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Ntessalen M, Krasniqi A, Murchie P. Development and piloting of an online course to improve knowledge, confidence and attitudes towards triaging images of skin lesions submitted online in primary care. BMC MEDICAL EDUCATION 2024; 24:839. [PMID: 39103798 DOI: 10.1186/s12909-024-05840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/30/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Melanoma is the 5th commonest cancer in the UK and survivors require frequent and thorough skin checks. During the Achieving Self-directed Integrated Cancer Aftercare (ASICA) trial, melanoma survivors used an app to submit images of concerning lesions for assessment by a dermatology nurse. In the past, online courses have been used to train non-specialist primary care practitioners (PCPs) in this skill. OBJECTIVES This study aimed to determine whether an online course could increase knowledge, confidence, and attitudes towards skin image triage in PCPs in the Grampian area. METHODS Preliminary discussions were held with PCPs to determine the need for an online course. The course was designed at the University of Aberdeen and included an introduction to the skin, case studies and quizzes on a variety of skin conditions based on melanoma survivors' submissions via the ASICA app. Two pre- and post-course questionnaires were administered to all participants to (1) assess knowledge gained and (2) assess any improvements in confidence and attitudes towards triaging skin lesions that could be indicative of skin cancer. All PCPs in the Grampian area were invited to participate with almost 70 medical practices contacted. Results were analysed using a paired sample T-test. RESULTS The course was advertised to all GP practices in the Grampian area and 38 PCPs completed all its stages. Undertaking the course improved all PCPs' confidence and attitudes towards triaging (p < 0.001). It also improved knowledge in all non-GP PCPs (p = 0.01). Most participants found the course useful; thought it was at the right level of difficulty, right format and thought the design was good. CONCLUSIONS Our online course in triaging skin lesions submitted digitally to PCPs was able to improve knowledge, confidence, and attitudes towards triaging. The course was acceptable in its design and was deemed useful and applicable to practice. Further research should investigate the effect the course has on secondary care referral numbers.
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Affiliation(s)
- Maria Ntessalen
- Academic Primary Care Research Group, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, AB25 2ZD, Aberdeen, Scotland
| | - Albana Krasniqi
- Academic Primary Care Research Group, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, AB25 2ZD, Aberdeen, Scotland
| | - Peter Murchie
- Academic Primary Care Research Group, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, AB25 2ZD, Aberdeen, Scotland.
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Montagnoli DRABS, Leite VF, Godoy YS, Lafetá VM, Junior EAP, Chaurasia A, Aguiar MCF, Abreu MHNG, Martins RC. Can predictive factors determine the time to treatment initiation for oral and oropharyngeal cancer? A classification and regression tree analysis. PLoS One 2024; 19:e0302370. [PMID: 38630775 PMCID: PMC11023193 DOI: 10.1371/journal.pone.0302370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
This ecological study aimed to identify the factors with the greatest power to discriminate the proportion of oral and oropharyngeal cancer (OOC) records with time to treatment initiation (TTI) within 30 days of diagnosis in Brazilian municipalities. A descriptive analysis was performed on the variables grouped into five dimensions related to patient characteristics, access to health services, support for cancer diagnosis, human resources, and socioeconomic characteristics of 3,218 Brazilian municipalities that registered at least one case of OOC in 2019. The Classification and Regression Trees (CART) technique was adopted to identify the explanatory variables with greater discriminatory power for the TTI response variable. There was a higher median percentage of records in the age group of 60 years or older. The median percentage of records with stage III and IV of the disease was 46.97%, and of records with chemotherapy, radiation, or both as the first treatment was 50%. The median percentage of people with private dental and health insurance was low. Up to 75% had no cancer diagnostic support services, and up to 50% of the municipalities had no specialist dentists. Most municipalities (49.4%) started treatment after more than 30 days. In the CART analysis, treatment with chemotherapy, radiotherapy, or both explained the highest TTI in all municipalities, and it was the most relevant for predicting TTI. The final model also included anatomical sites in the oral cavity and oropharynx and the number of computed tomography services per 100,000. There is a need to expand the availability of oncology services and human resources specialized in diagnosing and treating OOC in Brazilian municipalities for a timely TTI of OOC.
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Affiliation(s)
| | | | - Yasmim Silva Godoy
- School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vitória Marçolla Lafetá
- Technical High School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Akhilanand Chaurasia
- Department of Oral Medicine and Radiology, King George´s Medical University, Lucknow, Uttar Pradesh, India
| | - Maria Cássia Ferreira Aguiar
- Department of Clinic, Dental Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Renata Castro Martins
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Veljanoski D, Barlas R, Jamjoom AAB, Walkden J, Horgan G, Moleron R, Myint PK, Giamouriadis A. Impact of remoteness and rurality on the treatment and survival of patients with glioblastoma in the north of Scotland. World Neurosurg X 2024; 22:100331. [PMID: 38455242 PMCID: PMC10918251 DOI: 10.1016/j.wnsx.2024.100331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
Background The geographical catchment area served by the Neurosurgical Unit in Aberdeen, Scotland is the largest in the United Kingdom. We examined whether a distance-decay effect on survival exists for patients diagnosed with glioblastoma, who have to travel substantial distances for neurosurgical and oncological treatment in the north of Scotland. Methods Electronic medical records of adult patients with glioblastoma, referred for treatment between 2007 and 2018, who underwent surgical resection were reviewed. Travel time by car (as a measure of distance travelled) was calculated from the patients' home to their general practice (GP) and to their main neuro-oncological centre. Results There were 122 patients; 71 (58.2%) were male and the mean age was 57.8 years. The urban-rural split was 61.5% and 38.5%, respectively. Median driving time to the neuro-oncological centre was 36 min and to the GP this was 6 min. Most patients underwent either sub-total (49.6%) or gross total (46.3%) surgical resection. Post-operative treatments included: radiotherapy only (15.6%), chemotherapy only (6.6%), and chemotherapy with radiotherapy (63.1%). Temozolomide was used in 70.5% of patients. Seventeen patients did not receive any post-operative chemo-radiotherapy. The median survival time was 345 days. There was no statistically significant association between distance travelled and survival time in days. MGMT methylation status, extent of resection, Charlson co-morbidity index and treatment received significantly affected survival. Conclusions There was no evidence of disadvantage on survival time for patients living further from their neuro-oncological centre compared to those who live nearer.
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Affiliation(s)
- Damjan Veljanoski
- Department of Neurosurgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, AB25 2ZN, United Kingdom
| | - Raphae Barlas
- Department of Acute Medicine, Ward 101/103, Aberdeen Royal Infirmary, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, AB25 2ZN, United Kingdom
| | - Aimun A B Jamjoom
- Department of Neurosurgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, AB25 2ZN, United Kingdom
| | - James Walkden
- Department of Neurosurgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, AB25 2ZN, United Kingdom
| | - Graham Horgan
- Biomathematics & Statistics Scotland, Ashgrove Rd W, Aberdeen, AB25 2ZD, United Kingdom
| | - Rafael Moleron
- Department of Oncology, Aberdeen Royal Infirmary, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, AB25 2ZN, United Kingdom
| | - Phyo Kyaw Myint
- Institute of Applied Health Sciences, University of Aberdeen Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom
| | - Anastasios Giamouriadis
- Department of Neurosurgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, AB25 2ZN, United Kingdom
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Kugler CM, Gretschel S, Scharfe J, Pfisterer-Heise S, Mantke R, Pieper D. [Effects of new minimum volume standards in visceral surgery on healthcare in Brandenburg, Germany, from the perspective of healthcare providers]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:1015-1021. [PMID: 37882840 PMCID: PMC10689523 DOI: 10.1007/s00104-023-01971-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The legally prescribed minimum volume standards for complex esophageal and pancreatic surgery have been increased or will increase in 2023 and 2025, respectively. Hospitals not reaching the minimum volume standards are no longer allowed to perform these surgeries and are not entitled tor reimbursement. OBJECTIVE The study aims to explore which effects are expected by healthcare professionals and patient representatives and what possible solutions exist for Brandenburg, a rural federal state in northeast Germany. MATERIAL AND METHODS In this study 19 expert interviews were conducted with hospital employees (head/senior physicians, nursing director), resident physicians and patient representatives between July 2022 and January 2023. The data analysis was based on content analysis. RESULTS Healthcare professionals and patient representatives expect a redistribution into a few clinics for surgical care (specialized centres); conversely more clinics that do not (no longer) perform the defined surgeries but could function as gatekeeping hospitals for basic care, diagnostics and follow-up (regional centres). The redistribution could also impact forms of treatment that are not directly defined within the regulation for minimum volume standards. The increased thresholds could also affect medical training and staff recruitment. A solution could be collaborations between different hospitals, which would have to be structurally promoted. CONCLUSION The study showed that minimum volume standards not only influence the quality of outcomes and accessibility but also have a multitude of other effects. Particularly for rural regions, minimum volume standards are challenging for access to esophageal and pancreatic surgery as well as for communication between specialized and regional centres or resident providers.
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Affiliation(s)
- C M Kugler
- Fakultät für Gesundheitswissenschaften Brandenburg, Institut für Versorgungs- und Gesundheitssystemforschung (IVGF), Medizinische Hochschule Brandenburg (Theodor Fontane), Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Deutschland.
- Zentrum für Versorgungsforschung Brandenburg (ZVF-BB), Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland.
| | - S Gretschel
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Ruppin-Brandenburg (ukrb), Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
- Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
| | - J Scharfe
- Fakultät für Gesundheitswissenschaften Brandenburg, Institut für Versorgungs- und Gesundheitssystemforschung (IVGF), Medizinische Hochschule Brandenburg (Theodor Fontane), Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Deutschland
- Zentrum für Versorgungsforschung Brandenburg (ZVF-BB), Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland
| | - S Pfisterer-Heise
- Fakultät für Gesundheitswissenschaften Brandenburg, Institut für Versorgungs- und Gesundheitssystemforschung (IVGF), Medizinische Hochschule Brandenburg (Theodor Fontane), Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Deutschland
- Zentrum für Versorgungsforschung Brandenburg (ZVF-BB), Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland
| | - R Mantke
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Brandenburg an der Havel (ukb), Medizinische Hochschule Brandenburg, Brandenburg an der Havel, Deutschland
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg an der Havel, Deutschland
| | - D Pieper
- Fakultät für Gesundheitswissenschaften Brandenburg, Institut für Versorgungs- und Gesundheitssystemforschung (IVGF), Medizinische Hochschule Brandenburg (Theodor Fontane), Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Deutschland
- Zentrum für Versorgungsforschung Brandenburg (ZVF-BB), Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland
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Turner M, Carriere R, Fielding S, Ramsay G, Samuel L, Maclaren A, Murchie P. The impact of travel time to cancer treatment centre on post-diagnosis care and mortality among cancer patients in Scotland. Health Place 2023; 84:103139. [PMID: 37979314 DOI: 10.1016/j.healthplace.2023.103139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 11/20/2023]
Abstract
Limited data exist on the effect of travelling time on post-diagnosis cancer care and mortality. We analysed the impact of travel time to cancer treatment centre on secondary care contact time and one-year mortality using a data-linkage study in Scotland with 17369 patients. Patients with longer travelling time and island-dwellers had increased incidence rate of secondary care cancer contact time. For outpatient oncology appointments, the incidence rate was decreased for island-dwellers. Longer travelling time was not associated with increased secondary care contact time for emergency cancer admissions or time to first emergency cancer admission. Living on an island increased mortality at one-year. Adjusting for cancer-specific secondary care contact time increased the hazard of death, and adjusting for oncology outpatient time decreased the hazard of death for island-dwellers. Those with longer travelling times experience the cancer treatment pathway differently with poorer outcomes. Cancer services may need to be better configured to suit differing needs of dispersed populations.
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Affiliation(s)
- Melanie Turner
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Romi Carriere
- Population Health Sciences Institute, Campus of Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK
| | - Shona Fielding
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - George Ramsay
- Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Health Campus, Foresterhill Road, Aberdeen, AB25 2ZN, UK
| | - Leslie Samuel
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZN, UK
| | - Andrew Maclaren
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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Maxwell S, Pearce C, Kynn M, Anderson LA, Weller D, Murchie P. The impact of rurality on patient experience and diagnostic pathway intervals in Scotland's cancer patients: Further results from a national cancer diagnosis audit. Cancer Epidemiol 2023; 86:102414. [PMID: 37499334 DOI: 10.1016/j.canep.2023.102414] [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: 05/15/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND In Scotland 17 % of the population reside rurally and previous research has demonstrated worse cancer outcomes in this group. The underlying reason for this is unclear. This study aims to determine whether patient presenting factors, GP consultation factors or the diagnostic pathways differ between urban and rural patients within Scotland. METHODS This study combined two Scottish National Cancer Diagnosis Audits. Participating GPs collected data on the diagnostic pathway from primary to secondary care for cancer patients diagnosed during the audit period. Using the Scottish Government Urban Rural Classification, patients were designated as rural or urban dwellers and compared in descriptive analyses. Key cancer intervals (primary, diagnostic, secondary and treatment interval) were compared between urban and rural dwellers with an additional adjusted analysis for the main cancer sites. RESULTS A total of 4309 cancer diagnoses were included in the study; 22 % were in patients from rural locations. Rural patients had significantly more consultations and investigations prior to referral than their urban counterparts. There was no difference in prolonged cancer pathways between the two groups except in lung cancer patients where rural patients had a significantly increased odds of a diagnostic interval of >90 days. CONCLUSION Our findings suggest differences in the interaction between patients and GPs prior to referral in urban and rural settings. However, this does not appear to lead to prolonged patient pathways, except in lung cancer. Further research is needed to determine whether this delay is clinically significant and contributing to poorer outcomes in Scottish rural dwellers with lung cancer.
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Affiliation(s)
- Susanne Maxwell
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Clara Pearce
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
| | - Mary Kynn
- Faculty of Science and Engineering, Curtin University, Kent Street, Bentley WA 6102, Australia
| | - Lesley Ann Anderson
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
| | - David Weller
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom.
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Graham B, Kruger E, Tennant M, Shiikha Y. An assessment of the spatial distribution of bulk billing-only GP services in Australia in relation to area-based socio-economic status. Aust J Prim Health 2023; 29:437-444. [PMID: 36812933 DOI: 10.1071/py22125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/15/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The accessibility to affordable primary healthcare services contributes to population health and health equity. A key aspect to accessibility is the geographical distribution of primary healthcare services. Limited studies have assessed the nationwide spatial distribution of bulk billing-only medical practices or 'no-fee' services. The aim of this study was to provide a nationwide approximation of bulk billing-only services and evaluate the socio-demographic status and population characteristics in relation to the distribution of bulk billing-only GP services. METHODS The methodology in this study used Geographic Information System (GIS) technology to map the locations of all bulk bulking-only medical practices collected in mid-2020 and linked this with population data. The population data and practice locations were analysed at the level of Statistical Areas Level 2 (SA2) regions and used the most recent Census data. RESULTS The study sample included (n =2095) bulk billing-only medical practice locations. The nationwide average Population-to-Practice (PtP) ratio was 1 practice to 8529 people for regions with access to bulk billing-only practice, and 57.4% of the Australian population lives within an SA2 that has access to at least one bulk billing-only medical practices. No significant associations were identified between practice distribution and area socio-economic status. CONCLUSION The study identified areas with low access to affordable GP services, with many SA2 regions having no access to bulk billing-only practices. Findings also indicate that there was no association between area socio-economic status and the distribution of bulk billing-only services.
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Affiliation(s)
- Bree Graham
- School of Human Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
| | - Estie Kruger
- School of Human Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
| | - Marc Tennant
- School of Human Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
| | - Yulia Shiikha
- School of Human Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
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Berger E, Reichebner C, Eriksen A, Hildebrandt M, Kuklinski D, Busse R. [Specialised treatment of colorectal cancer in certified cancer centres: Do patients really have to travel further?]. DAS GESUNDHEITSWESEN 2023; 85:657-666. [PMID: 37321253 PMCID: PMC10442894 DOI: 10.1055/a-2055-9599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION In Germany, many cancer patients are treated outside of cancer centres certified by the German Cancer Society (DKG) resulting in underuse of these facilities and inferior oncological treatment. One way to address this issue would be to restructure the healthcare landscape by following the Danish approach that limits cancer treatment to specialized hospitals. Such an approach would have an impact on the travelling times to treatment centers. The present study determines the impact on patient travel times using the example of colorectal cancer. METHODS For the present analysis, data from structured quality reports (sQB) and from patients insured with the AOK who underwent resection of the colon or rectum during 2018 were used. In addition, data from the DKG regarding an existing certification of a colorectal cance centre were used. Travel time was defined as the time patients spent in an average car with average traffic from the midpoint of the ZIP code of their residence to the coordinates of the hospital. The coordinates of the hospitals and the midpoints of the ZIP codes were obtained by querying the Google API. Travel times were calculated with a local Open Routing Machine server. The statistical programs R and Stata were used for analyses and cartographic representations. RESULTS In 2018, nearly half of all patients with colon cancer were treated at the hospital nearest to their place of residence, of whom approximately 40% were treated at a certified colorectal cancer centre. Overall, only about 47% of all treatments took place at a certified colorectal cancer centre. Travel time to the chosen treatment site averaged 20 minutes. It was minimally shorter (18 minutes) if no certified centre was chosen and minimally longer (21 minutes) for those whose treatment took place in a certified colorectal cancer centre. Modeling of redistributions of all patients to certified centres resulted on an average travel time of 29 minutes. CONCLUSION Even if treatment were limited to specialized hospitals, treatment close to home would still be guaranteed. Regardless of certification, parallel structures can be identified, especially in metropolitan areas, which indicate a potential for restructuring.
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Affiliation(s)
- Elke Berger
- Fachgebiet Management im Gesundheitswesen, Technische
Universität Berlin, Fakultät VII Wirtschaft und Management,
Berlin, Germany
| | - Christoph Reichebner
- Fachgebiet Management im Gesundheitswesen, Technische
Universität Berlin, Fakultät VII Wirtschaft und Management,
Berlin, Germany
| | - Astrid Eriksen
- Fachgebiet Management im Gesundheitswesen, Technische
Universität Berlin, Fakultät VII Wirtschaft und Management,
Berlin, Germany
| | - Meik Hildebrandt
- Fachgebiet Management im Gesundheitswesen, Technische
Universität Berlin, Fakultät VII Wirtschaft und Management,
Berlin, Germany
| | - David Kuklinski
- School of Medicine, Universität St Gallen School of Medicine,
St Gallen, Switzerland
| | - Reinhard Busse
- Fachgebiet Management im Gesundheitswesen, Technische
Universität Berlin, Fakultät VII Wirtschaft und Management,
Berlin, Germany
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Derakhshan A, Shaye D, McCarty JC, Nellis J, -Lyford Pike S, Hadlock TA, Gadkaree SK. Surgical Management of Facial Paralysis: Demographic and Socioeconomic Associations. Facial Plast Surg Aesthet Med 2023; 25:165-171. [PMID: 36099197 DOI: 10.1089/fpsam.2021.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To determine demographic and socioeconomic variables associated with whether surgery is performed for patients with facial paralysis (FP). Background: Management of FP may include elective surgery dependent on patient goals of care and physician experience. Methods: The 2016 State Inpatient Database and State Ambulatory Surgery Services Database for six states were queried to identify patients with FP. These patients were then stratified based on receiving surgery for FP. Demographic and socioeconomic information was collected. Multivariable logistic regression modeling was used to identify predictors of undergoing FP surgery, as well as the hospital setting in which surgery was performed. Results: Of 20,218 patients with FP, 515 underwent surgery. Black patients were significantly less likely to undergo surgery (p < 0.001), as were patients with Medicaid or self-pay insurance (p < 0.001). Those living in rural areas were also less likely to receive surgery (p = 0.001). Individuals receiving surgery in the inpatient setting were more likely to have private insurance, whereas those in the ambulatory setting were more likely to have Medicare (p < 0.001). Conclusion: Several variables are correlated with whether FP is managed surgically, including insurance status, race, and type of residential area.
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Affiliation(s)
- Adeeb Derakhshan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Shaye
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Justin C McCarty
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason Nellis
- Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sofia -Lyford Pike
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tessa A Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Shekhar K Gadkaree
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of Miami, Miami, Florida, USA
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Lim J, Akbar Ali S, Prawira A, Sim HW. Impact of travel distance on outcomes for clinical trial patients: the Kinghorn Cancer Centre experience. Intern Med J 2023; 53:242-249. [PMID: 34613656 DOI: 10.1111/imj.15561] [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: 07/01/2021] [Revised: 09/18/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Geographic isolation and travel distance to specialist care is a known social determinant of health and contributes to poorer oncology survival outcomes. AIMS To compare survival and toxicity outcomes for patients travelling long distances (>50 km) for treatment on clinical trials with local patients (<10 km and 10-50 km). METHODS We performed a retrospective cohort study based at the Kinghorn Cancer Centre, a comprehensive cancer care centre in metropolitan Sydney. We included adult patients with advanced solid-organ malignancies who were enrolled on therapeutic clinical trials between July 2015 and December 2017. Outcome measures included overall survival, progression-free survival, rates of grade 3-4 toxicity and unplanned hospital admissions for the duration of the clinical trial. RESULTS We included 173 patients, of whom 27% lived within 10 km, 29% lived between 10 and 50 km and 44% lived further than 50 km. We did not identify significant differences between survival or toxicity outcomes between patients travelling long distances and local patients. CONCLUSIONS All patients should be considered for clinical trial referral based on clinical parameters and preference, regardless of geographic proximity. In the meantime, improving access to clinical trials for rural and regional patients continues to be a priority.
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Affiliation(s)
- Jennifer Lim
- Department of Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Syafiq Akbar Ali
- Department of Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Amy Prawira
- Department of Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Hao-Wen Sim
- Department of Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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11
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Dobson C, Deane J, Macdonald S, Murchie P, Ellwood C, Angell L, Rubin G. Barriers to Early Presentation amongst Rural Residents Experiencing Symptoms of Colorectal Cancer: A Qualitative Interview Study. Cancers (Basel) 2022; 15:274. [PMID: 36612270 PMCID: PMC9818976 DOI: 10.3390/cancers15010274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023] Open
Abstract
Rural cancer inequalities are evident internationally, with rural cancer patients 5% less likely to survive than their urban counterparts. There is evidence to suggest that diagnostic delays prior to entry into secondary care may be contributing to these poorer rural cancer outcomes. This study explores the symptom appraisal and help-seeking decision-making of people experiencing symptoms of colorectal cancer in rural areas of England. Patients were randomly invited from 4 rural practices, serving diverse communities. Semi-structured interviews were undertaken with 40 people who had experienced symptoms of colorectal cancer in the preceding 8 weeks. Four key themes were identified as influential in participants' willingness and timeliness of consultation: a desire to rule out cancer (facilitator of help-seeking); stoicism and self-reliance (barrier to help-seeking); time scarcity (barrier to help-seeking); and GP/patient relationship (barrier or facilitator, depending on perceived strength of the relationship). Self-employed, and "native" rural residents most commonly reported experiencing time scarcity and poor GP/patient relationships as a barrier to (re-)consultation. Targeted, active safety-netting approaches, and increased continuity of care, may be particularly beneficial to expedite timely diagnoses and minimise cancer inequalities for rural populations.
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Affiliation(s)
- Christina Dobson
- Population Health Sciences Institute, Newcastle University, Ridley1 Building, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK
| | - Jennifer Deane
- Population Health Sciences Institute, Newcastle University, Ridley1 Building, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK
| | - Sara Macdonald
- School of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, UK
| | - Peter Murchie
- Division of Applied Health Sciences, Section of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Christina Ellwood
- JJR MacLeod Centre for Diabetes, Endocrinology and Metabolism, Aberdeen Royal Infirmary, Aberdeen AB25 2ZP, UK
| | | | - Greg Rubin
- Population Health Sciences Institute, Newcastle University, Ridley1 Building, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK
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12
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Giannakou K, Lamnisos D. Small-Area Geographic and Socioeconomic Inequalities in Colorectal Cancer in Cyprus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:341. [PMID: 36612661 PMCID: PMC9819875 DOI: 10.3390/ijerph20010341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Colorectal cancer (CRC) is one of the leading causes of death and morbidity worldwide. To date, the relationship between regional deprivation and CRC incidence or mortality has not been studied in the population of Cyprus. The objective of this study was to analyse the geographical variation of CRC incidence and mortality and its possible association with socioeconomic inequalities in Cyprus for the time period of 2000-2015. This is a small-area ecological study in Cyprus, with census tracts as units of spatial analysis. The incidence date, sex, age, postcode, primary site, death date in case of death, or last contact date of all alive CRC cases from 2000-2015 were obtained from the Cyprus Ministry of Health's Health Monitoring Unit. Indirect standardisation was used to calculate the sex and age Standardise Incidence Ratios (SIRs) and Standardised Mortality Ratios (SMRs) of CRC while the smoothed values of SIRs, SMRs, and Mortality to Incidence ratio (M/I ratio) were estimated using the univariate Bayesian Poisson log-linear spatial model. To evaluate the association of CRC incidence and mortality rate with socioeconomic deprivation, we included the national socioeconomic deprivation index as a covariate variable entering in the model either as a continuous variable or as a categorical variable representing quartiles of areas with increasing levels of socioeconomic deprivation. The results showed that there are geographical areas having 15% higher SIR and SMR, with most of those areas located on the east coast of the island. We found higher M/I ratio values in the rural, remote, and less dense areas of the island, while lower rates were observed in the metropolitan areas. We also discovered an inverted U-shape pattern in CRC incidence and mortality with higher rates in the areas classified in the second quartile (Q2-areas) of the socioeconomic deprivation index and lower rates in rural, remote, and less dense areas (Q4-areas). These findings provide useful information at local and national levels and inform decisions about resource allocation to geographically targeted prevention and control plans to increase CRC screening and management.
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13
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Hultstrand C, Hörnsten C, Lilja M, Coe A, Fjällström P, Hajdarevic S. The association between sociodemographic factors and time to diagnosis for colorectal cancer in northern Sweden. Eur J Cancer Care (Engl) 2022; 31:e13687. [PMID: 35970596 PMCID: PMC9787547 DOI: 10.1111/ecc.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 06/29/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study examined whether sociodemographic factors, including distance to hospital, were associated with differences in the diagnostic interval and the treatment interval for colorectal cancer in northern Sweden. METHODS Data were retrieved from the Swedish cancer register on patients (n = 446) diagnosed in three northern regions during 2017-2018, then linked to data from Statistics Sweden and medical records. Also, Google maps was used to map the distance between patients' place of residence and nearest hospital. The different time intervals were analysed using Mann-Whitney U-test and Cox regression. RESULTS Differences in time to diagnosis were found between groups for income and distance to hospital, favouring those with higher income and shorter distance. The unadjusted regression analysis showed higher income to be associated with more rapid diagnosis (HR 1.004, CI 1.001-1.007). This association remained in the fully adjusted model for income (HR 1.004, CI 1.000-1.008), but not for distance. No differences between sociodemographic groups were found in the treatment interval. CONCLUSION Higher income and shorter distance to hospital were in the unadjusted models associated with shorter time to diagnosis for patients with CRC in northern Sweden. The association remained for income when adjusting for other variables even though the difference was small.
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Affiliation(s)
- Cecilia Hultstrand
- Department of NursingUmeå UniversityUmeåSweden,Department of Public Health and Clinical Medicine, Family MedicineUmeå UniversityUmeåSweden
| | | | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and DevelopmentÖstersund Hospital, Umeå UniversityUmeåSweden
| | | | | | - Senada Hajdarevic
- Department of NursingUmeå UniversityUmeåSweden,Department of Public Health and Clinical Medicine, Family MedicineUmeå UniversityUmeåSweden
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14
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Obrochta CA, Parada H, Murphy JD, Nara A, Trinidad D, Araneta MR(H, Thompson CA. The impact of patient travel time on disparities in treatment for early stage lung cancer in California. PLoS One 2022; 17:e0272076. [PMID: 36197902 PMCID: PMC9534452 DOI: 10.1371/journal.pone.0272076] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 07/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Travel time to treatment facilities may impede the receipt of guideline-concordant treatment (GCT) among patients diagnosed with early-stage non-small cell lung cancer (ES-NSCLC). We investigated the relative contribution of travel time in the receipt of GCT among ES-NSCLC patients. METHODS We included 22,821 ES-NSCLC patients diagnosed in California from 2006-2015. GCT was defined using the 2016 National Comprehensive Cancer Network guidelines, and delayed treatment was defined as treatment initiation >6 versus ≤6 weeks after diagnosis. Mean-centered driving and public transit times were calculated from patients' residential block group centroid to the treatment facilities. We used logistic regression to estimate risk ratios and 95% confidence intervals (CIs) for the associations between patients' travel time and receipt of GCT and timely treatment, overall and by race/ethnicity and neighborhood socioeconomic status (nSES). RESULTS Overall, a 15-minute increase in travel time was associated with a decreased risk of undertreatment and delayed treatment. Compared to Whites, among Blacks, a 15-minute increase in driving time was associated with a 24% (95%CI = 8%-42%) increased risk of undertreatment, and among Filipinos, a 15-minute increase in public transit time was associated with a 27% (95%CI = 13%-42%) increased risk of delayed treatment. Compared to the highest nSES, among the lowest nSES, 15-minute increases in driving and public transit times were associated with 33% (95%CI = 16%-52%) and 27% (95%CI = 16%-39%) increases in the risk of undertreatment and delayed treatment, respectively. CONCLUSION The benefit of GCT observed with increased travel times may be a 'Travel Time Paradox,' and may vary across racial/ethnic and socioeconomic groups.
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Affiliation(s)
- Chelsea A. Obrochta
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
| | - Humberto Parada
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
| | - James D. Murphy
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
| | - Atsushi Nara
- Department of Geography, San Diego State University, San Diego, California, United States of America
| | - Dennis Trinidad
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
| | | | - Caroline A. Thompson
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- * E-mail:
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15
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Ross-Driscoll K, Gunasti J, Lynch RJ, Massie A, Segev DL, Snyder J, Axelrod D, Patzer RE. Listing at non-local transplant centers is associated with increased access to deceased donor kidney transplantation. Am J Transplant 2022; 22:1813-1822. [PMID: 35338697 PMCID: PMC9580509 DOI: 10.1111/ajt.17044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 01/25/2023]
Abstract
The ability of kidney transplant candidates to travel outside of their usual place of care varies by sociodemographic factors, potentially exacerbating disparities in access. We used Transplant Referral Regions (TRRs) to overcome previous methodological barriers of using geographic distance to assess the characteristics and outcomes of patients listed for kidney transplant at centers in neighboring TRR or beyond neighboring TRRs. Among listed kidney transplant candidates, 20.9% traveled to a neighbor and 5.6% beyond a neighbor. A higher proportion of travelers were White, had some college education, and lived in ZIP codes with lower poverty. Travel to a neighbor was associated with a 7% increase in likelihood of deceased donor transplant (cHR: 1.07, 95% CI: 1.05, 1.09) and traveling beyond a neighbor with a 19% increase (cHR: 1.19, 95% CI: 1.15, 1.24). Travelers had similar rates of living donor transplant and waitlist mortality as patients who did not travel; those who traveled beyond a neighbor had slightly lower posttransplant mortality (HR: 0.91, 95% CI: 0.83, 0.99). In conclusion, the ability to travel outside of the recipient's assigned TRR increases access to transplantation and improves long-term survival.
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Affiliation(s)
- Katherine Ross-Driscoll
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathan Gunasti
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia,Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Raymond J. Lynch
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Allan Massie
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Jon Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota,Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - David Axelrod
- Solid Organ Transplant Center, Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Rachel E. Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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16
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Assessing the impact of rurality on oesophagogastric cancer survival in the North-East of Scotland- a prospective population cohort study. Surgeon 2022; 21:e97-e103. [PMID: 35606259 DOI: 10.1016/j.surge.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Despite advances in oncology therapies and surgical techniques, survival from oesophagogastric cancer remains low. Poorer cancer outcomes and survival for rural dwellers is documented worldwide and has been an area of focus in Scotland since 2007 when changes to suspected cancer national referral guidelines and governmental mandates on delivering remote and rural healthcare occurred. Whether these changes in clinical practice has impacted upon upper gastrointestinal cancer remains unclear. METHODS A prospective, single-centre observation study was performed. Data from the regional oesophagogastric cancer MDT between 2013 and 2019 were included. The Scottish Index of Multiple Deprivation 2020 tool provided a rurality code (1 or 2) based on patient postcode at time of referral. Survival outcomes for urban and rural patients were compared across demographic factors, disease factors and stage at presentation. RESULTS A total of 1038 patients were included in this study. There was no significant difference between rural and urban groups in terms of sex of patient, age at diagnosis, cancer location, or tumour stage. Furthermore, no difference was identified between those commenced on a radical therapy with other treatment plans. Despite this, rurality predicted for an improved outcome on survival analysis (p = 0.012) and this was independent of other factors on multivariable analysis (HR = 0.78, 95%CI 0.66-0.98; p = 0.032). DISCUSSION The difference in survival demonstrated here between urban and rural groups is not easily explained but may represent improvements to rural access to healthcare delivered as a result of Scottish Government reports.
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17
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Souza JADM, Rocha HAD, Santos MADC, Cherchiglia ML. Factors associated with time to initiate lung cancer treatment in Minas Gerais, Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:1133-1146. [PMID: 35293450 DOI: 10.1590/1413-81232022273.02992021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/18/2021] [Indexed: 12/18/2022] Open
Abstract
The aim was to verify the association of individual factors and healthcare system characteristics with time to initiate treatment of lung cancer by the Brazilian National Health System, in Minas Gerais state. A retrospective cohort study, with patients who initiated treatment for lung cancer by the SUS, from 2008 to 2015. Sociodemographic and clinical characteristics of patients, besides organizational variables of the healthcare system were selected. The logistic regression model evaluated the association of selected explanatory variables with the outcome of initiating treatment within 60 days after diagnosis. Odds ratio (OR) and respective 95% confidence interval were used to measure the power of association. Most treatments for lung cancer in the state of Minas Gerais initiated within 60 days after diagnosis. However, being male and diagnosed as stage IV increased the likelihood of starting treatment within 60 days. On the other hand, the patient's age, radiation therapy as first treatment, and the place of residence decreased such chance. Time to initiate treatment is associated with individual characteristics and provision of services in macroregions, and the observed inequalities possibly raised from the better or worse access of the population to the services provided by SUS.
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Affiliation(s)
- Jakeline Andrea de Melo Souza
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena 190 Santa Efigênia, 30130-100. Belo Horizonte MG Brasil.
| | - Hugo André da Rocha
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena 190 Santa Efigênia, 30130-100. Belo Horizonte MG Brasil.
| | - Marcos Antônio da Cunha Santos
- Departamento de Estatística, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | - Mariangela Leal Cherchiglia
- Programa de Pós-Graduação em Saúde Pública, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
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18
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Schiaffino MK, Murphy JD, Nalawade V, Nguyen P, Shakya H. Association of Physician Referrals with Timely Cancer Care Using Tumor Registry and Claims Data. Health Equity 2022; 6:106-115. [PMID: 35261937 PMCID: PMC8896170 DOI: 10.1089/heq.2021.0089] [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] [Accepted: 10/04/2021] [Indexed: 12/02/2022] Open
Abstract
More Americans are being screened for and more are surviving colorectal cancer due to advanced treatments and better quality of care; however, these benefits are not equitably distributed among diverse or older populations. Differential care delivery outcomes are driven by multiple factors, including access to timely treatment that comes from high-quality care coordination. Providers help ensure such coordinated care, which includes timely referrals to specialists. Variation in referrals between providers can also result in differences in treatment plans and outcomes. Patients who are more often referred between the same diagnosing and treating providers may benefit from more timely care compared to those who are not. Our objective is to examine patterns of referral, or patient-sharing networks (PSNs), and our outcome, treatment delay of 30-days (yes/no). We hypothesize that if a patient is in a PSN they will have lower odds of a 30-day treatment initiation delay. Our observational population-based analysis using the National Cancer Institute (NCI)-linked tumor registry and Medicare claims database includes records for 27,689 patients diagnosed with colorectal cancer from 2001 to 2013, and treated with either chemotherapy, radiotherapy, or surgery. We modeled the adjusted odds of a delay and found 17.04% of patients experienced a 30-day delay in initial treatment. Factors that increased odds of a delay were lack of membership in a PSN (adjusted odds ratio [AOR]: 2.20; 95% confidence interval [CI]: 1.71-2.84), racial/ethnic minority status, and having multiple comorbidities. Provider characteristics significantly associated with greater odds of a delay were if dyads were not in the same facility (AOR: 1.95; 95% CI: 1.81-2.10), if providers were different genders, most notably male (diagnosing) and female (treating) [AOR: 1.23; 95% CI: 1.08-1.40, p = 0.0015]. PSNs appear to be associated with reduced of a care delay. The associations observed in our study address the demand for developing multilevel interventions to improve the delivery and coordination of high-quality of care for older cancer patients.
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Affiliation(s)
- Melody K. Schiaffino
- Division of Health Management and Policy, School of Public Health, San Diego State University, San Diego, California, USA
- Center for Health Equity, Education, and Research (CHEER), University of California San Diego, La Jolla, California, USA
| | - James D. Murphy
- Center for Health Equity, Education, and Research (CHEER), University of California San Diego, La Jolla, California, USA
- Department of Radiation Medicine and Applied Sciences, and University of California San Diego, La Jolla, California, USA
| | - Vinit Nalawade
- Center for Health Equity, Education, and Research (CHEER), University of California San Diego, La Jolla, California, USA
- Department of Radiation Medicine and Applied Sciences, and University of California San Diego, La Jolla, California, USA
| | - Phuong Nguyen
- Division of Health Management and Policy, School of Public Health, San Diego State University, San Diego, California, USA
| | - Holly Shakya
- Division of Global Health, University of California San Diego, La Jolla, California, USA
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Moreira DP, Santos MADC, Pilecco FB, Dumont-Pena É, Reis IA, Cherchiglia ML. Tratamento ambulatorial do câncer do colo do útero em tempo oportuno: a influência da região de residência de mulheres no Estado de Minas Gerais, Brasil. CAD SAUDE PUBLICA 2022; 38:e00277521. [DOI: 10.1590/0102-311xpt277521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/25/2022] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo é investigar se há associação entre as Regiões Ampliadas de Saúde (RAS) de residência de Minas Gerais, Brasil, e o intervalo entre diagnóstico e início de tratamento de mulheres que realizaram tratamento ambulatorial (quimioterapia ou radioterapia) para câncer do colo do útero pelo Sistema Único de Saúde (SUS), entre 2001 e 2015. Trata-se de um estudo transversal, recorte de uma coorte, com 8.857 mulheres. Para avaliar a associação da RAS de residência e o intervalo entre diagnóstico e início de tratamento (em dias), foram utilizados modelos de regressão binomial negativa, considerando nível de significância de 5%. Os modelos foram construídos usando blocos de covariáveis sociodemográficas, clínicas e relacionadas ao tratamento. Foi determinado que a RAS de residência das mulheres está associada ao intervalo entre o diagnóstico e o início de tratamento. A RAS Norte foi a região do estado onde a média de tempo para iniciar o tratamento foi menor, e não residir nessa RAS aumenta a média de tempo para iniciar o tratamento entre 24% e 93% em comparação com outras RAS do estado. Fica evidente a disparidade no intervalo entre diagnóstico e início de tratamento entre as regiões do Estado de Minas Gerais. A disponibilidade de serviços habilitados para o tratamento do câncer nas RAS não reflete necessariamente em maior agilidade para início de tratamento. Compreender os fluxos das Redes de Atenção Oncológica e suas diferenças regionais é fundamental para aprimorar políticas públicas que garantam o cumprimento de leis vigentes, como a Lei nº 12.732/2012, que preconiza o início do tratamento de pacientes com câncer em até 60 dias após o diagnóstico.
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20
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Taiwo OJ, Orunmuyi AT. Maximal covering location problem for nuclear medicine clinics allocation in Nigeria. SPATIAL INFORMATION RESEARCH 2021. [PMCID: PMC8088759 DOI: 10.1007/s41324-021-00405-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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21
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Mendieta CV, Gómez-Neva ME, Rivera-Amézquita LV, de Vries E, Arévalo-Reyez ML, Rodriguez-Ariza S, Castro E CJ, Faithfull S. Cancer as a Chronic Illness in Colombia: A Normative Consensus Approach to Improving Healthcare Services for those Living with and beyond Cancer and Its Treatment. Healthcare (Basel) 2021; 9:1655. [PMID: 34946381 PMCID: PMC8701263 DOI: 10.3390/healthcare9121655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/11/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Cancer survivorship care in Colombia is of increasing importance. International survivorship initiatives and studies show that continuing symptoms, psychological distress, and late effects impact the quality of life for survivors. Priorities for quality survivorship according to Colombian patients and clinicians are unknown. We undertook a nominal consensus approach with 24 participants using virtual meeting technology to identify the priorities for cancer survivorship. We applied an iterative approach conducted over eight weeks with five workshops and one patient focus group followed by a priority setting survey. The consensus group established six main themes, which were subsequently evaluated by experts: (i) symptoms and secondary effects of cancer; (ii) care coordination to increase patient access and integration of cancer care; (iii) psychosocial support after cancer treatment; (iv) mapping information resources and available support services for long-term cancer care; (v) identifying socioeconomic and regional inequalities in cancer survival to improve care and outcomes; and (vi) health promotion and encouraging lifestyle change. The order of priorities differed between clinicians and patients: patients mentioned psychosocial support as the number one priority, and clinicians prioritized symptoms and surveillance for cancer recurrence. Developing survivorship care needs consideration of both views, including barriers such as access to services and socioeconomic disparities.
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Affiliation(s)
- Cindy V. Mendieta
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
| | - Maria Elizabeth Gómez-Neva
- Clinical Nursing Department, Faculty of Nursing, Pontificia Universidad Javeriana, Bogotá 110221, Colombia;
| | - Laura Victoria Rivera-Amézquita
- Grupo de Investigación en Ciencias de la Rehabilitación, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá 111711, Colombia;
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
| | | | - Santiago Rodriguez-Ariza
- Grupo de Bioquímica Experimental y Computacional, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá 110221, Colombia;
| | - Carlos J. Castro E
- Scientific Director of Liga Colombiana Contra el Cáncer, Bogotá 110231, Colombia;
| | - Sara Faithfull
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
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22
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Murchie P, Falborg AZ, Turner M, Vedsted P, Virgilsen LF. Geographic variation in diagnostic and treatment interval, cancer stage and mortality among colorectal patients - An international comparison between Denmark and Scotland using data-linked cohorts. Cancer Epidemiol 2021; 74:102004. [PMID: 34419802 DOI: 10.1016/j.canep.2021.102004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/03/2021] [Accepted: 08/08/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rurald wellers with colorectal cancer have poorer outcomes than their urban counterparts. The reasons why are not known but are likely to be complex and be determined by an interplay between geography and health service organization. By comparing the associations related to travel-time to primary and secondary healthcare facilities in two neighbouring countries, Denmark and Scotland, we aimed to shed light on potential mechanisms. METHODS Analysis was based on two comprehensive cohorts of patients diagnosed with colorectal cancer in Denmark (2010-16) and Scotland (2007-14). Associations between travel-time and cancer pathway intervals, tumour stage at diagnosis and one-year mortality were analysed using generalised linear models. Travel-time was modelled using restricted cubic splines for each country and combined. Adjustments were made for key confounders. RESULTS Travel-time to key healthcare facilities influenced the diagnostic experience and outcomes of CRC patients from Scotland and Denmark to some extent differently. The longest travel-times to a specialised hospital appeared to afford the most rapid secondary care interval, whereas moderate travel-times to hospital (about 20-60 min) appeared to impact on later stage and greater one-year mortality in Scotland, but not in Denmark. A U-shaped association was seen between travel-time to the GP and one year-mortality. CONCLUSIONS This is the first international data-linkage study to explore how different national geographies and health service structures may determine cancer outcomes. Future research should compare more countries and more cancer sites and evaluate the impact and implications of differences in national health service organisation.
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Affiliation(s)
- Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom.
| | - Alina Zalounina Falborg
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Bartholin's Allé 2, 8000, Aarhus C, Denmark
| | - Melanie Turner
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Bartholin's Allé 2, 8000, Aarhus C, Denmark
| | - Line F Virgilsen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Bartholin's Allé 2, 8000, Aarhus C, Denmark
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23
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Walji LT, Murchie P, Lip G, Speirs V, Iversen L. Exploring the influence of rural residence on uptake of organized cancer screening - A systematic review of international literature. Cancer Epidemiol 2021; 74:101995. [PMID: 34416545 DOI: 10.1016/j.canep.2021.101995] [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: 02/25/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022]
Abstract
Lower screening uptake could impact cancer survival in rural areas. This systematic review sought studies comparing rural/urban uptake of colorectal, cervical and breast cancer screening in high income countries. Relevant studies (n = 50) were identified systematically by searching Medline, EMBASE and CINAHL. Narrative synthesis found that screening uptake for all three cancers was generally lower in rural areas. In meta-analysis, colorectal cancer screening uptake (OR 0.66, 95 % CI = 0.50-0.87, I2 = 85 %) was significantly lower for rural dwellers than their urban counterparts. The meta-analysis found no relationship between uptake of breast cancer screening and rural versus urban residency (OR 0.93, 95 % CI = 0.80-1.09, I2 = 86 %). However, it is important to note the limitation of the significant statistical heterogeneity found which demonstrates the lack of consistency between the few studies eligible for inclusion in the meta-analyses. Cancer screening uptake is apparently lower for rural dwellers which may contribute to poorer survival. National screening programmes should consider geography in planning.
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Affiliation(s)
- Lauren T Walji
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Peter Murchie
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Gerald Lip
- North East Scotland Breast Screening Programme, NHS Grampian, Aberdeen, UK
| | - Valerie Speirs
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Lisa Iversen
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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24
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Gurney J, Stanley J, McLeod M, Koea J, Jackson C, Sarfati D. Disparities in Cancer-Specific Survival Between Māori and Non-Māori New Zealanders, 2007-2016. JCO Glob Oncol 2021; 6:766-774. [PMID: 32511067 PMCID: PMC7328125 DOI: 10.1200/go.20.00028] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE While cancer survival is improving across most developed nations, those improvements are not shared equally within their population. Using high-quality national data, we have reviewed the extent to which cancer survival inequities are persisting for indigenous Māori compared with non-Māori New Zealanders and the extent to which these disparities are driven by deprivation, comorbidity, and stage of disease. METHODS Incident cases of cancer (2007-2016) were extracted from the New Zealand Cancer Registry and linked to mortality and hospitalization data. Descriptive, Kaplan-Meier, and Cox regression methods were used to compare survival outcomes between Māori and non-Māori. RESULTS Māori continue to have poorer survival than non-Māori for 23 of the 24 most common causes of Māori cancer death, with the extent of this disparity ranging from 12% to 156%. The magnitude of these disparities varies according to deprivation, comorbidity, and stage. Of note, there was a tendency for survival disparities to be largest among those with no comorbidity. CONCLUSION Māori continue to experience substantial cancer survival inequities. These observations are in keeping with reports from previous decades, which suggest that these disparities persist despite heightened attention. Reduction of the cancer burden on Māori and achievement of equitable survival outcomes require us to prevent cancer for Māori where we can, diagnose Māori patients early when we cannot, and once diagnosed, deliver equitable care to Māori patients at each step along the treatment path.
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Affiliation(s)
- Jason Gurney
- Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Melissa McLeod
- Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- Waitemata District Health Board, Auckland, New Zealand
| | - Chris Jackson
- Southern District Health Board, Dunedin, New Zealand.,Cancer Society of New Zealand, Wellington, New Zealand
| | - Diana Sarfati
- Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
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25
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Yee EK, Coburn NG, Zuk V, Davis LE, Mahar AL, Liu Y, Gupta V, Darling G, Hallet J. Geographic impact on access to care and survival for non-curative esophagogastric cancer: a population-based study. Gastric Cancer 2021; 24:790-799. [PMID: 33550518 DOI: 10.1007/s10120-021-01157-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Among patients not undergoing curative-intent therapy for esophagogastric cancer, access to care may vary. We examined the geographic distribution of care delivery and survival and their relationship with distance to cancer centres for non-curative esophagogastric cancer, hypothesising that patients living further from cancer centres have worse outcomes. METHODS We conducted a population-based analysis of adults with non-curative esophagogastric cancer from 2005 to 2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival. Using geographic information system analysis, we mapped locations of cancer centres and outcomes across census divisions. Bivariate choropleth maps identified regional outcome discordances. Multivariable regression models assessed the relationship between distance from patient residence to the nearest cancer centre and outcomes, adjusting for demographic, clinical, and socioeconomic factors. RESULTS Of 10,228 patients surviving a median 5.1 months (IQR: 2.0-12.0), 68.5% had medical oncology consultation and 32.2% received chemotherapy. Certain distances (reference ≤ 10 km) were associated with lower consultation [relative risk 0.79 (95% CI 0.63-0.97) for ≥ 101 km], chemotherapy receipt [relative risk 0.67 (95% CI 0.53-0.85) for ≥ 101 km], and overall survival [hazard ratio 1.07 (95% CI 1.02-1.13) for 11-50 km, hazard ratio 1.13 (95% CI 1.04-1.23) for 51-100 km]. CONCLUSION A third of patients did not see medical oncology and most did not receive chemotherapy. Outcomes exhibited high geographic variability. Location of residence influenced outcomes, with inferior outcomes at certain distances > 10 km from cancer centres. These findings are important for designing interventions to reduce access disparities for non-curative esophagogastric cancer care.
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Affiliation(s)
- Elliott K Yee
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Natalie G Coburn
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Victoria Zuk
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Laura E Davis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ying Liu
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Vaibhav Gupta
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Gail Darling
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Toronto General Hospital Research Institute, Toronto General Hospital, Toronto, ON, Canada
| | - Julie Hallet
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Department of Surgery, University of Toronto, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada.
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26
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Kemp E, Knott V, Ward P, Freegard S, Olver I, Fallon-Ferguson J, Emery J, Christensen C, Bareham M, Koczwara B. Barriers to employment of Australian cancer survivors living with geographic or socio-economic disadvantage: A qualitative study. Health Expect 2021; 24:951-966. [PMID: 33826222 PMCID: PMC8235884 DOI: 10.1111/hex.13238] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/18/2021] [Accepted: 02/27/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Opportunities for cancer survivors' employment can both reflect and perpetuate health inequities, as employment is an important social determinant of health. Socio-economic and geographic disadvantage is associated with greater difficulty finding work, but little is known about work needs of Australian cancer survivors living with disadvantage. OBJECTIVE This study examined survivor and health-care professional (HCP) perspectives on barriers experienced by Australian cancer survivors experiencing disadvantage when attempting to remain at or return to work. METHOD Focus groups and individual interviews were held with cancer survivors (N = 15) and oncology and primary HCPs (N = 41), focusing on communities at risk of disadvantage. Participants were asked about employment barriers and facilitators in general and in the context of disadvantage. Themes were identified using framework analysis. RESULTS Geographic and socio-economic disadvantage resulted in specific individual- and system-level barriers. These related to distance from treatment and support services and limited availability and suitability of work for survivors living with geographic disadvantage, and limited availability, security, and flexibility of work and previous unemployment for survivors living with socio-economic disadvantage. Identified needs included system-level changes such as public and workplace-level education, legislative and policy changes, and better access to resources. CONCLUSIONS Cancer survivors living with disadvantage experience limited access to flexible employment opportunities and resources, further perpetuating their disadvantage. Promotion of health equity for cancer survivors living with disadvantage requires systemic changes to support attempts to remain at/return to work. PATIENT OR PUBLIC CONTRIBUTION This study included cancer survivors and HCPs as investigators, authors and participants.
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Affiliation(s)
- Emma Kemp
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Flinders Centre for Innovation in Cancer, Bedford Park, Australia
| | - Vikki Knott
- Australian College of Applied Psychology, Brisbane, Australia.,Menzies School of Health Research, Brisbane, Australia
| | - Paul Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Suzana Freegard
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Flinders Centre for Innovation in Cancer, Bedford Park, Australia.,School of Health Sciences, University of South Australia, South Australia, Australia
| | - Ian Olver
- University of Adelaide, Adelaide, Australia
| | - Julia Fallon-Ferguson
- School of Primary, Aboriginal, and Rural Health Care, University of Western Australia, Perth, Australia.,NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, Australia
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | | | | | - Bogda Koczwara
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Flinders Centre for Innovation in Cancer, Bedford Park, Australia
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27
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Murchie P, Fielding S, Turner M, Iversen L, Dibben C. Is place or person more important in determining higher rural cancer mortality? A data-linkage study to compare individual versus area-based measures of deprivation. Int J Popul Data Sci 2021; 6:1403. [PMID: 34007900 PMCID: PMC8103996 DOI: 10.23889/ijpds.v6i1.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Data from Northeast Scotland for 11,803 cancer patients (diagnosed 2007-13) were linked to UK Censuses to explore relationships between hospital travel-time, timely-treatment and one-year-mortality, adjusting for both area and individual-level socioeconomic status (SES). Adjusting for area-based SES, those living >60 minutes from hospital received timely-treatment more often than those living <15 minutes. Substituting individual-level SES changed little. Adjusting for area-based SES those living >60 minutes from hospital died within one year more often than those living <15 minutes. Again, substituting individual-level SES changed little. In Northeast Scotland distance to services, rather than individual SES, likely explains poorer rural cancer survival. BACKGROUND AND OBJECTIVE The Northeast and Aberdeen Scottish Cancer and Residence (NASCAR) study found rural-dwellers are treated quicker but more likely to die within a year of a cancer diagnosis. A potential confounder of the relationship between geography and cancer mortality is socioeconomic status (SES). We linked the original NASCAR cohort to the UK Censuses of 2001 and 2011, at an individual level, to explore the relationship between travel time to key healthcare facilities, timely cancer treatment and one-year mortality adjusting for both area and individual-level markers of socioeconomic status. METHODS A data linkage study of 11803 patients examined the association between travel times, timely treatment and one-year mortality with adjustment for area, and for individual-level, markers of socioeconomic status. RESULTS Following adjustment for area-based SES measures those living more than 60 minutes from the cancer treatment centre were significantly more likely to be treated within 62 days of GP referral than those living within 15 minutes (Odds Ratio [OR]) 1.41; 95% (Confidence Interval [CI]) 1.23, 1.60]. Replacing area-based with individual-level SES measures from UK Censuses made little impact on the results [OR 1.39; 95% CI 1.22, 1.57].Following adjustment for area-based SES measures of socioeconomic status those living more than 60 minutes from the cancer treatment centre were significantly more likely to die within one year than those living closer by [OR 1.22; 95% CI 1.08, 1.38]. Again, replacing area-based with individual-level SES measures from UK Censuses made little impact on the result [OR 1.20; CI 1.06, 1.35]. CONCLUSIONS Distribution of individual measures of socioeconomic status did not differ significantly between rural and urban cancer patients. The relationship between distance to service, timely treatment and one-year survival were the same adjusting for both area-based and individual SES. Overall, it seems that distance to services, rather than personal characteristics, influences poorer rural cancer survival.
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Affiliation(s)
- Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Shona Fielding
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Melanie Turner
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Lisa Iversen
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Chris Dibben
- School of Geosciences, Drummond Street, University of Edinburgh EH8 9XP
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Brice SN, Harper P, Crosby T, Gartner D, Arruda E, England T, Aspland E, Foley K. Factors influencing the delivery of cancer pathways: a summary of the literature. J Health Organ Manag 2021; 35:121-139. [PMID: 33818048 PMCID: PMC9136872 DOI: 10.1108/jhom-05-2020-0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/16/2020] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The study aims to summarise the literature on cancer care pathways at the diagnostic and treatment phases. The objectives are to find factors influencing the delivery of cancer care pathways; to highlight any interrelating factors; to find gaps in the literature concerning areas of research; to summarise the strategies and recommendations implemented in the studies. DESIGN/METHODOLOGY/APPROACH The study used a qualitative approach and developed a causal loop diagram to summarise the current literature on cancer care pathways, from screening and diagnosis to treatment. A total of 46 papers was finally included in the analysis, which highlights the recurring themes in the literature. FINDINGS The study highlights the myriad areas of research applied to cancer care pathways. Factors influencing the delivery of cancer care pathways were classified into different albeit interrelated themes. These include access barriers to care, hospital emergency admissions, fast track diagnostics, delay in diagnosis, waiting time to treatment and strategies to increase system efficiency. ORIGINALITY/VALUE As far as the authors know, this is the first study to present a visual representation of the complex relationship between factors influencing the delivery of cancer care pathways.
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Affiliation(s)
| | - Paul Harper
- School of Mathematics
,
Cardiff University
, Cardiff,
UK
| | | | - Daniel Gartner
- School of Mathematics
,
Cardiff University
, Cardiff,
UK
| | - Edilson Arruda
- Department of Decision Analytics and Risk,
Southampton Business School
,
University of Southampton
, Southampton,
UK
- Alberto Luiz Coimbra Institute-Graduate School and Research in Engineering
,
Federal University of Rio de Janeiro
, Rio de Janeiro,
Brazil
| | - Tracey England
- Department of Decision Analytics and Risk,
Southampton Business School
,
University of Southampton
, Southampton,
UK
| | - Emma Aspland
- School of Mathematics
,
Cardiff University
, Cardiff,
UK
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29
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Yee EK, Coburn NG, Davis LE, Mahar AL, Zuk V, Gupta V, Liu Y, Earle CC, Hallet J. Impact of Geography on Care Delivery and Survival for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis. J Natl Compr Canc Netw 2020; 18:1642-1650. [PMID: 33285520 DOI: 10.6004/jnccn.2020.7605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about how the geographic distribution of cancer services may influence disparities in outcomes for noncurable pancreatic adenocarcinoma. We therefore examined the geographic distribution of outcomes for this disease in relation to distance to cancer centers. METHODS We conducted a retrospective population-based analysis of adults in Ontario, Canada, diagnosed with noncurable pancreatic adenocarcinoma from 2004 through 2017 using linked administrative healthcare datasets. The exposure was distance from place of residence to the nearest cancer center providing medical oncology assessment and systemic therapy. Outcomes were medical oncology consultation, receipt of cancer-directed therapy, and overall survival. We examined the relationship between distance and outcomes using adjusted multivariable regression models. RESULTS Of 15,970 patients surviving a median of 3.3 months, 65.6% consulted medical oncology and 38.5% received systemic therapy. Regions with comparable outcomes were clustered throughout Ontario. Mapping revealed regional discordances between outcomes. Increasing distance (reference, ≤10 km) was independently associated with lower likelihood of medical oncology consultation (relative risks [95% CI] for 11-50, 51-100, and ≥101 km were 0.90 [0.83-0.98], 0.78 [0.62-0.99], and 0.77 [0.55-1.08], respectively) and worse survival (hazard ratios [95% CI] for 11-50, 51-100, and ≥101 km were 1.08 [1.04-1.12], 1.17 [1.10-1.25], and 1.10 [1.02-1.18], respectively), but not with likelihood of receiving therapy. Receipt of therapy seems less sensitive to distance, suggesting that distance limits entry into the cancer care system via oncology consultation. Regional outcome discordances suggest inefficiencies within and protective factors outside of the cancer care system. CONCLUSIONS These findings provide a basis for clinicians to optimize their practices for patients with noncurable pancreatic adenocarcinoma, for future studies investigating geographic barriers to care, and for regional interventions to improve access.
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Affiliation(s)
- Elliott K Yee
- 1Faculty of Medicine, University of Toronto, Toronto, Ontario.,2Cancer Program - Evaluative Clinical Sciences, and
| | - Natalie G Coburn
- 2Cancer Program - Evaluative Clinical Sciences, and.,3Department of Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario.,4Department of Surgery, University of Toronto, Toronto, Ontario.,5ICES, Toronto, Ontario
| | - Laura E Davis
- 6Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec
| | - Alyson L Mahar
- 7Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; and
| | - Victoria Zuk
- 2Cancer Program - Evaluative Clinical Sciences, and
| | - Vaibhav Gupta
- 2Cancer Program - Evaluative Clinical Sciences, and.,4Department of Surgery, University of Toronto, Toronto, Ontario
| | - Ying Liu
- 4Department of Surgery, University of Toronto, Toronto, Ontario
| | - Craig C Earle
- 2Cancer Program - Evaluative Clinical Sciences, and.,5ICES, Toronto, Ontario.,8Division of Medical Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- 2Cancer Program - Evaluative Clinical Sciences, and.,3Department of Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario.,4Department of Surgery, University of Toronto, Toronto, Ontario.,5ICES, Toronto, Ontario
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30
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Harris JA, Hunter WP, Hanna GJ, Treister NS, Menon RS. Rural patients with oral squamous cell carcinoma experience better prognosis and long-term survival. Oral Oncol 2020; 111:105037. [DOI: 10.1016/j.oraloncology.2020.105037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
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31
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Gotfrit J, Thangarasa T, Dudani S, Goodwin R, Tang PA, Monzon J, Dennis K, Cheung WY, Marginean H, Vickers M. The impact of driving time, distance, and socioeconomic factors on outcomes of patients with locally advanced rectal cancer. PUBLIC HEALTH IN PRACTICE 2020; 1:100012. [PMID: 36101686 PMCID: PMC9461354 DOI: 10.1016/j.puhip.2020.100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022] Open
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Harris M, Brekke M, Dinant GJ, Esteva M, Hoffman R, Marzo-Castillejo M, Murchie P, Neves AL, Smyrnakis E, Vedsted P, Aubin-Auger I, Azuri J, Buczkowski K, Buono N, Foreva G, Babić SG, Jacob E, Koskela T, Petek D, Šter MP, Puia A, Sawicka-Powierza J, Streit S, Thulesius H, Weltermann B, Taylor G. Primary care practitioners' diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries. BMJ Open 2020; 10:e035678. [PMID: 33130560 PMCID: PMC7783622 DOI: 10.1136/bmjopen-2019-035678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Cancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners' (PCPs) referral decisions in patients who could have cancer.This study aimed to explore PCPs' diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries. DESIGN A primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated. SETTING Centres in 20 European countries with widely varying cancer survival rates. PARTICIPANTS A total of 2086 PCPs answered the survey question, with a median of 72 PCPs per country. RESULTS PCPs' likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers. CONCLUSION When given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.
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Affiliation(s)
- Michael Harris
- Department for Health, University of Bath, Bath, Somerset, UK
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Mette Brekke
- Department of General Practice and General Practice Research Unit, University of Oslo, Oslo, Norway
| | - Geert-Jan Dinant
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | - Magdalena Esteva
- Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Illes Balears, Spain
| | - Robert Hoffman
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Peter Murchie
- Division of Applied Health Science, University of Aberdeen, Aberdeen, UK
| | - Ana Luísa Neves
- Centre for Health Policy, Imperial College London, London, UK
- Centre for Health Technology and Services Research, Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Peter Vedsted
- Research Unit for General Practice, University of Aarhus, Aarhus, Denmark
| | - Isabelle Aubin-Auger
- Department of General Practice, Université Paris Diderot, Paris, Île-de-France, France
| | - Joseph Azuri
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Krzysztof Buczkowski
- Department of Family Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Nicola Buono
- Department of Family Medicine, National Society of Medical Education in General Practice (SNaMID), Prata Sannita, Italy
| | | | | | - Eva Jacob
- Primary Health Centre, Centro de Saúde Sarria, Sarria, Lugo, Spain
| | - Tuomas Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Davorina Petek
- Department of Family Medicine, Univerza v Ljubljani, Ljubljana, Slovenia
| | - Marija Petek Šter
- Department of Family Medicine, Univerza v Ljubljani, Ljubljana, Slovenia
| | - Aida Puia
- Family Medicine Department, Iuliu Hagieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | | | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Hans Thulesius
- Department of Research and Development, Lund University, Malmö, Sweden
| | - Birgitta Weltermann
- Institut für Hausarztmedizin, University of Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
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Fonkem E, Gatson NTN, Tadipatri R, Cole S, Azadi A, Sanchez M, Stefanowicz E. Telemedicine review in neuro-oncology: comparative experiential analysis for Barrow Neurological Institute and Geisinger Health during the 2020 COVID-19 pandemic. Neurooncol Pract 2020; 8:109-116. [PMID: 33889416 DOI: 10.1093/nop/npaa066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has grossly affected how we deliver health care and how health care institutions derive value from the care provided. Adapting to new technologies and reimbursement patterns were challenges that had to be met by the institutions while patients struggled with decisions to prioritize concerns and to identify new pathways to care. With the implementation of social distancing practices, telemedicine plays an increasing role in patient care delivery, particularly in the field of neurology. This is of particular concern in our cancer patient population given that these patients are often at increased infectious risk on immunosuppressive therapies and often have mobility limitations. We reviewed telemedicine practices in neurology pre- and post-COVID-19 and evaluated the neuro-oncology clinical practice approaches of 2 large care systems, Barrow Neurological Institute and Geisinger Health. Practice metrics were collected for impact on clinic volumes, institutional recovery techniques, and task force development to address COVID-19 specific issues. Neuro-Oncology divisions reached 67% or more of prepandemic capacity (patient visits and slot utilization) within 3 weeks and returned to 90% or greater capacity within 6 weeks of initial closures due to COVID-19. The 2 health systems rapidly and effectively implemented telehealth practices to recover patient volumes. Although telemedicine will not replace the in-person clinical visit, telemedicine will likely continue to be an integral part of neuro-oncologic care. Telemedicine has potential for expanding access in remote areas and provides a convenient alternative to patients with limited mobility, transportation, or other socioeconomic complexities that otherwise challenge patient visit adherence.
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Affiliation(s)
- Ekokobe Fonkem
- Barrow Neurological Institute Neuro-Oncology Department, Phoenix, Arizona
| | - Na Tosha N Gatson
- Geisinger Health, Danville, Pennsylvania.,Cancer Institute, Scranton, Pennsylvania.,Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Ramya Tadipatri
- Barrow Neurological Institute Neuro-Oncology Department, Phoenix, Arizona
| | - Sara Cole
- Geisinger Health, Danville, Pennsylvania
| | - Amir Azadi
- Barrow Neurological Institute Neuro-Oncology Department, Phoenix, Arizona
| | - Marvin Sanchez
- Barrow Neurological Institute Neuro-Oncology Department, Phoenix, Arizona
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Sjöström O, Dahlin AM, Silander G, Syk I, Melin B, Hellquist BN. Travel time to care does not affect survival for patients with colorectal cancer in northern Sweden: A data linkage study from the Risk North database. PLoS One 2020; 15:e0236799. [PMID: 32756574 PMCID: PMC7406033 DOI: 10.1371/journal.pone.0236799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Numerous prior studies, even from countries with free access to care, have associated long travel time to care with poor survival in patients with colorectal cancer. Methods This is a data-linkage study of all 3718 patients with colorectal cancer, diagnosed between 2007 and 2013 in Northern Sweden, one of the most sparsely populated areas in Europe. Travel time to nearest hospital was calculated based on GPS coordinates and multivariable Cox regression was used to analyse possible associations between travel time and cause-specific survival. Results No association between travel time and survival was observed, either in univariable analysis (colon HR 1.00 [95% CI 0.998–1.003]; rectal HR 0.998; [95% CI 0.995–1.002]) or in multivariable Cox regression analysis (colon HR 0.999 [95% CI 0.997–1.002]; rectal HR 0.997 [95% CI 0.992–1.002]). Conclusions In contrast to most other studies, no association between travel time and colorectal cancer survival was found; despite that longer travel time was associated with known risk factors for poorer outcome. In the Swedish health care setting, travel time does not appear to represent a barrier to care or to negatively influence outcomes.
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Affiliation(s)
- Olle Sjöström
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- * E-mail:
| | - Anna M. Dahlin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Gustav Silander
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Ingvar Syk
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
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Murchie P, Adam R, Khor WL, Smith S, McNair E, Swann R, Witt J, Weller D. Impact of geography on Scottish cancer diagnoses in primary care: Results from a national cancer diagnosis audit. Cancer Epidemiol 2020; 66:101720. [PMID: 32361641 DOI: 10.1016/j.canep.2020.101720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND A recent meta-analysis of global research found cancer patients living in rural locations are 5% less likely to survive than their urban counterparts, a survival disadvantage that has never been satisfactorily explained. AIMS [1] To describe and compare primary-care involvement in the diagnosis of cancer between rural and urban patients in Scotland. [2] To compare the length of key diagnostic pathway intervals between rural and urban cancer patients in Scotland. METHODS Participating GPs in the Scottish National Cancer Audit of cancer diagnosis (2017) collected data from primary-care medical records on the diagnostic pathway of patients diagnosed in 2014. Residential postcodes designated the patients as rural or urban dwellers. Key cancer diagnostic pathway intervals (primary, diagnostic, secondary, and treatment) were compared using binary logistic regression. Descriptive analysis included comparison of patient characteristics, and routes to diagnosis. RESULTS 73 Scottish general practices provided data on 1,905 cancer diagnoses. Rural patients did not have higher odds of prolonged diagnostic intervals compared to urban patients but were significantly more likely to have had a cancer alarm feature at presentation and three or more primary-care consultations prior to referral. Rural GPs were significantly more likely to perceive an avoidable delay in their patient's diagnostic pathway. CONCLUSION There was no evidence that rural patients were more likely to be subject to prolonged cancer diagnostic delays than urban patients. Rural patients may experience primary care differently in the lead-up to a cancer diagnosis. The effect on outcome is probably negligible, but further research is required to confirm this.
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Affiliation(s)
- Peter Murchie
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom.
| | - Rosalind Adam
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom
| | - Wei Lynn Khor
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom
| | - Sarah Smith
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom
| | - Emma McNair
- Information Services Division (ISD), NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, United Kingdom
| | - Ruth Swann
- Cancer Research UK, 2 Redman Place, Stratford, London, E20 1JQ, United Kingdom; Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, United Kingdom
| | - Jana Witt
- Cancer Research UK, 2 Redman Place, Stratford, London, E20 1JQ, United Kingdom
| | - David Weller
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom
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Murchie P, Khor WL, Adam R, Esteva M, Smyrnakis E, Petek D, Thulesius H, Vedsted P, McLernon D, Harris M. Influences of rurality on action to diagnose cancer by primary care practitioners - Results from a Europe-wide survey in 20 countries. Cancer Epidemiol 2020; 65:101698. [PMID: 32151979 DOI: 10.1016/j.canep.2020.101698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rural-dwellers have poorer cancer outcomes than urban counterparts, for reasons which are unclear. At healthcare institution level, poorer access to investigations and different clinical decision-making by rural primary healthcare practitioners (PCPs) could be important. AIM To compare access to investigations, attitudes to cancer diagnosis and clinical decision-making between rural and urban PCPs. SETTING A vignette-based cross-sectional survey of rural and urban PCPs in 20 European countries. METHODS Data on PCPs' decision-making and attitudes to cancer diagnosis were based on clinical scenarios. Comparisons were made using tests of proportion, univariable and multivariable binary logistic regression. RESULTS Of the 1779 PCPs completing the survey 541 30.4 %) practiced rurally. Rural PCPs had significantly less direct access to all investigative modalities: ultrasound; endoscopy; x-ray and advanced screening (all p < 0.001). Rural PCPs were as likely as urban PCPs to take diagnostic action (investigation and/or referral) at the index consultation in all four clinical vignettes ((OR, 95 % CI) for lung: 0.90, 0.72-1.12; ovarian: 0.95, 0.75-1.19; breast: 0.87, 0.69-1.09; colorectal: 0.98, 0.75-1.30). Rural PCPs were less likely to refer to a specialist at the index consultation for ovarian cancer (OR 0.71 95 % CI 0.51-0.99). Rural PCPs were significantly more likely to report that their patients faced barriers to accessing specialist care, but practitioners did not report greater difficulties making specialist referral than their urban counterparts CONCLUSIONS: European rural PCPs report poorer access to investigations but are at least as likely as urban PCPs to investigate or refer patients that might have cancer at the index consultation.
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Affiliation(s)
- Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| | - Wei Lynn Khor
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Rosalind Adam
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Magdalena Esteva
- Cap Formació Continuada, Majorca Primary Care Department, Unit of Research, Balearic Islands Health Research Institute (IdISBa), Preventive Activities and Health Promotion Network (redIAPP), Escola Graduada 3, 07002 Palma Mallorca, Spain
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research - Medical School, Aristotle University of Thessaloniki, Greece
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski Nasip 58, 1000 Ljubljana, Slovenia
| | | | - Peter Vedsted
- Research Unit for General Practice in Aarhus, Bartholins Allé 2, Aarhus University, 8000 Aarhus C, Denmark
| | - David McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Michael Harris
- Department for Health, University of Bath, England, BA2 7AY, UK; Berner Institut für Hausarztmedizin (BIHAM), University of Bern, Bern, Switzerland
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Association of Rurality With Survival and Guidelines-Concordant Management in Early-stage Non-Small Cell Lung Cancer. Am J Clin Oncol 2020; 42:607-614. [PMID: 31232724 DOI: 10.1097/coc.0000000000000549] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rural populations of the United States have not experienced a similar degree of decline in lung cancer mortality recently seen nationwide. Several investigations examining survival differences in rural lung cancer patients have been incongruent. We investigated the association of rural residence with survival outcomes and receipt of guidelines-concordant treatment in early-stage non-small cell lung cancer (NSCLC). METHODS Retrospective study of National Cancer Data Base patients with NSCLC diagnosed from 2004 to 2015. Comparisons of survival outcomes and guidelines-concordant management with lobectomy or stereotactic body radiation therapy among rural and nonrural patients, classified according to the US Department of Agriculture's Rural-Urban Continuum Codes. RESULTS We identified 840,566 patients; 18.7% resided in rural areas. Rurality was associated with greater proportions of males, white patients, and higher comorbidities. Larger proportions of rural stage I patients (53.4%) did not undergo guidelines-concordant management with lobectomy or stereotactic body radiation therapy relative to nonrural patients (50.1%, P<0.001). Although rural patients within each stage at diagnosis have a significant disparity in overall survival (OS), stage I NSCLC had the largest absolute difference (nonrural=61.4 mo, rural=50.3 mo, difference of 11.1 mo, P<0.0001). In multivariable Cox regression, rurality was independently associated with impaired survival in both all-stages (hazard ratio=1.08, P<0.001) and stage I NSCLC (hazard ratio=1.09, P<0.001). CONCLUSIONS Small differences exist in OS among all rural NSCLC patients, but rural patients with stage I NSCLC have a marked disadvantage in OS. Rurality is an independent risk factor for decreased survival in all-stages and stage I NSCLC.
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Reconceptualising Rural Cancer Inequalities: Time for a New Research Agenda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041455. [PMID: 32102462 PMCID: PMC7068553 DOI: 10.3390/ijerph17041455] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/13/2022]
Abstract
Evidence has shown for over 20 years that patients residing in rural areas face poorer outcomes for cancer. The inequalities in survival that rural cancer patients face are observed throughout the developed world, yet this issue remains under-examined and unexplained. There is evidence to suggest that rural patients are more likely to be diagnosed as a result of an emergency presentation and that rural patients may take longer to seek help for symptoms. However, research to date has been predominantly epidemiological, providing us with an understanding of what is occurring in these populations, yet failing to explain why. In this paper we outline the problems inherent in current research approaches to rural cancer inequalities, namely how ‘cancer symptoms’ are conceived of and examined, and the propensity towards a reductionist approach to rural environments and populations, which fails to account for their heterogeneity. We advocate for a revised rural cancer inequalities research agenda, built upon in-depth, community-based examinations of rural patients’ experiences across the cancer pathway, which takes into account both the micro and macro factors which exert influence on these experiences, in order to develop meaningful interventions to improve cancer outcomes for rural populations.
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Virgilsen LF, Møller H, Vedsted P. Travel distance to cancer-diagnostic facilities and tumour stage. Health Place 2019; 60:102208. [DOI: 10.1016/j.healthplace.2019.102208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 01/01/2023]
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Murchie P, Turner M, Adam R, Carierre R, Wood R, Fielding S. The future of primary care rural cancer research: a commentary on Murage et al. Fam Pract 2019; 36:526-527. [PMID: 30649265 DOI: 10.1093/fampra/cmy132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Melanie Turner
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Rosalind Adam
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Romi Carierre
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Rose Wood
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Shona Fielding
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
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Murchie P, Adam R, Wood R, Fielding S. Can we understand and improve poorer cancer survival in rural-dwellers? BJGP Open 2019; 3:bjgpopen19X101646. [PMID: 31366677 PMCID: PMC6662870 DOI: 10.3399/bjgpopen19x101646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/18/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Peter Murchie
- Professor of Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Rosalind Adam
- Senior Clinical Fellow, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Rose Wood
- Clinical Academic Fellow, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Shona Fielding
- Senior Lecturer in Medical Statistics, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Flytkjær Virgilsen L, Møller H, Vedsted P. Cancer diagnostic delays and travel distance to health services: A nationwide cohort study in Denmark. Cancer Epidemiol 2019; 59:115-122. [PMID: 30738284 DOI: 10.1016/j.canep.2019.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/16/2019] [Accepted: 01/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aims to investigate the association between distance to health services and intervals in the cancer diagnostic pathway, and explore whether the diagnostic difficulty of the cancer influences this association. METHOD A nationwide cohort study was conducted based on data from both questionnaires and registries. Danish cancer patients diagnosed in 2005-2016 and their general practitioner (GP) were included if enrolled in the Danish Cancer in Primary Care (CaP) cohort (n = 37,872). The CaP cohorts provided data on intervals assessed by patients and GPs. The Geographical Information System (GIS) was used to calculate travel distances from the residence of the patient to their GP surgery and to the hospital of diagnosis. RESULTS Longer travel distance to the hospital of diagnosis was associated with longer diagnostic interval. This association was strongest in the period before the implementation of Cancer Patient Pathways (CPP) in 2010. Patients with a cancer categorised as ´hard to diagnose´ contributed mostly to the association. Longer travel distance to the GP was associated with shorter patient interval and primary care interval for patients diagnosed with cancer types ´intermediate to diagnose´. CONCLUSION Travel distance to cancer diagnostic health care services was associated with interval length in the diagnostic pathway. This association was less pronounced in the period after introducing CPPs and also strongly depending of the underlying cancer type and symptomatology.
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Affiliation(s)
- Line Flytkjær Virgilsen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Henrik Møller
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark; The Danish Clinical Registries (RKKP), Olof Palmes Allé 15, 8200, Aarhus N, Denmark; Cancer Epidemiology & Population Health, King's College London, Strand, London, WC2R 2LS, UK
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Xu Y, Steckle S, Lui A, Dixon E, Ball CG, Sutherland FR, Spratlin J, Bathe OF. Effect of proximity to specialty care on outcomes for biliary cancers: a population-based retrospective cohort study. CMAJ Open 2019; 7:E131-E139. [PMID: 30819693 PMCID: PMC6397033 DOI: 10.9778/cmajo.20180082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The management of biliary cancers is complex and requires a multidisciplinary approach. Because it is unknown how access to specialty care affects resource use and survival in patients with biliary cancer, we conducted a population-based study to understand the needs of these patients and the relation of geography to care delivery and clinical outcomes for biliary cancer in Alberta. METHODS All patients with biliary cancer diagnosed in Alberta from Sept. 1, 2001, to Dec. 31, 2015 were included in this population-based retrospective cohort study. Data were extracted from administrative databases and the 2011 Canadian census. Driving time and types of medical services were tracked throughout the patients' clinical course. We categorized proximity to specialty care according to driving time to the nearest specialist. The primary outcome was overall survival. We conducted Cox proportional hazard regression to evaluate the effects of driving time on overall survival and multivariate logistic regression to evaluate the effect of driving time on treatment types and stage at diagnosis. RESULTS We identified 1610 patients with biliary cancer; they accounted for 117 381 medical encounters. Patients living 120 minutes or more from the nearest hepatobiliary surgeon and from the nearest cancer centre had significantly decreased survival (hazard ratio [and 95% confidence interval (CI)] 1.27 [1.17-1.37]) and 1.27 [1.14-1.41], respectively). Location of residence was not associated with advanced stage or probability of undergoing surgery or a biliary drainage procedure. Patients who lived 120 minutes or more from a cancer centre were less likely than those who lived less than 120 minutes away to receive chemotherapy (odds ratio 0.51, 95% CI 0.29-0.88). Subgroup analysis showed that the effect of travel time was especially pronounced among those who received only best supportive care and those who had biliary drains. INTERPRETATION Geography and accessibility to specialty care affected survival in patients with biliary cancer. Further study is required to understand how patients with biliary drains and those receiving best supportive care are affected by proximity to specialty care. This will aid in the identification of strategies to provide improved care for this subgroup who are particularly affected by geography.
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Affiliation(s)
- Yuan Xu
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Sue Steckle
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Arthur Lui
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Elijah Dixon
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Chad G Ball
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Francis R Sutherland
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Jennifer Spratlin
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Oliver F Bathe
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta.
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Carriere R, Adam R, Fielding S, Barlas R, Ong Y, Murchie P. Rural dwellers are less likely to survive cancer - An international review and meta-analysis. Health Place 2018; 53:219-227. [PMID: 30193178 DOI: 10.1016/j.healthplace.2018.08.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/15/2018] [Accepted: 08/22/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Existing research from several countries has suggested that rural-dwellers may have poorer cancer survival than urban-dwellers. However, to date, the global literature has not been systematically reviewed to determine whether a rural cancer survival disadvantage is a global phenomenon. METHODS Medline, CINAHL, and EMBASE were searched for studies comparing rural and urban cancer survival. At least two authors independently screened and selected studies. We included epidemiological studies comparing cancer survival between urban and rural residents (however defined) that also took socioeconomic status into account. A meta-analysis was conducted using 11 studies with binary rural:urban classifications to determine the magnitude and direction of the association between rurality and differences in cancer survival. The mechanisms for urban-rural cancer survival differences reported were narratively synthesised in all 39 studies. FINDINGS 39 studies were included in this review. All were retrospective observational studies conducted in developed countries. Rural-dwellers were significantly more likely to die when they developed cancer compared to urban-dwellers (HR 1.05 (95% CI 1.02 - 1.07). Potential mechanisms were aggregated into an ecological model under the following themes: Patient Level Characteristics; Institutions; Community, Culture and Environment; Policy and Service Organization. INTERPRETATION Rural residents were 5% less likely to survive cancer. This effect was consistently observed across studies conducted in various geographical regions and using multiple definitions of rurality. High quality mixed-methods research is required to comprehensively evaluate the underlying factors. We have proposed an ecological model to provide a coherent framework for future explanatory research. FUNDING None.
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Affiliation(s)
- Romi Carriere
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, AB25 2ZD Aberdeen, Scotland, United Kingdom.
| | - Rosalind Adam
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, AB25 2ZD Aberdeen, Scotland, United Kingdom.
| | - Shona Fielding
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, AB25 2ZD Aberdeen, Scotland, United Kingdom.
| | - Raphae Barlas
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, AB25 2ZD Aberdeen, Scotland, United Kingdom.
| | - Yuhan Ong
- Western General Hospital, EH42XU Edinburgh, Scotland, United Kingdom.
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, AB25 2ZD Aberdeen, Scotland, United Kingdom.
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Bergin RJ, Emery J, Bollard RC, Falborg AZ, Jensen H, Weller D, Menon U, Vedsted P, Thomas RJ, Whitfield K, White V. Rural–Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:1036-1046. [DOI: 10.1158/1055-9965.epi-18-0210] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/10/2018] [Accepted: 06/26/2018] [Indexed: 11/16/2022] Open
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Impact of rurality on processes and outcomes in melanoma care: results from a whole-Scotland melanoma cohort in primary and secondary care. Br J Gen Pract 2018; 68:e566-e575. [PMID: 29914883 DOI: 10.3399/bjgp18x697901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/14/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Those living in rural areas have poorer cancer outcomes, but current evidence on how rurality impacts melanoma care and survival is contradictory. AIM To investigate the impact of rurality on setting of melanoma excision and mortality in a whole-nation cohort. DESIGN AND SETTING Analysis of linked routine healthcare data comprising every individual in Scotland diagnosed with melanoma, January 2005-December 2013, in primary and secondary care. METHOD Multivariate binary logistic regression was used to explore the relationship between rurality and setting of melanoma excision; Cox proportional hazards regression between rurality and mortality was used, with adjustments for key confounders. RESULTS In total 9519 patients were included (54.3% [n = 5167] female, mean age 60.2 years [SD 17.5]). Of melanomas where setting of excision was known, 90.3% (n = 8598) were in secondary care and 8.1% (n = 771) in primary care. Odds of primary care excision increased with increasing rurality/remoteness. Compared with those in urban areas, those in the most remote rural locations had almost twice the odds of melanoma excision in primary care (adjusted odds ratio [aOR] 1.92; 95% confidence interval [CI] = 1.33 to 2.77). No significant association was found between urban or rural residency and all-cause mortality. Melanoma-specific mortality was significantly lower in individuals residing in accessible small towns than in large urban areas (adjusted hazards ratio [HR] 0.53; 95% CI = 0.33 to 0.87) with no trend towards poorer survival with increasing rurality. CONCLUSION Patients in Scottish rural locations were more likely to have a melanoma excised in primary care. However, those in rural areas did not have significantly increased mortality from melanoma. Together these findings suggest that current UK melanoma management guidelines could be revised to be more realistic by recognising the role of primary care in the prompt diagnosis and treatment of those in rural locations.
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Mollica MA, Weaver KE, McNeel TS, Kent EE. Examining urban and rural differences in perceived timeliness of care among cancer patients: A SEER‐CAHPS study. Cancer 2018; 124:3257-3265. [DOI: 10.1002/cncr.31541] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/13/2018] [Accepted: 04/16/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Michelle A. Mollica
- Healthcare Delivery Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteBethesda Maryland
| | - Kathryn E. Weaver
- Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐Salem North Carolina
| | | | - Erin E. Kent
- Healthcare Delivery Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteBethesda Maryland
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Salmasi L, Capobianco E. Predictive Assessment of Cancer Center Catchment Area from Electronic Health Records. Front Public Health 2017; 5:303. [PMID: 29201863 PMCID: PMC5696335 DOI: 10.3389/fpubh.2017.00303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 10/31/2017] [Indexed: 11/17/2022] Open
Abstract
Healthcare facilities (HF) may identify catchment areas (CA) by selecting criteria that depend on various factors. These refer to hospital activities, geographical definition, patient covariates, and more. The analyses that were traditionally pursued have a limiting factor in the consideration of only static conditions. Instead, some of the CA determinants involve influences occurring at both temporal and spatial scales. The study of CA in the cancer context means choosing between HF, usually divided into general hospitals versus oncological centers (OCs). In the CA context, electronic health records (EHRs) promise to be a valuable source of information, one driving the next-generation patient-driven clinical decision support systems. Among the challenges, digital health requires the re-definition of a role of stochastic modeling to deal with emerging complexities from data heterogeneity. To model CA with cancer EHR, we have chosen a computational framework centered on a logistic model, as a reference, and on a multivariate statistical approach. We also provided a battery of tests for CA assessment. Our results indicate that a more refined CA model’s structure yields superior discrimination power between health facilities. The increased significance was also visualized by comparative evaluations with ad hoc geo-localized maps. Notably, a cancer-specific spatial effect can be noticed, especially for breast cancer and through OCs. To mitigate the data distributional influences, bootstrap analysis was performed, and gains in some cancer-specific and spatially concentrated regions were obtained. Finally, when the temporal dynamics are assessed along a 3-year timeframe, negligible differential effects appear between predicted probabilities observed between standard critical values and bootstrapped values. In conclusion, for interpreting CA in terms of both spatial and temporal dynamics, sophisticated models are required. The one here proposed suggests that bootstrap can improve test accuracy. We recommend that evidences from stochastic modeling are merged with visual analytics, as this combination may be exploited by policy-makers in support to quantitative CA assessment.
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Affiliation(s)
- Luca Salmasi
- Department of Political Science, University of Perugia, Perugia, Italy
| | - Enrico Capobianco
- Center for Computational Science, University of Miami, Coral Gables, FL, United States
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