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Jacobs KT, Liu Q, Brown CP, Lopes G, Pinheiro PS. Racial/ethnic disparities in curative-intent treatment for early-stage non-small cell lung cancer patients among heterogeneous Black populations: US-born Black, Afro-Haitian, West Indian Black, and Hispanic Black. Cancer Med 2024; 13:e7449. [PMID: 39377643 PMCID: PMC11459681 DOI: 10.1002/cam4.7449] [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] [Received: 02/01/2024] [Revised: 06/10/2024] [Accepted: 06/24/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Heterogeneous Black populations encounter significant obstacles in accessing cancer care, yet research on lung cancer treatment disparities remains limited. This study investigates whether the disparity in receiving curative-intent treatment (curative-intent surgery and/or stereotactic body radiation therapy [SBRT]) for early-stage non-small cell lung cancer (NSCLC) between non-Hispanic Whites (NHWs) and total Blacks extends to diverse Black populations, including US-born, Afro-Haitian, West Indian Black, and Hispanic Black individuals. METHODS This cross-sectional study included all Florida cancer registry early-stage NSCLC cases 2005-2017, linked to individual-level discharge data containing comorbidity and specific treatment details (surgery and/or SBRT). Multivariable logistic regression assessed the association between race/ethnicity and the receipt of curative-intent treatment, while accounting for sociodemographic factors (poverty, age, insurance, and smoking status) and clinical variables. RESULTS Among 55,655 early-stage NSCLC patients, 71.1% received curative-intent treatment: 72.1% NHW and 59.7% Black (non-Hispanic and Hispanic) individuals. Black patients had 35% lower odds (ORadj, 0.65; 95% CI, 0.59-0.70) of receiving curative-intent treatment compared to NHW patients. ORs varied from 0.57 (95% CI, 0.59-0.70) for Hispanic Black to 0.76 (95% CI, 0.56-1.02) for West Indian Black. Remarkably, Black-White disparities persisted despite the availability of curative treatment options (SBRT) for both high Charlson Comorbidity Index (CCI) observed among US-born Blacks and surgery for low CCI patients among all other Black subgroups. CONCLUSIONS Pronounced disparities in accessing curative-intent treatments for early-stage NSCLC were evident across all Black subgroups, regardless of treatment availability and comorbidity profile. These findings underscore the need to address Black heterogeneity and prompt further research to rectify treatment disparities in early-stage NSCLC.
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Affiliation(s)
- Kamaria T. Jacobs
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public HealthFlorida A&M UniversityTallahasseeFloridaUSA
| | - Qinran Liu
- Department of Public Health SciencesUniversity of Miami School of MedicineMiamiFloridaUSA
- Department of Surveillance and Health Equity ScienceAmerican Cancer SocietyAtlantaGeorgiaUSA
| | - Clyde P. Brown
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public HealthFlorida A&M UniversityTallahasseeFloridaUSA
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Paulo S. Pinheiro
- Department of Public Health SciencesUniversity of Miami School of MedicineMiamiFloridaUSA
- Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFloridaUSA
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Van Haren RM, Kovacic MB, Delman AM, Pratt CG, Griffith A, Arbili L, Harvey K, Kohli E, Pai A, Topalian A, Rai SN, Shah SA, Kues J. Disparities Associated with Decision to Undergo Oncologic Surgery: A Prospective Mixed-Methods Analysis. Ann Surg Oncol 2024; 31:5757-5764. [PMID: 38869765 PMCID: PMC11300547 DOI: 10.1245/s10434-024-15610-4] [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] [Received: 01/26/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Underrepresented minority patients with surgical malignancies experience disparities in outcomes. The impact of provider-based factors, including communication, trust, and cultural competency, on outcomes is not well understood. This study examines modifiable provider-based barriers to care experienced by patients with surgical malignancies. METHODS A parallel, prospective, mixed-methods study enrolled patients with lung or gastrointestinal malignancies undergoing surgical consultation. Surveys assessed patients' social needs and patient-physician relationship. Semi-structured interviews ascertained patient experiences and were iteratively analyzed, identifying key themes. RESULTS The cohort included 24 patients (age 62 years; 63% White and 38% Black/African American). The most common cancers were lung (n = 18, 75%) and gastroesophageal (n = 3, 13%). Survey results indicated that food insecurity (n = 5, 21%), lack of reliable transportation (n = 4, 17%), and housing instability (n = 2, 8%) were common. Lack of trust in their physician (n = 3, 13%) and their physician's treatment recommendation (n = 3, 13%) were identified. Patients reported a lack of empathy (n = 3, 13%), lack of cultural competence (n = 3, 13%), and inadequate communication (n = 2, 8%) from physicians. Qualitative analysis identified five major themes regarding the decision to undergo surgery: communication, trust, health literacy, patient fears, and decision-making strategies. Five patients (21%) declined the recommended surgery and were more likely Black (100% vs. 21%), lower income (100% vs. 16%), and reported poor patient-physician relationship (40% vs. 5%; all p < 0.05). CONCLUSIONS Factors associated with declining recommended cancer surgery were underrepresented minority race and poor patient-physician relationships. Interventions are needed to improve these barriers to care and racial disparities.
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Affiliation(s)
- Robert M Van Haren
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Melinda Butsch Kovacic
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Aaron M Delman
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Catherine G Pratt
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Azante Griffith
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lana Arbili
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Krysten Harvey
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Eshika Kohli
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ahna Pai
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alique Topalian
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Shesh N Rai
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Shimul A Shah
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John Kues
- University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Jindani R, Rodriguez-Quintero JH, Kamel M, Zhu R, Vimolratana M, Chudgar N, Stiles B. Trends and Disparities in Robotic Surgery Utilization for Non-Small Cell Lung Cancer. J Surg Res 2024; 302:24-32. [PMID: 39074425 DOI: 10.1016/j.jss.2024.07.008] [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: 12/04/2023] [Revised: 05/04/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION Robotic surgery has become an increasingly utilized approach for resectable lung cancer. However, availability may be limited for certain patient populations, underscoring inequity in access to innovative surgical techniques. We hypothesize that there is an association between social determinants of health and robotic surgery utilization for resectable non-small cell lung cancer (NSCLC). METHODS We queried the National Cancer Database (2010-2019) for patients with clinical stage I-III NSCLC who underwent resection, stratifying the cohort based on surgical technique. Multivariable logistic regression analysis was performed to identify associations between sociodemographic and clinicopathologic factors and the robotic approach. RESULTS Among the 226,455 clinical stage I-III NSCLC patients identified, 34,059 (15%) received robotic resections, 78,039 (34.5%) underwent thoracoscopic resections, and 114,357 (50.5%) had open resections. Robotic surgery utilization increased from 3.1% in 2010 to 34% in 2019 (P < 0.001). Despite this, after adjusting by clinical stage, extent of resection, site of tumor, and receipt of neoadjuvant therapy, multivariable analysis revealed various sociodemographic and treatment facility factors that were associated with underutilization of this approach: lack of insurance (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.73-0.93), lower income brackets (aOR 0.93, 95% CI 0.91-0.96), provincial settings (urban aOR 0.79, 95% CI 0.76-0.82; rural aOR 0.57, 95% CI 0.51-0.64), and treatment at community centers (comprehensive community cancer programs aOR 0.73, 95% CI 0.70-0.75; community cancer programs aOR 0.51, 95% CI 0.47-0.55). CONCLUSIONS This study suggests that disparities in determinants of health influence accessibility to robotic surgery for resectable NSCLC. Identification of these gaps is crucial to target vulnerable sectors of the population in promoting equality and uniformity in surgical treatment.
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Affiliation(s)
- Rajika Jindani
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | | | - Mohamed Kamel
- Division of Thoracic and Foregut Surgery, University of Rochester Medical Center, Rochester, New York
| | - Roger Zhu
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Marc Vimolratana
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Neel Chudgar
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Brendon Stiles
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
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Carver A, Scaggion A, Jurado-Bruggeman D, Blanck O, Dalqvist E, Romana Giglioli F, Jenko A, Karlsson K, Staykova V, Swinnnen A, Warren S, Mancosu P, Jornet N. Treatment planning and delivery practice of lung SBRT: Results of the 2022 ESTRO physics survey. Radiother Oncol 2024; 196:110318. [PMID: 38702015 DOI: 10.1016/j.radonc.2024.110318] [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: 11/20/2023] [Revised: 03/18/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE The use of Stereotactic Body Radiation Therapy (SBRT) in lung cancer is increasing. However, there is no consensus on the most appropriate treatment planning and delivery practice for lung SBRT. To gauge the range of practice, quantify its variability and identify where consensus might be achieved, ESTRO surveyed the medical physics community. MATERIALS AND METHODS An online survey was distributed to ESTRO's physicist membership in 2022, covering experience, dose and fractionation, target delineation, dose calculation and planning practice, imaging protocols, and quality assurance. RESULTS Two-hundred and forty-four unique answers were collected after data cleaning. Most respondents were from Europe the majority of which had more than 5 years' experience in SBRT. The large majority of respondents deliver lung SBRT with the VMAT technique on C-arm Linear Accelerators (Linacs) employing daily pre-treatment CBCT imaging. A broad spectrum of fractionation schemes were reported, alongside an equally wide range of dose prescription protocols. A clear preference was noted for prescribing to 95% or greater of the PTV. Several issues emerged regarding the dose calculation algorithm: 22% did not state it while 24% neglected to specify the conditions under which the dose was calculated. Contouring was usually performed on Maximum or Average Intensity Projection images while dose was mainly computed on the latter. No clear indications emerged for plan homogeneity, complexity, and conformity assessment. Approximately 40% of the responders participated in inter-centre credentialing of SBRT in the last five years. Substantial differences emerged between high and low experience centres, with the latter employing less accurate algorithms and older equipment. CONCLUSION The survey revealed an evident heterogeneity in numerous aspects of the clinical implementation of lung SBRT treatments. International guidelines and codes of practice might promote harmonisation.
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Affiliation(s)
- Antony Carver
- University Hospitals Birmingham NHS Foundation Trust, Department of Medical Physics, Birmingham, United Kingdom
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Diego Jurado-Bruggeman
- Institut Català d'Oncologia, Medical Physics and Radiation Protection Department, Girona, Spain
| | - Oliver Blanck
- University Medical Center Schleswig-Holstein, Department of Radiation Oncology, Kiel, Germany
| | - Emmy Dalqvist
- Karolinska University Hospital, Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden; KarolinskaInstitutet, Department of Oncology-Pathology, Stockholm, Sweden
| | | | - Aljasa Jenko
- Institute of Oncology Ljubljana, Department of Radiotherapy, Ljubljana, Slovenia
| | - Kristin Karlsson
- Karolinska University Hospital, Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden; KarolinskaInstitutet, Department of Oncology-Pathology, Stockholm, Sweden
| | - Vanya Staykova
- Guy's and St Thomas' NHS Foundation Trust, Radiotherapy Physics, London, United Kingdom
| | - Ans Swinnnen
- GROW School for Oncology, Maastricht University Medical Centre+, Department of Radiation Oncology (Maastro), Maastricht, The Netherlands
| | - Samantha Warren
- Northern Centre for Cancer Care, Freeman Hospital, Department of Medical Physics, Newcastle Upon Tyne, United Kingdom
| | - Pietro Mancosu
- IRCCS Humanitas Research Hospital, Medical Physics Unit, Department of Radiotherapy and Radiosurgery, Rozzano-Milan, Italy.
| | - Nuria Jornet
- Hospital de la Santa Creu i Sant Pau, Servei de Radiofísica i Radioprotecció, Barcelona, Spain
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Wainwright JV, Aggarwal C, Beucker S, Dougherty DW, Gabriel PE, Jacobs LA, Kalman J, Linn KA, Martella AO, Mehta SJ, Rhodes CM, Roy M, Schapira MM, Shulman LN, Steltz J, Stephens Shields AJ, Tan ASL, Thompson JC, Toneff H, Wender RC, Zeb S, Rendle KA, Vachani A, Bekelman JE. University of Pennsylvania Telehealth Research Center of Excellence. J Natl Cancer Inst Monogr 2024; 2024:62-69. [PMID: 38924794 PMCID: PMC11207744 DOI: 10.1093/jncimonographs/lgae011] [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: 12/01/2023] [Revised: 01/17/2024] [Accepted: 02/16/2024] [Indexed: 06/28/2024] Open
Abstract
Drawing from insights from communication science and behavioral economics, the University of Pennsylvania Telehealth Research Center of Excellence (Penn TRACE) is designing and testing telehealth strategies with the potential to transform access to care, care quality, outcomes, health equity, and health-care efficiency across the cancer care continuum, with an emphasis on understanding mechanisms of action. Penn TRACE uses lung cancer care as an exemplar model for telehealth across the care continuum, from screening to treatment to survivorship. We bring together a diverse and interdisciplinary team of international experts and incorporate rapid-cycle approaches and mixed methods evaluation in all center projects. Our initiatives include a pragmatic sequential multiple assignment randomized trial to compare the effectiveness of telehealth strategies to increase shared decision-making for lung cancer screening and 2 pilot projects to test the effectiveness of telehealth to improve cancer care, identify multilevel mechanisms of action, and lay the foundation for future pragmatic trials. Penn TRACE aims to produce new fundamental knowledge and advance telehealth science in cancer care at Penn and nationally.
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Affiliation(s)
- Jocelyn V Wainwright
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Charu Aggarwal
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Beucker
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - David W Dougherty
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter E Gabriel
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda A Jacobs
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Jillian Kalman
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin A Linn
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony O Martella
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Shivan J Mehta
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Corinne M Rhodes
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Megan Roy
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Marilyn M Schapira
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Lawrence N Shulman
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer Steltz
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alisa J Stephens Shields
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andy S L Tan
- Annenberg School for Communications, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey C Thompson
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah Toneff
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard C Wender
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sana Zeb
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katharine A Rendle
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anil Vachani
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Justin E Bekelman
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Liu Q, Medina HN, Rodriguez E, Jacobs KT, Brown C, Koru-Sengul T, Lopes G, Pinheiro PS. Trends and Disparities in Curative-Intent Treatment for Early-Stage Non-Small Cell Lung Cancer: A Population-Based Analysis of Surgery and SBRT. Cancer Epidemiol Biomarkers Prev 2024; 33:489-499. [PMID: 38252069 DOI: 10.1158/1055-9965.epi-23-1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/01/2023] [Accepted: 01/18/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Despite the increasing adoption of stereotactic body radiotherapy (SBRT) as a recommended alternative for early-stage non-small cell lung cancer (NSCLC), population-based research on racial/ethnic disparities in curative-intent treatment accounting for SBRT remains limited. This study investigated trends and disparities in receiving curative-intent surgery and/or SBRT in a diverse, retrospective cohort. METHODS Early-stage NSCLC cases (2005-2017) from the Florida cancer registry were linked to individual-level statewide discharge data containing comorbidities and specific treatment information. Joinpoint regression assessed trends in treatment receipt. Multivariable logistic regression examined associations between race/ethnicity and treatment type. RESULTS Among 64,999 patients with early-stage NSCLC, 71.6% received curative-intent treatment (surgery and/or SBRT): 73.1%, 72.4%, and 60.3% among Hispanic, White, and Black patients, respectively (P < 0.01). SBRT use increased steeply from 2005 to 2007 and then by 7.9% annually from 2007 to 2017 (P < 0.01); curative-intent surgery remained stable from 2005 to 2014 before declining by 6.2% annually during 2014-2017 (P = 0.04). The Black-White disparity in receipt of curative-intent treatment was significant [ORadj, 0.65; 95% confidence interval (CI), 0.60-0.71]. Patients with Charlson comorbidity index (CCI)≥3 had 36% (ORadj, 0.64; 95% CI, 0.60-0.69) lower odds of receiving curative-intent surgery and no significant difference for SBRT (ORadj, 1.06; 95% CI, 0.93-1.20) compared with CCI = 0. CONCLUSIONS Racial disparities in receiving curative-intent treatment for early-stage NSCLC persist despite the availability of SBRT, suggesting the full potential of curative-intent treatment for early-stage NSCLC remains unachieved. IMPACT Addressing disparities in early-stage NSCLC requires addressing differential treatment patterns and enhancing accessibility to treatments like underutilized SBRT, particularly for high-comorbidity populations such as Black patients.
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Affiliation(s)
- Qinran Liu
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | | | - Kamaria T Jacobs
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, Florida
| | - Clyde Brown
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, Florida
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
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McFadgen H, Lethbridge L, Dunbar M, Plourde M. Trends in lung cancer diagnosis and care among visible minorities and non-visible minorities in Canada. Cancer Causes Control 2024; 35:575-582. [PMID: 37932475 DOI: 10.1007/s10552-023-01816-6] [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: 07/28/2022] [Accepted: 10/12/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Identifying factors that influence the diagnosis and treatment of lung cancer is an important public health initiative. Various sociodemographic factors, including race and ethnicity, may influence an individual's risk of developing lung cancer, as well as access to relevant diagnostic and therapeutic procedures. METHODS Data from the 2006 Canadian long-form census were cross-linked with the Canadian Cancer Registry and hospital data to determine rates of lung cancer diagnosis among visible minorities and non-visible minorities in Canada, and to assess for differences in rates of hospital-based procedures pertaining to a lung cancer diagnosis based on visible-minority status. Individuals were allocated into six visible-minority categories, and separate results were generated nationally and across seven regions. Multivariate logistic regression controlled for relevant confounders. RESULTS Rates of lung cancer were significantly lower among visible minorities versus non-visible minorities (329 versus 1108 cases per 100 000). This result is consistent across all visible-minority subgroups. Among those with a diagnosis of lung cancer, procedure rates were higher for all visible minorities nationally (53.4% [95% CI 53.2-53.6]). Multivariable analysis demonstrated higher procedure rates in general for visible minorities with a lung cancer diagnosis compared to non-visible minorities (OR 1.158 95% CI 1.053-1.273). INTERPRETATION In Canada, visible minorities experience lower rates of lung cancer diagnosis than non-visible minorities. Among those with a lung cancer diagnosis, we did not identify any negative disparities in rates of relevant diagnostic or therapeutic procedures, based on visible-minority status.
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Affiliation(s)
- H McFadgen
- Department of Surgery, Dalhousie University, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada.
| | - L Lethbridge
- Department of Surgery, Dalhousie University, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - M Dunbar
- Department of Surgery, Dalhousie University, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - M Plourde
- Department of Surgery, Dalhousie University, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
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8
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Elbahrawy MM, Kamel MK, Rodriguez-Quintero JH, Vimolratana M, Chudgar NP, Stiles BM. Association of socioeconomic factors with the receipt of neoadjuvant therapy for patients with non-small cell lung cancer. J Thorac Cardiovasc Surg 2024; 167:1458-1466.e4. [PMID: 37741315 PMCID: PMC11000266 DOI: 10.1016/j.jtcvs.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Neoadjuvant therapy (NT) will be increasingly used for patients with non-small cell lung cancer (NSCLC), particularly given the recent approval of neoadjuvant chemoimmunotherapy. Several barriers may prevent the uptake of NT and should be identified and addressed. We queried the National Cancer Database (NCDB) to determine predictors of the use of NT. METHODS Using the NCDB (2006-2019), we identified 80,707 patients who underwent surgery for clinical stage II and III NSCLC. Sociodemographic and clinical factors were reviewed, and univariable and multivariable analyses were performed to identify associations with the uptake of NT. In propensity score-matched groups, survival was determined using the Kaplan-Meier method. RESULTS Among 80,707 eligible patients, 17,262 (21.4%) received NT. Clinical stage and node positivity were associated with receipt of NT. On multivariable analysis, factors associated with lower rates of NT included black race (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.67-0.90), Charlson Comorbidity Index ≥2 (OR, 0.75; 95% CI, 0.67-0.85), Medicaid/Medicare insurance (OR, 0.82; 95% CI, 0.75-0.90), lower income level (OR, 0.79; 95% CI, 0.71-0.87), and treatment at a community center (OR, 0.81; 95% CI, 0.67-0.96). In an exploratory analysis, those patients who received NT had longer 5-year overall survival compared with those who did not (48.3% vs 46.0%; P < .001). CONCLUSIONS Rates of NT are relatively low for patients with clinical stage II/III NSCLC treated prior to recent chemoimmunotherapy trials. Socioeconomic barriers to the uptake of NT include race, insurance status, income, and area of residence. As NT becomes more widely offered, accessibility for vulnerable populations must be assured.
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Affiliation(s)
- Mostafa M Elbahrawy
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Mohamed K Kamel
- Division of Thoracic and Foregut Surgery, University of Rochester Medical Center, Rochester, NY
| | - J Humberto Rodriguez-Quintero
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Marc Vimolratana
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Neel P Chudgar
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Brendon M Stiles
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
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9
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Udelsman BV, Canavan ME, Zhan PL, Ely S, Park HS, Boffa DJ, Mase VJ. Overall survival in low-comorbidity patients with stage I non-small cell lung cancer who chose stereotactic body radiotherapy compared to surgery. J Thorac Cardiovasc Surg 2024; 167:822-833.e7. [PMID: 37500052 DOI: 10.1016/j.jtcvs.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/10/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To evaluate trends in the utilization of stereotactic body radiotherapy (SBRT) and to compare overall survival (OS) of patients with early-stage non-small cell lung cancer (NSCLC) undergoing SBRT versus those undergoing surgery. METHODS The National Cancer Database was queried for patients without documented comorbidities who underwent surgical resection (lobectomy, segmentectomy, or wedge resection) or SBRT for clinical stage I NSCLC between 2012 and 2018. Peritreatment mortality and 5-year OS were compared among propensity score-matched cohorts. RESULTS A total of 30,658 patients were identified, including 24,729 (80.7%) who underwent surgery and 5929 (19.3%) treated with SBRT. Between 2012 and 2018, the proportion of patients receiving SBRT increased from 15.9% to 26.0% (P < .001). The 30-day mortality and 90-day mortality were higher among patients undergoing surgical resection versus those receiving SBRT (1.7% vs 0.3%, P < .001; 2.8% vs 1.7%, P < .001). In propensity score-matched patients, OS favored SBRT for the first several months, but this was reversed before 1 year and significantly favored surgical management in the long term (5-year OS, 71.0% vs 41.8%; P < .001). The propensity score-matched analysis was repeated to include only SBRT patients who had documented refusal of a recommended surgery, which again demonstrated superior 5-year OS with surgical management (71.4% vs 55.9%; P < .001). CONCLUSIONS SBRT is being increasingly used to treat early-stage lung cancer in low-comorbidity patients. However, for patients who may be candidates for either treatment, the long-term OS favors surgical management.
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Affiliation(s)
- Brooks V Udelsman
- Division of Thoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif.
| | - Maureen E Canavan
- Department of Internal Medicine, Cancer Outcomes Public Policy and Effectiveness Research Center, Yale University School of Medicine, New Haven, Conn
| | - Peter L Zhan
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Sora Ely
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Conn
| | - Daniel J Boffa
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Vincent J Mase
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
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10
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Somayaji D, Mohedat H, Li CS. Evaluating Social Determinants of Health Related to Cancer Survivorship and Quality of Care. Cancer Nurs 2024:00002820-990000000-00215. [PMID: 38416076 DOI: 10.1097/ncc.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Social determinants of health posit that negative outcomes are influenced by individuals living in underserved and underresourced neighborhoods. OBJECTIVE This study examines a cancer diagnosis, race/ethnicity, age, geographic location (residence), education, and social economic status factors at disease onset and treatment. METHODS A multivariable PO regression analysis was run for quality of care at testing or diagnosis, and quality of care at treatment and the quality of received care compared with another person. RESULTS Participants are representative of the Southern Community Cohort Study (SCCS) of adults diagnosed with breast (n = 263), prostate (n = 195), lung (n = 46), colorectal (n = 105), or other cancers (n = 526). This study includes cancer survivors who completed the SCCS Baseline and Cancer Navigation Surveys in urban (73.13%) and rural (26.87%) areas. White participants reported a higher quality of received care for testing or diagnosis and care for treatment compared with Black participants. Participants with high school or equivalent education (odds ratio, 1.662; 95% confidence interval, 1.172-2.356; P = .0044) or some college or junior college education (odds ratio, 1.970; 95% confidence interval, 1.348-2.879; P = .0005) were more likely to report a better level of quality of received care for treatment. CONCLUSIONS The SCCS represents individuals who are historically underrepresented in cancer research. The results of this study will have broad implications across diverse communities to reduce disparities and inform models of care. IMPLICATIONS FOR PRACTICE Nurses are positioned to evaluate the quality of population health and design and lead interventions that will benefit underserved and underresourced communities.
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Affiliation(s)
- Darryl Somayaji
- Author Affiliation: School of Nursing, University at Buffalo (Dr Somayaji and Mrs Mohedat), New York; and Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center (Dr Li), Rochester, New York
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11
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Awodutire PO, Kattan MW, Ilori OS, Ilori OR. An Accelerated Failure Time Model to Predict Cause-Specific Survival and Prognostic Factors of Lung and Bronchus Cancer Patients with at Least Bone or Brain Metastases: Development and Internal Validation Using a SEER-Based Study. Cancers (Basel) 2024; 16:668. [PMID: 38339420 PMCID: PMC10854571 DOI: 10.3390/cancers16030668] [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: 12/21/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND This study addresses the significant challenge of low survival rates in patients with cause-specific lung cancer accompanied by bone or brain metastases. Recognizing the critical need for an effective predictive model, the research aims to establish survival prediction models using both parametric and non-parametric approaches. METHODS Clinical data from lung cancer patients with at least one bone or brain metastasis between 2000 and 2020 from the SEER database were utilized. Four models were constructed: Cox proportional hazard, Weibull accelerated failure time (AFT), log-normal AFT, and Zografos-Balakrishnan log-normal (ZBLN). Independent prognostic factors for cause-specific survival were identified, and model fit was evaluated using Akaike's and Bayesian information criteria. Internal validation assessed predictive accuracy and discriminability through the Harriel Concordance Index (C-index) and calibration plots. RESULTS A total of 20,412 patients were included, with 14,290 (70%) as the training cohort and 6122 (30%) validation. Independent prognostic factors selected for the study were age, race, sex, primary tumor site, disease grade, total malignant tumor in situ, metastases, treatment modality, and histology. Among the accelerated failure time (AFT) models considered, the ZBLN distribution exhibited the most robust model fit for the 3- and 5-year survival, as evidenced by the lowest values of Akaike's information criterion of 6322 and 79,396, and the Bayesian information criterion of 63,495 and 79,396, respectively. This outperformed other AFT and Cox models (AIC = [156,891, 211,125]; BIC = [158,848, 211,287]). Regarding predictive accuracy, the ZBLN AFT model achieved the highest concordance C-index (0.682, 0.667), a better performance than the Cox model (0.669, 0.643). The calibration curves of the ZBLN AFT model demonstrated a high degree of concordance between actual and predicted values. All variables considered in this study demonstrated significance at the 0.05 level for the ZBLN AFT model. However, differences emerged in the significant variations in survival times between subgroups. The study revealed that patients with only bone metastases have a higher chance of survival compared to only brain and those with bone and brain metastases. CONCLUSIONS The study highlights the underutilized but accurate nature of the accelerated failure time model in predicting lung cancer survival and identifying prognostic factors. These findings have implications for individualized clinical decisions, indicating the potential for screening and professional care of lung cancer patients with at least one bone or brain metastasis in the future.
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Affiliation(s)
| | | | - Oluwatosin Stephen Ilori
- Ladoke Akintola University of Technology Teaching Hospital, Ogbomosho 212102, Nigeria; (O.S.I.); (O.R.I.)
| | - Oluwatosin Ruth Ilori
- Ladoke Akintola University of Technology Teaching Hospital, Ogbomosho 212102, Nigeria; (O.S.I.); (O.R.I.)
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12
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Hamzat I, Fenton D, Saunders M, Daramola T, Balkhy H, Dorsey C. Workforce diversity in cardiothoracic surgery: An examination of recent demographic changes and the training pathway. J Thorac Cardiovasc Surg 2024; 167:765-774. [PMID: 37330207 DOI: 10.1016/j.jtcvs.2023.04.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/19/2023] [Accepted: 04/30/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The purpose of our study was to examine changes in the demographic makeup of resident physicians in integrated 6-year cardiothoracic surgery and traditional thoracic surgery residency programs from 2013 to 2022 compared with other surgical subspecialties and determine potential leaks in the training pathway. METHODS Data from US Graduate Medical Education reports from 2013 to 2022 and medical student enrollment data from the Association of American Medical Colleges were obtained. Average percentages of women and underrepresented minorities were calculated in 2 5-year intervals: 2013 to 2017 and 2018 to 2022. Average percentages of women, Black, and Hispanic medical students and residents were calculated for the 2019 to 2022 period. Pearson χ2 tests were conducted to determine significant differences in proportions of women, Black/African American, and Hispanic trainees across time (α = 0.05). RESULTS Thoracic surgery and I6 residents saw a significant increase in the proportion of women trainees across the 2 time periods (19.9% (210 out of 1055) to 24.6% (287 out of 1169) (P < .01) and 24.1% (143 out of 592) to 28.9% (330 out of 1142) (P < .05)), respectively. There was no significant change in the proportion of Black and Hispanic trainees in thoracic surgery fellowship or integrated 6-year cardiothoracic residency programs. Hispanic trainees were the only group whose proportion of cardiothoracic surgery trainees was not significantly lower than their medical school proportion. Women and Black trainees had significantly lower proportions of thoracic surgery residents and integrated 6-year cardiothoracic residency program residents than their proportions in medical school (P < .01). CONCLUSIONS Cardiothoracic surgery has not significantly increased the number of Black and Hispanic trainees during the past decade. The lower proportion of Blacks and women in thoracic surgery residency and fellowship programs compared with their proportion in medical schools is concerning and is an opportunity for intervention.
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Affiliation(s)
- Ibraheem Hamzat
- Pritzker School of Medicine, University of Chicago, Chicago, Ill.
| | - David Fenton
- Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - Milda Saunders
- Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | | | - Husam Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - Chelsea Dorsey
- Section of Vascular Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill
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Naunheim KS, Platz JJ. Integrating Advocacy into Your Practice. Thorac Surg Clin 2024; 34:77-84. [PMID: 37953055 DOI: 10.1016/j.thorsurg.2023.08.007] [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: 11/14/2023]
Abstract
In the last 60 years, health care has evolved due to many trends including the introduction of third-party payers, a progressively aging society, advancing technology, emerging recognition of social issues of race/gender/poverty, the relative decline in the physician workforce, rising health care costs, ongoing consolidation of health care entities, and the corporatization of health care delivery. This has led to problems in health care delivery with respect to cost, quality, and access. Many medical leaders feel it is now the duty of the physician to go beyond the classic patient-doctor clinical responsibility and work to advocate for their patients and society regarding economic, financial, educational, and social issues.
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Affiliation(s)
- Keith S Naunheim
- St Louis University School of Medicine, 1008 South Spring Avenue, St Louis, MO 63104, USA.
| | - Joseph J Platz
- St Louis University School of Medicine, 1008 South Spring Avenue, St Louis, MO 63104, USA
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14
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Bonner SN, Curley R, Love K, Akande T, Akhtar A, Erhunmwunsee L. Structural Racism and Lung Cancer Risk: A Scoping Review. JAMA Oncol 2024; 10:122-128. [PMID: 38032677 DOI: 10.1001/jamaoncol.2023.4897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Importance Structural racism is associated with persistent inequities in health and health outcomes in the US for racial and ethnic minority groups. This review summarizes how structural racism contributes to differential population-level exposure to lung cancer risk factors and thus disparate lung cancer risk across different racial and ethnic groups. Observations A scoping review was conducted focusing on structural racism and lung cancer risk for racial and ethnic minority groups. The domains of structural racism evaluated included housing and built environment, occupation and employment, health care, economic and educational opportunity, private industry, perceived stress and discrimination, and criminal justice involvement. The PubMed, Embase, and MedNar databases were searched for English-language studies in the US from January 1, 2010, through June 30, 2022. The review demonstrated that racial and ethnic minority groups are more likely to have environmental exposures to air pollution and known carcinogens due to segregation of neighborhoods and poor housing quality. In addition, racial and ethnic minority groups were more likely to have exposures to pesticides, silica, and asbestos secondary to higher employment in manual labor occupations. Furthermore, targeted marketing and advertisement of tobacco products by private industry were more likely to occur in neighborhoods with more racial and ethnic minority groups. In addition, poor access to primary care services and inequities in insurance status were associated with elevated lung cancer risk among racial and ethnic minority groups. Lastly, inequities in tobacco use and cessation services among individuals with criminal justice involvement had important implications for tobacco use among Black and Hispanic populations. Conclusions and Relevance The findings suggest that structural racism must be considered as a fundamental contributor to the unequal distribution of lung cancer risk factors and thus disparate lung cancer risk across different racial and ethnic groups. Additional research is needed to better identify mechanisms contributing to inequitable lung cancer risk and tailor preventive interventions.
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Affiliation(s)
- Sidra N Bonner
- Department of Surgery, University of Michigan, Ann Arbor
- National Clinician Scholars Program, University of Michigan, Ann Arbor
| | - Richard Curley
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Kyra Love
- Library Services, City of Hope, Duarte, California
| | - Tola Akande
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Aamna Akhtar
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, California
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15
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Sheshadri A, Rajaram R, Baugh A, Castro M, Correa AM, Soto F, Daniel CR, Li L, Evans SE, Dickey BF, Vaporciyan AA, Ost DE. Association of Preoperative Lung Function with Complications after Lobectomy Using Race-Neutral and Race-Specific Normative Equations. Ann Am Thorac Soc 2024; 21:38-46. [PMID: 37796618 PMCID: PMC10867917 DOI: 10.1513/annalsats.202305-396oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/04/2023] [Indexed: 10/07/2023] Open
Abstract
Rationale: Pulmonary function testing (PFT) is performed to aid patient selection before surgical resection for non-small cell lung cancer (NSCLC). The interpretation of PFT data relies on normative equations, which vary by race, but the relative strength of association of lung function using race-specific or race-neutral normative equations with postoperative pulmonary complications is unknown. Objectives: To compare the strength of association of lung function, using race-neutral or race-specific equations, with surgical complications after lobectomy for NSCLC. Methods: We studied 3,311 patients who underwent lobectomy for NSCLC and underwent preoperative PFT from 2001 to 2021. We used Global Lung Function Initiative equations to generate race-specific and race-neutral normative equations to calculate percentage predicted forced expiratory volume in 1 second (FEV1%). The primary outcome of interest was the occurrence of postoperative pulmonary complications within 30 days of surgery. We used unadjusted and race-adjusted logistic regression models and least absolute shrinkage and selection operator analyses adjusted for relevant comorbidities to measure the association of race-specific and race-neutral FEV1% with pulmonary complications. Results: Thirty-one percent of patients who underwent surgery experienced pulmonary complications. Higher FEV1, whether measured with race-neutral (odds ratio [OR], 0.98 per 1% change in FEV1% [95% confidence interval (CI), 0.98-0.99]; P < 0.001) or race-specific (OR, 0.98 per 1% change in FEV1% [95% CI, 0.98-0.98]; P < 0.001) normative equations, was associated with fewer postoperative pulmonary complications. The area under the receiver operator curve for pulmonary complications was similar for race-adjusted race-neutral (0.60) and race-specific (0.60) models. Using least absolute shrinkage and selection operator regression, higher FEV1% was similarly associated with a lower rate of pulmonary complications in race-neutral (OR, 0.99 per 1% [95% CI, 0.98-0.99]) and race-specific (OR, 0.99 per 1%; 95% CI, 0.98-0.99) models. The marginal effect of race on pulmonary complications was attenuated in all race-specific models compared with all race-neutral models. Conclusions: The choice of race-specific or race-neutral normative PFT equations does not meaningfully affect the association of lung function with pulmonary complications after lobectomy for NSCLC, but the use of race-neutral equations unmasks additional effects of self-identified race on pulmonary complications.
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Affiliation(s)
| | | | - Aaron Baugh
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California; and
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, Missouri
| | | | | | | | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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16
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Griesemer I, Gottfredson NC, Thatcher K, Rini C, Birken SA, Kothari A, John R, Guerrab F, Clodfelter T, Lightfoot AF. Intervening in the Cancer Care System: An Analysis of Equity-Focused Nurse Navigation and Patient-Reported Outcomes. Health Promot Pract 2023:15248399231213042. [PMID: 38050901 DOI: 10.1177/15248399231213042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Nurse navigation can improve quality of cancer care and reduce racial disparities in care outcomes. Addressing persistent structurally-rooted disparities requires research on strategies that support patients by prompting structural changes to systems of care. We applied a novel conceptualization of social support to an analysis of racial equity-focused navigation and patient-reported outcomes. METHOD We applied an antiracism lens to create a theory-informed definition of system-facing social support: intervening in a care system on a patient's behalf. Participants were adults with early-stage breast or lung cancer, who racially identified as Black or White, and received specialized nurse navigation (n = 155). We coded navigators' clinical notes (n = 3,251) to identify instances of system-facing support. We then estimated models to examine system-facing support in relation to race, perceived racism in health care settings, and mental health. RESULTS Twelve percent of navigators' clinical notes documented system-facing support. Black participants received more system-facing support than White participants, on average (b = 0.78, 95% confidence interval [CI]: [0.25, 1.31]). The interaction of race*system-facing support was significant in a model predicting perceived racism in health care settings at the end of the study controlling for baseline scores (b = 0.05, 95% CI [0.01, 0.09]). Trends in simple slopes indicated that among Black participants, more system-facing support was associated with slightly more perceived racism; no association among White participants. DISCUSSION The term system-facing support highlights navigators' role in advocating for patients within the care system. More research is needed to validate the construct system-facing support and examine its utility in interventions to advance health care equity.
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Affiliation(s)
- Ida Griesemer
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | | | - Kari Thatcher
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | | | - Sarah A Birken
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Aneri Kothari
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Fatima Guerrab
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- People's Action Institute, Washington, DC, USA
| | | | - Alexandra F Lightfoot
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Rodriguez-Quintero JH, Kamel MK, Jindani R, Zhu R, Friedmann P, Vimolratana M, Chudgar NP, Stiles B. Is underutilization of adjuvant therapy in resected non-small-cell lung cancer associated with socioeconomic disparities? Eur J Cardiothorac Surg 2023; 64:ezad383. [PMID: 37952179 PMCID: PMC11007729 DOI: 10.1093/ejcts/ezad383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/17/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVES Although adjuvant systemic therapy (AT) has demonstrated improved survival in patients with resected non-small-cell lung cancer (NSCLC), it remains underutilized. Recent trials demonstrating improved outcomes with adjuvant immunotherapy and targeted treatment imply that low uptake of systemic therapy in at-risk populations may widen existing outcome gaps. We, therefore, sought to determine factors associated with the underutilization of AT. METHODS The National Cancer Database (2010-2018) was queried for patients with completely resected stage II-IIIA NSCLC and stratified based on the receipt of AT. Logistic regression was used to identify factors associated with AT delivery. The Kaplan-Meier method was applied to estimate survival after propensity-matching to adjust for confounders. RESULTS Of 37 571 eligible patients, only 20 616 (54.9%) received AT. While AT rates increased over time, multivariable analysis showed that older age [adjusted odds ratio (aOR) 0.45, 95% confidence interval (CI) 0.43-0.47], male sex (aOR 0.88, 95% CI 0.85-0.93) and multiple comorbidities (aOR 0.86, 95% CI: 0.81-0.91) were associated with decreased AT. Socioeconomic factors were additionally associated with underutilization, including public insurance (aOR 0.70, 95% CI: 0.66-0.74), lower education indicators (aOR 0.93, 95% CI: 0.88-0.97) and living more than 10 miles from a treatment facility (aOR 0.89, 95% CI: 0.85-0.93). After propensity matching, receipt of adjuvant therapy was associated with improved overall survival (median 76.35 vs 47.57 months, P ≤ 0.001). CONCLUSIONS AT underutilization in patients with resected stage II-III NSCLC is associated with patient, institutional and socioeconomic factors. It is critical to implement measures to address these inequities, especially in light of newer adjuvant immunotherapy and targeted therapy treatment options which are expected to improve survival.
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Affiliation(s)
| | - Mohamed K Kamel
- Department of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Rajika Jindani
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roger Zhu
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Patricia Friedmann
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marc Vimolratana
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Neel P Chudgar
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brendon Stiles
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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18
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Dingillo G, Alvarado CE, Rice JD, Sinopoli J, Badrinathan A, Linden PA, Towe CW. Affordable Care Act Medicaid Expansion is Associated With Increased Utilization of Minimally Invasive Lung Resection for Early Stage Lung Cancer. Am Surg 2023; 89:5147-5155. [PMID: 36341749 DOI: 10.1177/00031348221138081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
OBJECTIVE Minimally invasive lung resection (MILR) is underutilized in the United States. Under the Affordable Care Act (ACA), 39 states adopted Medicaid expansion, while 12 did not. Although Medicaid expansion has been associated with improved access to cancer care, its effect on utilization of MILR is unclear. We hypothesize that MILR would increase in Medicaid expansion states. METHODS The National Cancer Database was queried for adult patients from 2010 to 2018 with cT1/2N0M0 non-small cell lung cancer who received surgical resection by wedge, segmentectomy, or lobectomy. Patients were grouped by whether they received care in a state without Medicaid expansion vs expansion in January 2014. The outcome of interest was MILR (defined as video-assisted or robotic-assisted thoracoscopy) relative to open. Multivariable difference in differences (DID) cross-sectional analysis was used to estimate the average treatment effect (ATE) of Medicaid expansion. RESULTS There were 41,439 patients who met inclusion criteria: 20,446 (49.3%) in expansion states and 20,993 (50.7%) in non-expansion states. Multivariable DID analysis showed that Medicaid expansion was associated with an increase in Medicaid insurance type with an ATE of 7.4% (95% CI 7.1-7.7%, P = .002). Medicaid expansion was also associated with increased MILR utilization in unadjusted analysis (10,278/20,446 (50.3%) vs 9,953/20,993 (47.4%), p < .001) and in multivariable DID analysis (ATE 0.6%, 95% CI 0.3-0.8%, P = .008). CONCLUSIONS Although Medicaid expansion was associated with increased utilization of MILR for early stage lung cancer, the treatment effect was modest. This suggests that barriers in access to MILR are larger than simply access to care.
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Affiliation(s)
- Gianna Dingillo
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Christine E Alvarado
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jonathan D Rice
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jillian Sinopoli
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Avanti Badrinathan
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Emmerick ICM, Campos MR, Castanheira D, Muzy J, Marques A, Arueira Chaves L, Sobreira da Silva MJ. Lung Cancer Screening in Brazil Comparing the 2013 and 2021 USPSTF Guidelines. JAMA Netw Open 2023; 6:e2346994. [PMID: 38079172 PMCID: PMC10714246 DOI: 10.1001/jamanetworkopen.2023.46994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023] Open
Abstract
Importance It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most frequent cancer in Brazil, but the country does not have an LC screening (LCS) policy. Objective To compare the number of individuals eligible for screening, 5-year preventable LC deaths, and years of life gained (YLG) if LC death is averted by LCS, considering 3 eligibility strategies by sociodemographic characteristics. Design, Setting, and Participants This comparative effectiveness research study assessed 3 LCS criteria by applying a modified version of the LC-Death Risk Assessment Tool (LCDRAT) and the LC-Risk Assessment Tool (LCRAT). Data are from the 2019 Brazilian National Household Survey. Participants included ever-smokers aged 50 to 80 years. Data analysis was performed from February to May 2023. Exposures Exposures included ever-smokers aged 50 to 80 years, US Preventive Services Task Force (USPSTF) 2013 guidelines (ever-smokers aged 55 to 80 years with ≥30 pack-years and <15 years since cessation), and USPSTF 2021 guidelines (ever-smokers aged 50 to 80 years with 20 pack-years and <15 years since cessation). Main Outcomes and Measures The primary outcomes were the numbers of individuals eligible for LCS, the 5-year preventable deaths attributable to LC, and the number of YLGs if death due to LC was averted by LCS. Results In Brazil, the eligible population for LCS was 27 280 920 ever-smokers aged 50 to 80 years (13 387 552 female [49.1%]; 13 249 531 [48.6%] aged 50-60 years; 394 994 Asian or Indigenous [1.4%]; 3 111 676 Black [11.4%]; 10 942 640 Pardo [40.1%]; 12 830 904 White [47.0%]; 12 428 536 [45.6%] with an incomplete middle school education; and 12 860 132 [47.1%] living in the Southeast region); 5 144 322 individuals met the USPSTF 2013 criteria for LCS (2 090 636 female [40.6%]; 2 290 219 [44.5%] aged 61-70 years; 66 430 Asian or Indigenous [1.3%]; 491 527 Black [9.6%]; 2 073 836 Pardo [40.3%]; 2 512 529 [48.8%] White; 2 436 221 [47.4%] with an incomplete middle school education; and 2 577 300 [50.1%] living in the Southeast region), and 8 380 279 individuals met the USPSTF 2021 LCS criteria (3 507 760 female [41.9%]; 4 352 740 [51.9%] aged 50-60 years; 119 925 Asian or Indigenous [1.4%]; 839 171 Black [10.0%]; 3 330 497 Pardo [39.7%]; 4 090 687 [48.8%] White; 4 022 784 [48.0%] with an incomplete middle school education; and 4 162 070 [49.7%] living in the Southeast region). The number needed to screen to prevent 1 death was 177 individuals according to the USPSTF 2013 criteria and 242 individuals according to the USPSTF 2021 criteria. The YLG was 23 for all ever-smokers, 19 for the USPSTF 2013 criteria, and 21 for the USPSTF 2021 criteria. Being Black, having less than a high school education, and living in the North and Northeast regions were associated with increased 5-year risk of LC death. Conclusions and Relevance In this comparative effectiveness study, USPSTF 2021 criteria were better than USPSTF 2013 in reducing disparities in LC death rates. Nonetheless, the risk of LC death remained unequal, and these results underscore the importance of identifying an appropriate approach for high-risk populations for LCS, considering the local epidemiological context.
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Affiliation(s)
| | - Mônica Rodrigues Campos
- Departamento de Ciências Sociais, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Debora Castanheira
- Laboratório de Pesquisa Clínica em DST e Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jessica Muzy
- Laboratório de Informações em Saúde, Instituto de Comunicação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Aline Marques
- Laboratório de Informações em Saúde, Instituto de Comunicação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luisa Arueira Chaves
- Instituto de Ciências Farmacêuticas, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
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20
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Valerio TS, Emmerick ICM, Sobreira-da-Silva MJ. Factors associated with late-stage diagnosis and overall survival for lung cancer: An analysis of patients treated in a Brazilian hospital and a US-hospital from 2009 to 2019. Cancer Epidemiol 2023; 86:102443. [PMID: 37611485 DOI: 10.1016/j.canep.2023.102443] [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: 04/28/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Lung cancer is a major public health problem due to its high incidence and mortality rates worldwide. Histology, socioeconomic conditions, access, quality of healthcare, and regional aspects are associated with lung cancer stages at diagnosis and survival outcomes. This paper aims to examine and contrast the factors associated with late-stage diagnosis of lung cancer and overall survival rates in two different settings: a Brazilian hospital and a US hospital, spanning from 2009 to 2019. METHODS This is a retrospective cohort study of the incidence of lung cancer cases at the institution's cancer registry from a Brazilian and a US-based cohort. Descriptive analyses are presented using either the mean and standard deviation or the median and interquartile interval. Frequency is used to present categorical variables. Factors associated with late-stage lung cancer diagnosis were identified through bivariate and multivariable forward stepwise logistic regression. One-year overall survival and its associated factors were identified by Kaplan-Meier curves and Cox's proportional hazards model. RESULTS Between January 2009 and December 2019, a total of 5286 individuals were diagnosed with LC in the Brazilian cohort, and out of these cases, 85.6% were diagnosed with late-stage disease. The US-cohort consisted of 3594 individuals, of whom 60.3% were diagnosed with late-stage disease in lung cancer. The one-year overall survival was 8.6 months for the US cohort and 6.4 months for the Brazilian cohort. In both cohorts, late-stage diagnosis emerged as the most significant factor influencing overall survival. However, the factors associated with late-stage diagnosis differed between the US and Brazilian cohorts. In the Brazilian cohort, being male and belonging to black or brown ethnic groups, along with having a lower education level, were linked to late-stage diagnosis. On the other hand, in the US-based cohort, the factors related to late-stage diagnosis were being male, having been diagnosed before 2015, and possessing private insurance coverage. CONCLUSION Late-stage diagnosis was associated with the worst survival in both the US and Brazilian cohorts. This study provides valuable information on inequities and barriers to access for lung patients with cancer from upper-middle-income and high-income countries.
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Affiliation(s)
- Tayná Sequeira Valerio
- National Cancer Institute of Brazil - Rua Marquês de Pombal, 125 - Centro, Rio de Janeiro 20255-155, Brazil.
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21
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Bonner SN, Lagisetty K, Reddy RM, Engeda Y, Griggs JJ, Valley TS. Clinical Implications of Removing Race-Corrected Pulmonary Function Tests for African American Patients Requiring Surgery for Lung Cancer. JAMA Surg 2023; 158:1061-1068. [PMID: 37585181 PMCID: PMC10433136 DOI: 10.1001/jamasurg.2023.3239] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/20/2023] [Indexed: 08/17/2023]
Abstract
Importance Removal of race correction in pulmonary function tests (PFTs) is a priority, given that race correction inappropriately conflates race, a social construct, with biological differences and falsely assumes worse lung function in African American than White individuals. However, the impact of decorrecting PFTs for African American patients with lung cancer is unknown. Objectives To identify how many hospitals providing lung cancer surgery use race correction, examine the association of race correction with predicted lung function, and test the effect of decorrection on surgeons' treatment recommendations. Design, Setting, and Participants In this quality improvement study, hospitals participating in a statewide quality collaborative were contacted to determine use of race correction in PFTs. For hospitals performing race correction, percent predicted preoperative and postoperative forced expiratory volume in 1 second (FEV1) was calculated for African American patients who underwent lung cancer resection between January 1, 2015, and September 31, 2022, using race-corrected and race-neutral equations. US cardiothoracic surgeons were then randomized to receive 1 clinical vignette that differed by the use of Global Lung Function Initiative equations for (1) African American patients (percent predicted postoperative FEV1, 49%), (2) other race or multiracial patients (percent predicted postoperative FEV1, 45%), and (3) race-neutral patients (percent predicted postoperative FEV1, 42%). Main Outcomes and Measures Number of hospitals using race correction in PFTs, change in preoperative and postoperative FEV1 estimates based on race-neutral or race-corrected equations, and surgeon treatment recommendations for clinical vignettes. Results A total of 515 African American patients (308 [59.8%] female; mean [SD] age, 66.2 [9.4] years) were included in the study. Fifteen of the 16 hospitals (93.8%) performing lung cancer resection for African American patients during the study period reported using race correction, which corresponds to 473 African American patients (91.8%) having race-corrected PFTs. Among these patients, the percent predicted preoperative FEV1 and postoperative FEV1 would have decreased by 9.2% (95% CI, -9.0% to -9.5%; P < .001) and 7.6% (95% CI, -7.3% to -7.9%; P < .001), respectively, if race-neutral equations had been used. A total of 225 surgeons (194 male [87.8%]; mean [SD] time in practice, 19.4 [11.3] years) were successfully randomized and completed the vignette items regarding risk perception and treatment outcomes (76% completion rate). Surgeons randomized to the vignette with African American race-corrected PFTs were more likely to recommend lobectomy (79.2%; 95% CI, 69.8%-88.5%) compared with surgeons randomized to the other race or multiracial-corrected (61.7%; 95% CI, 51.1%-72.3%; P = .02) or race-neutral PFTs (52.8%; 95% CI, 41.2%-64.3%; P = .001). Conclusions and Relevance Given the findings of this quality improvement study, surgeons should be aware of changes in PFT testing because removal of race correction PFTs may change surgeons' treatment decisions and potentially worsen existing disparities in receipt of lung cancer surgery among African American patients.
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Affiliation(s)
- Sidra N. Bonner
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor
- National Clinician Scholars Program, University of Michigan, Ann Arbor
| | - Kiran Lagisetty
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor
- Veterans Affairs Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Rishindra M. Reddy
- Veterans Affairs Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
- Michigan Society of Thoracic and Cardiovascular Surgeons General Thoracic Quality Collaborative, Ann Arbor
| | | | - Jennifer J. Griggs
- Department of Internal Medicine, Division of Hematology and Oncology, Department of Health Management and Policy, School of Public Health University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Thomas S. Valley
- Veterans Affairs Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
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22
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Cooley-Rieders K, Glenn C, Van Haren RM, Salfity H, Starnes SL. A decade of surgical outcomes in a structured lung cancer screening program. J Thorac Cardiovasc Surg 2023; 166:1245-1253.e1. [PMID: 36858845 DOI: 10.1016/j.jtcvs.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Lung cancer screening can decrease mortality. The majority of screen-detected cancers are early stage and undergo surgical resection. However, there are little data regarding the outcomes of surgical treatment outside of clinical trials. The purpose of this study was to compare the outcomes of curative resection for screen-detected lung cancers with nonscreened, incidentally detected cancers at an institution with a structured screening program. METHODS Patients undergoing lung cancer curative resection from January 2012 to June 2021 were identified from a prospective database. Baseline patient characteristics, tumor characteristics, and outcomes were compared between cancer detected from screening and cancer detected incidentally. RESULTS There were 199 patients in the incidental group and 82 patients in the screened group. Mean follow-up was 33.3 ± 25 months. The screened group had more African Americans (P = .04), a higher incidence of emphysema (P = .02), less prior cancers (P < .01), and more pack-years smoked (P < .01). The screened group had a smaller size (1.74 vs 2.31 cm, P < .01); however, pathologic stage was similar, with the majority being stage I. Postoperative morbidity, 30-day mortality, and overall and recurrence-free survival were similar between groups. Only 48.7% of the incidental group met current US Preventative Services Task Force screening criteria (age 50-80 years, ≥20 pack-year smoking history). CONCLUSIONS Screen-detected lung cancers have excellent postoperative and long-term outcomes with curative resection, similar to incidentally detected cancers. A large portion of incidentally detected lung cancers do not meet current screening guidelines, which is an opportunity for further refinement of eligibility.
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Affiliation(s)
- Keaton Cooley-Rieders
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carter Glenn
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert M Van Haren
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Hai Salfity
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sandra L Starnes
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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23
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Wish J, Villena-Vargas J, Harrison S, Lee B, Chow O, Port J, Altorki N, Stiles BM. Surgical Treatment at an Academic Medical Center is Associated with Statistically Insignificant Lung Cancer Survival Outcome Differences Related to ZIP Code. World J Surg 2023; 47:2052-2064. [PMID: 37046063 DOI: 10.1007/s00268-023-07006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Low socioeconomic status is a well-characterized adverse prognostic factor in large lung cancer databases. However, such characterizations may be confounded as patients of lower socioeconomic status are more often treated at low-volume, non-academic centers. We evaluated whether socioeconomic status, as defined by ZIP code median income, was associated with differences in lung cancer resection outcomes within a high-volume academic medical center. METHODS Consecutive patients undergoing resection for non-small cell lung cancer were identified from a prospectively maintained database (2011-18). Patients were assigned an income value based on the median income of their ZIP code as determined by census-based geographic data. We stratified the population into income quintiles representative of SES and compared demographics (chi-square), surgical outcomes, and survival (Kaplan-Meier). RESULTS We identified 1,693 patients, representing 516 ZIP codes. Income quintiles were Q1: $24,421-53,151; Q2:$53,152-73,982; Q3:$73,983-99,063; Q4:$99,064-123,842; and Q5:$123,843-250,001. Compared to Q5 patients, Q1 patients were younger (median 69 vs. 73, p < 0.001), more likely male (44 vs. 36%, p = 0.035), and more likely Asian, Black, or self-identified as other than white, Asian, or Black. (67 vs. 11%, p = < 0.001). We found minor differences in surgical outcomes and no significant difference in 5-year survival between Q1 and Q5 patients (5-year: 86 vs. 85%, p = 0.886). CONCLUSIONS Surgical care patterns at a high-volume academic medical center are similar among patients from varying ZIP codes. Surgical treatment at such a center is associated with no survival differences based upon socioeconomic status as determined by ZIP code. Centralization of lung cancer surgical care to high-volume centers may reduce socioeconomic outcome disparities.
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Affiliation(s)
- Jack Wish
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA.
| | - Jonathan Villena-Vargas
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Ben Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Oliver Chow
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Jeffrey Port
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Brendon M Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, 111 East 210th Street, New York, NY, 10467, USA
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24
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Vachani A, Caruso C. Impact of low-dose computed tomography screening on lung cancer incidence and outcomes. Curr Opin Pulm Med 2023; 29:232-238. [PMID: 37191171 PMCID: PMC10247528 DOI: 10.1097/mcp.0000000000000974] [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] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW To review findings from clinical trials of lung cancer screening (LCS), assess contemporary issues with implementation in clinical practice, and review emerging strategies to increase the uptake and efficiency of LCS. RECENT FINDINGS In 2013, the USPSTF recommended annual screening for individuals aged 55-80 years and currently smoke or quit within the past 15 years based on reduced mortality from lung cancer with annual low-dose computed tomography (LDCT) screening in the National Lung Screening Trial. Subsequent trials have demonstrated similar mortality outcomes in individuals with lower pack-year smoking histories. These findings, coupled with evidence for disparities in screening eligibility by race, resulted in updated guidelines by USPSTF to broaden eligibility criteria for screening. Despite this body of evidence, implementation in the United States has been suboptimal with fewer than 20% of eligible individuals receiving a screen. Barriers to efficient implementation are multifactorial and include patient, clinician, and system-level factors. SUMMARY Multiple randomized trials have established that annual LCS reduces mortality from lung cancer; however, several areas of uncertainty exist on the effectiveness of annual LDCT. Ongoing research is examining approaches to improve the uptake and efficiency of LCS, such as the use of risk-prediction models and biomarkers for identification of high-risk individuals.
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Affiliation(s)
- Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Perelman School of Medicine
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Christopher Caruso
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Perelman School of Medicine
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25
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Griesemer I, Lightfoot AF, Eng E, Bosire C, Guerrab F, Kotey A, Alexander KM, Baker S, Black KZ, Dixon C, Ellis KR, Foley K, Goettsch C, Moore A, Ryals CA, Smith B, Yongue C, Cykert S, Robertson LB. Examining ACCURE's Nurse Navigation Through an Antiracist Lens: Transparency and Accountability in Cancer Care. Health Promot Pract 2023; 24:415-425. [PMID: 36582178 PMCID: PMC11384289 DOI: 10.1177/15248399221136534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There are persistent disparities in the delivery of cancer treatment, with Black patients receiving fewer of the recommended cancer treatment cycles than their White counterparts on average. To enhance racial equity in cancer care, innovative methods that apply antiracist principles to health promotion interventions are needed. The parent study for the current analysis, the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) intervention, was a system-change intervention that successfully eliminated the Black-White disparity in cancer treatment completion among patients with early-stage breast and lung cancer. The intervention included specially trained nurse navigators who leveraged real-time data to follow-up with patients during their treatment journeys. Community and academic research partners conducted thematic analysis on all clinical notes (n = 3,251) written by ACCURE navigators after each contact with patients in the specialized navigation arm (n = 162). Analysis was informed by transparency and accountability, principles adapted from the antiracist resource Undoing Racism and determined as barriers to treatment completion through prior research that informed ACCURE. We identified six themes in the navigator notes that demonstrated enhanced accountability of the care system to patient needs. Underlying these themes was a process of enhanced data transparency that allowed navigators to provide tailored patient support. Themes include (1) patient-centered advocacy, (2) addressing system barriers to care, (3) connection to resources, (4) re-engaging patients after lapsed treatment, (5) addressing symptoms and side effects, and (6) emotional support. Future interventions should incorporate transparency and accountability mechanisms and examine the impact on racial equity in cancer care.
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Affiliation(s)
- Ida Griesemer
- VA Boston Healthcare System, Boston, MA, USA
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | - Alexandra F Lightfoot
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, Chapel Hill, NC, USA
| | - Eugenia Eng
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claire Bosire
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fatima Guerrab
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Community-Campus Partnerships for Health, Raleigh, NC
| | - Amanda Kotey
- Alliant Health Solutions, Inc., Atlanta, GA, USA
| | - Kimberly M Alexander
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- The Alexander Group, Durham, NC, USA
- Elon University, Elon, NC, USA
| | - Stephanie Baker
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Elon University, Elon, NC, USA
| | - Kristin Z Black
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- East Carolina University, Greenville, NC, USA
| | - Crystal Dixon
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Wake Forest University, Winston-Salem, NC, USA
| | - Katrina R Ellis
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Karen Foley
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Antionette Moore
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Winston-Salem State University, Winston-Salem, NC, USA
| | - Cleo A Ryals
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cone Health Cancer Center, Greensboro, NC, USA
| | - Beth Smith
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Christina Yongue
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Samuel Cykert
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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26
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Loehrer AP, Chen L, Wang Q, Colla CH, Wong SL. Rural Disparities in Lung Cancer-directed Surgery: A Medicare Cohort Study. Ann Surg 2023; 277:e657-e663. [PMID: 36745766 PMCID: PMC9902761 DOI: 10.1097/sla.0000000000005091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The primary objective of this study was to determine the influence of rural residence on access to and outcomes of lung cancer-directed surgery for Medicare beneficiaries. SUMMARY OF BACKGROUND DATA Lung cancer is the leading cause of cancerrelated death in the United States and rural patients have 20% higher mortality. Drivers of rural disparities along the continuum of lung cancercare delivery are poorly understood. METHODS Medicare claims (2015-2018) were used to identify 126,352 older adults with an incident diagnosis of nonmetastatic lung cancer. Rural Urban Commuting Area codes were used to define metropolitan, micropolitan, small town, and rural site of residence. Multivariable logistic regression models evaluated influence of place of residence on 1) receipt of cancer-directed surgery, 2) time from diagnosis to surgery, and 3) postoperative outcomes. RESULTS Metropolitan beneficiaries had higher rate of cancer-directed surgery (22.1%) than micropolitan (18.7%), small town (17.5%), and isolated rural (17.8%) (P < 0.001). Compared to patients from metropolitan areas, there were longer times from diagnosis to surgery for patients living in micropolitan, small, and rural communities. Multivariable models found nonmetropolitan residence to be associated with lower odds of receiving cancer-directed surgery and MIS. Nonmetropolitan residence was associated with higher odds of having postoperative emergency department visits. CONCLUSIONS Residence in nonmetropolitan areas is associated with lower probability of cancer-directed surgery, increased time to surgery, decreased use of MIS, and increased postoperative ED visits. Attention to timely access to surgery and coordination of postoperative care for nonmetropolitan patients could improve care delivery.
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Affiliation(s)
- Andrew P. Loehrer
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geisel School of Medicine at Dartmouth, Hanover, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Louisa Chen
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Qianfei Wang
- Geisel School of Medicine at Dartmouth, Hanover, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Carrie H. Colla
- Geisel School of Medicine at Dartmouth, Hanover, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Sandra L. Wong
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geisel School of Medicine at Dartmouth, Hanover, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
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27
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Logan CD, Feinglass J, Halverson AL, Durst D, Lung K, Kim S, Bharat A, Merkow RP, Bentrem DJ, Odell DD. Rural-Urban Disparities in Receipt of Surgery for Potentially Resectable Non-Small Cell Lung Cancer. J Surg Res 2023; 283:1053-1063. [PMID: 36914996 PMCID: PMC10289009 DOI: 10.1016/j.jss.2022.10.097] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/25/2022] [Accepted: 10/15/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Access to cancer care, especially surgery, is limited in rural areas. However, the specific reasons rural patient populations do not receive surgery for non-small cell lung cancer (NSCLC) is unknown. We investigated geographic disparities in reasons for failure to receive guideline-indicated surgical treatment for patients with potentially resectable NSCLC. METHODS The National Cancer Database was used to identify patients with clinical stage I-IIIA (N0-N1) NSCLC between 2004 and 2018. Patients from rural areas were compared to urban areas, and the reason for nonreceipt of surgery was evaluated. Adjusted odds of (1) primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery were determined. RESULTS The study included 324,785 patients with NSCLC with 42,361 (13.0%) from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery (P < 0.001). Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management (adjusted odds ratio [aOR]: 1.14, 95% confidence interval [CI]: 1.05-1.23), (2) surgery being deemed contraindicated due to risk (aOR: 1.19, 95% CI: 1.07-1.33), (3) surgery being recommended but not performed (aOR: 1.13, 95% CI: 1.01-1.26), and (4) overall failure to receive surgery (aOR: 1.21, 95% CI: 1.13-1.29; all P < 0.001). CONCLUSIONS There are geographic disparities in the management of NSCLC. Rural patient populations are more likely to fail to undergo surgery for potentially resectable disease for every reason examined.
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Affiliation(s)
- Charles D Logan
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611; Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Joe Feinglass
- Department of Medicine, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Amy L Halverson
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Dalya Durst
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Kalvin Lung
- Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Samuel Kim
- Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Ankit Bharat
- Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - David J Bentrem
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - David D Odell
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611; Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611.
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Siddiqi N, Pan G, Liu A, Lin Y, Jenkins K, Zhao J, Mak K, Tapan U, Suzuki K. Timeliness of Lung Cancer Care From the Point of Suspicious Image at an Urban Safety Net Hospital. Clin Lung Cancer 2023; 24:e87-e93. [PMID: 36642641 DOI: 10.1016/j.cllc.2022.12.007] [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: 10/07/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Timeliness of care is an important metric for lung cancer patients, and care delays in the safety-net setting have been described. Timeliness from the point of the suspicious image is not well-studied. Herein, we evaluate time intervals in the workup of lung cancer at an urban, safety net hospital and assess for disparities by demographic and clinical factors. PATIENTS AND METHODS We performed a retrospective analysis of lung cancer patients receiving some portion of their care at Boston Medical Center between 2015 and 2020. A total of 687 patients were included in the final analysis. Median times from suspicious image to first treatment (SIT), suspicious image to diagnosis (SID), and diagnosis to treatment (DT) were calculated. Nonparametric tests were applied to assess for intergroup differences in time intervals. RESULTS SIT, SID, and DT for the entire cohort was 78, 34, and 32 days, respectively. SIT intervals were 87 days for females and 72 days for males (p < .01). SIT intervals were 106, 110, 81, and 41 days for stages I, II, III, and IV, respectively (p < .01). SID intervals differed between black (40.5) and Hispanic (45) patients compared to white (28) and Asian (23) patients (p < .05). CONCLUSION Advanced stage at presentation and male gender were associated with more timely treatment from the point of suspicious imaging while white and Asian were associated with more timely lung cancer diagnosis. Future analyses should seek to elucidate drivers of timeliness differences and assess for the impact of timeliness disparities on patient outcomes in the safety net setting.
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Affiliation(s)
- Noreen Siddiqi
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Gilbert Pan
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Anqi Liu
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Yue Lin
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Kendall Jenkins
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Jenny Zhao
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Kimberley Mak
- Department of Radiation Oncology, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Umit Tapan
- Department of Hematology/Oncology, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Kei Suzuki
- Department of Surgery, Inova Fairfax Hospital, Fairfax, VA
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Till BM, Mack S, Whitehorn G, Rahman U, Thosani D, Grenda T, Evans NR, Okusanya O. Impact of stereotactic body radiation therapy volume on surgical patient selection, short-term survival, and long-term survival in early-stage non-small cell lung cancer. J Thorac Cardiovasc Surg 2023; 165:471-479. [PMID: 36088141 DOI: 10.1016/j.jtcvs.2022.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/23/2022] [Accepted: 07/17/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Stereotactic body radiation therapy (SBRT) is increasingly used to treat non-small cell lung cancer. The purpose of this study is to analyze relationships between facility SBRT utilization and surgical patient selection and survival after surgery. METHODS Data on patients with TI/T2N0M0 lesions and treatment facility characteristics were abstracted from the National Cancer Database, 2008 to 2017. Facilities were stratified using an SBRT/surgery ratio previously associated with short-term survival benefit for patients treated surgically, and by a previously identified surgical volume threshold. Multiple regression analyses, Cox proportional-hazard regressions, and Kaplan-Meier log rank test were employed. RESULTS In total, 182,610 patients were included. Proportion of high SBRT:surgery ratio (≥17%) facilities increased from 118 (11.5%) to 558 (48.4%) over the study period. Patients undergoing surgery at high-SBRT facilities had comparable comorbidity scores and tumor sizes to those at low-SBRT facilities, and nonclinically significant differences in age, race, and insurance status. Among low-volume surgical facilities, treatment at a high SBRT-using facility was associated with decreased 30-day mortality (1.8% vs 1.4%, P < .001) and 90-day mortality (3.3% vs 2.6%, P < .001). At high-volume surgical facilities, no difference was observed. At 5 years, a survival advantage was identified for patients undergoing resection at facilities with high surgical volumes (hazard ratio, 0.91; confidence interval, 0.90-0.93 P < .001) but not at high SBRT-utilizing facilities. CONCLUSIONS Differences in short-term survival following resection at facilities with high-SBRT utilization may be attributable to low surgical volume facilities. Patients treated at high volume surgical facilities do not demonstrate differences in short-term or long-term survival based on facility SBRT utilization.
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Affiliation(s)
- Brian M Till
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Shale Mack
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Gregory Whitehorn
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Uzma Rahman
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Darshak Thosani
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Tyler Grenda
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Nathaniel R Evans
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Olugbenga Okusanya
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa.
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Williams BM, McAllister M, Erkmen C, Mody GN. Disparities in thoracic surgical oncology. J Surg Oncol 2023; 127:329-335. [PMID: 36630104 DOI: 10.1002/jso.27180] [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] [Received: 11/13/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023]
Abstract
Disparities in access and outcomes of thoracic surgical oncology are long standing. This article examines the patient, population, and systems-level factors that contribute to these disparities and inequities. The need for research and policy to identify and solve these problems is apparent. As leaders in the field of thoracic oncology, surgeons will be instrumental in narrowing these gaps and moving the discipline forward.
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Affiliation(s)
- Brittney M Williams
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Miles McAllister
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cherie Erkmen
- Department of Thoracic Surgery, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Gita N Mody
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Olateju OA, Zeng Z, Adenaiye OO, Varisco TJ, Zakeri M, Sujit SS. Investigation of racial differences in survival from non-small cell lung cancer with immunotherapy use: A Texas study. Front Oncol 2023; 12:1092355. [PMID: 36698397 PMCID: PMC9869031 DOI: 10.3389/fonc.2022.1092355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Background The use of immunotherapy is associated with improved survival among patients with Non-Small Cell Lung Cancer (NSCLC) and has gained widespread use in its management. However, there is limited information on whether the survival benefits associated with immunotherapy differ among races and ethnicities. Objective This study aimed to investigate racial differences in survival amongst patients with NSCLC who received immunotherapy as the first-line treatment in Texas. Methods Patients with NSCLC who received immunotherapy between October 2015 to December 2018 were identified from the Texas Cancer Registry (TCR). Disease-specific survival was evaluated and compared among patients across racial/ethnic categories using the Kaplan-Meier survival analysis, log-rank test, and a multivariable Cox proportional hazard regression model following an inverse probability treatment weighting (IPTW) propensity score analysis. Results A total of 1453 patients were included in the analysis. Median survival (in months) was longest among Asians (34, 95% CI: 15-Not Estimable), followed by African Americans (AAs) (23, 95% CI: 15-34), Hispanics (22, 95% CI: 16-26), and Whites (19, 95% CI: 17-22). The adjusted regression estimates had no statistically significant differences in survival among AAs (aHR = 0.97; 95% CI = 0.78-1.20; P =0.77) and Hispanics (aHR = 0.96; 95% CI = 0.77-1.19, P =0.73) when compared to White patients. Asians on the other hand, had 40% reduction in mortality risk compared to Whites (aHR = 0.60; 95% CI = 0.39-0.94, P = 0.03). Conclusions Our study indicated that African Americans and Hispanics do not have poorer survival compared to White patients when receiving immunotherapy as first-line treatment. Asians however had longer survival compared to Whites. Our findings suggest that existing racial disparity in NSCLC survival might be mitigated with the use of immunotherapy and should be considered in providing care to these minority groups.
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Affiliation(s)
- Olajumoke A. Olateju
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, United States
| | - Zhen Zeng
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, United States
| | - Oluwasanmi O. Adenaiye
- Department of Medicine and Rehabilitation Science, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Tyler J. Varisco
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, United States
| | - Marjan Zakeri
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, United States
| | - Sansgiry S. Sujit
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, United States,*Correspondence: Sansgiry S. Sujit,
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Bonner SN, He C, Clark M, Adams K, Orelaru F, Popoff A, Chang A, Wakeam E, Lagisetty K. Understanding Racial Differences in Lung Cancer Surgery Through a Statewide Quality Collaborative. Ann Surg Oncol 2023; 30:517-526. [PMID: 36018516 DOI: 10.1245/s10434-022-12435-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Persistent racial disparities in lung cancer incidence, treatment, and survival are well documented. Given the importance of surgical resection for lung cancer treatment, racial disparities in surgical quality were investigated using a statewide quality collaborative. METHODS This retrospective study used data from the Michigan Society of Cardiothoracic Surgeons General Thoracic database, which includes data gathered for the Society of Thoracic Surgeons General Thoracic Surgery Database at 17 institutions in Michigan. Adult patients undergoing resection for lung cancer between 2015 and 2021 were included. Propensity score-weighting methodology was used to assess differences in surgical quality, including extent of resection, adequate lymph node evaluation, 30-day mortality, and 30-day readmission rate between white and black patients. RESULTS The cohort included 5073 patients comprising 357 (7%) black and 4716 (93%) white patients. The black patients had significantly higher unadjusted rates of wedge resection than the white patients, but after propensity score-weighting for clinical factors, wedge resection did not differ from lobectomy (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.78-1.49; P = 0.67). The black patients had fewer lymph nodes collected (incidence rate ratio [IRR], 0.77; 95% CI, 0.73-0.81; P < 0.0001) and lymph node stations sampled (IRR, 0.89; 95% CI, 0.84-0.94; P < 0.0001). The black patients did not differ from the white patients in terms of mortality (OR, 0.65; 95% CI, 0.19-2.34; P = 0.55) or readmission (OR, 0.79; 95 % CI, 0.49-1.27; P = 0.32). The black patients had longer hospital stays (OR, 1.08; 95% CI, 1.02-1.14; P = 0.01). CONCLUSION In a statewide quality collaborative that included high-volume centers, black patients received a less extensive lymph node evaluation, with fewer non-anatomic wedge resections performed, and a more limited lymph node evaluation with lobectomy.
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Affiliation(s)
- Sidra N Bonner
- Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI, USA. .,Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA. .,National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA.
| | - Chang He
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA
| | - Melissa Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA
| | - Kumari Adams
- Department of Thoracic Surgery, St. Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Felix Orelaru
- Department of Thoracic Surgery, St. Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Andrew Popoff
- Department of Thoracic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Andrew Chang
- Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Elliot Wakeam
- Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI, USA.,Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Kiran Lagisetty
- Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI, USA
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Chen P, Yang Q, Li Y, Jing X, Chen J. Cost-effectiveness analysis of adjuvant therapy with atezolizumab in Chinese patients with stage IB-IIIA resectable NSCLC after adjuvant chemotherapy. Front Oncol 2022; 12:894656. [PMID: 36158650 PMCID: PMC9490556 DOI: 10.3389/fonc.2022.894656] [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: 03/12/2022] [Accepted: 08/15/2022] [Indexed: 12/24/2022] Open
Abstract
Background Atezolizumab was first shown to significantly improve progression-free survival (PFS) after platinum-based chemotherapy in early-stage non-small cell lung cancer (NSCLC) in the IMpower010 Phase 3 trial. However, the cost-effectiveness and potential economic impact of atezolizumab treatment in Chinese patients are unknown. Methods Markov models were constructed based on follow-up data from the IMpower010 trial and assessed separately in the programmed cell death receptor ligand-1 (PD-L1) tumor cells (TC) ≥ 1% stage II – IIIA group, all stage II – IIIA groups, and the intention-to-treat (ITT) group (stage IB–IIIA). Efficacy and safety data were obtained from the IMpower010 trial, and costs and utility values were derived from the literature and local surveys to estimate their incremental cost-effectiveness ratios (ICERs) compared with willingness-to-pay (WTP) thresholds in scenarios implementing patient assistance programs (PAP) or drug price negotiations. Univariate sensitivity analysis and probabilistic sensitivity analysis (PSA) were performed to investigate the stability of the model results. Results Compared with best supportive care (BSC), atezolizumab produced an additional 0.45 quality-adjusted life-years (QALYs), 0.04 QALYs, and -0.0028 QALYs in the PD-L1 TC ≥ 1% stage II – IIIA group, all stage II – IIIA groups, and the ITT group, and the ICERs were 108,825.37/QALY, 1,028,538.22/QALY, and -14,381,171.55/QALY, respectively. The ICERs all exceeded the WTP threshold of $27,354 per QALY (three times the per capita gross domestic product of China in 2022), and univariate sensitivity analysis showed that the price of atezolizumab played a crucial role in the model results. PSA showed that the probability of cost-effectiveness of atezolizumab in the PD-L1 TC ≥ 1% stage II – IIIA group, all stage II – IIIA groups, and the ITT group increased with the increasing WTP threshold. Conclusion From the perspective of China’s health care system, in the PD-L1 TC ≥ 1% stage II – IIIA group, all stage II – IIIA groups, and the ITT group, the use of atezolizumab in the adjuvant treatment of patients with early-stage NSCLC after platinum-based chemotherapy is unlikely to be cost-effective. The implementation of PAP or price reduction negotiations for atezolizumab might be among the most effective measures to improve its cost-effectiveness.
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Affiliation(s)
- Ping Chen
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qing Yang
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Qing Yang,
| | - Yinfeng Li
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaomei Jing
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Chen
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Savitch SL, Grenda TR, Yi M, Till B, Mack S, Huang C, Barta JA, Evans NR, Okusanya OT. Facility-level national trends in racial disparities of surgical therapy for early-stage lung cancer. J Thorac Cardiovasc Surg 2022; 164:650-657. [PMID: 35000683 DOI: 10.1016/j.jtcvs.2021.11.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/30/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The racial gap in surgical treatment for early-stage non-small cell lung cancer (NSCLC) has been narrowing at the population level, but it is unknown if this trend persists at the facility level. PATIENTS AND METHODS We queried the National Cancer Database Participant User File from 2006 to 2016 for patients with stage I NSCLC. Facilities were grouped by type, location, and resection volume. The cumulative surgery rate for Black and White patients in each group was calculated, and an incidence rate difference of receipt of surgery was determined. Logistic regression with estimation of marginal effects was used to assess the probability difference of receiving surgery in Black versus White patients in each year. RESULTS In total, 315,474 patients were included; 287,585 (91.2%) were White and 27,889 (8.8%) were Black. The surgery rate was greater for White patients (60.2% vs 55.8%, P < .001). For most groups, the surgery disparity narrowed over the study period. The disparity widened in community cancer programs; facilities in the New England, West North Central, and Pacific regions; and the lowest volume facilities. The probability difference for receiving surgery was significantly smaller in 2016 versus 2006 in the Middle Atlantic region and community cancer programs; the difference was unchanged for all other groupings. CONCLUSIONS Trends in disparities in the use of resection for early-stage NSCLC are not universal across facility groupings. As efforts are made toward addressing racial disparities in surgical care for NSCLC, it will be important to remember that population-level analyses may mask lack of progress in certain facility groups.
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Affiliation(s)
- Samantha L Savitch
- Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, Pa
| | - Tyler R Grenda
- Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, Pa
| | - Misung Yi
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pa
| | - Brian Till
- Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, Pa
| | - Shale Mack
- Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, Pa
| | - Charles Huang
- Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, Pa
| | - Julie A Barta
- Division of Pulmonary, Allergy, and Critical Care Medicine, Sidney Kimmel Medical College, Philadelphia, Pa
| | - Nathaniel R Evans
- Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, Pa
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Rekulapelli A, Desai RP, Narayan A, Martin LW, Hall R, Larner JM, Balkrishnan R. Racial and Treatment Center Differences on Time to Treatment Initiation for Nonsmall Cell Lung Cancer Patients Receiving Radiation Therapy As an Initial Treatment. Health Equity 2022; 6:603-609. [PMID: 36081886 PMCID: PMC9448516 DOI: 10.1089/heq.2022.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Because time to treatment has been shown to be associated with increase in the risk of death for Non Small Cell Lung Cancer (NSCLC) patients, we examined the prevalence and magnitude of racial disparities in mean time to radiation therapy (TTRT) for Stage I-III non-small cell lung cancer patients across a variety of treatment facilities. Methods: Utilizing the United States National Cancer Database (NCDB), we determined differences in TTRT between different races and different treatment facilities. Results: Concordant with past research, we found that non-White patients and patients treated at academic facilities, regardless of race, have longer mean TTRT, and that racial disparities in TTRT extend across all treatment facilities (all p<0.05). Conclusions: These findings shed light on the potential presence of and impact of structural racism on patients seeking cancer treatment, and the need for further investigation behind the reasonings behind longer TTI for non-White patients. To elucidate the real-world applicability of these results, further investigation into the societal determinants that perpetuate disparity in time to radiation therapy, and potential interventions in the clinical setting to improve cultural and racial sensitivity among healthcare professionals is recommended.
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Affiliation(s)
- Akhil Rekulapelli
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Raj P. Desai
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Aditya Narayan
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Linda W. Martin
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Richard Hall
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - James M. Larner
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Rajesh Balkrishnan
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Núñez ER, Caverly TJ, Zhang S, Glickman ME, Qian SX, Boudreau JH, Miller DR, Slatore CG, Wiener RS. Factors Associated With Declining Lung Cancer Screening After Discussion With a Physician in a Cohort of US Veterans. JAMA Netw Open 2022; 5:e2227126. [PMID: 35972738 PMCID: PMC9382440 DOI: 10.1001/jamanetworkopen.2022.27126] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/29/2022] [Indexed: 12/17/2022] Open
Abstract
Importance Lung cancer screening (LCS) is underused in the US, particularly in underserved populations, and little is known about factors associated with declining LCS. Guidelines call for shared decision-making when LCS is offered to ensure informed, patient-centered decisions. Objective To assess how frequently veterans decline LCS and examine factors associated with declining LCS. Design, Setting, and Participants This retrospective cohort study included LCS-eligible US veterans who were offered LCS between January 1, 2013, and February 1, 2021, by a physician at 1 of 30 Veterans Health Administration (VHA) facilities that routinely used electronic health record clinical reminders documenting LCS eligibility and veterans' decisions to accept or decline LCS. Data were obtained from the Veterans Affairs (VA) Corporate Data Warehouse or Medicare claims files from the VA Information Resource Center. Main Outcomes and Measures The main outcome was documentation, in clinical reminders, that veterans declined LCS after a discussion with a physician. Logistic regression analyses with physicians and facilities as random effects were used to assess factors associated with declining LCS compared with agreeing to LCS. Results Of 43 257 LCS-eligible veterans who were offered LCS (mean [SD] age, 64.7 [5.8] years), 95.9% were male, 84.2% were White, and 37.1% lived in a rural zip code; 32.0% declined screening. Veterans were less likely to decline LCS if they were younger (age 55-59 years: odds ratio [OR], 0.69; 95% CI, 0.64-0.74; age 60-64 years: OR, 0.80; 95% CI, 0.75-0.85), were Black (OR, 0.80; 95% CI, 0.73-0.87), were Hispanic (OR, 0.62; 95% CI, 0.49-0.78), did not have to make co-payments (OR, 0.92; 95% CI, 0.85-0.99), or had more frequent VHA health care utilization (outpatient: OR, 0.70; 95% CI, 0.67-0.72; emergency department: OR, 0.86; 95% CI, 0.80-0.92). Veterans were more likely to decline LCS if they were older (age 70-74 years: OR, 1.27; 95% CI, 1.19-1.37; age 75-80 years: OR, 1.93; 95% CI, 1.73-2.17), lived farther from a VHA screening facility (OR, 1.06; 95% CI, 1.03-1.08), had spent more days in long-term care (OR, 1.13; 95% CI, 1.07-1.19), had a higher Elixhauser Comorbidity Index score (OR, 1.04; 95% CI, 1.03-1.05), or had specific cardiovascular or mental health conditions (congestive heart failure: OR, 1.25; 95% CI, 1.12-1.39; stroke: OR, 1.14; 95% CI, 1.01-1.28; schizophrenia: OR, 1.87; 95% CI, 1.60-2.19). The physician and facility offering LCS accounted for 19% and 36% of the variation in declining LCS, respectively. Conclusions and Relevance In this cohort study, older veterans with serious comorbidities were more likely to decline LCS and Black and Hispanic veterans were more likely to accept it. Variation in LCS decisions was accounted for more by the facility and physician offering LCS than by patient factors. These findings suggest that shared decision-making conversations in which patients play a central role in guiding care may enhance patient-centered care and address disparities in LCS.
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Affiliation(s)
- Eduardo R. Núñez
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Tanner J. Caverly
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan Medical School, Ann Arbor
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
| | - Sanqian Zhang
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Mark E. Glickman
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
| | - Shirley X. Qian
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Donald R. Miller
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Christopher G. Slatore
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
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Brouwer AF, Engle JM, Jeon J, Meza R. Sociodemographic Survival Disparities for Lung Cancer in the United States, 2000-2016. J Natl Cancer Inst 2022; 114:1492-1500. [PMID: 35866998 PMCID: PMC9664170 DOI: 10.1093/jnci/djac144] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/02/2022] [Accepted: 07/19/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Understanding the impact of patient and tumor characteristics on lung cancer survival can help build personalized prognostic models and identify health disparities. METHODS We identified 557 555 patients aged 25 years and older diagnosed with lung or bronchus carcinoma from the Surveillance, Epidemiology, and End Results database, 2000-2016. We estimated hazard ratios (HR) for demographic (sex, age, race and ethnicity), tumor (stage, histology, year of diagnosis), and geographic characteristics (census tract-level urbanicity, socioeconomic status [SES]), as well as selected interactions, on the rate of lung cancer-specific death using multivariable proportional hazards models. RESULTS Women had a higher survival (lower hazard) of lung cancer-specific death than men (HR = 0.83, 95% confidence interval [CI] = 0.82 to 0.83). Hazards differed by race and ethnicity. Regional (HR = 2.41, 95% CI = 2.37 to 2.44) and distant (HR = 6.61, 95% CI = 6.53 to 6.69) tumors were associated with a lower survival (higher hazard) than localized tumors. Small cell tumors were associated with a lower survival (HR = 1.19, 95% CI = 1.18 to 1.20) than non-small cell tumors. Patients diagnosed after 2009 had lower hazards (HR = 0.86, 95% CI = 085 to 0.86) than those diagnosed 2000-2009. Lung cancer-specific survival did not depend on urbanicity after adjusting for census tract-level SES, but survival decreased with decreasing census tract-level SES. Differences in survival between non-Hispanic Black and White patients were greater for younger patients and localized tumors and increased with census tract-level SES. Differences by sex were greatest for young patients and localized tumors. CONCLUSIONS Disparities in survival after lung cancer diagnosis remain, with intersectional patterns suggesting differential access to and quality of care. Efforts are needed to ensure that high-risk groups receive guideline-concordant treatment.
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Affiliation(s)
- Andrew F Brouwer
- Correspondence to: Andrew F. Brouwer, PhD, Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA (e-mail: )
| | - Jason M Engle
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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Snyder RA, Hu CY, DiBrito SR, Chang GJ. Association of Medicaid Expansion with Racial Disparities in Cancer Stage at Presentation. Cancer 2022; 128:3340-3351. [PMID: 35818763 DOI: 10.1002/cncr.34347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study evaluates the independent association of Medicaid expansion on stage of presentation among patients of Black and White race with colorectal (CRC), breast, or non-small cell lung cancer (NSCLC). METHODS A cohort study of patients with CRC, breast cancer, or NSCLC (2009-2017) in the National Cancer Database was performed. Difference-in-differences (DID) analysis was used to compare changes in tumor stage at diagnosis between Medicaid expansion (MES) and non-expansion states (non-MES) before and after expansion. Predictive margins were calculated by race, year, and insurance status to account for effect heterogeneity. Stage migration was determined by measuring the combined proportional increase in stage I and decrease in stage IV disease at diagnosis. RESULTS Black patients gained less Medicaid coverage than White patients (6.0% vs 13.1%, p < 0.001) after expansion. Among Black and White patients, there was a shift towards increased early-stage diagnosis (DID 3.5% and 3.5%, respectively; p < 0.001) and decreased late-stage diagnosis (DID White: -3.5%; Black -2.5%; p < 0.001) in MES compared to non-MES following expansion. Overall stage migration was greater for White compared to Black patients with CRC (10.3% vs. 5.1%) and NSCLC (8.1% vs. 6.7%) after expansion. Stage migration effects in patients with breast cancer were similar by race (White 4.8% vs. Black 4.5%). CONCLUSION An increased proportion of Black and White patients residing in Medicaid expansion states presented with earlier stage cancer following Medicaid expansion. However, because the proportion of Black patients is higher in non-expansion states, national racial disparities in cancer stage at presentation appear worse following Medicaid expansion.
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Affiliation(s)
- Rebecca A Snyder
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.,Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Chung-Yuan Hu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sandra R DiBrito
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George J Chang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Oliver AL, Takahashi-Pipkin C, Wong JH, Burch AE, Irish WD. Disparate Access to Surgery for Operable Carcinoma of the Lung in North Carolina. Ann Surg Oncol 2022; 29:7485-7493. [PMID: 35810228 DOI: 10.1245/s10434-022-12101-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/12/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE Disparities in access to surgical care are associated with poorer outcomes in patients with cancer. We sought to determine whether vulnerable populations undergo an expected rate of surgery for Stage I-IIIA lung cancer in North Carolina (NC). METHODS We calculated the proportional surgical ratio (PSR) to identify a potential disparity in surgery rates for early stage (I-IIIA) lung cancer, first in the five counties with the worst health outcomes (LRC) and subsequently the entire state. The reference was the five healthiest counties (HRC), initially, and then the single county with the best health outcomes. RESULTS In 2016, 3,452 individuals with Stage I-IIIA lung cancer were diagnosed in NC of which 246,854 resided in LRC, whereas 1,865,588 resided in HRC. A total of 453 operable lung cancers were diagnosed in the HRC and 107 in the LRC. The observed lobectomy rate in HRC was 40.1% (range 20.2-58.3%) of early-stage lung cancer and 19% (range 12-36%) for LRC. The PSR was 0.65 (95% confidence interval [CI] = 0.35, 0.90). For all 99 counties across NC, the PSR ranged from 0.33 to 0.96 (mean = 0.49, standard deviation [SD] = 0.10). In a multivariable model, only other primary care provider ratio (relative rate per 100 increase = 0.997; 95% CI = 0.994, 0.999) was significantly associated with PSR. CONCLUSIONS Individuals residing in LRC in NC are 42% less likely to undergo surgery for operable lung cancer than patients living in HRC. Understanding how factors impact access is key to designing informed interventions.
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Affiliation(s)
- Aundrea L Oliver
- Department of Cardiovascular Science, Division of Thoracic Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Caitlin Takahashi-Pipkin
- Department of Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Jan H Wong
- Department of Surgery, Division of Surgical Research, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
| | - Ashley E Burch
- Department of Internal Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.,Department of Health Services and Information Management, East Carolina University, Greenville, NC, USA
| | - William D Irish
- Department of Surgery, Division of Surgical Research, Brody School of Medicine at East Carolina University, Greenville, NC, USA.,Department of Public Health, East Carolina University, Greenville, NC, USA
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40
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Hu X, Fujiwara T, Houdek MT, Chen L, Huang W, Sun Z, Sun Y, Yan W. Impact of racial disparities and insurance status in patients with bone sarcomas in the USA : a population-based cohort study. Bone Joint Res 2022; 11:278-291. [PMID: 35549518 PMCID: PMC9130676 DOI: 10.1302/2046-3758.115.bjr-2021-0258.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims Socioeconomic and racial disparities have been recognized as impacting the care of patients with cancer, however there are a lack of data examining the impact of these disparities on patients with bone sarcoma. The purpose of this study was to examine socioeconomic and racial disparities that impact the oncological outcomes of patients with bone sarcoma. Methods We reviewed 4,739 patients diagnosed with primary bone sarcomas from the Surveillance, Epidemiology and End Results (SEER) registry between 2007 and 2015. We examined the impact of race and insurance status associated with the presence of metastatic disease at diagnosis, treatment outcome, and overall survival (OS). Results Patients with Medicaid (odds ratio (OR) 1.41; 95% confidence interval (CI) 1.15 to 1.72) and uninsured patients (OR 1.90; 95% CI 1.26 to 2.86) had higher risks of metastatic disease at diagnosis compared to patients with health insurance. Compared to White patients, Black (OR 0.63, 95% CI 0.47 to 0.85) and Asian/Pacific Islander (OR 0.65, 95% CI 0.46 to 0.91) were less likely to undergo surgery. In addition, Black patients were less likely to receive chemotherapy (OR 0.67, 95% CI 0.49 to 0.91) compared to White patients. In patients with chondrosarcoma, those with Medicaid had worse OS compared to patients with insurance (hazard ratio (HR) 1.65, 95% CI 1.06 to 2.56). Conclusion In patients with a bone sarcoma, the cancer stage at diagnosis varied based on insurance status, and racial disparities were identified in treatment. Further studies are needed to identify modifiable factors which can mitigate socioeconomic and racial disparities found in patients with bone sarcomas. Cite this article: Bone Joint Res 2022;11(5):278–291.
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Affiliation(s)
- Xianglin Hu
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Matthew T Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Lingxiao Chen
- Faculty of Medicine and Health, University of Sydney, The Kolling Institute, Sydney, Australia
| | - Wending Huang
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhengwang Sun
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yangbai Sun
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wangjun Yan
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Abstract
PURPOSE OF REVIEW Despite an overall reduction in lung cancer incidence and mortality rates worldwide, Blacks still have higher mortality rates compared to Whites. There are many factors that contribute to this difference. This review seeks to highlight racial disparities in treatment and the possible reasons for these disparities. RECENT FINDINGS Factors attributing to racial disparities in lung cancer treatment include social determinants of health, differences in the administration of guideline-concordant therapy as well as molecular testing that is essential for most NSCLC patients. One way to circumvent disparities in lung cancer survivorship is to ensure equal representation of race in research at all levels that will provide insight on interventions that will address social determinants of health, differences in treatment patterns, molecular testing, and clinical trial involvement.
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Affiliation(s)
- Sharon Harrison
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave., Philadelphia, PA, 19111, USA
- African Caribbean Cancer Consortium, Philadelphia, PA, 19111, USA
| | - Julia Judd
- Department of Hematology/Oncology, Fox Chase Cancer Center, Temple University Hospital, 333 Cottman Ave., Philadelphia, PA, 19111, USA
| | - Sheray Chin
- African Caribbean Cancer Consortium, Philadelphia, PA, 19111, USA
- Department of Pathology (Division of Haematology & Oncology), Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave., Philadelphia, PA, 19111, USA.
- African Caribbean Cancer Consortium, Philadelphia, PA, 19111, USA.
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Patel PB, Alpert N, Taioli E, Flores R. Disparities in clinical and demographic characteristics among Asian/Pacific Islander and Non-Hispanic White newly diagnosed lung cancer patients. Cancer Causes Control 2022; 33:547-557. [PMID: 35043281 DOI: 10.1007/s10552-021-01548-5] [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: 01/22/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Racial disparities persist among lung cancer patients but have not been adequately studied among Asian/Pacific Islander (API) subgroups, which are heterogeneous. This study compared clinical and demographic characteristics at diagnosis of API subgroups and NHW patients. METHODS NHW and API adults diagnosed with lung cancer were identified from the Surveillance, Epidemiology, and End Results database (1990-2015). API was divided into eight subgroups: Chinese, Japanese, Filipino, Hawaiian/Pacific Islander, Korean, Vietnamese, Asian Indian/Pakistani, and Other. Multivariable multinomial logistic regression models were used to assess adjusted associations of clinical and demographic factors with API/subgroups. RESULTS There were 522,702 (92.6%) NHW and 41,479 (7.4%) API lung cancer patients. API were less likely to be diagnosed at the age of ≥ 80 years (ORadj 0.53, 95% CI 0.48-0.58 for ≥ 80 vs. ≤ 39 years) than NHW. However, Japanese patients were more often diagnosed at ≥ 80 years compared to other ethnic subgroups. API were less often female (ORadj 0.85, 95% CI 0.83-0.86), and unmarried (ORadj 0.71, 95% CI 0.68-0.74); however, among API, Japanese, Hawaiian/Pacific Islander, Korean, and Vietnamese were more often unmarried, compared to Chinese patients. API were more frequently diagnosed at stage IV, compared to stage I (ORadj 1.31, 95% CI 1.27-1.35). API had significantly less squamous cell carcinoma (ORadj 0.54, 95% CI 0.52-0.56, compared to adenocarcinoma); among API, Japanese, Filipino, Hawaiian/Pacific Islander, Korean, Asian Indian/Pakistani, and Other were more likely than Chinese patients to present with squamous cell histology (range: ORadj[Other] 1.24, 95% CI 1.09-1.41; ORadj[Hawaiian/Pacific Islander] 2.47, 95% CI 2.22-2.75). CONCLUSION At diagnosis, there are significant differences in demographic and clinical characteristics between NHW, API, and API subgroups. Treating API patients as a single population may overlook biological, environmental, and behavioral differences that might be beneficial in designing prevention strategies and treatment.
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Affiliation(s)
- Parth B Patel
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi Alpert
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Emmerick ICM, Singh A, Powers M, Lou F, Lin P, Maxfield M, Uy K. Factors associated with diagnosis of stages I and II lung cancer: a multivariate analysis. Rev Saude Publica 2021; 55:112. [PMID: 34932701 PMCID: PMC8664062 DOI: 10.11606/s1518-8787.2021055003345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To present the overall survival rate for lung cancer and identify the factors associated with early diagnosis of stage I and II lung cancer. METHODS This is a retrospective cohort study including individuals diagnosed with lung cancer, from January 2009 to December 2017, according to the cancer registry at UMass Memorial Medical Center. Five-year overall survival and its associated factors were identified by Kaplan-Meier curves and Cox's proportional hazards model. Factors associated with diagnosing clinical stage I and II lung cancer were identified by bivariate and multivariate backward stepwise logistic regression (Log-likelihood ratio (LR)) at 95% confidence interval (CI). RESULTS The study was conducted with data on 2730 individuals aged 67.9 years on average, 51.5% of whom female, 92.3% white, and 6.6% never smoked. Five-year overall survival was 21%. Individuals diagnosed with early-stage disease had a 43% five-year survival rate compared to 8% for those diagnosed at late stages. Stage at diagnosis was the main factor associated with overall survival [HR = 4.08 (95%CI: 3.62-4.59)]. Factors associated with early diagnosis included patients older than 68 years [OR = 1.23 (95%CI: 1.04-1.45)], of the female gender [OR = 1.47 (95%CI: 1.24-1.73)], white [OR = 1.63 (95%CI: 1.16-2.30)], and never-smokers [OR = 1.37 (95%CI: 1.01-1.86)]; as well as tumors affecting the upper lobe [OR = 1.46 (95%CI: 1.24-1.73)]; adenocarcinoma [OR = 1.43 (95%CI: 1.21-1.69)]; and diagnosis after 2014 [OR = 1.61 (95%CI: 1.37-1.90)]. CONCLUSIONS Stage at diagnosis was the most decisive predictor for survival. Non-white and male individuals were more likely to be diagnosed at a late stage. Thus, promoting lung cancer early diagnosis by improving access to health care is vital to enhance overall survival for individuals with lung cancer.
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Affiliation(s)
| | - Anupama Singh
- University of Massachusetts Medical School. Worcester, Massachusetts, USA
| | - Maggie Powers
- University of Massachusetts Medical School. Division of Thoracic Surgery. Department of Surgery. Worcester, Massachusetts, USA
| | - Feiran Lou
- University of Massachusetts Medical School. Division of Thoracic Surgery. Department of Surgery. Worcester, Massachusetts, USA
| | - Poliana Lin
- University of Massachusetts Medical School. Division of Thoracic Surgery. Department of Surgery. Worcester, Massachusetts, USA
| | - Mark Maxfield
- University of Massachusetts Medical School. Division of Thoracic Surgery. Department of Surgery. Worcester, Massachusetts, USA
| | - Karl Uy
- University of Massachusetts Medical School. Division of Thoracic Surgery. Department of Surgery. Worcester, Massachusetts, USA
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Abstract
Social disparities in lung cancer diagnosis, treatment, and survival have been studied using national databases, statewide registries, and institution-level data. Some disparities emerge consistently, such as lower adherence to treatment guidelines and worse survival by race and socioeconomic status, whereas other disparities are less well studied. A critical appraisal of current data is essential to increasing equity in lung cancer care.
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Affiliation(s)
- Irmina Elliott
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA
| | - Cayo Gonzalez
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA
| | - Leah Backhus
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA
| | - Natalie Lui
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA.
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Brawley OW, Luhn P, Reese-White D, Ogbu UC, Madhavan S, Wilson G, Cox M, Ewing A, Hammer C, Richie N. Disparities in Tumor Mutational Burden, Immunotherapy Use, and Outcomes Based on Genomic Ancestry in Non-Small-Cell Lung Cancer. JCO Glob Oncol 2021; 7:1537-1546. [PMID: 34752134 PMCID: PMC8577674 DOI: 10.1200/go.21.00309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE In patients with advanced non–small-cell lung cancer (aNSCLC), tumor mutational burden (TMB) may vary by genomic ancestry; however, its impact on treatment outcomes is unclear. This retrospective, observational study describes treatment patterns of patients with aNSCLC by genomic ancestry and electronic health record (EHR)-reported race and/or ethnicity and evaluates differences in TMB, cancer immunotherapy (CIT) access, and treatment outcomes across racial and ancestral groups. METHODS Patients diagnosed with aNSCLC after January 1, 2011, were selected from a real-world deidentified clinicogenomics database and EHR-derived database; continuously enrolled patients were evaluated. Race and/or ethnicity was recorded using variables from the EHR database; genomic ancestry was classified by single-nucleotide polymorphisms on a next-generation sequencing panel. A threshold of 16 mutations per megabase was used to categorize TMB status. RESULTS Of 59,559 patients in the EHR-derived database and 7,548 patients in the clinicogenomics database, 35,016 (58.8%) and 4,392 (58.2%) were continuously enrolled, respectively. CIT use was similar across EHR-reported race groups, ranging from 34.4% to 37.3% for non-Hispanic Asian and non-Hispanic Black patients, respectively. TMB levels varied significantly across ancestry groups (P < .001); patients of African ancestry had the highest median TMB (8.75 mutations per megabase; interquartile range, 4.35-14.79). In patients who had received CIT, high TMB was associated with improved overall survival compared with low TMB (20.89 v 11.83 months; hazard ratio, 0.60; 95% CI, 0.51 to 0.70) across genomic ancestral groups. CONCLUSION These results suggest that equitable access to next-generation sequencing may improve aNSCLC outcome disparities in racially and ancestrally diverse populations.
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Delman AM, Turner KM, Wima K, Simon VE, Starnes SL, Shah SA, Van Haren RM. Offering lung resection to current smokers: An opportunity for more equitable care. J Thorac Cardiovasc Surg 2021; 164:400-408.e1. [PMID: 34802749 DOI: 10.1016/j.jtcvs.2021.09.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/21/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Minority patients with lung cancer are less likely to undergo surgical resection and experience worse survival than non-Hispanic White patients. Currently, 40% of thoracic surgeons require smoking cessation before surgery, which may disproportionately affect minority patients. Our objective was to assess the risk of smoking status on postoperative morbidity and mortality among patients with lung cancer. METHODS A prospectively maintained institutional database was queried for all patients who underwent surgical resection of a primary lung malignancy between 2006 and 2020. Operative mortality, major morbidity, and a composite of morbidity and mortality were compared between current smokers and prior smokers. RESULTS A total of 601 patients underwent resection, and 236 (39.3%) were current smokers. Current smokers were more likely to be younger (P < .01), to have a greater pack-years history (P = .03), and to have worse pulmonary function test results (P < .01). Pretreatment stage, surgical approach, and extent of resection were similar between groups. There was no difference in operative mortality (0.9% vs 1.9%, P = .49), major morbidity (12.7% vs 9.3%, P = .19), or composite major morbidity and mortality between groups (13.1% vs 9.3%, P = .14). After adjusting for pulmonary function status, current smoking status was not associated with mortality or major morbidity on multivariable logistic regression (odds ratio, 1.51; 95% confidence interval, 0.76-3.03, P = .24). CONCLUSIONS Current smokers experienced similar rates of mortality and major morbidity as prior smokers. In the context of continued racial and ethnic disparities in lung cancer survival, in particular decreased resection rates among minorities, smoking cessation requirements should not delay or prevent operative intervention for lung cancer.
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Affiliation(s)
- Aaron M Delman
- Department of Surgery, Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kevin M Turner
- Department of Surgery, Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Koffi Wima
- Department of Surgery, Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Victoria E Simon
- Department of Surgery, Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sandra L Starnes
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shimul A Shah
- Department of Surgery, Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert M Van Haren
- Department of Surgery, Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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47
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Kee D, Wisnivesky J, Kale MS. Lung Cancer Screening Uptake: Analysis of BRFSS 2018. J Gen Intern Med 2021; 36:2897-2899. [PMID: 32959352 PMCID: PMC8390735 DOI: 10.1007/s11606-020-06236-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Dustin Kee
- Icahn School of Medicine at Mount Sinai, , New York, NY, USA.
| | - Juan Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Minal S Kale
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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48
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Nizam W, Yeo HL, Obeng-Gyasi S, Brock MV, Johnston FM. Disparities in Surgical Oncology: Management of Advanced Cancer. Ann Surg Oncol 2021; 28:8056-8073. [PMID: 34268636 DOI: 10.1245/s10434-021-10275-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023]
Abstract
Significant variations in the patterns of care, incidence, and mortality rates of several common cancers have been noted. These disparities have been attributed to a complex interplay of factors, including genetic, environmental, and healthcare-related components. Within this review, primarily focusing on commonly occurring cancers (breast, lung, colorectal), we initially summarize the burden of these disparities with regard to incidence and screening patterns. We then explore the interaction between several proven genetic, epigenetic, and environmental influences that are known to contribute to these disparities.
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Affiliation(s)
- Wasay Nizam
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Heather L Yeo
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Malcolm V Brock
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. .,Division of Gastrointestinal Surgical Oncology, Peritoneal Surface Malignancy Program, Complex General Surgical Oncology Fellowship, Division of Surgical Oncology, Johns Hopkins University, Baltimore, MD, USA.
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49
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DuMontier C, Loh KP, Soto-Perez-de-Celis E, Dale W. Decision Making in Older Adults With Cancer. J Clin Oncol 2021; 39:2164-2174. [PMID: 34043434 PMCID: PMC8260915 DOI: 10.1200/jco.21.00165] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/12/2021] [Accepted: 03/11/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Clark DuMontier
- Brigham and Women's Hospital, Boston, MA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - William Dale
- City of Hope Comprehensive Cancer Center, Duarte, CA
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50
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Stein JN, Rivera MP, Weiner A, Duma N, Henderson L, Mody G, Charlot M. Sociodemographic disparities in the management of advanced lung cancer: a narrative review. J Thorac Dis 2021; 13:3772-3800. [PMID: 34277069 PMCID: PMC8264681 DOI: 10.21037/jtd-20-3450] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/14/2021] [Indexed: 12/25/2022]
Abstract
Treatment of advanced non-small cell lung cancer (NSCLC) has markedly changed in the past decade with the integration of biomarker testing, targeted therapies, immunotherapy, and palliative care. These advancements have led to significant improvements in quality of life and overall survival. Despite these improvements, racial and socioeconomic disparities in lung cancer mortality persist. This narrative review aims to assess and synthesize the literature on sociodemographic disparities in the management of advanced NSCLC. A narrative overview of the literature was conducted using PubMed and Scopus and was narrowed to articles published from January 1, 2010, until July 22, 2020. Articles relevant to sociodemographic variation in (I) chemoradiation for stage III NSCLC, (II) molecular biomarker testing, (III) systemic treatment, including chemotherapy, targeted therapy, and immunotherapy, and (IV) palliative and end of life care were included in this review. Twenty-two studies were included. Sociodemographic disparities in the management of advanced NSCLC varied, but recurring findings emerged. Across most treatment domains, Black patients, the uninsured, and patients with Medicaid were less likely to receive recommended lung cancer care. However, some of the literature was limited due to incomplete data to adequately assess appropriateness of care, and several studies were out of date with current practice guidelines. Sociodemographic disparities in the management of advanced lung cancer are evident. Given the rapidly evolving treatment paradigm for advanced NSCLC, updated research is needed. Research on interventions to address disparities in advanced NSCLC is also needed.
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Affiliation(s)
- Jacob Newton Stein
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ashley Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Narjust Duma
- Division of Hematology, Oncology and Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA.,University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Louise Henderson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Gita Mody
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Marjory Charlot
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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