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Mollalo A, Hamidi B, Lenert L, Alekseyenko AV. Application of Spatial Analysis for Electronic Health Records: Characterizing Patient Phenotypes and Emerging Trends. RESEARCH SQUARE 2024:rs.3.rs-3443865. [PMID: 37886509 PMCID: PMC10602163 DOI: 10.21203/rs.3.rs-3443865/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background Electronic health records (EHR) commonly contain patient addresses that provide valuable data for geocoding and spatial analysis, enabling more comprehensive descriptions of individual patients for clinical purposes. Despite the widespread use of EHR in clinical decision support and interventions, no systematic review has examined the extent to which spatial analysis is used to characterize patient phenotypes. Objective This study reviews advanced spatial analyses that employed individual-level health data from EHR within the US to characterize patient phenotypes. Methods We systematically evaluated English-language peer-reviewed articles from PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases from inception to August 20, 2023, without imposing constraints on time, study design, or specific health domains. Results Only 49 articles met the eligibility criteria. These articles utilized diverse spatial methods, with a predominant focus on clustering techniques, while spatiotemporal analysis (frequentist and Bayesian) and modeling were relatively underexplored. A noteworthy surge (n = 42, 85.7%) in publications was observed post-2017. The publications investigated a variety of adult and pediatric clinical areas, including infectious disease, endocrinology, and cardiology, using phenotypes defined over a range of data domains, such as demographics, diagnoses, and visits. The primary health outcomes investigated were asthma, hypertension, and diabetes. Notably, patient phenotypes involving genomics, imaging, and notes were rarely utilized. Conclusions This review underscores the growing interest in spatial analysis of EHR-derived data and highlights knowledge gaps in clinical health, phenotype domains, and spatial methodologies. Additionally, this review proposes guidelines for harnessing the potential of spatial analysis to enhance the context of individual patients for future clinical decision support.
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Chen JC, Stover DG, Ballinger TJ, Bazan JG, Schneider BP, Andersen BL, Carson WE, Obeng-Gyasi S. Racial Disparities in Breast Cancer: from Detection to Treatment. Curr Oncol Rep 2024; 26:10-20. [PMID: 38100011 DOI: 10.1007/s11912-023-01472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW Update on current racial disparities in the detection and treatment of breast cancer. RECENT FINDINGS Breast cancer remains the leading cause of cancer death among Black and Hispanic women. Mammography rates among Black and Hispanic women have surpassed those among White women, with studies now advocating for earlier initiation of breast cancer screening in Black women. Black, Hispanic, Asian, and American Indian and Alaskan Native women continue to experience delays in diagnosis and time to treatment. Further, racial discrepancies in receipt of guideline-concordant care, access to genetic testing and surgical reconstruction persist. Disparities in the initiation, completion, toxicity, and efficacy of chemotherapy, endocrine therapy, and targeted drug therapy remain for racially marginalized women. Efforts to evaluate the impact of race and ethnicity across the breast cancer spectrum are increasing, but knowledge gaps remain and further research is necessary to reduce the disparity gap.
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Affiliation(s)
- J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Daniel G Stover
- Department of Internal Medicine, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Tarah J Ballinger
- Department of Internal Medicine, Indiana University, Indianapolis, IN, USA
| | - Jose G Bazan
- Department of Radiation Oncology, City of Hope, Duarte, CA, USA
| | - Bryan P Schneider
- Department of Internal Medicine, Indiana University, Indianapolis, IN, USA
| | | | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA.
- The Ohio State University, N924 Doan Hall, 410 West 10th, Columbus, OH, 43210, USA.
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Hallemeier CL, Moughan J, Haddock MG, Herskovic AM, Minsky BD, Suntharalingam M, Zeitzer KL, Garg MK, Greenwald BD, Komaki RU, Puckett LL, Kim H, Lloyd S, Bush DA, Kim HE, Lad TE, Meyer JE, Okawara GS, Raben A, Schefter TE, Barker JL, Falkson CI, Videtic GMM, Jacob R, Winter KA, Crane CH. Association of Radiotherapy Duration With Clinical Outcomes in Patients With Esophageal Cancer Treated in NRG Oncology Trials: A Secondary Analysis of NRG Oncology Randomized Clinical Trials. JAMA Netw Open 2023; 6:e238504. [PMID: 37083668 PMCID: PMC10122174 DOI: 10.1001/jamanetworkopen.2023.8504] [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: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 04/22/2023] Open
Abstract
Importance For many types of epithelial malignant neoplasms that are treated with definitive radiotherapy (RT), treatment prolongation and interruptions have an adverse effect on outcomes. Objective To analyze the association between RT duration and outcomes in patients with esophageal cancer who were treated with definitive chemoradiotherapy (CRT). Design, Setting, and Participants This study was an unplanned, post hoc secondary analysis of 3 prospective, multi-institutional phase 3 randomized clinical trials (Radiation Therapy Oncology Group [RTOG] 8501, RTOG 9405, and RTOG 0436) of the National Cancer Institute-sponsored NRG Oncology (formerly the National Surgical Adjuvant Breast and Bowel Project, RTOG, and Gynecologic Oncology Group). Enrolled patients with nonmetastatic esophageal cancer underwent definitive CRT in the trials between 1986 and 2013, with follow-up occurring through 2014. Data analyses were conducted between March 2022 to February 2023. Exposures Treatment groups in the trials used standard-dose RT (50 Gy) and concurrent chemotherapy. Main Outcomes and Measures The outcomes were local-regional failure (LRF), distant failure, disease-free survival (DFS), and overall survival (OS). Multivariable models were used to examine the associations between these outcomes and both RT duration and interruptions. Radiotherapy duration was analyzed as a dichotomized variable using an X-Tile software to choose a cut point and its median value as a cut point, as well as a continuous variable. Results The analysis included 509 patients (median [IQR] age, 64 [57-70] years; 418 males [82%]; and 376 White individuals [74%]). The median (IQR) follow-up was 4.01 (2.93-4.92) years for surviving patients. The median cut point of RT duration was 39 days or less in 271 patients (53%) vs more than 39 days in 238 patients (47%), and the X-Tile software cut point was 45 days or less in 446 patients (88%) vs more than 45 days in 63 patients (12%). Radiotherapy interruptions occurred in 207 patients (41%). Female (vs male) sex and other (vs White) race and ethnicity were associated with longer RT duration and RT interruptions. In the multivariable models, RT duration longer than 45 days was associated with inferior DFS (hazard ratio [HR], 1.34; 95% CI, 1.01-1.77; P = .04). The HR for OS was 1.33, but the results were not statistically significant (95% CI, 0.99-1.77; P = .05). Radiotherapy duration longer than 39 days (vs ≤39 days) was associated with a higher risk of LRF (HR, 1.32; 95% CI, 1.06-1.65; P = .01). As a continuous variable, RT duration (per 1 week increase) was associated with DFS failure (HR, 1.14; 95% CI, 1.01-1.28; P = .03). The HR for LRF 1.13, but the result was not statistically significant (95% CI, 0.99-1.28; P = .07). Conclusions and Relevance Results of this study indicated that in patients with esophageal cancer receiving definitive CRT, prolonged RT duration was associated with inferior outcomes; female patients and those with other (vs White) race and ethnicity were more likely to have longer RT duration and experience RT interruptions. Radiotherapy interruptions should be minimized to optimize outcomes.
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Affiliation(s)
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
| | | | - Arnold M. Herskovic
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Bruce D. Minsky
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston
| | - Mohan Suntharalingam
- Department of Radiation Oncology, University of Maryland and Greenebaum Comprehensive Cancer Center, Baltimore
| | - Kenneth L. Zeitzer
- Department of Radiation Oncology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Madhur K. Garg
- Department of Radiation Oncology, Montefiore Medical Center–Moses Campus, Bronx, New York
| | - Bruce D. Greenwald
- Department of Gastroenterology and Hepatology, University of Maryland and Greenebaum Cancer Center, Baltimore
| | - Ritsuko U. Komaki
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston
| | - Lindsay L. Puckett
- Department of Radiation Oncology, Medical College of Wisconsin and Zablocki Veterans' Administration Medical Center, Milwaukee
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah Health Science Center, Salt Lake City
| | - David A. Bush
- Department of Radiation Oncology, Loma Linda University Cancer Institute, Loma Linda, California
| | - Harold E. Kim
- Department of Radiation Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan
| | - Thomas E. Lad
- Department of Medical Oncology, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | - Joshua E. Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Gordon S. Okawara
- Department of Radiation Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Adam Raben
- Department of Radiation Oncology, Christiana Care Health Services Inc Community Clinical Oncology Program, Newark, Delaware
| | | | - Jerry L. Barker
- Department of Radiation Oncology, US Oncology Texas Oncology-Sugar Land, Fort Worth
| | - Carla I. Falkson
- Department of Medicine, Hematology/Oncology, University of Rochester, Rochester, New York
| | | | - Rojymon Jacob
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham
| | - Kathryn A. Winter
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
| | - Christopher H. Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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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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Bhatia S, Landier W, Paskett ED, Peters KB, Merrill JK, Phillips J, Osarogiagbon RU. Rural-Urban Disparities in Cancer Outcomes: Opportunities for Future Research. J Natl Cancer Inst 2022; 114:940-952. [PMID: 35148389 PMCID: PMC9275775 DOI: 10.1093/jnci/djac030] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/27/2021] [Accepted: 02/01/2022] [Indexed: 01/12/2023] Open
Abstract
Cancer care disparities among rural populations are increasingly documented and may be worsening, likely because of the impact of rurality on access to state-of-the-art cancer prevention, diagnosis, and treatment services, as well as higher rates of risk factors such as smoking and obesity. In 2018, the American Society of Clinical Oncology undertook an initiative to understand and address factors contributing to rural cancer care disparities. A key pillar of this initiative was to identify knowledge gaps and promote the research needed to understand the magnitude of difference in outcomes in rural vs nonrural settings, the drivers of those differences, and interventions to address them. The purpose of this review is to describe continued knowledge gaps and areas of priority research to address them. We conducted a comprehensive literature review by searching the PubMed (Medline), Embase, Web of Science, and Cochrane Library databases for studies published in English between 1971 and 2021 and restricted to primary reports from populations in the United States and abstracted data to synthesize current evidence and identify continued gaps in knowledge. Our review identified continuing gaps in the literature regarding the underlying causes of rural-urban disparities in cancer outcomes. Rapid advances in cancer care will worsen existing disparities in outcomes for rural patients without directed effort to understand and address barriers to high-quality care in these areas. Research should be prioritized to address ongoing knowledge gaps about the drivers of rurality-based disparities and preventative and corrective interventions.
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Affiliation(s)
- Smita Bhatia
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Wendy Landier
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Hubler A, Wakefield DV, Makepeace L, Carnell M, Sharma AM, Jiang B, Dove AP, Garner WB, Edmonston D, Little JG, Ozdenerol E, Hanson RB, Martin MY, Shaban-Nejad A, Pisu M, Schwartz DL. Independent Predictors for Hospitalization-Associated Radiotherapy Interruptions. Adv Radiat Oncol 2022; 7:101041. [PMID: 36158745 PMCID: PMC9489733 DOI: 10.1016/j.adro.2022.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/24/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Radiation treatment interruption associated with unplanned hospitalization remains understudied. The intent of this study was to benchmark the frequency of hospitalization-associated radiation therapy interruptions (HARTI), characterize disease processes causing hospitalization during radiation, identify factors predictive for HARTI, and localize neighborhood environments associated with HARTI at our academic referral center. Methods and Materials This retrospective review of electronic health records provided descriptive statistics of HARTI event rates at our institutional practice. Uni- and multivariable logistic regression models were developed to identify significant factors predictive for HARTI. Causes of hospitalization were established from primary discharge diagnoses. HARTI rates were mapped according to patient residence addresses. Results Between January 1, 2015, and December 31, 2017, 197 HARTI events (5.3%) were captured across 3729 patients with 727 total missed treatments. The 3 most common causes of hospitalization were malnutrition/dehydration (n = 28; 17.7%), respiratory distress/infection (n = 24; 13.7%), and fever/sepsis (n = 17; 9.7%). Factors predictive for HARTI included African-American race (odds ratio [OR]: 1.48; 95% confidence interval [CI], 1.07-2.06; P = .018), Medicaid/uninsured status (OR: 2.05; 95% CI, 1.32-3.15; P = .0013), Medicare coverage (OR: 1.7; 95% CI, 1.21-2.39; P = .0022), lung (OR: 5.97; 95% CI, 3.22-11.44; P < .0001), and head and neck (OR: 5.6; 95% CI, 2.96-10.93; P < .0001) malignancies, and prescriptions >20 fractions (OR: 2.23; 95% CI, 1.51-3.34; P < .0001). HARTI events clustered among Medicaid/uninsured patients living in urban, low-income, majority African-American neighborhoods, and patients from middle-income suburban communities, independent of race and insurance status. Only the wealthiest residential areas demonstrated low HARTI rates. Conclusions HARTI disproportionately affected socioeconomically disadvantaged urban patients facing a high treatment burden in our catchment population. A complementary geospatial analysis also captured the risk experienced by middle-income suburban patients independent of race or insurance status. Confirmatory studies are warranted to provide scale and context to guide intervention strategies to equitably reduce HARTI events.
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Affiliation(s)
- Adam Hubler
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Daniel V. Wakefield
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
- Tennessee Oncology, Nashville, Tennessee
| | - Lydia Makepeace
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Matt Carnell
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Ankur M. Sharma
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Bo Jiang
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Austin P. Dove
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennesse
| | - Wesley B. Garner
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Drucilla Edmonston
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - John G. Little
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Esra Ozdenerol
- Department of Earth Sciences, University of Memphis, Memphis, Tennessee
| | - Ryan B. Hanson
- Department of Earth Sciences, University of Memphis, Memphis, Tennessee
| | - Michelle Y. Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Arash Shaban-Nejad
- UTHSC-ORNL Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, Tennesse
| | - Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David L. Schwartz
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
- Corresponding author: David L. Schwartz, MD, FACR
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7
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Price AT, Canfield C, Hugo GD, Kavanaugh JA, Henke LE, Laugeman E, Samson P, Reynolds-Kueny C, Cudney EA. Techno-Economic Feasibility Analysis of a Fully Mobile Radiation Oncology System Using Monte Carlo Simulation. JCO Glob Oncol 2022; 8:e2100284. [PMID: 35609229 PMCID: PMC9173580 DOI: 10.1200/go.21.00284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Disparities in radiation oncology (RO) can be attributed to geographic location, socioeconomic status, race, sex, and other societal factors. One potential solution is to implement a fully mobile (FM) RO system to bring radiotherapy to rural areas and reduce barriers to access. We use Monte Carlo simulation to quantify techno-economic feasibility with uncertainty, using two rural Missouri scenarios.
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Affiliation(s)
- Alex T Price
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO.,Department of Engineering Management and Systems Engineering, Missouri University of Science and Technology, Rolla, MO
| | - Casey Canfield
- Department of Engineering Management and Systems Engineering, Missouri University of Science and Technology, Rolla, MO
| | - Geoffrey D Hugo
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - James A Kavanaugh
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Pamela Samson
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Clair Reynolds-Kueny
- Department of Psychological Science, Missouri University of Science and Technology, Rolla, MO
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Sholklapper TN, Creswell ML, Payne AT, Markel M, Pepin A, Carrasquilla M, Zwart A, Danner M, Ayoob M, Yung T, Collins B, Kumar D, Aghdam N, Suy S, Hankins RA, Kowalczyk K, Collins SP. Patient-Reported Financial Burden Following Stereotactic Body Radiation Therapy for Localized Prostate Cancer. Front Oncol 2022; 12:852844. [PMID: 35402242 PMCID: PMC8990911 DOI: 10.3389/fonc.2022.852844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction and Objectives In patients with localized prostate cancer, 5-fraction, stereotactic body radiation therapy (SBRT) has been found to offer comparable oncologic outcomes and potential for improved treatment compliance compared to conventional, 40-plus fraction radiation therapy (RT). Recent studies of oncologic patient experiences have highlighted both the impact of therapy-associated financial toxicity (FT) on treatment adherence and health-related quality of life (HRQOL). Methods A cross-sectional assessment of FT after SBRT was performed using the 12-item COST questionnaire. The total questionnaire score (range 0–44) was used to evaluate the FT grade (0–3), with a higher COST value representing lower grade. The patient zip code was used to approximate the distance from the index hospital. Univariate and multivariate analyses of the average COST score (0–4) are performed. Results The response rate was 57.5% (332 of 575 consented patients) with 90.7%, 8.2%, and 1.1% experiencing grade 0, 1, and 2 FT, respectively, with no grade 3. Unemployment or disability, non-white race, low income, and concurrent hormonal therapy were associated with a statistically significant worse FT (lower COST value) on univariate and multivariate analyses (p < 0.05). Education level and insurance status significant were evaluated on univariate analysis only. There was a non-statistically significant difference in age, marital status, time since treatment, and distance from the index hospital. Conclusions SBRT was associated with low FT. However, statistically significant socioeconomic disparities in FT remain despite ultra-hypofractionated treatment.
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Affiliation(s)
| | | | - Alexandra T Payne
- Georgetown University School of Medicine, Washington, DC, United States
| | - Michael Markel
- Georgetown University School of Medicine, Washington, DC, United States
| | - Abigail Pepin
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Michael Carrasquilla
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Alan Zwart
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Malika Danner
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Marilyn Ayoob
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Brian Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Deepak Kumar
- Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, Durham, NC, United States
| | - Nima Aghdam
- Department of Radiation Medicine, Beth Israel Deaconess, Boston, MA, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Ryan A Hankins
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Keith Kowalczyk
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
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Kronfli D, Savla B, Lievers A, Baker K, Eggleston C, Miller R, Bentzen SM, Mohindra P, Vyfhuis MA. Identifying Psychosocial Needs of Cancer Patients Undergoing Curative Radiation Therapy in an Inner-City Academic Center to Address Racial Disparities. Int J Radiat Oncol Biol Phys 2022; 114:185-194. [DOI: 10.1016/j.ijrobp.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/17/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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10
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Wakefield DV, Eichler T, Wilson E, Gardner L, Collet-Lipscomb C, Schwartz DL. Variable Impact of the COVID-19 Pandemic on U.S. Radiation Oncology Practices. Int J Radiat Oncol Biol Phys 2022; 113:14-20. [PMID: 35122927 PMCID: PMC8810273 DOI: 10.1016/j.ijrobp.2022.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/01/2022]
Abstract
Early in the pandemic, the American Society for Radiation Oncology (ASTRO) surveyed physician leaders at U.S. radiation oncology practices to understand how the field was responding to the outbreak of COVID-19. Surveys were repeated at multiple points during the pandemic, with a response rate of 43% in April 2020 and 23% in January 2021. To our knowledge, this is the only longitudinal COVID-19 practice survey in oncology in the U.S. The surveys indicate that patient access to essential radiation oncology services in the United States has been preserved throughout the COVID-19 pandemic. Safety protocols were universally adopted, telehealth was widely adopted and remains in use, and most clinics no longer deferred or postponed radiation treatments as of early 2021. Late-stage disease presentation, treatment interruptions, PPE shortages, and vaccination barriers were reported significantly more at community-based practices than academic practices, and rural practices appear to have faced increased obstacles. These findings provide unique insights into the initial longitudinal impact of the COVID-19 pandemic on the delivery of radiation therapy in the United States. Downstream lessons in service adaptation and improvement can potentially be guided by formal concepts of resilience, which have been broadly embraced across the U.S. economy.
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Affiliation(s)
| | - Thomas Eichler
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| | - Emily Wilson
- American Society for Radiation Oncology, Arlington, VA
| | - Liz Gardner
- American Society for Radiation Oncology, Arlington, VA
| | | | - David L Schwartz
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, TN
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Abstract
Neighborhood has significant implications for breast cancer screening, stage, treatment, and mortality. Patients residing in neighborhoods with high deprivation or rurality face barriers and challenges to accessing and receiving care. Consequently, they experience higher mortality rates than their financially affluent or urban counterparts. There are multiple gaps in the literature on the relationship between place of residence and the use of systemic therapies or emerging surgical strategies for disease management. As the management of breast cancer continues to evolve, additional studies are needed to understand the implications of place on the implementation and dissemination of new and emerging treatment modalities.
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Affiliation(s)
- Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th, Columbus, OH 43210, USA.
| | - Barnabas Obeng-Gyasi
- Department of Radiology, Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710, USA
| | - Willi Tarver
- Division of Cancer Prevention & Control, Department of Internal Medicine, College of Medicine, The Ohio State University, 460 Medical Center Drive, Room 526, Columbus, OH 43210, USA
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