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Tao R, Fan L, Song Y, Hu Y, Zhang W, Wang Y, Xu W, Li J. Sintilimab for relapsed/refractory extranodal NK/T cell lymphoma: a multicenter, single-arm, phase 2 trial (ORIENT-4). Signal Transduct Target Ther 2021; 6:365. [PMID: 34702811 PMCID: PMC8548511 DOI: 10.1038/s41392-021-00768-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
This study (ORIENT-4) aimed to assess the efficacy and safety of sintilimab, a humanized anti-PD-1 antibody, in patients with relapsed/refractory extranodal NK/T cell lymphoma (r/r ENKTL). ORIENT-4 is a multicenter, single-arm, phase 2 clinical trial (NCT03228836). Patients with r/r ENKTL who failed to at least one asparaginase-based regimen were enrolled to receive sintilimab 200 mg intravenously every 3 weeks for up to 24 months. The primary endpoint was the objective response rate (ORR) based on Lugano 2014 criteria. Twenty-eight patients with r/r ENKTL were enrolled from August 31, 2017 to February 7, 2018. Twenty-one patients (75.0%, 95% CI: 55.1-89.3%) achieved an objective response. With a median follow-up of 30.4 months, the median overall survival (OS) was not reached. The 24-month OS rate was 78.6% (95% CI, 58.4-89.8%). Most treatment-related adverse events (TRAEs) were grade 1-2 (71.4%), and the most common TRAE was decreased lymphocyte count (42.9%). Serious adverse events (SAEs) occurred in 7 (25.0%) patients, and no patient died of adverse events. Sintilimab is effective and well tolerated in patients with r/r ENKTL and could be a novel therapeutic approach for the control of ENKTL in patients.
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Affiliation(s)
- Rong Tao
- Department of Hematology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Fan
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China.
| | - Yongping Song
- The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Yu Hu
- Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhang
- Peking Union Medical College Hospital, Beijing, China
| | - Yafei Wang
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wei Xu
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Jianyong Li
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China.
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Davis LE, Coburn NG, Hallet J, Earle CC, Liu Y, Myrehaug S, Mahar AL. Material deprivation and access to cancer care in a universal health care system. Cancer 2020; 126:4545-4552. [DOI: 10.1002/cncr.33107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Laura E. Davis
- Department of Epidemiology, Biostatistics, and Occupational Health McGill University Montreal Quebec Canada
| | - Natalie G. Coburn
- Division of Surgical Oncology Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
- ICES Toronto Ontario Canada
| | - Julie Hallet
- Division of Surgical Oncology Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
- ICES Toronto Ontario Canada
| | - Craig C. Earle
- ICES Toronto Ontario Canada
- Division of Medical Oncology Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
| | | | - Sten Myrehaug
- Division of Radiation Oncology Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Alyson L. Mahar
- ICES Toronto Ontario Canada
- Department of Community Health Sciences University of Manitoba Winnipeg Manitoba Canada
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Becerra AZ, Probst CP, Fleming FJ, Xu Z, Aquina CT, Justiniano CF, Boodry CI, Swanger AA, Noyes K, Katz AW, Monson JR, Jusko TA. Patterns and Yearly Time Trends in the Use of Radiation Therapy During the Last 30 Days of Life Among Patients With Metastatic Rectal Cancer in the United States From 2004 to 2012. Am J Hosp Palliat Care 2017; 35:336-342. [PMID: 28494653 DOI: 10.1177/1049909117706959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Although radiation therapy (RT) can provide palliative benefits for patients with metastatic rectal cancer, its role at the end of life remains unclear. The objective of this study was to assess sociodemographic and clinical factors associated with the use of RT during the last 30 days of life and to evaluate yearly time trends in RT utilization among stage IV patients with rectal cancer. METHODS The 2004 to 2012 National Cancer DataBase was queried for patients with metastatic rectal cancer who had a documented death during follow-up. A Bayesian multilevel logistic regression model was used to characterize predictive factors and yearly time trends associated with RT use in the last 30 days of life. RESULTS Among 10 431 patients who met inclusion criteria, 345 (3%) received RT during the last 30 days of life. Factors independently associated with RT use included older age, female sex, African American race, nonprivate insurance, higher comorbidity burden, and worse grade. The odds of RT use at the end of life decreased by 28% between 2007 and 2009 (odds ratio [OR] = 0.72, 95% Credible Interval (CI) = 0.58-0.93), but then increased by 16% from 2010 to 2012 (OR = 1.16, 95% CI = 1.13-1.33), relative to 2004 to 2006. CONCLUSION Radiation therapy use for patients with metastatic rectal cancer is beneficial, and efforts to optimize its appropriate use are important. Several factors associated with RT use during the last 30 days of life included disparities in sociodemographic and clinical subgroups. Research is needed to understand the underlying causes of these inequalities and the role of predictive models in clinical decision-making.
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Affiliation(s)
- Adan Z Becerra
- 1 Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.,2 Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Christian P Probst
- 2 Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Fergal J Fleming
- 2 Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Zhaomin Xu
- 2 Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher T Aquina
- 2 Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Carla F Justiniano
- 2 Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Courtney I Boodry
- 2 Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Alex A Swanger
- 2 Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Katia Noyes
- 2 Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.,3 Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Alan W Katz
- 4 Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - John R Monson
- 5 Center for Colon and Rectal Surgery, Florida Hospital Medical Group, Orlando, FL, USA
| | - Todd A Jusko
- 1 Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Ganti AK, Hirsch FR, Wynes MW, Ravelo A, Ramalingam SS, Ionescu-Ittu R, Pivneva I, Borghaei H. Access to Cancer Specialist Care and Treatment in Patients With Advanced Stage Lung Cancer. Clin Lung Cancer 2017; 18:640-650.e2. [PMID: 28522158 DOI: 10.1016/j.cllc.2017.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Access to specialty care is critical for patients with advanced stage lung cancer. This study assessed access to cancer specialists and cancer treatment in a broad population of patients with advanced stage lung cancer. MATERIALS AND METHODS Two study samples were extracted from 2 claims databases and analyzed independently: patients aged ≥ 18 years with de novo diagnosis of metastatic lung cancer in the MarketScan database between 2008 and 2014 (commercially insured adult patients; n = 22,268); and patients aged ≥ 65 years in the Surveillance, Epidemiology, and End Results-Medicare database with a diagnosis of advanced non-small-cell lung cancer between 2007 and 2011 (Medicare-insured elderly patients; n = 9651). The study period spanned from 6 weeks before the first lung biopsy tied to the initial lung cancer diagnosis until the end of continuous health insurance enrollment, or data availability, or death. RESULTS Among the commercially insured adults (MarketScan), most patients were seen by a cancer specialist within a month of first lung biopsy (80%), 12% were never seen by a cancer specialist, and 6% did not receive cancer-directed therapy. Among the Medicare-insured elderly patients (SEER-Medicare), the proportions were 79%, 4%, and 10%, respectively. Patients seen by a cancer specialist were more likely to receive cancer-directed therapy (95% vs. 92%, P < .001 and 92% vs. 38%, P < .001, respectively). CONCLUSION Between 4% and 12% of patients with advanced stage lung cancer do not have appropriate access to cancer specialist, which appears to negatively affect access to optimal and timely treatment.
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Affiliation(s)
- Apar Kishor Ganti
- Veteran's Affairs Nebraska-Western Iowa Health Care System, University of Nebraska Medical Center, Omaha, NE.
| | - Fred R Hirsch
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Murry W Wynes
- International Association for the Study of Lung Cancer (IASLC), Aurora, CO
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Wu J, Song Y, Su L, Xu L, Chen T, Zhao Z, Zhang M, Li W, Hu Y, Zhang X, Gao Y, Niu Z, Feng R, Wang W, Peng J, Li X, Ouyang X, Wu C, Zhang W, Zeng Y, Xiao Z, Liang Y, Zhuang Y, Wang J, Sun Z, Bai H, Cui T, Feng J. Rituximab plus chemotherapy as first-line treatment in Chinese patients with diffuse large B-cell lymphoma in routine practice: a prospective, multicentre, non-interventional study. BMC Cancer 2016; 16:537. [PMID: 27460571 PMCID: PMC4962436 DOI: 10.1186/s12885-016-2523-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/05/2016] [Indexed: 12/23/2022] Open
Abstract
Background The efficacy and safety of rituximab-based chemotherapy (R-chemo), the standard regimen for patients with diffuse large B-cell lymphoma (DLBCL), which is more common in Asia than in Western countries, are well confirmed in randomized controlled trials (RCTs). However, the safety and effectiveness of R-chemo in patients who are largely excluded from RCTs have not been well characterized. This real-world study investigated the safety and effectiveness of R-chemo as first-line treatment in Chinese patients with DLBCL. Methods Treatment-naive DLBCL patients who were CD20 positive and eligible to receive R-chemo were enrolled with no specific exclusion criteria. Data collected at baseline included age, gender, disease stage, international prognostic index (IPI), B symptoms, extranodal involvement, performance status, and medical history. In the present study, data on safety, treatment effectiveness, and HBV infection management were collected 120 days after the last R-chemo administration. Results Overall, R-chemo was well tolerated. The safety profile of R-chemo in patients with a history of heart or liver disease was well described without any additional unexpected safety concerns. The overall response rate (ORR) in the Chinese patients from this study was 94.2 % (complete response [CR], 55.0 %; CR unconfirmed [CRu] 18.2 %; and partial response [PR], 20.9 %). Compared to patients with no history of disease, the CR and PR rates of patients with a history of heart or liver disease were lower and higher, respectively; this tendency could be in part explained by treatment interruptions in patients with heart or liver diseases. HBsAg positivity and a maximum tumor diameter of ≥7.5 cm negatively correlated with CR + CRu, whereas age and HBsAg positivity negatively correlated with CR. Conclusions This study further validated the safety and effectiveness of R-chemo in Chinese patients with DLBCL. Patients with a history of heart or liver disease may further benefit from R-chemo if preventive measures are taken to reduce hepatic and cardiovascular toxicity. In addition to IPI and tumor diameter, HBsAg positivity could also be a poor prognostic factor for CR in Chinese patients with DLBCL. Trial registration ClinicalTrials.gov #NCT01340443, April 20, 2011. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2523-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jianqiu Wu
- Jiangsu Cancer Hospital, Nanjing, 210000, China
| | | | - Liping Su
- Shanxi Cancer Hospital, Taiyuan, China
| | - Li Xu
- Shanghai Roche Pharmaceuticals Ltd, Shanghai, China
| | | | - Zhiyun Zhao
- Shanghai Roche Pharmaceuticals Ltd, Shanghai, China
| | - Mingzhi Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Li
- Jilin University First Affiliated Hospital, Changchun, China
| | - Yu Hu
- Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohong Zhang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yuhuan Gao
- Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zuoxing Niu
- Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, China
| | - Ru Feng
- Nanfang Medical University Nanfang Hospital, Guangzhou, China
| | - Wei Wang
- Guangdong Foshan First Hospital, Foshan, China
| | - Jiewen Peng
- Guangdong Zhongshan People's Hospital, Zhongshan, China
| | - Xiaolin Li
- Xiangya Hospital Central South University, Changsha, China
| | - Xuenong Ouyang
- Fuzhou General Hospital of Nanjing Military Command, Fuzhou, China
| | - Changping Wu
- Changzhou First People's Hospital, Changzhou, China
| | | | - Yun Zeng
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhen Xiao
- Affiliated hospital of Neimenggu Medical College, Huhehaote, China
| | - Yingmin Liang
- The Fourth Military Medical University Affiliated Tangdu Hospital, Xi'an, China
| | - Yongzhi Zhuang
- Daqing General Hospital Group Oilfield General Hospital, Daqing, China
| | - Jishi Wang
- Affiliated Hospital of Guiyang Medical College, Guiyang, China
| | - Zimin Sun
- Anhui Provincial Hospital, Hefei, China
| | - Hai Bai
- Lanzhou Military Hospital, Lanzhou, China
| | | | - Jifeng Feng
- Jiangsu Cancer Hospital, Nanjing, 210000, China.
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Sinding C, Warren R, Fitzpatrick-Lewis D, Sussman J. Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours. Support Care Cancer 2014; 22:3101-20. [PMID: 25120008 DOI: 10.1007/s00520-014-2348-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/29/2014] [Indexed: 02/03/2023]
Abstract
The paper reviews published studies focused on disparities in receipt of cancer treatments and supportive care services in countries where cancer care is free at the point of access. We map these studies in terms of the equity stratifiers they examined, the countries in which they took place, and the care settings and cancer populations they investigated. Based on this map, we reflect on patterns of scholarly attention to equity and disparity in cancer care. We then consider conceptual challenges and opportunities in the field, including how treatment disparities are defined, how equity stratifiers are defined and conceptualized and how disparities are explained, with special attention to the challenge of psychosocial explanations.
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Affiliation(s)
- Christina Sinding
- School of Social Work & Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada,
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Esteva M, Ruiz A, Ramos M, Casamitjana M, Sánchez-Calavera MA, González-Luján L, Pita-Fernández S, Leiva A, Pértega-Díaz S, Costa-Alcaraz AM, Macià F, Espí A, Segura JM, Lafita S, Novella MT, Yus C, Oliván B, Cabeza E, Seoane-Pillado T, López-Calviño B, Llobera J. Age differences in presentation, diagnosis pathway and management of colorectal cancer. Cancer Epidemiol 2014; 38:346-53. [DOI: 10.1016/j.canep.2014.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 01/12/2023]
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8
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Goulart BHL, Reyes CM, Fedorenko CR, Mummy DG, Satram-Hoang S, Koepl LM, Blough DK, Ramsey SD. Referral and treatment patterns among patients with stages III and IV non-small-cell lung cancer. J Oncol Pract 2013; 9:42-50. [PMID: 23633970 DOI: 10.1200/jop.2012.000640] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Little is known about how referrals to different cancer specialists influence cancer care for non-small-cell lung cancer (NSCLC). Among Medicare enrollees, we identified factors of patients and their primary care physician that were associated with referrals to cancer specialists, and how the types of cancer specialists seen correlated with delivery of guideline-based therapies (GBTs). METHODS Data from patients with stages III and IV NSCLC included in the SEER-Medicare database were linked to their physicians in the American Medical Association Masterfile database. Using logistic regression, we (1) identified patient and physician factors that were associated with referrals to cancer specialists (medical oncologists, radiation oncologists, and surgeons); (2) identified the types of referral to cancer specialists that predicted greater likelihood of receiving GBT (per National Comprehensive Cancer Network guidelines). RESULTS A total of 28,977 patients with NSCLC diagnosed from January 1, 2000 to December 31, 2005 met eligibility criteria. Younger age, white race, higher income, and primary physician specialty other than family practice predicted higher likelihood of referrals to medical oncologists (P < .01 for all predictors). Seeing the three types of cancer specialists predicted higher likelihood of GBT (stage IIIA: odds ratio [OR] = 20.6; P < .001; IIIB: OR = 77.2; P < .001; and IV: OR = 1.2; P = .011), compared with seeing a medical oncologist only. Use of GBTs increased over the study period (42% to 48% from 2000 to 2005; P < .001). CONCLUSION Referrals to all types of cancer specialists increased the likelihood of treatment with standard therapies, particularly in stage III patients. However, racial and income disparities still prevent optimal referrals to cancer specialists.
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Affiliation(s)
- Bernardo H L Goulart
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle, WA, USA.
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9
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Lin CC, Virgo KS. Association between the availability of medical oncologists and initiation of chemotherapy for patients with stage III colon cancer. J Oncol Pract 2013; 9:27-33. [PMID: 23633968 DOI: 10.1200/jop.2012.000627] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Although the number of medical oncologists (MOs) has steadily increased over time, and adjuvant chemotherapy provides significant survival benefit for patients with stage III colon cancer, many patients still do not receive chemotherapy. Uneven geographic distribution of MOs may contribute to decreasing access to cancer care. This study explored the association of MO availability by hospital service area (HSA) of patient residence and access to chemotherapy treatment. METHODS Using the linked SEER-Medicare database, the study identified 9,262 patients who were age ≥66 years and underwent colectomy for stage III colon cancer diagnosed from 2000 to 2005. MOs were identified by physician specialty codes. HSAs are geographic areas that are relatively self-contained with respect to routine hospital care. Multivariate logistic regression was used to investigate the association between MO availability by HSA of patient residence and initiation of chemotherapy. RESULTS Within 3 months after colectomy, 5,622 patients (60.7%) initiated chemotherapy. Adjusting for clinical and patient characteristics, patients residing in an HSA with ≥ one MO had an increased likelihood of initiating chemotherapy within 3 months after colectomy compared with those living in areas with no MOs (one to two MOs: OR, 1.451 [P < .01]; three to eight MOs: OR, 1.497 [P < .01]; ≥ nine MOs: OR, 1.322 [P < .01]). CONCLUSION Results suggest that the availability of ≥ one MO within the HSA in which a patient resides was associated with greater access to chemotherapy after surgery.
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Affiliation(s)
- Chun Chieh Lin
- American Cancer Society; and Emory University, Atlanta, GA, USA
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10
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Gillan C, Briggs K, Pazos AG, Maurus M, Harnett N, Catton P, Wiljer D. Barriers to accessing radiation therapy in Canada: a systematic review. Radiat Oncol 2012; 7:167. [PMID: 23062109 PMCID: PMC3551743 DOI: 10.1186/1748-717x-7-167] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 09/26/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Radiation therapy (RT) is effective treatment for curing and palliating cancer, yet concern exists that not all Canadians for whom RT is indicated receive it. Many factors may contribute to suboptimal use of RT. A review of recent Canadian literature was undertaken to identify such barriers. METHODS MEDLINE, CINAHL, and EMBase databases were used to search keywords relating to barriers to accessing or utilizing RT in Canada. Collected abstracts were reviewed independently. Barriers identified in relevant articles were categorized as relating to the health systems, patient socio-demographic, patient factors, or provider factors contexts and thematic analysis performed for each context. RESULTS 535 unique abstracts were collected. 75 met inclusion criteria. 46 (61.3%) addressed multiple themes. The most cited barriers to accessing RT when indicated were patient age (n = 26, 34.7%), distance to treatment centre (n = 23, 30.7%), wait times (n = 22, 29.3%), and lack of physician understanding about the use of RT (n = 16, 21.6%). CONCLUSIONS Barriers to RT are reported in many areas. The role of provider factors and the lack of attention to patient fears and mistrust as potential barriers were unexpected findings demanding further attention. Solutions should be sought to overcome identified barriers facilitating more effective cancer care for Canadians.
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Affiliation(s)
- Caitlin Gillan
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Kaleigh Briggs
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
| | | | - Melanie Maurus
- ELLICSR: Health, Wellness, and Cancer Survivorship Centre, Toronto, Canada
| | - Nicole Harnett
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Pamela Catton
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- ELLICSR: Health, Wellness, and Cancer Survivorship Centre, Toronto, Canada
| | - David Wiljer
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- ELLICSR: Health, Wellness, and Cancer Survivorship Centre, Toronto, Canada
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Mols F, Oerlemans S, Denollet J, Roukema JA, van de Poll-Franse LV. Type D personality is associated with increased comorbidity burden and health care utilization among 3080 cancer survivors. Gen Hosp Psychiatry 2012; 34:352-9. [PMID: 22459997 DOI: 10.1016/j.genhosppsych.2012.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 01/09/2012] [Accepted: 01/27/2012] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Cancer survivors often report comorbid diseases, but there are individual differences in risk. Type D personality is a general propensity to psychological distress that is related to poor cardiovascular outcomes. In this study, we examined whether type D was also related to comorbidity burden and health care utilization among cancer survivors. METHODS Individuals diagnosed with endometrial cancer or colorectal cancer between 1998 and 2007, or with lymphoma or multiple myeloma between 1999 and 2008 as registered in the Eindhoven Cancer Registry, received the Self-Administered Comorbidity Questionnaire, questions on health care utilization and the Type D personality scale; 69% (n=3080) responded. RESULTS Nineteen percent of survivors had a type D personality. Over a 12-month period, type D survivors significantly more often reported osteoarthritis, back pain, and depression than non-type D survivors. Also, type D survivors more often reported to feel bothered by high blood pressure, osteoarthritis, heart disease, depression, diabetes and lung disease during daily activities. Type D survivors more often visited their general practitioner than non-type D survivors (P<.001), also in relation to cancer (0 visits: 54% vs. 60%; 1-5: 28% vs. 22%; >5: 9% vs. 5%; P<.001), as well as their specialist (0 visits: 6% vs. 7%; 1-5 visits: 59% vs. 64%; >5 visits: 30% vs. 23%; P<.01). CONCLUSION Type D personality is a vulnerability factor that may help to identify subgroups of cancer survivors who are at an increased risk for comorbidity burden and increased health care utilization.
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Affiliation(s)
- Floortje Mols
- Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands.
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12
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Small AC, Tsao CK, Moshier EL, Gartrell BA, Wisnivesky JP, Godbold JH, Smith CB, Sonpavde G, Oh WK, Galsky MD. Prevalence and characteristics of patients with metastatic cancer who receive no anticancer therapy. Cancer 2012; 118:5947-54. [PMID: 22707387 DOI: 10.1002/cncr.27658] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 04/18/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A subset of patients who present with metastatic solid tumors never receive anticancer therapy. Reasons may include poor functional status, comorbidities, and patient preference. To the authors' knowledge, the prevalence and characteristics of this population have not previously been described. METHODS The National Cancer Data Base was queried for patients diagnosed with metastatic (stage IV according to the American Joint Committee on Cancer) solid tumors (including those of the breast, cervix, colon, and kidney; small cell and nonsmall cell lung cancer [NSCLC]; and tumors of the prostate, rectum, and uterus) who received neither radiotherapy nor systemic therapy. Log-binomial regression analysis was used to estimate prevalence ratios (PRs) for the percentage of untreated to treated patients with stage IV cancer. RESULTS Between 2000 and 2008, 773,233 patients with stage IV cancer were identified, 159,284 of whom (20.6%; 95% confidence interval, 20.5%-20.7%) received no anticancer therapy. Patients with NSCLC accounted for 55% of the untreated population. Patients with cancers of the kidney and lung had the highest rates of no treatment at 25.5% and 24.0%, respectively, whereas patients with prostate cancer had the lowest rate of no treatment at 11.1%. Across all cancer types, older age (PR range, 1.37-1.49; all P < .001), black race (PR range, 1.05-1.32; all P < .001), lack of medical insurance (PR range, 1.47-2.46; all P < .001), and lower income (except for cancer of the uterus; PR range, 0.91-0.98 for every $10,000-increase in income [all P < .001]) were associated with a lack of treatment. CONCLUSIONS Approximately 20% of patients who present with stage IV solid tumors do not receive anticancer therapy. Although there are likely multiple reasons for this lack of treatment, including appropriate indications, these findings have potential implications with regard to health care policy and access to care.
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Affiliation(s)
- Alexander C Small
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, New York, USA
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