1
|
Wang X, Lian Z, Wu Q, Wu F, Zhang G, Liu J, Chen C, Sun J. Refusal of treatment among HER2-positive breast cancer patients in China: a retrospective analysis. Front Public Health 2024; 11:1305544. [PMID: 38303960 PMCID: PMC10832033 DOI: 10.3389/fpubh.2023.1305544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/19/2023] [Indexed: 02/03/2024] Open
Abstract
Background There is a need to update the understanding of treatment refusal among cancer patients in China, taking into account recent developments. This study investigated how public insurance coverage of the first breast cancer targeted therapy contributed to the changes in treatment refusal among HER2-positive breast cancer patients in China. And it intensively examined and discussed additional barriers affecting patient utilization of innovative anticancer medicines based on the types and reasons for treatment refusal. Methods This retrospective study included female breast cancer patients diagnosed as HER2-positive who received treatment at a provincial oncology center in southern China between 2014 and 2020. Multivariable analysis was conducted using a binary logistic regression model. Subgroup analysis was performed with the same regression model. Results Among the 1,322 HER2-positive breast cancer patients who received treatment at the study hospital between 2014 and 2020, 327 (24.55%) had ever refused treatment. Economic reasons were reported as the primary cause by 142 patients (43.43%). Patients diagnosed after September 2017, when the first breast cancer targeted therapy was included in the public health insurance, were less likely to refuse treatment (OR = 0.64, 95% CI:0.45 ~ 0.91, p = 0.01) compared to those diagnosed before September 2017. Patients enrolled in the resident health insurance were more likely to refuse treatment (OR = 2.43, 95% CI:1.77 ~ 3.35, p < 0.001) than those enrolled in the employee health insurance. Conclusion This study reveals a high rate of treatment refusal among HER2-positive breast cancer patients, primarily attributed to financial factors. The disparity in public health insurance benefits resulted in a heavier economic burden for patients with less comprehensive benefits. Furthermore, the study identified challenges faced by patients seeking quality-assured cancer care in underdeveloped regions in China. By addressing economic barriers, promoting accurate health information, and improving cancer care capacity across the country can reduce the rate of treatment refusal.
Collapse
Affiliation(s)
- Xin Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiwei Lian
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Qiyou Wu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Wu
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Gong Zhang
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jian Liu
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Chuanben Chen
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jing Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
2
|
Bassiri A, Badrinathan A, Alvarado CE, Boutros C, Jiang B, Kwak M, Sinopoli J, Tapias Vargas L, Linden PA, Towe CW. Uncovering Health-Care Disparities Through Patient Decisions in Lung Cancer Surgery. J Surg Res 2024; 293:248-258. [PMID: 37804794 DOI: 10.1016/j.jss.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Declining cancer surgery represents a conflict between patients' rights to autonomy and providers' perspectives of best practice. We hypothesize that, among patients with nonmetastatic lung cancer, patient demographics would be associated with different rates of declination of lung cancer surgery. METHODS Patients with nonmetastatic lung cancer from 2004 to 2018 in the National Cancer Database were identified. Patients were categorized into two groups based on surgical treatment: surgical resection and declined surgery. Patient characteristics were compared using bivariate and multivariate models to identify factors associated with surgical declination. Additionally, we performed subgroup analyses of cT1N0M0 patients with no comorbidities. Survival analysis done using multivariate cox analysis and Kaplan-Meier survival analysis. RESULTS 478,757 patients were identified. In a multivariate model, declining surgery was associated with increased age (odds ratio 1.09, 1.09-1.10), non-Hispanic Black race (odds ratio 1.95, 1.73-2.21), nonprivate insurance, and lower Socioeconomic Status. In a subgroup of cT1N0M0 patients with no comorbidities, declining surgery was associated with increasing age, non-Hispanic Black race, nonprivate insurance, and socioeconomic status. Patient's that declined surgery demonstrated lower overall survival when compared to patients that underwent surgical resection (5 y overall survival: declined surgery 40% versus underwent resection 72%, P < 0.001). CONCLUSIONS Although early-stage lung cancer is potentially curable, many patients decline guideline-based surgery, and have worse overall survival. There are social and economic factors associated with patients declining lung cancer surgery. Providers have an ethical responsibility to understand the basis of patient's decision to decline recommended surgery and address endemic disparities related to race and access to care.
Collapse
Affiliation(s)
- Aria Bassiri
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Avanti Badrinathan
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christine E Alvarado
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christina Boutros
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Boxiang Jiang
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Minyoung Kwak
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jillian Sinopoli
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Leonidas Tapias Vargas
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| |
Collapse
|
3
|
Ezeh UC, Al-Awady A, Buitron I, Lee M, Forman G, Peifer S, Deo A, Sweeny L, Weed D, Kobetz EK, Reis IM, Franzmann E. Investigating Disparities in Hypopharyngeal/Laryngeal Cancer Survival in Florida With Geospatial Mapping Analysis. Cancer Control 2024; 31:10732748241246958. [PMID: 38623948 PMCID: PMC11022680 DOI: 10.1177/10732748241246958] [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: 12/03/2023] [Revised: 03/01/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE Identify predictors of overall survival (OS) after hypopharyngeal/laryngeal cancer in Florida. MATERIAL AND METHODS We conducted a retrospective cohort study using data from the Florida Cancer Data System (FCDS) on patients diagnosed with hypopharyngeal or laryngeal cancer from 2010-2017. Primary outcome was OS. Hazard ratios (HRs) were estimated from univariable and multivariable Cox regression models for OS. Data was analyzed from November 1, 2022, to June 30, 2023. RESULTS We analyzed 6771 patients, who were primarily male (81.2%), White non-Hispanic (WNH) (78.2%), publicly insured (70.1%), married (51.8%), and residents of urban counties (73.6%). Black patients were more likely to be younger at diagnosis (38.9%), single (43.4%), to have distant SEER stage disease (25.6%). Median OS were lowest among patients who were uninsured (34 months), with hypopharyngeal site disease (18 months), and a smoking history (current: 34 months, former: 46 months, no smoking: 63 months). Multivariable Cox regression analysis showed worse OS for single/unmarried vs married (HR 1.47 [95%CI: 1.36-1.59], P < .001), history of tobacco use (current: HR 1.62 [95%CI: 1.440-1.817], P < .001; former smokers: (HR 1.28 [95%CI: 1.139-1.437], P < .001) vs no history). Improved OS was observed among White Hispanics (WH) vs WNH (HR .73 [95%CI: .655-.817], P < .001) and women vs men (HR .88 [95%CI: .807-.954], P = .002). Geographical mapping showed that mortality rates were highest in census tracts with low income and education. CONCLUSION Our findings suggest that sociodemographic and clinical factors impact OS from hypopharyngeal/laryngeal cancer in Florida and vary geographically within the state. These results will help guide future public health interventions.
Collapse
Affiliation(s)
- Uche C. Ezeh
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abdurrahman Al-Awady
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Ming Lee
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Garrett Forman
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sophia Peifer
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alana Deo
- University of California Santa Barbara, Santa Barbara, CA, USA
| | - Larissa Sweeny
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Donald Weed
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Erin K. Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Isildinha M Reis
- Division of Biostatistics, Department of Public Health Sciences, Sylvester Biostatistics and Bioinformatics Shared Resource, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Franzmann
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
4
|
Madrigal J, Tie EK, Verma A, Benharash P, Rapkin DA, St John MA. The Increasing Burden of Depression in Patients Undergoing Head and Neck Cancer Operations. Laryngoscope 2023; 133:3396-3402. [PMID: 37161918 DOI: 10.1002/lary.30735] [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: 02/07/2023] [Revised: 03/30/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Depression remains prevalent in patients undergoing head and neck cancer (HNCA) operations. The present study aimed to assess the impact of depression on perioperative and readmission outcomes following HNCA resection. METHODS All elective hospitalizations involving HNCA resection were identified from the 2010-2019 Nationwide Readmissions Database. Patients were stratified by history of depression. To perform risk-adjustment in assessing perioperative and readmission outcomes, 3:1 nearest neighbor matching was performed. A subpopulation analysis was also conducted to assess interval development of depression in the postoperative period. RESULTS Of an estimated 133,018 patients undergoing HNCA operations, 8.9% (n = 11,855) had comorbid depression. Over the decade-long study period, the prevalence of depression in this population increased (7.8% in 2010 vs. 10.0% in 2019, NPTrend<0.001). Among 24,938 propensity matched patients, those with depression had similar incidence of in-hospital mortality (0.4 vs. 0.7%, p = 0.14) as well as perioperative medical (22.0 vs. 21.9%, p = 0.93) and surgical (10.2 vs. 10.3, p = 0.84) complications, though had higher rates of non-home discharge (16.9 vs. 13.5%, p < 0.001) and 30-day readmission (13.6 vs. 11.8%, p = 0.030). Predictors of depression in the postoperative period included primary coverage by Medicare or Medicaid as well as comorbid anxiety or drug use disorder. CONCLUSION The prevalence of depression in HNCA patients continues to increase. Although depression was not associated with increased in-hospital mortality and complications, it did impact rates of rehospitalization as well as non-routine discharge. Screening and therapeutic interventions addressing such postoperative events may serve to improve long-term clinical and financial outcomes in this at-risk population. LEVEL OF EVIDENCE 3-Retrospective cohort study Laryngoscope, 133:3396-3402, 2023.
Collapse
Affiliation(s)
- Josef Madrigal
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Edward K Tie
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, California, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - David A Rapkin
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| |
Collapse
|
5
|
Laccourreye O, Gervais C, Garcia D, Amiri G, Mirghani H, Giraud P. Harmful impact of treatment refusal in T3-4M0 endolaryngeal squamous cell carcinoma candidates for total laryngectomy: A STROBE analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:221-225. [PMID: 37321906 DOI: 10.1016/j.anorl.2023.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE To evaluate the consequences of treatment refusal in total laryngectomy (TL) candidates with T3-4M0 endolaryngeal squamous cell carcinoma (SCC). MATERIALS AND METHODS A retrospective observational study was conducted in an inception cohort of 576 isolated T3-4M0 endolaryngeal SCC candidates for TL consecutively managed between 1970 and 2019 in a French university teaching hospital. The main endpoint was survival time and cause of death in 2 groups. Group A, 4.5% of the cohort, consisted of 26 patients who declined any laryngeal treatment. Group B consisted of 550 patients who accepted TL. Accessory endpoints were causes of TL refusal and associated variables. The STROBE guideline was applied. The significance threshold was set at P<0.005. RESULTS One-and 3-year actuarial survival estimates increased significantly (P<0.0001) from 39% and 15% in group A, to 83% and 63% in group B, respectively. In group A, 92% of causes of death implicated index SCC progression, whereas in group B intercurrent disease, metachronous second primary, locoregional and/or metastatic SCC progression and postoperative complications accounted for 37%, 31%, 29%, and 2%, respectively. The actuarial survival estimates within group A increased significantly (P=0.0003) from 0% at 1-year in patients managed with isolated supportive care to 56% in patients managed with chemotherapy (reaching 0% at 5years). Reasons for TL refusal were fear of surgery, refusal of tracheostoma, loss of physiologic phonation, and certain comorbidities. Age and chronologic period correlated significantly with TL refusal. Median age decreased (P<0.001) from 69years in group A to 58 years in group B. Percentage TL refusal increased (P<0.0001) from 2% to 11% before and after start 1990, respectively. CONCLUSION The current study determined loss of survival with refusal of any laryngeal treatment including TL, noted benefit of chemotherapy associated to supportive care, and discussed the possible contribution of immunotherapy.
Collapse
Affiliation(s)
- O Laccourreye
- Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, HEGP, Université Paris Cité, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
| | - C Gervais
- Service d'Oncologie Médicale, HEGP, Université Paris Cité, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - D Garcia
- Hôpital Français, SO1 Pho Phuong Mai, Dong Da District, Hanoi, Viet Nam
| | - G Amiri
- Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, HEGP, Université Paris Cité, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - H Mirghani
- Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, HEGP, Université Paris Cité, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - P Giraud
- Service de Radiothérapie-Oncologie, HEGP, Université Paris Cité, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| |
Collapse
|
6
|
Samuel D, Kwon D, Huang M, Zhao W, Roy M, Tabuyo-Martin A, Siemon J, Schlumbrecht MP, Pearson JM, Sinno AK. Disparities in refusal of surgery for gynecologic cancer. Gynecol Oncol 2023; 174:1-10. [PMID: 37141816 DOI: 10.1016/j.ygyno.2023.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To identify sociodemographic and clinical factors associated with refusal of gynecologic cancer surgery and to estimate its effect on overall survival. METHODS The National Cancer Database was surveyed for patients with uterine, cervical or ovarian/fallopian tube/primary peritoneal cancer treated between 2004 and 2017. Univariate and multivariate logistic regression were used to assess associations between clinico-demographic variables and refusal of surgery. Overall survival was estimated using the Kaplan-Meier method. Trends in refusal over time were evaluated using joinpoint regression. RESULTS Of 788,164 women included in our analysis, 5875 (0.75%) patients refused surgery recommended by their treating oncologist. Patients who refused surgery were older at diagnosis (72.4 vs 60.3 years, p < 0.001) and more likely Black (OR 1.77 95% CI 1.62-1.92). Refusal of surgery was associated with uninsured status (OR 2.94 95% CI 2.49-3.46), Medicaid coverage (OR 2.79 95% CI 2.46-3.18), low regional high school graduation (OR 1.18 95% CI 1.05-1.33) and treatment at a community hospital (OR 1.59 95% CI 1.42-1.78). Patients who refused surgery had lower median overall survival (1.0 vs 14.0 years, p < 0.01) and this difference persisted across disease sites. Between 2008 and 2017, there was a significant increase in refusal of surgery annually (annual percent change +1.41%, p < 0.05). CONCLUSIONS Multiple social determinants of health are independently associated with refusal of surgery for gynecologic cancer. Given that patients who refuse surgery are more likely from vulnerable, underserved populations and have inferior survival, refusal of surgery should be considered a surgical healthcare disparity and tackled as such.
Collapse
Affiliation(s)
- David Samuel
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America.
| | - Deukwoo Kwon
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York, NY, United States of America
| | - Marilyn Huang
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America; Sylvester Comprehensive Cancer Center, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, Biostatistics and Bioinformatics Shared Resource, Miami, FL, United States of America
| | - Molly Roy
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - Angel Tabuyo-Martin
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - John Siemon
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - Matthew P Schlumbrecht
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America; Sylvester Comprehensive Cancer Center, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - J Matt Pearson
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America; Sylvester Comprehensive Cancer Center, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - Abdulrahman K Sinno
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America; Sylvester Comprehensive Cancer Center, Division of Gynecologic Oncology, Miami, FL, United States of America
| |
Collapse
|
7
|
Birkenbeuel JL, Lehrich BM, Goshtasbi K, Abiri A, Hsu FPK, Kuan EC. Refusal of Surgery in Pituitary Adenoma Patients: A Population-Based Analysis. Cancers (Basel) 2022; 14:cancers14215348. [PMID: 36358767 PMCID: PMC9656152 DOI: 10.3390/cancers14215348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 12/04/2022] Open
Abstract
We characterized the clinical and sociodemographic factors predictive of surgery refusal in pituitary adenoma (PA) patients. We queried the National Cancer Database (NCDB) to identify adult PA patients treated from 2004−2015 receiving or refusing surgery. Multivariate logistic regression and Cox proportional-hazards analysis identified clinical and/or sociodemographic factors predictive of surgery refusal or mortality, respectively. Of the 34,226 patients identified, 280 (0.8%) refused surgery. On multivariate logistic regression, age > 65 (OR: 2.64; p < 0.001), African American race (OR: 1.70; p < 0.001), Charlson-Deyo Comorbidity (C/D) Index > 2 (OR: 1.52; p = 0.047), and government insurance (OR: 2.03; p < 0.001) or being uninsured (OR: 2.16; p = 0.03) were all significantly associated with surgery refusal. On multivariate cox-proportional hazard analysis, age > 65 (HR: 2.66; p < 0.001), tumor size > 2 cm (HR: 1.30; p < 0.001), C/D index > 1 (HR: 1.53; p < 0.001), having government insurance (HR: 1.66; p < 0.001) or being uninsured (HR: 1.67; p < 0.001), and surgery refusal (HR: 2.28; p < 0.001) were all significant predictors of increased mortality. Macroadenoma patients receiving surgery had a significant increase in overall survival (OS) compared to those who refused surgery (p < 0.001). There are significant sociodemographic factors that influence surgery refusal in PA patients. An individualized approach is warranted that considers functional status, clinical presentations, and patient choice.
Collapse
Affiliation(s)
- Jack L. Birkenbeuel
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92868, USA
| | - Brandon M. Lehrich
- Medical Scientist Training Program, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92868, USA
| | - Arash Abiri
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92868, USA
| | - Frank P. K. Hsu
- Department of Neurosurgery, University of California, Irvine, CA 92868, USA
| | - Edward C. Kuan
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92868, USA
- Department of Neurosurgery, University of California, Irvine, CA 92868, USA
- Correspondence: ; Tel.: +1-714-456-5753
| |
Collapse
|
8
|
Smith BD, Osazuwa-Peters OL, Cannon TY, Reed WT, Puscas L, Osazuwa-Peters N. Nonsurgical Risk Factors Associated With Pharyngocutaneous Fistula in Patients Who Have Undergone Laryngectomy. JAMA Otolaryngol Head Neck Surg 2021; 147:966-973. [PMID: 34591065 DOI: 10.1001/jamaoto.2021.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy. Despite the well-described clinical risk factors for PCF and its association with poor quality of life, there is a paucity of data on the nonclinical factors that may be associated with this complication. Objective To determine whether nonclinical risk factors (eg, age, sex, race and ethnicity) are associated with an increased risk of developing a PCF after total laryngectomy, and whether or not the method of reconstruction explains any differences found. Design, Setting, and Participants This retrospective multicenter cohort study used data from a nationally validated, risk-adjusted, outcomes-based, surgical quality improvement database (the National Surgical Quality Improvement Program) to examine outcomes in patients who underwent a total laryngectomy from 2005 to 2018. The database was queried from January 1, 2005, to December 31, 2018; data analyses were performed from September 1, 2020, to March 31, 2021. Main Outcomes and Measures The primary outcome was development of a PCF within 30 days of a total laryngectomy. Patient characteristics, including age, sex, race and ethnicity, comorbidities, and mode of reconstruction, were analyzed. Results A cohort of 1573 adult patients (median age [IQR], 63 [56-71] years; 1280 [81.4%] men; 293 [18.6%] women; 1001 [63.6%] non-Hispanic White individuals) had undergone a total laryngectomy during the study period and were included in the analyses. The overall rate of PCF formation was 4.3% (68 of 1573 patients). Hispanic patients had the highest rate (9.5%; 9 of 95 patients) of PCF formation, which was more than twice the rate among non-Hispanic White patients (3.8%; 38 of 1001) and non-Hispanic Black patients (4.7%; 11 of 236). After adjusting for clinical and other covariates, women were 1.9 times more likely to develop a PCF compared with men (adjusted odds ratio, 1.90; 95% CI, 1.08-3.35). We also found that the odds of developing a PCF were 3-fold higher among Hispanic patients compared with non-Hispanic White patients (adjusted odds ratio, 2.96; 95% CI, 1.36-6.47). The type of reconstruction did not differ across age or race and ethnicity after controlling for clinical risk factors. Conclusions and Relevance This multicenter cohort study found that 2 nonclinical risk factors-Hispanic ethnicity and female sex-were associated with an increased risk of PCF formation. Knowledge of these risk factors should be included in patient-physician decision-making as well as future interventions to decrease the rate of PCF formation after laryngectomy.
Collapse
Affiliation(s)
- Blaine D Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Oyomoare L Osazuwa-Peters
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Trinitia Y Cannon
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - William T Reed
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Liana Puscas
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Duke Cancer Institute, Durham, North Carolina
| |
Collapse
|
9
|
Coffman AR, Tao R, Cohan JN, Huang LC, Pickron TB, Torgeson AM, Lloyd S. Factors associated with the refusal of surgery and the associated impact on survival in patients with rectal cancer using the National Cancer Database. J Gastrointest Oncol 2021; 12:1482-1497. [PMID: 34532104 DOI: 10.21037/jgo-20-437] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 06/08/2021] [Indexed: 11/06/2022] Open
Abstract
Background Surgical resection is an integral component of the curative-intent treatment for most patients with non-metastatic rectal cancer. However, some patients refuse surgery for a number of reasons. Utilizing the National Cancer Database (NCDB), we investigated the sociodemographic and clinical factors associated with patients who were coded as having been offered but refused surgery, and the factors affecting overall survival (OS) in these patients. Methods Adult patients with adenocarcinoma of the rectum (excluding T1N0M0 and M1 disease) diagnosed from 2004 to 2015 were analyzed in this retrospective cohort study. Logistic regression was performed to identify factors associated with refusal of surgery. OS of patients refusing surgery was compared using Kaplan-Meier estimate, log-rank test, propensity score matching, and proportional hazards regression. Results A total of 55,704 patients were identified: 54,266 received definitive surgery (97.4%) and 1,438 refused (2.6%). Of patients refusing surgery, 135 (9.4%) were stage I, 709 (49.3%) were stage II, and 594 (41.3%) were stage III. Patients were more likely to refuse surgery as the study period progressed (P<0.01). Factors associated with refusal of surgery on multivariate analysis include: age ≥70 years, Black race, non-private insurance, and tumor size greater than 2 cm (all values P≤0.01). The 5-year OS was 61.6% for the surgery cohort and 35.7% for the refusal cohort. In the propensity matched groups, median survival was 84.2 months in patients who received definitive surgery compared to 43.7 months in patients who refused surgery. As an index for comparison, patients who refused surgery but received both radiotherapy and chemotherapy had a median survival of 48.5 months. Among patients that refused surgery, those that received radiotherapy alone, chemotherapy alone, or radiotherapy and chemotherapy (compared to no treatment) experienced a survival benefit (all values P≤0.01). Conclusions In patients with non-metastatic adenocarcinoma of the rectum reported in the NCDB, age, race, and insurance status were associated with refusal of surgery. Refusal of surgery was more common in the later years of the study. Survival is poor in patients who refused surgical resection.
Collapse
Affiliation(s)
- Alex R Coffman
- Department of Radiation Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Randa Tao
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Jessica N Cohan
- Department of Surgery, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Lyen C Huang
- Department of Surgery, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - T Bartley Pickron
- Department of Surgery, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Anna M Torgeson
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| |
Collapse
|
10
|
Massa ST, Mazul AL, Puram SV, Pipkorn P, Zevallos JP, Piccirillo JF. Association of Demographic and Geospatial Factors With Treatment Selection for Laryngeal Cancer. JAMA Otolaryngol Head Neck Surg 2021; 147:590-598. [PMID: 33885716 DOI: 10.1001/jamaoto.2021.0453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Guidelines for many head and neck cancers, especially laryngeal cancers, allow for multiple treatment options. Currently, inequitable provision of surgery may contribute to outcome disparities. However, the role of geospatial factors remains understudied. Objective To assess the association between US geospatial factors and treatment selection for patients with laryngeal cancer. Design, Setting, and Participants In this retrospective cohort study, patients diagnosed with laryngeal squamous cell carcinoma between January 1, 2004, and December 31, 2014, were identified from the Surveillance, Epidemiology, and End Results database. Adjusted odds ratios (aORs) for surgical treatment were generated from multivariable, hierarchical models to assess associations with oncologic, demographic, and county variables. Outlier US counties with the highest and lowest aORs were described. Data analysis was performed from April 29 to September 11, 2020. Exposures County of residence. Main Outcomes and Measures The aORs for surgical treatment were generated from multivariable, hierarchical models. Outlier counties with the highest and lowest aORs are described. Results The cohort includes 21 289 patients (mean [SD] age, 63.6 [11.2] years; 17 214 [80.9%] male) in 598 counties. Most counties had no otolaryngologist (365 [61.0%]) or radiation oncologist (434 [72.6%]). Surgery rates varied from 7.1% to 85.7% among counties with at least 10 cases. After oncologic variables were controlled for, factors independently associated with surgical treatment included patient age (aOR [95% CI], 0.94; 0.91-0.98 per 10 years), marital status (single versus married: aOR [95% CI], 0.87 [0.79-0.97]), and county social deprivation index (aOR [95% CI], 0.98 [0.97-1.00 per 5 points]) but not physician number (≥2 otolaryngologists: aOR [95% CI], 0.91 [0.75-1.11] vs ≥1 radiation oncologist: aOR [95% CI], 0.91; 0.75-1.11). The 5% of counties most likely to provide surgery (aOR, >1.23) were nearly all large metropolitan areas (2593 patients [93.3%]) and treated a disproportionately large number of patients (2778 [13.1%]). The 5% of counties least likely to provide surgery (aOR, <0.79) were also mostly large metropolitan areas (1676 patients [91.2%]) and treated a disproportionately large number of patients (1838 [8.6%]). Patients in counties least likely to provide surgery had inferior survival compared with those most likely to provide surgery (adjusted hazard ratio, 1.16; 95% CI, 1.00-1.35). Conclusions and Relevance These findings suggest that sociodemographic factors contribute to the wide variety in surgical treatment practices by county. The largest metropolitan counties were often outliers regarding their adjusted odds of surgical treatment. This finding is concerning for the counties least likely to provide surgery where survival is inferior.
Collapse
Affiliation(s)
- Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University in St Louis, St Louis, Missouri
| | - Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.,School of Population Health, Washington University in St Louis, St Louis, Missouri
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.,Department of Genetics, Washington University in St Louis, St Louis, Missouri
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.,Editor, JAMA Otolaryngology-Head and Neck Surgery
| |
Collapse
|
11
|
Mirdad RS, Tsilimigras DI, Hyer JM, Diaz A, Azap RA, Pawlik TM. Refusal of Surgery Among Patients with Early-Stage Hepato-Pancreato-Biliary Cancers: Predictive Factors and Outcomes. J Gastrointest Surg 2021; 25:1573-1575. [PMID: 33230686 DOI: 10.1007/s11605-020-04885-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/12/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Adrian Diaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Rosevine A Azap
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
| |
Collapse
|
12
|
Treatment outcomes of laryngectomy compared to non-surgical management of T 3 laryngeal carcinomas: a 10-year multicentre audit of 179 patients in the northeast of England. J Laryngol Otol 2021; 134:1103-1107. [PMID: 33431081 DOI: 10.1017/s0022215120002704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Wide-ranging outcomes have been reported for surgical and non-surgical management of T3 laryngeal carcinomas. This study compared the outcomes of T3 tumours treated with laryngectomy or (chemo)radiotherapy in the northeast of England. METHODS The outcomes of T3 laryngeal carcinoma treatment at three centres (2007-2016) were retrospectively analysed using descriptive statistics and survival curves. RESULTS Of 179 T3 laryngeal carcinomas, 68 were treated with laryngectomies, 57 with chemoradiotherapy and 32 with radiotherapy. There was no significant five-year survival difference between treatment with laryngectomy (34.1 per cent) and chemoradiotherapy (48.6 per cent) (p = 0.184). The five-year overall survival rate for radiotherapy (12.5 per cent) was significantly inferior compared to laryngectomy and chemoradiotherapy (p = 0.003 and p < 0.001, respectively). The recurrence rates were 22.1 per cent for laryngectomy, 17.5 per cent for chemoradiotherapy and 50 per cent for radiotherapy. There were significant differences in recurrence rates when laryngectomy (p = 0.005) and chemoradiotherapy (p = 0.001) were compared to radiotherapy. CONCLUSION Laryngectomy and chemoradiotherapy had significantly higher five-year overall survival and lower recurrence rates compared with radiotherapy alone. Laryngectomy should be considered in patients unsuitable for chemotherapy, as it may convey a significant survival advantage over radiotherapy alone.
Collapse
|
13
|
Feit NZ, Wang Z, Demetres MR, Drenis S, Andreadis K, Rameau A. Healthcare Disparities in Laryngology: A Scoping Review. Laryngoscope 2020; 132:375-390. [PMID: 33314122 DOI: 10.1002/lary.29325] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/06/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS This scoping review aims to map out existing disparities research within the subspecialty of laryngology in order to highlight gaps in knowledge and guide future research. STUDY DESIGN Scoping Review. METHODS We completed a scoping review of PubMed, Ovid Embase, and the Cochrane Library for primary research focused on evaluating the existence and impact of disparities in race/ethnicity, sex/gender, insurance status, education level, income, geography, and LGBTQ identity in the context of various laryngological conditions. Publications of any design and date, performed in the United States, and focusing on the adult population exclusively were included. RESULTS Of the 4,999 unique abstracts identified, 51 articles were ultimately included. The most frequently examined condition in relation to disparities was laryngeal cancer (27 of 51), followed by voice disorders (15 of 51), deglutitive disorders (eight of 51), and airway disorders (one of 51). Sources of inequity evaluated from most common to least common were race/ethnicity (43 of 51), sex/gender (39 of 51), insurance status (23 of 51), geography (23 of 51), income (21 of 51), and education level (16 of 51). No study examined the association of LGBTQ identity with inequity. CONCLUSIONS This scoping review highlights the limited extent of disparities research in laryngology and establishes the need for further scholarship on the impact of disparities in laryngology care. The pathologies studied were, in decreasing order of frequency: laryngeal cancer, voice disorders, deglutitive disorders, and airway disorders. Race/ethnicity and sex/gender were the most common disparities examined, with no evaluation of LGBTQ-related care inequity. LEVEL OF EVIDENCE NA Laryngoscope, 2020.
Collapse
Affiliation(s)
- Noah Z Feit
- Otolaryngology Department, Weill Cornell Medical College, New York, New York, U.S.A
| | - Zhaorui Wang
- Otolaryngology Department, Weill Cornell Medical College, New York, New York, U.S.A
| | - Michelle R Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York, U.S.A
| | - Sotirios Drenis
- Department of Otolaryngology, Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
| | - Katerina Andreadis
- Department of Otolaryngology, Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A.,Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, U.S.A
| | - Anaïs Rameau
- Department of Otolaryngology, Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A.,Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, U.S.A
| |
Collapse
|
14
|
Jumaily M, Gallogly JA, Gropler MC, Faraji F, Ward GM. Does Subglottic Squamous Cell Carcinoma Warrant a Different Strategy Than Other Laryngeal Subsites? Laryngoscope 2020; 131:E1117-E1124. [PMID: 32846040 DOI: 10.1002/lary.28946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Subglottic squamous cell carcinoma (SSCC) is a rare cancer with limited evidence-based treatment guidelines. This study aimed to describe the treatment patterns for SSCC and to determine which treatments provide the best overall survival. STUDY DESIGN Retrospective database review. METHODS The National Cancer Database (NCDB) was queried for patients treated for SSCC from 2004 through 2014. Overall survival (OS) rates were determined by the Kaplan-Meier method. Clinicopathologic characteristics were assessed by univariable and multivariable Cox proportional hazards models, which corrected for age, sex, race, insurance status, income quartile, residence, Charlson-Deyo comorbidity score, facility type providing treatment, tumor grade, and clinical N and T category. RESULTS In this cohort of 549 patients with SSCC, the 5-year OS was 48.2%. SSCC presented at an advanced stage (American Joint Committee on Cancer stage III or IV) in 60.1% of cases; 78.3% of cases had no nodal metastases. Among only stage IV cases, multivariable analysis showed that radiotherapy (RT) (hazard ratio [HR] = 5.944; 95% confidence interval [CI]: 2.76-12.8; P < .001) and chemoradiotherapy (CRT) (HR = 2.321; 95% CI: 1.36-3.97; P = .002) were both associated with decreased 5-year OS compared to a group consisting of all surgeries. When this analysis was repeated for only stage III cases, RT (HR = 1.134; 95% CI: 0.38-3.37; P = .821) and CRT (HR = 1.784; 95% CI: 0.78-4.08; P = .170) were equivalent to surgery. CONCLUSIONS Using the NCDB to study the largest cohort of SSCC with known staging and treatment, primary surgery may provide a better 5-year OS in advanced-stage SSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1117-E1124, 2021.
Collapse
Affiliation(s)
- Mejd Jumaily
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - James A Gallogly
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A
| | - Matthew C Gropler
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A
| | - Farhoud Faraji
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, La Jolla, California, U.S.A
| | - Gregory M Ward
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A
| |
Collapse
|
15
|
Racial and socioeconomic disparities associated with 90-day mortality among patients with head and neck cancer in the United States. Oral Oncol 2018; 89:95-101. [PMID: 30732966 DOI: 10.1016/j.oraloncology.2018.12.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/11/2018] [Accepted: 12/22/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To quantify head and neck cancer (HNC) mortality rates and identify racial and socioeconomic factors associated with 90-day mortality. METHODS The National Cancer Database (2004-2014) was queried for eligible HNC cases (n = 260,011) among adults treated with curative intent. Outcome of interest was any-cause 90-day mortality. Kaplan-Meier curves (Log-rank tests) estimated crude survival differences. A Cox proportional hazards model with further adjustments using the Šidák multiple comparison method adjusted for racial, socioeconomic and clinical factors. RESULTS There were 9771 deaths (90-day mortality rate = 3.8%). There were crude differences in sex, race/ethnicity, comorbidity, distance, income, and insurance (Log-rank p-value < 0.0001). In the final model, blacks (aHR = 1.10, 95% CI 1.00, 1.21) and males (aHR = 1.07; 95% CI 1.00, 1.15) had greater 90-day mortality hazard, as did those uninsured (aHR = 1.72; 95% CI 1.48, 1.99), covered by Medicaid (aHR = 1.72; 95% CI 1.53, 1.93) or Medicare (aHR = 1.40; 95% CI 1.27, 1.53). Residence in lower median income zip code was associated with greater 90-day mortality [(aHR <$30,000 = 1.30; 95% CI 1.18, 1.44); (aHR $30,000-$34,999 = 1.24; 95% CI 1.13, 1.36); (aHR $35,000-$45,999 = 1.18; 95% CI 1.08, 1.27)]; and farther travel distance for treatment was associated with decreased 90-day mortality [(aHR 50-249.9 miles = 0.86; 95% CI 0.77, 0.97); (aHR > 250 miles = 0.70; 95% CI 50, 0.99)]. CONCLUSIONS There are significant race and socioeconomic disparities among patients with HNC, and these disparities impact mortality within 90 days of treatment.
Collapse
|
16
|
Rohde RL, Adjei Boakye E, Challapalli SD, Patel SH, Geneus CJ, Tobo BB, Simpson MC, Mohammed KA, Deshields T, Varvares MA, Osazuwa-Peters N. Prevalence and sociodemographic factors associated with depression among hospitalized patients with head and neck cancer-Results from a national study. Psychooncology 2018; 27:2809-2814. [DOI: 10.1002/pon.4893] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/04/2018] [Accepted: 09/13/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | - Eric Adjei Boakye
- Saint Louis University Center for Health Outcomes Research; St Louis Missouri
| | | | - Shivam H. Patel
- Saint Louis University School of Medicine; St Louis Missouri
| | - Christian J. Geneus
- Department of Biostatistics and Bioinformatics; Tulane University School of Public Health and Tropical Medicine; New Orleans Louisiana
| | - Betelihem B. Tobo
- Department of Epidemiology and Biostatistics; Saint Louis University College for Public Health and Social Justice; St Louis Missouri
| | - Matthew C. Simpson
- Department of Otolaryngology; Harvard Medical School, Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Kahee A. Mohammed
- Department of Internal Medicine; Saint Louis University School of Medicine; St Louis Missouri
| | - Teresa Deshields
- Department of Medicine; Washington University School of Medicine; St Louis Missouri
| | - Mark A. Varvares
- Department of Otolaryngology; Harvard Medical School, Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology and Biostatistics; Saint Louis University College for Public Health and Social Justice; St Louis Missouri
- Department of Otolaryngology-Head and Neck Surgery; Saint Louis University School of Medicine; St Louis Missouri
- Saint Louis University Cancer Center; St Louis Missouri
| |
Collapse
|
17
|
Coffman A, Torgeson A, Lloyd S. Correlates of Refusal of Surgery in the Treatment of Non-metastatic Pancreatic Adenocarcinoma. Ann Surg Oncol 2018; 26:98-108. [PMID: 30145650 DOI: 10.1245/s10434-018-6708-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Surgical resection is the most important therapeutic intervention for eligible patients with pancreatic cancer; however, a majority of patients never receive surgery for a variety of reasons, including patient refusal. Utilizing the National Cancer Database, we investigated the associated sociodemographic and clinical factors for those patients who refused surgery, and the impact of this decision on overall survival (OS). METHODS AND MATERIALS We analyzed adult patients with non-metastatic adenocarcinoma of the pancreas diagnosed from 2004 to 2013. Univariate and multivariate logistic regression modeling was used to identify factors predictive of refusing surgery, and Kaplan-Meier and log-rank analysis was performed to investigate the effect on OS. RESULTS A total of 48,902 patients were identified: 47,107 received surgery (96.3%) and 1795 were offered surgery but refused (3.7%). Factors associated with refusing surgery include both sociodemographic factors [age > 50 years, female sex, Black race, non-private insurance, treatment at a non-academic institution or non-metro facility, Carlson Comorbidity Index of 2 + (p ≤ 0.01)], and clinical factors [advanced clinical T (tumor) category and tumor size > 20 cm (p ≤ 0.01)]. Patients who refused surgery and received no treatment at all experienced a median survival of 5.1 months, while those who refused surgery but received chemoradiotherapy experienced a median survival of 11.2 months. As an index for comparison, those who received surgery had a median survival of 20.5 months. CONCLUSION Refusing surgery is an understudied phenomenon associated with several sociodemographic and clinical factors. The expected prognosis for patients who refuse surgery is presented.
Collapse
Affiliation(s)
- Alex Coffman
- Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Anna Torgeson
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
18
|
Wu SG, Zhang QH, Zhang WW, Sun JY, Lin Q, He ZY. The Effect of Marital Status on Nasopharyngeal Carcinoma Survival: A Surveillance, Epidemiology and End Results Study. J Cancer 2018; 9:1870-1876. [PMID: 29805714 PMCID: PMC5968776 DOI: 10.7150/jca.23965] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/29/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose: This study examined the role of marital status on survival outcome of nasopharyngeal carcinoma (NPC) patients using a population-based cancer registry. Methods: Patients with primary NPC diagnosed between 2004 and 2013 were included using the Surveillance, Epidemiology and End Results program. Patient demographic, clinicopathologic features, management, and survival outcomes were compared according to marital status. Cause-specific survival (CSS, NPC-related death) for marital status was analyzed. Results: The data of 3018 patients were included, with 61.4%, 11.1%, 21.8, and 5.6% of patients married, divorced (or separated), single, and widowed, respectively. Widowed patients had the highest proportion of elderly age (p < 0.001), were more likely to be female (p < 0.001), and had more well-to-moderately differentiated (p < 0.001) and node-negative disease (p = 0.038). Widowed patients were also less likely to have received radiotherapy and chemotherapy compared with patients of other marital status (p < 0.001). The 5-year CSS was 76.1%, 70.8%, 73.4%, and 59.8% in the married, divorced, single, and widowed groups, respectively (p = 0.001). Marital status was the independent prognostic factor for CSS. Widowed patients had a significantly increased risk of NPC-related death compared with married (hazard ratio [HR] 2.014, 95% confidence interval [CI] 1.477-2.747, p < 0.001), divorced (HR 1.580, 95% CI 1.087-2.295, p = 0.017), and single (HR 2.000, 95% CI 1.402-2.854, p < 0.001) patients. The divorced (p = 0.067) and single (p = 0.949) groups had similar CSS to the married group. Conclusions: Being widowed was associated with an increased the risk of cancer mortality in NPC compared with being married, divorced, or single.
Collapse
Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Qing-Hong Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Qin Lin
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
| |
Collapse
|