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Bai J, Barandouzi ZA, Yeager KA, Graetz I, Gong C, Norman M, Hankins J, Paul S, Torres MA, Bruner DW. Analysis of travel burden and travel support among patients treated at a comprehensive cancer center in the Southeastern United States. Support Care Cancer 2024; 32:451. [PMID: 38907006 DOI: 10.1007/s00520-024-08656-3] [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: 12/03/2023] [Accepted: 06/13/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Travel burden leads to worse cancer outcomes. Understanding travel burden and the level and types of travel support provided at large cancer centers is critical for developing systematic programs to alleviate travel burden. This study analyzed patients who received travel assistance, including their travel burden, types and amount of travel support received, and factors that influenced these outcomes. METHODS We analyzed 1063 patients who received travel support from 1/1/2021 to 5/1/2023 at Winship Cancer Institute, in which ~18,000 patients received cancer care annually. Travel burden was measured using distance and time to Winship sites from patients' residential address. Travel support was evaluated using the monetary value of total travel support and type of support received. Patients' sociodemographic and clinical factors were extracted from electronic medical records. Area-level socioeconomic disadvantage was coded by the Area Deprivation Index using patient ZIP codes. RESULTS On average, patients traveled 57.2 miles and 67.3 min for care and received $74.1 in total for travel support. Most patients (88.3%) received travel-related funds (e.g., gas cards), 5% received direct rides (e.g., Uber), 3.8% received vouchers for taxi or public transportation, and 3% received combined travel support. Male and White had longer travel distance and higher travel time than female and other races, respectively. Patients residing in more disadvantaged neighborhoods had an increased travel distance and travel time. Other races and Hispanics received more travel support ($) than Black and White patients or non-Hispanics. Patients with higher travel distance and travel time were more like to receive travel-related financial support. CONCLUSION Among patients who received travel support, those from socioeconomically disadvantaged neighborhoods had greater travel burden. Patients with greater travel burden were more likely to receive travel funds versus other types of support. Further understanding of the impact of travel burden and travel support on cancer outcomes is needed.
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Affiliation(s)
- Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, USA.
- Winship Cancer Institute, Emory University, Atlanta, GA, USA.
| | - Zahra A Barandouzi
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Ilana Graetz
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Claire Gong
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, USA
| | - Maria Norman
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, USA
| | - James Hankins
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, USA
| | - Mylin A Torres
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Deborah Watkins Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, GA, USA
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Hande V, Chan J, Polo A. Value of Geographical Information Systems in Analyzing Geographic Accessibility to Inform Radiotherapy Planning: A Systematic Review. JCO Glob Oncol 2022; 8:e2200106. [PMID: 36122318 PMCID: PMC9812498 DOI: 10.1200/go.22.00106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Vulnerable populations face geographical barriers in accessing radiotherapy (RT) facilities, resulting in heterogeneity of care received and cancer burden faced. We aimed to explore the current use of Geographical Information Systems (GIS) in access to RT and use these findings to create sustainable solutions against barriers for access in low- and middle-income countries. MATERIALS AND METHODS A systematic review using the PRISMA search strategy was done for studies using GIS to explore outcomes among patients with cancer. Included studies were reviewed and classified into three umbrella categories of how GIS has been used in studying access to RT. RESULTS Forty articles were included in the final review. Thirty-eight articles were set in high-income countries and two in upper-middle-income countries. Included studies were published from 2000 to 2020, and were comprised of patients with all-cancers combined, breast, colon, skin, lung, prostate, ovarian, and rectal carcinoma patients. Studies were categorized under three groups on the basis of how they used GIS in their analyses: to describe geographic access to RT, to associate geographic access to RT with outcomes, and for RT planning. Most studies fell under multiple categories. CONCLUSION Although this field is relative nascent, there is a wide array of functions possible through GIS for RT planning, including identifying high-risk populations, improving access in high-need areas, and providing valuable information for future resource allocation. GIS should be incorporated in future studies, especially set in low- and middle-income countries, which evaluate access to RT.
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Affiliation(s)
- Varsha Hande
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jessica Chan
- Department of Radiation Oncology, BC Cancer, Vancouver, BC, Canada,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Alfredo Polo
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria,Alfredo Polo, MD, PhD, Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna International Centre, PO Box 100, 1400 Vienna, Austria; e-mail:
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Conti B, Bochaton A, Charreire H, Kitzis-Bonsang H, Desprès C, Baffert S, Ngô C. Influence of geographic access and socioeconomic characteristics on breast cancer outcomes: A systematic review. PLoS One 2022; 17:e0271319. [PMID: 35853035 PMCID: PMC9295987 DOI: 10.1371/journal.pone.0271319] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Socio-economic and geographical inequalities in breast cancer mortality have been widely described in European countries and the United States. To investigate the combined effects of geographic access and socio-economic characteristics on breast cancer outcomes, a systematic review was conducted exploring the relationships between: (i) geographic access to healthcare facilities (oncology services, mammography screening), defined as travel time and/or travel distance; (ii) breast cancer-related outcomes (mammography screening, stage of cancer at diagnosis, type of treatment and rate of mortality); (iii) socioeconomic status (SES) at individuals and residential context levels. In total, n = 25 studies (29 relationships tested) were included in our systematic review. The four main results are: The statistical significance of the relationship between geographic access and breast cancer-related outcomes is heterogeneous: 15 were identified as significant and 14 as non-significant. Women with better geographic access to healthcare facilities had a statistically significant fewer mastectomy (n = 4/6) than women with poorer geographic access. The relationship with the stage of the cancer is more balanced (n = 8/17) and the relationship with cancer screening rate is not observed (n = 1/4). The type of measures of geographic access (distance, time or geographical capacity) does not seem to have any influence on the results. For example, studies which compared two different measures (travel distance and travel time) of geographic access obtained similar results. The relationship between SES characteristics and breast cancer-related outcomes is significant for several variables: at individual level, age and health insurance status; at contextual level, poverty rate and deprivation index. Of the 25 papers included in the review, the large majority (n = 24) tested the independent effect of geographic access. Only one study explored the combined effect of geographic access to breast cancer facilities and SES characteristics by developing stratified models.
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Affiliation(s)
- Benoit Conti
- LVMT, Université Gustave Eiffel, Ecole des Ponts, Champs-sur-Marne, France
- * E-mail:
| | - Audrey Bochaton
- Université Paris Nanterre, UMR 7533 LADYSS, Nanterre, France
| | - Hélène Charreire
- Université Paris-Est, Lab’Urba, France
- Institut Universitaire de France (IUF), Paris, France
| | | | - Caroline Desprès
- Centre de recherche des Cordeliers, Sorbonne Université, Université de Paris, INSERM, Equipe Etres, France
| | | | - Charlotte Ngô
- Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
- Centre de recherche des Cordeliers, Sorbonne Université, Université de Paris, INSERM, Equipe Etres, France
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Faeni H, Yarso KY, Wasita B, Rahayu RF, Suyatmi S, Wiyono N, Persik RN, Wicaksana IH, Azmiardi A, Ramadhanty Z. Age as a Determinant in Selecting Type of Breast Cancer Surgery in Lovely Pink Solo Cancer Community. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast-Conserving Surgery as a treatment option for older patients with early breast cancerHanum Faeni, MD1., Kristanto Yuli Yarso, MD2., Brian Wasita, MD3., Rachmi Fauziah Rahayu, MD4., Suyatmi Suyatmi, MD5., Nanang Wiyono, MD6., Riza Novierta Persik, MD3., Iman Hakim Wicaksana, MD1., Akhmad Azmiardi, MD7., Zhafira Ramadhanty, MD8.1 Resident of Surgery, Department of Surgery, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia2 Oncology Surgeon, Department of Surgery, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia3 Department of Anatomical Pathology, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia4 Department of Radiology, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia5 Department of Histology, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia6 Department of Anatomy, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia7 Doctoral Program on Public Health, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia8 Medical Student, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
Objective: Breast cancer is one of the most common malignancies in Indonesia. Breast cancer occurs due to rapid and abnormal cell growth due to infiltration of lymphatic tissue and blood vessels. For this reason, surgery is vital to use as a treatment for breast cancer at an early stage. There are two surgical methods: Breast-Conserving Surgery (BCS) and mastectomy. In this regard, several factors have been studied to influence patients in choosing BCS or mastectomy. Looking at the age factor, the results varied and differed significantly throughout the study.Method: This analytical study used a retrospective cross-sectional approach. The research subjects were patients with breast cancer who were the Lovely Pink community members in Surakarta City, Central Java. Subjects were selected by simple random sampling with inclusion criteria consisting of female patients aged 20 to 80 years, being diagnosed with stage 1 and 2 breast cancer, and having received surgery employing BCS or mastectomy techniques.Result: This study was conducted on 218 breast cancer patients who had undergone mastectomy or BCS in Surakarta City, Central Java. It was found that 104 patients were < 50 years old and 114 patients > 50 years old. 76 patients (34.9%) and 142 patients (65.1%) had a total income of more or less than Rp2.5 million/month. As many as 155 patients (71.1%) and 63 patients (28.9%) had no history of disease. Based on the type of surgery performed, 141 people (64.7%) underwent mastectomy, and 77 people (35.3%) underwent BCS.Conclusion: It can be concluded that patients prefer to undergo mastectomy with significant results at the age of under and above 50 years supported by income, medical history, and work history.Keywords: breast-conserving surgery, mastectomy, age
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Hatton A, Heriot N, Zalcberg J, Ayton D, Evans J, Roder D, Chua BH, Hersch J, Lippey J, Fox J, Saunders C, Mann GB, Synnot J, Bell RJ. Factors involved in treatment decision making for women diagnosed with ductal carcinoma in situ: A qualitative study. Breast 2021; 60:123-130. [PMID: 34624754 PMCID: PMC8503564 DOI: 10.1016/j.breast.2021.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Whilst some of the diversity in management of women with ductal carcinoma in situ (DCIS) may be explained by tumour characteristics, the role of patient preference and the factors underlying those preferences have been less frequently examined. We have used a descriptive qualitative study to explore treatment decisions for a group of Australian women diagnosed with DCIS through mammographic screening. Semi-structured telephone interviews were performed with 16 women diagnosed with DCIS between January 2012 and December 2018, recruited through the LifePool dataset (a subset of BreastScreen participants who have agreed to participate in research). Content analysis using deductive coding identified three themes: participants did not have a clear understanding of their diagnosis or prognosis; reported involvement in decision making about management varied; specific factors including the psychosexual impact of mastectomy and perceptions of radiotherapy, could act as barriers or facilitators to specific decisions about treatment. The treatment the women received was not simply determined by the characteristics of their disease. Interaction with the managing clinician was pivotal, however many other factors played a part in individual decisions. Recognising that decisions are not purely a function of disease characteristics is important for both women with DCIS and the clinicians who care for them.
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Affiliation(s)
- Amy Hatton
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Natalie Heriot
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - John Zalcberg
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia; Medical Oncology Unit, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, 3004, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | | | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - Boon H Chua
- Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Jolyn Hersch
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Jocelyn Lippey
- Department of Surgery University of Melbourne, Australia
| | - Jane Fox
- Department of Surgery Monash University, Monash Health Clayton Road Clayton Victoria, Australia
| | - Christobel Saunders
- Department of Surgery, School of Medicine, University of Western Australia, Australia
| | - G Bruce Mann
- Department of Surgery University of Melbourne, Australia
| | - Jane Synnot
- Consumer Representative Breast Cancer Network Australia, Australia
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
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Wang C, Wang F, Onega T. Spatial Behavior of Cancer Care Utilization in Distance Decay in the Northeast Region of the U.S. TRAVEL BEHAVIOUR & SOCIETY 2021; 24:291-302. [PMID: 34123728 PMCID: PMC8189327 DOI: 10.1016/j.tbs.2021.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PURPOSE Spatial behavior of patients in utilizing health care reflects their travel burden or mobility, accessibility for medical service, and subsequently outcomes from treatment. This paper derives the best-fitting distance decay function to capture the spatial behaviors of cancer patients in the Northeast region of the U.S., and examines and explains the spatial variability of such behaviors across sub-regions. PRINCIPAL RESULTS (1) 46.8%, 85.5%, and 99.6% of cancer care received was within a driving time of 30, 60 and 180 minutes, respectively. (2) The exponential distance decay function is the best in capturing the travel behavior of cancer patients in the region and across most sub-regions. (3) The friction coefficient in the distance decay function is negatively correlated with the mean travel time. (4) The best-fitting function forms are associated with network structures. (5) The variation of the friction coefficient across sub-regions is related to factors such as urbanicity, economic development level, and market competition intensity. MAJOR CONCLUSIONS The distance decay function offers an analytic metric to capture a full spectrum of travel behavior, and thus a more comprehensive measure than average travel time. Examining the geographic variation of travel behavior needs a reliable analysis unit such as organically defined "cancer service areas", which capture relevant health care market structure and thus are more meaningful than commonly-used geopolitical or census area units.
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Affiliation(s)
- Changzhen Wang
- Department of Geography & Anthropology, Louisiana State University, Baton Rouge, LA 70803
| | - Fahui Wang
- Department of Geography & Anthropology, Louisiana State University, Baton Rouge, LA 70803
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah; Huntsman Cancer Institute. Salt Lake City, UT 84112
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Russell T. Women who undergo mastectomy for breast cancer are now offered reconstruction in line with national guidelines but the majority decline: A UK teaching hospital experience. Breast Dis 2021; 40:69-73. [PMID: 33523033 DOI: 10.3233/bd-201047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to evaluate what proportion of breast cancer patients were offered reconstruction following mastectomy (to assess compliance with national guidelines) and to consider the reasoning if patients were not given this option. METHODS Records of all mastectomies were obtained from a prospectively maintained database (September 2018-October 2019). The following were collected: demographics, indication for surgery, tumour properties, and indication for mastectomy over breast-conserving surgery. Clinic letters were used to determine whether patients were offered reconstruction and whether they accepted. If a patient was not offered reconstruction, the rationale for this was recorded. RESULTS 201 mastectomies were carried out on 179 patients. 77.3% of women were offered reconstruction following mastectomy for cancer and 92.9% of women were offered reconstruction following mastectomy for non-invasive disease. Patients were not offered reconstruction only if they had significant co-morbidities (ASA grade III or higher); no patients who expressed an interest in reconstruction were declined. The most common reasons reconstruction was not offered included: deemed too frail following surgeon assessment (29.7%), advanced cancer (16.2%), and deemed high-risk following anaesthetist assessment (16.2%). 59.1% of patients who were offered reconstruction declined. Mean age in those who declined was significantly higher (P > 0.001). CONCLUSIONS Our unit now complies with national guidelines when offering reconstruction to mastectomy patients; this service was not previously offered. Further research into the reasons behind why women are declining reconstruction is necessary to ensure we are providing adequate information in an appropriate format.
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Survival Benefit of Guideline-Concordant Postoperative Radiation for Local Merkel Cell Carcinoma. J Surg Res 2021; 266:168-179. [PMID: 34015514 DOI: 10.1016/j.jss.2021.03.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Postoperative radiation therapy (RT) for early-stage Merkel Cell Carcinoma (MCC) decreases the risk of locoregional recurrence and improve overall survival. However, concordance with RT guidelines is unknown. MATERIALS AND METHODS The National Cancer Database was queried for stage I/II MCC patients receiving surgical intervention from 2006-2017. The cohort was stratified by patients who had and did not have indication(s) for adjuvant RT of the primary tumor site based on National Comprehensive Cancer Network guidelines. We captured the use of RT, patient demographics, socioeconomic characteristics, and clinical characteristics. Logistic regression, Kaplan-Meier method, and propensity score weighted Cox proportional hazards model examined associations and survival benefits of RT. RESULTS 2,330 stage I/II MCC patients underwent surgical intervention. 1,858 (79.7%) met National Comprehensive Cancer Network criteria for RT of the primary tumor site, of which 1,062 (57.2%) received RT. 472 (20.3%) did not meet criteria for RT, of which 203 (43.0%) received RT. Five-year overall survival advantage was identified for patients who received RT when it was indicated (P < 0.003). There was no evidence of overall survival advantage when patients received guideline-discordant RT (P = 0.478). CONCLUSIONS Surgical resection with adjuvant RT of the primary tumor site has an overall survival benefit for local MCC when patients meet criteria for RT. This study found a group who received guideline-discordant RT with no survival advantage. Further investigation is warranted to identify the socio-demographic and oncologic reasons for guideline discordance in the treatment of MCC for both under- and over-treatment.
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Astell-Burt T, Navakatikyan MA, Arnolda LF, Feng X. Multilevel modeling of geographic variation in general practice consultations. Health Serv Res 2021; 56:1252-1261. [PMID: 33723855 DOI: 10.1111/1475-6773.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To test relatively simple and complex models for examining model fit, higher-level variation in, and correlates of, GP consultations, where known nonhierarchical data structures are present. SETTING New South Wales (NSW), Australia. DESIGN Association between socioeconomic circumstances and geographic remoteness with GP consultation frequencies per participant was assessed using single-level, hierarchical, and multiple membership cross-classified (MMCC) models. Models were adjusted for age, gender, and a range of socioeconomic and demographic confounds. DATA COLLECTION/EXTRACTION METHODS A total of 261,930 participants in the Sax Institute's 45 and Up Study were linked to all GP consultation records (Medicare Benefits Schedule; Department of Human Services) within 12 months of baseline (2006-2009). PRINCIPAL FINDINGS Deviance information criterion values indicated the MMCC negative binomial regression was the best fitting model, relative to an MMCC Poisson equivalent and simpler hierarchical and single-level models. Between-area variances were relatively consistent across models, even when between GP variation was estimated. Lower rates of GP consultation outside of major cities were only observed once between-GP variation was assessed simultaneously with between-area variation in the MMCC models. CONCLUSIONS Application of the MMCC model is necessary for estimation of variances and effect sizes in sources of big data on primary care in which complex nonhierarchical clustering by geographical area and GP is present.
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Affiliation(s)
- Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, New South Wales, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia.,National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.,School of Population Medicine and Public Health, Peking Union Medical College, The Chinese Academy of Medical Sciences, Beijing, China
| | - Michael A Navakatikyan
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Leonard F Arnolda
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, New South Wales, Australia
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, New South Wales, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia.,School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Payne SR, Fowler S, Mundy AR, Alhasso A, Almallah Y, Anderson P, Andrich D, Baird A, Biers S, Browning A, Chapple C, Cherian J, Clarke L, Conn I, Dickerson D, Doble A, Dorkin T, Duggan B, Eardley I, Garaffa G, Greenwell T, Hadway P, Harding C, Hilmy M, Inman R, Kayes O, Kirchin V, Krishnan R, Kumar V, Lemberger J, Malone P, Moore J, Moore K, Mundy A, Noble J, Nurse D, Palmer M, Payne S, Pickard R, Rai J, Rees R, Roux J, Seipp C, Shabbir M, Saxby M, Sharma D, Sinclair A, Summerton D, Tatarov O, Thiruchelvam N, Venn S, Watkin N, Zacherakis E. The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415819894182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons. Methods: Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups. Results: More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures. Conclusion: Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology. Level of evidence: Level IV
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Affiliation(s)
| | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | - Anthony R Mundy
- University College London Hospitals NHS Foundation Trust, London, UK
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Chan TY, Tang JI, Tan PW, Roberts N. Dosimetric evaluation and systematic review of radiation therapy techniques for early stage node-negative breast cancer treatment. Cancer Manag Res 2018; 10:4853-4870. [PMID: 30425577 PMCID: PMC6205528 DOI: 10.2147/cmar.s172818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Radiation therapy (RT) is essential in treating women with early stage breast cancer. Early stage node-negative breast cancer (ESNNBC) offers a good prognosis; hence, late effects of breast RT becomes increasingly important. Recent literature suggests a potential for an increase in cardiac and pulmonary events after RT. However, these studies have not taken into account the impact of newer and current RT techniques that are now available. Hence, this review aimed to evaluate the clinical evidence for each technique and determine the optimal radiation technique for ESNNBC treatment. Currently, six RT techniques are consistently used and studied: 1) prone positioning, 2) proton beam RT, 3) intensity-modulated RT, 4) breath-hold, 5) partial breast irradiation, and 6) intraoperative RT. These techniques show dosimetric promise. However, limited data on late cardiac and pulmonary events exist due to challenges in long-term follow-up. Moving forward, future studies are needed to validate the efficacy and clinical outcomes of these current techniques.
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Affiliation(s)
- Tabitha Y Chan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Johann I Tang
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Poh Wee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Neill Roberts
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Gu J, Groot G, Boden C, Busch A, Holtslander L, Lim H. Review of Factors Influencing Women's Choice of Mastectomy Versus Breast Conserving Therapy in Early Stage Breast Cancer: A Systematic Review. Clin Breast Cancer 2018; 18:e539-e554. [DOI: 10.1016/j.clbc.2017.12.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/22/2017] [Indexed: 01/11/2023]
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Gu J, Groot G. Creation of a new clinical framework - why women choose mastectomy versus breast conserving therapy. BMC Med Res Methodol 2018; 18:77. [PMID: 29986654 PMCID: PMC6038174 DOI: 10.1186/s12874-018-0533-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 06/27/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Clinical medicine has lagged behind other fields in understanding and utilizing frameworks to guide research. In this article, we introduce a new framework to examine why women choose mastectomy versus breast conserving therapy in early stage breast cancer, and highlight the importance of utilizing a conceptual framework to guide clinical research. METHODS The framework we present was developed through integrating previous literature, frameworks, theories, models, and the author's past research. RESULTS We present a conceptual framework that illustrates the central domains that influence women's choice between mastectomy versus breast conserving therapy. These have been organized into three broad constructs: clinicopathological factors, physician factors, and individual factors with subgroups of sociodemographic, geographic, and individual belief factors. The aim of this framework is to provide a comprehensive basis to describe, examine, and explain the factors that influence women's choice of mastectomy versus breast conserving therapy at the individual level. CONCLUSION We have developed a framework with the purpose of helping health care workers and policy makers better understand the multitude of factors that influence a patient's choice of therapy at an individual level. We hope this framework is useful for future scholars to utilize, challenge, and build upon in their own work on decision-making in the setting of breast cancer. For clinician-researchers who have limited experience with frameworks, this paper will highlight the importance of utilizing a conceptual framework to guide future research and provide an example.
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Affiliation(s)
- Jeffrey Gu
- Department of Community Health and Epidemiology, University of Saskatchewan, Box 7, Health Science Building, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada.
| | - Gary Groot
- Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Melnychuk M, Vindrola-Padros C, Aitchison M, Clarke CS, Fulop NJ, Levermore C, Maddineni SB, Moore CM, Mughal MM, Perry C, Pritchard-Jones K, Ramsay AIG, Shackley D, Vickers J, Morris S. Centralising specialist cancer surgery services in England: survey of factors that matter to patients and carers and health professionals. BMC Cancer 2018; 18:226. [PMID: 29486730 PMCID: PMC6389051 DOI: 10.1186/s12885-018-4137-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/15/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The centralisation of specialist cancer surgical services across London Cancer and Greater Manchester Cancer, England, may significantly change how patients experience care. These centres are changing specialist surgical pathways for several cancers including prostate, bladder, kidney, and oesophago-gastric cancers, increasing the specialisation of centres and providing surgery in fewer hospitals. While there are potential benefits related to centralising services, changes of this kind are often controversial. The aim of this study was to identify factors related to the centralisation of specialist surgical services that are important to patients, carers and health care professionals. METHODS This was a questionnaire-based study involving a convenience sample of patient and public involvement (PPI) and cancer health care professional (HCP) sub-groups in London and Greater Manchester (n = 186). Participants were asked to identify which of a list of factors potentially influenced by the centralisation of specialist cancer surgery were important to them and to rank these in order of importance. We ranked and shortlisted the most important factors. RESULTS We obtained 52 responses (28% response rate). The factors across both groups rated most important were: highly trained staff; likelihood and severity of complications; waiting time for cancer surgery; and access to staff members from various disciplines with specialised skills in cancer. These factors were also ranked as being important separately by the PPI and HCP sub-groups. There was considerable heterogeneity in the relative ordering of factors within sub-groups and overall. CONCLUSIONS This study examines and ranks factors important to patients and carers, and health care professionals in order to inform the implementation of centralisation of specialist cancer surgical services. The most important factors were similar in the two stakeholder sub-groups. Planners should consider the impact of reorganising services on these factors, and disseminate this information to patients, the public and health care professionals when deciding whether or not and how to centralise specialist cancer surgical services.
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Affiliation(s)
- Mariya Melnychuk
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT UK
| | - Cecilia Vindrola-Padros
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT UK
| | - Michael Aitchison
- Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG UK
| | - Caroline S. Clarke
- Research Department of Primary Care & Population Health, Royal Free Campus, University College London, Rowland Hill St, London, NW3 2PF UK
| | - Naomi J. Fulop
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT UK
| | - Claire Levermore
- University College London Hospital NHS Foundation Trust, 47 Wimpole Street, London, W1G 8SE UK
| | - Satish B. Maddineni
- Departments of Urology, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD UK
- The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX UK
| | - Caroline M. Moore
- Division of Surgical & Interventional Science, University College London, Gower Street, London, WC1E 6BT UK
| | - Muntzer M. Mughal
- University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU UK
| | - Catherine Perry
- Alliance Manchester Business School, University of Manchester, Booth Street East, Manchester, M13 9SS UK
| | - Kathy Pritchard-Jones
- UCLPartners Cancer Programme, 170 Tottenham Court Road, London, W1T 7HA UK
- University College London Hospitals Cancer Collaborative, 250 Euston Road, London, NW1 2PG UK
| | - Angus I. G. Ramsay
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT UK
| | - David Shackley
- Greater Manchester Cancer, A Block, Christie NHS Foundation Trust, 550 Wilmslow Rd, Manchester, M20 4BX UK
| | - Jonathan Vickers
- Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT UK
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Gu J, Groot G, Holtslander L, Engler-Stringer R. Understanding Women's Choice of Mastectomy Versus Breast Conserving Therapy in Early-Stage Breast Cancer. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2017; 11:1179554917691266. [PMID: 28469511 PMCID: PMC5395266 DOI: 10.1177/1179554917691266] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify factors that influence Saskatchewan women's choice between breast conserving therapy (BCT) and mastectomy in early-stage breast cancer (ESBC) and to compare and contrast underlying reasons behind choice of BCT versus mastectomy. METHODS Interpretive description methods guided this practice-based qualitative study. Data were analyzed using thematic analysis and presented in thematic maps. RESULTS Women who chose mastectomy described 1 of the 3 main themes: worry about cancer recurrence, perceived consequences of BCT treatment, or breast-tumor size perception. In contrast, women chose BCT because of 3 different themes: mastectomy being too radical, surgeon influence, and feminine identity. CONCLUSIONS Although individual reasons for choosing mastectomy versus BCT have been discussed in the literature before, different rationale underlying each choice has not been previously described. These results are novel in identifying interdependent subthemes and secondary reasons for each choice. This is important for increased understanding of factors influencing a complicated decision-making process.
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Affiliation(s)
- Jeffrey Gu
- Division of General Surgery, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lorraine Holtslander
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel Engler-Stringer
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
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Crawford S, Skinner J, Coombes E, Jones A. Cancer of Unknown Primary: a Cancer Registry Study of Factors Affecting Access to Diagnosis. Clin Oncol (R Coll Radiol) 2017; 29:e39-e46. [DOI: 10.1016/j.clon.2016.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/11/2016] [Accepted: 08/23/2016] [Indexed: 11/15/2022]
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Kelly C, Hulme C, Farragher T, Clarke G. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review. BMJ Open 2016; 6:e013059. [PMID: 27884848 PMCID: PMC5178808 DOI: 10.1136/bmjopen-2016-013059] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate whether there is an association between differences in travel time/travel distance to healthcare services and patients' health outcomes and assimilate the methodologies used to measure this. DESIGN Systematic Review. We searched MEDLINE, Embase, Web of Science, Transport database, HMIC and EBM Reviews for studies up to 7 September 2016. Studies were excluded that included children (including maternity), emergency medical travel or countries classed as being in the global south. SETTINGS A wide range of settings within primary and secondary care (these were not restricted in the search). RESULTS 108 studies met the inclusion criteria. The results were mixed. 77% of the included studies identified evidence of a distance decay association, whereby patients living further away from healthcare facilities they needed to attend had worse health outcomes (eg, survival rates, length of stay in hospital and non-attendance at follow-up) than those who lived closer. 6 of the studies identified the reverse (a distance bias effect) whereby patients living at a greater distance had better health outcomes. The remaining 19 studies found no relationship. There was a large variation in the data available to the studies on the patients' geographical locations and the healthcare facilities attended, and the methods used to calculate travel times and distances were not consistent across studies. CONCLUSIONS The review observed that a relationship between travelling further and having worse health outcomes cannot be ruled out and should be considered within the healthcare services location debate.
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Affiliation(s)
- Charlotte Kelly
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Institute for Transport Studies, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tracey Farragher
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Mossanen M, Holt S, Gore JL, Lin DW, Wright JL. 15 Years of penile cancer management in the United States: An analysis of the use of partial penectomy for localized disease and chemotherapy in the metastatic setting. Urol Oncol 2016; 34:530.e1-530.e7. [PMID: 27495001 DOI: 10.1016/j.urolonc.2016.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Penile cancer remains a rare disease in the United States, and its understanding may be limited by the uncommon nature of the malignancy. We sought to describe recent penile cancer treatment patterns using the National Cancer Data Base. METHODS A retrospective review of data obtained from the National Cancer Data Base from 1998 to 2012 was performed. We obtained demographic information and therapeutic approaches within the following2 clinical scenarios: performance of partial penectomy for early stage disease (clinical Ta-T2) and the use of chemotherapy for metastatic disease. Multivariate logistic analysis was performed. RESULTS A total of 2,677 patients presented with early stage penile carcinoma. The proportion receiving partial penectomy increased from 74% in 1998 to 2000 to 80% in 2010 to 2012 (P<0.001). Partial penectomy was more common in the elderly (age>80, odd ratios [OR] = 1.53, 95% CI: 1.05-2.23), young (age<50, OR = 1.46, 95% CI: 1.02-2.07), and in African Americans (OR = 1.45, 95% CI: 1.00-2.12). Increasing tumor size was significantly associated with decreased likelihood of receiving partial penectomy. Of those presenting with metastatic disease (n = 819), use of chemotherapy increased over the time period from 39% receiving chemotherapy in 1998 to 2000 to 49% in 2010 to 2012 (P<0.03). Patients least likely to receive chemotherapy were older and with higher Comorbidity score (both P<0.05), African American (OR = 0.46, 95% CI: 0.30-0.73), and living≥50 miles from the nearest treatment hospital (OR = 0.37, 95% CI: 0.25-0.55). CONCLUSIONS Penile-sparing surgery for early stage disease and the use of chemotherapy for metastatic disease are becoming more commonly utilized over the past several years. Further work is needed to define clinical and nonclinical factors associated with the treatment.
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Affiliation(s)
- Matthew Mossanen
- Department of Urology, University of Washington School of Medicine, Seattle, WA.
| | - Sarah Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Daniel W Lin
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA
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Morris M, Woods LM, Rachet B. What might explain deprivation-specific differences in the excess hazard of breast cancer death amongst screen-detected women? Analysis of patients diagnosed in the West Midlands region of England from 1989 to 2011. Oncotarget 2016; 7:49939-49947. [PMID: 27363022 PMCID: PMC5226559 DOI: 10.18632/oncotarget.10255] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast cancer survival is higher in less deprived women, even amongst women whose tumor was screen-detected, but reasons behind this have not been comprehensively investigated. METHODS The excess hazard of breast cancer death in 20,265 women diagnosed with breast cancer, followed up to 2012, was estimated for screen-detected and non-screen-detected women, comparing more deprived to less deprived women using flexible parametric models. Models were adjusted for individual and tumor factors, treatment received and comorbidity. For screen-detected women, estimates were also corrected for lead-time and overdiagnosis. RESULTS The excess hazard ratio (EHR) of breast cancer death in the most deprived group, adjusted only for age and year of diagnosis, was twice that of the least deprived among screen-detected women (EHR=2.12, 95%CI 1.48-2.76) and 64% higher among non-screen-detected women (EHR=1.64, 95%CI 1.41-1.87). Adjustment for stage at diagnosis lowered these estimates by 25%. Further adjustment had little extra impact. In the final models, the excess hazard for the most deprived women was 54% higher (EHR=1.54, 95%CI 1.10-1.98) among screen-detected women and 39% higher (EHR=1.39, 95%CI 1.20-1.59) among non-screen-detected women. CONCLUSION A persistent socio-economic gradient in breast cancer-related death exists in this cohort, even for screen-detected women. The impact of differential lifestyles, management and treatment warrant further investigation.
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Affiliation(s)
- Melanie Morris
- Cancer Research UK Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Laura M. Woods
- Cancer Research UK Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Bernard Rachet
- Cancer Research UK Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Coombs NJ, Coombs JM, Vaidya UJ, Singer J, Bulsara M, Tobias JS, Wenz F, Joseph DJ, Brown DA, Rainsbury R, Davidson T, Adamson DJA, Massarut S, Morgan D, Potyka I, Corica T, Falzon M, Williams N, Baum M, Vaidya JS. Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT. BMJ Open 2016; 6:e010703. [PMID: 27160842 PMCID: PMC4890331 DOI: 10.1136/bmjopen-2015-010703] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To quantify the journeys and CO2 emissions if women with breast cancer are treated with risk-adapted single-dose targeted intraoperative radiotherapy (TARGIT) rather than several weeks' course of external beam whole breast radiotherapy (EBRT) treatment. SETTING (1) TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy, (2) 2 additional UK centres offering TARGIT. PARTICIPANTS 485 UK patients (249 TARGIT, 236 EBRT) in the prepathology stratum of TARGIT-A trial (where randomisation occurred before lumpectomy and TARGIT was delivered simultaneously with lumpectomy) for whom geographical data were available and 22 patients treated with TARGIT after completion of the TARGIT-A trial in 2 additional UK breast centres. OUTCOME MEASURES The shortest total journey distance, time and CO2 emissions from home to hospital to receive all the fractions of radiotherapy. METHODS Distances, time and CO2 emissions were calculated using Google Maps and assuming a fuel efficiency of 40 mpg. The groups were compared using the Student t test with unequal variance and the non-parametric Wilcoxon rank-sum (Mann-Whitney) test. RESULTS TARGIT patients travelled significantly fewer miles: TARGIT 21 681, mean 87.1 (SE 19.1) versus EBRT 92 591, mean 392.3 (SE 30.2); had lower CO2 emissions 24.7 kg (SE 5.4) vs 111 kg (SE 8.6) and spent less time travelling: 3 h (SE 0.53) vs 14 h (SE 0.76), all p<0.0001. Patients treated with TARGIT in 2 hospitals in semirural locations were spared much longer journeys (753 miles, 30 h, 215 kg CO2 per patient). CONCLUSIONS The use of TARGIT intraoperative radiotherapy for eligible patients with breast cancer significantly reduces their journeys for treatment and has environmental benefits. If widely available, 5 million miles (8 000 000 km) of travel, 170 000 woman-hours and 1200 tonnes of CO2 (a forest of 100 hectares) will be saved annually in the UK. TRIAL REGISTRATION NUMBER ISRCTN34086741; Post-results.
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Affiliation(s)
| | | | - Uma J Vaidya
- Nonsuch High School for Girls, UK
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
| | - Julian Singer
- Department of Radiotherapy, Princess Alexandra Hospital, Harlow, UK
| | - Max Bulsara
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
- University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jeffrey S Tobias
- Department of Radiation Oncology(JST), University College London, London, UK
| | - Frederik Wenz
- Department of Radiation Oncology, University of Heidelberg, Germany
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | | | | | | | | | | | - David Morgan
- Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
| | - Ingrid Potyka
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
| | - Tammy Corica
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Mary Falzon
- Department of Pathology, University College London, London, UK
| | - Norman Williams
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
| | - Michael Baum
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
| | - Jayant S Vaidya
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
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Ristevski E, Regan M, Birks D, Steers N, Byrne A. A qualitative study of rural women's views for the treatment of early breast cancer. Health Expect 2014; 18:2928-40. [PMID: 25267503 DOI: 10.1111/hex.12277] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 11/28/2022] Open
Abstract
AIM Identify what factors rural women perceived to influence their surgical choice for EBC. BACKGROUND Higher rates of mastectomy still remain for women with early breast cancer (EBC) in rural areas. While access to radiotherapy is a commonly identified barrier, there is growing debate around other factors which are also important influences on surgical choice. METHODS Qualitative study with 70 interviews with women diagnosed with EBC in rural Gippsland, Australia. Twenty-nine women had a mastectomy and 41 had breast conserving surgery (BCS). RESULTS Patient led psychosocial and surgeon led factors influenced surgical choice. Psychosocial factors were a greater influence for the mastectomy group. These included a high fear of cancer recurrence and radiotherapy, negative views of the body and breast, a family history of cancer, wanting to avoid the negative treatment experiences they had seen significant others go through, and not wanting to travel for treatment. Surgeon led factors were a greater influence for the BCS group, in particular, the direct recommendation made by the surgeon for BCS. For both groups, urgency to act was a shared psychosocial factor. Trust and confidence in the expertise and reputation of the surgeon and their consultation style were surgeon led factors shared by the groups. CONCLUSIONS To ensure women achieve the best treatment outcome, patients and clinicians need to work together to identify how important and influential the various factors are for the women and, if necessary, to seek support to ensure informed decisions are made.
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Affiliation(s)
- Eli Ristevski
- Monash University, School of Rural Health - Monash University Department of Rural and Indigenous Health, Moe, Victoria, Australia
| | - Melanie Regan
- Monash University, School of Rural Health - Monash University Department of Rural and Indigenous Health, Moe, Victoria, Australia
| | - David Birks
- Monash University, School of Rural Health - Churchill, Churchill, Victoria, Australia
| | - Nicole Steers
- Latrobe Community Health Service, Morwell, Victoria, Australia
| | - Anny Byrne
- West Gippsland HealthCare Group, Warragul, Victoria, Australia
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Sinding C, Warren R, Fitzpatrick-Lewis D, Sussman J. Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours. Support Care Cancer 2014; 22:3101-20. [PMID: 25120008 DOI: 10.1007/s00520-014-2348-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/29/2014] [Indexed: 02/03/2023]
Abstract
The paper reviews published studies focused on disparities in receipt of cancer treatments and supportive care services in countries where cancer care is free at the point of access. We map these studies in terms of the equity stratifiers they examined, the countries in which they took place, and the care settings and cancer populations they investigated. Based on this map, we reflect on patterns of scholarly attention to equity and disparity in cancer care. We then consider conceptual challenges and opportunities in the field, including how treatment disparities are defined, how equity stratifiers are defined and conceptualized and how disparities are explained, with special attention to the challenge of psychosocial explanations.
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Affiliation(s)
- Christina Sinding
- School of Social Work & Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada,
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Mossanen M, Izard J, Wright JL, Harper JD, Porter MP, Daratha KB, Holt SK, Gore JL. Identification of underserved areas for urologic cancer care. Cancer 2014; 120:1565-71. [PMID: 24523042 DOI: 10.1002/cncr.28616] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/16/2014] [Accepted: 01/22/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND The delivery of urologic oncology care is susceptible to regional variation. In the current study, the authors sought to define patterns of care for patients undergoing genitourinary cancer surgery to identify underserved areas for urologic cancer care in Washington State. METHODS The authors accessed the Washington State Comprehensive Hospital Abstract Reporting System from 2003 through 2007. They identified patients undergoing radical prostatectomy, radical cystectomy (RC), partial nephrectomy (PN), radical nephrectomy, and transurethral resection of the prostate (TURP). TURP was included for comparison as a reference procedure indicative of access to urologic care. Hospital service areas (HSAs) are where the majority of local patients are hospitalized; hospital referral regions (HRR) are where most patients receive tertiary care. The authors created multivariate hierarchical logistic regression models to examine patient and HSA characteristics associated with the receipt of urologic oncology care out of the HRR for each procedure. RESULTS Greater than one-half of patients went out of their HRR in 7 HSAs (11%) for radical prostatectomy, 3 HSAs (5%) for radical nephrectomy, 10 HSAs (15%) for PN, and 14 HSAs (22%) for RC. No HSAs had high export rates for TURP. Few patient factors were found to be associated with surgical care out of the HRR. High-export HSAs for PN and RC exhibited lower socioeconomic characteristics than low-export HSAs, adjusting for HSA population, race, and HSA procedure rates for PN and RC. CONCLUSIONS Patients living in areas with lower socioeconomic status have a greater need to travel for complex urologic surgery. Consideration of geographic delineation in the delivery of urologic oncology care may aid in regional quality improvement initiatives.
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Affiliation(s)
- Matthew Mossanen
- Department of Urology, University of Washington, Seattle, Washington
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The effect of provider density on lung cancer survival among blacks and whites in the United States. J Thorac Oncol 2013; 8:549-53. [PMID: 23446202 DOI: 10.1097/jto.0b013e318287c24c] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Lung cancer mortality rates may vary with access to specialty providers and local resources. We sought to examine the effect of access to care, using density of lung cancer care providers, on lung cancer mortality among blacks and whites in the United States. METHODS We examined U.S. county-level data for age-adjusted lung cancer mortality rates from 2003 to 2007. Our primary independent variable was per capita number of thoracic oncologic providers, adjusting for county-level smoking rates, socioeconomic status, and other geographic factors. Data were obtained from 2009 Area Resource File, National Center for Health Statistics, and the County Health Rankings Project. RESULTS Providers of lung cancer care were unevenly distributed among the U.S. counties. For example, 41.4% of the U.S. population reside in counties with less than four thoracic surgeons per 100,000 people, 23.4% in counties with 4 to 15 surgeons per 100,000 people, and 35.3% in counties with more than 15 surgeons per 100,000 people. Geographically, 4.3% of whites compared with 11.2% of blacks lived in high lung cancer mortality zones. Lung cancer mortality did not vary by density of thoracic surgeons or oncology services; however, higher primary care provider density was associated with lung cancer mortality reduction of 4.1 per 100,000 for whites. CONCLUSION Variation in provider density for thoracic oncology in the United States was not associated with a difference in lung cancer mortality. Lower mortality associated with higher primary care provider density suggests that equitable access to primary care may lead to reduced cancer disparities.
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Green J, Murchie P, Lee AJ. Does patients' place of residence affect the type of physician performing primary excision of cutaneous melanoma in northern Scotland? J Rural Health 2013; 29 Suppl 1:s35-42. [PMID: 23944278 DOI: 10.1111/jrh.12011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rural residence may adversely affect cancer outcomes, perhaps because rural cancer patients are managed differently. Current UK guidelines recommend all patients with suspected melanoma be referred urgently for specialist excision biopsy; however, up to 20% of patients receive their biopsy in primary care. This project explored if rural dwellers with melanoma were more likely to have their primary biopsy in primary care. METHODS A clinical database of all primary cutaneous melanomas diagnosed in Northern Scotland between January 1991 and July 2007 was analyzed for patient demographics, clinical variables, and intermediate outcomes. Significant findings on univariate analysis were then included in a binary logistic regression model to adjust for confounders. RESULTS On univariate analysis patients living in rural areas were significantly more likely to have their melanomas excised in primary care compared with those living in the city (26.3% compared with 17.7%, P < .001). There were no significant differences between rural and urban dwellers in Breslow thickness or completeness of excision. Following adjustment for key confounders, those living in suburban areas and remote small towns were significantly more likely to be treated contrary to current UK melanoma guidelines compared to those in cities. CONCLUSIONS In Northern Scotland patients living in suburban areas and remote small towns are significantly more likely to have an initial melanoma excision in primary care, contrary to current UK guidelines. This geographical contrast signposts the way to further in-depth research into the interplay between place of residence and how the cancer journey is experienced.
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Affiliation(s)
- Joanna Green
- Division of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, Scotland
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González-Santos SP. Space, structure and social dynamics within the clinical setting: two case studies of assisted reproduction in Mexico City. Health Place 2010; 17:166-74. [PMID: 20961798 DOI: 10.1016/j.healthplace.2010.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 09/19/2010] [Accepted: 09/20/2010] [Indexed: 12/30/2022]
Abstract
Drawing on the concept of therapeutic environments and comparing two case studies, this paper explores the interaction between the spatial factors of the clinical setting, the structural elements of the health system, and the specific treatment requirements of assisted reproduction in order to see the type and degree of privacy and accessibility, as well as the particular social dynamics (i.e. patient-physician and among patients) fostered in two Mexico City fertility clinics. Both cases suggest that certain types of therapeutic environments encourage the formation of spontaneous support groups while others favour the patient-physician relationship.
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Affiliation(s)
- Sandra P González-Santos
- University of Sussex, Sociology Department, Plaza Popocatépetl 41-2, Colonia Hipódromo, D.F. 06100 Delegación Cuahutemoc, Mexico.
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Boulos DNK, Ghali RR, Ibrahim EM, Boulos MNK, AbdelMalik P. An eight-year snapshot of geospatial cancer research (2002-2009): clinico-epidemiological and methodological findings and trends. Med Oncol 2010; 28:1145-62. [PMID: 20589539 DOI: 10.1007/s12032-010-9607-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 06/16/2010] [Indexed: 12/14/2022]
Abstract
Geographic information systems (GIS) offer a very rich toolbox of methods and technologies, and powerful research tools that extend far beyond the mere production of maps, making it possible to cross-link and study the complex interaction of disease data and factors originating from a wide range of disparate sources. Despite their potential indispensable role in cancer prevention and control programmes, GIS are underrepresented in specialised oncology literature. The latter has provided an impetus for the current review. The review provides an eight-year snapshot of geospatial cancer research in peer-reviewed literature (2002-2009), presenting the clinico-epidemiological and methodological findings and trends in the covered corpus (93 papers). The authors concluded that understanding the relationship between location and cancer/cancer care services can play a crucial role in disease control and prevention, and in better service planning, and appropriate resource utilisation. Nevertheless, there are still barriers that hinder the wide-scale adoption of GIS and related technologies in everyday oncology practice.
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Affiliation(s)
- Dina N Kamel Boulos
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
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Pilkington H, Blondel B, Papiernik E, Cuttini M, Charreire H, Maier RF, Petrou S, Combier E, Künzel W, Bréart G, Zeitlin J. Distribution of maternity units and spatial access to specialised care for women delivering before 32 weeks of gestation in Europe. Health Place 2010; 16:531-8. [DOI: 10.1016/j.healthplace.2009.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 12/11/2009] [Accepted: 12/18/2009] [Indexed: 10/20/2022]
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The role of GIS for health utilization studies: literature review. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2009. [DOI: 10.1007/s10742-009-0046-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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