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Nalluri H, Marmor S, Prathibha S, Jenkins A, Dindinger-Hill K, Kihara M, Sundberg MA, Day LW, Owen MJ, Lowry AC, Tuttle TM. Evaluating Disparities in Colon Cancer Survival in American Indian/Alaskan Native Patients Using the National Cancer Database. J Racial Ethn Health Disparities 2024; 11:2407-2415. [PMID: 37432562 DOI: 10.1007/s40615-023-01706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Studies demonstrate higher mortality rates from colon cancer in American Indian/Alaskan Native (AI/AN) patients compared to non-Hispanic White (nHW). We aim to identify factors that contribute to survival disparities. METHODS We used the National Cancer Database to identify AI/AN (n = 2127) and nHW (n = 527,045) patients with stage I-IV colon cancer from 2004 to 2016. Overall survival among stage I-IV colon cancer patients was estimated by Kaplan-Meier analysis; Cox proportional hazard ratios were used to identify independent predictors of survival. RESULTS AI/AN patients with stage I-III disease had significantly shorter median survival than nHW (73 vs 77 months, respectively; p < 0.001); there were no differences in survival for stage IV. Adjusted analyses demonstrated that AI/AN race was an independent predictor of higher overall mortality compared to nHW (HR 1.19, 95% CI 1.01-1.33, p = 0.002). Importantly, compared to nHW, AI/AN were younger, had more comorbidities, had greater rurality, had more left-sided colon cancers, had higher stage but lower grade tumors, were less frequently treated at an academic facility, were more likely to experience a delay in initiation of chemotherapy, and were less likely to receive adjuvant chemotherapy for stage III disease. We found no differences in sex, receipt of surgery, or adequacy of lymph node dissection. CONCLUSION We found patient, tumor, and treatment factors that potentially contribute to worse survival rates observed in AI/AN colon cancer patients. Limitations include the heterogeneity of AI/AN patients and the use of overall survival as an endpoint. Additional studies are needed to implement strategies to eliminate disparities.
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Affiliation(s)
- Harika Nalluri
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Saranya Prathibha
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Asher Jenkins
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Michelle Kihara
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Michael A Sundberg
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA
| | - Mary J Owen
- Department of Family Medicine and BioBehavioral Health, University of Minnesota, Duluth, MN, USA
- Center for American Indian and Minority Health, University of Minnesota, Duluth, MN, USA
| | - Ann C Lowry
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
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Mizuno S, Shigeta K, Kato Y, Okui J, Morita S, Sonal S, Goldstone R, Berger D, Al-Masri R, Al-Masri M, Tajima Y, Kikuchi H, Hirata A, Nakadai J, Baba H, Sugiura K, Hoshino G, Seo Y, Makino A, Suzumura H, Suzuki Y, Adachi Y, Shimada T, Kondo T, Matsui S, Seishima R, Okabayashi K, Kitagawa Y, Kunitake H. Stratification of Stage II Colon Cancer Using Recurrence Prediction Value: A Multi-institutional International Retrospective Study. Ann Surg 2024; 280:274-282. [PMID: 37823278 DOI: 10.1097/sla.0000000000006120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To create a recurrence prediction value (RPV) of high-risk factor and identify the patients with high risk of cancer recurrence. BACKGROUND There are several high-risk factors known to lead to poor outcomes. Weighting each high-risk factor based on their association with increased risk of cancer recurrence can provide a more precise understanding of risk of recurrence. METHODS We performed a multi-institutional international retrospective analysis of patients with stage II colon cancer patients who underwent surgery from 2010 to 2020. Patient data from a multi-institutional database were used as the Training data, and data from a completely separate international database from 2 countries were used as the Validation data. The primary endpoint was recurrence-free survival. RESULTS A total of 739 patients were included from Training data. To validate the feasibility of RPV, 467 patients were included from Validation data. Training data patients were divided into RPV low (n=564) and RPV high (n=175). Multivariate analysis revealed that risk of recurrence was significantly higher in the RPV high than the RPV low [hazard ratio (HR) 2.628; 95% confidence interval (CI) 1.887-3.660; P <0.001). Validation data patients were divided into 2 groups (RPV low, n=420) and RPV high (n=47). Multivariate analysis revealed that risk of recurrence was significantly higher in the RPV high than the RPV low (HR 3.053; 95% CI 1.962-4.750; P <0.001). CONCLUSIONS RPV can identify stage II colon cancer patients with high risk of cancer recurrence worldwide.
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Affiliation(s)
- Shodai Mizuno
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Shigeta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yujin Kato
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Jun Okui
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Satoru Morita
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Swati Sonal
- General and Gastrointestinal Surgery, Massachusetts General Hospital, MA
| | - Robert Goldstone
- General and Gastrointestinal Surgery, Massachusetts General Hospital, MA
| | - David Berger
- General and Gastrointestinal Surgery, Massachusetts General Hospital, MA
| | - Rama Al-Masri
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Mahmoud Al-Masri
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Yuki Tajima
- Department of Surgery, Hiratsuka City Hospital, Kanagawa, Japan
| | - Hiroto Kikuchi
- Department of Surgery, Hiratsuka City Hospital, Kanagawa, Japan
| | - Akira Hirata
- Department of Surgery, Hiratsuka City Hospital, Kanagawa, Japan
| | - Jumpei Nakadai
- Department of Surgery, Saitama City Hospital, Saitama, Japan
| | - Hideo Baba
- Department of Surgery, Saitama City Hospital, Saitama, Japan
| | - Kiyoaki Sugiura
- Department of Surgery, Japan Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Go Hoshino
- Department of Surgery, Japan Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Yuki Seo
- Department of Surgery, Japan Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Akitsugu Makino
- Department of Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Hirofumi Suzumura
- Department of Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Yoshiyuki Suzuki
- Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yoko Adachi
- Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takehiro Shimada
- Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takayuki Kondo
- Department of Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Shimpei Matsui
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Seishima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroko Kunitake
- General and Gastrointestinal Surgery, Massachusetts General Hospital, MA
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3
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Tobin EC, Dobbs E, Deslich S, Richmond BK. Race/Ethnicity and Social Determinants of Health and Their Impact on the Timely Receipt of Appropriate Operative Treatment of Colon Cancer. Am Surg 2024; 90:1475-1480. [PMID: 38551594 DOI: 10.1177/00031348241241697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Rates of appropriate surgical treatment of colon cancer are historically worse in traditionally marginalized populations. We sought to examine which social determinants of health may be associated with longer time to appropriate operative intervention. METHODS The National Cancer Databank was queried for this retrospective study. Adult patients (18 to 90 years of age) diagnosed between 2004 and 2018 with single or primary, stage III colon cancer were included. Patient demographic variables included age at diagnosis, sex, ethnicity (Hispanic or non-Hispanic), comorbidity score, median household income, education status, rural/urban status, treatment facility type and location, and insurance status. Disease characteristics include stage (stage 3), primary site, surgical margins, tumor size, and number of nodes resected. Reported descriptive statistics include means and 95% confidence intervals for continuous variables and frequency and proportions for categorical variables. Univariate and multivariate analyses were performed. RESULTS A total of 134,601 individuals diagnosed with stage 3 colon cancer were included. Time to surgery in all cases had a mean of 26.4 ± 19.0 days. Multivariate analysis of time to surgery indicated that receiving surgery at a Community Cancer Program, Charlson-Deyo Score of 0, younger age, and non-Hispanic-White race/ethnicity are associated with decreased time to surgery (P < .001). CONCLUSION Patients who receive surgery at a Community Cancer Program, have fewer comorbidities, have lower household income, are younger, and receive surgery within 50 miles of their primary residence are more likely to have timely surgery.
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Affiliation(s)
- Edward C Tobin
- Department of Surgery, Charleston Area Medical Center, Charleston, WV, USA
| | - Erica Dobbs
- Department of Surgery, Charleston Area Medical Center, Charleston, WV, USA
| | - Stacie Deslich
- Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV, USA
| | - Bryan K Richmond
- Department of Surgery, West Virginia University Charleston, Charleston Area Medical Center, Charleston, WV, USA
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Buchheit JT, Silver CM, Huang R, Hu YY, Bentrem DJ, Odell DD, Merkow RP. Association Between Racial and Socioeconomic Disparities and Hospital Performance in Treatment and Outcomes for Patients with Colon Cancer. Ann Surg Oncol 2024; 31:1075-1086. [PMID: 38062293 DOI: 10.1245/s10434-023-14607-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/31/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Disparities in colon cancer care and outcomes by race/ethnicity, socioeconomic status (SES), and insurance are well recognized; however, the extent to which inequalities are driven by patient factors versus variation in hospital performance remains unclear. We sought to compare disparities in care delivery and outcomes at low- and high-performing hospitals. METHODS We identified patients with stage I-III colon adenocarcinoma from the 2012-2017 National Cancer Database. Adequate lymphadenectomy and timely adjuvant chemotherapy administration defined hospital performance. Multilevel regression models evaluated disparities by race/ethnicity, SES, and insurance at the lowest- and highest-performance quartile hospitals. RESULTS Of 92,573 patients from 704 hospitals, 45,982 (49.7%) were treated at 404 low-performing hospitals and 46,591 (50.3%) were treated at 300 high-performing hospitals. Low-performing hospitals treated more non-Hispanic (NH) Black, Hispanic, low SES, and Medicaid patients (all p < 0.01). Among low-performing hospitals, patients with low versus high SES (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.82-0.92), and Medicare (OR 0.90, 95% CI 0.85-0.96) and Medicaid (OR 0.88, 95% CI 0.80-0.96) versus private insurance, had decreased odds of receiving high-quality care. At high-performing hospitals, NH Black versus NH White patients (OR 0.83, 95% CI 0.72-0.95) had decreased odds of receiving high-quality care. Low SES, Medicare, Medicaid, and uninsured patients had worse overall survival at low- and high-performing hospitals (all p < 0.01). CONCLUSION Disparities in receipt of high-quality colon cancer care occurred by SES and insurance at low-performing hospitals, and by race at high-performing hospitals. However, survival disparities by SES and insurance exist irrespective of hospital performance. Future steps include improving low-performing hospitals and identifying mechanisms affecting survival disparities.
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Affiliation(s)
- Joanna T Buchheit
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Casey M Silver
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Reiping Huang
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- American College of Surgeons, Chicago, IL, USA
| | - Yue-Yung Hu
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - David J Bentrem
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David D Odell
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ryan P Merkow
- American College of Surgeons, Chicago, IL, USA.
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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5
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Amini N, Demyan L, Shah M, Standring O, Gazzara E, Lad N, Deperalta DK, Weiss M, Deutsch G. Decreasing utilization of surgical interventions amongst patients with pancreatic neuroendocrine tumor with liver metastases. Am J Surg 2024; 227:77-84. [PMID: 37798150 DOI: 10.1016/j.amjsurg.2023.09.035] [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: 06/30/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Since 2013, North American Neuroendocrine Tumor Society (NANETS) consensus-guidelines have endorsed consideration of surgical intervention for pancreatic- neuroendocrine tumors (PNET) with liver metastases. METHODS Patients with non-functional PNET with liver only metastases from 2010 to 2019 were identified from the National Cancer Database. RESULTS 34.7% underwent surgical intervention (13% PNET resection, 2.1% surgical management of liver metastases (SMLM), 19.5% PNET resection + SMLM). In multivariable analysis, government insurance, year of diagnosis>2013, increasing primary tumor size were associated with lower rate of surgical intervention. Receiving treatment at an academic center (OR 3.59, 95%CI 1.81-7.11; P < 0.001) or integrated cancer network (OR 3.21, 95%CI 1.57-6.54; P = 0.001) was associated with a higher rate of surgical intervention. The overall rate of surgical intervention decreased from 45.7% in 2010 to 23.0% in 2019. CONCLUSION Despite guideline recommendations and the suggested survival benefits, only one-third of patients underwent surgical intervention, potentially influenced by the rising utilization of systemic therapy in the past decade.
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Affiliation(s)
- Neda Amini
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Lyudmyla Demyan
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Manav Shah
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA
| | - Oliver Standring
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Emma Gazzara
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Neha Lad
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Danielle K Deperalta
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA; Northwell Health Cancer Institute, 1111 Marcus Avenue, Lake Success, NY, 11042, USA; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA
| | - Matthew Weiss
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA; Northwell Health Cancer Institute, 1111 Marcus Avenue, Lake Success, NY, 11042, USA; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA
| | - Gary Deutsch
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA; Northwell Health Cancer Institute, 1111 Marcus Avenue, Lake Success, NY, 11042, USA; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA.
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6
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Horsey ML, Lai D, Sparks AD, Herur-Raman A, Borum M, Rao S, Ng M, Obias VJ. Disparities in utilization of robotic surgery for colon cancer: an evaluation of the U.S. National Cancer Database. J Robot Surg 2022; 16:1299-1306. [DOI: 10.1007/s11701-022-01371-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/09/2022] [Indexed: 12/15/2022]
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Hao S, Parikh AA, Snyder RA. Racial Disparities in the Management of Locoregional Colorectal Cancer. Surg Oncol Clin N Am 2021; 31:65-79. [PMID: 34776065 DOI: 10.1016/j.soc.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Racial disparities pervade nearly all aspects of management of locoregional colorectal cancer, including time to treatment, receipt of resection, adequacy of resection, postoperative complications, and receipt of neoadjuvant and adjuvant multimodality therapies. Disparate gaps in treatment translate into enduring effects on survivorship, recurrence, and mortality. Efforts to reduce these gaps in care must be undertaken on a multilevel basis and focus on modifiable factors that underlie racial disparity.
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Affiliation(s)
- Scarlett Hao
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Surgical Oncology Suite, 4S-24, Greenville, NC 27834, USA
| | - Alexander A Parikh
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Surgical Oncology Suite, 4S-24, Greenville, NC 27834, USA
| | - Rebecca A Snyder
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Surgical Oncology Suite, 4S-24, Greenville, NC 27834, USA.
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8
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Shannon AB, Straker RJ, Keele L, Kelz RR, Fraker DL, Roses RE, Miura JT, Karakousis GC. The impact of hospital volume on racial disparities in resected rectal cancer. J Surg Oncol 2021; 125:465-474. [PMID: 34705272 DOI: 10.1002/jso.26731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although high volume centers (HVC) equate to improved outcomes in rectal cancer, the impact of surgical volume related to race is less defined. METHODS Patients who underwent surgical resection for stage I-III rectal adenocarcinoma were divided into cohorts based on race and hospital surgical volume. Outcomes were analyzed following 1:1 propensity-score matching using logistic, Poisson, and Cox regression analyses with marginal effects. RESULTS Fifty-four thousand one hundred and eighty-four (91.5%) non-Black and 5043 (8.5%) Black patients underwent resection of rectal cancer. Following 1:1 matching of non-Black (N = 5026) and Black patients, 5-year overall survival (OS) of Black patients was worse (72% vs. 74.4%, average marginal effects [AME] 0.66, p = 0.04) than non-Black patients. When compared to non-Black patients managed at HVCs, Black patients had worse OS (70.1% vs. 74.7%, AME 1.55, p = 0.03), but this difference was not significant when comparing OS between non-Black and Black patients managed at HVCs (72.3% vs. 74.7%, AME 0.62, p = 0.06). Length of stay was longer among Black and HVC patients across all cohorts. There was no difference across cohorts in 90-day mortality. CONCLUSIONS Although racial disparities exist in rectal cancer, this disparity appears to be ameliorated when patients are managed at HVCs.
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Affiliation(s)
- Adrienne B Shannon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard J Straker
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Luke Keele
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel R Kelz
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas L Fraker
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert E Roses
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John T Miura
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Salem ME, Puccini A, Trufan SJ, Sha W, Kadakia KC, Hartley ML, Musselwhite LW, Symanowski JT, Hwang JJ, Raghavan D. Impact of Sociodemographic Disparities and Insurance Status on Survival of Patients with Early-Onset Colorectal Cancer. Oncologist 2021; 26:e1730-e1741. [PMID: 34288237 PMCID: PMC8488791 DOI: 10.1002/onco.13908] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background Low socioeconomic status (SES) has been linked to worse survival in patients with colorectal cancer (CRC); however, the impact of SES on early‐onset CRC remains undescribed. Materials and Methods Retrospective analysis of data from the National Cancer Database (NCDB) between 2004 and 2016 was conducted. We combined income and education to form a composite measure of SES. Logistic regression and χ2 testing were used to examine early‐onset CRC according to SES group. Survival rates and Cox proportional hazards models compared stage‐specific overall survival (OS) between the SES groups. Results In total, 30,903 patients with early‐onset CRC were identified, of whom 78.7% were White; 14.5% were Black. Low SES compared with high SES patients were more likely to be Black (26.3% vs. 6.1%) or Hispanic (25.3% vs. 10.5%), have T4 tumors (21.3% vs. 17.8%) and/or N2 disease (13% vs. 11.1%), and present with stage IV disease (32.8% vs. 27.7%) at diagnosis (p < .0001, all comparisons). OS gradually improved with increasing SES at all disease stages (p < .001). In stage IV, the 5‐year survival rate was 13.9% vs. 21.7% for patients with low compared with high SES. In multivariable analysis, SES (low vs. high group; adjusted hazard ratio [HRadj], 1.35; 95% confidence interval [CI], 1.26–1.46) was found to have a significant effect on survival (p < .0001) when all of the confounding variables were adjusted. Insurance (not private vs. private; HRadj, 1.38; 95% CI, 1.31–1.44) mediates 31% of the SES effect on survival. Conclusion Patients with early‐onset CRC with low SES had the worst outcomes. Our data suggest that SES should be considered when implementing programs to improve the early detection and treatment of patients with early‐onset CRC. Implications for Practice Low socioeconomic status (SES) has been linked to worse survival in patients with colorectal cancer (CRC); however, the impact of SES on early‐onset CRC remains undescribed. In this retrospective study of 30,903 patients with early‐onset CRC in the National Cancer Database, a steady increase in the yearly rate of stage IV diagnosis at presentation was observed. The risk of death increased as socioeconomic status decreased. Race and insurance status were independent predictors for survival. Implementation of programs to improve access to care and early diagnostic strategies among younger adults, especially those with low SES, is warranted. The incidence of and mortality from early‐onset colorectal cancer (CRC) is on the rise. This article details the relationship between socioeconomic status and clinical outcomes of young adults with early‐onset CRC.
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Affiliation(s)
- Mohamed E Salem
- Departments of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Alberto Puccini
- Ospedale Policlinico San Martino IRCCS, University of Genova, Genoa, Italy
| | - Sally J Trufan
- Cancer Biostatistics, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Wei Sha
- Cancer Biostatistics, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Kunal C Kadakia
- Departments of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Marion L Hartley
- The Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Laura W Musselwhite
- Departments of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - James T Symanowski
- Cancer Biostatistics, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Jimmy J Hwang
- Departments of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Derek Raghavan
- Departments of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
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10
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Bridges LC, Honaker MD, Smith BE, Montgomery A. Insurance Status in Rectal Cancer is Associated With Age at Diagnosis and May be Associated With Overall Survival. Am Surg 2020; 87:105-108. [PMID: 32833496 DOI: 10.1177/0003134820942161] [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 There are approximately 44 180 new cases of rectal cancer diagnosed annually. While surgical resection remains the standard of care for definitive treatment, neoadjuvant chemoradiation therapy (NCRT) has significantly reduced recurrence rates postoperatively. NCRT is indicated for T3/T4 tumors, and relative indications include patients with T1/T2 lesions with clinically positive nodes. While this remains the standard of care, all patients may not receive equal treatment for their rectal cancer depending on various healthcare disparities. We aimed to discover how insurance status affected rectal cancer patients' time of diagnosis to treatment, age of diagnosis, and overall vitality. METHODS A single-center retrospective chart and cancer registry review was performed for all patients diagnosed with rectal cancer of any stage between 2011 and 2018. A total of 94 rectal cancer patients were included in the analysis. Age, race, sex, insurance status, vitality, and grade were assessed. Time in days of diagnosis to the time of first treatment (neoadjuvant chemotherapy or radiation) was measured. Continuous variables were reported as means and SDs or medians and interquartile ranges and were analyzed with the unpaired t-test or Mann-Whitney U-test. Categorical variables were reported as frequencies and percentages and were analyzed with Fisher's exact test. Statistical significance was determined with a P < .05. All analyses were conducted using SAS version 9.4 (SAS Institute, Cary, NC, USA). RESULTS Total race breakdown was as follows: white (61%), African-American (30%), and other (3%). There was no statistically significant difference in diagnosis time to first treatment in the uninsured versus insured groups (P = .9). There was a statistically significant difference in the age of diagnosis with insured mean age of 60.9 years and uninsured mean age of 52.4 years (P = .0080). There was no statistically significant difference in survival between the 2 groups (P = .54). For those who went onto have surgery, there was no difference in the median number of lymph nodes harvested between the 2 groups (P = .73). CONCLUSION Insurance status did not affect timing to treatment or survival. Uninsured patients had a younger age of diagnosis by approximately 8 years on average. Uninsured patients received the same quality surgeries as uninsured patients in regard to lymph node harvests.
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Affiliation(s)
- Lindsey C Bridges
- 5223Department of Surgery, Medical Center Navicent Health, Macon, GA, USA
| | - Michael D Honaker
- 5225Department of Surgical Oncology and Colorectal Surger, Mercer University School of Medicine, Macon, GA, USA
| | - Betsy E Smith
- 5225Internal Medicine and Community Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Anne Montgomery
- 5225Department of Biostatistics, Georgia Rural Health Innovation Center, Mercer University School of Medicine, Mercer University, Macon, GA, USA
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Alty IG, Dee EC, Cusack JC, Blaszkowsky LS, Goldstone RN, Francone TD, Wo JY, Qadan M. Refusal of surgery for colon cancer: Sociodemographic disparities and survival implications among US patients with resectable disease. Am J Surg 2020; 221:39-45. [PMID: 32723488 DOI: 10.1016/j.amjsurg.2020.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND We aimed to identify factors associated with refusal of surgery among patients with colon cancer. METHODS This 2004-2016 NCDB retrospective study identified AJCC stage I-III colon cancer patients who were recommended surgery. Multivariable logistic regression defined adjusted odds ratios of refusing treatment, with sociodemographic and clinical covariates. Treatment propensity-adjusted Cox proportional hazard ratios defined differential survival stratified by clinical stage, controlling for potential confounders. RESULTS Of 170,594 patients recommended surgery, 1116 refused. Increased rates of surgery refusal were associated with older age, African American race, CDCC>3, and female sex. Decreased rates of surgery refusal were associated with higher income and private insurance. Stratifying by stage, refusal rates among African Americans remained disparately high. Refusal of surgery was associated with worse overall survival. CONCLUSIONS Disparate rates of refusal of surgery for resectable colon cancer by race and other sociodemographic factors highlight potential treatment adherence reinforcement beneficiaries, necessitating further study of shared decision-making.
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Affiliation(s)
| | | | - James C Cusack
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Jennifer Y Wo
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Newton-Wellesley Hospital, Newton, MA, USA
| | - Motaz Qadan
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Newton-Wellesley Hospital, Newton, MA, USA.
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