronic symptomatology. Although tumors typically involve the axial skeleton, some malignancies may be confined to extraosseous tissue only. This report presents the case of a 15-year-old Hispanic male with a tender, slow-growing mass of seven months in the subcutaneous tissue of the right hand. Core needle biopsy and fine needle aspiration confirmed the diagnosis of high-grade extraosseous Ewing's sarcoma and the patient was treated via surgical resection and chemotherapy. Nonspecific findings of Ewing's sarcoma may mimic infection or trauma and contribute to a delay in diagnosis. However, social and economic influences including limited English proficiency and insurance status also critically affect the timing of presentation.
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Affiliation(s)
- Dylan B McBee
- School of Medicine, Baylor College of Medicine, Houston, USA
| | - Hope A Bentley
- School of Medicine, McGovern Medical School, Houston, USA
| | - Giancarlo Toledanes
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Texas Children's Hospital, Houston, USA
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Goulding D, Arguinchona L, Anderson-Mellies A, Mikkelsen M, Eguchi M, Marinoff H, Zahedi S, Ribeiro KB, Cockburn M, Galindo CR, Green AL. Sociodemographic Disparities in Presentation and Survival of Pediatric Bone Cancers. J Pediatr Hematol Oncol 2023; 45:e31-e43. [PMID: 36044295 PMCID: PMC9812857 DOI: 10.1097/mph.0000000000002531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/09/2022] [Indexed: 02/03/2023]
Abstract
Osteosarcoma (OST) and Ewing sarcoma (ES) are the most common pediatric bone cancers. Patients with metastatic disease at diagnosis have poorer outcomes compared with localized disease. Using the Surveillance, Epidemiology, and End Results registries, we identified children and adolescents diagnosed with OST or ES between 2004 and 2015. We examined whether demographic and socioeconomic disparities were associated with a higher likelihood of metastatic disease at diagnosis and poor survival outcomes. In OST, Hispanic patients and those living in areas of high language isolation were more likely to have metastatic disease at diagnosis. Regardless of metastatic status, OST patients with public insurance had increased odds of death compared to those with private insurance. Living in counties with lower education levels increased odds of death for adolescents with metastatic disease. In ES, non-White adolescents had higher odds of death compared with white patients. Adolescents with metastatic ES living in higher poverty areas had increased odds of death compared with those living in less impoverished areas. Disparities in both diagnostic and survival outcomes based on race, ethnicity, and socioeconomic factors exist in pediatric bone cancers, potentially due to barriers to care and treatment inequities.
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Affiliation(s)
- DeLayna Goulding
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Lauren Arguinchona
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | | | - Margit Mikkelsen
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Megan Eguchi
- Center of Biostatistics, University of Colorado School of Medicine, Aurora, CO
| | - Hannah Marinoff
- Center of Biostatistics, University of Colorado School of Medicine, Aurora, CO
| | - Shadi Zahedi
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | | | - Myles Cockburn
- Center of Biostatistics, University of Colorado School of Medicine, Aurora, CO
| | | | - Adam L. Green
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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Westermann C, Weller J, Pedroso F, Canner J, Pratilas CA, Rhee DS. Socioeconomic and health care coverage disparities in children, adolescents, and young adults with sarcoma. Pediatr Blood Cancer 2020; 67:e28708. [PMID: 32939963 DOI: 10.1002/pbc.28708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Socioeconomic and health care coverage disparities are established as poor prognostic markers in adults with sarcoma, but few studies examine these differences among pediatric, adolescents and young adults (AYA). This study examines the association between socioeconomic status (SES), insurance status, and disease presentation among children and AYA patients with sarcoma. METHODS This is a retrospective cohort study of patients aged 0-25 years with bone or soft tissue sarcoma from the National Cancer Database. SES assignments were based on estimated median income and education level. Patient demographics and clinical factors were compared by SES and insurance status. Multivariate logistic regression models were fitted to determine adjusted odds ratios of SES and insurance status on metastatic disease or tumor size ≥5 cm at time of presentation. RESULTS In a cohort of 9112 patients, 2932 (32.1%) had low, 2084 (22.8%) middle, and 4096 (44.9%) high SES. For insurance status, 5864 (64.3%) had private, 2737 (30.0%) public, and 511 (5.6%) were uninsured. Compared to high SES, patients with low SES were more likely to have metastatic disease (OR = 1.16, P = .03) and tumors ≥5 cm (OR = 1.29, P < .01). Compared to private insurance, public and no insurance were associated with metastatic disease (OR = 1.35, P < .01 and OR = 1.32, P = .02) and increased tumors ≥5 cm (OR = 1.28, P < .01 and OR = 1.67, P < .01). CONCLUSIONS SES disparities exist among children and AYA patients with sarcoma. Low SES and public or no insurance are associated with advanced disease at presentation. Further studies are needed to identify interventions to improve earlier detection of sarcomas in at-risk children and young adults.
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Affiliation(s)
- Carly Westermann
- Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Jennine Weller
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Felipe Pedroso
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joe Canner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine A Pratilas
- Division of Pediatric Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Smits-Seemann RR, Pettit J, Li H, Kirchhoff AC, Fluchel MN. Infection-related mortality in Hispanic and non-Hispanic children with cancer. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26502. [PMID: 28436579 PMCID: PMC6719562 DOI: 10.1002/pbc.26502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hispanic children with cancer experience poorer survival than their White counterparts. Infection is a known cause of cancer-related mortality; however, little is known about the risk of infection-related death among Hispanic children with cancer. We examine the association of Hispanic ethnicity with infection-related mortality and life-threatening events among children with cancer. PROCEDURE For a cohort of all pediatric cancer patients diagnosed from 1986 to 2012 and treated at a single tertiary care center, we obtained national death records to determine all-cause mortality and infection-related mortality, as well as intensive care unit (ICU) admissions as a surrogate for life-threatening events. Cox proportional hazard models assessed all-cause mortality and infection-related mortality using ethnicity as the main independent variable. ICU admission rates were modeled using a zero-inflated Poisson regression model. Models were adjusted for gender, diagnosis year, age, residential location, and diagnosis. RESULTS Of 6,198 patients, 741 (12%) were Hispanic. Mean follow-up was 11 years (SD = 8.04). There were 1,205 deaths, with 193 attributable to infection. Differences in all-cause mortality between Hispanic and non-Hispanic patients did not reach significance (hazard ratio [HR] = 1.14, 95% confidence interval [CI]: 0.96-1.36). However, Hispanic patients were 68% (HR = 1.68, 95% CI: 1.16-2.43) more likely to have an infection-related cause of death. Hispanic ethnicity was statistically associated with a higher rate of ICU admissions (rate ratio = 1.32, 95% CI: 1.12-1.56). CONCLUSION Hispanic pediatric cancer patients were more likely to have an infection-related death and higher rates of ICU admissions than non-Hispanic patients. Infection may be an overlooked contributor to poorer outcomes among Hispanic patients.
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Affiliation(s)
- Rochelle R. Smits-Seemann
- Department of Institutional Research and Reporting, Salt Lake Community College, Salt Lake City, Utah
| | | | - Hongyan Li
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Mark N. Fluchel
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah,Primary Children’s Hospital, Salt Lake City, Utah
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Green AL, Furutani E, Ribeiro KB, Rodriguez Galindo C. Death Within 1 Month of Diagnosis in Childhood Cancer: An Analysis of Risk Factors and Scope of the Problem. J Clin Oncol 2017; 35:1320-1327. [PMID: 28414926 DOI: 10.1200/jco.2016.70.3249] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose Despite advances in childhood cancer care, some patients die soon after diagnosis. This population is not well described and may be under-reported. Better understanding of risk factors for early death and scope of the problem could lead to prevention of these occurrences and thus better survival rates in childhood cancer. Methods We retrieved data from SEER 13 registries on 36,337 patients age 0 to 19 years diagnosed with cancer between 1992 and 2011. Early death was defined as death within 1 month of diagnosis. Socioeconomic status data for each individual's county of residence were derived from Census 2000. Crude and adjusted odds ratios and corresponding 95% CIs were estimated for the association between early death and demographic, clinical, and socioeconomic factors. Results Percentage of early death in the period was 1.5% (n = 555). Children with acute myeloid leukemia, infant acute lymphoblastic leukemia, hepatoblastoma, and malignant brain tumors had the highest risk of early death. On multivariable analysis, an age younger than 1 year was a strong predictor of early death in all disease groups examined. Black race and Hispanic ethnicity were both risk factors for early death in multiple disease groups. Residence in counties with lower than median average income was associated with a higher risk of early death in hematologic malignancies. Percentages of early death decreased significantly over time, especially in hematologic malignancies. Conclusion Risk factors for early death in childhood cancer include an age younger than 1 year, specific diagnoses, minority race and ethnicity, and disadvantaged socioeconomic status. The population-based disease-specific percentages of early death were uniformly higher than those reported in cooperative clinical trials, suggesting that early death is under-reported in the medical literature. Initiatives to identify those at risk and develop preventive interventions should be prioritized.
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Affiliation(s)
- Adam L Green
- Adam L. Green, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO; Elissa Furutani, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA; Carlos Rodriguez Galindo, St Jude Children's Research Hospital, Memphis, TN; and Karina Braga Ribeiro, Faculdade de Ciencias Medicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Elissa Furutani
- Adam L. Green, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO; Elissa Furutani, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA; Carlos Rodriguez Galindo, St Jude Children's Research Hospital, Memphis, TN; and Karina Braga Ribeiro, Faculdade de Ciencias Medicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Karina Braga Ribeiro
- Adam L. Green, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO; Elissa Furutani, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA; Carlos Rodriguez Galindo, St Jude Children's Research Hospital, Memphis, TN; and Karina Braga Ribeiro, Faculdade de Ciencias Medicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Carlos Rodriguez Galindo
- Adam L. Green, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO; Elissa Furutani, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA; Carlos Rodriguez Galindo, St Jude Children's Research Hospital, Memphis, TN; and Karina Braga Ribeiro, Faculdade de Ciencias Medicas da Santa Casa de São Paulo, São Paulo, Brazil
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Kazak AE, Barakat LP, Askins MA, McCafferty M, Lattomus A, Ruppe N, Deatrick J. Provider Perspectives on the Implementation of Psychosocial Risk Screening in Pediatric Cancer. J Pediatr Psychol 2017; 42:700-710. [DOI: 10.1093/jpepsy/jsw110] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/27/2016] [Indexed: 01/24/2023] Open
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Smits-Seemann RR, Kaul S, Hersh AO, Fluchel MN, Boucher KM, Kirchhoff AC, Smits-Seemann RR, Kaul S, Hersh AO, Fluchel MN, Boucher KM, Kirchhoff AC. ReCAP: Gaps in Insurance Coverage for Pediatric Patients With Acute Lymphoblastic Leukemia. J Oncol Pract 2016; 12:175-6; e207-14. [DOI: 10.1200/jop.2015.005686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
QUESTION ASKED: We sought to determine the likelihood that pediatric and adolescent acute lymphoblastic leukemia (ALL) patients experience a gap in health insurance coverage in the first 2 years of therapy. SUMMARY ANSWER: We found that 12% of patients with ALL in our sample who had insurance at diagnosis experienced a gap in insurance coverage during the first 2 years of therapy; that is, they had one or more clinic encounter at which they did not have insurance. Patients with public insurance at diagnosis were more likely to experience an insurance gap than those with private insurance at diagnosis, and those diagnosed in more recent years were less likely to experience a gap. METHODS/APPROACH: We determined insurance status at all clinic encounters at a tertiary children’s hospital within 2 years of diagnosis for patients diagnosed with ALL between 1998 and 2010, and calculated the odds of a gap occurring on the basis of demographic and diagnostic variables. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Our assessment is from years before the roll-out of key Patient Protection and Affordable Care Act provisions, which should improve insurance coverage for pediatric and adolescent patients with ALL. In addition, we lacked information on patient or caregiver socioeconomic status, which may be important for explaining insurance gaps. Finally, our assessment is based on a single institution. REAL-LIFE IMPLICATIONS: Gaps in health insurance may exacerbate the financial and emotional burden associated with pediatric and adolescent cancer. Understanding the likelihood that these gaps will occur, as well as predictors of insurance gaps, will allow social workers and other providers to help families manage anticipated changes in insurance, with the goal of reducing unnecessary burden. [Figure: see text]
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Affiliation(s)
- Rochelle R. Smits-Seemann
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Sapna Kaul
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Aimee O. Hersh
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Mark N. Fluchel
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Kenneth M. Boucher
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Anne C. Kirchhoff
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Rochelle R. Smits-Seemann
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
| | - Sapna Kaul
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
| | - Aimee O. Hersh
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
| | - Mark N. Fluchel
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
| | - Kenneth M. Boucher
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
| | - Anne C. Kirchhoff
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
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Brunetto AL, Castillo LA, Petrilli AS, Macedo CD, Boldrini E, Costa C, Almeida MT, Kirst D, Rodriguez-Galindo C, Pereira WV, Watanabe FM, Pizza M, Benites E, Morais V, Gadelha A, Nakasato A, Abujamra AL, Gregianin LJ. Carboplatin in the treatment of Ewing sarcoma: Results of the first Brazilian collaborative study group for Ewing sarcoma family tumors-EWING1. Pediatr Blood Cancer 2015; 62:1747-53. [PMID: 25917418 DOI: 10.1002/pbc.25562] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/24/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Large cooperative group studies have shown the efficacy of risk-adapted treatment for Ewing sarcoma. However, validation and local adaptation by National cooperative groups is needed. A multicenter protocol to determine the efficacy and safety of a risk-adapted intensive regimen was developed by the Brazilian cooperative group. PROCEDURE Patients <30 years old with Ewing sarcoma were eligible. Induction chemotherapy consisted of two cycles of ICE (ifosfamide, carboplatin, and etoposide) followed by two cycles of VDC (vincristine, doxorubicin, and cyclophosphamide), followed by local control. Patients with low risk (LR) disease (localized resectable with normal LDH) received 10 additional alternating courses of IE with VDC. For patients with high-risk (HR) disease (unresectable, pelvic, metastatic, or high LDH), two additional cycles of ICE were given. RESULTS One-hundred seventy five patients (39% metastatic) were enrolled. Fifty-two patients (29.7%) were LR and 123 (70.3%) were HR. Overall response rate at end of induction was 27.4%. Five-year event-free survival (EFS) and overall survival (OS) estimates were 51.4% and 54.4%, respectively. Patients with localized disease had better outcomes than patients with metastases (5-year EFS 67.9% vs. 25.5%, and 5-year OS 70.3% vs. 29.1%, respectively). On multivariate analysis, the presence of metastatic disease was the only prognostic factor (P < 0.01). CONCLUSION The VDC/ICE protocol was feasible, and considering the high tumor burden in our population, resulted in comparable results to those reported by cooperative groups in high-income countries. Further adaptation to maximize efficacy and minimize toxicity will be required.
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Affiliation(s)
| | | | - Antonio S Petrilli
- Department of Pediatrics, Pediatric Oncology Institute (IOP/GRAACC/UNIFESP), Federal University of S, ã, o Paulo, São Paulo, SP, Brazil
| | - Carla D Macedo
- Department of Pediatrics, Pediatric Oncology Institute (IOP/GRAACC/UNIFESP), Federal University of S, ã, o Paulo, São Paulo, SP, Brazil
| | - Erica Boldrini
- Fundação Pio XII - Hospital Infantojuvenil, Barretos, SP, Brazil
| | - Cecilia Costa
- Hospital do Câncer AC Camargo, São Paulo, SP, Brazil
| | - Maria T Almeida
- Hospital das Clínicas de São Paulo - ITACI, São Paulo, SP, Brazil
| | - Daniela Kirst
- Hospital da Criança Santo Antonio, Porto Alegre, RS, Brazil
| | | | - Waldir V Pereira
- Hospital Universit, á, rio de Santa Maria, Santa Maria, RS, Brazil
| | | | - Maria Pizza
- Santa Casa de Misericórdia de São Paulo, SP, Brazil
| | - Eliana Benites
- Instituto de Clínicas Pediátricas Bolívar Risso, Jundiaí, SP, Brazil
| | - Vera Morais
- Hospital Universitário Oswaldo Cruz, Recife, PE, Brazil
| | | | | | | | - Lauro J Gregianin
- Hospital São Lucas - PUC-RS, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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