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Strelko O, Swanson J, Woldt P, Frazzetta J, Simon J, Ng I, Baker MS, Barton KP, Thakkar JP, Prabhu VC, Germanwala AV. National Trends and Factors Associated with Voluntary Refusal of Glioblastoma Treatment: A Retrospective Review of the National Cancer Database. World Neurosurg 2024:S1878-8750(24)01038-6. [PMID: 38906477 DOI: 10.1016/j.wneu.2024.06.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE Adherence to combinatorial treatments are important predictors of improved long-term outcomes for patients with glioblastoma (GB); however, factors associated with refusal of surgery, chemotherapy, or radiotherapy (RT) by patients with GB have not been studied. METHODS The National Cancer Database was queried from 2004 to 2018 to identify patients with a primary diagnosis of GB who underwent surgical resection alone or followed by either RT or chemotherapy. Adult patients who voluntarily rejected a physician's recommendations for 1 or more treatment were selected. Multivariable regression was used to identify factors associated with rejection of surgical resection, chemotherapy, and RT. Patients receiving treatment were 3:1 propensity score matched to those rejecting treatment and median overall survival (OS) was compared. RESULTS 58,788 patients were included in the analysis. Factors associated with voluntary refusal of GB treatment included: old age, nonprivate insurance, female sex, Black race, comorbidities, treatment at a nonacademic facility, and living 55+ miles away from a treatment facility (P < 0.05). On propensity matched analysis, refusal of surgery conferred a 4 month decrease in OS (P < 0.001), RT an 8 month decrease in OS (P < 0.001), and chemotherapy a 7 month decrease in OS (P < 0.001). CONCLUSIONS In patients with GB, age, sex, race, nonprivate insurance, medical comorbidities, distance from treatment facility, and geographic location were associated with refusal of surgery, postsurgical RT, and chemotherapy. In addition, treatment refusal had a significant impact on OS length.
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Affiliation(s)
- Oleksandr Strelko
- Loyola University Stritch School of Medicine, Maywood, Illinois, USA.
| | - James Swanson
- Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Parker Woldt
- Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Joseph Frazzetta
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Joshua Simon
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Isaac Ng
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Marshall S Baker
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kevin P Barton
- Department of Oncology, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Jigisha P Thakkar
- Department of Neurology, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Vikram C Prabhu
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Anand V Germanwala
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
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Dwyer LL, Vadagam P, Vanderpoel J, Cohen C, Lewing B, Tkacz J. Disparities in Lung Cancer: A Targeted Literature Review Examining Lung Cancer Screening, Diagnosis, Treatment, and Survival Outcomes in the United States. J Racial Ethn Health Disparities 2024; 11:1489-1500. [PMID: 37204663 PMCID: PMC11101514 DOI: 10.1007/s40615-023-01625-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/31/2023] [Accepted: 04/30/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Although incidence and mortality of lung cancer have been decreasing, health disparities persist among historically marginalized Black, Hispanic, and Asian populations. A targeted literature review was performed to collate the evidence of health disparities among these historically marginalized patients with lung cancer in the U.S. METHODS Articles eligible for review included 1) indexed in PubMed®, 2) English language, 3) U.S. patients only, 4) real-world evidence studies, and 5) publications between January 1, 2018, and November 8, 2021. RESULTS Of 94 articles meeting selection criteria, 49 publications were selected, encompassing patient data predominantly between 2004 and 2016. Black patients were shown to develop lung cancer at an earlier age and were more likely to present with advanced-stage disease compared to White patients. Black patients were less likely to be eligible for/receive lung cancer screening, genetic testing for mutations, high-cost and systemic treatments, and surgical intervention compared to White patients. Disparities were also detected in survival, where Hispanic and Asian patients had lower mortality risks compared to White patients. Literature on survival outcomes between Black and White patients was inconclusive. Disparities related to sex, rurality, social support, socioeconomic status, education level, and insurance type were observed. CONCLUSIONS Health disparities within the lung cancer population begin with initial screening and continue through survival outcomes, with reports persisting well into the latter portion of the past decade. These findings should serve as a call to action, raising awareness of persistent and ongoing inequities, particularly for marginalized populations.
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Affiliation(s)
- Lisa L Dwyer
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
| | - Pratyusha Vadagam
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Julie Vanderpoel
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
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Freeman JQ, Li JL, Fisher SG, Yao KA, David SP, Huo D. Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer. JAMA Netw Open 2024; 7:e249449. [PMID: 38722630 PMCID: PMC11082691 DOI: 10.1001/jamanetworkopen.2024.9449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/28/2024] [Indexed: 05/12/2024] Open
Abstract
Importance Declining treatment negatively affects health outcomes among patients with cancer. Limited research has investigated national trends of and factors associated with treatment declination or its association with overall survival (OS) among patients with breast cancer. Objectives To examine trends and racial and ethnic disparities in treatment declination and racial and ethnic OS differences stratified by treatment decision in US patients with breast cancer. Design, Setting, and Participants This retrospective cross-sectional study used data for patients with breast cancer from the 2004 to 2020 National Cancer Database. Four treatment modalities were assessed: chemotherapy, hormone therapy (HT), radiotherapy, and surgery. The chemotherapy cohort included patients with stage I to IV disease. The HT cohort included patients with stage I to IV hormone receptor-positive disease. The radiotherapy and surgery cohorts included patients with stage I to III disease. Data were analyzed from March to November 2023. Exposure Race and ethnicity and other sociodemographic and clinicopathologic characteristics. Main Outcomes and Measures Treatment decision, categorized as received or declined, was modeled using logistic regression. OS was modeled using Cox regression. Models were controlled for year of initial diagnosis, age, sex, health insurance, median household income, facility type, Charlson-Deyo comorbidity score, histology, American Joint Committee on Cancer stage, molecular subtype, and tumor grade. Results The study included 2 837 446 patients (mean [SD] age, 61.6 [13.4] years; 99.1% female), with 1.7% American Indian, Alaska Native, or other patients; 3.5% Asian or Pacific Islander patients; 11.2% Black patients; 5.6% Hispanic patients; and 78.0% White patients. Of 1 296 488 patients who were offered chemotherapy, 124 721 (9.6%) declined; 99 276 of 1 635 916 patients (6.1%) declined radiotherapy; 94 363 of 1 893 339 patients (5.0%) declined HT; and 15 846 of 2 590 963 patients (0.6%) declined surgery. Compared with White patients, American Indian, Alaska Native, or other patients (adjusted odds ratio [AOR], 1.47; 95% CI, 1.26-1.72), Asian or Pacific Islander patients (AOR, 1.29; 95% CI, 1.15-1.44), and Black patients (AOR, 2.01; 95% CI, 1.89-2.14) were more likely to decline surgery; American Indian, Alaska Native, or other patients (AOR, 1.13; 95% CI, 1.05-1.21) and Asian or Pacific Islander patients (AOR, 1.21; 95% CI, 1.16-1.27) were more likely to decline chemotherapy; and Black patients were more likely to decline radiotherapy (AOR, 1.05; 95% CI, 1.02-1.08). Asian or Pacific Islander patients (AOR, 0.81; 95% CI, 0.77-0.85), Black patients (AOR, 0.86; 95% CI, 0.83-0.89), and Hispanic patients (AOR, 0.66; 95% CI, 0.63-0.69) were less likely to decline HT. Furthermore, Black patients who declined chemotherapy had a higher mortality risk than White patients (adjusted hazard ratio [AHR], 1.07; 95% CI, 1.02-1.13), while there were no OS differences between Black and White patients who declined HT (AHR, 1.05; 95% CI, 0.97-1.13) or radiotherapy (AHR, 0.98; 95% CI, 0.92-1.04). Conclusions and Relevance This cross-sectional study highlights racial and ethnic disparities in treatment declination and OS, suggesting the need for equity-focused interventions, such as patient education on treatment benefits and improved patient-clinician communication and shared decision-making, to reduce disparities and improve patient survival.
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Affiliation(s)
- Jincong Q. Freeman
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
| | - James L. Li
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Susan G. Fisher
- NorthShore Research Institute, NorthShore University HealthSystem, Evanston, Illinois
| | - Katharine A. Yao
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Sean P. David
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
- NorthShore Research Institute, NorthShore University HealthSystem, Evanston, Illinois
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
- Center for Clinical Cancer Genetics and Global Health, University of Chicago, Chicago, Illinois
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Rodriguez-Quintero JH, Kamel MK, Dawodu G, Elbahrawy M, Vimolratana M, Chudgar NP, Stiles BM. Underutilization of Systemic Therapy in Patients With NSCLC Undergoing Pneumonectomy: A Missed Opportunity for Survival. JTO Clin Res Rep 2023; 4:100547. [PMID: 37644968 PMCID: PMC10460993 DOI: 10.1016/j.jtocrr.2023.100547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/13/2023] [Accepted: 06/24/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Recent trials have reported promising results with the addition of immunotherapy to chemotherapy for patients with locally advanced NSCLC, but in practice, the proportion of patients who receive systemic therapy (ST) has historically been low. Underutilization of ST may be particularly apparent in patients undergoing pneumonectomy, in whom the physiologic insult and surgical complications may preclude adjuvant therapy (ADJ). We, therefore, evaluated the use of ST for patients with NSCLC undergoing pneumonectomy. Methods We queried the National Cancer Database, including all patients with NSCLC who underwent pneumonectomy between 2006 and 2018. Logistic regression was used to identify associations with ST and neo-ADJ (NEO). Overall survival was compared after propensity score matching (1:1) patients undergoing ST to those undergoing surgery alone using Kaplan-Meier and Cox regression methods. Results A total of 2619 patients were identified. Among these, 12% received NEO, 43% received ADJ, and 45% surgery alone. Age younger than 65 years (adjusted odds ratio [aOR] = 1.53, 95% confidence interval; [CI]: 1.10-2.11), Asian ethnicity (aOR = 2.68, 95% CI: 1.37-5.23), treatment at a high-volume center (aOR = 1.39, 95% CI: 1.06-1.81), and private insurance (aOR = 1.42, 95% CI: 1.05-1.94) were associated with NEO, whereas age younger than 65 years (aOR = 1.95, 95% CI: 1.61-2.38), comorbidity index less than or equal to 1 (aOR = 1.66, 95% CI: 1.29-2.16), and private insurance (aOR = 1.47, 95% CI: 1.20-1.80) were associated with any ST. In the matched cohort, ST was associated with better survival than surgery (adjusted hazard ratio = 0.67, 95% CI: 0.58-0.78). Conclusions A high proportion of patients who undergo pneumonectomy do not receive ST. Patient and socioeconomic factors are associated with the receipt of ST. Given its survival benefit, emphasis should be placed on multimodal treatment strategies, perhaps with greater consideration given to neoadjuvant approaches.
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Affiliation(s)
| | - Mohamed K. Kamel
- Department of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York
| | - Gbalekan Dawodu
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Mostafa Elbahrawy
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Marc Vimolratana
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Neel P. Chudgar
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Brendon M. Stiles
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Gupta A, Omeogu C, Islam JY, Joshi A, Zhang D, Braithwaite D, Karanth SD, Tailor TD, Clarke JM, Akinyemiju T. Socioeconomic disparities in immunotherapy use among advanced-stage non-small cell lung cancer patients: analysis of the National Cancer Database. Sci Rep 2023; 13:8190. [PMID: 37210410 DOI: 10.1038/s41598-023-35216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/15/2023] [Indexed: 05/22/2023] Open
Abstract
Socioeconomic and racial disparities exist in access to care among patients with non-small cell lung cancer (NSCLC) in the United States. Immunotherapy is a widely established treatment modality for patients with advanced-stage NSCLC (aNSCLC). We examined associations of area-level socioeconomic status with receipt of immunotherapy for aNSCLC patients by race/ethnicity and cancer facility type (academic and non-academic). We used the National Cancer Database (2015-2016), and included patients aged 40-89 years who were diagnosed with stage III-IV NSCLC. Area-level income was defined as the median household income in the patient's zip code, and area-level education was defined as the proportion of adults aged ≥ 25 years in the patient's zip code without a high school degree. We calculated adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) using multi-level multivariable logistic regression. Among 100,298 aNSCLC patients, lower area-level education and income were associated with lower odds of immunotherapy treatment (education: aOR 0.71; 95% CI 0.65, 0.76 and income: aOR 0.71; 95% CI 0.66, 0.77). These associations persisted for NH-White patients. However, among NH-Black patients, we only observed an association with lower education (aOR 0.74; 95% CI 0.57, 0.97). Across all cancer facility types, lower education and income were associated with lower immunotherapy receipt among NH-White patients. However, among NH-Black patients, this association only persisted with education for patients treated at non-academic facilities (aOR 0.70; 95% CI 0.49, 0.99). In conclusion, aNSCLC patients residing in areas of lower educational and economic wealth were less likely to receive immunotherapy.
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Affiliation(s)
- Anjali Gupta
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27708, USA
| | - Chioma Omeogu
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27708, USA
| | - Jessica Y Islam
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27708, USA
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ashwini Joshi
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27708, USA
| | - Dongyu Zhang
- Johnson and Johnson, Medical Device Epidemiology, New Brunswick, NJ, USA
| | | | - Shama D Karanth
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Tina D Tailor
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Jeffrey M Clarke
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27708, USA.
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Duma N, Evans N, Mitchell E. Disparities in lung cancer. J Natl Med Assoc 2023; 115:S46-S53. [PMID: 37202003 DOI: 10.1016/j.jnma.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/01/2023] [Indexed: 05/20/2023]
Abstract
Lung cancer is the second most common cancer and the leading cause of cancer death among men and women in the United States. Despite a substantial decline in lung cancer incidence and mortality across all races in the last few decades, medically underserved racial and ethnic minority populations continue to carry the greatest burden of disease throughout the lung cancer continuum. Black individuals experience a higher incidence of lung cancer due to lower rates of low-dose computed tomography screening, which translate into advanced disease stage at diagnosis and poorer survival outcomes compared with White individuals. With respect to treatment, Black patients are less likely to receive gold standard surgery, have access to biomarker testing or high-quality treatment compared with White patients. The reasons for those disparities are multifactorial and include socioeconomic (eg, poverty, lack of health insurance, and inadequate education), and geographic inequalities. The objective of this article is to review the sources of racial and ethnic disparities in lung cancer, and to propose recommendations to help address them.
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Affiliation(s)
| | | | - Edith Mitchell
- Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, PA, USA.
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Factors Associated with the Decision to Decline Chemotherapy in Metastatic Non-Small Cell Lung Cancer. Cancers (Basel) 2023; 15:cancers15061686. [PMID: 36980573 PMCID: PMC10046757 DOI: 10.3390/cancers15061686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
(1) Background: Disparities in cancer treatment and outcomes have long been well-documented in the medical literature. With the eruption of advances in new treatment modalities, the long-existing disparities are now being further uncovered and brought to the attention of the medical community. While social health determinants have previously been linked to treatment disparities in lung cancer, we analyzed data from the National Cancer Database to explore sociodemographic and geographic factors related to accepting or declining physician-recommended chemotherapy. Patients diagnosed with metastatic lung cancer between 2004 and 2016 who declined chemotherapy recommended by their physicians were included in this study. Multivariate logistic regression analysis was performed. Cox Regression and Kaplan-Meier analyses were performed to look for survival characteristics. (2) Results: 316,826 patients with Stage IV lung cancer were identified. Factors related to a higher rate of refusal by patients included older age > 70, female sex, low income, lack of insurance coverage, residency in the New England region, and higher comorbidity. Patients living in areas with lower education were less likely to decline chemotherapy. (3) Conclusion: Further understanding of the factors impacting treatment decisions would be essential to improve the efficacy of care delivery in patients with cancer and reduce reversible causes of disparity.
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Asokan S, Pavesi F, Bains A, Qureshi MM, Shetty S, Singh S, Mak KS, Litle VR, Suzuki K. Frailty Index is Associated with Treatment Decisions for Stage I Non-Small Cell Lung Cancer at a High-Burden Safety-Net Hospital. Clin Lung Cancer 2023; 24:153-164. [PMID: 36641324 DOI: 10.1016/j.cllc.2022.12.002] [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: 05/30/2022] [Revised: 10/20/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Lobectomy remains the cornerstone of care for stage I NSCLC while sublobar resection and stereotactic body radiation therapy (SBRT) are reserved for patients with smaller tumors and/or poor operative risk. Herein, we investigate the effect of patient frailty on treatment modality for stage I NSCLC at a safety-net hospital. PATIENTS AND METHODS A retrospective chart review was performed of stage I NSCLC patients between 2006 and 2015. Demographics, patient characteristics, and treatment rates were compared to a National Cancer Database cohort of stage 1 NSCLC patients. Patient frailty was assessed using the MSK-FI. RESULTS In our cohort of 304 patients, significantly fewer patient were treated via lobectomy compared to national rates (P < .001). Advanced age (P = .02), lower FEV1 (P < .001) and DLCO (P < .001), not socioeconomic factors, were associated with higher utilization of non-lobectomy (sublobar resection or SBRT). Patients with lower MSK-FI were more likely to receive any surgical treatment (P = .01) and lobectomy (P = .03). Lower MSK-FI was an independent predictor for use of lobectomy over other modalities (OR 0.75, P = .04). MSK-FI (OR 0.64, P = .02), and FEV1 (OR 1.03, P < .001) were independently associated with use of SBRT over any surgery. CONCLUSION Our safety-net hospital performed fewer lobectomies and lung resections compared to national rates. Patient frailty and clinical factors were associated with use of SBRT or sublobar resection suggesting that the increased illness burden of a safety-net population may drive the lower use of lobectomy. The MSK-FI may help physicians stratify patient risk to guide stage I NSCLC management.
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Affiliation(s)
- Sainath Asokan
- Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Flaminio Pavesi
- Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Ashank Bains
- Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Muhammad M Qureshi
- Department of Surgery, Division of Thoracic Surgery, Intermountain Healthcare and Invoma Medical Group, Murray, UT
| | - Syona Shetty
- Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Sarah Singh
- Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Kimberley S Mak
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Virginia R Litle
- Department of Surgery, Division of Thoracic Surgery, Intermountain Healthcare and Invoma Medical Group, Murray, UT
| | - Kei Suzuki
- Department of Surgery, Division of Thoracic Surgery, Intermountain Healthcare and Invoma Medical Group, Falls Church, VA
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Wong WG, Dasari A, Shen C. Association of Surgery and Chemotherapy in Stage IV Gastroenteropancreatic Neuroendocrine Carcinoma. J Surg Res 2023; 283:407-415. [PMID: 36434836 DOI: 10.1016/j.jss.2022.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/19/2022] [Accepted: 10/16/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The survival benefit of chemotherapy for patients with metastatic gastroenteropancreatic neuroendocrine carcinomas (GEP-NECs) is well established. However, reasons for underutilization of chemotherapy are unknown. METHODS The National Cancer Database (NCDB) was queried for metastatic GEP-NECs from 2009 to 2016. The cohort was stratified by patients who had received chemotherapy and who did not receive chemotherapy. Demographic, socioeconomic, clinical, and treatment characteristics were captured. Multivariable logistic regression examined factors associated with chemotherapy utilization. RESULTS Of the 2367 stage IV GEP-NECs patients identified, 1647 (69.6%) received chemotherapy. Patients with primary site at colon and small bowel, age ≥75, no insurance, and ≥2 comorbidities were less likely to receive chemotherapy than patients with other primary sites, age <75, private insurance, and no comorbidities (P < 0.005). The small bowel and colon were the primary sites with the greatest percentage of patients who received surgery (46.4% and 41.8%, respectively). In these subgroup of patients, surgical intervention was also associated with lower probability of receiving chemotherapy (odds ratio = 0.60, P < 0.005). CONCLUSIONS About 30% of patients with metastatic GEP-NECs did not receive chemotherapy. Primary site location and receipt of surgery were significantly associated with receipt of chemotherapy, with NECs in small bowel and colon being more likely to receive surgery and less likely to receive chemotherapy. While surgery may be considered on an individual basis, increasing efforts to ensure patients with colon or small bowel NECs receive guideline-concordant chemotherapy will positively impact survival. In addition, interventions to improve health insurance coverage to increase receipt of chemotherapy are warranted.
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Affiliation(s)
- William G Wong
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Arvind Dasari
- Division of Cancer Medicine, Department of Gastrointestinal (GI) Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chan Shen
- Division of Outcomes Research and Quality, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Division of Health Services and Behavioral Research, Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
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Jabbal IS, Bilani N, Yaghi M, Elson L, Liang H, Nahleh ZA. Geographical Disparities and Factors Associated With the Decision to Decline Chemotherapy in Breast Cancer. JCO Oncol Pract 2022; 18:e1417-e1426. [PMID: 35658495 DOI: 10.1200/op.21.00719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Social determinants of health have been linked to treatment-related disparities in breast cancer. We analyzed data from a large national registry to explore factors related to accepting or declining recommended chemotherapy and whether patients' decisions vary geographically across the United States. METHODS We used the National Cancer Database to study treatment decision making in patients with advanced breast cancer (American Joint Committee on Cancer clinical stage III-IV) between 2004 and 2017. We focused the analysis on patients who were recommended chemotherapy by their physicians but who declined this treatment. Multivariate logistic regression analysis was performed. RESULTS A total of N = 215,284 patients with stage III and IV breast cancers were included. Patients in the New England region were more likely to refuse chemotherapy compared with the rest, with patients in the East South Central regions (AL, KY, MS, and TN) and West South Central (AR, LA, OK, and TX) noted to be least likely to refuse chemotherapy. Factors related to a higher rate of refusal by patients included older age > 70 years; hormone receptor-positive tumors; and having higher comorbidity. Patients identified as Hispanic, those who are privately insured, and patients at academic institutions were less likely to decline chemotherapy. CONCLUSION This analysis identified a significant difference in rates of refusal of recommended chemotherapy by geographical location, insurance status, and treatment facility after adjusting for known social determinants of health. Further understanding of the factors affecting treatment decisions would be important to improve the efficacy of care delivery in patients with cancer and reduce reversible causes of disparity.
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Affiliation(s)
- Iktej S Jabbal
- Department of Hematology/Oncology, Cleveland Clinic, Weston, FL
| | - Nadeem Bilani
- Department of Hematology/Oncology, Cleveland Clinic, Weston, FL
| | - Marita Yaghi
- Department of Hematology/Oncology, Cleveland Clinic, Weston, FL
| | - Leah Elson
- Department of Hematology/Oncology, Cleveland Clinic, Weston, FL
| | - Hong Liang
- Department of Clinical Research, Cleveland Clinic, Weston, FL
| | - Zeina A Nahleh
- Department of Hematology/Oncology, Cleveland Clinic, Weston, FL
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Tang S, Gong Y, Yao L, Xu Y, Liu M, Yang T, Ye C, Bai Y. Do medical treatment choices affect the health of chronic patients in middle and old age in China?-Evidence from CHARLS 2018. BMC Public Health 2022; 22:937. [PMID: 35538471 PMCID: PMC9088154 DOI: 10.1186/s12889-022-13309-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 04/26/2022] [Indexed: 12/21/2022] Open
Abstract
Different medical treatment choices may affect the health of patients with chronic diseases. This study aims to assess the relationship between treatment choices, including the use of traditional Chinese medicine (TCM), and the health levels of middle-aged and elderly patients with six chronic diseases. The sample data comes from China Health and Retirement Longitudinal Study (CHARLS 2018). Basic conditions, medical choices and health status of patients are incorporated. The ordered Logit and Logit regression models are used to analyze and compare the effects of six chronic disease patients’ medical options on their self-rated health (SRH) and depression. The overall average score of SRH is the highest in patients with heart disease (the worst in SRH), which is 3.433. Arthritis patients have the highest overall depression average score (depression) at 0.444. Under the premise of controlling a variety of socio-demographic factors, compared with the non-treatment group, taking TCM has a significant positive effect on SRH of patients with five diseases except hypertension. Both taking western medicine (WM) and taking integrated Chinese and Western medicine (IM) have a significant positive effect on SRH scores of patients with six chronic diseases in middle and old age. Taking TCM has effect on depression of patients with heart or stomach diseases, and taking WM and IM affects depression of middle-aged and elderly chronic patients except diabetes. Taking IM has a greater effect on SRH and depression of chronically ill patients, followed by taking WM, and the effect of taking TCM is relatively small, which is related to the development stage of the disease. Therefore, in the future, the control and treatment of chronic diseases in the middle and late stages can be discussed from the perspective of integrated traditional Chinese and western medicine, but attention should be paid to drug interactions. In order to improve the treatment rate and health level of patients with chronic diseases, their economic burden should be reduced, and they should be guided to choose more reasonable treatment methods.
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Affiliation(s)
| | - Ying Gong
- Nanjing University of Chinese Medicine, Nanjing, China.
| | - Ling Yao
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yun Xu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Meixian Liu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Tongling Yang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Chaoyu Ye
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yamei Bai
- Nanjing University of Chinese Medicine, Nanjing, China
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12
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Kshirsagar RS, Eide JG, Prasad A, Carey RM, Rajasekaran K, Brant JA, Newman JG, Palmer J, Adappa N. Determinants of Patient Refusal of Post-Operative Radiation Therapy in Sinonasal Squamous Cell Carcinoma. J Neurol Surg B Skull Base 2022; 84:232-239. [PMID: 37187475 PMCID: PMC10171933 DOI: 10.1055/a-1780-4157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/17/2022] [Indexed: 10/19/2022] Open
Abstract
Objectives
Although adjuvant radiotherapy may be indicated in patients with sinonasal squamous cell carcinoma (SNSCC) following primary surgery, some patients choose to forgo recommended post-operative radiation (PORT). This study aimed to elucidate factors associated with patient refusal of recommended PORT in SNSCC and examine overall survival.
Methods
Retrospective analysis of patients with SNSCC treated with primary surgery from the National Cancer Database diagnosed between 2004 and 2016. A multivariable logistic regression model was created to determine the association between clinical or demographic covariates and likelihood of PORT refusal. Unadjusted Kaplan-Meier estimates, log-rank tests, and a multivariable Cox proportional hazard model were used to assess overall survival.
Results
2231 patients were included in the final analysis, of which 1456 (65.3%) were male and 73 (3.3%) refused recommended PORT. Patients older than 74 years old were more likely to refuse PORT than those younger than 54 (OR 3.43, 95% CI: 1.84-6.62). Median survival among the entire cohort, those that received recommended PORT, and those that refused PORT was 83.0 months (95% CI: 74.6-97.1), 83.0 months (95% CI: 74.9-98.2), and 63.6 months (95% CI: 37.3-101.4). Refusal of PORT was not associated with overall survival (HR 0.99, 95% CI: 0.69-1.42).
Conclusions
PORT refusal in patients with SNSCC is rare and was found to be associated with several patient factors. The decision to forgo PORT is not independently associated with overall survival in this cohort. Further study is required to determine the clinical implications of these findings as the treatment decisions are complex.
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Affiliation(s)
- Rijul Sudhir Kshirsagar
- Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, United States
| | - Jacob G Eide
- Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, United States
| | - Aman Prasad
- University of Pennsylvania Perelman School of Medicine, Philadelphia, United States
| | - Ryan M. Carey
- Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, United States
| | - Karthik Rajasekaran
- Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, United States
| | - Jason A. Brant
- Corporal Michael J Crescenz VA Medical Center, Philadelphia, United States
- Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, United States
| | - Jason G. Newman
- Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, United States
| | - James Palmer
- Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, United States
| | - Nithin Adappa
- Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, United States
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Abstract
Social disparities in lung cancer diagnosis, treatment, and survival have been studied using national databases, statewide registries, and institution-level data. Some disparities emerge consistently, such as lower adherence to treatment guidelines and worse survival by race and socioeconomic status, whereas other disparities are less well studied. A critical appraisal of current data is essential to increasing equity in lung cancer care.
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Affiliation(s)
- Irmina Elliott
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA
| | - Cayo Gonzalez
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA
| | - Leah Backhus
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA
| | - Natalie Lui
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA.
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14
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Effects of Nurse Navigators During the Transition from Cancer Screening to the First Treatment Phase: A Systematic Review and Meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci) 2021; 15:291-302. [PMID: 34743002 DOI: 10.1016/j.anr.2021.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/25/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Implementation of nurse navigators during cancer screening to the first treatment visit may facilitate early diagnosis and treatment. This study aims to demonstrate the evidence of the effects of nurse navigators during cancer screening in the first treatment phase. METHODS Eleven electronic databases were searched, including PubMed, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science, ScienceDirect, PsycINFO, KoreaMed, KISS, RISS, and DBPIA. The final search was completed in August 2021. Two reviewers independently screened and selected studies, extracted data, and conducted a quality assessment. Data to evaluate the effects of nurse navigators was analyzed through meta-analysis and narrative summary. Subgroup analyses were performed. RESULTS A total of 16 studies was included. With low to moderate quality of evidence, nurse navigators had favorable effects on improving the timeliness of care during screening during the first treatment visits (MD = 20.42, 95% CI = 8.74 to 32.10, p = .001). Additionally, 13.0% to 45.0% of nurse navigated patients were more likely to complete cancer care services, although insignificant effects were observed. Study participants from individual studies reported a high satisfaction to the nurse navigators. Subgroup analyses indicated that nurse navigators working as key members in multidisciplinary programs had the greatest effect on reducing waiting times. CONCLUSION Nurse navigators improve cancer patient outcomes by providing more timely care. Additionally, nurse navigators have the substantial potential to increase completion rates to cancer care services and patient satisfaction. For facilitating multidisciplinary care, the use of nurse navigators is highly recommended in the future.
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Stein JN, Rivera MP, Weiner A, Duma N, Henderson L, Mody G, Charlot M. Sociodemographic disparities in the management of advanced lung cancer: a narrative review. J Thorac Dis 2021; 13:3772-3800. [PMID: 34277069 PMCID: PMC8264681 DOI: 10.21037/jtd-20-3450] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/14/2021] [Indexed: 12/25/2022]
Abstract
Treatment of advanced non-small cell lung cancer (NSCLC) has markedly changed in the past decade with the integration of biomarker testing, targeted therapies, immunotherapy, and palliative care. These advancements have led to significant improvements in quality of life and overall survival. Despite these improvements, racial and socioeconomic disparities in lung cancer mortality persist. This narrative review aims to assess and synthesize the literature on sociodemographic disparities in the management of advanced NSCLC. A narrative overview of the literature was conducted using PubMed and Scopus and was narrowed to articles published from January 1, 2010, until July 22, 2020. Articles relevant to sociodemographic variation in (I) chemoradiation for stage III NSCLC, (II) molecular biomarker testing, (III) systemic treatment, including chemotherapy, targeted therapy, and immunotherapy, and (IV) palliative and end of life care were included in this review. Twenty-two studies were included. Sociodemographic disparities in the management of advanced NSCLC varied, but recurring findings emerged. Across most treatment domains, Black patients, the uninsured, and patients with Medicaid were less likely to receive recommended lung cancer care. However, some of the literature was limited due to incomplete data to adequately assess appropriateness of care, and several studies were out of date with current practice guidelines. Sociodemographic disparities in the management of advanced lung cancer are evident. Given the rapidly evolving treatment paradigm for advanced NSCLC, updated research is needed. Research on interventions to address disparities in advanced NSCLC is also needed.
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Affiliation(s)
- Jacob Newton Stein
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ashley Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Narjust Duma
- Division of Hematology, Oncology and Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA.,University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Louise Henderson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Gita Mody
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Marjory Charlot
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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16
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Beutler BD, Ulanja MB, Krishan R, Aluru V, Ndukwu ML, Hagen MM, Dupin ZD, Willyard CE, Moody AE, Boampong-Konam K, Zell SC. Sociodemographic Characteristics as Predictors of Outcomes in Hepatocellular Carcinoma: A Retrospective Cohort Study. Cancer Control 2021; 27:1073274820956615. [PMID: 32951450 PMCID: PMC7791478 DOI: 10.1177/1073274820956615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Race, gender, insurance status, and income play important roles in predicting health care outcomes. However, the impact of these factors has yet to be fully elucidated in the setting of hepatocellular carcinoma (HCC). METHODS We designed a retrospective cohort study utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients diagnosed with resectable HCC (N = 28,518). Demographic factors of interest included race (Asian/Pacific Islander [API], African American [AA], Native American/Alaska Native [NA], or White [WH]) and gender (male [M] or female [F]). Insurance classifications included those having Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]. Median household income was estimated for all diagnosed with HCC. Endpoints included: (1) overall survival; (2) likelihood of receiving a recommendation for surgery; and (3) specific surgical intervention performed. Multivariate multinomial logistic regression for relative risk ratio (RRR) and Cox regression models were used to identify pertinent associations. RESULTS Race, gender, insurance status, and income had statistically significant effects on the likelihood of surgical recommendation and overall survival. API were more likely to receive a recommendation for hepatic resection (RRR = 1.45; 95% CI: 1.31-1.61; Reference Race: AA) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73-0.82; Reference Race: AA) as compared to members of any other ethnic group; there was no difference in these endpoints between AA, NA, or WH individuals. Gender also had a significant effect on survival: Females exhibited superior overall survival (HR = 0.89; 95% CI: 0.85-0.93; Reference Gender: M) as compared to males. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Conclusions: Race, gender, insurance status, and income have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation.
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Affiliation(s)
- Bryce D Beutler
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Mark B Ulanja
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Rohee Krishan
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Vijay Aluru
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Munachismo L Ndukwu
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Molly M Hagen
- Office of Medical Research, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Zachary D Dupin
- Miller Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Charles E Willyard
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | | | | | - Steven C Zell
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, USA
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17
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Camidge DR, Park H, Smoyer KE, Jacobs I, Lee LJ, Askerova Z, McGinnis J, Zakharia Y. Race and ethnicity representation in clinical trials: findings from a literature review of Phase I oncology trials. Future Oncol 2021; 17:3271-3280. [PMID: 34047192 DOI: 10.2217/fon-2020-1262] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: To provide an assessment of published literature on the demographic representation in Phase I trials of biopharmaceutical oncology agents. Materials & methods: We conducted a rapid evidence assessment to identify demographic representation reported in Phase I clinical trials for biopharmaceutical oncology agents published in 2019. Results: Globally, the population was predominantly White/Caucasian (62.2%). In the USA, the distribution was heavily skewed toward White/Caucasian (84.2%), with minimal representation of Blacks/African-Americans (7.3%), Asians (3.4%), Hispanics/Latinos (2.8%) or other race/ethnicity groups. Conclusion: Our data highlight that Phase I oncology trials do not reflect the population at large, which may perpetuate health disparities. Further research is needed to understand and address barriers to participation, particularly among under-represented groups.
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Affiliation(s)
- D Ross Camidge
- Division of Medical Oncology, University of Colorado Hospital, Aurora, CO 80045, USA
| | - Haeseong Park
- Division of Oncology, Siteman Cancer Center, Washington University in St. Louis, MO 63110, USA
| | | | | | | | | | | | - Yousef Zakharia
- University of Iowa, Holden Comprehensive Cancer Center, Iowa City, IA 52242, USA
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18
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Stein JN, Charlot M, Cykert S. Building Toward Antiracist Cancer Research and Practice: The Case of Precision Medicine. JCO Oncol Pract 2021; 17:273-277. [PMID: 33974820 PMCID: PMC8257901 DOI: 10.1200/op.20.01070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Jacob N. Stein
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Marjory Charlot
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Samuel Cykert
- Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC
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Ramalingam S, Dinan MA, Crawford J. Treatment at Integrated Centers Might Bridge the Academic-Community Survival Gap in Patients With Metastatic Non-Small Cell Carcinoma of the Lung. Clin Lung Cancer 2021; 22:e646-e653. [PMID: 33582071 DOI: 10.1016/j.cllc.2020.12.013] [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: 08/10/2020] [Revised: 12/14/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is responsible for the most cancer-related deaths in the United States. A better understanding of treatment-related disparities and ways to address them are important to improving survival for patients with metastatic NSCLC. MATERIALS AND METHODS We performed a retrospective analysis using the National Cancer Database. Included in this analysis were 107,116 patients with metastatic NSCLC who were treated at academic centers (AC), community-based centers (CC), and integrated centers (IC) between 2004 and 2015. The primary end point was overall survival, with comparisons of AC, CC, and IC. RESULTS The survival disparity between AC and CC continued to grow over the study period, from a 5.7% difference in 2-year survival to a 7.5% difference. Treatment at IC was initially associated with survival similar to CC (hazard ratio [HR], 0.93), however, later in the study period treatment at IC improved (HR, 0.74) outpacing the improvement in survival in CC (HR, 0.82) but not to the same degree as the improvement in AC (HR, 0.64). The improvement in survival at IC was noted predominantly in patients with adenocarcinoma (HR, 0.72; P < .001) but not in squamous-cell carcinoma (HR, 0.89; P value not significant). CONCLUSION Treatment of metastatic NSCLC at IC was associated with improved survival during our study period compared with treatment at CC. This appeared to be histology-dependent, suggesting a treatment-related improvement in survival because over this period newer therapies were preferentially available for adenocarcinoma. Integrating care across treatment facilities might be one way to bridge the growing gap in survival between AC and CC.
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20
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Long FJ, Chen H, Wang YF, He LM, Chen L, Liang ZB, Chen YN, Gong XH. Research on the effect of health care integration on patients’ negative emotions and satisfaction with lung cancer nursing activities. World J Clin Cases 2020; 8:4059-4066. [PMID: 33024763 PMCID: PMC7520783 DOI: 10.12998/wjcc.v8.i18.4059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/25/2020] [Accepted: 08/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung cancer is a clinical disease with multiple malignant tumors. Currently, it is difficult for patients to benefit from routine clinical nursing due to the lack of a pertinent and systematic approach.
AIM To investigate the effect of integrated nursing care on the negative emotions and satisfaction of lung cancer patients.
METHODS From January 2018 to December 2019, 92 patients with lung cancer were selected and divided into the study group and the control group; there were 46 patients in each group. The control group received routine nursing, and the study group received integrated medical care in addition to the care received by the control group. Negative emotions before and after the intervention, the self-management ability score after the intervention, family care burden after the intervention and nursing satisfaction after the intervention were measured in the two groups.
RESULTS After the intervention, the self-rating anxiety scale and self-rating depression scale scores in the study group were lower than those in the control group (P < 0.05); the scores for health knowledge, self-concept, self-responsibility and self-care skills in the study group were higher than those in the control group (P < 0.05); the scores for individual burden and responsibility burden in the study group were lower than those before the intervention (P < 0.05); and the nursing satisfaction in the study group (93.48%) was higher than that in the control group (78.26%, P < 0.05).
CONCLUSION An integrated nursing care approach for lung cancer patients can effectively relieve the patient’s negative feelings, improve their self-management ability, help to reduce the burden of family care and improve patient satisfaction with nursing activities.
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Affiliation(s)
- Feng-Jiao Long
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Hui Chen
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Yue-Feng Wang
- Department of Otolaryngology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Lan-Man He
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Lin Chen
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Zi-Bin Liang
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Yan-Ni Chen
- Department of Otolaryngology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Xiao-Hua Gong
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
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