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Zhu Z, Wang Y, Han J, Li Y. Associations of Pap test utilisation with comorbidity and functional impairment among middle-aged non-Hispanic black women in the USA: a cross-sectional analysis of the 2018 BRFSS data. BMJ Open 2024; 14:e076247. [PMID: 39053959 DOI: 10.1136/bmjopen-2023-076247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES Limited evidence exists on the association of Pap test utilisation with comorbidity and functional impairment among middle-aged non-Hispanic black (NHB) women in the USA. We aimed to assess whether middle-aged NHB women with a higher burden of comorbidity and functional impairment have a lower rate of Pap test utilisation. DESIGN Nationwide cross-sectional survey in the USA. SETTING 2018 Behavioral Risk Factor Surveillance System. PARTICIPANTS 6359 middle-aged NHB women. EXPOSURES AND OUTCOME The primary exposures were comorbidity and functional impairment. The outcome of interest was whether a woman reported having a Pap test in the last 3 years. DATA ANALYSIS We fit unadjusted and multivariable logistic regression models to calculate ORs and 95% CI for comorbidity and functional impairment. Sensitivity analysis was restricted to women without a history of hysterectomy or cancer. We added interaction terms between exposures and age, as well as lifestyle indicators. RESULTS Of the 6359 women, 4141 (65.1%) had comorbidity and 2429 (38.2%) had functional impairment. Middle-aged NHB women with comorbidity (≥2 vs 0, aOR=0.72, 95% CI=0.61 to 0.85, p trend<0.01) or functional impairment (≥2 vs 0, aOR=0.69, 95% CI=0.57 to 0.83, p trend<0.01) had a lower rate of Pap test utilisation compared with healthier counterparts, regardless of histories of hysterectomy and prior cancer. The analyses for age and lifestyle indicators subgroup difference indicated no statistically significant effect (p interaction>0.05). However, the magnitude of these associations was stronger among women with adverse lifestyle factors (eg, comorbidity ≥2 v.s. 0, aOR=0.53, 95% CI=0.40, to 0.71; functional impairment ≥2 v.s. 0, aOR=0.35, 95% CI=0.16, to 0.72 among binge drinkers). CONCLUSION Comorbidity or functional impairment could be a potential barrier to Pap test utilisation among middle-aged NHB women in the USA. Our study highlights the importance of implementing targeted intervention programmes and prioritised health resource allocation to promote Pap test utilisation. Cohort studies with clear temporality and indicators reflecting disease severity will be essential for further understanding this association.
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Affiliation(s)
- Zhikai Zhu
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yali Wang
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiefei Han
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Li
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
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Sharon CE, Wang M, Tortorello GN, Perry NJ, Ma KL, Tchou JC, Fayanju OM, Mahmoud NN, Miura JT, Karakousis GC. Impact of Patient Comorbidities on Presentation Stage of Breast and Colon Cancers. Ann Surg Oncol 2023; 30:4617-4626. [PMID: 37208570 PMCID: PMC10788153 DOI: 10.1245/s10434-023-13596-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND While patients with multiple comorbidities may have frequent contact with medical providers, it is unclear whether their healthcare visits translate into earlier detection of cancers, specifically breast and colon cancers. METHODS Patients diagnosed with stage I-IV breast ductal carcinoma and colon adenocarcinoma were identified from the National Cancer Database and stratified by comorbidity burden, dichotomized as a Charlson Comorbidity Index (CCI) Score of <2 or ≥2. Characteristics associated with comorbidities were analyzed by univariate and multivariate logistic regression. Propensity-score matching was performed to determine the impact of CCI on stage at cancer diagnosis, dichotomized as early (I-II) or late (III-IV). RESULTS A total of 672,032 patients with colon adenocarcinoma and 2,132,889 with breast ductal carcinoma were included. Patients with colon adenocarcinoma who had a CCI ≥ 2 (11%, n = 72,620) were more likely to be diagnosed with early-stage disease (53% vs. 47%; odds ratio [OR] 1.02, p = 0.017), and this finding persisted after propensity matching (CCI ≥ 2 55% vs. CCI < 2 53%, p < 0.001). Patients with breast ductal carcinoma who had a CCI ≥ 2 (4%, n = 85,069) were more likely to be diagnosed with late-stage disease (15% vs. 12%; OR 1.35, p < 0.001). This finding also persisted after propensity matching (CCI ≥ 2 14% vs. CCI < 2 10%, p < 0.001). CONCLUSIONS Patients with more comorbidities are more likely to present with early-stage colon cancers but late-stage breast cancers. This finding may reflect differences in practice patterns for routine screening in these patients. Providers should continue guideline directed screenings to detect cancers at an earlier stage and optimize outcomes.
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Affiliation(s)
- Cimarron E Sharon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Michael Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gabriella N Tortorello
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nikhita J Perry
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin L Ma
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Julia C Tchou
- Division of Breast Surgery, Department of surgery, The University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Philadelphia, PA, USA
| | - Oluwadamilola M Fayanju
- Division of Breast Surgery, Department of surgery, The University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Philadelphia, PA, USA
| | - Najjia N Mahmoud
- Abramson Cancer Center, Philadelphia, PA, USA
- Division of Colon and Rectal Surgery, Department of Surgery, The University of Pennsylvania, Philadelphia, PA, USA
| | - John T Miura
- Abramson Cancer Center, Philadelphia, PA, USA
- Division of Endocrine and Oncologic Surgery, Department of Surgery, The University of Pennsylvania, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Abramson Cancer Center, Philadelphia, PA, USA
- Division of Endocrine and Oncologic Surgery, Department of Surgery, The University of Pennsylvania, Philadelphia, PA, USA
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Edmonds MC, Dahman B, Kim SJ, McGuire KP, Sheppard VB. Surveillance Mammography Behaviors in Black and White Breast Cancer Survivors: Behavioral Risk Factors and Surveillance System, 2016. BMC Womens Health 2023; 23:148. [PMID: 36997881 PMCID: PMC10061852 DOI: 10.1186/s12905-023-02246-x] [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: 03/30/2022] [Accepted: 02/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Surveillance mammography is recommended annually for early detection of disease relapse among breast cancer survivors; yet Black women have poorer national rates of surveillance mammography compared to White women. Factors that influence racial disparities in surveillance mammography rates are poorly understood. The purpose of this study is to evaluate the contribution of health care access, socioeconomic status, and perceived health status on adherence to surveillance mammography among breast cancer survivors. METHODS This is a secondary analysis of a cross-sectional survey among Black and White women ≥ 18 years, who reported a breast cancer diagnosis and completed breast surgery and adjuvant treatment from the 2016 Behavioral Risk Factor Surveillance System National Survey (BRFSS). Bivariate associations (chi-squared, t-test) for independent variables (e.g., health insurance, marital status) were analyzed with adherence to nationally recommended surveillance guidelines defined as two levels: adherent (received a mammogram in the last 12 months), vs. non- adherent ("received a mammogram in the last 2-5 years, 5 or more years or unsure). Multivariable logistic regression models were used to evaluate the relationship between study variables with adherence, while adjusting for potential confounders. RESULTS Of 963 breast cancer survivors, 91.7% were White women with an average age of 65. 71.7% reported a surveillance mammogram in the last 12 months, while 28.2% did not. Diagnosed > 5 years (p < 0.001); not having a routine checkup visit within 12 months (p = 0.045); and not seeing a doctor when needed due to cost (p = 0.026), were significantly related to survivor's non-adherence to surveillance mammography guidelines. A significant interaction was found between race and residential area (p < 0.001). Compared to White women, Black women living in metropolitan/suburban residential areas were more likely to receive surveillance guidelines (OR:3.77;95% CI: 1.32-10.81); however Black women living in non-metropolitan areas were less likely to receive a surveillance mammogram compared to White women living in non-metropolitan areas (OR: 0.04; 95% CI: 0.00-0.50). CONCLUSION Findings from our study further explain the impact of socioeconomic disparities on racial differences in the use of surveillance mammography among breast cancer survivors. Black women living in non-metropolitan counties are an important subgroup for future research and screening and navigation interventions.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, 17 E. 102 St, New York, NY, USA.
| | - Bassam Dahman
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- VCU Massey Cancer Center, Richmond, VA, USA
| | - Kandace P McGuire
- VCU Massey Cancer Center, Richmond, VA, USA
- Department of Surgery, VCU Massey Cancer Center, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- VCU Massey Cancer Center, Richmond, VA, USA
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Karam D, Vierkant RA, Ehlers S, Freedman RA, Austin J, Khanani S, Larson NL, Loprinzi CL, Couch F, Olson JE, Ruddy KJ. Surveillance mammography in older breast cancer survivors: Current practice patterns and patient perceptions. J Geriatr Oncol 2022; 13:1038-1042. [PMID: 35853817 DOI: 10.1016/j.jgo.2022.07.003] [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: 02/16/2022] [Revised: 05/31/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although the benefits of surveillance mammography for older breast cancer survivors have not been quantified prospectively, it is unlikely that mammography provides substantial benefit (and possible that mammography is harmful) to women with limited life expectancy and a low risk for in-breast cancer events. MATERIALS AND METHODS We identified 1268 women aged 77 and older with a history of Stage I-III breast cancer, who did not undergo bilateral mastectomy, were diagnosed with cancer at least three years prior to study entry, and who had consented to be surveyed as part of the Mayo Clinic Breast Disease Registry. We mailed them a one-time survey asking about their experiences with surveillance mammography. Women with metastatic disease were excluded. The primary endpoint was whether or not women reported at least one mammogram since breast cancer surgery. RESULTS Eight hundred forty-six of 1268 (67%) returned the survey, 734 of whom were eligible for analysis. The median age at the time of survey was 82, and the median time since cancer diagnosis was 12 years. Ninety-three percent reported having had at least one mammogram since their initial breast cancer surgery. Seventy-nine percent reported that they had surveillance mammography annually over the prior three years, including 76% of the 491 aged 80+ and 64% of the 189 aged 85 + . DISCUSSION Most older breast cancer survivors who have residual breast tissue are undergoing annual mammograms. Additional educational materials may be beneficial for patients and clinicians to better individualize plans for surveillance mammography in older breast cancer survivors.
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Affiliation(s)
- Dhauna Karam
- Department of Community Internal Medicine, Mayo Clinic Health System at Austin and Albert Lea, Albert Lea, MN 56007, USA.
| | - Robert A Vierkant
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN 55905, USA
| | - Shawna Ehlers
- Division of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rachel A Freedman
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jessica Austin
- Division of Epidemiology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Sadia Khanani
- Division of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Nicole L Larson
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Fergus Couch
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Janet E Olson
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kathryn J Ruddy
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Zhang D, Abraham L, Sprague BL, Onega T, Advani S, Demb J, Miglioretti DL, Henderson LM, Wernli KJ, Walter LC, Kerlikowske K, Schousboe JT, Chrischilles E, Braithwaite D, O'Meara ES. Mammography adherence in relation to function-related indicators in older women. Prev Med 2022; 154:106869. [PMID: 34762965 PMCID: PMC8724400 DOI: 10.1016/j.ypmed.2021.106869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/08/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
Prior studies of screening mammography patterns by functional status in older women show inconsistent results. We used Breast Cancer Surveillance Consortium-Medicare linked data (1999-2014) to investigate the association of functional limitations with adherence to screening mammography in 145,478 women aged 66-74 years. Functional limitation was represented by a claims-based function-related indicator (FRI) score which incorporated 16 items reflecting functional status. Baseline adherence was defined as mammography utilization 9-30 months after the index screening mammography. Longitudinal adherence was examined among women adherent at baseline and defined as time from the index mammography to end of the first 30-month gap in mammography. Multivariable logistic regression and Cox proportional hazards models were used to investigate baseline and longitudinal adherence, respectively. Subgroup analyses were conducted by age (66-70 vs. 71-74 years). Overall, 69.6% of participants had no substantial functional limitation (FRI score 0), 23.5% had some substantial limitations (FRI score 1), and 6.8% had serious limitations (FRI score ≥ 2). Mean age at baseline was 68.5 years (SD = 2.6), 85.3% of participants were white, and 77.1% were adherent to screening mammography at baseline. Women with a higher FRI score were more likely to be non-adherent at baseline (FRI ≥ 2 vs. 0: aOR = 1.13, 95% CI = 1.06, 1.20, p-trend < 0.01). Similarly, a higher FRI score was associated with longitudinal non-adherence (FRI ≥ 2 vs. 0: aHR = 1.16, 95% CI = 1.11, 1.22, p-trend < 0.01). Effect measures of FRI did not differ substantially by age categories. Older women with a higher burden of functional limitations are less likely to be adherent to screening mammography recommendations.
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Affiliation(s)
- Dongyu Zhang
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States of America; University of Florida Health Cancer Center, Gainesville, FL, United States of America
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Brian L Sprague
- Department of Surgery, University of Vermont College of Medicine, Burlington, VT, United States of America
| | - Tracy Onega
- Department of Population Health Sciences and the Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America
| | - Shailesh Advani
- Department of Oncology, Georgetown University School of Medicine, Washington DC, United States of America
| | - Joshua Demb
- Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla, CA, United States of America
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America; Department of Public Health Sciences, University of California, Davis, CA, United States of America
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, NC, United States of America
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Louise C Walter
- Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc, Bloomington, MN, United States of America; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, United States of America
| | - Elizabeth Chrischilles
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Dejana Braithwaite
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States of America; University of Florida Health Cancer Center, Gainesville, FL, United States of America; Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida.
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America. Ellen.S.O'
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Kim SE, Bachorik AE, Bertrand KA, Gunn CM. Differences in Breast Cancer Screening Practices by Diabetes Status and Race/Ethnicity in the United States. J Womens Health (Larchmt) 2021; 31:848-855. [PMID: 34935471 DOI: 10.1089/jwh.2021.0396] [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: 11/13/2022] Open
Abstract
Introduction: Socioeconomic and health-related factors, including comorbid illness, may affect mammography screening rates and subsequently contribute to breast cancer outcomes. We explored the association between diabetes and mammography screening, and whether this association varied between racial, ethnic, and geographic groups. Methods: Cross-sectional data from the 2012, 2014, 2016, and 2018 Behavioral Risk Factor Surveillance System were used to fit logistic regression models assessing the association between diabetes and up-to-date mammography screening in 497,600 women, aged 50-74 years. Participants were considered exposed if they responded "yes" to "(Ever told) you have diabetes?" and up to date on screening if they responded "yes" to having a mammogram within the past 2 years. Models were adjusted for age, health status, socioeconomic, and access variables. Results: The majority of participants were White (79.6%), non-Hispanic (88.9%), and up to date on screening (78.8%). Overall, 16.8% reported having diabetes. In fully adjusted models, White women with diabetes were 12% more likely to be up to date on screening (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.06-1.19) than those without diabetes. Black/African American women and those of Hispanic ethnicity with diabetes were more likely to report being up to date with mammography (ORBlack: 1.28, 95% CI: 1.12-1.45; ORHispanic: 1.19, 95% CI: 1.13-1.24) than those without. Patterns were similar across geographic regions. Conclusions: Women of ages 50-74 years with diabetes were more likely to be up to date on screening than women without diabetes. Chronic disease management may represent an opportunity to address cancer screening.
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Affiliation(s)
- Sydney E Kim
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alexandra E Bachorik
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Christine M Gunn
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Zhang D, Abraham L, Demb J, Miglioretti DL, Advani S, Sprague BL, Henderson LM, Onega T, Wernli KJ, Walter LC, Kerlikowske K, Schousboe JT, O'Meara ES, Braithwaite D. Function-related Indicators and Outcomes of Screening Mammography in Older Women: Evidence from the Breast Cancer Surveillance Consortium Cohort. Cancer Epidemiol Biomarkers Prev 2021; 30:1582-1590. [PMID: 34078641 DOI: 10.1158/1055-9965.epi-21-0152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/02/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous reports suggested risk of death and breast cancer varied by comorbidity and age in older women undergoing mammography. However, impacts of functional limitations remain unclear. METHODS We used data from 238,849 women in the Breast Cancer Surveillance Consortium-Medicare linked database (1999-2015) who had screening mammogram at ages 66-94 years. We estimated risk of breast cancer, breast cancer death, and non-breast cancer death by function-related indicator (FRI) which incorporated 16 claims-based items and was categorized as an ordinal variable (0, 1, and 2+). Fine and Gray proportional sub-distribution hazards models were applied with breast cancer and death treated as competing events. Risk estimates by FRI scores were adjusted by age and NCI comorbidity index separately and stratified by these factors. RESULTS Overall, 9,252 women were diagnosed with breast cancer, 406 died of breast cancer, and 41,640 died from non-breast cancer causes. The 10-year age-adjusted invasive breast cancer risk slightly decreased with FRI score [FRI = 0: 4.0%, 95% confidence interval (CI) = 3.8-4.1; FRI = 1: 3.9%, 95% CI = 3.7-4.2; FRI ≥ 2: 3.5%, 95% CI = 3.1-3.9). Risk of non-breast cancer death increased with FRI score (FRI = 0: 18.8%, 95% CI = 18.5-19.1; FRI = 1: 24.4%, 95% CI = 23.9-25.0; FRI ≥ 2: 39.8%, 95% CI = 38.8-40.9]. Risk of breast cancer death was low with minimal differences across FRI scores. NCI comorbidity index-adjusted models and stratified analyses yielded similar patterns. CONCLUSIONS Risk of non-breast cancer death substantially increases with FRI score, whereas risk of breast cancer death is low regardless of functional status. IMPACT Older women with functional limitations should be informed that they may not benefit from screening mammography.
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Affiliation(s)
- Dongyu Zhang
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, Florida.,University of Florida Health Cancer Center, Gainesville, Florida
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Joshua Demb
- Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla, California
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington.,Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, California
| | - Shailesh Advani
- Transplant Education Research Center, Terasaki Institute of Biomedical Innovation, Los Angeles, California
| | - Brian L Sprague
- Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah, and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Louise C Walter
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc, Bloomington, Minnesota.,Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Zhang D, Tailor T, Kim C, Atkins M, Braithwaite D, Akinyemiju T. Immunotherapy Utilization Among Patients With Metastatic NSCLC: Impact of Comorbidities. J Immunother 2021; 44:198-203. [PMID: 33758148 PMCID: PMC10294120 DOI: 10.1097/cji.0000000000000366] [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: 10/27/2020] [Accepted: 02/02/2021] [Indexed: 12/31/2022]
Abstract
In patients with metastatic non-small cell lung cancer (mNSCLC), the extent to which immunotherapy utilization rate varies by comorbidities is unclear. Using the National Cancer Database from 2015 to 2016, we assessed the association between levels of comorbidity and immunotherapy utilization among mNSCLC patients. Burden of comorbidities was ascertained based on the modified Charlson-Deyo score and categorized as an ordinal variable (0, 1, and ≥2). Immunotherapy utilization was determined based on registry data. Multivariable logistic regressions were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the comorbidity score while adjusting for sociodemographic factors, histopathologic subtype, surgery, chemotherapy, radiotherapy, insurance, facility type, and other cancer history. Subgroup analyses were conducted by age and race/ethnicity. Overall, of the 89,030 patients with mNSCLC, 38.6% (N=34,382) had the comorbidity score of ≥1. Most patients were non-Hispanic white (82.3%, N=73,309) and aged 65 years and above (63.2%, N=56,300), with the mean age of 68.4 years (SD=10.6). Only 7.0% (N=6220) of patients received immunotherapy during 2015-2106. Patients with a comorbidity score of ≥2 had a significantly lower rate of immunotherapy utilization versus those without comorbidities (aOR=0.85; 95% CI, 0.78-0.93; P-trend<0.01). In subgroup analysis by age, association patterns were similar among patients younger than 65 and those aged 65-74 years. There were no significant differences in subgroup analysis by race/ethnicity, although statistical significance was only observed for white patients (comorbidity score ≥2 vs. 0: aOR=0.85; 95% CI, 0.77-0.93; P-trend<0.01). In conclusion, mNSCLC patients with a high burden of comorbidities are less likely to receive immunotherapy.
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Affiliation(s)
- Dongyu Zhang
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- University of Florida Health Cancer Center, Gainesville, FL
| | - Tina Tailor
- Department of Radiology, Duke University School of Medicine, Durham, NC
| | - Chul Kim
- Department of Oncology, Georgetown University School of Medicine, Washington, DC
| | - Michael Atkins
- Department of Oncology, Georgetown University School of Medicine, Washington, DC
| | - Dejana Braithwaite
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL
- University of Florida Health Cancer Center, Gainesville, FL
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
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