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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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Bing X, Lei H, Zhao X, Cheng Y, Wang L, Yang J, Xu M, Yu C, Chen T. Use of Period Analysis to Timely Assess Five-Year Relative Survival for Patients with Ovarian Cancer from Taizhou, Eastern China. J Clin Med 2023; 12:jcm12103480. [PMID: 37240586 DOI: 10.3390/jcm12103480] [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: 01/13/2023] [Revised: 03/02/2023] [Accepted: 03/31/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Ovarian cancer is a deadly gynecologic malignancy with a poor prognosis. It is essential to evaluate the early detection and screening programs of ovarian cancer via timely assessment of long-time survival, particularly in China where those data are incredibly limited. Here, we aimed to provide timely and accurately assessment of long-term survival estimate of ovarian cancer patients from eastern China. METHODS Data of 770 ovarian cancer patients diagnosed between 2004-2018 were obtained from four cancer registries in Taizhou, eastern China, were included. We used period analysis to calculate five-year relative survival (RS) of aforementioned ovarian cancer patients for overall and the stratification by age at diagnosis and region. RESULTS Our findings demonstrated that the overall five-year RS for ovarian cancer patients in Taizhou between 2014 and 2018 was 69.2%, while urban areas were higher compared to rural areas (77.6% vs. 64.9%). We also observed a significant age gradient with the five-year RS decreasing from 79.6% for age group < 55 years to 66.9% for age group > 74 years. Furthermore, we identified a clear upward trend of five-year RS over the study period, both overall and stratified by region and age at diagnosis. CONCLUSION This is the first study in China using period analysis to provide the most up-to-date five-year RS for ovarian cancer patients from Taizhou, eastern China, which reaches 69.2% during 2014-2018. Our results provide valuable information for timely assessment of early detection and screening programs for ovarian cancer in eastern China.
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Affiliation(s)
- Xin Bing
- Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou 310022, China
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, China
| | - Huijun Lei
- Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou 310022, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
| | - Xiaojiao Zhao
- Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou 310022, China
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, China
| | - Yongran Cheng
- School of Public Health, Hangzhou Medical College, Hangzhou 310013, China
| | - Liangyou Wang
- Department of Non-Communicable Chronic Disease Control and Prevention, Taizhou Center for Disease Control and Prevention, Taizhou 318000, China
| | - Jun Yang
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, China
| | - Mingzhi Xu
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
- Department of General Medicine, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Chenhuan Yu
- Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou 310022, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
| | - Tianhui Chen
- Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou 310022, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo 315211, China
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Jochum F, Hamy AS, Gaillard T, Lecointre L, Gougis P, Dumas É, Grandal B, Feron JG, Laas E, Fourchotte V, Girard N, Pauly L, Osdoit M, Gauroy E, Darrigues L, Reyal F, Akladios C, Lecuru F. Impact of the Area of Residence of Ovarian Cancer Patients on Overall Survival. Cancers (Basel) 2022; 14:cancers14235987. [PMID: 36497469 PMCID: PMC9736843 DOI: 10.3390/cancers14235987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Survival disparities persist in ovarian cancer and may be linked to the environments in which patients live. The main objective of this study was to analyze the global impact of the area of residence of ovarian cancer patients on overall survival. The data were obtained from the Surveillance, Epidemiology and End Results (SEER) database. We included all the patients with epithelial ovarian cancers diagnosed between 2010 and 2016. The areas of residence were analyzed by the hierarchical clustering of the principal components to group similar counties. A multivariable Cox proportional hazards model was then fitted to evaluate the independent effect of each predictor on overall survival. We included a total of 16,806 patients. The clustering algorithm assigned the 607 counties to four clusters, with cluster 1 being the most disadvantaged and cluster 4 having the highest socioeconomic status and best access to care. The area of residence cluster remained a statistically significant independent predictor of overall survival in the multivariable analysis. The patients living in cluster 1 had a risk of death more than 25% higher than that of the patients living in cluster 4. This study highlights the importance of considering the sociodemographic factors within the patient's area of residence when developing a care plan and follow-up.
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Affiliation(s)
- Floriane Jochum
- Residual Tumor & Response to Treatment Laboratory (RT2Lab), Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France
- Department of Gynecology, Strasbourg University Hospital, 67000 Strasbourg, France
- Correspondence:
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, University Paris Cite, 75005 Paris, France
| | - Thomas Gaillard
- Department of Surgery, Institut Curie, University Paris Cite, 75005 Paris, France
| | - Lise Lecointre
- ICube UMR 7357—Laboratoire des Sciences de l’Ingénieur, de l’Informatique et de l’Imagerie, Université de Strasbourg, 67000 Strasbourg, France
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67000 Strasbourg, France
| | - Paul Gougis
- Residual Tumor & Response to Treatment Laboratory (RT2Lab), Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France
| | - Élise Dumas
- Residual Tumor & Response to Treatment Laboratory (RT2Lab), Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France
| | - Beatriz Grandal
- Residual Tumor & Response to Treatment Laboratory (RT2Lab), Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France
| | - Jean-Guillaume Feron
- Department of Surgery, Institut Curie, University Paris Cite, 75005 Paris, France
| | - Enora Laas
- Department of Surgery, Institut Curie, University Paris Cite, 75005 Paris, France
| | - Virginie Fourchotte
- Department of Surgery, Institut Curie, University Paris Cite, 75005 Paris, France
| | - Noemie Girard
- Department of Surgery, Institut Curie, University Paris Cite, 75005 Paris, France
| | - Lea Pauly
- Department of Surgery, Institut Curie, University Paris Cite, 75005 Paris, France
| | - Marie Osdoit
- Department of Surgery, Institut Curie, University Paris Cite, 75005 Paris, France
| | - Elodie Gauroy
- Department of Surgery, Institut Curie, University Paris Cite, 75005 Paris, France
| | - Lauren Darrigues
- Department of Surgery, Institut Curie, University Paris Cite, 75005 Paris, France
| | - Fabien Reyal
- Department of Surgery, Institut Curie, University Paris Cite, 75005 Paris, France
| | - Cherif Akladios
- Department of Gynecology, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Fabrice Lecuru
- Department of Surgery, Institut Curie, University Paris Cite, 75005 Paris, France
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Ellis SD, Thompson JA, Boyd SS, Roberts AW, Charlton M, Brooks JV, Birken SA, Wulff-Burchfield E, Amponsah J, Petersen S, Kinney AY, Ellerbeck E. Geographic differences in community oncology provider and practice location characteristics in the central United States. J Rural Health 2022; 38:865-875. [PMID: 35384064 PMCID: PMC9589478 DOI: 10.1111/jrh.12663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE How care delivery influences urban-rural disparities in cancer outcomes is unclear. We sought to understand community oncologists' practice settings to inform cancer care delivery interventions. METHODS We conducted secondary analysis of a national dataset of providers billing Medicare from June 1, 2019 to May 31, 2020 in 13 states in the central United States. We used Kruskal-Wallis rank and Fisher's exact tests to compare physician characteristics and practice settings among rural and urban community oncologists. FINDINGS We identified 1,963 oncologists practicing in 1,492 community locations; 67.5% practiced in exclusively urban locations, 11.3% in exclusively rural locations, and 21.1% in both rural and urban locations. Rural-only, urban-only, and urban-rural spanning oncologists practice in an average of 1.6, 2.4, and 5.1 different locations, respectively. A higher proportion of rural community sites were solo practices (11.7% vs 4.0%, P<.001) or single specialty practices (16.4% vs 9.4%, P<.001); and had less diversity in training environments (86.5% vs 67.8% with <2 medical schools represented, P<.001) than urban community sites. Rural multispecialty group sites were less likely to include other cancer specialists. CONCLUSIONS We identified 2 potentially distinct styles of care delivery in rural communities, which may require distinct interventions: (1) innovation-isolated rural oncologists, who are more likely to be solo providers, provide care at few locations, and practice with doctors with similar training experiences; and (2) urban-rural spanning oncologists who provide care at a high number of locations and have potential to spread innovation, but may face high complexity and limited opportunity for care standardization.
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Affiliation(s)
- Shellie D Ellis
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Jeffrey A Thompson
- University of Kansas Cancer Center, Kansas City, Kansas, USA
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Samuel S Boyd
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew W Roberts
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mary Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Sarah A Birken
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Elizabeth Wulff-Burchfield
- University of Kansas Cancer Center, Kansas City, Kansas, USA
- Division of Medical Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jonah Amponsah
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shariska Petersen
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Haven, Kansas, USA
| | - Edward Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
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