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Patel N, Karimi S, Egger ME, Little B, Antimisiaris D. Disparity in Treatment Receipt by Race and Treatment Guideline Revision Years for Stage 1A Non-Small Cell Lung Cancer Patients in the US. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02040-x. [PMID: 38861121 DOI: 10.1007/s40615-024-02040-x] [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: 10/10/2023] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Treatment guideline revision introduced by the National Comprehensive Cancer Network (NCCN) is referred to by about 95% of the United States (US) oncologists in treatment decision-making for stage 1A non-small cell lung cancer. It is vital to account for this factor that affects the standard treatment receipt among stage 1A patients, with about a 75% survival rate if treated on time. The first choice for medically fit patients is lobectomy; however, over the decades since the initial guidelines were published, several medical advances have introduced trends in treatment receipt along with other sociodemographic factors that could help identify survival outcomes associated with treatment receipt. Establishing the role of treatment guideline revision years is important to determine a close to true causal relationship in racial treatment disparities. METHODS US national cancer registry data for all US counties and historical Area Health Resource Files for the study period 1988-2015 were utilized. Logistic regression analysis was adjusted for clustering of standard errors at the state level and for time-invariant unobserved factors for the year of diagnosis and county. The time-invariant unobservable for each year of diagnosis and county specificity were accounted for by including their dummy variables in the regression model with standard errors clustered at the state level. RESULTS Black patients, Medicaid beneficiaries, large fringe metropolitan residents, and those diagnosed post-2007 treatment revisions years are less likely to receive lobectomy, which is the standard treatment guideline for medically fit patients. CONCLUSION The study concludes that there exists a difference in treatment type received among stage 1A NSCLC patients in the US by race, socioeconomic status, and treatment guideline revisions.
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Affiliation(s)
- Naiya Patel
- School of Public Health, University of Louisville, 485 East Gray St., Louisville, KY, 40202, USA.
| | - Seyed Karimi
- School of Public Health, University of Louisville, 485 East Gray St., Louisville, KY, 40202, USA
| | - Michael E Egger
- Department of Surgery, Division of Surgical Oncology, University of Louisville, 315 E. Broadway, M-10, Louisville, KY, 40202, USA
| | - Bertis Little
- School of Public Health, University of Louisville, 485 East Gray St., Louisville, KY, 40202, USA
| | - Demetra Antimisiaris
- School of Public Health, University of Louisville, 485 East Gray St., Louisville, KY, 40202, USA
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Richardson CL, Saeed M, Sharp L, Todd A. The association between marital status and treatment initiation in lung cancer: A systematic review and meta-analysis of observational studies. Cancer Epidemiol 2023; 87:102494. [PMID: 37992417 DOI: 10.1016/j.canep.2023.102494] [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: 07/14/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
Lung cancer is associated with high mortality, and significant health burden. Marital status has been associated with lung cancer survival. This systematic review and meta-analysis set out to investigate the association between marital status and treatment receipt in lung cancer. The search was conducted across three databases: Medline (OVID), Embase and CINAHL, from inception to June 2022. Retrospective or prospective observational studies that quantified treatment receipt by marital status were eligible for inclusion. Study quality was assessed via a modified checklist for retrospective databased-based studies. Meta-analysis using a random effects model was undertaken by chemotherapy, radiotherapy, surgery, and any treatment relative to married or not married. Pooled unadjusted odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for each type of treatment. 837 papers were screened and 18 met the inclusion criteria with eight being eligible for inclusion in the meta-analysis. Studies were excluded from meta-analysis due to overlap in the data reported in papers; the mean quality score of the 18 included papers was 12/17. Being married was associated with increased odds of overall treatment OR 1.43 (95 % CI 1.14-1.79; I2 = 82 %; Tau2 = 0.07; six studies) and also increased receipt of: chemotherapy 1.40 (95 % CI 1.35-1.44; I2 = 82 %; Tau2 = 0.00); radiotherapy 1.29 (95 % CI 0.96-1.75; I2 = 100 %; Tau2= 0.09; four studies) and surgery (95 % CI 1.31-1.52; I2 = 86 %; Tau2 = 0.00; five studies). The results indicate that those who are married are more likely to receive treatment for lung cancer compared to those who are not married. This requires further investigation to better understand the explanations behind this finding and how we can work to combat this inequality.
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Affiliation(s)
- Charlotte Lucy Richardson
- School of Pharmacy, Newcastle University, King George VI Building, King's Road, Newcastle-upon-Tyne NE1 7RU, UK; Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK.
| | - Mariam Saeed
- School of Pharmacy, Newcastle University, King George VI Building, King's Road, Newcastle-upon-Tyne NE1 7RU, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
| | - Adam Todd
- School of Pharmacy, Newcastle University, King George VI Building, King's Road, Newcastle-upon-Tyne NE1 7RU, UK; Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
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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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Kembou Nzale S, Weeks WB, Ouafik L, Rouquette I, Beau-Faller M, Lemoine A, Bringuier PP, Le Coroller Soriano AG, Barlesi F, Ventelou B. Inequity in access to personalized medicine in France: Evidences from analysis of geo variations in the access to molecular profiling among advanced non-small-cell lung cancer patients: Results from the IFCT Biomarkers France Study. PLoS One 2020; 15:e0234387. [PMID: 32609781 PMCID: PMC7329126 DOI: 10.1371/journal.pone.0234387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/26/2020] [Indexed: 11/19/2022] Open
Abstract
In this article, we studied geographic variation in the use of personalized genetic testing for advanced non-small cell lung cancer (NSCLC) and we evaluated the relationship between genetic testing rates and local socioeconomic and ecological variables. We used data on all advanced NSCLC patients who had a genetic test between April 2012 and April 2013 in France in the frame of the IFCT Biomarqueurs-France study (n = 15814). We computed four established measures of geographic variation of the sex-adjusted rates of genetic testing utilization at the "départment" (the French territory is divided into 94 administrative units called 'départements') level. We also performed a spatial regression model to determine the relationship between département-level sex-adjusted rates of genetic testing utilization and economic and ecological variables. Our results are the following: (i) Overall, 46.87% lung cancer admission patients obtained genetic testing for NSCLC; département-level utilization rates varied over 3.2-fold. Measures of geographic variation indicated a relatively high degree of geographic variation. (ii) there was a statistically significant relationship between genetic testing rates and per capita supply of general practitioners, radiotherapists and surgeons (negative correlation for the latter); lower genetic testing rates were also associated with higher local poverty rates. French policymakers should pursue effort toward deprived areas to obtain equal access to personalized medicine for advanced NSCLC patients.
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Affiliation(s)
- Samuel Kembou Nzale
- Aix-Marseille Univ., CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
| | - William B. Weeks
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Building, DHMC, Lebanon, NH, United States of America
| | - L’Houcine Ouafik
- Assistance Publique Hôpitaux de Marseille, Service de Transfert d'Oncologie Biologique, Aix-Marseille Univ, Marseille, France
| | - Isabelle Rouquette
- Institut Universitaire du Cancer de Toulouse, Oncopôle, Service d'Anatomie Pathologique, Toulouse, France
| | - Michèle Beau-Faller
- Centre Hospitalier Universitaire de Hautepierre, Laboratoire de Biochimie et de Biologie Moléculaire & Plate-forme de Génomique des Cancers, Strasbourg, France
| | - Antoinette Lemoine
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Paris-Sud, Service d'Oncogénétique- Oncomolpath, Université Paris 11, Villejuif, France
| | - Pierre-Paul Bringuier
- Hôpital Edouard Herriot, Service d'Anatomie et de Cytologie Pathologique, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon Cancer Research Center, UMR 1057 INSERM, Lyon, France
| | - Anne-Gaëlle Le Coroller Soriano
- Mixed Research Unit 912, Institute of Research and Development, National Institute of Health and Medical Research, Paoli Calmettes Institute, Aix-Marseille University, Marseille, France
- * E-mail:
| | - Fabrice Barlesi
- Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Department, Aix-Marseille Univ, Centre d'Investigation Clinique, Marseille, France
| | - Bruno Ventelou
- Aix-Marseille Univ., CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
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Sineshaw HM, Sahar L, Osarogiagbon RU, Flanders WD, Yabroff KR, Jemal A. County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States. Chest 2020; 157:212-222. [PMID: 31813533 PMCID: PMC6965692 DOI: 10.1016/j.chest.2019.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although counties are the smallest geographic level for comprehensive health-care delivery analysis, little is known about county-level variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) and factors contributing to such variations in the United States. METHODS A total of 179,189 patients aged ≥ 35 years who were diagnosed with stage I to II NSCLC between 2007 and 2014 in 2,263 counties were identified from 39 states, the District of Columbia, and Detroit population-based cancer registries; the data were compiled by the North American Association of Central Cancer Registries. The percentage of patients who underwent surgery was calculated for each county with ≥ 20 cases. Adjusted risk ratios were generated by using generalized estimating equation models with modified Poisson regression. RESULTS Receipt of surgery for early-stage NSCLC during 2007 to 2014 according to county ranged from 12.8% to 48.6% in the lowest decile of counties, to 74.3% to 91.7% in the highest decile of counties. There were pockets of low surgery receipt rate counties within each state. For example, there was a 25% absolute difference between the lowest and highest surgery receipt rate counties in Massachusetts. Counties in the lowest quartile for receipt of surgery were those with a high proportion of non-Hispanic black subjects, high poverty and uninsured rates, low surgeon-to-population ratio, and nonmetropolitan status. CONCLUSIONS Receipt of curative-intent surgery for early-stage NSCLC varied substantially across counties in the United States, with pockets of low receipt counties in each state. Low surgery receipt counties were characterized by unfavorable area-level socioeconomic and health-care delivery factors.
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Affiliation(s)
| | | | | | - W Dana Flanders
- American Cancer Society, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
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Belot A, Fowler H, Njagi EN, Luque-Fernandez MA, Maringe C, Magadi W, Exarchakou A, Quaresma M, Turculet A, Peake MD, Navani N, Rachet B. Association between age, deprivation and specific comorbid conditions and the receipt of major surgery in patients with non-small cell lung cancer in England: A population-based study. Thorax 2019; 74:51-59. [PMID: 30100577 DOI: 10.1136/thoraxjnl-2017-211395] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/05/2018] [Accepted: 07/16/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We investigated socioeconomic disparities and the role of the main prognostic factors in receiving major surgical treatment in patients with lung cancer in England. METHODS Our study comprised 31 351 patients diagnosed with non-small cell lung cancer in England in 2012. Data from the national population-based cancer registry were linked to Hospital Episode Statistics and National Lung Cancer Audit data to obtain information on stage, performance status and comorbidities, and to identify patients receiving major surgical treatment. To describe the association between prognostic factors and surgery, we performed two different analyses: one using multivariable logistic regression and one estimating cause-specific hazards for death and surgery. In both analyses, we used multiple imputation to deal with missing data. RESULTS We showed strong evidence that the comorbidities 'congestive heart failure', 'cerebrovascular disease' and 'chronic obstructive pulmonary disease' reduced the receipt of surgery in early stage patients. We also observed gender differences and substantial age differences in the receipt of surgery. Despite accounting for sex, age at diagnosis, comorbidities, stage at diagnosis, performance status and indication of having had a PET-CT scan, the socioeconomic differences persisted in both analyses: more deprived people had lower odds and lower rates of receiving surgery in early stage lung cancer. DISCUSSION Comorbidities play an important role in whether patients undergo surgery, but do not completely explain the socioeconomic difference observed in early stage patients. Future work investigating access to and distance from specialist hospitals, as well as patient perceptions and patient choice in receiving surgery, could help disentangle these persistent socioeconomic inequalities.
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Affiliation(s)
- Aurélien Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Fowler
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Edmund Njeru Njagi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Miguel-Angel Luque-Fernandez
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Camille Maringe
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Winnie Magadi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aimilia Exarchakou
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Manuela Quaresma
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Adrian Turculet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael D Peake
- Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
- National Cancer Registration and Analysis Service, Public Health England, London, UK
- Centre for Cancer Outcomes, University College London Hospitals, London, UK
| | - Neal Navani
- UCL Respiratory, University College London, London, UK
- Department of Thoracic Medicine, University College London Hospital, London, UK
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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