1
|
Lubarsky M, Hernandez AE, Collie BL, Westrick AC, Thompson C, Kesmodel SB, Goel N. Does structural racism impact receipt of NCCN guideline-concordant breast cancer treatment? Breast Cancer Res Treat 2024; 206:509-517. [PMID: 38809304 DOI: 10.1007/s10549-024-07245-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/03/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Disparities in breast cancer survival remain a challenge. We aimed to analyze the effect of structural racism, as measured by the Index of Concentration at the Extremes (ICE), on receipt of National Cancer Center Network (NCCN) guideline-concordant breast cancer treatment. METHODS We identified patients treated at two institutions from 2005 to 2017 with stage I-IV breast cancer. Census tracts served as neighborhood proxies. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed to create 5 models, controlling for economic segregation, non-Hispanic Black (NHB) segregation, NHB/economic segregation, Hispanic segregation, and Hispanic/economic segregation. Multi-level logistic regression models were used to determine the association between individual and neighborhood-level characteristics on receipt of NCCN guideline-concordant breast cancer treatment. RESULTS 5173 patients were included: 55.2% were Hispanic, 27.5% were NHW, and 17.3% were NHB. Regardless of economic or residential segregation, a NHB patient was less likely to receive appropriate treatment [(OR)Model1 0.58 (0.45-0.74); ORModel2 0.59 (0.46-0.78); ORModel3 0.62 (0.47-0.81); ORModel4 0.53 (0.40-0.69); ORModel5 0.59(0.46-0.76); p < 0.05]. CONCLUSION To our knowledge, this is the first analysis assessing receipt of NCCN guideline-concordant treatment by ICE, a validated measure for structural racism. While much literature emphasizes neighborhood-level barriers to treatment, our results demonstrate that compared to NHW patients, NHB patients are less likely to receive NCCN guideline-concordant breast cancer treatment, independent of economic or residential segregation. Our study suggests that there are potential unaccounted individual or neighborhood barriers to receipt of appropriate care that go beyond economic or residential segregation.
Collapse
Affiliation(s)
- Maya Lubarsky
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alexandra E Hernandez
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA
| | - Brianna L Collie
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA
| | - Ashly C Westrick
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Cheyenne Thompson
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA
| | - Susan B Kesmodel
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Neha Goel
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA.
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA.
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
- Division of Surgical Oncology | Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street | Suite 410, Miami, FL, 33136, USA.
| |
Collapse
|
2
|
Hernandez AE, Benck KN, Huerta CT, Ogobuiro I, De La Cruz Ku G, Möller MG. Rural Melanoma Patients Have Less Surgery and Higher Melanoma-Specific Mortality. Am Surg 2024; 90:510-517. [PMID: 38061913 DOI: 10.1177/00031348231216485] [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] [Indexed: 12/22/2023]
Abstract
BACKGROUND Melanoma causes most skin cancer-related deaths, and disparities in mortality persist. Rural communities, compared to urban, face higher levels of poverty and more barriers to care, leading to higher stage at presentation and shorter survival in melanoma. To further evaluate these disparities, we sought to assess the association between rurality and melanoma cause-specific mortality and receipt of recommended surgery in a national cohort. METHODS Patients with primary non-ocular, cutaneous melanoma from the SEER database, 2000-2017, were included. Outcomes included melanoma-specific survival and receipt of recommended surgery. Rurality was based on Rural-Urban Continuum Codes. Variables included age, sex, race, ethnicity, income, and stage. Multivariate regression models assessed the effect of rurality on survival and receipt of recommended surgery. RESULTS 103,606 patients diagnosed with non-ocular cutaneous primary melanoma met criteria during this period. 93.3% (n = 96620) were in urban areas and 6.7% (n = 6986) were in rural areas. On multivariate regression controlling for age, sex, race, ethnicity, and stage patients living in a rural area were less likely to receive recommended surgery (aOR .52, 95% CI: .29-.90, P = .02) and had increased hazard of melanoma-specific mortality (aHR 1.19, 95% CI: 1.02-1.40, P = .03) even after additionally controlling for surgery receipt. CONCLUSION Using a large national cohort, our study found that rural patients were less likely to receive recommended surgery and had shorter melanoma cause-specific survival. Our findings highlight the importance of access to cancer care in rural areas and how this ultimately effects survival for these patients.
Collapse
Affiliation(s)
- Alexandra E Hernandez
- Department of Surgery, Division of Surgical Oncology,University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kelley N Benck
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carlos T Huerta
- Department of Surgery, Division of Surgical Oncology,University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ifeanyichukwu Ogobuiro
- Department of Surgery, Division of Surgical Oncology,University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gabriel De La Cruz Ku
- University of Massachusetts School of Medicine, Worcester, MA, USA
- Universidad Cientifica del Sur, Lima, Peru
| | - Mecker G Möller
- University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| |
Collapse
|
3
|
Wu V, Chichura AM, Dickard J, Turner C, Al-Hilli Z. Perioperative genetic testing and time to surgery in patients with breast cancer. Surgery 2024; 175:712-717. [PMID: 37848355 DOI: 10.1016/j.surg.2023.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Time to treatment has been identified as a quality metric, with longer time to treatment associated with poorer outcomes. Genetic evaluation is an integral part of treatment counseling for patients with breast cancer. With expanding indications for genetic testing and consideration of expansion of genetic testing to all patients with a personal history of breast cancer, this study aims to evaluate the effect of genetic evaluation on the time interval from initial surgical visit to surgery. METHODS A retrospective review of patients undergoing upfront surgery for stage 0-3 breast cancer from June 2022 to December 2022. Patient demographics, treatment characteristics, National Comprehensive Cancer Network criteria for genetic testing, and results were obtained. RESULTS The study included 492 patients (489 females). Eighty-one (16.2%) were ≤50 years of age at diagnosis. In total, 281 patients (57.1%) met National Comprehensive Cancer Network criteria for genetic testing and 199 consulted with a genetic counselor (72.4%). Seventy-six patients (27.6%) not meeting National Comprehensive Cancer Network criteria pursued genetic counseling. In total, 218 patients (79.3%) referred for genetic counseling completed testing. Mean turnaround time to genetic testing result was 11 days (range, 6-66 days). Twenty-six patients (11.9%) had a pathogenic or likely pathogenic variant. Twenty-four of these patients met National Comprehensive Cancer Network testing criteria (92.3%) and 2 did not (7.7%). The time to treatment for patients undergoing genetic testing was 33 vs 34 days in those without testing (P = .45). Three patients (11.5%) with pathogenic or likely pathogenic variants altered their initial surgical plan due to their genetic testing results. Seven patients with pathogenic or likely pathogenic variant results returning postoperatively did not undergo additional surgery. CONCLUSION Hereditary breast cancer evaluation and genetic testing did not appear to delay time to treatment for patients with breast cancer in our study cohort.
Collapse
Affiliation(s)
- Vincent Wu
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Anna M Chichura
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH; Department of Benign Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Jennifer Dickard
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Christine Turner
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
4
|
Pleasant V. A Public Health Emergency: Breast Cancer Among Black Communities in the United States. Obstet Gynecol Clin North Am 2024; 51:69-103. [PMID: 38267132 DOI: 10.1016/j.ogc.2023.11.001] [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] [Indexed: 01/26/2024]
Abstract
While Black people have a similar incidence of breast cancer compared to White people, they have a 40% increased death rate. Black people are more likely to be diagnosed with aggressive subtypes such as triple-negative breast cancer. However, despite biological factors, systemic racism and social determinants of health create delays in care and barriers to treatment. While genetic testing holds incredible promise for Black people, uptake remains low and results may be challenging to interpret. There is a need for more robust, multidisciplinary, and antiracist interventions to reverse breast cancer-related racial disparities.
Collapse
Affiliation(s)
- Versha Pleasant
- Department of Obstetrics and Gynecology, Cancer Genetics & Breast Health Clinic, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| |
Collapse
|
5
|
Phillips W, Stallworth J, Gillis A, Lindeman B, Chen H, Fazendin J, Zmijewski P. Patient perspectives on barriers to obtaining surgery for primary hyperparathyroidism: A qualitative review. Am J Surg 2024; 228:122-125. [PMID: 37640639 DOI: 10.1016/j.amjsurg.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The purpose of this study was to qualitatively explore patient-reported barriers to surgery for primary hyperparathyroidism (PHPT) and identify actionable interventions to improve access to surgical care. METHODS We recruited forty-nine patients in an endocrine surgery clinic at a large, academic medical to participate in an 11- question phone interview. All interviewees underwent parathyroidectomy for primary hyperparathyroidism. Responses were recorded and a codebook of qualitative themes, blinded to patient race and sex, was created by 3 independent reviewers. Comments were subsequently sorted into the codebook with patient demographic information. RESULTS Patients that experienced delays in parathyroidectomy most commonly cited "issues with the referral process" and "missed diagnosis" as the cause. Patients were asked to identify the most challenging part about the surgery process. Commonly evoked themes among patients of both races and sexes included "transportation" and "financial" with subthemes of "no ride," "distance from surgeon," "insurance," and "difficulty taking time off work." Patients were asked to name actionable interventions to improve access to surgical care. The most commonly evoked theme involved "support systems," with subthemes of "transportation assistance," "financial," and "patient advocacy." Physician factors were also commonly evoked among patients of both races with subthemes of "knowledge", "communication," and "listening." CONCLUSION PHPT patients cited multiple barriers to undergoing surgery. Future work can focus on examining these questions with a larger patient cohort and examining delays at the referral and diagnosis stage, which was most commonly cited by our respondents.
Collapse
Affiliation(s)
- Walker Phillips
- Department of Surgery, The University of Alabama at Birmingham, USA
| | - James Stallworth
- Department of Surgery, The University of Alabama at Birmingham, USA
| | - Andrea Gillis
- Department of Surgery, The University of Alabama at Birmingham, USA
| | | | - Herbert Chen
- Department of Surgery, The University of Alabama at Birmingham, USA
| | - Jessica Fazendin
- Department of Surgery, The University of Alabama at Birmingham, USA
| | - Polina Zmijewski
- Department of Surgery, The University of Alabama at Birmingham, USA.
| |
Collapse
|
6
|
Silva TS, Tavassoli M, Lee E, Annie Nguyen LA, Vu B, Sinjali K, Allison-Aipa T, Molina DC, Lum S. Timeliness of Multimodal Care for At-Risk Breast Cancer Patients at a Safety Net Institution. J Surg Res 2023; 291:367-373. [PMID: 37516043 DOI: 10.1016/j.jss.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/05/2023] [Accepted: 06/18/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Because limited data exist, we sought to evaluate timeliness of multimodal treatments in a safety net breast cancer population. METHODS Breast cancer patients treated at a safety net hospital from 2016 to 2020 were analyzed retrospectively. Time intervals were defined as primary time (PT) from diagnosis to initiation of primary intervention, secondary time (ST) from completion of primary to initiation of secondary intervention, and tertiary time (TT) from completion of secondary to initiation of tertiary intervention. Variables included primary language, insurance type, and race. RESULTS Of 223 patients, 99 (44.4%) primarily spoke Spanish, 29 (13.0%) were of Black race, and 184 (82.5%) had Medicaid or uninsured status. Median (IQR) age at diagnosis was 55 (48-62) years. Primary intervention was surgical in 127/216 (58.8%); secondary intervention was systemic in 38/169 (22.5%); and tertiary intervention was radiation in 67/80 (83.8%). Overall, median days (IQR) for PT were 69 (53, 98), ST were 65 (42, 95), and TT were 69 (43, 88). PT was significantly longer in Black [105 (76, 142) days] patients compared to non-Hispanic White patients [68 (51, 107) days, P = 0.031)] and White Hispanic patients [65 (53,91) days, P = 0.014]. There were no significant differences in PT, ST, or TT by spoken language or insurance type. CONCLUSIONS Black patients remain at risk due to prolonged time to intervention. Spanish-speaking status was not associated with inferior timeliness or completion of multimodal care at a safety net hospital. Identifying safety net hospital barriers to achieving benchmarks for timely completion of all phases of multimodal care warrants further attention.
Collapse
Affiliation(s)
- Trevor S Silva
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Morvarid Tavassoli
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Esther Lee
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Lan-Anh Annie Nguyen
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Brandon Vu
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Kiran Sinjali
- Department of Radiology, Loma Linda University Health, Loma Linda, California
| | - Timothy Allison-Aipa
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System, Moreno Valley, California
| | - David Caba Molina
- Department of Surgery, Riverside University Health System, Moreno Valley, California; Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Sharon Lum
- Department of Surgery, Riverside University Health System, Moreno Valley, California; Department of Surgery, Loma Linda University Health, Loma Linda, California.
| |
Collapse
|
7
|
Wieder R, Adam N. Racial Disparities in Breast Cancer Treatments and Adverse Events in the SEER-Medicare Data. Cancers (Basel) 2023; 15:4333. [PMID: 37686609 PMCID: PMC10486612 DOI: 10.3390/cancers15174333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Despite lower incidence rates, African American (AA) patients have shorter survival from breast cancer (BC) than white (W) patients. Multiple factors contribute to decreased survival, including screening disparities, later presentation, and access to care. Disparities in adverse events (AEs) may contribute to delayed or incomplete treatment, earlier recurrence, and shortened survival. Here, we analyzed the SEER-Medicare dataset, which captures claims from a variety of venues, in order to determine whether the cancer care venues affect treatment and associated adverse events. We investigated a study population whose claims are included in the Outpatient files, consisting of hospital and healthcare facility venues, and a study population from the National Claims History (NCH) files, consisting of claims from physicians, office practices, and other non-institutional providers. We demonstrated statistically and substantively significant venue-specific differences in treatment rates, drugs administered, and AEs from treatments between AA and W patients. We showed that AA patients in the NCH dataset received lower rates of treatment, but patients in the Outpatient dataset received higher rates of treatment than W patients. The rates of recorded AEs per treatment were higher in the NCH setting than in the Outpatient setting in all patients. AEs were consistently higher in AA patients than in W patients. AA patients had higher comorbidity indices and were younger than W patients, but these variables did not appear to play roles in the AE differences. The frequency of specific anticancer drugs administered in cancer- and venue-specific circumstances and their associated AEs varied between AA and W patients. The higher AE rates were due to slightly higher frequencies in the administration of drugs with higher associated AE rates in AA patients than in W patients. Our investigations demonstrate significant differences in treatment rates and associated AEs between AA and W patients with BC, depending on the venues of care, likely contributing to differences in outcomes.
Collapse
Affiliation(s)
- Robert Wieder
- Rutgers New Jersey Medical School and the Cancer Institute of New Jersey, 185 South Orange Avenue, MSB F671, Newark, NJ 07103, USA
| | | |
Collapse
|
8
|
Yoon SC, Taylor-Cho MW, Charles MG, Grimm L. Racial Disparities in Breast Imaging Wait Times Before and After the Implementation of a Same-Day Biopsy Program. JOURNAL OF BREAST IMAGING 2023; 5:159-166. [PMID: 38416937 DOI: 10.1093/jbi/wbad003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To examine time from screening to diagnostic workup, biopsy, and surgery for non-Hispanic White (NHW) and Black women following implementation of a same-day biopsy program. METHODS All NHW and Black women with BI-RADS category 0 screening mammogram at Duke University Hospital were identified between August 1, 2020, and August 1, 2021. Patient characteristics were recorded. Time between screening mammogram, diagnostic workup, breast biopsy, surgical consultation, and surgery were recorded. Comparisons were made between NHW and Black women using a multivariable regression model. Diagnostic imaging to biopsy time interval was compared to historical averages before same-day biopsy implementation. RESULTS There were 2156 women: 69.9% NHW (1508/2156) and 30.1% Black (648/2156). Mean ± standard deviation time from screening to diagnostic imaging overall was 13.5 ± 32.5 days but longer for Black (18.0 ± 48.3 days) than for NHW women (11.5 ± 22.2 days) (P < 0.001). The mean time from diagnostic mammogram to biopsy was 5.9 ± 18.9 days, longer for Black (9.0 ± 27.9 days) than for NHW women (4.4 ± 11.8 days) (P = 0.017). The same-day biopsy program shortened the time from diagnostic imaging to biopsy overall (12.5 ± 12.4 days vs 5.9 ± 18.9 days; P < 0.001), with a significant reduction for NHW women (12.4 ± 11.7 days vs 4.4 ± 11.8 days) (P < 0.001) but not Black women (11.5 ± 9.9 days vs 9.0 ± 27.9 days) (P = 0.527). CONCLUSION Disparities exist along the breast imaging pathway. A same-day biopsy program benefited NHW women more than Black women.
Collapse
Affiliation(s)
- Sora C Yoon
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
| | | | - Matthew G Charles
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
| | - Lars Grimm
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
| |
Collapse
|
9
|
Dee EC, Taunk NK, Chino FL, Deville C, McClelland S, Muralidhar V, McBride SN, Gillespie EF, Yamoah K, Nguyen PL, Mahal BA, Winkfield KM, Vapiwala N, Santos PMG. Shorter Radiation Regimens and Treatment Noncompletion Among Patients With Breast and Prostate Cancer in the United States: An Analysis of Racial Disparities in Access and Quality. JCO Oncol Pract 2023; 19:e197-e212. [PMID: 36399692 PMCID: PMC9970278 DOI: 10.1200/op.22.00383] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/14/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Compared with conventional external-beam radiation therapy (cEBRT) for patients with breast cancer (BC) and prostate cancer (PC), shorter radiation regimens may be associated with lower treatment noncompletion rates. We assess disparities in receipt of shorter radiation regimens and treatment noncompletion for BC and PC. PATIENTS AND METHODS The 2004-2017 National Cancer Database was queried for adjuvant cEBRT or hypofractionated EBRT (hEBRT) for nonmetastatic BC; and definitive cEBRT, moderate hypofractionation (mEBRT), or stereotactic body radiotherapy (SBRT) for localized PC. Multivariable logistic regression identified factors associated with treatment noncompletion and receipt of shorter regimens. FINDINGS We identified 170,386 men with PC (median age [interquartile range], 70 [64-75] years; Black, 17.5%; White, 82.5%) and 306,846 women with BC (61 [52-69] years; Black, 12.3%; White, 87.7%). Among patients who received cEBRT for PC, Black men had higher treatment noncompletion rates compared with White (14.1% v 13.0%; odds ratio [95% CI] 1.07 [1.03 to 1.12]; P < .001). In contrast, treatment noncompletion was not disparate with SBRT (Black 1.6% v White 1.3%; 1.20 [0.72 to 2.00], P = .49) or mEBRT (Black 9.0% v White 7.1%; 1.05 [0.72 to 1.54], P = .79). From 2004 to 2017, SBRT (0.07% to 11.8%; 1.32 [1.31 to 1.33]) and mEBRT (0.35% to 9.1%; 1.27 [1.25 to 1.28]) increased (both P < .001); however, Black men were consistently less likely to receive SBRT (7.4% v White, 8.3%; 0.84 [0.79 to 0.89], P < .001). Among women with BC, there were no racial differences in treatment noncompletion; however, hEBRT was associated with lower treatment noncompletion rates (1.0% v cEBRT 2.3%; 0.39 [0.35 to 0.44], P < .001). Although hEBRT for BC increased (0.8% to 35.6%) between 2004 and 2017, Black women were less likely to receive hEBRT (10.4% v 15.3%; 0.78 [0.75 to 0.81], P < .001). INTERPRETATION Black patients were consistently less likely to receive hypofractionated radiation for PC or BC, despite evidence suggesting that shorter regimens may lower rates of treatment noncompletion with similar oncologic outcomes.
Collapse
Affiliation(s)
| | - Neil K. Taunk
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Fumiko L. Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shearwood McClelland
- Departments of Radiation Oncology and Neurological Surgery, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA
| | - Sean N. McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erin F. Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kosj Yamoah
- Cancer Epidemiology Program, Moffitt Cancer Center, Tampa, FL
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - Paul L. Nguyen
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA
| | - Brandon A. Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL
| | - Karen M. Winkfield
- Meharry-Vanderbilt Alliance, Nashville, TN
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Meharry Medical College; Nashville, TN
| | - Neha Vapiwala
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
10
|
Cronin KA, Scott S, Firth AU, Sung H, Henley SJ, Sherman RL, Siegel RL, Anderson RN, Kohler BA, Benard VB, Negoita S, Wiggins C, Cance WG, Jemal A. Annual report to the nation on the status of cancer, part 1: National cancer statistics. Cancer 2022; 128:4251-4284. [PMID: 36301149 PMCID: PMC10092838 DOI: 10.1002/cncr.34479] [Citation(s) in RCA: 156] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/11/2022] [Accepted: 07/26/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries collaborate to provide annual updates on cancer occurrence and trends in the United States. METHODS Data on new cancer diagnoses during 2001-2018 were obtained from the North American Association of Central Cancer Registries' Cancer in North America Incidence file, which is comprised of data from Centers for Disease Control and Prevention-funded and National Cancer Institute-funded, population-based cancer registry programs. Data on cancer deaths during 2001-2019 were obtained from the National Center for Health Statistics' National Vital Statistics System. Five-year average incidence and death rates along with trends for all cancers combined and for the leading cancer types are reported by sex, racial/ethnic group, and age. RESULTS Overall cancer incidence rates were 497 per 100,000 among males (ranging from 306 among Asian/Pacific Islander males to 544 among Black males) and 431 per 100,000 among females (ranging from 309 among Asian/Pacific Islander females to 473 among American Indian/Alaska Native females) during 2014-2018. The trend during the corresponding period was stable among males and increased 0.2% on average per year among females, with differing trends by sex, racial/ethnic group, and cancer type. Among males, incidence rates increased for three cancers (including pancreas and kidney), were stable for seven cancers (including prostate), and decreased for eight (including lung and larynx) of the 18 most common cancers considered in this analysis. Among females, incidence rates increased for seven cancers (including melanoma, liver, and breast), were stable for four cancers (including uterus), and decreased for seven (including thyroid and ovary) of the 18 most common cancers. Overall cancer death rates decreased by 2.3% per year among males and by 1.9% per year among females during 2015-2019, with the sex-specific declining trend reflected in every major racial/ethnic group. During 2015-2019, death rates decreased for 11 of the 19 most common cancers among males and for 14 of the 20 most common cancers among females, with the steepest declines (>4% per year) reported for lung cancer and melanoma. Five-year survival for adenocarcinoma and neuroendocrine pancreatic cancer improved between 2001 and 2018; however, overall incidence (2001-2018) and mortality (2001-2019) continued to increase for this site. Among children (younger than 15 years), recent trends were stable for incidence and decreased for mortality; and among, adolescents and young adults (aged 15-39 years), recent trends increased for incidence and declined for mortality. CONCLUSIONS Cancer death rates continued to decline overall, for children, and for adolescents and young adults, and treatment advances have led to accelerated declines in death rates for several sites, such as lung and melanoma. The increases in incidence rates for several common cancers in part reflect changes in risk factors, screening test use, and diagnostic practice. Racial/ethnic differences exist in cancer incidence and mortality, highlighting the need to understand and address inequities. Population-based incidence and mortality data inform prevention, early detection, and treatment efforts to help reduce the cancer burden in the United States.
Collapse
Affiliation(s)
- Kathleen A Cronin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Susan Scott
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Albert U Firth
- Information Management Services, Inc, Rockville, Maryland, USA
| | - Hyuna Sung
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Recinda L Sherman
- North American Association of Central Cancer Registries, Springfield, Illinois, USA
| | - Rebecca L Siegel
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Robert N Anderson
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA
| | - Betsy A Kohler
- North American Association of Central Cancer Registries, Springfield, Illinois, USA
| | - Vicki B Benard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Serban Negoita
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Charles Wiggins
- New Mexico Tumor Registry, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | | | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| |
Collapse
|
11
|
Breast Cancer Disparities Related to Young Age at Diagnosis. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Dee EC, Pierce LJ, Winkfield KM, Lam MB. In pursuit of equity in cancer care: moving beyond the Affordable Care Act. Cancer 2022; 128:3278-3283. [PMID: 35818772 DOI: 10.1002/cncr.34346] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022]
Abstract
Although Medicaid Expansion under the Patient Protection and Affordable Care Act (ACA) has been associated with many improvements for patients with cancer, Snyder et al. provide evidence demonstrating the persistence of racial disparities in cancer. This Editorial describes why insurance coverage alone does not ensure access to health care, highlights various manifestations of structural racism that constitute barriers to access beyond the direct costs of care, and calls for not just equality, but equity, in cancer care.
Collapse
Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lori J Pierce
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Chen H. From the Editor - in - Chief: Papers from the North Pacific Surgical Association. Am J Surg 2022; 224:647. [PMID: 35753835 DOI: 10.1016/j.amjsurg.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
14
|
Khubchandani JA, Greenup RA. Time to surgery delays: Barriers to care for black women with breast cancer. Am J Surg 2022; 224:809-810. [DOI: 10.1016/j.amjsurg.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/28/2022]
|