1
|
Thobie A, Bouvier AM, Bouvier V, Jooste V, Queneherve L, Nousbaum JB, Alves A, Dejardin O. Survival variability across hospitals after resection for pancreatic adenocarcinoma: A multilevel survival analysis on a high-resolution population-based study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1450-1456. [PMID: 37055280 DOI: 10.1016/j.ejso.2023.03.228] [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: 10/18/2022] [Revised: 01/23/2023] [Accepted: 03/24/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Resection is the cornerstone of curative management for pancreatic ductal adenocarcinoma (PDAC). Hospital surgical volume influence post-operative mortality. Few is known about impact on survival. METHODS Population included 763 patients resected for PDAC within the 4 French digestive tumor registries between 2000 and 2014. Spline method was used to determine annual surgical volume thresholds influencing survival. A multilevel survival regression model was used to study center effect. RESULTS Population was divided into three groups: low-volume (LVC) (<41 hepatobiliary/pancreatic procedures/year), medium-volume (MVC) (41-233) and high-volume centers (HVC) (>233). Patients in LVC were older (p = 0.02), had a lower rate of disease-free margins (76.7% vs. 77.2% and 69.5%, p = 0.028) and a higher post-operative mortality than in MVC and HVC (12.5% and 7.5% vs. 2.2%; p = 0.004). Median survival was higher in HVC than in other centers (25 vs. 15.2 months, p < 0.0001). Survival variance attributable to center effect accounted for 3.7% of total variance. In multilevel survival analysis, surgical volume explained the inter-hospital survival heterogeneity (non-significant variance after adding the volume to the model p = 0.3). Patients resected in HVC had a better survival than in LVC (HR 0.64 [0.50-0.82], p < 0.0001). There was no difference between MVC and HVC. CONCLUSION Regarding center effect, individual characteristics had little impact on survival variability across hospitals. Hospital volume was a major contributor to the center effect. Given the difficulty of centralizing pancreatic surgery, it would be wise to determine which factors would indicate management in a HVC.
Collapse
Affiliation(s)
- Alexandre Thobie
- Department of Digestive Surgery, Hospital of Avranches-Granville, Avranches, France; UMR INSERM 1086 'ANTICIPE', Centre François Baclesse, Caen, France.
| | - Anne-Marie Bouvier
- Registre des cancers digestifs de Bourgogne, University Hospital of Dijon, Dijon, France; INSERM UMR 1231, University of Burgundy, Dijon, France
| | - Véronique Bouvier
- UMR INSERM 1086 'ANTICIPE', Centre François Baclesse, Caen, France; Registre des cancers digestifs du Calvados, University Hospital of Caen, Caen, France; Department of Research, Epidemiology Research and Evaluation Unit, University Hospital of Caen, Caen, France
| | - Valérie Jooste
- Registre des cancers digestifs de Bourgogne, University Hospital of Dijon, Dijon, France; INSERM UMR 1231, University of Burgundy, Dijon, France
| | - Lucille Queneherve
- Registre des cancers digestifs du Finistère, University Hospital of Brest, Brest, France; EA7479 SPURBO, University of Western Brittany, Brest, France
| | - Jean-Baptiste Nousbaum
- Registre des cancers digestifs du Finistère, University Hospital of Brest, Brest, France; EA7479 SPURBO, University of Western Brittany, Brest, France
| | - Arnaud Alves
- UMR INSERM 1086 'ANTICIPE', Centre François Baclesse, Caen, France; Registre des cancers digestifs du Calvados, University Hospital of Caen, Caen, France; Department of Digestive Surgery, University Hospital of Caen, Caen, France
| | - Olivier Dejardin
- UMR INSERM 1086 'ANTICIPE', Centre François Baclesse, Caen, France; Department of Research, Epidemiology Research and Evaluation Unit, University Hospital of Caen, Caen, France
| |
Collapse
|
2
|
Roth GS, Fayet Y, Benmameche-Medjahed S, Ducimetière F, Charreton A, Cropet C, Chabaud S, Marion-Audibert AM, Berthelet O, Walter T, Adham M, Baconnier M, Tavan D, Williet N, Artru P, Huet-Penz F, Ray-Coquard I, Farsi F, Labrosse H, de la Fouchardière C. Structural and Socio-Spatial Determinants Influencing Care and Survival of Patients with a Pancreatic Adenocarcinoma: Results of the PANDAURA Cohort. Cancers (Basel) 2022; 14:cancers14215413. [PMID: 36358831 PMCID: PMC9658615 DOI: 10.3390/cancers14215413] [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: 10/03/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background and aims: Pancreatic cancer is highly lethal and often diagnosed at an advanced stage. This cohort study analyzes the impact of care pathways, delays, and socio-spatial determinants on pancreatic cancer patients’ diagnosis, treatment, and prognosis. Method: Patients with pancreatic adenocarcinoma newly diagnosed at all stages between January and June 2016 in the AuRA French region were included. The influence on survival of delays of care, healthcare centers’ expertise, and socio-spatial determinants was evaluated. Results: Here, 538 patients were included in 76 centers including 116 patients (21.8%) with resectable, 64 (12.0%) borderline-resectable, 147 (27.6%) locally-advanced tumors, and 205 (38.5%) with metastatic disease. A delay between first symptoms and CT scans did not statistically influence overall survival (OS). In resected patients, OS was significantly higher in centers with more than 20 surgeries (HR<5 surgeries/year = 2.236 and HR5-20 surgeries/year = 1.215 versus centers with > 20 surgeries/year p = 0.0081). Regarding socio-spatial determinants, patients living in municipalities with greater access to a general practitioner (HR = 1.673, p = 0.0153) or with a population density below 795.1 people/km2 (HR = 1.881, p = 0.0057) were significantly more often resectable. Conclusion: This cohort study supports the pivotal role of general practitioner in cancer care and the importance of the centralization of pancreatic surgery to optimize pancreatic cancer patients’ care and outcomes. However, delays of care did not impact patient survival.
Collapse
Affiliation(s)
- Gaël S. Roth
- University Grenoble Alpes/Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes/Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209, 38043 Grenoble, France
- Correspondence: (G.S.R.); (C.d.l.F.)
| | - Yohan Fayet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Equipe EMS-Social and Human Sciences Department, Centre Léon Bérard, 69008 Lyon, France
| | - Sakina Benmameche-Medjahed
- Medical Oncology Department, Centre Léon Bérard/Research Center of Lyon (CRCL), UMR INSERM 1052, 28 rue Laennec, 69008 Lyon, France
| | - Françoise Ducimetière
- Medical Oncology Department, Centre Léon Bérard/Research Center of Lyon (CRCL), UMR INSERM 1052, 28 rue Laennec, 69008 Lyon, France
| | - Amandine Charreton
- Medical Oncology Department, Centre Léon Bérard/Research Center of Lyon (CRCL), UMR INSERM 1052, 28 rue Laennec, 69008 Lyon, France
| | - Claire Cropet
- Biostatistics Deparment, Centre Léon Bérard/Research Center of Lyon (CRCL), UMR INSERM 1052, 28 rue Laennec, 69008 Lyon, France
| | - Sylvie Chabaud
- Biostatistics Deparment, Centre Léon Bérard/Research Center of Lyon (CRCL), UMR INSERM 1052, 28 rue Laennec, 69008 Lyon, France
| | - Anne-Marie Marion-Audibert
- Gastroenterology and Hepatology, Clinique du Val d’Ouest, 39 Chemin de la Vernique, 69130 Ecully, France
| | - Olivier Berthelet
- Hepato-Gastroenterology Department, Centre Hospitalier Métropole Savoie, 73011 Chambery, France
| | - Thomas Walter
- Medical Oncology Department, Hopital Edouard Herriot, 69003 Lyon, France
| | - Mustapha Adham
- Surgery Department, Hopital Edouard Herriot, 69003 Lyon, France
| | - Mathieu Baconnier
- Hépatogastroenterology Department, Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France
| | - David Tavan
- Hépatogastroentérology Department, Infirmerie Protestante, 69300 Caluire-et-Cuire, France
| | - Nicolas Williet
- Hepatogastroenterology and Digestive oncology Department, University Hospital of Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Pascal Artru
- Gastroenterology Department, Hopital privé Jean Mermoz, 69008 Lyon, France
| | - Floriane Huet-Penz
- Hepato-Gastroenterologie, Centre Hospitalier Alpes Léman, 74130 Contamine sur Arve, France
| | - Isabelle Ray-Coquard
- Medical Oncology Department, Centre Léon Bérard/Research Center of Lyon (CRCL), UMR INSERM 1052, 28 rue Laennec, 69008 Lyon, France
| | - Fadila Farsi
- ONCOAURA, Dispositif Spécifique Régional de Cancérologie, 60 Avenue Rockefeller, 69008 Lyon, France
| | - Hélène Labrosse
- ONCOAURA, Dispositif Spécifique Régional de Cancérologie, 60 Avenue Rockefeller, 69008 Lyon, France
| | - Christelle de la Fouchardière
- Medical Oncology Department, Centre Léon Bérard/Research Center of Lyon (CRCL), UMR INSERM 1052, 28 rue Laennec, 69008 Lyon, France
- Correspondence: (G.S.R.); (C.d.l.F.)
| |
Collapse
|
3
|
Dupont B, Dejardin O, Bouvier V, Piquet MA, Alves A. Systematic Review: Impact of Social Determinants of Health on the Management and Prognosis of Gallstone Disease. Health Equity 2022; 6:819-835. [PMID: 36338799 PMCID: PMC9629913 DOI: 10.1089/heq.2022.0063] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Due to its prevalence, gallstone disease is a major public health issue. It affects diverse patient populations across various socioeconomic levels. Socioeconomic and geographic deprivation may impact both morbidity and mortality associated with digestive diseases, such as biliary tract disease. Aim: The aim of this systematic review was to review the available data on the impact of socioeconomic determinants and geographic factors on gallstone disease and its complications. Methods: This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE and Web of Science databases were searched by two investigators to retrieve studies about the impact of income, insurance status, hospital status, education level, living areas, and deprivation indices on gallstone disease. Thirty-seven studies were selected for this review. Results: Socially disadvantaged populations appear to be more frequently affected by complicated or severe forms of gallstone disease. The prognosis of biliary tract disease is poor in these populations regardless of patient status, and increased morbidity and mortality were observed for acute cholangitis or subsequent cholecystectomy. Limited or delayed access and low-quality therapeutic interventions could be among the potential causes for this poor prognosis. Conclusions: This systematic review suggests that socioeconomic determinants impact the management of gallstone disease. Enhanced knowledge of these parameters could contribute to improved public health policies to manage these diseases.
Collapse
Affiliation(s)
- Benoît Dupont
- Departement d'Hepato-Gastroenterologie et Nutrition, UNICAEN, CHU de Caen Normandie, Normandie Univ, Caen, France
- “Anticipe” U1086 INSERM-UCBN, “Cancers & Preventions,” Team Labelled “League Against Cancer,” UNICAEN, Normandie Univ, CAEN, France
| | - Olivier Dejardin
- “Anticipe” U1086 INSERM-UCBN, “Cancers & Preventions,” Team Labelled “League Against Cancer,” UNICAEN, Normandie Univ, CAEN, France
- Registre des Tumeurs Digestives du Calvados, “Anticipe” U1086 INSERM-UCBN, UNICAEN, Normandie Univ, Caen, France
| | - Véronique Bouvier
- “Anticipe” U1086 INSERM-UCBN, “Cancers & Preventions,” Team Labelled “League Against Cancer,” UNICAEN, Normandie Univ, CAEN, France
- Registre des Tumeurs Digestives du Calvados, “Anticipe” U1086 INSERM-UCBN, UNICAEN, Normandie Univ, Caen, France
| | - Marie-Astrid Piquet
- Departement d'Hepato-Gastroenterologie et Nutrition, UNICAEN, CHU de Caen Normandie, Normandie Univ, Caen, France
| | - Arnaud Alves
- “Anticipe” U1086 INSERM-UCBN, “Cancers & Preventions,” Team Labelled “League Against Cancer,” UNICAEN, Normandie Univ, CAEN, France
- Service de Chirurgie Digestive, UNICAEN, CHU de Caen Normandie, Normandie Univ, Caen, France
| |
Collapse
|
4
|
Petric J, Handshin S, Jonnada PK, Karunakaran M, Barreto SG. The influence of socioeconomic status on access to cancer care and survival in resectable pancreatic cancer: a systematic review and meta-analysis. ANZ J Surg 2022; 92:2795-2807. [PMID: 35938456 DOI: 10.1111/ans.17964] [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: 04/29/2022] [Revised: 06/21/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Socioeconomic status (SES) is an important factor affecting access to cancer care and survival. Its role in pancreatic cancer warrants scrutiny. METHODS A systematic review of major reference databases was undertaken. Categorization of the study population into low SES (LSES) and high SES (HSES) was based on the criteria employed in the individual studies. The outcome measures studied were stage of cancer presentation, access to care and overall survival. Meta-analysis was performed using random-effects models and trial sequential analysis (TSA) was used to assess the precision and conclusiveness of the results. RESULTS Thirteen studies meeting inclusion criteria were included in the meta-analysis, which demonstrated that LSES was associated with significantly lower rates of presentation at a non-metastatic stage and poorer access to cancer care, viz. surgery, chemotherapy and radiation therapy. Despite heterogeneity, TSA supported the findings, displaying minimal type I error. CONCLUSION As LSES is associated with delayed presentation, poorer access to care and poorer survival, SES should be considered a modifiable risk factor for poor outcomes in pancreatic cancer.
Collapse
Affiliation(s)
- Josipa Petric
- Department of Surgery, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Samuel Handshin
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Pavan Kumar Jonnada
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
| | - Monish Karunakaran
- College of Medicine and Public Health, Flinders University, South Australia, Australia.,Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Savio George Barreto
- College of Medicine and Public Health, Flinders University, South Australia, Australia.,Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| |
Collapse
|
5
|
Logan K, Pearson F, Kenny RP, Pandanaboyana S, Sharp L. Are older patients less likely to be treated for pancreatic cancer? A systematic review and meta-analysis. Cancer Epidemiol 2022; 80:102215. [PMID: 35901624 DOI: 10.1016/j.canep.2022.102215] [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: 02/18/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022]
Abstract
Pancreatic cancer is the seventh commonest cause of cancer-related death worldwide. Although prognosis is poor, both surgery and adjuvant chemotherapy improve survival. However, it has been suggested that not all pancreatic cancer patients who may benefit from treatment receive it. This systematic review and meta-analysis investigated the existence of age-related inequalities in receipt of first-line pancreatic cancer treatment. Medline, Embase, Cochrane Library and grey literature were searched for population-based studies investigating treatment receipt, reported by age, for patients with primary pancreatic cancer from inception until 4th June 2020, and updated 5th August 2021. Studies from countries with universal healthcare were included, to minimise influence of health system-related economic factors. A modified version of the Newcastle-Ottawa Scale was used to assess risk of bias. Random-effects meta-analysis was undertaken comparing likelihood of treatment receipt in older versus younger patients. Sensitivity and subgroup analyses were conducted. Eighteen papers were included; 12 independent populations were eligible for meta-analysis. In most studies, < 10% of older patients were treated. Older age (generally ≥65) was significantly associated with reduced receipt of any treatment (OR=0.14, 95% CI 0.10-0.21, n = 12 studies), surgery (OR=0.15, 95% CI 0.09-0.24, n = 9 studies) and chemotherapy as a primary treatment (OR=0.13, 95% CI 0.07-0.24, n = 5 studies). The effect of age was independent of methodological quality, patient population or time-period of patient diagnosis and remained in studies with confounder adjustment. The mean quality score of included studies was 6/8. Inequalities in receipt of healthcare interventions across social groups is a recognised concern internationally. This review shows that older age is significantly, and consistently, associated with non-receipt of treatment in pancreatic cancer. However, there are risks and side-effects associated with pancreatic cancer treatment. Further research on what influences patient and professional treatment decision-making is required to better understand these apparent inequalities.
Collapse
Affiliation(s)
- Kirsty Logan
- Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Fiona Pearson
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Ryan Pw Kenny
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Sanjay Pandanaboyana
- Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom; HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom.
| |
Collapse
|
6
|
Adelsheimer A, Wang J, Lu DY, Elbaum L, Krishnan U, Cheung JW, Feldman DN, Wong SC, Horn EM, Sobol I, Goyal P, Karas MG, Kim LK. Impact of Socioeconomic Status on Mechanical Circulatory Device Utilization and Outcomes in Cardiogenic Shock. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100027. [PMID: 39132559 PMCID: PMC11307802 DOI: 10.1016/j.jscai.2022.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 08/13/2024]
Abstract
Objectives This study evaluates the impact of socioeconomic status (SES) on utilization of mechanical circulatory support (MCS) devices and outcomes in cardiogenic shock (CS). Background CS is associated with significant mortality. There is increasing use of temporary MCS devices in CS, and its impact on outcomes is currently under investigation. There is a lack of data on the effect of SES on the utilization of MCS devices in CS. Methods CS hospitalizations were obtained from the State Inpatient Databases in 2016 from 9 states representing various regions in the United States. The study had exempt institutional review board status as the database includes deidentified data. Hospitalizations were separated into SES cohorts based on the median household income of the patient residence zip code. Utilization of MCS devices and revascularization procedures along with clinical outcomes with CS were compared across the quartiles. Results There were 38,520 hospitalizations identified with CS, 42.6% of which were secondary to acute myocardial infarction. Patients from higher SES areas were significantly older but had lower burden of comorbidities. Utilization of temporary MCS devices was higher for hospitalizations from higher SES regions (frequency from the lowest SES quartile to the highest SES quartile: 21.3%, 21.5%, 23.5, and 24.1%, P < .01), though revascularization rates were similar. However, there was no significant difference in overall mortality from CS among the 4 quartiles. Patients from regions of higher SES experienced increased hospital costs. Conclusions Higher SES regions had increased use of temporary MCS. There was no difference in mortality between SES cohorts.
Collapse
Affiliation(s)
- Andrew Adelsheimer
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Joseph Wang
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Daniel Y. Lu
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Lindsay Elbaum
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Udhay Krishnan
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York, New York
| | - Jim W. Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York, New York
| | - Dmitriy N. Feldman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York, New York
| | - S. Chiu Wong
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Evelyn M. Horn
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Irina Sobol
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Parag Goyal
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York, New York
| | - Maria G. Karas
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Luke K. Kim
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York, New York
| |
Collapse
|
7
|
Tron L, Fauvernier M, Bouvier AM, Robaszkiewicz M, Bouvier V, Cariou M, Jooste V, Dejardin O, Remontet L, Alves A, Molinié F, Launoy G. Socioeconomic Environment and Survival in Patients with Digestive Cancers: A French Population-Based Study. Cancers (Basel) 2021; 13:cancers13205156. [PMID: 34680305 PMCID: PMC8533795 DOI: 10.3390/cancers13205156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 12/16/2022] Open
Abstract
Social inequalities are an important prognostic factor in cancer survival, but little is known regarding digestive cancers specifically. We aimed to provide in-depth analysis of the contextual social disparities in net survival of patients with digestive cancer in France, using population-based data and relevant modeling. Digestive cancers (n = 54,507) diagnosed between 2006-2009, collected through the French network of cancer registries, were included (end of follow-up 30 June 2013). Social environment was assessed by the European Deprivation Index. Multidimensional penalized splines were used to model excess mortality hazard. We found that net survival was significantly worse for individuals living in a more deprived environment as compared to those living in a less deprived one for esophageal, liver, pancreatic, colon and rectal cancers, and for stomach and bile duct cancers among females. Excess mortality hazard was up to 57% higher among females living in the most deprived areas (vs. least deprived) at 1 year of follow-up for bile duct cancer, and up to 21% higher among males living in the most deprived areas (vs. least deprived) regarding colon cancer. To conclude, we provide a better understanding of how the (contextual) social gradient in survival is constructed, offering new perspectives for tackling social inequalities in digestive cancer survival.
Collapse
Affiliation(s)
- Laure Tron
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Correspondence:
| | - Mathieu Fauvernier
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France; (M.F.); (L.R.)
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, University of Lyon 1, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, Dijon University Hospital, INSERM UMR 1231, University of Burgundy, 21079 Dijon, France; (A.-M.B.); (V.J.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
| | - Michel Robaszkiewicz
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Tumors Registry of Finistère, EA SPURBO 7479, CHRU Morvan, 29200 Brest, France
| | - Véronique Bouvier
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Cancer Registry of Calvados, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
| | - Mélanie Cariou
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Tumors Registry of Finistère, EA SPURBO 7479, CHRU Morvan, 29200 Brest, France
| | - Valérie Jooste
- Digestive Cancer Registry of Burgundy, Dijon University Hospital, INSERM UMR 1231, University of Burgundy, 21079 Dijon, France; (A.-M.B.); (V.J.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
| | - Olivier Dejardin
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
| | - Laurent Remontet
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France; (M.F.); (L.R.)
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, University of Lyon 1, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Arnaud Alves
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
- Department of Digestive Surgery, University Hospital of Caen, 14000 Caen, France
| | | | - Florence Molinié
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Loire-Atlantique/Vendée Cancer Registry, 44000 Nantes, France
- CERPOP, Université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - Guy Launoy
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
| |
Collapse
|
8
|
Mora J, Krepline AN, Aldakkak M, Christians KK, George B, Hall WA, Erickson BA, Kulkarni N, Evans DB, Tsai S. Adjuvant therapy rates and overall survival in patients with localized pancreatic cancer from high Area Deprivation Index neighborhoods. Am J Surg 2021; 222:10-17. [DOI: 10.1016/j.amjsurg.2020.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/01/2020] [Accepted: 12/01/2020] [Indexed: 02/03/2023]
|
9
|
Louie AD, Nwaiwu CA, Rozenberg J, Banerjee D, Lee GJ, Senthoor D, Miner TJ. Providing Appropriate Pancreatic Cancer Care for People Experiencing Homelessness: A Surgical Perspective. Am Soc Clin Oncol Educ Book 2021; 41:1-9. [PMID: 33929879 DOI: 10.1200/edbk_100027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
People experiencing homelessness are particularly vulnerable when diagnosed with pancreatic cancer. Patients with lower socioeconomic status have worse outcomes from pancreatic cancer as the result of disparities in access to treatment and barriers to navigation of the health care system. Patients with lower socioeconomic status, or who are vulnerably housed, are less likely to receive surgical treatment even when it is recommended by National Comprehensive Cancer Network guidelines. This disparity in access to surgical care explains much of the gap in pancreatic cancer outcomes. There are many factors that contribute to this disparity in surgical management of pancreatic cancer in people experiencing homelessness. These include a lack of reliable transportation, feeling unwelcome in the medical setting, a lack of primary care and health insurance, and implicit biases of health care providers, including racial bias. Solutions that focus on rectifying these problems include utilizing patient navigators, addressing implicit biases of all health care providers and staff, creating an environment that caters to the needs of patients experiencing homelessness, and improving their access to insurance and regional support networks. Implementing these potential solutions all the way from the individual provider to national safety nets could improve outcomes for patients with pancreatic cancer who are experiencing homelessness.
Collapse
Affiliation(s)
- Anna D Louie
- Department of Surgery, Lifespan Health System, and Warren Alpert Medical School of Brown University, Providence, RI.,Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI
| | - Chibueze A Nwaiwu
- Department of Surgery, Lifespan Health System, and Warren Alpert Medical School of Brown University, Providence, RI.,Supporting Underrepresented Research to Generate Equity (SURGE) Lab Collaborators, Warren Alpert Medical School of Brown University, Providence, RI
| | - Julia Rozenberg
- Department of Surgery, Lifespan Health System, and Warren Alpert Medical School of Brown University, Providence, RI
| | - Debolina Banerjee
- Department of Surgery, Lifespan Health System, and Warren Alpert Medical School of Brown University, Providence, RI
| | - Gillian J Lee
- Department of Surgery, Lifespan Health System, and Warren Alpert Medical School of Brown University, Providence, RI
| | - Dewahar Senthoor
- Department of Surgery, Lifespan Health System, and Warren Alpert Medical School of Brown University, Providence, RI
| | - Thomas J Miner
- Department of Surgery, Lifespan Health System, and Warren Alpert Medical School of Brown University, Providence, RI.,Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI
| |
Collapse
|
10
|
Physician practice variation in head and neck cancer therapy: Results of a national survey. Oral Oncol 2021; 117:105293. [PMID: 33862559 DOI: 10.1016/j.oraloncology.2021.105293] [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: 02/02/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Choice between surgical or medical treatments in head and neck cancer depends of many patient-related and disease-related factors. We investigated how patients' socioeconomic status and practitioners' specialty could affect medical decision-making. MATERIALS AND METHODS We conducted a cross-sectional online, nationwide survey, send to surgeons, oncologists and radiotherapists specialized in head and neck oncology. We collected data on medical decision-making for seven clinical scientific scenarios involving head and neck carcinoma and physicians' demographic data. Patients' gender and socioeconomic position were distributed across scientific scenarios using a Latin square design. The scientific scenarios were grouped into several categories according to the prognostic and functional impact of the therapeutic choice. RESULTS We obtained 206 assessable answers. Surgeons seemed to propose surgery in 49% of cases, whereas oncologists and radiotherapists opted for it in 34% of cases only. This was particularly relevant when the oncological result of surgery and the medical approach were equivalent, and when the surgery appeared to be superior in terms of curative potential but was burdened by a large functional impact. Patient's socioeconomic position also influence therapeutic decision. Among surgeons, the "single male manager" had significantly more chance of being offered surgery than the "married male blue-collar worker". Among oncologists and radiotherapists, the "single male blue-collar worker" had the lowest probability of being proposed surgery. Regarding gender, surgeons tended to offer surgical management more to women regardless of their clinical profile. CONCLUSIONS Patients' sex, marital status, socioeconomic status, practitioners' specialty affect therapeutic management decisions in head and neck oncology.
Collapse
|
11
|
Oliveira C, Calmeiro J, Carrascal MA, Falcão A, Gomes C, Miguel Neves B, Teresa Cruz M. Exosomes as new therapeutic vectors for pancreatic cancer treatment. Eur J Pharm Biopharm 2021; 161:4-14. [PMID: 33561524 DOI: 10.1016/j.ejpb.2021.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
Pancreatic cancer (PC) is one of the deadliest cancers with a very short rate of survival and commonly without symptoms in its early stage. This absence of symptoms can lead to a late diagnosis associated with an advanced metastasis process, for which therapy is not effective. Although with extensive research in this field, the 5-year survival rate has not increased significantly. Notwithstanding, novel insights on risk factors, genetic mutations and molecular mechanisms pave the way for novel therapeutics that urge with a significant part of PC patients presenting resistance to chemotherapy treatments. Exosomes are presented as a promising strategy, working as delivery systems, since they can transport and release their cargoes after fusing with the membrane of pancreatic cells. Exosomes present advantages over liposomes, being less toxic and reaching higher levels in the bloodstream, working as molecule carriers that can inhibit oncogenes, activating tumor suppressor genes and inducing immune responses as well as controlling cell growth. This review intends to provide an overview about the scientific and clinical studies regarding the entire process, from isolation and purification of exosomes, to their design and transformation into anti-oncogenic drug delivering systems, particularly to target PC cells.
Collapse
Affiliation(s)
- Constança Oliveira
- Faculty of Pharmacy, FFUC, University of Coimbra, 3000-548 Coimbra, Portugal
| | - João Calmeiro
- Faculty of Pharmacy, FFUC, University of Coimbra, 3000-548 Coimbra, Portugal; Center for Neuroscience and Cell Biology, CNC, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Mylène A Carrascal
- Center for Neuroscience and Cell Biology, CNC, University of Coimbra, 3004-504 Coimbra, Portugal; Tecnimede Group, 2710-089 Sintra, Portugal
| | - Amílcar Falcão
- Faculty of Pharmacy, FFUC, University of Coimbra, 3000-548 Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research, CIBIT, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Célia Gomes
- Coimbra Institute for Clinical and Biomedical Research, iCBR, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; Center for Innovation in Biomedicine and Biotechnology, CIBB, University of Coimbra, 300-504 Coimbra, Portugal
| | - Bruno Miguel Neves
- Department of Medical Sciences and Institute of Biomedicine, iBiMED, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Maria Teresa Cruz
- Faculty of Pharmacy, FFUC, University of Coimbra, 3000-548 Coimbra, Portugal; Center for Neuroscience and Cell Biology, CNC, University of Coimbra, 3004-504 Coimbra, Portugal.
| |
Collapse
|
12
|
Municipality and Adjusted Gross Income Influence Outcome of Patients Diagnosed with Pancreatic Cancer in a Newly Developed Cancer Center in Mercer County New Jersey, USA, a Single Center Study. Cancers (Basel) 2021; 13:cancers13071498. [PMID: 33805136 PMCID: PMC8037458 DOI: 10.3390/cancers13071498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
Socioeconomic status (SES) correlates directly to ZIP code. Mercer County is not atypical as a collection of a dozen municipalities with a suburban/metropolitan population of 370,430 in the immediate vicinity of a major medical center. The purpose of this study for Mercer County, New Jersey, USA is to determine whether a patient's ZIP code is related to the outlook of pancreatic cancer defined as staging at diagnosis, prevalence, overall survival, type of insurance, and recurrence. Our hypothesis was that specific variables such as socio-economic status or race could be linked to the outcome of patients with pancreatic cancer. We interrogated a convenience sample from our cancer center registry and obtained 479 subjects diagnosed with pancreatic cancer in 1998-2018. We selected 339 subjects by ZIP code, representing the plurality of the cases in our catchment area. The outcome variable was overall survival; predictor variables were socio-economic status (SES), recurrence, insurance, type of treatment, gender, cancer stage, age, and race. We converted ZIP code to municipality and culled data using adjusted gross income (AGI, FY 2017). Comparative statistical analysis was performed using chi-square tests for nominal and ordinal variables, and a two-way ANOVA test was used for continuous variables; the p-value was set at 0.05. Our analysis confirmed that overall survival was significantly higher for Whites and for individuals who live in a municipality with a high SES. Tumor stage at the time of diagnosis was not different among race and SES; however, statistically significant differences for race or SES existed in the type of treatment received, with disparities found in those who received radiation therapy and surgery but not chemotherapy. The data may point to a lack of access to specific care modalities that subsequently may lead to lower survival in an underserved population. Access to care, optimal nutritional status, overall fitness, and co-morbidities could play a major role and confound the results. Our study suggests that low SES has a negative impact on overall pancreatic cancer survival. Surgery for pancreatic cancer should be appropriately decentralized to those community cancer centers that possess the expertise and the infrastructure to carry out specialized treatments regardless of race, ethnicity, SES, and insurance.
Collapse
|
13
|
Thobie A, Mulliri A, Bouvier V, Launoy G, Alves A, Dejardin O. Same Chance of Accessing Resection? Impact of Socioeconomic Status on Resection Rates Among Patients with Pancreatic Adenocarcinoma-A Systematic Review. Health Equity 2021; 5:143-150. [PMID: 33778318 PMCID: PMC7990568 DOI: 10.1089/heq.2019.0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 01/15/2023] Open
Abstract
Background: The incidence of pancreatic cancer is growing and the survival rate remains one of the worst in oncology. Surgical resection is currently a crucial curative option for pancreatic adenocarcinoma (PA). Socioeconomic factors could influence access to surgery. This article reviews the literature on the impact of socioeconomic status (SES) on access to curative surgery among patients with PA. Methods: The EMBASE, MEDLINE, Web of Science, and Scopus databases were searched by three investigators to generate 16 studies for review. Results: Patients with the lowest SES are less likely to undergo surgery than high SES. Low income, low levels of education, not being insured, and living in deprived and rural areas have all been associated with decreased rates of surgical resection. Given the type of health care system and geographic disparities, results in North American populations are difficult to transpose to European countries. However, a similar trend is observed in difficulty for the poorest patients in accessing resection. Low SES seems to be less likely to be offered surgery and more likely to refuse it. Conclusions: Inequalities in insurance coverage and living in poor/lower educational level areas are all demonstrated factors of a lower likelihood of resection populations. It is important to assess the causal effect of socioeconomic deprivation to improve understanding of this disease and improve access to care.
Collapse
Affiliation(s)
- Alexandre Thobie
- Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France.,UMR INSERM 1086 UCN 'ANTICIPE,' Caen, France
| | - Andrea Mulliri
- Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France
| | - Véronique Bouvier
- UMR INSERM 1086 UCN 'ANTICIPE,' Caen, France.,Registre des Tumeurs Digestives du Calvados, Caen, France.,Department of Research, University Hospital of Caen, Caen Cedex, France
| | - Guy Launoy
- UMR INSERM 1086 UCN 'ANTICIPE,' Caen, France.,Registre des Tumeurs Digestives du Calvados, Caen, France.,Department of Research, University Hospital of Caen, Caen Cedex, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France.,UMR INSERM 1086 UCN 'ANTICIPE,' Caen, France.,Registre des Tumeurs Digestives du Calvados, Caen, France.,Department of Research, University Hospital of Caen, Caen Cedex, France
| | - Olivier Dejardin
- UMR INSERM 1086 UCN 'ANTICIPE,' Caen, France.,Department of Research, University Hospital of Caen, Caen Cedex, France
| |
Collapse
|
14
|
Alabd A, Alabd A, Bolaji O, Sugumar K, Ammori J, Hardacre J, Winter JM. Elucidating the Causes of Improved Survival in Clinical Trials of Randomized Adjuvant Pancreatic Ductal Adenocarcinoma (PDAC). Ann Surg Oncol 2020; 28:1060-1068. [PMID: 32968957 DOI: 10.1245/s10434-020-08859-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Overall survival (OS) has increased in recent adjuvant clinical trials of pancreatic ductal adenocarcinoma (PDAC). Although oncologists have taken notice, the root causes have not been fully examined. METHODS All phase 3 adjuvant PDAC clinical trials were screened (n = 13), and eight trials (2007-2019) that met a study requirement of having a gemcitabine monotherapy arm to serve as a uniform comparative anchor across trials were identified. Patient enrollment eligibility criteria were compared across trials and categorized as tumor- or patient-related factors. Disease-free survival (DFS) and OS in the gemcitabine-only and non-gemcitabine arms were plotted and compared over time using linear regression. RESULTS In the non-gemcitabine arms, OS increased over time, but the slope did not achieve statistical significance (p = 0.0815). Interestingly, OS improved for patients receiving only gemcitabine (slope, 1.99 months; p = 0.0018), whereas DFS remained constant (p = 0.897). Carbohydrate antigen (CA) 19-9 values and pathologic profiles of tumors were only marginally different across all cohorts. Recent adjuvant trials had stricter inclusion criteria (i.e., more patients were excluded for medical reasons; linear regression, p = 0.010). CONCLUSION Survival for patients with resected PDAC has roughly doubled in phase 3 adjuvant trials during the past decade. Improved outcomes likely are attributable to improved adjuvant therapeutic regimens, but also reflect healthier patients enrolled in the more recent trials.
Collapse
Affiliation(s)
- Andre Alabd
- Indiana Health University Hospital, Indianapolis, IN, USA
| | | | | | - Kavin Sugumar
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44107, USA
| | - John Ammori
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44107, USA
| | - Jeffrey Hardacre
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44107, USA
| | - Jordan M Winter
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44107, USA.
| |
Collapse
|
15
|
Barreto SG. Pancreatic cancer in Australia: is not it time we address the inequitable resource problem? Future Oncol 2020; 16:1385-1392. [PMID: 32412798 DOI: 10.2217/fon-2020-0109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The present study reviewed the geographical variations in the delivery of pancreatic cancer therapy and whether this impacts overall survival. The evidence suggests a difference in the accessibility of pancreatic cancer care to patients in rural as compared with urban Australia. While centralization of pancreatic surgery is essential to deliver high quality care to patients, it may be interfering with the ease of access of this form of care to patients in regional areas. Access to chemotherapy in regional Australia is also limited. There is need for a concerted effort to improve the overall care and uptake of medical services to patients in metropolitan and remote Australia with the overarching aim of improving survival and meaningful quality of life.
Collapse
Affiliation(s)
- Savio George Barreto
- Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.,College of Medicine & Public Health, Flinders University, South Australia, Australia
| |
Collapse
|