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Davis LE, Strumpf EC, Patel SV, Mahar AL. Income differences in time to colon cancer diagnosis. Cancer Med 2024; 13:e6999. [PMID: 39096087 PMCID: PMC11297540 DOI: 10.1002/cam4.6999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval. METHODS This was a retrospective cohort study of colon cancer patients diagnosed 2007-2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis. RESULTS A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low-income neighborhoods was associated with longer 50th and 90th-percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6-23) longer in patients living in the lowest income neighborhoods compared to the highest. CONCLUSION These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.
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Affiliation(s)
- Laura E. Davis
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
- ICESTorontoCanada
| | - Erin C. Strumpf
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
- Department of EconomicsMcGill UniversityMontrealCanada
| | | | - Alyson L. Mahar
- ICESTorontoCanada
- School of NursingQueen's UniversityKingstonCanada
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Mangan AR, Cotton KM, Gardner JR, Shay A, Farsi S, Ross NB, King D, Sunde J, Vural E, Moreno MA. Functional Status Predicts Delay to Radiation in Free Tissue Transfer for Head and Neck Cancer. Laryngoscope 2024. [PMID: 38973546 DOI: 10.1002/lary.31628] [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: 08/21/2023] [Revised: 05/20/2024] [Accepted: 06/17/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Evaluate the effect of functional status and patient factors on delays in treatment with adjuvant therapy. METHODS Retrospective chart review (2020-2022) was conducted at a single tertiary referral center. Data were collected between January 2020 and October 2022, and 63 patients underwent free flap reconstructive surgery of the head and neck due to the presence of cancer and received adjuvant radiation therapy (RT). The main outcomes measured were Area Deprivation Index (ADI), Beale scores, distance to radiation center, functional status, patient demographics, gender, and length from surgery to initiation of RT. RESULTS Of the 63 patients who were reviewed, the average age was 65.5 years old and 63.8% were male. The average ADI state score was 5.6 and the national percentile of 77.1. The average Beale score was 3.7. The average distance traveled was 101.1 miles. Thirty-five patients were living independently, 16 were living in assisted living or received home care, and 15 were dependent or lived in a nursing home. Mann-Whitney U analysis revealed a significant association of increasing levels of dependence to delays in treatment compared to on-time treatment (p = 0.002). The odds of treatment delay were increased almost 10-fold for every additional increase in dependency level (OR = 9.87, 95% CI = 1.42-68.83). CONCLUSIONS AND RELEVANCE Degree of dependent functional status correlates with delays in postoperative adjuvant RT in patients undergoing free tissue transfer for head and neck cancer. Preoperative risk stratification allows for physicians to address barriers to adjuvant therapy prior to delay. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Andrew R Mangan
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Kenzo M Cotton
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - James Reed Gardner
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Aryan Shay
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Soroush Farsi
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Noah B Ross
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Deanne King
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Jumin Sunde
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Emre Vural
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Mauricio Alejandro Moreno
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
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Zhang FG, Sheni R, Zhang C, Viswanathan S, Fiori K, Mehta V. Association Between Social Determinants of Health and Cancer Treatment Delay in an Urban Population. JCO Oncol Pract 2024:OP2400118. [PMID: 38959443 DOI: 10.1200/op.24.00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/14/2024] [Accepted: 05/21/2024] [Indexed: 07/05/2024] Open
Abstract
PURPOSE Delays in oncologic time to treatment initiation (TTI) independently and adversely affect disease-specific mortality. Social Determinants of Health (SDoH) are increasingly recognized as significant contributors to patients' disease management and health outcomes. Our academic center has validated a 10-item SDoH screener, and we elucidated which specific needs may be predictive of delayed TTI. METHODS This is a retrospective cohort study at an urban academic center of patients with a SDoH screening and diagnosis of breast, colorectal, endocrine/neuroendocrine, GI, genitourinary, gynecologic, head and neck, hematologic, hepatobiliary, lung, or pancreatic cancer from 2018 to 2022. Variables of interest included household income, tumor stage, and emergency department (ED) or inpatient admission 30 days before diagnosis. Factors associated with delayed TTI ≥45 days were assessed using multivariable logistic regression. RESULTS Among 2,328 patients (mean [standard deviation] age, 64.0 (12.8) years; 66.6% female), having >1 unmet social need was associated with delayed TTI (odds ratio [OR], 1.68; 95% CI, 1.54 to 1.82). The disparities most associated with delay were legal help, transportation, housing stability, and needing to provide care for others. Those with ED (OR, 0.49; 95% CI, 0.44 to 0.54) or inpatient (OR, 0.54; 95% CI, 0.50 to 0.58) admission 30 days before diagnosis were less likely to experience delay. CONCLUSION Delays in oncologic TTI ≥45 days are independently associated with unmet social needs. ED or inpatient admissions before diagnosis increase care coordination, leading to improved TTI. Although limitations included the retrospective nature of the study and self-reporting bias, these findings more precisely identify targets for intervention that may more effectively decrease delay. Patients with SDoH barriers are at higher risk of treatment delay and could especially benefit from legal, transportation, caregiver, and housing assistance.
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Affiliation(s)
| | - Risha Sheni
- Albert Einstein College of Medicine, Bronx, NY
| | - Chenxin Zhang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Shankar Viswanathan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Kevin Fiori
- Department of Family and Social Medicine, Department of Pediatrics, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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4
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Nyström K, Olsson L. A systematic review of population-based studies on metachronous metastases of colorectal cancer. World J Surg 2024; 48:1521-1533. [PMID: 38747538 DOI: 10.1002/wjs.12204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/22/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND The occurrence of metachronous metastases (MM) of colorectal (CRC), colon (CC), and rectal (RC) cancer of population-based studies has not been compiled in a systematic review previously. METHODS MEDLINE, Embase, and Cochrane Library were searched for primary studies of any design from inception until January 2021 and updated in August 2023 (CRD42021261648). The PRISMA guidelines were adopted, and the Newcastle-Ottawa Quality Assessment Scale used for risk of bias assessment. Outcomes on overall and organ-specific MM were extracted. A narrative analysis followed. RESULTS Out of 2143 unique hits, 162 publications were read in full-text and 37 population-based cohort studies published in 1981-2022 were included. Ten studies adopted time-dependent analyses; eight were registry-based and seven had a low risk of bias. Three studies reported 5-year recurrence rate of MM overall of stages I-III; for CRC, it was 20.5%, for CC, it was 18% and 25.6%, and for RC, it was 23%. Four studies reported 5-year recurrence rate of organ-specific MM of stages I-III-for CRC, it was 2.2% and 5.5% for peritoneal metastases and 5.8% for lung metastases and for CC 4.5% for peritoneal metastases. Twenty-seven studies reported proportions of patients diagnosed with MM, but data on the length of follow-up was incomplete and varied widely. Proportions of patients with CRC stages I-III that developed MM overall was 14.4%-26.1% in 10 studies. In relation to the enrollment period, a downward trend may be discernible. CONCLUSION Studies adopting a more appropriate analysis were highly heterogeneous, whereas uncertain data of partly inadequate studies may indicate that MM are overall declining.
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Affiliation(s)
- Karin Nyström
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Louise Olsson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Centre for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden
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Osterman E, Syriopoulou E, Martling A, Andersson TML, Nordenvall C. Despite multi-disciplinary team discussions the socioeconomic disparities persist in the oncological treatment of non-metastasized colorectal cancer. Eur J Cancer 2024; 199:113572. [PMID: 38280280 DOI: 10.1016/j.ejca.2024.113572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND The introduction of national guidelines should eliminate previously observed associations between socioeconomic status (SES) and colorectal cancer treatment. The aim of the study was to investigate whether inequalities remain. METHODS CRCBaSe, a register-linkage originating from the Swedish Colorectal Cancer Registry, was used to identify information on patient and tumour characteristics, for 83,460 patients with stage I-III disease diagnosed 2008-2021. SES was measured as disposable income (quartiles) and the highest level of education. Outcomes of interest were emergency surgery, multidisciplinary team (MDT) conference discussion, and oncological treatment. Differences in treatment between SES groups were explored using multivariable logistic regression adjusted for year of diagnosis, age at diagnosis, sex, civil status, comorbidities, tumour location and stage. RESULTS Patients in the highest income quartile had a lower risk of emergency surgery (OR 0.73 95%CI 0.68-0.80), a higher chance of being discussed at the preoperative (OR 1.39 95%CI 1.28-1.51) and postoperative MDT (OR 1.41 95%CI 1.30-1.53), receiving neoadjuvant (OR 1.15 95%CI 1.06-1.25) and adjuvant treatment (OR 2.04 95%CI 1.88-2.20). Higher education level increased the odds of MDT discussion but was not associated with oncological treatment. The proportion of patients discussed at the MDT increased, with almost all patients discussed since 2016. Despite this, treatment differences remained when patients diagnosed since 2016 were analysed separately. CONCLUSION There were significant differences in how patients with different SES were treated for colorectal cancer. Further action is required to investigate the drivers of these differences as well as their impact on mortality and, ultimately, eliminate the inequalities.
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Affiliation(s)
- Erik Osterman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Department of Surgery, Gävle Hospital, Sweden.
| | - Elisavet Syriopoulou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Anna Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Sweden
| | | | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Sweden
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Buchheit JT, Silver CM, Huang R, Hu YY, Bentrem DJ, Odell DD, Merkow RP. Association Between Racial and Socioeconomic Disparities and Hospital Performance in Treatment and Outcomes for Patients with Colon Cancer. Ann Surg Oncol 2024; 31:1075-1086. [PMID: 38062293 DOI: 10.1245/s10434-023-14607-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/31/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Disparities in colon cancer care and outcomes by race/ethnicity, socioeconomic status (SES), and insurance are well recognized; however, the extent to which inequalities are driven by patient factors versus variation in hospital performance remains unclear. We sought to compare disparities in care delivery and outcomes at low- and high-performing hospitals. METHODS We identified patients with stage I-III colon adenocarcinoma from the 2012-2017 National Cancer Database. Adequate lymphadenectomy and timely adjuvant chemotherapy administration defined hospital performance. Multilevel regression models evaluated disparities by race/ethnicity, SES, and insurance at the lowest- and highest-performance quartile hospitals. RESULTS Of 92,573 patients from 704 hospitals, 45,982 (49.7%) were treated at 404 low-performing hospitals and 46,591 (50.3%) were treated at 300 high-performing hospitals. Low-performing hospitals treated more non-Hispanic (NH) Black, Hispanic, low SES, and Medicaid patients (all p < 0.01). Among low-performing hospitals, patients with low versus high SES (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.82-0.92), and Medicare (OR 0.90, 95% CI 0.85-0.96) and Medicaid (OR 0.88, 95% CI 0.80-0.96) versus private insurance, had decreased odds of receiving high-quality care. At high-performing hospitals, NH Black versus NH White patients (OR 0.83, 95% CI 0.72-0.95) had decreased odds of receiving high-quality care. Low SES, Medicare, Medicaid, and uninsured patients had worse overall survival at low- and high-performing hospitals (all p < 0.01). CONCLUSION Disparities in receipt of high-quality colon cancer care occurred by SES and insurance at low-performing hospitals, and by race at high-performing hospitals. However, survival disparities by SES and insurance exist irrespective of hospital performance. Future steps include improving low-performing hospitals and identifying mechanisms affecting survival disparities.
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Affiliation(s)
- Joanna T Buchheit
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Casey M Silver
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Reiping Huang
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- American College of Surgeons, Chicago, IL, USA
| | - Yue-Yung Hu
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - David J Bentrem
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David D Odell
- Department of Surgery, Northwestern Quality Improvement, Research and Education in Surgery Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ryan P Merkow
- American College of Surgeons, Chicago, IL, USA.
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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Rattenborg S, Frøstrup Hansen T, Möller S, Frostberg E, Rahr HB. Non-Curative Treatment Choices in Colorectal Cancer: Predictors and Between-Hospital Variations in Denmark: A Population-Based Register Study. Cancers (Basel) 2024; 16:366. [PMID: 38254854 PMCID: PMC10814909 DOI: 10.3390/cancers16020366] [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: 12/18/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Variations in treatment choices have been reported in colorectal cancer (CRC). In the context of national recommendations, we aimed to elucidate predictors and between-hospital variations in refraining from curatively intended surgery and adjuvant chemotherapy in potentially curable colorectal cancer. METHODS A total of 34,116 patients diagnosed with CRC from 2009 to 2018 were included for analyses on non-curative treatment in this register-based study. Subsequently 8006 patients were included in analyses on adjuvant treatment. Possible predictors included patient-, disease-, socioeconomic- and perioperative-related factors. Logistic regressions were utilized to examine the predictors of a non-curative aim of treatment and no adjuvant chemotherapy. RESULTS The predictors of non-curative treatment were high age, poor performance, distant metastases and being underweight. Predictors for no adjuvant treatment were high age, poor performance, kidney disease, postoperative complications and living alone. For both outcomes we found between-hospital variations to be present. CONCLUSIONS Non-curative overall treatment and refraining from adjuvant chemotherapy were associated with well-known risk factors, but the former was also associated with being underweight and the latter was also associated with living alone. Marked between-hospital variations were found and should be examined further.
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Affiliation(s)
- Søren Rattenborg
- Department of Surgery, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; (E.F.); (H.B.R.)
- Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark;
- Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Torben Frøstrup Hansen
- Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark;
- Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Sören Möller
- Open Patient Data Exploratory Network, Odense University Hospital, J. B. Winsløws Vej 9A, 3. Sal, 5000 Odense C, Denmark;
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Erik Frostberg
- Department of Surgery, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; (E.F.); (H.B.R.)
- Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Hans Bjarke Rahr
- Department of Surgery, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; (E.F.); (H.B.R.)
- Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark;
- Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
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Hassan S, Miles A, Rachet B, Morris M. Variations in the Type of Adjuvant Chemotherapy Among Stage III Colon Cancer Patients in England. J Gastrointest Cancer 2023; 54:1193-1201. [PMID: 36602753 DOI: 10.1007/s12029-022-00899-9] [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] [Accepted: 12/15/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Treatment with any adjuvant chemotherapy for stage III colon cancer has been shown to differ between population groups. Few studies, however, explore variations in the type of adjuvant chemotherapy received, none of which are from the UK. The aim of this study is to explore variation in the type of chemotherapy received by stage III colon cancer patients in England. METHODS Data from the national cancer registry was linked to the Systemic Anti-Cancer Therapy database, which provides detailed information on treatment of malignant diseases from all NHS England chemotherapy providers. Demographic and clinical characteristics were compared between those who received monotherapy (fluoropyrimidine) or combination chemotherapy (fluoropyrimidine and oxaliplatin) among stage III colon cancer patients between 2012 and 2017. RESULTS Of 8750 patients who received adjuvant chemotherapy, 22.3% (n = 2359) received monotherapy and 60.4% (n = 6391) received combination therapy. The odds of receiving combination therapy decreased with age. Those from the most deprived group had half the odds (OR: 0.5, CI: 0.42, 0.59, p < 0.001) of receiving combination therapy compared to the least deprived group. Women were 14% less likely to get combined therapy (OR: 0.86, CI: 0.77, 0.95, p = 0.005). Those with the largest tumour size (T4) and those with more than three lymph nodes involved (N2) had 30% (OR: 1.30; CI: 1.07, 1.59; p = 0.008) and 50% (OR: 1.50; 1.34, 1.69; p < 0.001) higher odds of receiving combination therapy compared to T1 or T2 and N1, respectively. CONCLUSION There is variation in the type of chemotherapy received for stage III colon cancer patients by sociodemographic factors, despite clear clinical guidelines.
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Affiliation(s)
- Syreen Hassan
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
- Department of Psychological Sciences, Birkbeck, University of London, Malet Street, London, WC1E 7HX, United Kingdom.
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, Malet Street, London, WC1E 7HX, United Kingdom
| | - Bernard Rachet
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Melanie Morris
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Yang G, Yu XR, Weisenberger DJ, Lu T, Liang G. A Multi-Omics Overview of Colorectal Cancer to Address Mechanisms of Disease, Metastasis, Patient Disparities and Outcomes. Cancers (Basel) 2023; 15:cancers15112934. [PMID: 37296894 DOI: 10.3390/cancers15112934] [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: 04/09/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Human colorectal cancer (CRC) is one of the most common malignancies in men and women across the globe, albeit CRC incidence and mortality shows a substantial racial and ethnic disparity, with the highest burden in African American patients. Even with effective screening tools such as colonoscopy and diagnostic detection assays, CRC remains a substantial health burden. In addition, primary tumors located in the proximal (right) or distal (left) sides of the colorectum have been shown to be unique tumor types that require unique treatment schema. Distal metastases in the liver and other organ systems are the major causes of mortality in CRC patients. Characterizing genomic, epigenomic, transcriptomic and proteomic (multi-omics) alterations has led to a better understanding of primary tumor biology, resulting in targeted therapeutic advancements. In this regard, molecular-based CRC subgroups have been developed that show correlations with patient outcomes. Molecular characterization of CRC metastases has highlighted similarities and differences between metastases and primary tumors; however, our understanding as to how to improve patient outcomes based on metastasis biology is lagging and remains a major obstacle to improving CRC patient outcomes. In this review, we will summarize the multi-omics features of primary CRC tumors and their metastases across racial and ethnic groups, the differences in proximal and distal tumor biology, molecular-based CRC subgroups, treatment strategies and challenges for improving patient outcomes.
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Affiliation(s)
- Guang Yang
- School of Sciences, China Pharmaceutical University, Nanjing 211121, China
- China Grand Enterprises, Beijing 100101, China
| | - Xi Richard Yu
- China Grand Enterprises, Beijing 100101, China
- Huadong Medicine Co., Ltd., Hangzhou 310011, China
| | - Daniel J Weisenberger
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Tao Lu
- School of Sciences, China Pharmaceutical University, Nanjing 211121, China
- State Key Laboratory of Natural Sciences, China Pharmaceutical University, Nanjing 211121, China
| | - Gangning Liang
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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10
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Mulliri A, Gardy J, Dejardin O, Bouvier V, Pocard M, Alves A. Social inequalities in health: How do they influence the natural history of colorectal cancer? J Visc Surg 2023:S1878-7886(23)00031-0. [PMID: 37062638 DOI: 10.1016/j.jviscsurg.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
As regards colorectal cancer (CRC) in France, social inequalities in health (SIH) exist. Underprivileged patients are characterized by reduced incidence of CRC and, conversely, by excess mortality. The explanatory mechanisms of the SIHs influencing survival are complex, multidimensional and variable according to healthcare system. Among the most deprived compared to the least deprived patients, SIHs are reflected by lower participation in screening campaigns, and CRC diagnosis is more frequently given at a later stage in an emergency context. During treatment, disadvantaged patients are more at risk of having to undergo open surgery and of enduring severe postoperative complications and belated chemotherapy (when recommended). Study of SIHs poses unusual challenges, as it is necessary not only to pinpoint social deprivation, but also to locate the different treatment facilities existing in a given territorial expanse. In the absence of individualized socioeconomic information, research in France on the social determinants of health is based on duly constituted cancer registries, in which an ecological index of social deprivation, the European Deprivation Index (EDI), provides an aggregate measure of the socioeconomic environment of a given individual in a given geographical setting at a given point in time. All in all, studies on SIHs are justified as means of identification and comprehension of the mechanisms underlying social deprivation, the objective being to more precisely orient programs and practices aimed at combating SIH.
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Affiliation(s)
- A Mulliri
- Inserm-UCN, ANTICIPE U1086, 14000 Caen, France; Department of visceral and digestive surgery, Caen University Hospital Center, 14000 Caen, France.
| | - J Gardy
- Inserm-UCN, ANTICIPE U1086, 14000 Caen, France; Registry of Digestive Tumors of Calvados, Caen University Hospital Center Center, 14000 Caen, France; François-Baclesse Cancer Center, 14000 Caen, France
| | - O Dejardin
- Inserm-UCN, ANTICIPE U1086, 14000 Caen, France; Research unit, Caen University Hospital Center, 14000 Caen, France
| | - V Bouvier
- Inserm-UCN, ANTICIPE U1086, 14000 Caen, France; Registry of Digestive Tumors of Calvados, Caen University Hospital Center Center, 14000 Caen, France
| | - M Pocard
- Inserm, U1275 CAP Paris-Tech, Paris Cité University, 75010 Paris, France; Digestive and Hepato-Bilio-Pancreatic Surgery, Liver Transplantation, Pitié Salpêtrière Hospital, AP-HP, 75013 Paris, France
| | - A Alves
- Inserm-UCN, ANTICIPE U1086, 14000 Caen, France; Department of visceral and digestive surgery, Caen University Hospital Center, 14000 Caen, France; Registry of Digestive Tumors of Calvados, Caen University Hospital Center Center, 14000 Caen, France
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11
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Richardson-Parry A, Baas C, Donde S, Ferraiolo B, Karmo M, Maravic Z, Münter L, Ricci-Cabello I, Silva M, Tinianov S, Valderas JM, Woodruff S, van Vugt J. Interventions to reduce cancer screening inequities: the perspective and role of patients, advocacy groups, and empowerment organizations. Int J Equity Health 2023; 22:19. [PMID: 36707816 PMCID: PMC9880917 DOI: 10.1186/s12939-023-01841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Health inequities lead to low rates of cancer screening in certain populations, such as low-income and ethnic minority groups. Different interventions to address this have been developed with mixed results. However, interventions are not always developed in collaboration with the people they target. The aim of our article is to present the viewpoint of patients, survivors, advocates, and lay persons on interventions to increase cancer screening from a health inequity perspective. METHODS We prepared talking points to guide discussions between coauthors, who included representatives from nine patient and survivor advocacy groups, organizations working for citizen/patient empowerment, and health equity experts. Perspectives and opinions were first collected through video conferencing meetings and a first draft of the paper was prepared. All authors, read through, revised, and discussed the contents to reach an agreement on the final perspectives to be presented. RESULTS Several themes were identified: it is important to not view screening as a discrete event; barriers underlying an individual's access and willingness to undergo screening span across a continuum; individually tailored interventions are likely to be more effective than a one-size fits-all approach because they may better accommodate the person's personal beliefs, knowledge, behaviors, and preferences; targeting people who are unknown to medical services and largely unreachable is a major challenge; including professional patient advocacy groups and relevant lay persons in the cocreation of interventions at all stages of design, implementation, and evaluation is essential along with relevant stakeholders (healthcare professionals, researchers, local government and community organizations etc). CONCLUSIONS Interventions to address cancer screening inequity currently do not adequately solve the issue, especially from the viewpoint of patients, survivors, and lay persons. Several core pathways should be focused on when designing and implementing interventions: advancing individually tailored interventions; digital tools and social media; peer-based approaches; empowerment; addressing policy and system barriers; better design of interventions; and collaboration, including the involvement of patients and patient advocacy organizations.
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Affiliation(s)
- Afua Richardson-Parry
- Viatris Global Healthcare UK, Building 4, Trident Place, Mosquito Way, Hatfield, London, AL10 9UL UK
| | - Carole Baas
- Alamo Breast Cancer Foundation, 909 Midland Creek Drive, Southlake, TX 76092 USA
| | - Shaantanu Donde
- Viatris Global Healthcare, Building 4, Trident Place, Mosquito Way, Hatfield, London, AL10 9UL UK
| | - Bianca Ferraiolo
- Cittadinanzattiva - Active Citizenship Network, Rue Philippe Le Bon 46, 1000 Brussels, Belgium
| | - Maimah Karmo
- Tigerlily Foundation, 42020 Village Center Plaza, #120-156, Stone Ridge, 20105 USA
| | - Zorana Maravic
- Digestive Cancers Europe, Rue de la Loi 235/27, 1040 Brussels, Belgium
| | - Lars Münter
- Danish Committee for Health Education, Classensgade 71, 5, 2100 Copenhagen, Denmark
| | - Ignacio Ricci-Cabello
- Balearic Islands Health Research Institute (IdISBa) and CIBER de Epidemiología y Salud Pública (CIBERESP), C/ Escola Graduada 3, 07002 Palma, Balearic Islands Spain
| | - Mitchell Silva
- Esperity, Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium
| | - Stacey Tinianov
- Advocates for Collaborative Education, 824 Windsor Street, Santa Cruz, CA 95062 USA
| | - Jose M. Valderas
- National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228 Singapore
| | | | - Joris van Vugt
- Viatris, Aalsterweg 172, 5644 RH Eindhoven, The Netherlands
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12
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Omland LH, Joensen UN, Toft BG, Lund CM, Lindberg H, Knudsen MB, Tolver A, Suetta C, Pappot H. Reasons for lack of treatment in patients with locally advanced, unresectable or metastatic urothelial carcinoma. Acta Oncol 2022; 61:1036-1042. [PMID: 36017555 DOI: 10.1080/0284186x.2022.2114378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The proportion of patients with locally advanced, unresectable or metastatic urothelial carcinoma that do not receive systemic anticancer treatment and the reasons for lack of treatment are largely unknown. The aim of this study was to investigate the prevalence and overall survival of this patient group and reasons for omission of treatment. MATERIAL AND METHODS This retrospective, single-center cohort study from Rigshospitalet, Denmark included patients diagnosed with locally advanced, unresectable or metastatic urothelial carcinoma during the study period from 1 January 2010 to 31 March 2016 who did not receive systemic anticancer treatment. Patients were identified through the Danish Pathology Register and the electronic medical records. RESULTS 100 patients were included, representing 34% of all patients diagnosed with locally advanced, unresectable or metastatic urothelial carcinoma at Rigshospitalet during the study period. Lack of treatment was most often due to poor physical condition (59%), decreased renal function (15%), or patient preferences (14%). Median overall survival was 1.9 months (95% CI: 1.6-2.8 months). CONCLUSION One in three patients diagnosed with locally advanced, unresectable or metastatic urothelial carcinoma in the pre-immunotherapy era did not receive systemic anticancer treatment. Prompt identification of advanced disease and interventions to optimize these patients for treatment are essential. Our findings underscore the compelling need for novel, better tolerated treatment regimens in this frail patient group.
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Affiliation(s)
- Lise H Omland
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ulla N Joensen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Birgitte G Toft
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Cecilia M Lund
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark.,CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark
| | - Henriette Lindberg
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark
| | - Mark B Knudsen
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Denmark
| | - Anders Tolver
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Denmark
| | - Charlotte Suetta
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Helle Pappot
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
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13
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Johnston FM, Yeo HL, Clark C, Stewart JH. Bias Issues in Colorectal Cancer Management: A Review. Ann Surg Oncol 2021; 29:2166-2173. [PMID: 34142287 DOI: 10.1245/s10434-021-10232-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/02/2021] [Indexed: 12/11/2022]
Abstract
Based on census data, over one-third of the US population identifies as a racial or ethnic minority. This group of racial and ethnic minorities is more likely to develop cancer and die from it when compared with the general population of the USA. These disparities are most pronounced in the African American community. Despite overall CRC rates decreasing nationally and within certain racial and ethnic minorities in the USA, there continue to be disparities in incidence and mortality when compared with non-Hispanic Whites. The disparities in CRC incidence and mortality are related to systematic racism and bias inherent in healthcare systems and society. Disparities in CRC management will continue to exist until specific interventions are implemented in the context of each racial and ethnic group. This review's primary aim is to highlight the disparities in CRC among African Americans in the USA. For surgeons, understanding these disparities is formative to creating change and improving the quality of care, centering equity for all patients.
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Affiliation(s)
- Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
| | - Heather L Yeo
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Callisia Clark
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John H Stewart
- Department of Surgery, The University of Illinois at Chicago, Chicago, IL, USA.,University of Illinois Cancer Center, Chicago, IL, USA
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