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Kamal UH, Jamil A, Fatima E, Khurram A, Khan Z, Kamdi ZA, Ahmed S, Farooq MZ, Jaglal M. Mortality Patterns of Esophageal Cancer in the United States: A 21-Year Retrospective Analysis. Am J Clin Oncol 2024:00000421-990000000-00230. [PMID: 39359061 DOI: 10.1097/coc.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
OBJECTIVES Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first 5 years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States. METHODS The mortality trends among adults with EC were analyzed using data from the CDC WONDER database. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joinpoint regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups. RESULTS Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999 to 2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and nonmetropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared with states falling in the lower 10th percentile. CONCLUSIONS Over the last 2 decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.
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Affiliation(s)
| | - Adeena Jamil
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Eeshal Fatima
- Department of Medicine, Services Institute of Medical Sciences, Lahore
| | - Abiha Khurram
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Zoha Khan
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Zainab Anwar Kamdi
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sana Ahmed
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Tustumi F, Eri RY, Wende KW, Nakamura ET, Usón Junior PLS, Szor DJ. Disparities in esophageal cancer care: a population-based study. J Gastrointest Surg 2024; 28:1674-1681. [PMID: 39079844 DOI: 10.1016/j.gassur.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/22/2024] [Accepted: 07/04/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND Vulnerable populations potentially have a worse prognosis for cancer. The present study aimed to identify individual and municipal characteristics of access to health, including education, use of health insurance, gross domestic product per capita (GDPpc), and urban aspects, which could impact the prognosis of patients with esophageal cancer. METHODS Data on urban concentration, administrative hierarchy, GDPpc, individual patient characteristics, and access to healthcare were collected from national and state public databases spanning between 2013 and 2022. The study included cities in the state of Sao Paulo, Brazil. Independent variables such as GDPpc, urban concentration, municipal administrative hierarchy, health insurance status, education level, and individual cancer and patient characteristics were evaluated against the outcomes of overall survival (OS), likelihood of undergoing surgical treatment, and time-to-treatment initiation. RESULTS A total of 9280 patients with esophageal cancer (85% squamous cell carcinoma and 15% adenocarcinoma) treated in 42 cities were included in the study. In univariate analysis, higher education (hazard ratio [HR] = 0.6; P < .001), female gender (HR = 0.85; P < .001), and having private health insurance (HR = 0.65; P < .001) were identified as protective factors for OS in esophageal cancer. After adjusting for other variables in multivariate analysis, higher education (HR = 0.77; P = .009), female gender (HR = 0.82; P < .001), and private insurance (HR = 0.65; P < .001) remained protective factors. GDPpc was not associated with OS. Urban concentration and hierarchy influenced the likelihood of receiving surgical treatment. Patients from high urban concentrations had shorter time-to-treatment initiation intervals. CONCLUSION Populations at risk, particularly those with limited access to education and healthcare, face a worse prognosis for esophageal cancer.
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Affiliation(s)
- Francisco Tustumi
- Department of Health Sciences, Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Department of Gastroenterology, Universidade de São Paulo, Sao Paulo, Brazil.
| | - Ricardo Yugi Eri
- Department of Health Sciences, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Klaus Werner Wende
- Department of Health Sciences, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | - Daniel José Szor
- Department of Health Sciences, Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Department of Gastroenterology, Universidade de São Paulo, Sao Paulo, Brazil
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Thavanesan N, Farahi A, Parfitt C, Belkhatir Z, Azim T, Vallejos EP, Walters Z, Ramchurn S, Underwood TJ, Vigneswaran G. Insights from explainable AI in oesophageal cancer team decisions. Comput Biol Med 2024; 180:108978. [PMID: 39106674 DOI: 10.1016/j.compbiomed.2024.108978] [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: 04/15/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Clinician-led quality control into oncological decision-making is crucial for optimising patient care. Explainable artificial intelligence (XAI) techniques provide data-driven approaches to unravel how clinical variables influence this decision-making. We applied global XAI techniques to examine the impact of key clinical decision-drivers when mapped by a machine learning (ML) model, on the likelihood of receiving different oesophageal cancer (OC) treatment modalities by the multidisciplinary team (MDT). METHODS Retrospective analysis of 893 OC patients managed between 2010 and 2022 at our tertiary unit, used a random forests (RF) classifier to predict four possible treatment pathways as determined by the MDT: neoadjuvant chemotherapy followed by surgery (NACT + S), neoadjuvant chemoradiotherapy followed by surgery (NACRT + S), surgery-alone, and palliative management. Variable importance and partial dependence (PD) analyses then examined the influence of targeted high-ranking clinical variables within the ML model on treatment decisions as a surrogate model of the MDT decision-making dynamic. RESULTS Amongst guideline-variables known to determine treatments, such as Tumour-Node-Metastasis (TNM) staging, age also proved highly important to the RF model (16.1 % of total importance) on variable importance analysis. PD subsequently revealed that predicted probabilities for all treatment modalities change significantly after 75 years (p < 0.001). Likelihood of surgery-alone and palliative therapies increased for patients aged 75-85yrs but lowered for NACT/NACRT. Performance status divided patients into two clusters which influenced all predicted outcomes in conjunction with age. CONCLUSION XAI techniques delineate the relationship between clinical factors and OC treatment decisions. These techniques identify advanced age as heavily influencing decisions based on our model with a greater role in patients with specific tumour characteristics. This study methodology provides the means for exploring conscious/subconscious bias and interrogating inconsistencies in team-based decision-making within the era of AI-driven decision support.
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Affiliation(s)
| | - Arya Farahi
- Department of Statistics and Data Science, University of Texas at Austin, United States
| | | | - Zehor Belkhatir
- School of Electronics and Computer Science, University of Southampton, UK
| | - Tayyaba Azim
- School of Electronics and Computer Science, University of Southampton, UK
| | - Elvira Perez Vallejos
- School of Computer Science, Horizon Digital Economy Research, University of Nottingham, UK
| | - Zoë Walters
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK
| | - Sarvapali Ramchurn
- School of Electronics and Computer Science, University of Southampton, UK
| | - Timothy J Underwood
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK. https://twitter.com/TimTheSurgeon
| | - Ganesh Vigneswaran
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK. https://twitter.com/ganesh_vignes
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Yang VB, Rando HJ, Menta AK, Zhao X, Blum J, Battafarano R, Broderick S, Yang SC, Ha J. Maryland's Global Budget Revenue Program and Equitable Access to Esophagectomy for Esophageal Cancer. J Surg Res 2024; 302:403-410. [PMID: 39153362 DOI: 10.1016/j.jss.2024.07.073] [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: 12/01/2023] [Revised: 07/09/2024] [Accepted: 07/19/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION We evaluated equity in access to esophagectomy after Maryland's 2014 "Global Budget Revenue" (GBR) implementation, which equalizes reimbursement rates irrespective of patient insurance and employs an annual hospital revenue ceiling to incentivize reductions in unnecessary resource utilization. We hypothesized that more traditionally underserved patients would undergo surgical treatment for esophageal cancers after GBR. METHODS Using Maryland's Health Services Cost Review Commission database, we retrospectively analyzed patient demographics, insurance statuses, inflation-adjusted hospital charges, postoperative outcomes, and discharge dispositions for esophagectomies for neoplasms between 2012 and 2018. RESULTS Four hundred eighty six patients were included: 22.0% (107) pre-GBR and 78.0% (379) post-GBR. The proportion of African-American patients increased post-GBR (5.6% versus 12.9%, P = 0.035) and subsequently exhibited year-over-year increases. While not statistically significant, the proportion of Medicaid patients increased from 4.7% to 10.0% (P = 0.085). The post-GBR era also saw patients from 10 new counties, six of which were in Maryland's bottom half of counties ranked by median household income, receive operative esophageal cancer treatment without losing representation from pre-GBR counties. Patient age and sex were comparable between the two groups, and there were no significant differences in mortality or 30-day readmissions. Inflation-adjusted hospital charges and length of hospital stay did not appreciably change post-GBR, including after adjusting for age, comorbidities, and surgical approach. CONCLUSIONS GBR increased access to esophagectomy for African-Americans, those insured by Medicaid, and those from lower socioeconomic status counties. Contrary to prior studies of outpatient and emergency room settings, we found the GBR program's goal of reduction of resource utilization and cost were not apparent in this complex surgical population.
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Affiliation(s)
- Victor B Yang
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Hannah J Rando
- Division of Cardiac Surgery, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Arjun K Menta
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiyu Zhao
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jacob Blum
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard Battafarano
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen Broderick
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen C Yang
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jinny Ha
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hutchings H, Behinaein P, Okereke I. Well-being Through the Synergy of Community Engagement, Health Equity, and Advocacy. Thorac Surg Clin 2024; 34:281-290. [PMID: 38944455 DOI: 10.1016/j.thorsurg.2024.04.005] [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: 07/01/2024]
Abstract
Facets of well-being for cardiothoracic surgeons include interconnectivity, or a sense of belonging within a community, and social relatedness. Striving for health equity achieves a sense of belonging and meaning to one's work. In "Elevating Health Equity: The Synergy of Community Engagement and Advocacy," the imperative for mentorship and diversification within health care is expounded, establishing a multitiered blueprint for equity. Integral to this framework is the nurturing of a heterogeneous health care workforce, ameliorating racial and gender disparities in patient care. This article puts forth an intricate, empirically substantiated roadmap toward a more empathic and efficacious health care system.
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Affiliation(s)
- Hollis Hutchings
- Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Parnia Behinaein
- School of Medicine, Wayne State University, 540 Canfield Street, Detroit, MI 48201, USA
| | - Ikenna Okereke
- Department of Surgery, Thoracic Surgery, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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Pan CW, Wang Y, Abboud Y, Dominguez AN, Lo CH, Pang M. Esophageal cancer mortality disparities between Black and White adults in the United States, 1999-2020: insights from CDC-WONDER. J Gastroenterol Hepatol 2024. [PMID: 39048101 DOI: 10.1111/jgh.16689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/16/2024] [Accepted: 07/13/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND AIM Esophageal cancer significantly contributes to US cancer mortality, with notable racial disparities. This study aims to provide updated esophageal cancer mortality trends among Black and White adults from 1999 to 2020. METHODS CDC-WONDER was used to identify Black and White adults in the United States from 1999 to 2020. We calculated age-standardized mortality rates, absolute rate differences, and rate ratios to compare the mortality differences between these populations. RESULTS From 1999 to 2020 in the United States, there were 303 267 esophageal cancer deaths, with significant racial disparities. The age-adjusted mortality rate for Black adults fell from 6.52 to 2.62 per 100 000, while for White adults, it declined from 4.19 to 3.97 per 100 000, narrowing the racial mortality gap. Gender-wise, the study showed a decrease in the mortality rate from 3.31 to 2.29 per 100 000 in Black women, but an increase from 1.52 to 1.99 per 100 000 in White women. Among young men, the rate dropped in Black men from 12.82 to 6.26 per 100 000 but rose in White men from 9.90 to 10.57 per 100 000. Regionally, Black adults in the Midwest and South initially had higher mortality rates than Whites, but this gap reduced over time. By 2020, Black men had lower mortality rates across all regions. CONCLUSIONS Over the last two decades, age-adjusted esophageal cancer mortality decreased in Black adults but stabilized in White adults, reflecting distinct cancer trends and risk factors. The study highlights the importance of tailored public health strategies for healthcare access and risk factor management.
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Affiliation(s)
- Chun-Wei Pan
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Yichen Wang
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yazan Abboud
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Chun-Han Lo
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Maoyin Pang
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Bonner SN, Edwards MA. The Impact of Racial Disparities and the Social Determinants of Health on Esophageal and Gastric Cancer Outcomes. Surg Oncol Clin N Am 2024; 33:595-604. [PMID: 38789201 DOI: 10.1016/j.soc.2023.12.015] [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: 05/26/2024]
Abstract
Reducing long-standing inequities in gastric and esophageal cancers is a priority of patients, providers, and policy makers. Many social determinants of health influence risk factors for disease development, incidence, treatment, and outcomes of gastric and esophageal cancers.
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Affiliation(s)
- Sidra N Bonner
- Department of Surgery, University of Michigan, 1500 East Medical Center Drive, 2100 Taubman Center, Ann Arbor, MI 48109, USA
| | - Melanie A Edwards
- Trinity Health IHA Medical Group, Cardiovascular & Thoracic Surgery Ann Arbor, 5325 Elliott Drive, Suite 102, Ypsilanti, MI 48197, USA.
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Banks KC, Wei J, Morales LM, Islas ZA, Alcasid NJ, Susai CJ, Sun A, Burapachaisri K, Patel AR, Ashiku SK, Velotta JB. Differences in outcomes by race/ethnicity after thoracic surgery in a large integrated health system. Surg Open Sci 2024; 19:118-124. [PMID: 38655068 PMCID: PMC11035076 DOI: 10.1016/j.sopen.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
Background Disparities exist throughout surgery. We aimed to assess for racial/ethnic disparities among outcomes in a large thoracic surgery patient population. Methods We reviewed all thoracic surgery patients treated at our integrated health system from January 1, 2016-December 31, 2020. Post-operative outcomes including length of stay (LOS), 30-day return to the emergency department (30d-ED), 30-day readmission, 30- and 90-day outpatient appointments, and 30- and 90-day mortality were compared by race/ethnicity. Bivariate analyses and multivariable logistic regression were performed. Our multivariable models adjusted for age, sex, body mass index, Charlson Comorbidity Index, surgery type, neighborhood deprivation index, insurance, and home region. Results Of 2730 included patients, 59.4 % were non-Hispanic White, 15.0 % were Asian, 11.9 % were Hispanic, 9.6 % were Black, and 4.1 % were Other. Median (Q1-Q3) LOS (in hours) was shortest among non-Hispanic White (37.3 (29.2-76.1)) and Other (36.5 (29.3-75.4)) patients followed by Hispanic (46.8 (29.9-78.1)) patients with Asian (51.3 (30.7-81.9)) and Black (53.7 (30.6-101.6)) patients experiencing the longest LOS (p < 0.01). 30d-ED rates were highest among Hispanic patients (21.3 %), followed by Black (19.2 %), non-Hispanic White (18.1 %), Asian (13.4 %), and Other (8.0 %) patients (p < 0.01). On multivariable analysis, Hispanic ethnicity (Odds Ratio (OR) 1.43 (95 % CI 1.03-1.97)) and Medicaid insurance (OR 2.37 (95 % CI 1.48-3.81)) were associated with higher 30d-ED rates. No racial/ethnic disparities were found among other outcomes. Conclusions Despite parity across multiple surgical outcomes, disparities remain related to patient encounters within our system. Health systems must track such disparities in addition to standard clinical outcomes. Key message While our large integrated health system has been able to demonstrate parity across many major surgical outcomes among our thoracic surgery patients, race/ethnicity disparities persist including in the number of post-operative return trips to the emergency department. Tracking outcome disparities to a granular level such as return visits to the emergency department and number of follow up appointments is critical as health systems strive to achieve equitable care.
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Affiliation(s)
- Kian C. Banks
- Division of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA 94602, USA
| | - Julia Wei
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Leyda Marrero Morales
- University of California, San Francisco, School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, USA
| | - Zeuz A. Islas
- Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Nathan J. Alcasid
- Division of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA 94602, USA
| | - Cynthia J. Susai
- Division of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA 94602, USA
| | - Angela Sun
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Katemanee Burapachaisri
- University of California, San Francisco, School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, USA
| | - Ashish R. Patel
- Division of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA 94602, USA
| | - Simon K. Ashiku
- Division of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA 94602, USA
| | - Jeffrey B. Velotta
- Division of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA 94602, USA
- University of California, San Francisco, School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S Los Robles Ave, Pasadena, CA 91101, USA
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Whitehead RA, Patel EA, Liu JC, Bhayani MK. Racial Disparities in Head and Neck Cancer: It's Not Just About Access. Otolaryngol Head Neck Surg 2024; 170:1032-1044. [PMID: 38258967 DOI: 10.1002/ohn.653] [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: 09/13/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Medical literature identifies stark racial disparities in head and neck cancer (HNC) in the United States, primarily between non-Hispanic white (NHW) and non-Hispanic black (NHB) populations. The etiology of this disparity is often attributed to inequitable access to health care and socioeconomic status (SES). However, other contributors have been reported. We performed a systematic review to better understand the multifactorial landscape driving racial disparities in HNC. DATA SOURCES A systematic review was conducted in Covidence following Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines. A search of PubMed, SCOPUS, and CINAHL for literature published through November 2022 evaluating racial disparities in HNC identified 2309 publications. REVIEW METHODS Full texts were screened by 2 authors independently, and inconsistencies were resolved by consensus. Three hundred forty publications were ultimately selected and categorized into themes including disparities in access/SES, treatment, lifestyle, and biology. Racial groups examined included NHB and NHW patients but also included Hispanic, Native American, and Asian/Pacific Islander patients to a lesser extent. RESULTS Of the 340 articles, 192 focused on themes of access/SES, including access to high-quality hospitals, insurance coverage, and transportation contributing to disparate HNC outcomes. Additional themes discussed in 148 articles included incongruities in surgical recommendations, tobacco/alcohol use, human papillomavirus-associated malignancies, and race-informed silencing of tumor suppressor genes. CONCLUSION Differential access to care plays a significant role in racial disparities in HNC, disproportionately affecting NHB populations. However, there are other significant themes driving racial disparities. Future studies should focus on providing equitable access to care while also addressing these additional sources of disparities in HNC.
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Affiliation(s)
- Russell A Whitehead
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Evan A Patel
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeffrey C Liu
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Mihir K Bhayani
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Hutchings H, Behinaein P, Enofe N, Brue K, Tam S, Chang S, Movsas B, Poisson L, Wang A, Okereke I. Association of Social Determinants with Patient-Reported Outcomes in Patients with Cancer. Cancers (Basel) 2024; 16:1015. [PMID: 38473374 DOI: 10.3390/cancers16051015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Patient-reported outcome (PRO) scores have been utilized more frequently, but the relationship of PRO scores to determinants of health and social inequities has not been widely studied. Our goal was to determine the association of PRO scores with social determinants. All patients with a new cancer diagnosis who completed a PRO survey from 2020 to 2022 were included. The PRO survey recorded scores for depression, fatigue, pain interference and physical function. Higher depression, fatigue and pain scores indicated more distress. Higher physical condition scores indicated improved functionality. A total of 1090 patients were included. Married patients had significantly better individual PRO scores for each domain. Patients who were able to use the online portal to complete their survey also had better individual scores. Male patients and non-White patients had worse pain scores than female and White patients, respectively. Patients with prostate cancer had the best scores while patients with head and neck and lung cancer had the worst scores. PRO scores varied by cancer disease site and stage. Social support may act in combination with specific patient/tumor factors to influence PRO scores. These findings present opportunities to address patient support at institutional levels.
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Affiliation(s)
- Hollis Hutchings
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
| | - Parnia Behinaein
- School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - Nosayaba Enofe
- Division of Surgical Oncology, Department of Thoracic Surgery, Fox Chase Cancer Center, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Kellie Brue
- School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - Samantha Tam
- Department of Otolaryngology, Henry Ford Health, Detroit, MI 48202, USA
| | - Steven Chang
- Department of Otolaryngology, Henry Ford Health, Detroit, MI 48202, USA
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI 48202, USA
| | - Laila Poisson
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI 48202, USA
| | - Anqi Wang
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI 48202, USA
| | - Ikenna Okereke
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
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11
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Zhou MJ, Ladabaum U, Triadafilopoulos G, Clarke JO. Impact of race/ethnicity and socioeconomic status on incident and prevalent esophageal cancer in patients with Barrett's esophagus. Dis Esophagus 2023; 36:doad044. [PMID: 37431107 DOI: 10.1093/dote/doad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/02/2023] [Indexed: 07/12/2023]
Abstract
The impact of race/ethnicity (RE) or socioeconomic status (SES) on progression from Barrett's esophagus (BE) to esophageal cancer (EC) is not well established. We aimed to evaluate the association between demographic factors and SES on EC diagnosis in an ethnically diverse BE cohort. Patients aged 18-63 with incident BE diagnosed in October 2015-March 2020 were identified in the Optum Clinformatics DataMart Database. Patients were followed until the diagnosis of prevalent EC <1 year or incident EC ≥1 year from BE diagnosis, or until the end of their continuous enrollment period. Cox proportional hazards analysis was used to determine associations between demographics, SES factors, BE risk factors, and EC. Demographics of the 12,693 patients included mean age of BE diagnosis 53.0 (SD 8.5) years, 56.4% male, 78.3% White/10.0% Hispanic/6.4% Black/3.0% Asian. The median follow-up was 26.8 (IQR 19.0-42.0) months. In total, 75 patients (0.59%) were diagnosed with EC (46 [0.36%] prevalent EC; 29 [0.23%] incident EC), and 74 patients (0.58%) developed high-grade dysplasia (HGD) (46 [0.36%] prevalent HGD; 28 [0.22%] incident HGD). Adjusted HR (95% CI) for prevalent EC comparing household net worth ≥$150,000 vs. <$150,000 was 0.57 (0.33-0.98). Adjusted HRs (95% CI) for prevalent and incident EC comparing non-White vs. White patients were 0.93 (0.47-1.85) and 0.97 (0.21-3.47), respectively. In summary, a lower SES, captured by the household net worth, was associated with prevalent EC. There was no significant difference in prevalent or incident EC among White vs. non-White patients. EC progression in BE may be similar among racial/ethnic groups, but SES disparities may impact BE outcomes.
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Affiliation(s)
- Margaret J Zhou
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Lee JH, Arora A, Bergman R, Gomez-Rexrode A, Sidhom D, Reddy RM. Increased Variation in Esophageal Cancer Treatment and Geographic Healthcare Disparity in Michigan. J Am Coll Surg 2023; 237:779-785. [PMID: 37581370 DOI: 10.1097/xcs.0000000000000819] [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: 08/16/2023]
Abstract
BACKGROUND Regional variation in complex healthcare is shown to negatively impact health outcomes. We sought to characterize geographic variance in esophageal cancer operation in Michigan. STUDY DESIGN Data for patients with locoregional esophageal cancer from the Michigan Cancer Surveillance Program from 2000 to 2013 was analyzed. We reviewed the incidence of esophageal cancer by county and region, and those with locoregional disease receiving an esophagectomy. Counties were aggregated into existing state-level "urban vs rural" designations, regions were aggregated using the Michigan Economic Recovery Council designations, and data was analyzed with ANOVA, F-test, and chi-square test. RESULTS Of the 8,664 patients with locoregional disease, 2,370 (27.4%) were treated with operation. Men were significantly more likely to receive esophagectomy than women (p < 0.001). Likewise, White, insured, and rural patients were more likely than non-White (p < 0.001), non-insured (p = 0.004), and urban patients (p < 0.001), respectively. There were 8 regions and 83 counties, with 61 considered rural and 22 urban. Region 1 (Detroit metro area, southeast) comprises the largest urban and suburban populations; with 4 major hospital systems it was considered the baseline standard for access to care. Regions 2 (west; p = 0.011), 3 (southwest; p = 0.024), 4 (east central; p = 0.012), 6 (northern Lower Peninsula; p = 0.008), and 8 (Upper Peninsula; p < 0.001) all had statistically significant greater variance in annual rates of operation compared with region 1. Region 8 had the largest variance and was the most rural and furthest from region 1. The variance in operation rate between urban and rural differed significantly (p = 0.005). CONCLUSIONS A significant increase in variation of care was found in rural vs urban counties, as well as in regions distant to larger hospital systems. Those of male sex, White race, rural residence, and those with health insurance were significantly more likely to receive operation.
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Affiliation(s)
- John H Lee
- From the University of Michigan Medical School, Ann Arbor, MI (Lee, Arora, Gomez-Rexrode, Sidhom, Reddy)
| | - Akul Arora
- From the University of Michigan Medical School, Ann Arbor, MI (Lee, Arora, Gomez-Rexrode, Sidhom, Reddy)
| | - Rachel Bergman
- the Department of Orthopedic Surgery, Northwestern Medicine, Chicago, IL (Bergman)
| | - Amalia Gomez-Rexrode
- From the University of Michigan Medical School, Ann Arbor, MI (Lee, Arora, Gomez-Rexrode, Sidhom, Reddy)
| | - David Sidhom
- From the University of Michigan Medical School, Ann Arbor, MI (Lee, Arora, Gomez-Rexrode, Sidhom, Reddy)
| | - Rishindra M Reddy
- From the University of Michigan Medical School, Ann Arbor, MI (Lee, Arora, Gomez-Rexrode, Sidhom, Reddy)
- Department of Surgery, Section of Thoracic, University of Michigan, Ann Arbor, MI (Reddy)
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Qureshi MM, Lin Y, Moeller AR, Yan SX, Dyer MA, Suzuki K, Everett P, Litle V, Truong MT, Mak KS. Change in stage after neoadjuvant chemoradiation is associated with survival in patients with esophageal cancer. J Surg Oncol 2023; 128:781-789. [PMID: 37288789 DOI: 10.1002/jso.27367] [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: 12/12/2022] [Revised: 05/17/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The aim of this study was to determine if change in stage after neoadjuvant chemoradiation (CRT) was associated with improved survival in esophageal cancer using a national database. METHODS Using the National Cancer Database, patients with non-metastatic, resectable esophageal cancer who received neoadjuvant CRT and surgery were identified. Comparing clinical to the pathologic stage, change in stage was classified as pathologic complete response (pCR), downstaged, same-staged, or upstaged. Univariable and multivariable Cox regression models were used to identify factors associated with survival. RESULTS A total of 7745 patients were identified. The median overall survival (OS) was 34.9 months. Median OS was 60.3 months if pCR, 39.1 months if downstaged, 28.3 months if same-staged, and 23.4 months if upstaged (p < 0.0001). On multivariable analysis, pCR was associated with improved OS compared to the other groups (downstaged: hazard ratio [HR]: 1.32 [95% confidence interval [CI]: 1.18-1.46]; same-staged: HR: 1.89 [95% CI: 1.68-2.13]; upstaged: HR: 2.54 [95% CI: 2.25-2.86]; all p < 0.0001). CONCLUSIONS In this large database study, change in stage after neoadjuvant CRT was strongly associated with survival for patients with non-metastatic, resectable esophageal cancer. There was a significant stepwise decline in survival, in descending order of pCR, downstaged tumor, same-staged tumor, and upstaged tumor.
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Affiliation(s)
- Muhammad M Qureshi
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts, USA
| | - Yue Lin
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Alexander R Moeller
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sherry X Yan
- Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts, USA
| | - Michael A Dyer
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts, USA
| | - Kei Suzuki
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Peter Everett
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Virginia Litle
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Minh-Tam Truong
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts, USA
| | - Kimberley S Mak
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts, USA
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Douse DM, Yin LX, Olawuni FO, Glasgow AE, Habermann EB, Price DL, Tasche KK, Moore EJ, Van Abel KM. Racial disparities in surgical treatment of oropharyngeal cancer: A Surveillance, Epidemiology, and End Results review. Head Neck 2023; 45:2313-2322. [PMID: 37461323 DOI: 10.1002/hed.27467] [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: 01/06/2023] [Revised: 06/03/2023] [Accepted: 07/09/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES Oropharyngeal squamous cell carcinoma (OPSCC) has been rising. This manuscript looks to explore racial disparities in the surgical management of OPSCC. METHODS A cancer database was queried for patients with OPSCC diagnosed from 2004 to 2017. Univariate and multivariable logistic regressions were used to evaluate associations between patient race/ethnicity, surgical treatment, and reasons for lack of surgery. RESULTS 37 306 (74.3%) patients did not undergo surgery, while 12 901 (25.7%) patients did. Non-Hispanic black (NHB) patients were less likely to undergo surgery than other races (17.9% vs. 26.5%; p < 0.0001). In clinical discussions, the Asian, Native American, Hawaiian, Pacific Islander (ANAHPI), and unknown race group was more likely to directly refuse surgery when recommended (2.5% vs. 1.5%; p = 0.015). CONCLUSION Racial differences exist in treatment for OPSCC. NHB patients are less likely to actually undergo surgical management for OPSCC, while other patients are more likely to directly "refuse" surgery outright when offered.
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Affiliation(s)
- Dontre' M Douse
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Felicia O Olawuni
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy E Glasgow
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kendall K Tasche
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Freudenberger DC, Vudatha V, Wolfe LG, Riner AN, Herremans KM, Sparkman BK, Fernandez LJ, Trevino JG. Race and Ethnicity Impacts Overall Survival of Patients with Appendiceal Cancer Who Undergo Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Cancers (Basel) 2023; 15:3990. [PMID: 37568806 PMCID: PMC10417044 DOI: 10.3390/cancers15153990] [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: 05/31/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Appendiceal cancer treatment may include cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). We investigated whether patient race/ethnicity influences outcomes and overall survival for patients with appendiceal cancer who undergo CRS/HIPEC. We queried the National Cancer Database for adult patients with appendiceal cancer treated with CRS/HIPEC from 2006 to 2018. Patients were stratified by race/ethnicity: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, and Other. Sociodemographics and outcomes were compared using descriptive statistics. Kaplan-Meier survival analysis and Log-rank tests assessed differences in overall survival (OS). Cox Multivariate Regression evaluated factors associated with OS. In total, 2532 patients were identified: 2098 (82.9%) NHW, 186 (7.3%) NHB, 127 (5.0%) Hispanic, and 121 (4.8%) Other patients. The sociodemographics were statistically different across groups. The perioperative and postoperative outcomes were similar. OS was significantly different by race/ethnicity (p = 0.0029). NHB patients compared to Hispanic patients had the shortest median OS (106.7 vs. 145.9 months, p = 0.0093). Race/ethnicity was independently associated with OS: NHB (HR: 2.117 [1.306, 3.431], p = 0.0023) and NHW (HR: 1.549 [1.007, 2.383], p = 0.0463) patients compared to Hispanic patients had worse survival rates. Racial/ethnic disparities exist for patients with appendiceal cancer undergoing CRS/HIPEC. Despite having similar tumor and treatment characteristics, OS is associated with patient race/ethnicity.
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Affiliation(s)
- Devon C. Freudenberger
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
| | - Vignesh Vudatha
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
| | - Luke G. Wolfe
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
| | - Andrea N. Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA; (A.N.R.); (K.M.H.)
| | - Kelly M. Herremans
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA; (A.N.R.); (K.M.H.)
| | - Brian K. Sparkman
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
| | - Leopoldo J. Fernandez
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
| | - Jose G. Trevino
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
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Vedire Y, Rana N, Groman A, Siromoni B, Yendamuri S, Mukherjee S. Geographical Disparities in Esophageal Cancer Incidence and Mortality in the United States. Healthcare (Basel) 2023; 11:healthcare11050685. [PMID: 36900690 PMCID: PMC10001323 DOI: 10.3390/healthcare11050685] [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: 01/10/2023] [Revised: 02/01/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Our previous research on neuroendocrine and gastric cancers has shown that patients living in rural areas have worse outcomes than urban patients. This study aimed to investigate the geographic and sociodemographic disparities in esophageal cancer patients. METHODS We conducted a retrospective study on esophageal cancer patients between 1975 and 2016 using the Surveillance, Epidemiology, and End Results database. Both univariate and multivariable analyses were performed to evaluate overall survival (OS) and disease-specific survival (DSS) between patients residing in rural (RA) and urban (MA) areas. Further, we used the National Cancer Database to understand differences in various quality of care metrics based on residence. RESULTS N = 49,421 (RA [12%]; MA [88%]). The incidence and mortality rates were consistently higher during the study period in RA. Patients living in RA were more commonly males (p < 0.001), Caucasian (p < 0.001), and had adenocarcinoma (p < 0.001). Multivariable analysis showed that RA had worse OS (HR = 1.08; p < 0.01) and DSS (HR = 1.07; p < 0.01). Quality of care was similar, except RA patients were more likely to be treated at a community hospital (p < 0.001). CONCLUSIONS Our study identified geographic disparities in esophageal cancer incidence and outcomes despite the similar quality of care. Future research is needed to understand and attenuate such disparities.
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Affiliation(s)
- Yeshwanth Vedire
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Navpreet Rana
- Department of Medicine, University at Buffalo School of Medicine, Buffalo, NY 14263, USA
| | - Adrienne Groman
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Beas Siromoni
- School of Health Sciences, University of South Dakota, Vermillion, SD 57069, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Sarbajit Mukherjee
- Department of Medicine, University at Buffalo School of Medicine, Buffalo, NY 14263, USA
- Department of Hematology and Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
- Correspondence: ; Tel.: +1-716-845-1300; Fax: +1-716-845-8935
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Okeke B, Hillmon C, Jones J, Obanigba G, Obi A, Nkansah M, Odiase N, Khanipov K, Okereke IC. The relationship of social determinants and distress in newly diagnosed cancer patients. Sci Rep 2023; 13:2153. [PMID: 36750604 PMCID: PMC9905536 DOI: 10.1038/s41598-023-29375-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Patients with a new cancer diagnosis can experience distress when diagnosed. There are disparities in treatment of cancer patients based on social determinants, but minimal research exists on the relationship of those social determinants and distress after a new cancer diagnosis. Our goals were to determine the social determinants associated with distress after a new cancer diagnosis and determine the relationship of distress with outcome. Patients with a new cancer diagnosis at one institution from January 2019 to December 2020 were analyzed. Patients were given the National Comprehensive Cancer Network (NCCN) distress thermometer during their first visit. Demographics, tumor characteristics, clinical variables and survival were recorded. Patients were also asked to share specific factors that led to distress, including: (1) financial, (2) transportation, (3) childcare and (4) religious. A total of 916 patients returned distress thermometers. Mean age was 59.1 years. Females comprised 71.3 (653/916) percent of the cohort. On Dunn's multiple comparison, the following factors were associated with increased distress level: female (p < 0.01), ages 27 to 45 (p < 0.01), uninsured (p < 0.01) and unemployed (p < 0.01). Patients with higher distress scores also experienced worse overall survival (p < 0.05). Females, young patients, uninsured patients and unemployed patients experience more distress after a new cancer diagnosis. Increased distress is independently associated with worse overall survival. Social determinants can be used to predict which patients may require focused interventions to reduce distress after a new cancer diagnosis.
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Affiliation(s)
- Brandon Okeke
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Cheron Hillmon
- Department of Care Management, University of Texas Medical Branch, Galveston, TX, USA
| | - Jasmine Jones
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Grace Obanigba
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ann Obi
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Meagan Nkansah
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Nicholas Odiase
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kamil Khanipov
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna C Okereke
- Department of Surgery, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
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