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Gupta A, Omeogu C, Islam JY, Joshi A, Zhang D, Braithwaite D, Karanth SD, Tailor TD, Clarke JM, Akinyemiju T. Socioeconomic disparities in immunotherapy use among advanced-stage non-small cell lung cancer patients: analysis of the National Cancer Database. Sci Rep 2023; 13:8190. [PMID: 37210410 DOI: 10.1038/s41598-023-35216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/15/2023] [Indexed: 05/22/2023] Open
Abstract
Socioeconomic and racial disparities exist in access to care among patients with non-small cell lung cancer (NSCLC) in the United States. Immunotherapy is a widely established treatment modality for patients with advanced-stage NSCLC (aNSCLC). We examined associations of area-level socioeconomic status with receipt of immunotherapy for aNSCLC patients by race/ethnicity and cancer facility type (academic and non-academic). We used the National Cancer Database (2015-2016), and included patients aged 40-89 years who were diagnosed with stage III-IV NSCLC. Area-level income was defined as the median household income in the patient's zip code, and area-level education was defined as the proportion of adults aged ≥ 25 years in the patient's zip code without a high school degree. We calculated adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) using multi-level multivariable logistic regression. Among 100,298 aNSCLC patients, lower area-level education and income were associated with lower odds of immunotherapy treatment (education: aOR 0.71; 95% CI 0.65, 0.76 and income: aOR 0.71; 95% CI 0.66, 0.77). These associations persisted for NH-White patients. However, among NH-Black patients, we only observed an association with lower education (aOR 0.74; 95% CI 0.57, 0.97). Across all cancer facility types, lower education and income were associated with lower immunotherapy receipt among NH-White patients. However, among NH-Black patients, this association only persisted with education for patients treated at non-academic facilities (aOR 0.70; 95% CI 0.49, 0.99). In conclusion, aNSCLC patients residing in areas of lower educational and economic wealth were less likely to receive immunotherapy.
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Affiliation(s)
- Anjali Gupta
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27708, USA
| | - Chioma Omeogu
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27708, USA
| | - Jessica Y Islam
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27708, USA
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ashwini Joshi
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27708, USA
| | - Dongyu Zhang
- Johnson and Johnson, Medical Device Epidemiology, New Brunswick, NJ, USA
| | | | - Shama D Karanth
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Tina D Tailor
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Jeffrey M Clarke
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27708, USA.
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Asare M, Elizondo A, Dwumfour-Poku M, Mena C, Gutierrez M, Mamudu HM. Intervention to Increase Cervical Cancer Screening Behavior among Medically Underserved Women: Effectiveness of 3R Communication Model. Healthcare (Basel) 2023; 11:healthcare11091323. [PMID: 37174865 PMCID: PMC10178119 DOI: 10.3390/healthcare11091323] [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: 04/01/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Human Papillomavirus (HPV) self-sampling has the potential to increase Cervical Cancer Screening (CCS) and reduce the cervical cancer burden in Medically Underserved Women (MUW). However, interventions promoting self-sampling are limited. We examined the effectiveness of an intervention study in increasing CCS among MUW. We conducted a quasi-experimental intervention study. A face-to-face verbal approach was used to recruit MUW (n = 83, mean age 48.57 ± 11.02) living in a small city in the US. Behavioral intervention based on reframing, reprioritizing, and reforming (3R model) was used to educate the women about CCS in a group format. The women (n = 83) completed pre-and post-intervention assessments, and 10 of them were invited for follow-up interviews. The primary outcome was CCS uptake. Mixed methods analyses were conducted using a t-test for the primary outcome, PROCESS for mediation analysis, and NVivo for interview data. The majority of women (75%) completed self-testing. High-risk HPV among women was 11%, and of those, 57% followed up with physicians for care. We found that the significant increase in the women's post-intervention screening behaviors was mediated by the increase in knowledge (Indirect Effect [IE] = 0.1314; 95% CI, 0.0104, 0.4079) and attitude (IE = 0.2167; 95% CI, 0.0291, 0.6050) scores, (p < 0.001). Interview analyses offered further explanations why MUW found the intervention messages acceptable (encourages proactive behavior), feasible (simple and easy to understand), and appropriate (helpful and informative). Barriers, including lack of trust and fear of results, were identified. The findings suggest that an intervention that combines the 3R model and self-sampling may increase CCS among MUW.
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Affiliation(s)
- Matthew Asare
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Anjelica Elizondo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Mina Dwumfour-Poku
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Carlos Mena
- North American University, Stafford, TX 77477, USA
| | - Mariela Gutierrez
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Hadii M Mamudu
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson City, TN 37614, USA
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Vengaloor Thomas T, Gandhi S, Bhanat E, Krishna K, Robinson W, Ridgway M, Abraham A, Vijayakumar S, Packianathan S. An Analysis of the Racial Disparities Among Cervical Cancer Patients Treated at an Academic Medical Center in the Southeastern United States. Cureus 2021; 13:e13296. [PMID: 33732559 PMCID: PMC7956045 DOI: 10.7759/cureus.13296] [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] [Indexed: 11/16/2022] Open
Abstract
Objective The purpose of this study was to identify racial disparities in treatment outcomes, if any, among patients with carcinoma of the cervix treated at a tertiary care institution in the state of Mississippi. Methods A retrospective review of patients with carcinoma of the cervix treated in the Department of Radiation Oncology at our institution between 2010 and 2018 was performed. Data regarding demographics, disease stage, treatments administered, and follow-up were collected. Patient outcomes, including median survival and overall survival, were analyzed using the Kaplan-Meier method. All analyses were performed using SPSS Statistics version 24 (IBM, Armonk, NY). Results Between January 2010 and December 2018, a total of 165 patients with carcinoma of the cervix were treated at our institution. We had a significantly higher proportion of African American (AA) compared to Caucasian American (CA) patients (59.4 vs. 36.4%; p=0.03). There was a significant difference in the disease stage at the time of presentation between AA and CA in that compared to AA women, a higher number of CA patients presented with locally advanced disease [Federation of Gynecology and Obstetrics (FIGO) stages IB2 to IVA] (78.6 vs. 86.7%; p<0.001). However, a higher number of AA patients presented with metastatic disease at diagnosis compared to CA women (13.3 vs. 8.3%; p<0.001). Regarding their treatment, 157 (95.2%) underwent definitive chemoradiotherapy, while three (1.8%) had definitive surgery followed by adjuvant radiation or chemoradiation, depending on the risk factors identified operatively. The treatment details of five patients were not available. The median follow-up and the median survival of the entire cohort were 16 months and 79 months, respectively. In our cohort, there was no significant difference in overall survival between AA and CA patients at either three years (80 vs. 68%; p=0.883) or five years (77 vs. 68%; p=0.883). As expected, patients with locally advanced disease showed a significantly better median survival of 79 months compared to only 11 months for those with metastatic disease at their presentation (p<0.001). Conclusions Our study revealed that more AA women presented with metastatic disease compared to CA women. However, our analysis did not identify any racial disparities in the prognosis of the entire cohort.
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Affiliation(s)
| | | | - Eldrin Bhanat
- Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, USA
| | - Kati Krishna
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - William Robinson
- Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
| | - Mildred Ridgway
- Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
| | - Anu Abraham
- Pathology, Universtiy of Mississippi Medical Center, Jackson, USA
| | | | - Satya Packianathan
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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Abdalla E, Troy R, Fall S, Elhussin I, Egiebor-Aiwan O, Nganwa D. Racial differences in 5-year relative survival rates of cervical cancer by stage at diagnosis, between African American (black) and white women, living in the state of Alabama, USA. BMC Cancer 2020; 20:830. [PMID: 32873252 PMCID: PMC7465406 DOI: 10.1186/s12885-020-07338-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our objective was to assess racial differences in the 5-year relative survival rates (RSRs) of Cervical Cancer (CerCancer) by stage at diagnosis, between Black and White women, living in Alabama, USA. METHODS Data for 3484 Blacks and 21,059 Whites diagnosed with CerCancer were extracted from the 2004 to 2013 Surveillance, Epidemiology, and End Results (SEER) database. We incorporated age groups, CerCancer stages, county, and year of diagnosis to compare the RSR between Blacks and Whites, using SEER*Stat software. RESULTS In urban, Black Belt (BB) and other rural counties, Whites diagnosed with localized stage of CerCancer always had better chances of survival because their RSRs were always more than 77%, compared to Blacks. Only exception was in Blacks living in other rural counties, who had a significantly higher RSR of 83.8% (95% Cl, 74.2-90.1). Which was the same as in Whites (83.8% (95% CI 74.5-89.9) living in BBC. Although, in other rural counties, Whites had a slightly lower RSR of 83.7% (95% CI 79.9-86.8%), their RSR was better compared to Blacks and Whites living in BB and other rural counties who had slightly higher RSRs of 83.8%. This was due to statistical precision, which depended on their larger sample size and a lower variability therefore, more reliability resulting in a tighter confidence interval with a smaller margin of error. In all the three county groups, Whites 15-44 years old diagnosed with localized stage of CerCancer had a higher RSR of 93.6% (95% CI 91.4-95.2%) for those living in urban and BB counties, and 94.6% (95% CI 93.6-95.4) for those living in other rural counties. The only exception was in Blacks 65-74 years old living in other rural counties who had the highest RSR of 96.9% (95% Cl, 82.9-99.5). However, Whites were considered to have a better RSR. This was also due to the statistical precision as mentioned above. CONCLUSION There were significant racial differences in the RSRs of CerCancer. Overall, Black women experienced the worst RSRs compared to their White counterparts.
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Affiliation(s)
- Ehsan Abdalla
- Department of Graduate Public Health (College of Veterinary Medicine), Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL 36088 USA
| | - Roberta Troy
- Biology Department (College of Arts and Sciences), Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL 36088 USA
| | - Souleymane Fall
- Department of Agriculture and Environmental Sciences (College of Agriculture, Environment and Nutrition Sciences), Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL 36088 USA
| | - Isra Elhussin
- Integrative Biosciences PhD program, Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL 36088 USA
| | - Oyoyo Egiebor-Aiwan
- Southern Illinois School of Medicine, 2711 Covered Wagon, Trail Springfield, IL 62711 USA
| | - David Nganwa
- Department of Pathobiology/Department of Graduate Public Health, Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL 36088 USA
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Hagopian GS, Lieber M, Dottino PR, Margaret Kemeny M, Li X, Overbey J, Clark LD, Beddoe AM. The impact of nativity on cervical cancer survival in the public hospital system of Queens, New York. Gynecol Oncol 2018; 149:63-69. [PMID: 29605052 DOI: 10.1016/j.ygyno.2017.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We studied cervical cancer patients who presented to the Public Hospital System in ethnically-diverse Queens, New York from 2000 to 2010 with the purpose of examining the relationship between nativity (birthplace) and survival. METHODS A retrospective review of tumor registries was used to identify patients diagnosed with cervical cancer between January 1, 2000 and December 31, 2010. Using electronic medical records, data from 317 patients were available for this analysis. RESULTS The majority of patients were born outside the United States (US) (85.5% versus 14.5%). One hundred patients (31.5%) were born in Latin America, 105 in the Caribbean Islands (33.1%), 48 in Asia (15.1%), 8 in the South Asia (2.5%), 10 in Russia/Eastern Europe (3.2%) and 46 (14.5%) in the United States. Patients presented at varying stages of disease: 51.4% at stage I, 19.6% at stage II, 19.6% at stage III, and 8.5% at stage IV. Kaplan-Meier estimated survival curves stratified by birthplace demonstrated significant differences in survival distributions among the groups using the log-rank test (P<0.0001). The most favorable survival curves were observed among patients born in Latin America and Asia whereas the least favorable was demonstrated in US-born patients. Time to death was analyzed using the Cox proportional hazards model. Adjusting for age at diagnosis, insurance status, stage and treatment modality, nodal metastases and hydronephrosis, birthplace was significantly associated with survival time (P<0.0001). CONCLUSION An immigrant health paradox was defined for foreign-born Latino and Asian patients presenting with cervical cancer to the Public Hospital System of Queens, New York as patients born in Latin America and Asia were less likely to die at any given time compared to those born in the United States.
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Affiliation(s)
- George S Hagopian
- Department of Obstetrics and Gynecology, Elmhurst Hospital Center, Elmhurst, Queens, NY, United States; Department of Obstetrics and Gynecology, Queens Hospital Center, Jamaica, Queens, NY, United States; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Queens Cancer Center, Queens Hospital Center, Jamaica, Queens, NY, United States.
| | - Molly Lieber
- Division of Global Health, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, NY, New York, United States
| | - Peter R Dottino
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - M Margaret Kemeny
- Queens Cancer Center, Queens Hospital Center, Jamaica, Queens, NY, United States; Department of Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, United States
| | - Xilian Li
- Department of Radiation Oncology, Queens Hospital Center, United States; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, NY, New York, United States
| | - Jessica Overbey
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, New York, United States
| | - Li-Duen Clark
- Department of Obstetrics and Gynecology, Queens Hospital Center, Jamaica, Queens, NY, United States
| | - Ann Marie Beddoe
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of Global Health, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, NY, New York, United States
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Prognostic significance of residual lymph node status after definitive chemoradiotherapy in patients with node-positive cervical cancer. Gynecol Oncol 2018; 148:449-455. [PMID: 29329882 DOI: 10.1016/j.ygyno.2018.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 11/19/2022]
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Markt SC, Tang T, Cronin AM, Katz IT, Howitt BE, Horowitz NS, Lee LJ, Wright AA. Insurance status and cancer treatment mediate the association between race/ethnicity and cervical cancer survival. PLoS One 2018; 13:e0193047. [PMID: 29447263 PMCID: PMC5814056 DOI: 10.1371/journal.pone.0193047] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 02/02/2018] [Indexed: 11/18/2022] Open
Abstract
Cervical cancer outcomes remain poor among disadvantaged populations, including ethnic minorities, low-income, and underinsured women. The aim of this study was to evaluate the mechanisms that underlie the observed association between race/ethnicity and cervical cancer survival. We identified 13,698 women, ages 21 to 64 years, diagnosed with stages I-III primary cervical cancer between 2007-2013 in Surveillance, Epidemiology, and End Results (SEER). Multivariable Cox proportional hazards regression models evaluated associations between race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic, Other) and cervical cancer-specific mortality. We conducted mediation analysis to calculate the mediation proportion and its 95% confidence interval. Non-Hispanic black women had an increased risk of cervical cancer-specific mortality (HR: 1.23, 95% CI: 1.08-1.39), and Hispanic women a decreased risk of dying from their disease (HR: 0.82, 95% CI: 0.72-0.93), compared with non-Hispanic white. The estimated proportion of excess cervical cancer mortality for non-Hispanic black women relative to non-Hispanic white women that was mediated by insurance was 18.6% and by treatment was 47.2%. Furthermore, non-Hispanic black women were more likely to receive radiation and less likely to receive surgery for early-stage disease. In this population-based study we found that some of the excess cervical cancer-specific mortality for non-Hispanic black women is mediated by factors such as insurance status and treatment. These findings suggest that enhancing existing insurance coverage and ensuring equal and adequate treatment in all women may be a key strategy for improving cervical cancer outcomes.
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Affiliation(s)
- Sarah C. Markt
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Tianyu Tang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Angel M. Cronin
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ingrid T. Katz
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Brooke E. Howitt
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Neil S. Horowitz
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Obstetrics and Gynecology, Division Gynecologic Oncology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Larissa J. Lee
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Alexi A. Wright
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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Weragoda J, Azuero A, Badiga S, Bell WC, Matthews R, Piyathilake C. An examination of racial differences in 5-year survival of cervical cancer among African American and white American women in the southeastern US from 1985 to 2010. Cancer Med 2016; 5:2126-35. [PMID: 27185053 PMCID: PMC4873605 DOI: 10.1002/cam4.765] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/18/2016] [Accepted: 04/17/2016] [Indexed: 12/02/2022] Open
Abstract
Disparities in Cervical Cancer (CC) mortality outcomes between African American (AA) and White women have been studied for decades. However, conclusions about the effect of race on CC survival differ across studies. This study assessed differences in CC survival between AA and White women diagnosed between 1985 and 2010 and treated at two major hospitals in the southeastern US. The study sample included 925 AA and 1192 White women diagnosed with cervical adenocarcinoma, adenosquamous cell carcinoma, or squamous cell carcinoma. Propensity score adjustment and matching were employed to compare 5‐year survival between the two racial groups. Crude comparisons suggested relevant racial differences in survival. However, the racial differences became of small magnitude after propensity‐score adjustment and in matched analyses. Nonlinear models identified age at diagnosis, cancer stage, mode of treatment, and histological subtype as the most salient characteristics predicting 5‐year survival of CC, yet these characteristics were also associated with race. Crude racial differences in survival might be partly explained by underlying differences in the characteristics of racial groups, such as age at diagnosis, histological subtype, cancer stage, and the mode of treatment. The study results highlight the need to improve access to early screening and treatment opportunities for AA women to improve posttreatment survival from CC.
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Affiliation(s)
- Janaka Weragoda
- University of Alabama at Birmingham, Department of Nutrition Sciences, Birmingham, Alabama
| | - Andres Azuero
- University of Alabama at Birmingham, Department of Family, Community & Health Systems, Birmingham, Alabama
| | - Suguna Badiga
- University of Alabama at Birmingham, Department of Nutrition Sciences, Birmingham, Alabama
| | - Walter C Bell
- University of Alabama at Birmingham, Department of Pathology, Birmingham, Alabama
| | - Roland Matthews
- Morehouse School of Medicine, Department of Obstetrics and Gynecology, Atlanta, Georgia
| | - Chandrika Piyathilake
- University of Alabama at Birmingham, Department of Nutrition Sciences, Birmingham, Alabama
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Sheppard CS, El-Zein M, Ramanakumar AV, Ferenczy A, Franco EL. Assessment of mediators of racial disparities in cervical cancer survival in the United States. Int J Cancer 2016; 138:2622-30. [PMID: 26756569 DOI: 10.1002/ijc.29996] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/10/2015] [Accepted: 01/05/2016] [Indexed: 11/08/2022]
Abstract
Cervical cancer (CC) morbidity and mortality have decreased in the United States, but they remain high among black women. We assessed racial disparities in CC mortality, accounting for socioeconomic status (SES). We linked data from the 1988 to 2007 Surveillance Epidemiology and End Results (SEER) database to the US Census. Additional SES information was obtained through linkage with Area Resource Files. We used the Kaplan-Meier method for estimating probabilities following CC diagnosis and Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CC mortality by race. The models were incrementally adjusted for marital status, registry, period, stage, age at diagnosis, histology, treatment, household income, poverty and unemployment rates. We stratified the analyses by disease stage and American state. A total of 44,554 women with CC were identified. Compared to white women, black women had a higher risk of dying from CC; crude and adjusted HRs were 1.41 (CI: 1.34-1.48) and 1.09 (CI: 1.03-1.15), respectively. Corresponding estimates for Hispanic women were 0.85 (CI: 0.80-0.89) and 0.75 (CI: 0.71-0.80). Black women diagnosed at late disease stages had a higher risk of CC death, whereas Hispanic women diagnosed at early and late stages had significantly lower risks. Black CC patients in California experienced poorer survival relative to white women. Conversely, longer CC survival was seen among Hispanic women in California, Georgia and Utah. While crude estimates indicated an increased CC death risk among black women, risks diminished upon adjustment for clinical and sociodemographic characteristics.
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Affiliation(s)
- Candace S Sheppard
- Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Mariam El-Zein
- Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Agnihotram V Ramanakumar
- Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Alex Ferenczy
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Eduardo L Franco
- Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
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Kim S, Molina Y, Glassgow AE, Berrios N, Guadamuz J, Calhoun E. The effects of navigation and types of neighborhoods on timely follow-up of abnormal mammogram among black women. ACTA ACUST UNITED AC 2015; 2015. [PMID: 26949738 DOI: 10.18103/mra.v0i3.111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite the availability of relatively simple and inexpensive screening tools, minority women are more often diagnosed at a late stage of breast cancer, in part due to delays in follow-up of abnormal screening result. One of the key factors for timely follow-up of abnormal mammogram may be neighborhood characteristics. Patient Navigation (PN) programs aim to diminish barriers, but its differential effects by neighborhood have not been fully examined. The current study examines the effect of types of neighborhoods on time to follow-up of abnormal mammogram, and the differential effects of PN by neighborhood characteristics. METHODS We examined data from a total of 1,696 randomized patients from a randomized controlled trial, "the Patient Navigation in Medically Underserved Areas" study that explored the effect of navigation on breast health outcomes. We categorized participants' neighborhoods into three categories and compared the effect of navigation between these neighborhood types. RESULTS Navigated women in mixed race neighborhoods had a shorter time to follow-up compared with non-navigated women in the neighborhoods. Black women living in mixed neighborhoods had a significant longer time to follow-up of abnormal mammogram, compared with black women living in middle class black neighborhoods. CONCLUSION Patient navigation interventions improve timely follow-up of abnormal mammogram. Patient navigation may be particularly beneficial for minority women who reside in racially heterogeneous neighborhoods which may be less likely to have access to affordable health clinics and social services. Health policies concerning breast cancer early detection for minority women need to pay further attention to those who might potentially be excluded from health services due to the characteristics of neighborhoods. Socioeconomic conditions of neighborhood may affect individual health through multiple interlinked mechanisms. Neighborhood characteristics, such as poverty, segregation, access to resources, and social cohesion, cannot be fully understood with simplistic measures of neighborhood disadvantage.
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Tabatabai MA, Kengwoung-Keumo JJ, Eby WM, Bae S, Guemmegne JT, Manne U, Fouad M, Partridge EE, Singh KP. Disparities in cervical cancer mortality rates as determined by the longitudinal hyperbolastic mixed-effects type II model. PLoS One 2014; 9:e107242. [PMID: 25226583 PMCID: PMC4167327 DOI: 10.1371/journal.pone.0107242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/01/2014] [Indexed: 12/29/2022] Open
Abstract
Background The main purpose of this study was to model and analyze the dynamics of cervical cancer mortality rates for African American (Black) and White women residing in 13 states located in the eastern half of the United States of America from 1975 through 2010. Methods The cervical cancer mortality rates of the Surveillance, Epidemiology, and End Results (SEER) were used to model and analyze the dynamics of cervical cancer mortality. A longitudinal hyperbolastic mixed-effects type II model was used to model the cervical cancer mortality data and SAS PROC NLMIXED and Mathematica were utilized to perform the computations. Results Despite decreasing trends in cervical cancer mortality rates for both races, racial disparities in mortality rates still exist. In all 13 states, Black women had higher mortality rates at all times. The degree of disparities and pace of decline in mortality rates over time differed among these states. Determining the paces of decline over 36 years showed that Tennessee had the most rapid decline in cervical cancer mortality for Black women, and Mississippi had the most rapid decline for White Women. In contrast, slow declines in cervical cancer mortality were noted for Black women in Florida and for White women in Maryland. Conclusions In all 13 states, cervical cancer mortality rates for both racial groups have fallen. Disparities in the pace of decline in mortality rates in these states may be due to differences in the rates of screening for cervical cancers. Of note, the gap in cervical cancer mortality rates between Black women and White women is narrowing.
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Affiliation(s)
- Mohammad A. Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, Nashville, Tennessee, United States of America
| | | | - Wayne M. Eby
- Department of Mathematics, New Jersey City University, Jersey City, New Jersey, United States of America
| | - Sejong Bae
- Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Juliette T. Guemmegne
- Department of Economics, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Upender Manne
- Department of Pathology and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mona Fouad
- Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Edward E. Partridge
- Department of Obstetrics & Gynecology and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Karan P. Singh
- Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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McLeod M, Harris R, Purdie G, Cormack D, Robson B, Sykes P, Crengle S, Iupati D, Walker N. Improving survival disparities in cervical cancer between Māori and non-Māori women in New Zealand: a national retrospective cohort study. Aust N Z J Public Health 2013; 34:193-9. [PMID: 23331365 DOI: 10.1111/j.1753-6405.2010.00506.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Māori women in New Zealand have higher incidence of and mortality from cervical cancer than non-Māori women, however limited research has examined differences in treatment and survival between these groups. This study aims to determine if ethnic disparities in treatment and survival exist among a cohort of Māori and non-Māori women with cervical cancer. METHODS A retrospective cohort study of 1911 women (344 Māori and 1567 non-Māori) identified from the New Zealand Cancer Register with cervical cancer (adenocarcinoma, adenosquamous or squamous cell carcinoma) between 1 January 1996 and 31 December 2006. RESULTS Māori women with cervical cancer had a higher receipt of total hysterectomies, and similar receipt of radical hysterectomies and brachytherapy as primary treatment, compared to non-Māori women (age and stage adjusted). Over the cohort period, Māori women had poorer cancer specific survival than non-Māori women (mortality hazard ratio (HR) 2.07, 95% confidence interval (CI): 1.63-2.62). From 1996 to 2005, the survival for Māori improved significantly relative to non-Māori. CONCLUSION Māori continue to have higher incidence and mortality than non-Māori from cervical cancer although disparities are improving. Survival disparities are also improving. Treatment (as measured) by ethnicity is similar. IMPLICATIONS Primary prevention and early detection remain key interventions for addressing Māori needs and reducing inequalities in cervical cancer in New Zealand.
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Affiliation(s)
- Melissa McLeod
- Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, Wellington, School of Medicine and Health Sciences, New Zealand
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Nadpara PA, Madhavan SS, Khanna R, Smith M, Miller LA. Patterns of cervical cancer screening, diagnosis, and follow-up treatment in a state Medicaid fee-for-service population. Popul Health Manag 2012; 15:362-71. [PMID: 22788858 DOI: 10.1089/pop.2011.0093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite being a screening-amenable cancer, cervical cancer is the third most common genital cancer among white women and the most common among African American women. The study objective was to use administrative claims data for CC disease surveillance among recipients enrolled in a state Medicaid fee-for-service (FFS) program. West Virginia (WV) Medicaid FFS administrative claims data for female recipients aged 21-64 years from 2003 to 2008 were used for this study. All medical and prescription claims were aggregated to reflect each recipient's medical care and prescription drug utilization. The yearly prevalence of Pap smear testing declined from 23.9% in 2003 to 15.8% in 2008 in the Medicaid FFS population. During the 6-year study period, persistence with Pap smear testing was low; 41.8% of recipients received no Pap smear testing. Only 73.1% of recipients received Pap smear testing during the year prior to their CC or precancerous cervical lesions (PCL) diagnosis. The likelihood of a CC diagnosis increased with a decrease in Pap smear testing persistence. Only 10.1% of recipients received appropriate follow-up care following a diagnosis of high-grade PCL; only 31.5% of the recipients received appropriate follow-up care for low-grade PCL diagnosis. Although CC preventive services such as screening and PCL follow-up care are covered under Medicaid programs, underutilization of these services by recipients in the Medicaid FFS population is a concern. Results of this study emphasize the need to address disparities in screening and appropriate PCL follow-up care among recipients in the Medicaid FFS population.
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Affiliation(s)
- Pramit Amrutlal Nadpara
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA.
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Ghia AJ, Neeley ES, Gaffney DK. Postoperative radiotherapy use and patterns of care analysis for node positive or parametria positive cervical cancer. Gynecol Oncol 2010; 119:411-6. [DOI: 10.1016/j.ygyno.2010.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 07/06/2010] [Accepted: 07/11/2010] [Indexed: 11/29/2022]
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Coker AL, Eggleston KS, Du XL, Ramondetta L. Ethnic Disparities in Cervical Cancer Survival Among Medicare Eligible Women in a Multiethnic Population. Int J Gynecol Cancer 2009; 19:13-20. [PMID: 19258935 DOI: 10.1111/igc.0b013e318197f343] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives:To determine predictors of cervical cancer survival by socioeconomic status (SES), urbanization, race/ethnicity, comorbid conditions, and treatment among elderly Medicare-eligible women whose conditions were diagnosed with cervical cancer in a multiethnic population.Methods:A total of 538 women with cervical cancer aged 65 years or older were identified from 1999 to 2001 from the Texas Cancer Registry and were linked with the state Medicare data and Texas Vital Records to determine survival times. All women had similar access to care through Medicare fee-for-services insurance. A composite measure of SES was created using census tract-level data as was urbanization. Treatment and comorbid conditions were available from the Medicare data. Cox proportional hazards modeling was used for all-cause and cervical cancer-specific survival analysis.Results:Increased age (P < 0.0001) and advanced tumor stage (P < 0.0001) were associated with poorer all-cause and cervical cancer-specific survival. Having a comorbid condition was associated with all-cause survival (P < 0.01) but not cervical cancer-specific mortality. After adjusting for confounders, women receiving some form of treatment were almost half as likely to die with cervical cancer (adjusted hazard ratio = 0.68; 95% confidence interval, 0.52-0.89). After adjustment for all confounders, Hispanic women consistently had lower all-cause and cervical cancer-specific mortality rates relative to non-Hispanic white and non-Hispanic black women.Conclusions:Among women with similar health care coverage, Hispanic women had consistently lower all-cause and cervical cancer-specific mortality rates than other older women whose conditions were diagnosed with this disease in Texas. The presence of comorbid conditions and treatment were important predictors of survival, yet these factors do not explain the survival advantage for Hispanic women.
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Affiliation(s)
- Ann L Coker
- School of Medicine, University of Kentucky, Lexington, KY, USA.
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Movva S, Noone AM, Banerjee M, Patel DA, Schwartz K, Yee CL, Simon MS. Racial differences in cervical cancer survival in the Detroit metropolitan area. Cancer 2008; 112:1264-71. [PMID: 18257090 DOI: 10.1002/cncr.23310] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND African-American (AA) women have lower survival rates from cervical cancer compared with white women. The objective of this study was to examine the influence of socioeconomic status (SES) and other variables on racial disparities in overall survival among women with invasive cervical cancer. METHODS One thousand thirty-six women (705 white women and 331 AA women) who were diagnosed with primary invasive cancer of the cervix between 1988 and 1992 were identified through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a registry in the Surveillance, Epidemiology, and End Results (SEER) database. Pathology, treatment, and survival data were obtained through SEER. SES was categorized by using occupation, poverty, and educational status at the census tract level. Cox proportional hazards models were used to compare overall survival between AA women and white women adjusting for sociodemographics, clinical presentation, and treatment. RESULTS AA women were more likely to present at an older age (P<.001), with later stage disease (P<.001), and with squamous histology (P=.01), and they were more likely to reside in a census tract categorized as Working Poor (WP) (P<.001). After multivariate adjustment, race no longer had a significant impact on survival. Women who resided in a WP census tract had a higher risk of death than women from a Professional census tract (P=.05). There was a significant interaction between disease stage and time with the effect of stage on survival attenuated after 6 years. CONCLUSIONS In this study, factors that affected access to medical care appeared to have a more important influence than race on the long-term survival of women with invasive cervical cancer.
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Affiliation(s)
- Sujana Movva
- Department of Internal Medicine, Mclaren Regional Medical Center, Michigan State University, Flint, Michigan, USA
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Akers AY, Newmann SJ, Smith JS. Factors underlying disparities in cervical cancer incidence, screening, and treatment in the United States. Curr Probl Cancer 2007; 31:157-81. [PMID: 17543946 DOI: 10.1016/j.currproblcancer.2007.01.001] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Aletha Y Akers
- Robert Wood Johnson Clinical Scholars Program, University of North Carolina, Chapel Hill, North Carolina, USA
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Eggleston KS, Coker AL, Williams M, Tortolero-Luna G, Martin JB, Tortolero SR. Cervical cancer survival by socioeconomic status, race/ethnicity, and place of residence in Texas, 1995-2001. J Womens Health (Larchmt) 2007; 15:941-51. [PMID: 17087618 DOI: 10.1089/jwh.2006.15.941] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The current study explored whether socioeconomic status (SES), race/ethnicity, and rural residence may be linked to poorer cervical cancer survival by stage at diagnosis. METHODS Data from 7,237 cervical cancer cases reported to the Texas Cancer Registry from 1995-2001 were used to address the association by stage at diagnosis and cause of death. Zip code-level census data were used to classify residence and to develop a composite variable for SES. Multilevel Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Late stage at diagnosis was a strong predictor of cervical cancer mortality (HR = 6.2, 95% CI 5.5-7.2). SES and race/ethnicity were independently associated with stage at diagnosis. Women residing in areas with lower SES had significantly shorter survival times when diagnosed at an early stage (HR = 3.0, 95% CI 2.1-4.3). Hispanic women had a lower probability of dying from cervical cancer during the follow-up period (HR = 0.7, 95% CI 0.6- 0.8) after adjusting for confounders. The association between lower SES and poorer survival was consistent across all racial/ethnic groups, suggesting the effect of SES may be more important than race. CONCLUSIONS SES and race/ethnicity were independently associated with poorer cervical cancer survival in this large Texas sample. Further research is needed to investigate the role of optimal treatment and comorbid conditions in the association between SES and cervical cancer survival.
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Affiliation(s)
- Katherine S Eggleston
- School of Public Health, University of Texas Health Science Center, Houston, Texas 77225, USA.
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Coker AL, Du XL, Fang S, Eggleston KS. Socioeconomic status and cervical cancer survival among older women: findings from the SEER-Medicare linked data cohorts. Gynecol Oncol 2006; 102:278-84. [PMID: 16434087 DOI: 10.1016/j.ygyno.2005.12.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 12/08/2005] [Accepted: 12/13/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Tumor stage, age, and cell type are well-characterized predictors for cervical cancer survival; socioeconomic factors may also play an important role. The purpose of this study is to estimate cervical cancer survival by socioeconomic indicators and race/ethnicity among elderly women diagnosed with cervical cancer. METHODS We studied 1251 women with cervical cancer aged 65 or older, identified between 1992 and 1999 from the Surveillance, Epidemiology, and End Results [SEER]-Medicare linked data. All women had similar access to care through Medicare fee-for-services insurance. A composite measure of socioeconomic status was created using census tract level data for poverty, education, and income. Cox proportional hazard modeling was used for all-cause and cervical cancer-specific survival analysis. RESULTS Increased age (P < 0.0001) and advanced tumor stage (<0.0001) were associated with poorer all-cause and cervical cancer-specific survival. After adjustment for age, stage, and treatment, increased co-morbidity scores and having non-squamous cervical cancer were associated with poorer all-cause survival (P < 0.001). After adjusting for confounders, women receiving hysterectomy vs. no surgery or any treatment had significantly better all-cause and cervical cancer-specific survival. Socioeconomic factors were not associated with either all-cause (P for trend = 0.79) or cervical cancer-specific (P for trend = 0.81) survival. No racial/ethnic differences in all-cause or cervical cancer-specific survival were observed after adjusting for socioeconomic factors. CONCLUSION Among women with similar access to care, neither minority race/ethnicity nor poorer socioeconomic status were associated with poorer survival in this large sample of older women diagnosed with invasive cervical cancer. Presence of co-morbid conditions and treatment were important predictors of cervical cancer survival.
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Affiliation(s)
- Ann L Coker
- School of Public Health, University of Texas, 1200 Herman Pressler, PO Box 20186, Houston, TX 77225, USA.
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Abstract
OBJECTIVES We compared cervical cancer incidence, stage at diagnosis, and survival in Medicaid-insured and non-Medicaid-insured populations. METHODS We stratified the sample by age and used ordered logistic regression to predict stage at diagnosis and used Cox proportional hazards regression to predict survival. RESULTS Medicaid insured nearly one quarter of women diagnosed with cervical cancer. The likelihood of late-stage disease was greatest for women who enrolled in Medicaid after diagnosis. Women younger than 65 years who enrolled in Medicaid after diagnosis were more likely to die from cervical cancer than were women who were not insured by Medicaid (hazard ratio=2.40, 95% confidence interval=1.49, 3.86). CONCLUSIONS Our study underscores the importance of cervical cancer screening programs targeted at low-income women.
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Affiliation(s)
- Cathy J Bradley
- Michigan State University, Department of Medicine, East Lansing, MI 48824, USA.
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Schorge JO, Lea JS, Garner EO, Duska LR, Miller DS, Coleman RL. Cervical adenocarcinoma survival among Hispanic and white women: a multicenter cohort study. Am J Obstet Gynecol 2003; 188:640-4. [PMID: 12634634 DOI: 10.1067/mob.2003.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We compared the clinical outcome of cervical adenocarcinoma in Hispanic and white women to determine whether race was an independent predictor of survival. STUDY DESIGN All women who were diagnosed with cervical adenocarcinoma at three institutions between 1982 and 2000 were identified. Medical records were reviewed retrospectively. Hispanic and white cohorts were matched 1:2 for age, stage of disease, date of diagnosis, tumor size, histologic subtype, grade, and invasive depth. RESULTS The 65 Hispanic patients were more likely to be treated at the public hospital (71% vs 14%; P <.001) than the 122 matched white patients. Most Hispanic patients (72%) and white patients (76%) presented with early (stage IA-IIA), not advanced (IIB-IVB), disease. Early (81% vs 81%, P =.65), advanced (37% vs 26%, P =.21), and overall 5-year survival rates (67% vs 68%, P =.57) were similar among Hispanic and white patients, respectively. The relative risk of race on recurrence was 1.22 (95% CI, 0.56-2.42) and on survival was 0.72 (95% CI, 0.36-1.44). CONCLUSION Hispanic race is not an independent predictor of survival in cervical adenocarcinoma.
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Affiliation(s)
- John O Schorge
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75390, USA.
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Schultz PN, Stava C, Beck ML, Vassilopoulou-Sellin R. Ethnic/racial influences on the physiologic health of cancer survivors. Cancer 2003; 100:156-64. [PMID: 14692036 DOI: 10.1002/cncr.11897] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improvements in early detection, treatment, and general supportive care allow more people to survive cancer. Information regarding the long-term health impact of cancer and cancer treatments on these survivors of adult-onset malignancies is gradually accumulating. Although information is limited overall, it is apparent that the cancer experience differs across ethnically/racially diverse populations. METHODS In the current report, the authors characterized and compared health profiles among ethnic/racial groups within a large cohort (n > 6000) of long-term survivors of cancer. In addition, the authors focused on survivors of cervical carcinoma, because they constitute a substantial and relatively homogeneous portion of the overall cohort. RESULTS The authors observed significant differences among African American, Hispanic American, and Caucasian American cancer survivors in terms of age at diagnosis, time since diagnosis, family dynamics, education, type of malignancy, and perceived influences of cancer on specific physiologic health problems. Among survivors of cervical carcinoma, there were significant ethnic/racial differences in terms of disease histology as well as the impact of the disease on overall health. CONCLUSIONS The current study reveals significant ethnic/racial differences among cancer survivors and highlights the need for further investigation of the relation between cancer survivorship and ethnicity/race.
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Affiliation(s)
- Pamela N Schultz
- Life After Cancer Care Program, Division of Internal Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Abstract
BACKGROUND Death rates for most cancers continue to be higher for African Americans, particularly those in inner cities. Harlem Hospital serves a poor, predominantly African-American community in New York City. METHODS Tumor registry records for 615 patients treated for colorectal carcinoma at Harlem Hospital between 1973 and 1992 were reviewed. RESULTS Of the patients, 45.2% were male and 54.8% female, 97.2% were black, and 82% resided in Harlem. All patients were symptomatic at the time of diagnosis;15.3% were first diagnosed intraoperatively; 8.4% were in American Joint Committee on Cancer Stage I, 20.8% Stage II, 22.8% Stage III, 39.0% Stage IV, and 8.0% could not be staged. Colon resection with intention of cure was performed on 50.6%, 21.5% had palliative resection, and 11.6% had colostomy or other palliative surgery. Adjuvant chemotherapy or radiotherapy was given to 6.2%; 16.9% had no surgical treatment because of advanced stage, poor condition, or refusal of surgery; 12.7% presented with perforation or intestinal obstruction. Operative mortality was 15.3% overall and 10.6% for 311 patients who had surgery with intention of cure. Twenty-five patients had local recurrence, 86 had subsequent distant metastases, and 33 patients had both local and distant recurrence. Forty-nine patients (8%) were lost to follow-up. The 5-year crude survival rate for 615 patients was 18.7%. The relative survival rate was 19.7%, substantially lower than the national average for the same years. CONCLUSIONS Although colorectal carcinoma mortality continues to decline nationally, in this population of poor blacks the mortality rate remained high and unchanged. The most important cause of this is late presentation at an incurable stage, resulting from the combined effects of poverty, lack of education, and lack of access to primary care. Culturally sensitive educational programs and accessible health care systems for the poor are needed.
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Affiliation(s)
- Harold P Freeman
- Department of Surgery, Harlem Hospital Center, College of Physician and Surgeons of Columbia University, New York, New York, USA.
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