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Khalili R, Legaspi JM, Fabian MP, Levy JI, Korrick SA, Vieira VM. Multiple prenatal exposures and acute-care clinical encounters for asthma among children born to mothers living near a Superfund site. Am J Epidemiol 2024; 193:1088-1096. [PMID: 38576180 DOI: 10.1093/aje/kwae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 02/06/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024] Open
Abstract
Prenatal exposures are associated with childhood asthma, and risk may increase with simultaneous exposures. Pregnant women living in lower-income communities tend to have elevated exposures to a range of potential asthma risk factors, which may interact in complex ways. We examined the association between prenatal exposures and the risk of childhood acute-care clinical encounters for asthma (hospitalizations, emergency department visits, observational stays) using conditional logistic regression with a multivariable smoothing term to model the interaction between continuous variables, adjusted for maternal characteristics and stratified by sex. All births near the New Bedford Harbor (NBH) Superfund site (2000-2006) in New Bedford, Massachusetts, were followed through 2011 using the Massachusetts Pregnancy to Early Life Longitudinal (PELL) Data System to identify children aged 5-11 years with acute-care clinical asthma encounters (265 cases among 7787 children with follow-up). Hazard ratios (HRs) were higher for children living closer to the NBH site with higher umbilical cord blood lead levels than in children living further away from the NBH site with lower lead levels (P <.001). HRs were higher for girls (HR = 4.17; 95% CI, 3.60-4.82) than for boys (HR = 1.72; 95% CI, 1.46-2.02). Our results suggest that prenatal lead exposure in combination with residential proximity to the NBH Superfund site is associated with childhood asthma acute-care clinical encounters. This article is part of a Special Collection on Environmental Epidemiology.
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Meurette J, Daraï E, Tajahmady A, Fouard A, Ducastel A, Collin-Bund V, Jochum F, Lecointre L, Querleu D, Akladios C. [Arguments for centralization of surgical treatment of ovarian cancer in France based on morbidity and mortality data]. Bull Cancer 2024; 111:239-247. [PMID: 36797128 DOI: 10.1016/j.bulcan.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To examine the current state for ovarian cancer surgery in France from 2009 to 2016 and to examine the impact of the volume of activity on morbidity and mortality by institution. MATERIAL AND METHOD National retrospective study analyzing surgical sessions for ovarian cancer from the program of medicalization of information systems (PMSI), from January 2009 to December 2016. Institutions were divided according to the number of annual curative procedures into 3 groups: A<10; B: 10-19; C≥20. A propensity score (PS) and the Kaplan-Meier method were employed for statistical analyses. RESULTS In total, 27,105 patients were included. The 1-month mortality rate in group A, B and C was 1.6; 1 and 0.7 %, respectively (P<0.001). Compared to group C, the Relative Risk (RR) of death within the first month was 2.22 for group A and 1.32 for group B (P<0.01). After MS, the 3- and 5-year survival in group A+B and group C were 71.4 and 60.3% (P<0.05) and 56.6, and 60.3% (P<0.05), respectively. The 1-year recurrence rate was significantly lower in group C (P<0.0001). CONCLUSION An annual volume of activity>20 advanced stage ovarian cancers is associated with a decrease in morbidity, mortality, recurrence rate and improved survival.
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Affiliation(s)
- Jacques Meurette
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Emile Daraï
- Hôpital Tenon, service de gynécologie-obstétrique, Paris, France
| | - Ayden Tajahmady
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Annie Fouard
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Anne Ducastel
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Virginie Collin-Bund
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Floriane Jochum
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Lise Lecointre
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Denis Querleu
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Chérif Akladios
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France.
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Gomez SL, Chirikova E, McGuire V, Collin LJ, Dempsey L, Inamdar PP, Lawson-Michod K, Peters ES, Kushi LH, Kavecansky J, Shariff-Marco S, Peres LC, Terry P, Bandera EV, Schildkraut JM, Doherty JA, Lawson A. Role of neighborhood context in ovarian cancer survival disparities: current research and future directions. Am J Obstet Gynecol 2023; 229:366-376.e8. [PMID: 37116824 PMCID: PMC10538437 DOI: 10.1016/j.ajog.2023.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/01/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
Ovarian cancer is the fifth leading cause of cancer-associated mortality among US women with survival disparities seen across race, ethnicity, and socioeconomic status, even after accounting for histology, stage, treatment, and other clinical factors. Neighborhood context can play an important role in ovarian cancer survival, and, to the extent to which minority racial and ethnic groups and populations of lower socioeconomic status are more likely to be segregated into neighborhoods with lower quality social, built, and physical environment, these contextual factors may be a critical component of ovarian cancer survival disparities. Understanding factors associated with ovarian cancer outcome disparities will allow clinicians to identify patients at risk for worse outcomes and point to measures, such as social support programs or transportation aid, that can help to ameliorate such disparities. However, research on the impact of neighborhood contextual factors in ovarian cancer survival and in disparities in ovarian cancer survival is limited. This commentary focuses on the following neighborhood contextual domains: structural and institutional context, social context, physical context represented by environmental exposures, built environment, rurality, and healthcare access. The research conducted to date is presented and clinical implications and recommendations for future interventions and studies to address disparities in ovarian cancer outcomes are proposed.
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Affiliation(s)
- Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.
| | - Ekaterina Chirikova
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Valerie McGuire
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Lauren Dempsey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Pushkar P Inamdar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Katherine Lawson-Michod
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Edward S Peters
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Juraj Kavecansky
- Department of Hematology and Oncology, Kaiser Permanente Northern California, Antioch, CA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Paul Terry
- Department of Medicine, University of Tennessee, Knoxville, TN
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jennifer A Doherty
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Andrew Lawson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC; Usher Institute, School of Medicine, University of Edinburgh, Edinburgh, United Kingdom
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Moterani VC, Moterani NJW, Candido Dos Reis FJ. Treatment delay and treatment pattern modifications among epithelial ovarian cancer patients during the COVID-19 pandemic: A retrospective cohort study. J Surg Oncol 2022; 126:1155-1161. [PMID: 35929947 PMCID: PMC9538947 DOI: 10.1002/jso.27048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 11/26/2022]
Abstract
Background and Objectives The coronavirus disease 2019 (COVID‐19) pandemic disrupted healthcare access and medical treatment, including oncological care. Treatment delay in ovarian cancer could impact survival. We aimed to assess if there were delays and treatment changes in a cohort of epithelial ovarian cancer patients. Methods A retrospective cohort of epithelial ovarian cancer patients included cases diagnosed during the first 22 months of the COVID‐19 pandemic in the state of Sao Paulo and those diagnosed in the 22 months preceding the outbreak. Time‐to‐treat was measured in days. In each group, surgery and chemotherapy proportions were assessed according to healthcare insurance status. Results A 56.2% reduction in epithelial ovarian cancer diagnosis was identified during the pandemic group compared to the prepandemic group; fewer patients were diagnosed in stage I (p < 0.01). Time‐to‐treat increased from 18.9 to 23 days (p < 0.01). Surgery in the public sector fell from 74.6% to 65.3% during the pandemic, compared to 87.1% to 68.8% in the private sector. Conclusion There were fewer overall diagnoses, reduced stage I diagnosis, increased time‐to‐treat, and a reduction in the proportion of patients submitted to surgery. Brazil's public healthcare system demonstrated a higher resiliency to treatment change than the private sector.
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Affiliation(s)
- Vinicius Cesar Moterani
- Department of Gynaecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.,Department of Obstetrics and Gynaecology, Marilia Medical School, Marilia, Brazil
| | - Nino Jose Wilson Moterani
- Department of Gynaecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.,Department of Obstetrics and Gynaecology, Marilia Medical School, Marilia, Brazil
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Assessment of Travel Distance for Hyperthermic Intraperitoneal Chemotherapy in Women with Ovarian Cancer. Gynecol Oncol Rep 2022; 40:100951. [PMID: 35392128 PMCID: PMC8980495 DOI: 10.1016/j.gore.2022.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/24/2022] Open
Abstract
The median travel distance in women with EOC undergoing CRS with HIPEC was 57.0 miles in women with EOC. Over 20% of patients treated at our institution traveled more than 100 miles for HIPEC procedures. No differences were observed in post-operative complications or oncologic outcomes based upon travel distance.
Objective (s) To evaluate travel distance in women with advanced or recurrent epithelial ovarian cancer (OC) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) and the subsequent impact upon outcomes. Methods An IRB-approved single-institution prospective registry was queried for women with OC who underwent HIPEC from 1/1/2009–12/1/2020. Demographic, oncologic, and surgical data were recorded. The patient's home zip code was compared to the institutional zip code to determine travel distance using Google Maps. Patients were divided into three strata for analysis: 1) local: ≤50 miles, 2) regional: 51–99 miles, and 3) distant: ≥100 miles and univariate analysis was performed. Results Of 127 women, the median distance travelled was 57.0 miles (IQR: 20.6, 84.6). There were no significant differences in mild (28.3% vs. 26.3 vs. 24.1%), moderate (21.7% vs. 15.8% vs. 17.2%) or severe postoperative complications (11.7% vs. 5.3% vs. 17.2%) (p = 0.75) for local, regional and distant patients, respectively. There was no difference in progression-free survival (17.4 vs. 22.2 vs. 12.8 months, p > 0.05) or overall survival (57.3 vs. 61.6 vs. 29.2 months, p > 0.05) for local, regional or distant patients, respectively. Conclusions This study demonstrates that women with OC are willing to travel for HIPEC, with over 50% traveling > 50 miles. Our results suggest that women who travel for HIPEC procedures are not at increased risk for perioperative complications or worse oncologic outcomes than those local to HIPEC centers.
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Tseng TS, Celestin MD, Yu Q, Li M, Luo T, Moody-Thomas S. Use of Geographic Information System Technology to Evaluate Health Disparities in Smoking Cessation Class Accessibility for Patients in Louisiana Public Hospitals. Front Public Health 2021; 9:712635. [PMID: 34476230 PMCID: PMC8406529 DOI: 10.3389/fpubh.2021.712635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Research has shown cigarette smoking is a major risk factors for many type of cancer or cancer prognosis. Tobacco related health disparities were addressed continually in cancer screening, diagnosis, treatment, prevention and control. The present study evaluated the health disparities in attendance of smoking cessation counseling classes for 4,826 patients scheduled to attend between 2005 and 2007. Of 3,781 (78.4%) patients with records to calculate the distance from their home domicile to counseling sites using Geographic Information System technology, 1,435 (38%) of smokers who attended counseling had shorter travel distances to counseling sites (11.6 miles, SD = 11.29) compared to non-attendees (13.4 miles, SD = 16.72). When the travel distance was >20 miles, the estimated odds of attending decreased with greater travel distance. Smokers who actually attended were more likely to be older, female, White, living in urban areas, and receiving free healthcare. After controlling for other socio-demographic factors, shorter distances were associated with greater class attendance, and individuals more likely to attend included those that lived closer to the counseling site and in urban settings, were female, White, commercially insured, and older than their counterparts. These findings have the potential to provide important insights for reducing health disparities for cancer prevention and control, and to improve shared decision making between providers and smokers.
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Affiliation(s)
- Tung Sung Tseng
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Michael D Celestin
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Qingzhao Yu
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Mirandy Li
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States.,Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, United States
| | - Ting Luo
- Moores Cancer Center, School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Sarah Moody-Thomas
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
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Kim W, Han KT, Kim S. Do Patients Residing in Provincial Areas Transport and Spend More on Cancer Treatment in Korea? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179247. [PMID: 34501835 PMCID: PMC8431159 DOI: 10.3390/ijerph18179247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/27/2022]
Abstract
Background: With the increasing burden of cancer worldwide, a need exists to investigate patterns of healthcare utilization and costs. This study aimed to investigate whether the area of residence is associated with the likelihood of a patient receiving treatment at an institution located outside their residing region. This study also analyzed whether medical travel was related to levels of healthcare utilization and costs. Methods: This study used the 2007 to 2015 National Health Insurance (NHI) claims data. The residing area was categorized into capital area, metropolitan cities, and provincial area. Healthcare utilization was measured based on days of care and costs based on direct, covered medical costs. Chi-square test and analysis of variance (ANOVA) was conducted to investigate the general characteristics of the study population. The relationship between the dependent and independent variables were analyzed using the generalized estimating equation (GEE) model. Results: Of the 64,505 participants included in this study, 19,975 (31.0%) visited medical institutions located outside their residing area. Compared to individuals residing in the capital area, those living in provincial regions (OR 2.202, 95% CI 2.068–2.344) were more likely to visit medical institutions outside their residing area. Healthcare costs were higher in individuals receiving treatment at hospitals located elsewhere (RR 1.054, 95% CI 1.017–1.093). Conclusion: Cancer patients residing in provincial areas were likely to visit institutions located outside their residing area for treatment. Medical travel was associated with higher levels of spent healthcare costs. Policies should focus on preventing possible related regional cancer disparity and promoting optimal configuration of cancer services.
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Affiliation(s)
- Woorim Kim
- National Cancer Center, Division of Cancer Control & Policy, National Cancer Control Institute, Goyang 10408, Korea; (W.K.); (K.-T.H.)
| | - Kyu-Tae Han
- National Cancer Center, Division of Cancer Control & Policy, National Cancer Control Institute, Goyang 10408, Korea; (W.K.); (K.-T.H.)
| | - Seungju Kim
- Department of Nursing, College of Nursing, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-2-2258-7806; Fax: +82-2-2258-7772
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Stewart SL, Mezzo JL, Nielsen D, Rim SH, Moore AR, Bhalakia A, House M. Potential Strategies to Increase Gynecologic Oncologist Treatment for Ovarian Cancer. J Womens Health (Larchmt) 2021; 30:769-781. [PMID: 34128688 PMCID: PMC10120807 DOI: 10.1089/jwh.2021.0178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Evidence shows that treatment by gynecologic oncologists (GOs) increases overall survival among women with ovarian cancer. However, specific strategies for institutions and community-based public health programs to promote treatment by GOs are lacking. To address this, we conducted a literature review to identify evidence-based and promising system- and environmental-change strategies for increasing treatment by GOs, in effort to ensure that all women with ovarian cancer receive the standard of care. We searched for English-language literature published from 2008 to 2018. We used PubMed, PubMed Central, OVID, and EBSCO for peer-reviewed literature and Google and Google Scholar for gray literature related to increasing receipt of care by GOs among ovarian cancer patients. Numerous suggested and proposed strategies that have potential to increase treatment by GOs were discussed in several articles. We grouped these approaches into five strategic categories: increasing knowledge/awareness of role and importance of GOs, improving models of care, improving payment structures, improving/increasing insurance coverage for GO care, and expanding or enhancing the GO workforce. We identified several strategies with the potential for increasing GO care among ovarian cancer patients, although currently there is little evidence regarding their effectiveness across US populations. Public health programs and entities that measure delivery of quality health care may pilot the strategies in their populations. Certain strategies may work better in certain environments and a combination of strategies may be necessary for any one entity to increase GO ovarian cancer care. Findings, lessons learned, and recommendations from implementation projects would inform community and public health practice.
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Affiliation(s)
- Sherri L Stewart
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Sun Hee Rim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela R Moore
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Villanueva C, Chang J, Ziogas A, Bristow RE, Vieira VM. Ambient air pollution and ovarian cancer survival in California. Gynecol Oncol 2021; 163:155-161. [PMID: 34330535 DOI: 10.1016/j.ygyno.2021.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine whether exposure to ambient ozone, particulate matter with diameter less than 2.5 μm (PM2.5), nitrogen dioxide (NO2), and distance to major roadways (DTR) impact ovarian cancer-specific survival, while considering differences by stage, race/ethnicity, and socioeconomic status. METHODS Women diagnosed with epithelial ovarian cancer from 1996 to 2014 were identified through the California Cancer Registry and followed through 2016. Women's geocoded addresses were linked to pollutant exposure data and averaged over the follow-up period. Pollutants were considered independently and in multi-pollutant models. Cox proportional hazards models assessed hazards of disease-specific death due to environmental exposures, controlling for important covariates, with additional models stratified by stage at diagnosis, race/ethnicity and socioeconomic status. RESULTS PM2.5 and NO2, but not ozone or DTR, were significantly associated with survival in univariate models. In a multi-pollutant model for PM2.5, ozone, and DTR, an interquartile range increase in PM2.5 (Hazard Ratio [HR], 1.45; 95% Confidence Interval [CI], 1.41-1.49) was associated with worse prognosis. Similarly, in the multi-pollutant model with NO2, ozone, and DTR, women with higher NO2 exposures (HR for 20.0-30.0 ppb, 1.30; 95% CI, 1.25-1.36 and HR for >30.0 ppb, 2.48; 95% CI, 2.32-2.66) had greater mortality compared to the lowest exposed (<20.0 ppb). Stratified results show the effects of the pollutants differed by race/ethnicity and were magnified among women diagnosed in early stages. CONCLUSIONS Our analyses suggest that greater exposure to NO2 and PM2.5 may adversely impact ovarian cancer-specific survival, independent of sociodemographic and treatment factors. These findings warrant further study.
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Affiliation(s)
- Carolina Villanueva
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States of America.
| | - Jenny Chang
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, United States of America
| | - Argyrios Ziogas
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, United States of America
| | - Robert E Bristow
- Chao Family Comprehensive Cancer Center, Orange, CA, United States of America; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA, United States of America
| | - Verónica M Vieira
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States of America; Chao Family Comprehensive Cancer Center, Orange, CA, United States of America
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Wang C, Wang F, Onega T. Spatial Behavior of Cancer Care Utilization in Distance Decay in the Northeast Region of the U.S. TRAVEL BEHAVIOUR & SOCIETY 2021; 24:291-302. [PMID: 34123728 PMCID: PMC8189327 DOI: 10.1016/j.tbs.2021.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PURPOSE Spatial behavior of patients in utilizing health care reflects their travel burden or mobility, accessibility for medical service, and subsequently outcomes from treatment. This paper derives the best-fitting distance decay function to capture the spatial behaviors of cancer patients in the Northeast region of the U.S., and examines and explains the spatial variability of such behaviors across sub-regions. PRINCIPAL RESULTS (1) 46.8%, 85.5%, and 99.6% of cancer care received was within a driving time of 30, 60 and 180 minutes, respectively. (2) The exponential distance decay function is the best in capturing the travel behavior of cancer patients in the region and across most sub-regions. (3) The friction coefficient in the distance decay function is negatively correlated with the mean travel time. (4) The best-fitting function forms are associated with network structures. (5) The variation of the friction coefficient across sub-regions is related to factors such as urbanicity, economic development level, and market competition intensity. MAJOR CONCLUSIONS The distance decay function offers an analytic metric to capture a full spectrum of travel behavior, and thus a more comprehensive measure than average travel time. Examining the geographic variation of travel behavior needs a reliable analysis unit such as organically defined "cancer service areas", which capture relevant health care market structure and thus are more meaningful than commonly-used geopolitical or census area units.
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Affiliation(s)
- Changzhen Wang
- Department of Geography & Anthropology, Louisiana State University, Baton Rouge, LA 70803
| | - Fahui Wang
- Department of Geography & Anthropology, Louisiana State University, Baton Rouge, LA 70803
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah; Huntsman Cancer Institute. Salt Lake City, UT 84112
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Adherence to treatment guidelines as a major determinant of survival disparities between black and white patients with ovarian cancer. Gynecol Oncol 2020; 160:10-15. [PMID: 33208254 DOI: 10.1016/j.ygyno.2020.10.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/31/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate whether non-adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines and other factors related to treatment access contribute to racial disparities in ovarian cancer survival. METHODS This large cohort study included patients from the National Cancer Database who were diagnosed with ovarian cancer between 2004 and 2014, with follow-up data up to 2017. The multivariable Cox regression was used to assess the effect of study variables on five-year overall survival. The proportion contributions of prognostic factors to the survival disparities were estimated using individual and sequential adjustment of these factors based on the Cox proportional hazards models. RESULTS Of the 120,712 patients eligible for this study, 110,032 (91.1%) were whites and 10,680 (8.9%) were blacks. Black patients, compared with their white counterparts, had a lower adherence to NCCN guidelines (60.8% vs. 70.4%, respectively, P < 0.001), and a higher five-year mortality after cancer diagnosis (age- and tumor characteristics- adjusted hazard ratio: 1.22, 95% confidence interval: 1.19-1.25). Non-adherence to NCCN treatment guidelines was the most significant contributor to racial disparity in ovarian cancer survival, followed by access to care and comorbidity, each explaining 36.4%, 22.7%, and 18.2% of the racial differences in five-year overall survival, respectively. These factors combined explain 59.1% of racial survival disparities. Risk factors identified for non-adherence to treatment guidelines among blacks include insurance status, treatment facility type, educational attainment, age, and comorbidity. CONCLUSIONS Adherence status to NCCN treatment guidelines is the most important contributor to the survival disparities between black and white patients with ovarian cancer. Our findings call for measures to promote equitable access to guideline-adherence care to improve the survival of black women with ovarian cancer.
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Villanueva C, Chang J, Ziogas A, Bristow RE, Vieira VM. Ovarian cancer in California: Guideline adherence, survival, and the impact of geographic location, 1996-2014. Cancer Epidemiol 2020; 69:101825. [PMID: 33022472 DOI: 10.1016/j.canep.2020.101825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/12/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence suggests that geographic location may independently contribute to ovarian cancer survival. We aimed to investigate how the association between residential location and ovarian cancer-specific survival in California varies by race/ethnicity and socioeconomic status. METHODS Additive Cox proportional hazard models were used to predict hazard ratios (HRs) and 95% confidence intervals (CI) for the association between geographic location throughout California and survival among 29,844 women diagnosed with epithelial ovarian cancer between 1996 and 2014. We conducted permutation tests to determine a global P-value for significance of location. Adjusted analyses considered distance traveled for care, distance to closest high-quality-of-care hospital, and receipt of National Comprehensive Cancer Network guideline care. Models were also stratified by stage, race/ethnicity, and socioeconomic status. RESULTS Location was significant in unadjusted models (P = 0.009 among all stages) but not in adjusted models (P = 0.20). HRs ranged from 0.81 (95% CI: 0.70, 0.93) in Southern Central Valley to 1.41 (95% CI: 1.15, 1.73) in Northern California but were attenuated after adjustment (maximum HR = 1.17, 95% CI: 1.08, 1.27). Better survival was generally observed for patients traveling longer distances for care. Associations between survival and proximity to closest high-quality-of-care hospitals were null except for women of lowest socioeconomic status living furthest away (HR = 1.22, 95% CI: 1.03, 1.43). CONCLUSIONS Overall, geographic variations observed in ovarian cancer-specific survival were due to important predictors such as receiving guideline-adherent care. Improving access to expert care and ensuring receipt of guideline-adherent treatment should be priorities in optimizing ovarian cancer survival.
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Affiliation(s)
- Carolina Villanueva
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Anteater Instruction & Research Building, 653 East Peltason Drive, Irvine, CA, 92697, USA.
| | - Jenny Chang
- Department of Medicine, School of Medicine, University of California, 205 Irvine Hall, Irvine, CA, 92697, USA.
| | - Argyrios Ziogas
- Department of Medicine, School of Medicine, University of California, 205 Irvine Hall, Irvine, CA, 92697, USA.
| | - Robert E Bristow
- Chao Family Comprehensive Cancer Center, Orange, CA, USA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, 333 City Boulevard West, Ste 1400, Orange, CA, 92868, USA.
| | - Verónica M Vieira
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Anteater Instruction & Research Building, 653 East Peltason Drive, Irvine, CA, 92697, USA; Chao Family Comprehensive Cancer Center, Orange, CA, USA.
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13
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Moterani VC, Tiezzi DG, de Andrade JM, Candido Dos Reis FJ. Analysis of the relationship between hospital characteristics and survival in ovarian cancer: A historical cohort. J Surg Oncol 2020; 122:1802-1807. [PMID: 32851684 DOI: 10.1002/jso.26186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/20/2020] [Accepted: 08/14/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The management of ovarian cancer requires complex surgical and medical interventions. Specialized care is associated with superior outcomes in early and advanced stages. This study aimed to estimate the effect of hospital characteristics on the overall survival of women with epithelial ovarian cancer. METHODS We established a cohort with data recorded by the Fundação Oncocentro de São Paulo cancer registry. We included 6111 women treated for ovarian cancer in the state of Sao Paulo from January 2000 to December 2018. From 76 hospitals analyzed, 7 were high volume (20 or more cases a year) and 69 low volume. Twenty-nine were teaching and 47 community hospitals. A 10-year survival was analyzed using the Kaplan-Meyer estimator and the Cox model. RESULTS Fifty-two percent of the epithelial ovarian cancer patients were treated in high-volume hospitals. High-volume - (HR, 0.86; 95% CI, 0.8-0.92; P < .001) and teaching - (HR, 0.91; 95% CI, 0.85-0.99; P = .019) were hospital characteristics associated with low risk of death in 10 years. CONCLUSIONS High-volume and teaching hospitals are associated with better overall survival in ovarian cancer. Our data suggest that both hospital characteristics are important indicators of good quality of care in ovarian cancer treatment.
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Affiliation(s)
- Vinicius Cesar Moterani
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Daniel Guimarães Tiezzi
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Jurandyr Moreira de Andrade
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
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14
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Villanueva C, Chang J, Bartell SM, Ziogas A, Bristow R, Vieira VM. Contribution of Geographic Location to Disparities in Ovarian Cancer Treatment. J Natl Compr Canc Netw 2020; 17:1318-1329. [PMID: 31693984 DOI: 10.6004/jnccn.2019.7325] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND More than 14,000 women in the United States die of ovarian cancer (OC) every year. Disparities in survival have been observed by race and socioeconomic status (SES), and vary spatially even after adjusting for treatment received. This study aimed to determine the impact of geographic location on receiving treatment adherent to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for OC, independent of other predictors. PATIENTS AND METHODS Women diagnosed with all stages of epithelial OC (1996-2014) were identified through the California Cancer Registry. Generalized additive models, smoothing for residential location, were used to calculate adjusted odds ratios (ORs) and 95% CIs for receiving nonadherent care throughout California. We assessed the impact of distance traveled for care, distance to closest high-quality hospital, race/ethnicity, and SES on receipt of quality care, adjusting for demographic and cancer characteristics and stratifying by disease stage. RESULTS Of 29,844 patients with OC, 11,419 (38.3%) received guideline-adherent care. ORs for nonadherent care were lower in northern California and higher in Kern and Los Angeles counties. Magnitudes of associations with location varied by stage (OR range, 0.45-2.19). Living farther from a high-quality hospital increased the odds of receiving nonadherent care (OR, 1.18; 95% CI, 1.07-1.29), but travel >32 km to receive care was associated with decreased odds (OR, 0.76; 95% CI, 0.70-0.84). American Indian/other women were more likely to travel greater distances to receive care. Women in the highest SES quintile, those with Medicare insurance, and women of non-Hispanic black race were less likely to travel far. Patients who were Asian/Pacific Islander lived the closest to a high-quality hospital. CONCLUSIONS Among California women diagnosed with OC, living closer to a high-quality center was associated with receiving adherent care. Non-Hispanic black women were less likely to receive adherent care, and women with lower SES lived farthest from high-quality hospitals. Geographic location in California is an independent predictor of adherence to NCCN Guidelines for OC.
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Affiliation(s)
- Carolina Villanueva
- Program in Public Health, Susan and Henry Samueli College of Health Sciences
| | - Jenny Chang
- Department of Medicine, School of Medicine, and
| | - Scott M Bartell
- Program in Public Health, Susan and Henry Samueli College of Health Sciences.,Department of Statistics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California
| | | | - Robert Bristow
- Chao Family Comprehensive Cancer Center, Orange, California; and.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Orange, California
| | - Verónica M Vieira
- Program in Public Health, Susan and Henry Samueli College of Health Sciences.,Chao Family Comprehensive Cancer Center, Orange, California; and
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15
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Freeman VL, Naylor KB, Boylan EE, Booth BJ, Pugach O, Barrett RE, Campbell RT, McLafferty SL. Spatial access to primary care providers and colorectal cancer-specific survival in Cook County, Illinois. Cancer Med 2020; 9:3211-3223. [PMID: 32130791 PMCID: PMC7196057 DOI: 10.1002/cam4.2957] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/20/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Spatial access to primary care has been associated with late-stage and fatal breast cancer, but less is known about its relation to outcomes of other screening-preventable cancers such as colorectal cancer. This population-based retrospective cohort study examined whether spatial access to primary care providers associates with colorectal cancer-specific survival. METHODS Approximately 26 600 incident colorectal cancers diagnosed between 2000 and 2008 in adults residing in Cook County, Illinois were identified through the state cancer registry and georeferenced to the census tract of residence at diagnosis. An enhanced two-step floating catchment area method measured tract-level access to primary care physicians (PCPs) in the year of diagnosis using practice locations obtained from the American Medical Association. Vital status and underlying cause of death were determined using the National Death Index. Fine-Gray proportional subdistribution hazard models analyzed the association between tract-level PCP access scores and colorectal cancer-specific survival after accounting for tract-level socioeconomic status, case demographics, tumor characteristics, and other factors. RESULTS Increased tract-level access to PCPs was associated with a lower risk of death from colorectal cancer (hazard ratio [HR], 95% confidence interval [CI]) = 0.87 [0.79, 0.96], P = .008, highest vs lowest quintile), especially among persons diagnosed with regional-stage tumors (HR, 95% CI = 0.80 [0.69, 0.93], P = .004, highest vs lowest quintile). CONCLUSIONS Spatial access to primary care providers is a predictor of colorectal cancer-specific survival in Cook County, Illinois. Future research is needed to determine which areas within the cancer care continuum are most affected by spatial accessibility to primary care such as referral for screening, accessibility of screening and diagnostic testing, referral for treatment, and access to appropriate survivorship-related care.
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Affiliation(s)
- Vincent L. Freeman
- Division of Epidemiology and BiostatisticsSchool of Public HealthUniversity of Illinois at ChicagoChicagoILUSA
- University of Illinois Cancer CenterUniversity of Illinois Hospital and Health Sciences SystemChicagoILUSA
| | - Keith B. Naylor
- Division of Gastroenterology & HepatologyCollege of MedicineUniversity of Illinois at ChicagoChicagoILUSA
| | - Emma E. Boylan
- Division of Epidemiology and BiostatisticsSchool of Public HealthUniversity of Illinois at ChicagoChicagoILUSA
| | - Benjamin J. Booth
- Office of Community Health SystemsWashington State Department of HealthOlympiaWAUSA
| | - Oksana Pugach
- Division of Epidemiology and BiostatisticsSchool of Public HealthUniversity of Illinois at ChicagoChicagoILUSA
- Institute of Health Research and PolicySchool of Public HealthUniversity of Illinois at ChicagoChicagoILUSA
| | - Richard E. Barrett
- Department of SociologyCollege of Liberal and SciencesUniversity of Illinois at ChicagoChicagoILUSA
| | - Richard T. Campbell
- Institute of Health Research and PolicySchool of Public HealthUniversity of Illinois at ChicagoChicagoILUSA
| | - Sara L. McLafferty
- Department of Geography and Geographic Information ScienceUniversity of Illinois at Urbana‐ChampaignUrbanaILUSA
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16
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Karanth S, Fowler ME, Mao X, Wilson LE, Huang B, Pisu M, Potosky A, Tucker T, Akinyemiju T. Race, Socioeconomic Status, and Health-Care Access Disparities in Ovarian Cancer Treatment and Mortality: Systematic Review and Meta-Analysis. JNCI Cancer Spectr 2019; 3:pkz084. [PMID: 31840133 PMCID: PMC6899434 DOI: 10.1093/jncics/pkz084] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/23/2019] [Accepted: 10/04/2019] [Indexed: 01/11/2023] Open
Abstract
Background Ovarian cancer remains a leading cause of death from gynecological malignancies. Race, socioeconomic status (SES), and access to health care are important predictors of quality treatment and survival. We provide a systematic review and meta-analysis on the role of these predictors on disparities in ovarian cancer treatment and mortality. Methods Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, EMBASE, and Scopus for relevant articles published between January 2000 and March 2017. We selected studies published in the United States that evaluated the role of race, SES, or health-care access on disparities in ovarian cancer treatment or survival. Pooled relative risk (RR) and 95% confidence intervals (CIs) were calculated for each outcome using a random-effects model. Results A total of 41 studies met the inclusion criteria for systematic review. In meta-analysis, there was a 25% decrease (RR = 0.75, 95% CI = 0.66 to 0.84) in receipt of adherent ovarian cancer treatment and 18% increased risk (RR = 1.18, 95% CI = 1.11 to 1.26) of mortality for blacks compared to whites. Receipt of adherent ovarian cancer treatment was 15% lower (RR = 0.85, 95% CI = 0.77 to 0.94) in the lowest vs highest SES group and 30% lower (RR = 0.70, 95% CI = 0.58 to 0.85) among patients at lower vs higher hospital volumes. Conclusion We found consistent and strong evidence for continued lack of quality ovarian cancer treatment and higher mortality among ovarian cancer patients who are black, are of low SES, and/or have poor access to care. Interventions focused on these groups targeting specific barriers to care are needed to reduce disparities in ovarian cancer treatment and mortality.
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Affiliation(s)
- Shama Karanth
- See the Notes section for the full list of authors' affiliations
| | | | - XiHua Mao
- See the Notes section for the full list of authors' affiliations
| | - Lauren E Wilson
- See the Notes section for the full list of authors' affiliations
| | - Bin Huang
- See the Notes section for the full list of authors' affiliations
| | - Maria Pisu
- See the Notes section for the full list of authors' affiliations
| | - Arnold Potosky
- See the Notes section for the full list of authors' affiliations
| | - Tom Tucker
- See the Notes section for the full list of authors' affiliations
| | - Tomi Akinyemiju
- See the Notes section for the full list of authors' affiliations
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17
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Liao Y, Li D, Zhang N, Xia C, Zheng R, Zeng H, Zhang S, Wang J, Chen W. Application of sandwich spatial estimation method in cancer mapping: A case study for breast cancer mortality in the Chinese mainland, 2005. Stat Methods Med Res 2018; 28:3609-3626. [PMID: 30442073 DOI: 10.1177/0962280218811344] [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] [Indexed: 11/15/2022]
Abstract
High-accuracy spatial distribution estimation is crucial for cancer prevention and control. Due to their complicated pathogenic factors, the distributions of many cancers' mortalities appear blocky, and spatial heterogeneity is common. However, most of the commonly used cancer mapping methods are based on spatial autocorrelation theory. Sandwich estimation is a new method based on spatial heterogeneity theory. A modified sandwich estimation method suitable for the estimation of cancer mortality distribution is proposed in this study. The variances of cancer mortality data are used to fuse sandwich estimation results from various auxiliary variables, the feasibility of which in estimating cancer mortality distributions is explained theoretically. The breast cancer (BC) mortality of the Chinese mainland in 2005 was taken as a case, and the accuracy of the modified sandwich estimation method was compared with that of the Hierarchical Bayesian (HB), the Co-Kriging (CK) and the Ordinary Kriging (OK) methods. The accuracy of the modified sandwich estimation method was better than the HB, the CK and the OK methods, and the estimation result from the modified sandwich estimation method was more likely to be acceptable. Therefore, this study represents an attempt to apply the sandwich estimation method to the estimation of cancer mortality distributions with strong spatial heterogeneity, which holds great potential for further application.
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Affiliation(s)
- Yilan Liao
- The State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Dongyue Li
- The State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.,College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, China
| | - Ningxu Zhang
- The State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.,College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, China.,Jiangsu Center for Collaborative Innovation in Geographical Information Resource Development and Application, Nanjing, China
| | - Changfa Xia
- National Office for Cancer Prevention and Control, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rongshou Zheng
- National Office for Cancer Prevention and Control, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongmei Zeng
- National Office for Cancer Prevention and Control, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siwei Zhang
- National Office for Cancer Prevention and Control, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinfeng Wang
- The State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Wanqing Chen
- National Office for Cancer Prevention and Control, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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Rauh LA, Saks EJ, Nakad-Rodriguez D, Showalter TN, Duska LR. Cervical cancer care in rural Virginia: The impact of distance from an academic medical center on outcomes & the role of non-specialized radiation centers. Gynecol Oncol 2018; 150:338-342. [PMID: 29935911 DOI: 10.1016/j.ygyno.2018.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/11/2018] [Accepted: 06/16/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine whether distance to a tertiary care facility affects outcomes for locally advanced cervical cancer and to evaluate the impact of receiving care at non-specialized centers in rural communities. METHODS Retrospective, single institution study of patients with locally advanced cervical cancer managed with chemo-radiation from January 1, 2000 to June 1, 2014. Kaplan-Meier survival curves and Cox proportional hazard models were used to compare progression free and overall survival for patients by median distance to the tertiary care facility (<72 miles or >72 miles) and facility where treatment was received. RESULTS 180 patients met inclusion criteria. There was no difference in PFS or OS between the travel distance cohorts. When compared by location of external beam radiation, patients treated at outside facilities were older (p = 0.02) and significantly more likely to be insured (95.6% versus 71.7%, p < 0.0002). There were more recurrences among patients treated at outside facilities (31.1% versus 15.8%) but this was non-significant (p = 0.24). On multivariable analysis, FIGO stage and insurance status were associated with overall survival. Uninsured patients had a significantly increased hazard risk of death as compared to privately insured patients (HR 3.85 95% CI 3.07-4.64, p = 0.0008). CONCLUSIONS Median distance to a tertiary care facility had no significant impact on PFS or OS, however treating facility for radiation may influence recurrence rates. Having non-private insurance or being uninsured is significantly associated with increased risk of death and speaks to the many barriers these patients face.
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Affiliation(s)
- Lisa A Rauh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, United States of America.
| | - Erin J Saks
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Tech School of Medicine, Roanoke, VA, United States of America
| | - Diana Nakad-Rodriguez
- Division of Public Health Services, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, United States of America
| | - Linda R Duska
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, United States of America
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Spatial Surveillance of Childhood Lead Exposure in a Targeted Screening State: An Application of Generalized Additive Models in Denver, Colorado. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 23 Suppl 5 Supplement, Environmental Public Health Tracking:S79-S92. [PMID: 28763391 DOI: 10.1097/phh.0000000000000620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT The targeted nature of Colorado's childhood lead screening program presents several analytical issues that complicate routine epidemiologic surveillance. OBJECTIVES To analyze spatial patterns of childhood lead exposure among children younger than 6 years, identifying areas of increased risk along with associated covariates. METHODS We analyzed a spatial case-control data set of childhood lead poisoning using generalized additive models. Incident cases were represented by the residential locations of children younger than 6 years with confirmed elevated blood lead levels (EBLL) of 5 μg/dL or more recorded between calendar years 2010 and 2014, and controls were sampled from the population at risk. We modeled the effect of spatial location, adjusting for potential spatial confounders. We also adjusted for a number of covariates previously identified in the childhood lead poisoning literature to understand the ecologic-level drivers of spatial variation in risk. MAIN OUTCOME MEASURE(S) Crude and adjusted spatial odds ratios describing the relative frequency of lead poisoning among different locations in Denver, Colorado. RESULTS We found evidence of statistically significant spatial clustering in incident cases of lead poisoning even after adjustment for age, sex, year, season, and spatially smoothed screening rate. Spatial confounder-adjusted odds ratios in the Denver study area ranged from 0.22 to 2.7. Adjusting for additional ecologic-level covariates effectively accounted for the observed spatial variation. We found that ecologic-level indicators of low socioeconomic status, Hispanic ethnicity, Asian race, and older housing age were all positively and significantly associated with an increased EBLL risk. CONCLUSION Housing and socioeconomic factors continue to be the primary ecologic risk factors associated with childhood lead exposure and can be used to predict risk at a fine spatial resolution in the Denver study area. Our analysis demonstrates how other targeted screening states can be proactive about childhood lead surveillance within their major population centers and enhance the spatial specificity of lead mitigation efforts.
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20
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Greenwade MM, Moore KN, Gillen JM, Ding K, Rowland MR, Crim AK, Kleis B, Gunderson CC. Factors influencing clinical trial enrollment among ovarian cancer patients. Gynecol Oncol 2017; 146:465-469. [PMID: 28689668 DOI: 10.1016/j.ygyno.2017.06.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To characterize patients who did not enroll on a clinical trial and identify barriers that may limit enrollment among patients with advanced epithelial ovarian cancer (EOC) presenting for first-line chemotherapy. METHODS We conducted a retrospective review of patients diagnosed with stage II-IV EOC from 10/2009-4/2013, a time period during which multiple trials were available to all EOC patients, including optimally debulked, suboptimally debulked, or undergoing neoadjuvant chemotherapy. Enrollment status, demographics, tumor characteristics, and treatment details were recorded. SAS version 9.3 was used for all analyses. RESULTS 144 patients met study criteria; 67% were enrolled on a trial. Enrolled patients were significantly younger (median 61 vs 68years, p=0.002). Stage (p=0.30), race (p=0.75), and performance status (p=0.38) were similar between enrolled and non-enrolled patients. Distance did not impact enrollment, as nearly half of patients in both groups lived >50miles from the treatment center (39.0% vs 47.8%, p=0.36). Mode of chemotherapy administration significantly differed based on participation (all p<0.05). Despite similar residual disease status (p=1.00) and number of chemotherapy regimens received (p=0.59), patients treated on trial had a higher 3-year survival rate (70.7% vs 51.7%, p=0.031). The difference in median progression-free survival approached significance (20.2 vs 9.2months, p=0.091). CONCLUSION In an institution where the culture is to offer clinical trials to all eligible patients, 33% of front-line EOC patients did not participate. Increasing age was associated with non-participation. Modifiable barriers must be overcome so that trial enrollment can better reflect true EOC demographics.
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Affiliation(s)
- Molly M Greenwade
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Kathleen N Moore
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Jessica M Gillen
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Kai Ding
- Department of Biostatistics and Epidemiology, University of Oklahoma HSC, Oklahoma City, OK, United States.
| | - Michelle R Rowland
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Aleia K Crim
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Bailey Kleis
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Camille C Gunderson
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
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21
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Vieira VM, Villanueva C, Chang J, Ziogas A, Bristow RE. Impact of community disadvantage and air pollution burden on geographic disparities of ovarian cancer survival in California. ENVIRONMENTAL RESEARCH 2017; 156:388-393. [PMID: 28395243 PMCID: PMC5467739 DOI: 10.1016/j.envres.2017.03.057] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 05/07/2023]
Abstract
Ovarian cancer survival varies geographically throughout California. The objective of this study is to determine the impact of living in disadvantaged communities on spatial patterns of survival disparities. Including a bivariate spatial smooth of geographic location within the Cox proportional hazard models is an effective approach for spatial analyses of cancer survival. Women diagnosed with advanced Stage IIIC/IV epithelial ovarian cancer (1996-2006) were identified from the California Cancer Registry. The impact of living in disadvantaged communities, as measured by the California Office of Environmental Health Hazard Assessment cumulative CalEnviroScreen 2.0 score, on geographic disparities in survival was assessed while controlling for age, tumor characteristics, quality of care, and race. Community-level air quality indicators and socioeconomic status (SES) were also independently examined in secondary analyses. The Cox proportional hazard spatial methods are available in the MapGAM package implemented in R. An increase in the community disadvantage from the 5th (less disadvantage) to the 95th percentile (more disadvantage) was significantly associated with poorer ovarian cancer survival (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.07-1.26). Ozone levels and SES were the most influential indicators on geographic disparities that warrant further investigation. The use of a bivariate smoother of location within the survival model allows for more advanced spatial analyses for exploring potential air quality-related predictors of geographic disparities.
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Affiliation(s)
- Verónica M Vieira
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA, United States; Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, United States.
| | - Carolina Villanueva
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA, United States
| | - Jenny Chang
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA, United States
| | - Argyrios Ziogas
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA, United States
| | - Robert E Bristow
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, United States; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA, United States
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22
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Hillman RT, Saenz CC, McHale MT, Plaxe SC. Fertility preservation and survival among young women with early ovarian cancer living in US counties with gynecologic oncologist services. Int J Gynaecol Obstet 2017; 137:157-163. [DOI: 10.1002/ijgo.12109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 12/02/2016] [Accepted: 02/01/2017] [Indexed: 12/31/2022]
Affiliation(s)
- R. Tyler Hillman
- Division of Gynecologic Oncology; Department of Reproductive Medicine; Rebecca and John Moores UCSD Cancer Center; La Jolla CA USA
| | - Cheryl C. Saenz
- Division of Gynecologic Oncology; Department of Reproductive Medicine; Rebecca and John Moores UCSD Cancer Center; La Jolla CA USA
| | - Michael T. McHale
- Division of Gynecologic Oncology; Department of Reproductive Medicine; Rebecca and John Moores UCSD Cancer Center; La Jolla CA USA
| | - Steven C. Plaxe
- Division of Gynecologic Oncology; Department of Reproductive Medicine; Rebecca and John Moores UCSD Cancer Center; La Jolla CA USA
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Kelly C, Hulme C, Farragher T, Clarke G. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review. BMJ Open 2016; 6:e013059. [PMID: 27884848 PMCID: PMC5178808 DOI: 10.1136/bmjopen-2016-013059] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate whether there is an association between differences in travel time/travel distance to healthcare services and patients' health outcomes and assimilate the methodologies used to measure this. DESIGN Systematic Review. We searched MEDLINE, Embase, Web of Science, Transport database, HMIC and EBM Reviews for studies up to 7 September 2016. Studies were excluded that included children (including maternity), emergency medical travel or countries classed as being in the global south. SETTINGS A wide range of settings within primary and secondary care (these were not restricted in the search). RESULTS 108 studies met the inclusion criteria. The results were mixed. 77% of the included studies identified evidence of a distance decay association, whereby patients living further away from healthcare facilities they needed to attend had worse health outcomes (eg, survival rates, length of stay in hospital and non-attendance at follow-up) than those who lived closer. 6 of the studies identified the reverse (a distance bias effect) whereby patients living at a greater distance had better health outcomes. The remaining 19 studies found no relationship. There was a large variation in the data available to the studies on the patients' geographical locations and the healthcare facilities attended, and the methods used to calculate travel times and distances were not consistent across studies. CONCLUSIONS The review observed that a relationship between travelling further and having worse health outcomes cannot be ruled out and should be considered within the healthcare services location debate.
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Affiliation(s)
- Charlotte Kelly
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Institute for Transport Studies, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tracey Farragher
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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