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Nze C, Andersen CR, Ayers AA, Westin J, Wang M, Iyer S, Ahmed S, Pinnix C, Vega F, Nguyen L, McNeill L, Nastoupil LJ, Zhang K, Bauer CX, Flowers CR. Impact of patient demographics and neighborhood socioeconomic variables on clinical trial participation patterns for NHL. Blood Adv 2024; 8:3825-3837. [PMID: 38607394 PMCID: PMC11318327 DOI: 10.1182/bloodadvances.2023011040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 04/13/2024] Open
Abstract
ABSTRACT Prior studies have demonstrated that certain populations including older patients, racial/ethnic minority groups, and women are underrepresented in clinical trials. We performed a retrospective analysis of patients with non-Hodgkin lymphoma (NHL) seen at MD Anderson Cancer Center (MDACC) to investigate the association between trial participation, race/ethnicity, travel distance, and neighborhood socioeconomic status (nSES). Using patient addresses, we ascertained nSES variables on educational attainment, income, poverty, racial composition, and housing at the census tract (CT) level. We also performed geospatial analysis to determine the geographic distribution of clinical trial participants and distance from patient residence to MDACC. We examined 3146 consecutive adult patients with NHL seen between January 2017 and December 2020. The study cohort was predominantly male and non-Hispanic White (NHW). The most common insurance types were private insurance and Medicare; only 1.1% of patients had Medicaid. There was a high overall participation rate of 30.5%, with 20.9% enrolled in therapeutic trials. In univariate analyses, lower participation rates were associated with lower nSES including higher poverty rates and living in crowded households. Racial composition of CT was not associated with differences in trial participation. In multivariable analysis, trial participation varied significantly by histology, and participation declined nonlinearly with age in the overall, follicular lymphoma, and diffuse large B-cell lymphoma (DLBCL) models. In the DLBCL subset, Hispanic patients had lower odds of participation than White patients (odds ratio, 0.36; 95% confidence interval, 0.21-0.62; P = .001). In our large academic cohort, race, sex, insurance type, and nSES were not associated with trial participation, whereas age and diagnosis were.
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Affiliation(s)
- Chijioke Nze
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Clark R. Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amy A. Ayers
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason Westin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Wang
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Swaminathan Iyer
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chelsea Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Francisco Vega
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lynne Nguyen
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lorna McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Loretta J. Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kehe Zhang
- Department of Biostatistics and Data Science, University of Texas Health Science Center in Houston School of Public Health, Houston, TX
- Center for Spatial-Temporal Modeling for Applications in Population Sciences, University of Texas Health Science Center in Houston School of Public Health, Houston, TX
| | - Cici X. Bauer
- Department of Biostatistics and Data Science, University of Texas Health Science Center in Houston School of Public Health, Houston, TX
- Center for Spatial-Temporal Modeling for Applications in Population Sciences, University of Texas Health Science Center in Houston School of Public Health, Houston, TX
| | - Christopher R. Flowers
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
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Marôco JL, Manafi MM, Hayman LL. Race and Ethnicity Disparities in Cardiovascular and Cancer Mortality: the Role of Socioeconomic Status-a Systematic Review and Meta-analysis. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01872-3. [PMID: 38038904 DOI: 10.1007/s40615-023-01872-3] [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: 09/07/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023]
Abstract
To clarify the role of socioeconomic status (SES) in cardiovascular and cancer mortality disparities observed between Black, Hispanic, and Asian compared to White adults, we conducted a meta-analysis of the longitudinal research in the USA. A PubMed, Ovid Medline, Web of Science, and EBSCO search was performed from January 1995 to May 2023. Two authors independently screened the studies and conducted risk assessments, with conflicts resolved via consensus. Studies were required to analyze mortality data using Cox proportional hazard regression. Random-effects models were used to pool hazard ratios (HR) and reporting followed PRISMA guidelines. Twenty-two studies with cardiovascular mortality (White and Black (n = 22), Hispanic (n = 7), and Asian (n = 3) adults) and twenty-three with cancer mortality endpoints (White and Black (n = 23), Hispanic (n = 11), and Asian (n = 10) adults) were included. The meta-analytic sample for cardiovascular mortality endpoints was 6,199,049 adults (White = 4,891,735; Black = 935,002; Hispanic = 295,623; Asian = 76,689), while for cancer-specific mortality endpoints was 7,745,180 adults (White = 5,988,392; Black= 1,070,447; Hispanic= 484,848; Asian = 201,493). Median follow-up was 10 and 11 years in cohorts with cardiovascular and cancer mortality endpoints, respectively. Adjustments for SES attenuated the higher risk for cardiovascular (HR, 1.46; 95% CI, 1.30-1.64) and cancer mortality (HR, 1.35; 95% CI, 1.32-1.38) of Black compared to White adults by 25% (HR, 1.21; 95% CI, 1.15-1.28) and 19% (HR, 1.16; 95% CI, 1.13-1.18), respectively. However, the Hispanic cardiovascular (HR, 0.79; 95% CI, 0.73-0.85) and Asian cancer mortality (HR, 0.81; 95% CI, 0.76-0.86) advantage were independent of SES. These findings emphasize the need to develop strategies focused on SES to reduce cardiovascular and cancer mortality in Black adults.
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Affiliation(s)
- João L Marôco
- Integrative Human Physiology Laboratory, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA.
- Department of Exercise and Health Sciences, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA.
| | - Mahdiyeh M Manafi
- Department of Exercise and Health Sciences, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Laura L Hayman
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
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Herbach EL, Nash SH, Lizarraga IM, Carnahan RM, Wang K, Ogilvie AC, Curran M, Charlton ME. Patterns of Evidence-Based Care for the Diagnosis, Staging, and First-line Treatment of Breast Cancer by Race-Ethnicity: A SEER-Medicare Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1312-1322. [PMID: 37436422 PMCID: PMC10592343 DOI: 10.1158/1055-9965.epi-23-0218] [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: 03/10/2023] [Revised: 05/18/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in guideline-recommended breast cancer treatment are well documented, however studies including diagnostic and staging procedures necessary to determine treatment indications are lacking. The purpose of this study was to characterize patterns in delivery of evidence-based services for the diagnosis, clinical workup, and first-line treatment of breast cancer by race-ethnicity. METHODS SEER-Medicare data were used to identify women diagnosed with invasive breast cancer between 2000 and 2017 at age 66 or older (n = 2,15,605). Evidence-based services included diagnostic procedures (diagnostic mammography and breast biopsy), clinical workup (stage and grade determination, lymph node biopsy, and HR and HER2 status determination), and treatment initiation (surgery, radiation, chemotherapy, hormone therapy, and HER2-targeted therapy). Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (CI) for each service. RESULTS Black and American Indian/Alaska Native (AIAN) women had significantly lower rates of evidence-based care across the continuum from diagnostics through first-line treatment compared to non-Hispanic White (NHW) women. AIAN women had the lowest rates of HER2-targeted therapy and hormone therapy initiation. While Black women also had lower initiation of HER2-targeted therapy than NHW, differences in hormone therapy were not observed. CONCLUSIONS Our findings suggest patterns along the continuum of care from diagnostic procedures to treatment initiation may differ across race-ethnicity groups. IMPACT Efforts to improve delivery of guideline-concordant treatment and mitigate racial-ethnic disparities in healthcare and survival should include procedures performed as part of the diagnosis, clinical workup, and staging processes.
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Affiliation(s)
- Emma L. Herbach
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Sarah H. Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Ingrid M. Lizarraga
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Ryan M. Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Kai Wang
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA
| | - Amy C. Ogilvie
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Michaela Curran
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA
| | - Mary E. Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
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Urbano S, Gobbi E, Florio V, Rughetti A, Ercoli L. Protection of gender health and fight against gender violence during the COVID-19 pandemic: the experience of our street clinic in a disadvantaged suburb of Rome Metropolitan City. BMC Womens Health 2023; 23:434. [PMID: 37587488 PMCID: PMC10428561 DOI: 10.1186/s12905-023-02595-7] [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: 02/15/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECT In this study, we evaluated health, social inequalities and risk to gender violence of women living in a disadvantaged degraded suburb of Rome Metropolitan City, during COVID-19 pandemic. METHODS The study included 779 women referring to primary care services of Medicina Solidale Institute for gynecological/breast examinations (209), medical and support aid for the children (383) and COVID-19 test execution (187). RESULTS The data show that most women (68%) were unemployed or had an irregular job. The request of support varied depending on the ethnicity: while healthcare support was requested mostly by African female community, the COVID-19 test, mandatory for public transportation and work, was a need of the east-european community. Both these communities referred to Medical Solidale primary care service for the healthcare and food/clothing support for their children. It is interesting to note that the requests from the Italian women community was elevated in terms of personal healthcare, support for the children and COVID-19 test execution. The access to the national health system (NHS) resulted a complex administrative procedure despite the original social-ethnic communities. The vast majority of women lacked awareness of their crucial role for supporting the family entity, while inadequacy was commonly reported. CONCLUSIONS This study confirms a critical condition for women living in disadvantaged neighborhoods, whose vulnerability is further worsened by the limited access to primary care assistance with serious consequences for health and quality of life. Prevention and treatment, especially for the most vulnerable subjects, should be a priority for the public health system.
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Affiliation(s)
| | | | - Valeria Florio
- Gynecology Department, Fatebenefratelli Hospital, Rome, Italy
| | - Aurelia Rughetti
- Istituto Di Medicina Solidale Onlus, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Lucia Ercoli
- Istituto Di Medicina Solidale Onlus, Rome, Italy.
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.
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5
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Du XL, Song L. Age and Racial Disparities in the Utilization of Anticancer, Antihypertension, and Anti-diabetes Therapies, and in Mortality in a Large Population-Based Cohort of Older Women with Breast Cancer. J Racial Ethn Health Disparities 2023; 10:446-461. [PMID: 35040106 PMCID: PMC10721385 DOI: 10.1007/s40615-022-01235-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examined the receipt of therapies for cancer, hypertension, and diabetes in association with age and racial disparities in mortality among women with breast cancer. METHODS This study identified 92,829 women diagnosed with breast cancer at age ≥ 65 years in 2007-2015 with follow-up to 2016 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. RESULTS There were substantial age and racial disparities in the prevalence of hypertension and diabetes, which was higher in women ≥ 75 (86.3% and 32.0%) than younger women 65-74 (72.8% and 29.3%), and the highest in Black women (91.1% and 49.1%), followed by Asian women (80.2% and 40.5%), and White women (77.6 and 27.8%). Black women were significantly less likely to receive chemotherapy (odds ratio: 0.70, 95% CI: 0.64-0.75), radiation therapy (0.87, 0.83-0.92), and hormone therapy (0.80, 0.76-0.85), but significantly more likely to receive antihypertensive (1.26, 1.19-1.33) and antidiabetic (1.19, 1.10-1.28) drugs than White women, after adjusting for sociodemographic and tumor factors. As compared to White women, Black women had a significantly higher risk of all-cause mortality (1.46, 1.41-1.52), but it became insignificant after adjusting for treatment factors (1.01, 0.97-1.06), whereas the adjusted risk of breast cancer-specific mortality remained significantly higher (1.08, 1.01-1.15) in Black women; Asian and other ethnic women had a significantly lower risk of all-cause and breast cancer-specific mortality. CONCLUSIONS There were substantial age and racial disparities in the prevalence of hypertension and diabetes and in the receipt of medications. Black women did not have a significantly higher risk of all-cause mortality but had a significantly higher risk of breast cancer-specific mortality as compared to White women.
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Affiliation(s)
- Xianglin L Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX, 77030, USA.
| | - Lulu Song
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX, 77030, USA
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Acquati C, Chen TA, Martinez Leal I, Connors SK, Haq AA, Rogova A, Ramirez S, Reitzel LR, McNeill LH. The Impact of the COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer in the U.S.: A Mixed-Methods Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13084. [PMID: 34948695 PMCID: PMC8702073 DOI: 10.3390/ijerph182413084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has had critical consequences for cancer care delivery, including altered treatment protocols and delayed services that may affect patients' quality of life and long-term survival. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by treatment delays and social determinants of health (SDoH). This protocol details a mixed-methods study aimed at comparing cancer care disruption among a diverse sample of women (non-Hispanic White, non-Hispanic Black/African American, and Hispanic/Latina) and assessing how proximal, intermediate, and distal SDoH differentially contribute to care continuity and health-related quality of life. An embedded mixed-methods design will be implemented. Eligible participants will complete an online survey, followed by a semi-structured interview (with a subset of participants) to further understand factors that influence continuity of care, treatment decision-making, and self-reported engagement. The study will identify potentially modifiable factors to inform future models of care delivery and improve care transitions. These data will provide the necessary evidence to inform whether a subsequent, multilevel intervention is warranted to improve quality of care delivery in the COVID-19 aftermath. Additionally, results can be used to identify ways to leverage existing social resources to help manage and support patients' outcomes.
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Affiliation(s)
- Chiara Acquati
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX 77204, USA
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Tzuan A. Chen
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Isabel Martinez Leal
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Shahnjayla K. Connors
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Arooba A. Haq
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Anastasia Rogova
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Stephanie Ramirez
- College of Natural Sciences and Mathematics, University of Houston, 3507 Cullen Blvd, Houston, TX 77204, USA;
| | - Lorraine R. Reitzel
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Lorna H. McNeill
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
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Ingraham NE, Purcell LN, Karam BS, Dudley RA, Usher MG, Warlick CA, Allen ML, Melton GB, Charles A, Tignanelli CJ. Racial and Ethnic Disparities in Hospital Admissions from COVID-19: Determining the Impact of Neighborhood Deprivation and Primary Language. J Gen Intern Med 2021; 36:3462-3470. [PMID: 34003427 PMCID: PMC8130213 DOI: 10.1007/s11606-021-06790-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/01/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite past and ongoing efforts to achieve health equity in the USA, racial and ethnic disparities persist and appear to be exacerbated by COVID-19. OBJECTIVE Evaluate neighborhood-level deprivation and English language proficiency effect on disproportionate outcomes seen in racial and ethnic minorities diagnosed with COVID-19. DESIGN Retrospective cohort study SETTING: Health records of 12 Midwest hospitals and 60 clinics in Minnesota between March 4, 2020, and August 19, 2020 PATIENTS: Polymerase chain reaction-positive COVID-19 patients EXPOSURES: Area Deprivation Index (ADI) and primary language MAIN MEASURES: The primary outcome was COVID-19 severity, using hospitalization within 45 days of diagnosis as a marker of severity. Logistic and competing-risk regression models assessed the effects of neighborhood-level deprivation (using the ADI) and primary language. Within race, effects of ADI and primary language were measured using logistic regression. RESULTS A total of 5577 individuals infected with SARS-CoV-2 were included; 866 (n = 15.5%) were hospitalized within 45 days of diagnosis. Hospitalized patients were older (60.9 vs. 40.4 years, p < 0.001) and more likely to be male (n = 425 [49.1%] vs. 2049 [43.5%], p = 0.002). Of those requiring hospitalization, 43.9% (n = 381), 19.9% (n = 172), 18.6% (n = 161), and 11.8% (n = 102) were White, Black, Asian, and Hispanic, respectively. Independent of ADI, minority race/ethnicity was associated with COVID-19 severity: Hispanic patients (OR 3.8, 95% CI 2.72-5.30), Asians (OR 2.39, 95% CI 1.74-3.29), and Blacks (OR 1.50, 95% CI 1.15-1.94). ADI was not associated with hospitalization. Non-English-speaking (OR 1.91, 95% CI 1.51-2.43) significantly increased odds of hospital admission across and within minority groups. CONCLUSIONS Minority populations have increased odds of severe COVID-19 independent of neighborhood deprivation, a commonly suspected driver of disparate outcomes. Non-English-speaking accounts for differences across and within minority populations. These results support the ongoing need to determine the mechanisms that contribute to disparities during COVID-19 while also highlighting the underappreciated role primary language plays in COVID-19 severity among minority groups.
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Affiliation(s)
- Nicholas E. Ingraham
- Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN USA
| | - Laura N. Purcell
- Department of Surgery, University of North Carolina, Chapel Hill, NC USA
| | - Basil S. Karam
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI USA
| | - R. Adams Dudley
- Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN USA
| | - Michael G. Usher
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN USA
| | | | - Michele L. Allen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN USA
| | - Genevieve B. Melton
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN USA
- Department of Surgery, University of Minnesota, Minneapolis, MN USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina, Chapel Hill, NC USA
- School of Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Christopher J. Tignanelli
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN USA
- Department of Surgery, University of Minnesota, Minneapolis, MN USA
- Department of Surgery, North Memorial Health Hospital, Robbinsdale, MN USA
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8
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Ralli M, Urbano S, Gobbi E, Shkodina N, Mariani S, Morrone A, Arcangeli A, Ercoli L. Health and Social Inequalities in Women Living in Disadvantaged Conditions: A Focus on Gynecologic and Obstetric Health and Intimate Partner Violence. Health Equity 2021; 5:408-413. [PMID: 34235365 PMCID: PMC8237099 DOI: 10.1089/heq.2020.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: Gynecologic and obstetric health and intimate partner violence are particularly influenced by social determinants of health, such as poverty, low education, and poor nutritional status, and by ethnic and racial factors. In this study, we evaluated health and social inequalities of women living in disadvantaged neighborhoods in the city of Rome, Italy. Methods: The study included 128 women living in socioeconomically disadvantaged neighborhoods. For each woman, a medical record was compiled and a gynecologic examination with screening for cervical cancer was performed. Family network, risk factors for gender-based violence, and psychological abuse were also evaluated. Results: The largest part of the sample, although had adequate schooling, was unemployed or had a low-status job; this was at the basis of intimate partner violence in about one-third of our sample. Nearly 35% of our sample was composed of pregnant women; about half of them were not assisted by the public health system for routine obstetric examinations. Common findings at gynecologic examination for nonpregnant women were infections (n=18, 19.9%), pregnancy planning (n=13, 13.7%), menopause management (n=12, 12.6%), ovarian fibromas (n=6, 6.3%), and post-partum assistance (n=3, 3.2%). Screening for cervical cancer was executed in 62 women; 9 (14.5%) had low- or high-grade squamous intraepithelial lesion or cervical carcinoma. Conclusions: Health and social inequalities are frequent in women living in disadvantaged conditions, with serious consequences for health and quality of life of women and of their children. Prevention and treatment, especially for the most vulnerable subjects, should be a priority for the public health system.
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Affiliation(s)
- Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy.,Primary Care Services, Eleemosynaria Apostolica, Vatican City State, Vatican City
| | - Suleika Urbano
- Primary Care Services, Eleemosynaria Apostolica, Vatican City State, Vatican City.,Istituto di Medicina Solidale, Rome, Italy
| | | | - Nataliya Shkodina
- Primary Care Services, Eleemosynaria Apostolica, Vatican City State, Vatican City.,Istituto di Medicina Solidale, Rome, Italy
| | | | - Aldo Morrone
- San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Andrea Arcangeli
- Directorate of Health and Hygiene, Vatican City State, Vatican City.,Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucia Ercoli
- Primary Care Services, Eleemosynaria Apostolica, Vatican City State, Vatican City.,Istituto di Medicina Solidale, Rome, Italy.,Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
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9
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Miller MM, Meneveau MO, Rochman CM, Schroen AT, Lattimore CM, Gaspard PA, Cubbage RS, Showalter SL. Impact of the COVID-19 pandemic on breast cancer screening volumes and patient screening behaviors. Breast Cancer Res Treat 2021; 189:237-246. [PMID: 34032985 PMCID: PMC8145189 DOI: 10.1007/s10549-021-06252-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/04/2021] [Indexed: 12/14/2022]
Abstract
Purpose In order to facilitate targeted outreach, we sought to identify patient populations with a lower likelihood of returning for breast cancer screening after COVID-19-related imaging center closures. Methods Weekly total screening mammograms performed throughout 2019 (baseline year) and 2020 (COVID-19-impacted year) were compared. Demographic and clinical characteristics, including age, race, ethnicity, breast density, breast cancer history, insurance status, imaging facility type used, and need for interpreter, were compared between patients imaged from March 16 to October 31 in 2019 (baseline cohort) and 2020 (COVID-19-impacted cohort). Census data and an online map service were used to impute socioeconomic variables and calculate travel times for each patient. Logistic regression was used to identify patient characteristics associated with a lower likelihood of returning for screening after COVID-19-related closures. Results The year-over-year cumulative difference in screening mammogram volumes peaked in week 21, with 2962 fewer exams in the COVID-19-impacted year. By week 47, this deficit had reduced by 49.4% to 1498. A lower likelihood of returning for screening after COVID-19-related closures was independently associated with younger age (odds ratio (OR) 0.78, p < 0.001), residence in a higher poverty area (OR 0.991, p = 0.014), lack of health insurance (OR 0.65, p = 0.007), need for an interpreter (OR 0.68, p = 0.029), longer travel time (OR 0.998, p < 0.001), and utilization of mobile mammography services (OR 0.27, p < 0.001). Conclusion Several patient factors are associated with a lower likelihood of returning for screening mammography after COVID-19-related closures. Knowledge of these factors can guide targeted outreach to vulnerable patients to facilitate breast cancer screening. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06252-1.
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Affiliation(s)
- Matthew M Miller
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA.
| | - Max O Meneveau
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Carrie M Rochman
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Anneke T Schroen
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Courtney M Lattimore
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Patricia A Gaspard
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Richard S Cubbage
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Shayna L Showalter
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
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10
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Ingraham NE, Purcell LN, Karam BS, Dudley RA, Usher MG, Warlick CA, Allen ML, Melton GB, Charles A, Tignanelli CJ. Racial/Ethnic Disparities in Hospital Admissions from COVID-19 and Determining the Impact of Neighborhood Deprivation and Primary Language. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32909015 DOI: 10.1101/2020.09.02.20185983] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Despite past and ongoing efforts to achieve health equity in the United States, persistent disparities in socioeconomic status along with multilevel racism maintain disparate outcomes and appear to be amplified by COVID-19. Objective Measure socioeconomic factors and primary language effects on the risk of COVID-19 severity across and within racial/ethnic groups. Design Retrospective cohort study. Setting Health records of 12 Midwest hospitals and 60 clinics in the U.S. between March 4, 2020 to August 19, 2020. Patients PCR+ COVID-19 patients. Exposures Main exposures included race/ethnicity, area deprivation index (ADI), and primary language. Main Outcomes and Measures The primary outcome was COVID-19 severity using hospitalization within 45 days of diagnosis. Logistic and competing-risk regression models (censored at 45 days and accounting for the competing risk of death prior to hospitalization) assessed the effects of neighborhood-level deprivation (using the ADI) and primary language. Within race effects of ADI and primary language were measured using logistic regression. Results 5,577 COVID-19 patients were included, 866 (n=15.5%) were hospitalized within 45 days of diagnosis. Hospitalized patients were older (60.9 vs. 40.4 years, p<0.001) and more likely to be male (n=425 [49.1%] vs. 2,049 [43.5%], p=0.002). Of those requiring hospitalization, 43.9% (n=381), 19.9% (n=172), 18.6% (n=161), and 11.8% (n=102) were White, Black, Asian, and Hispanic, respectively. Independent of ADI, minority race/ethnicity was associated with COVID-19 severity; Hispanic patients (OR 3.8, 95% CI 2.72-5.30), Asians (OR 2.39, 95% CI 1.74-3.29), and Blacks (OR 1.50, 95% CI 1.15-1.94). ADI was not associated with hospitalization. Non-English speaking (OR 1.91, 95% CI 1.51-2.43) significantly increased odds of hospital admission across and within minority groups. Conclusions Minority populations have increased odds of severe COVID-19 independent of neighborhood deprivation, a commonly suspected driver of disparate outcomes. Non-English-speaking accounts for differences across and within minority populations. These results support the continued concern that racism contributes to disparities during COVID-19 while also highlighting the underappreciated role primary language plays in COVID-19 severity across and within minority groups.
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11
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Nama N, Cason FD, Misra S, Hai S, Tucci V, Haq F, Love J, Ullah A, Peterson P, Grishko FF, Akbar W, Khaliq K, Waheed A. Carcinosarcoma of the Uterus: A Study From the Surveillance Epidemiology and End Result (SEER) Database. Cureus 2020; 12:e10283. [PMID: 33042718 PMCID: PMC7538206 DOI: 10.7759/cureus.10283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Uterine cancer (UC) is one of the leading gynecologic neoplastic disorders in the United States (US), of which over 80% are endometrioid adenocarcinomas (EA). In contrast to EA, carcinosarcoma (CS) of the uterus is a sporadic and highly malignant tumor, phylogenetically containing both epithelial and mesenchymal histologic elements. This study sought to analyze demographic, pathological retrospectively, and survival characteristics of a large cohort of CS patients compared to EA patients to identify prognostic factors and treatment approaches that may improve the current clinical management of CS patients. Methods: Demographic and clinical data were abstracted from 88,530 patients diagnosed with uterine malignancy from the Surveillance, Epidemiology, and End Results (SEER) database for 38 years (1973-2010). Extracted variables were analyzed using the Chi-square test, paired t-test, and multivariate analysis, while Kaplan-Meier functions were used to compare survival between groups. Statistical analyses were performed with IBM Statistical Product and Service Solutions (SPSS©), version 20.2 (IBM Corp., Armonk, NY). Results: A total of 3,706 cases of CS comprised 38.2% of uterine sarcomas (n=9,702), and 4.1% of uterine cancers overall (n=88,530). EA made up 88.6% (n=78,481) of all uterine cancers. CS patients presented later in life (68.3±11.5 years) than EA (61.9±12.5 years). 65.2% of CS and 77.8% of EA occurred in Caucasians. The incidence (per million) of EA was higher in Caucasians compared to African-Americans (AA) (41% vs. 26.8%), while the incidence of CS was higher among AA than Caucasians (4% vs. 1.9%, p<0.001). 33.4% of CS was poorly differentiated at presentation, compared to 13.1% of EA. 27.8% of CS patients presented with a distant disease compared to only 4.7% of EA patients. 29.9% of AA patients with CS presented with metastatic disease, compared to 28.2% of Caucasian patients (p<0.001). Mean survival for CS patients (6.6±0.2 years) was significantly lower than that of EA patients (17.7±0.7 years, p<0.001), and AA CS patients had significantly lower survival than Caucasians CS patients (4.5±0.4 years vs. 7.1±0.3 years, p<0.001). CS patients treated with combined surgery and radiotherapy had the highest survival (9.4±0.5 years, p<0.001), while EA patients treated with surgery alone had the highest survival (20.4±1.2 years, p<0.001). Survival among AA CS patients treated with combination therapy was significantly inferior compared to Caucasians (6.5±0.6 years vs. 9.8±0.5 years, p<0.001). Multivariate analysis identified CS histology (odds ratio [OR] 1.9, CI=1.7-2.1), AA race (OR 1.3, CI=1.2-1.4), age over 40 (OR 3.4, CI=2.9-4.1), undifferentiated grade (OR 3.0, CI=2.6-3.4), and distant metastases (OR 6.2, CI=5.8-6.8) as independently associated with increased mortality (p<0.005). The use of radiotherapy in CS patients was independently associated with decreased mortality (OR 0.1, CI=0.02-0.6, p<0.005). Conclusions: Uterine CS is a highly malignant tumor with a significantly worse prognosis than EA. AA has a considerably higher CS incidence compared to EA. Moreover, AA CS had higher tumor grades, higher rates of metastatic disease, and experienced significantly lower overall survival compared to Caucasians despite receiving similar therapy. Primary radiotherapy or combination radiotherapy confers a survival advantage to AA uterine CS patients.
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Affiliation(s)
- Noor Nama
- Obstetrics and Gynaecology, Bolan Medical College, Quetta, PAK
| | | | | | - Shaikh Hai
- Surgery, Hospital Corporation of America East Florida Graduate Medical Education Consortium, Plantation, USA
| | - Veronica Tucci
- Emergency Medicine, Hospital Corporation of America East Florida Graduate Medical Education Consortium, Plantation, USA
| | - Furqan Haq
- Medicine, Hospital Corporation of America West Florida, Tampa, USA
| | - Joseph Love
- Surgery, Bayonet Point Regional Medical Center, Hudson, USA
| | - Asad Ullah
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Pete Peterson
- Surgery, University of South Florida Health, Tampa, USA
| | | | - Wazir Akbar
- Neurology, Bolan Medical College, Quetta, PAK
| | - Khalida Khaliq
- Psychiatry and Medicine, North Tampa Behavioral Health, Tampa, USA
| | - Abdul Waheed
- Surgery, Sandeman Provincial Hospital, Quetta, PAK
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Blankensteijn LL, Sparenberg S, Crystal DT, Ibrahim AMS, Lee BT, Lin SJ. Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP. J Reconstr Microsurg 2020; 36:592-599. [PMID: 32557451 DOI: 10.1055/s-0040-1713174] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In various surgical specialties, racial disparities in postoperative complications are widely reported. It is assumed that the effect of race can also be found in plastic surgical outcomes, although this remains largely undefined in literature. This study aims to provide data on the impact of race on outcomes of reconstructive breast surgery. METHODS Data were collected using the NSQIP (National Surgical Quality Improvement Program) database (2008-2016). Outcomes of the reconstructive breast surgery of White patients were compared with those of African American, Asian, or other races. Logistic regression was performed to control for variations between all groups. Analysis of racial disparities was further sub-stratified according to four different types of breast reconstruction: delayed or immediate autologous, and delayed or immediate prosthesis-based reconstruction. RESULTS In total, this study included 51,362 patients of which 43,864 were Caucasian, 5,135 African American, 2,057 Asian, and 332 of other races. When compared with White patients, patients of African American race had larger body mass indices (31.3 ± 7.0 vs. 27.6 ± 6.3, p-value < 0.001) in addition to higher rates of diabetes (12.3 vs 4.6%, p-value < 0.001) and hypertension (44.7 vs. 23.4%, p-value < 0.001). Both multivariate analysis and the sub-stratified analysis of different types of reconstruction showed no differences in overall complication rate. CONCLUSION Among the four types of reconstructive procedures, differences in surgical outcomes do not appear to be based on race and therefore seem to be less evident in reconstructive breast surgery compared with the current literature within other surgical specialties.
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Affiliation(s)
- Louise L Blankensteijn
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sebastian Sparenberg
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Dustin T Crystal
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ahmed M S Ibrahim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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13
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Racial/ethnic disparities in penile squamous cell carcinoma incidences, clinical characteristics, and outcomes: A population-based study, 2004-2016. Urol Oncol 2020; 38:688.e11-688.e19. [PMID: 32340796 DOI: 10.1016/j.urolonc.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/23/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE This study assessed the impact of race/ethnicity on penile squamous cell carcinoma (PSCC) incidence rates, clinical characteristics, and outcomes. MATERIALS AND METHODS Surveillance, Epidemiology and End Results data from 2004 to 2016 was used for this study. We evaluated racial/ethnic differences in clinical characteristics using χ2 tests. Overall survival (OS) and PSCC-specific survival (PSCC-SS) were estimated using the Kaplan-Meier method, and differences were determined using the log-rank test. Cox regression models were performed to assess independent predictors for PSCC patient survival. RESULTS A total of 2,720 PSCC patients were included for incidence analysis, and 2,438 patients were identified for the χ2 testing and survival analyses.The overall incidence of PSCC during 2004 to 2016 was 0.30 per 100,000. Only non-Hispanic white (NHW) patients had a statistically significant increase in age-adjusted incidence rates (annual percent change = 2.26, 95% confidence interval [CI]: 0.78-3.76; P = 0.01). In univariate analysis, race/ethnicity was an independent prognostic factor for OS and PSCC-SS. After adjusting for age, marital status, income, grade, TNM (tumor, node, metastasis) stage, and treatment strategies, non-Hispanic black patients still had a statistically significant hazard ratio of 1.35 (95% CI: 1.08-1.68; P = 0.007) for OS, and a hazard ratio of 1.36 (95% CI: 1.01-1.82; P = 0.045) for PSCC-SS compared to NHW. CONCLUSION NHW patients had a statistically significant increase in age-adjusted incidence rate during the period 2004 to 2016. Race/ethnicity is an independent prognostic factor for OS and PSCC-SS, and non-Hispanic black were proven to have unfavorable OS and PSCC-SS compared with NHW.
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14
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Wu HS, Davis JE, Chen L. Impact of Comorbidity on Symptoms and Quality of Life Among Patients Being Treated for Breast Cancer. Cancer Nurs 2020; 42:381-387. [PMID: 29933307 DOI: 10.1097/ncc.0000000000000623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer patients often have other noncancer medical conditions. Presence of comorbidities negatively affects cancer survival. OBJECTIVE The aim of this study was to investigate comorbidity, risk factors for comorbidity, and how comorbidity was associated with symptoms and quality of life in patients being treated for breast cancer. METHODS One hundred and one breast cancer chemotherapy outpatients completed this study. Comorbid conditions, weight, height, and smoking status were identified by chart review. Symptoms and quality of life were self-reported using psychometrically sound instruments. Log-linear regression analyses with age as the covariate examined impact of ethnicity, body mass index (BMI), and smoking on comorbidities. RESULTS Approximately 84% of the participants had 1 or more comorbid conditions. Adjusting for age, number of comorbidities differed by BMI (P = .000); the obese group had significantly more comorbidities than the normal and overweight groups. The interaction between BMI and smoking was significant (P = .047). The obese participants who smoked had significantly more comorbidities compared with those who were obese but did not smoke (P = .001). More comorbid conditions were associated with greater pain (P < .05) and poorer sleep quality (P < .05). Comorbidity significantly correlated with symptoms and functional aspects of quality of life (P < .01 and P < .05, respectively). A greater number of comorbidities was associated with lower physical and role functioning and worse fatigue, dyspnea, appetite loss, and nausea and vomiting (all P < .05). CONCLUSIONS Comorbidity exerts negative impacts on symptoms and quality of life. Weight and smoking status are strong determinants of breast cancer comorbidity. IMPLICATIONS FOR PRACTICE Personalized care planning, weight management, and smoking cessation may lead to better cancer outcomes.
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Affiliation(s)
- Horng-Shiuann Wu
- Author Affiliations: Goldfarb School of Nursing at Barnes-Jewish College (Drs Wu and Davis); and Washington University in St Louis (Dr Chen), St Louis, Missouri
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15
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San Miguel Y, Gomez SL, Murphy JD, Schwab RB, McDaniels-Davidson C, Canchola AJ, Molinolo AA, Nodora JN, Martinez ME. Age-related differences in breast cancer mortality according to race/ethnicity, insurance, and socioeconomic status. BMC Cancer 2020; 20:228. [PMID: 32178638 PMCID: PMC7076958 DOI: 10.1186/s12885-020-6696-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We assessed breast cancer mortality in older versus younger women according to race/ethnicity, neighborhood socioeconomic status (nSES), and health insurance status. METHODS The study included female breast cancer cases 18 years of age and older, diagnosed between 2005 and 2015 in the California Cancer Registry. Multivariable Cox proportional hazards modeling was used to generate hazard ratios (HR) of breast cancer specific deaths and 95% confidence intervals (CI) for older (60+ years) versus younger (< 60 years) patients separately by race/ethnicity, nSES, and health insurance status. RESULTS Risk of dying from breast cancer was higher in older than younger patients after multivariable adjustment, which varied in magnitude by race/ethnicity (P-interaction< 0.0001). Comparing older to younger patients, higher mortality differences were shown for non-Hispanic White (HR = 1.43; 95% CI, 1.36-1.51) and Hispanic women (HR = 1.37; 95% CI, 1.26-1.50) and lower differences for non-Hispanic Blacks (HR = 1.17; 95% CI, 1.04-1.31) and Asians/Pacific Islanders (HR = 1.15; 95% CI, 1.02-1.31). HRs comparing older to younger patients varied by insurance status (P-interaction< 0.0001), with largest mortality differences observed for privately insured women (HR = 1.51; 95% CI, 1.43-1.59) and lowest in Medicaid/military/other public insurance (HR = 1.18; 95% CI, 1.10-1.26). No age differences were shown for uninsured women. HRs comparing older to younger patients were similar across nSES strata. CONCLUSION Our results provide evidence for the continued disparity in Black-White breast cancer mortality, which is magnified in younger women. Moreover, insurance status continues to play a role in breast cancer mortality, with uninsured women having the highest risk for breast cancer death, regardless of age.
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Affiliation(s)
- Yazmin San Miguel
- Moores Cancer Center, University of California San Diego, La Jolla, CA USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA USA
| | - James D. Murphy
- Moores Cancer Center, University of California San Diego, La Jolla, CA USA
| | - Richard B. Schwab
- Moores Cancer Center, University of California San Diego, La Jolla, CA USA
| | | | - Alison J. Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | | | - Jesse N. Nodora
- Moores Cancer Center, University of California San Diego, La Jolla, CA USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA USA
| | - Maria Elena Martinez
- Moores Cancer Center, University of California San Diego, La Jolla, CA USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA USA
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Farias AJ, Ochoa CY, Toledo G, Bang SI, Hamilton AS, Du XL. Racial/ethnic differences in patient experiences with health care in association with earlier stage at breast cancer diagnosis: findings from the SEER-CAHPS data. Cancer Causes Control 2020; 31:13-23. [PMID: 31797123 PMCID: PMC7443934 DOI: 10.1007/s10552-019-01254-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/25/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Black women are more likely to be diagnosed with later stage breast cancer compared to white women due to biological or access to care factors. Therefore, our objective was to identify whether racial/ethnic differences in patient experiences with healthcare are associated with stage at diagnosis. METHODS We used the SEER registry data linked with patient surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) completed prior to the diagnosis date. We examined responses about various aspects of their care such as the ability to get needed care, and to get care quickly. We used multivariable linear regression to examine racial/ethnic differences in patient experiences, and a multivariable ordinal logistic regression to determine the association between patient experiences and earlier stage at diagnosis. RESULTS Of the 10,144 patients, 80.7% were non-Hispanic white, 7.6% black, 7.1% Hispanic, and 4.6% Asian. After controlling for potential confounders, black patients had significantly lower mean scores for getting care quickly (β = - 2.78), getting needed care (β = - 2.26), getting needed prescription drugs (β = - 3.83), and lower ratings of their health care (β = - 2.33) compared to white patients. More importantly, we found that black patients who reported a 1-unit increase in rating of their experiences with customer service (OR 1.04, 95% CI 1.01-1.06) and the ability to get care quickly (OR 1.03, 1.01-1.05) had higher odds of earlier stage breast cancer. CONCLUSION Racial/ethnic minorities reported poorer patient experiences with care preceding a diagnosis of breast cancer. Better ratings among black patients were associated with earlier stage at diagnosis.
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Affiliation(s)
- Albert J Farias
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA.
- Gehr Family Center for Health System Science, Keck School of Medicine of the University of Southern California, Los Angeles, USA.
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 1200 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA.
| | - Carol Y Ochoa
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Gabriela Toledo
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Soo-In Bang
- Department of Pharmaceutical and Health Economics, School of Pharmacy, Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Xianglin L Du
- Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, University of Texas Health Science Center At Houston, Houston, USA
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17
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Jang B, Chang JH. Socioeconomic status and survival outcomes in elderly cancer patients: A national health insurance service-elderly sample cohort study. Cancer Med 2019; 8:3604-3613. [PMID: 31066516 PMCID: PMC6601595 DOI: 10.1002/cam4.2231] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We hypothesized that lower socioeconomic status (SES) was associated with higher all-cause mortality in patients newly diagnosed with cancer, particularly in the elderly population. METHODS We collected study patients from the stratified random sample of Korean National Health Insurance Elderly Cohort (2002-2015). The Cox's proportional hazards model was used to investigate the risk factors for mortality. Income level and composite deprivation index (CDI) 2010 were used to define the SES: low, intermediate, and high SES groups. The comorbidities were measured using Charlson Comorbidity Index score. After a wash-out period (2002), the final study population was 108 626 (2003-2015). RESULTS In multivariate analysis, low SES was associated with poor overall survival (OS) (HR = 1.08, 95% CI: 1.05-1.12, P < 0.001) and cancer-specific survival (CSS) (HR = 1.11, 95% CI: 1.06-1.16, P < 0.001) particularly for patients aged 70-79 years. High SES was favorable prognostic factor of OS in patients aged 60-69 years (HR = 0.85, 95% CI: 0.81-0.89, P < 0.001), 70-79 years (HR = 0.90, 95% CI: 0.87-0.93, P < 0.001), and ≥80 years (HR = 0.91, 95% CI: 0.87-0.96, P < 0.001). However, SES was not associated with CSS in advanced age patients (≥80 years). Patients with low SES manifesting colorectal, urinary, liver, gastric, melanoma, and esophageal cancers demonstrated worse OS, compared to patients with intermediate SES. Also, low SES patients with urinary, liver, or colorectal cancers or melanoma demonstrated worse CSS compared to those with intermediate SES. CONCLUSION Low SES at the time of cancer diagnosis is associated with increased risk of OS and CSS in elderly patients. Depending on cancer sites, different patterns of OS and CSS were observed according to SES. Further elucidation of the causes underlying these phenomena is needed along with appropriate support for elderly cancer patients with low SES.
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Affiliation(s)
- Bum‐Sup Jang
- Department of Radiation OncologySeoul National University Bundang HospitalSeoulSouth Korea
| | - Ji Hyun Chang
- Department of Radiation OncologySMG-SNU Boramae Medical CenterSeoulSouth Korea
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Saini G, Ogden A, McCullough LE, Torres M, Rida P, Aneja R. Disadvantaged neighborhoods and racial disparity in breast cancer outcomes: the biological link. Cancer Causes Control 2019; 30:677-686. [PMID: 31111277 PMCID: PMC7043809 DOI: 10.1007/s10552-019-01180-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
Neighborhoods encompass complex environments comprised of unique economic, physical, and social characteristics that have a profound impact on the residing individual's health and, collectively, on the community's wellbeing. Neighborhood disadvantage (ND) is one of several factors that prominently contributes to racial breast cancer (BC) health disparities in American women. African American (AA) women develop more aggressive breast cancer features, such as triple-negative receptor status and more advanced histologic grade and tumor stage, and suffer worse clinical outcomes than European American (EA) women. While the adverse effects of neighborhood disadvantage on health, including increased risk of cancer and decreased longevity, have recently come into focus, the specific molecular mechanisms by which neighborhood disadvantage increases BC risk and worsens BC outcomes (survivorship, recurrence, mortality) are not fully elucidated. This review illuminates the probable biological links between neighborhood disadvantage and predominantly BC risk, with an emphasis on stress reactivity and inflammation, epigenetics and telomere length in response to adverse neighborhood conditions.
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Affiliation(s)
- Geetanjali Saini
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Angela Ogden
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Mylin Torres
- Department of Radiation Oncology, Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Padmashree Rida
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA.
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Raab GT, Lin A, Hillyer GC, Keller D, O'Neil DS, Accordino MK, Buono DL, Hur C, Kiran RP, Wright JD, Hershman DL, Neugut AI. Use of Bevacizumab for Elderly Patients With Stage IV Colon Cancer: Analysis of SEER-Medicare Data. Clin Colorectal Cancer 2019; 18:e294-e299. [PMID: 31266707 DOI: 10.1016/j.clcc.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bevacizumab is used for the treatment of metastatic colon cancer in conjunction with first-line chemotherapy. In this study, we examined receipt of first-line bevacizumab and predictors of its use among older patients with stage IV colon cancer. MATERIALS AND METHODS We used data from the Surveillance, Epidemiology, and End Results-Medicare dataset to identify patients with stage IV colon cancer diagnosed from 2005 to 2013 who received FOLFOX (5-fluorouracil/leucovorin/oxaliplatin) or FOLFIRI (5-fluorouracil/leucovorin/irinotecan) as first-line therapy. We used multivariable regression analysis to determine demographic and clinical factors associated with use of concomitant bevacizumab. RESULTS We identified 3785 patients with stage IV colon cancer who met our eligibility criteria. Of these, 2352 (62.1%) received bevacizumab. Bevacizumab use has decreased over time from 68.2% in 2005 to 57.6% in 2013 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.91-0.97). Patients were less likely to receive bevacizumab if they were older (compared with 65-69 years, ≥ 80 years: OR, 0.64; 95% CI, 0.52-0.80), or had multiple comorbidities (compared with comorbidity score of 0, score of 1: OR, 0.73; 95% CI, 0.60-0.89). CONCLUSION Over one-half of elderly patients received bevacizumab as part of their first-line therapy for stage IV colon cancer. Bevacizumab use has been slowly decreasing since 2005. Newer anti-epidermal growth factor receptor treatments have not been supplanting bevacizumab, as first-line biologic use in general has also decreased during this time period.
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Affiliation(s)
- Gabriel T Raab
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Aijing Lin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Grace Clarke Hillyer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Deborah Keller
- Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Daniel S O'Neil
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Melissa Kate Accordino
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Donna L Buono
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Chin Hur
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Ravi P Kiran
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jason D Wright
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Dawn L Hershman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Alfred I Neugut
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY.
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20
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Eaglehouse YL, Georg MW, Shriver CD, Zhu K. Racial Differences in Time to Breast Cancer Surgery and Overall Survival in the US Military Health System. JAMA Surg 2019; 154:e185113. [PMID: 30673075 DOI: 10.1001/jamasurg.2018.5113] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Racial disparities in time to surgery (TTS) after a breast cancer diagnosis and whether these differences account for disparities in overall survival have been understudied in the US population. Objectives To compare TTS in non-Hispanic black (NHB) and non-Hispanic white (NHW) women with breast cancer and to examine whether racial differences in TTS may explain possible racial disparities in overall survival in a universal health care system. Design, Setting, and Participants Retrospective cohort identified from the Department of Defense Central Cancer Registry and Military Health System Data Repository linked databases containing records between January 1, 1998, and December 31, 2008, of 998 NHB women and 3899 NHW women who received a diagnosis of stages I to III breast cancer and underwent breast-conserving surgery (BCS) or mastectomy in the US Military Health System during the study period. Data analyses were conducted from July 5, 2017, to December 29, 2017. Main Outcomes and Measures The main outcome was time to breast cancer surgery. Non-Hispanic black and NHW women were compared at the 25th, 50th (median), 75th, and 90th percentiles of TTS by using multivariable quantile regression. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for all-cause death in NHB compared with NHW women after controlling for potential confounders first without and then with TTS. Results Among the 4887 NHB and NHW women in the cohort, the mean (SD) age was 50.0 (9.4) years. The median TTS was 21 days (95% CI, 20.6-21.4 days) among NHW women and 22 days (95% CI, 20.6-23.4 days) among NHB women. Non-Hispanic black women had a significantly greater estimated TTS at the 75th (3.6 days; 95% CI, 1.6-5.5 days) and 90th (8.9 days; 95% CI, 5.1-12.6 days) percentiles than NHW women in multivariable models. The estimated differences were similar by surgery type. Non-Hispanic black women had a higher adjusted risk for death (HR, 1.45; 95% CI, 1.06-2.01) compared with NHW women among patients receiving breast-conserving surgery. The risks were similar between races among those receiving mastectomy (HR, 1.06; 95% CI, 0.76-1.48). The HRs remained similar after adding TTS to the Cox proportional hazards regression models. Conclusions and Relevance This study's results indicate that time to breast cancer surgery was delayed for NHB compared with NHW women in the Military Health System. However, the racial differences in TTS did not explain the observed racial differences in overall survival among women who received breast-conserving surgery.
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Affiliation(s)
- Yvonne L Eaglehouse
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
| | - Matthew W Georg
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Craig D Shriver
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
| | - Kangmin Zhu
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
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21
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Neugut AI, Lin A, Raab GT, Hillyer GC, Keller D, O'Neil DS, Accordino MK, Kiran RP, Wright J, Hershman DL. FOLFOX and FOLFIRI Use in Stage IV Colon Cancer: Analysis of SEER-Medicare Data. Clin Colorectal Cancer 2019; 18:133-140. [PMID: 30878317 DOI: 10.1016/j.clcc.2019.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Shortly after the year 2000, randomized trials demonstrated that patients with metastatic colon cancer treated with infusional 5-fluorouracil (5-FU)/leucovorin with either oxaliplatin (FOLFOX) or irinotecan (FOLFIRI) had a comparable progression-free survival benefit, superior to patients who received 5-FU/leucovorin alone. Factors associated with the initial receipt of the FOLFOX or FOLFIRI regimen are unknown. Our goal was to investigate the patterns and predictors of use for first-line FOLFOX and FOLFIRI. PATIENTS AND METHODS We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data set to identify patients with newly diagnosed stage IV colon cancer between the years 2005 and 2013 who received either first-line FOLFOX or FOLFIRI. We used logistic regression to assess demographic and clinical predictors for FOLFOX versus FOLFIRI. Survival was compared by Kaplan-Meier models. RESULTS Overall, 3000 patients (79.3%) received FOLFOX and 785 (20.7%) FOLFIRI. FOLFOX was associated with later year of diagnosis (odds ratio [OR] = 0.66, 95% confidence interval [CI], 0.54 to 0.82 for 2011-2013 vs. 2005-2007), being female (OR = 0.82; 95% CI 0.69 to 0.98), and living in the southern region of the United States. FOLFIRI was associated with having a higher comorbidity index (OR = 1.33; 95% CI, 1.07 to 1.67 for >1 comorbidity score vs. 0). There was no survival difference observed between the two treatments. CONCLUSION The majority of SEER-Medicare patients received FOLFOX and not FOLFIRI as a first-line treatment for stage IV colon cancer. Several demographic and clinical factors were associated with the use of each specific regimen. No survival difference was detected for the 2 groups.
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Affiliation(s)
- Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
| | - Aijing Lin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Gabriel T Raab
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Grace Clarke Hillyer
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Deborah Keller
- Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Daniel S O'Neil
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Melissa Kate Accordino
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Ravi P Kiran
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jason Wright
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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22
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Farias AJ, Wu WH, Du XL. Racial differences in long-term adjuvant endocrine therapy adherence and mortality among Medicaid-insured breast cancer patients in Texas: Findings from TCR-Medicaid linked data. BMC Cancer 2018; 18:1214. [PMID: 30514270 PMCID: PMC6280479 DOI: 10.1186/s12885-018-5121-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/21/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There are racial/ethnic disparities in breast cancer mortality may be attributed to differences in receipt of adjuvant cancer treatment. Our purpose was to determine whether the mortality disparities could be explained by racial/ethnic differences in long-term adherence to adjuvant endocrine therapy (AET). METHODS We conducted a retrospective cohort study with the Texas Cancer Registry and Medicaid claims-linked dataset of women (20-64 years) diagnosed with local and regional breast cancer who filled a prescription for AET from 2000-2008. Adherence to AET was measured at three time points (1-, 3-, and 5-year adherence) using a value for the percentage of medication filled for each period divided by the total number of possible prescriptions prescribed (Medication Possession Ratio, MPR). We created a binary variable of adherence (MPR≥80%). We performed multivariable logistic regressions to assess racial differences for the odds of AET adherence and Cox proportional hazard models to determine the risk of mortality adjusting for potential confounding variables of SES, comorbidities, tumor prognostic factors, and other cancer treatment. RESULTS Of the 1,497 women with breast cancer who initiated AET, 56.9%, 42.3%, and 33.3% were adherent for 1, 3, and 5-years, respectively. Hispanics compared to non-Hispanic whites did differ in the proportion that were adherent to 5-years of AET. In the adjusted analysis for long-term adherence to AET, Hispanics did not have a significantly increased risk of death compared to non-Hispanic white patients (HR: 1.13, 95% CI: 0.58-2.21). However, black compared to non-Hispanic white patients had significantly lower odds of three-year adherence (OR: 0.45, 95% CI: 0.28-0.73). After controlling for 5-year adherence to AET, the risk of death for black compared to non-Hispanic white patients was 12% lower (HR: 1.90; 95% CI: 1.03-3.51) and in the fully adjusted model, the disparity was reduced and no longer significant (OR: 1.86, 95% CI: 0.94-3.66). CONCLUSIONS Long-term adherence in the Medicaid population is suboptimal and racial/ethnic differences in AET adherence may partially explain disparities in mortality. This study underscores the critical need to ensure long-term adherence to AET for all racial/ethnic groups to decrease disparities in mortality.
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Affiliation(s)
- Albert J. Farias
- Department of Preventive Medicine, Gehr Family Center for Health Systems Science, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA 90032 USA
| | - Wen-Hsing Wu
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX USA
| | - Xianglin L. Du
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX USA
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23
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Galvin A, Helmer C, Coureau G, Amadeo B, Joly P, Sabathé C, Monnereau A, Baldi I, Rainfray M, Soubeyran P, Delva F, Mathoulin-Pélissier S. Determinants of cancer treatment and mortality in older cancer patients using a multi-state model: Results from a population-based study (the INCAPAC study). Cancer Epidemiol 2018; 55:39-44. [DOI: 10.1016/j.canep.2018.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
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24
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Farias AJ, Wu WH, Du XL. Racial and geographic disparities in adherence and discontinuation to adjuvant endocrine therapy in Texas Medicaid-insured patients with breast cancer. Med Oncol 2018; 35:113. [PMID: 29926275 DOI: 10.1007/s12032-018-1168-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/13/2018] [Indexed: 12/22/2022]
Abstract
The purpose of the study is to examine disparities in AET adherence and discontinuation among Texas Medicaid-insured early-stage breast cancer patients. Texas Cancer Registry Medicaid-linked database was used from 2000 to 2007 for breast cancer patients aged 20-64. Multivariable logistic regression was performed to test the association of race/ethnicity and geographic factors with AET adherence and discontinuation. Of the 1240 women with breast cancer, 60.8% of non-Hispanic white vs 46.6% of Black patients were adherent to AET in the first year. After adjusting for confounding, Black patients had lower odds of adherence compared to non-Hispanic white patients (Odds ratio 0.62, 95% CI 0.44-0.87), but they were not more likely to discontinue therapy during the study period. Patients from the Texas/Mexico border had higher odds of adherence compared to other regions (OR 2.32, 95% CI 1.29-4.18). There are substantial racial and geographic disparities in AET adherence and discontinuation among Texas Medicaid-insured women.
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Affiliation(s)
- Albert J Farias
- Department of Preventive Medicine, The Gehr Family Center for Health Systems Science, Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, 2001 N. Soto St, Suite 318B, Los Angeles, CA, 90032, USA.
| | - Wen-Hsing Wu
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Xianglin L Du
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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25
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Kong AL, Nattinger AB, McGinley E, Pezzin LE. The relationship between patient and tumor characteristics, patterns of breast cancer care, and 5-year survival among elderly women with incident breast cancer. Breast Cancer Res Treat 2018; 171:477-488. [DOI: 10.1007/s10549-018-4837-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022]
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26
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Prieto D, Soto-Ferrari M, Tija R, Peña L, Burke L, Miller L, Berndt K, Hill B, Haghsenas J, Maltz E, White E, Atwood M, Norman E. Literature review of data-based models for identification of factors associated with racial disparities in breast cancer mortality. Health Syst (Basingstoke) 2018; 8:75-98. [PMID: 31275571 PMCID: PMC6598506 DOI: 10.1080/20476965.2018.1440925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 01/03/2023] Open
Abstract
In the United States, early detection methods have contributed to the reduction of overall breast cancer mortality but this pattern has not been observed uniformly across all racial groups. A vast body of research literature shows a set of health care, socio-economic, biological, physical, and behavioural factors influencing the mortality disparity. In this paper, we review the modelling frameworks, statistical tests, and databases used in understanding influential factors, and we discuss the factors documented in the modelling literature. Our findings suggest that disparities research relies on conventional modelling and statistical tools for quantitative analysis, and there exist opportunities to implement data-based modelling frameworks for (1) exploring mechanisms triggering disparities, (2) increasing the collection of behavioural data, and (3) monitoring factors associated with the mortality disparity across time.
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Affiliation(s)
- Diana Prieto
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - Milton Soto-Ferrari
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Department of Marketing and Operations, Scott College of Business, Terre Haute, IN, USA
| | - Rindy Tija
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Lorena Peña
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Leandra Burke
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Lisa Miller
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Kelsey Berndt
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Brian Hill
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jafar Haghsenas
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Ethan Maltz
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Evan White
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Maggie Atwood
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Earl Norman
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Galvin A, Delva F, Helmer C, Rainfray M, Bellera C, Rondeau V, Soubeyran P, Coureau G, Mathoulin-Pélissier S. Sociodemographic, socioeconomic, and clinical determinants of survival in patients with cancer: A systematic review of the literature focused on the elderly. J Geriatr Oncol 2018; 9:6-14. [DOI: 10.1016/j.jgo.2017.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/03/2017] [Accepted: 07/10/2017] [Indexed: 01/06/2023]
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28
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Vijayasiri G, Molina Y, Chukwudozie IB, Tejeda S, Pauls HA, Rauscher GH, Campbell RT, Warnecke RB. Racial Disparities in Breast Cancer Survival: The Mediating Effects of Macro-Social Context and Social Network Factors. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2018; 11:6. [PMID: 34026339 PMCID: PMC8136761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study attempts to clarify the associations between macro-social and social network factors and the continuing racial disparities in breast cancer survival. The study improves on prior methodologies by using a neighborhood disadvantage measure that assesses both economic and social disadvantage and an ego-network measurement tool that assesses key social network characteristics. Our population-based sample included 786 breast cancer patients (nHWhite=388; nHBlack=398) diagnosed during 2005-2008 in Chicago, IL. The data included census-derived macro-social context, self-reported social network, self-reported demographic and medically abstracted health measures. Mortality data from the National Death Index (NDI) were used to determine 5-year survival. Based on our findings, neighborhood concentrated disadvantage was negatively associated with survival among nHBlack and nHWhite breast cancer patients. In unadjusted models, social network size, network density, practical support, and financial support were positively associated with 5-year survival. However, in adjusted models only practical support was associated with 5-year survival. Our findings suggested that the association between network size and breast cancer survival is sensitive to scaling of the network measure, which helps to explain inconsistencies in past findings. Social networks of nHWhites and nHBlacks differed in size, social support dimensions, network density, and geographic proximity. Among social factors, residence in disadvantaged neighborhoods and unmet practical support explained some of the racial disparity in survival. Differences in late stage diagnosis and comorbidities between nHWhites and nHBlacks also explained some of the racial disparity in survival. Our findings highlight the relevance of social factors, both macro and inter-personal in the racial disparity in breast cancer survival. Findings suggest that reduced survival of nHBlack women is in part due to low social network resources and residence in socially and economically deprived neighborhoods. To improve survival among breast cancer patients social policies need to continue improving health care access as well as racially patterned social and economic disadvantage.
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Affiliation(s)
- Ganga Vijayasiri
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Yamile Molina
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612
| | - Ifeanyi Beverly Chukwudozie
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Silvia Tejeda
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Heather A. Pauls
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave, Chicago, IL 60612
| | - Garth H Rauscher
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612
| | - Richard T. Campbell
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Richard B. Warnecke
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612
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29
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Hashim D, Manczuk M, Holcombe R, Lucchini R, Boffetta P. Cancer mortality disparities among New York City's Upper Manhattan neighborhoods. Eur J Cancer Prev 2017; 26:453-460. [PMID: 27104595 PMCID: PMC5074912 DOI: 10.1097/cej.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The East Harlem (EH), Central Harlem (CH), and Upper East Side (UES) neighborhoods of New York City are geographically contiguous to tertiary medical care, but are characterized by cancer mortality rate disparities. This ecological study aims to disentangle the effects of race and neighborhood on cancer deaths. Mortality-to-incidence ratios were determined using neighborhood-specific data from the New York State Cancer Registry and Vital Records Office (2007-2011). Ecological data on modifiable cancer risk factors from the New York City Community Health Survey (2002-2006) were stratified by sex, age group, race/ethnicity, and neighborhood and modeled against stratified mortality rates to disentangle race/ethnicity and neighborhood using logistic regression. Significant gaps in mortality rates were observed between the UES and both CH and EH across all cancers, favoring UES. Mortality-to-incidence ratios of both CH and EH were similarly elevated in the range of 0.41-0.44 compared with UES (0.26-0.30). After covariate and multivariable adjustment, black race (odds ratio=1.68; 95% confidence interval: 1.46-1.93) and EH residence (odds ratio=1.20; 95% confidence interval: 1.07-1.35) remained significant risk factors in all cancers' combined mortality. Mortality disparities remain among EH, CH, and UES neighborhoods. Both neighborhood and race are significantly associated with cancer mortality, independent of each other. Multivariable adjusted models that include Community Health Survey risk factors show that this mortality gap may be avoidable through community-based public health interventions.
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Affiliation(s)
- Dana Hashim
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marta Manczuk
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cancer Epidemiology, Maria Skłodowska-Curie Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Randall Holcombe
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto Lucchini
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Occupational Medicine, University of Brescia, Italy
| | - Paolo Boffetta
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Influence of clinical, societal, and treatment variables on racial differences in ER-/PR- breast cancer survival. Breast Cancer Res Treat 2017; 165:163-168. [PMID: 28547656 DOI: 10.1007/s10549-017-4300-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/14/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND African American (AA) women with breast cancer have persistently higher mortality compared to whites. We evaluated racial disparities in mortality among women with estrogen receptor (ER)/progesterone receptor (PR)-negative breast cancer. METHODS The study population included 542 women (45% AA) diagnosed with ER/PR-negative Stage I through III breast cancer treated at the Henry Ford Health System (HFHS) between 1996 and 2005. Linked datasets from HFHS, Metropolitan Detroit Cancer Surveillance System, and the U.S. Census Bureau were used to obtain demographic, socioeconomic, and clinical information. Economic deprivation was categorized using a previously validated deprivation index, which included 5 categories based on the quintile of census tract socioeconomic deprivation. Cox proportional hazards models were used to assess the relationship between race and mortality. RESULTS AA women were more likely to have larger tumors, have higher Charlson Comorbidity Indices (CCI), and to reside in economically deprived areas. In an unadjusted analysis, AA women demonstrated a significantly higher risk of death compared to whites [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.09-2.00]. Following adjustment for clinical factors (age, stage, CCI) and treatment (radiation and chemotherapy), AA race continued to have a significant impact on mortality (HR 1.51, CI 1.10-2.08 and HR 1.63, CI 1.20-2.21). Only after adjusting for deprivation was race no longer significant (HR 1.26, CI 0.84-1.87). CONCLUSIONS Social determinants of health play a large role in explaining racial disparities in breast cancer outcomes, especially among women with aggressive subtypes.
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Farias AJ, Du XL. Racial Differences in Adjuvant Endocrine Therapy Use and Discontinuation in Association with Mortality among Medicare Breast Cancer Patients by Receptor Status. Cancer Epidemiol Biomarkers Prev 2017; 26:1266-1275. [PMID: 28515111 DOI: 10.1158/1055-9965.epi-17-0280] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/25/2017] [Accepted: 05/09/2017] [Indexed: 01/13/2023] Open
Abstract
Background: There are racial disparities in breast cancer mortality. Our purpose was to determine whether racial/ethnic differences in use and discontinuation of adjuvant endocrine therapy (AET) differed by hormone receptor status and whether discontinuation was associated with mortality.Methods: We conducted a retrospective cohort study with SEER/Medicare dataset of women age ≥65 years diagnosed with stage I-III breast cancer in Medicare Part-D from 2007 to 2009, stratified by hormone receptor status. We performed multivariable logistic regressions to assess racial differences for the odds of AET initiation and Cox proportional hazards models to determine the risk of discontinuation and mortality.Results: Of 14,902 women, 64.5% initiated AET <12 months of diagnosis. Among those with hormone receptor-positive cancer, 74.8% initiated AET compared with 5.6% of women with negative and 54.0% with unknown-receptor status. Blacks were less likely to initiate [OR, 0.76; 95% confidence interval (CI), 0.66-0.88] compared with whites. However, those with hormone receptor-positive disease were less likely to discontinue (HR, 0.89; 95% CI, 0.80-0.98). Women who initiated with aromatase inhibitors had increased risk of discontinuation compared with women who initiated tamoxifen (HR, 1.12; 95% CI, 1.05-1.20). Discontinuation within 12 months was associated with higher risk of all-cause (HR, 1.75; 95% CI, 1.74-2.00) and cancer-specific mortality (HR, 2.76; 95% CI, 1.74-4.38) after controlling for race/ethnicity.Conclusions: There are racial/ethnic differences in AET use and discontinuation. Discontinuing treatment was associated with higher risk of all-cause and cancer-specific mortality regardless of hormone receptor status.Impact: This study underscores the need to study factors that influence discontinuation and the survival benefits of receiving AET for hormone receptor-negative breast cancer. Cancer Epidemiol Biomarkers Prev; 26(8); 1266-75. ©2017 AACR.
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Affiliation(s)
- Albert J Farias
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.
| | - Xianglin L Du
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
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Hinyard L, Wirth LS. Race is a Strong Predictor of Receipt of a Written Survivorship Care Plan: Results from the National Health Interview Survey. J Community Health 2017; 42:1156-1162. [PMID: 28455672 DOI: 10.1007/s10900-017-0365-0] [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] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to investigate the prevalence of receipt of written documentation of follow up care and of cancer treatments and to examine the predictors of receipt of such written documentation. Data from the 2010 National Health Interview Survey was used to identify individuals 18 years or older with a history of cancer. Binary and multinomial logistic regression were used to investigate patient-level variables associated with receipt of written documentation of cancer treatment, written advice about follow-up care, or both written documents. Patient-level variables included in the analysis were age, gender, region of residence, race/ethnicity, marital status, education level, insurance coverage, cancer type, employment status, and psychosocial support. Of the 1185 responses to the questions used to access receipt of a SCP, the prevalence of any receipt of a written documentation was 68%, where 30% obtained written advice only and 8% were provided a written treatment summary only; only 31% received both. Non-white race, cancer type, and psychosocial services were associated with increased odds of receiving written documentation. Patient-level characteristics are associated with receipt of care plan documentation. Further work needs to investigate the interaction of provider and patient-level characteristics. Understanding patient-level characteristics associated with receipt of written documentation may help uncover strategies for improved survivorship care plan implementation.
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Affiliation(s)
- Leslie Hinyard
- Saint Louis University Center for Health Outcomes Research, Saint Louis University Center for Interprofessional Education and Research, 3545 Lafayette Ave., Salus Center, Room 409, St. Louis, MO, 63104, USA. .,Saint Louis University Center for Health Outcomes Research, 3545 Lafayette Ave., Salus Center, 4th Floor, St. Louis, MO, 63104, USA.
| | - Lorinette S Wirth
- Saint Louis University Center for Health Outcomes Research, Saint Louis University Center for Interprofessional Education and Research, 3545 Lafayette Ave., Salus Center, Room 409, St. Louis, MO, 63104, USA
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Farias AJ, Du XL. Association Between Out-Of-Pocket Costs, Race/Ethnicity, and Adjuvant Endocrine Therapy Adherence Among Medicare Patients With Breast Cancer. J Clin Oncol 2016; 35:86-95. [PMID: 28034069 DOI: 10.1200/jco.2016.68.2807] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose Previous studies suggest that adherence to adjuvant endocrine therapy (AET) for patients with breast cancer is suboptimal, especially among minorities, and is associated with out-of-pocket medication costs. This study aimed to determine whether there are racial/ethnic differences in 1-year adherence to AET and whether out-of-pocket costs explain the racial/ethnic disparities in adherence. Methods This retrospective cohort study used the SEER-Medicare linked database to identify patients ≥ 65 years of age with hormone receptor-positive breast cancer who were enrolled in Medicare Part D from 2007 to 2009. The cohort included non-Hispanic whites, blacks, Hispanics, and Asians. Out-of-pocket costs for AET medications were standardized for a 30-day supply. Adherence to tamoxifen, aromatase inhibitors (AIs), and overall AET (tamoxifen or AIs) was assessed using the medication possession ratio (≥ 80%) during the 12-month period. Results Of 8,688 patients, 3,197 (36.8%) were nonadherent to AET. Out-of-pocket costs for AET medication were associated with lower adjusted odds of adherence for all four cost categories compared with the lowest category of ≤ $2.65 ( P < .01). In the univariable analysis, Hispanics had higher odds of adherence to any AET at initiation (OR, 1.30; 95% CI, 1.07 to 1.57), and blacks had higher odds of adherence to AIs at initiation (OR, 1.27; 95% CI, 1.04 to 1.54) compared with non-Hispanic whites. After adjusting for copayments, poverty status, and comorbidities, the association was no longer significant for Hispanics (OR, 0.95; 95% CI, 0.78 to 1.17) or blacks (OR, 0.96; 95% CI, 0.77 to 1.19). Blacks had significantly lower adjusted odds of adherence than non-Hispanic whites when they initiated AET therapy with tamoxifen (OR, 0.54; 95% CI, 0.31 to 0.93) after adjusting for socioeconomic, clinic, and prognostic factors. Conclusion Racial/ethnic disparities in AET adherence were largely explained by women's differences in socioeconomic status and out-of-pocket medication costs.
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Affiliation(s)
- Albert J Farias
- All authors: The University of Texas Health Science Center at Houston, Houston, TX
| | - Xianglin L Du
- All authors: The University of Texas Health Science Center at Houston, Houston, TX
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Krok-Schoen JL, Fisher JL, Baltic RD, Paskett ED. White-Black Differences in Cancer Incidence, Stage at Diagnosis, and Survival among Adults Aged 85 Years and Older in the United States. Cancer Epidemiol Biomarkers Prev 2016; 25:1517-1523. [PMID: 27528599 DOI: 10.1158/1055-9965.epi-16-0354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/29/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Increased life expectancy, growth of minority populations, and advances in cancer screening and treatment have resulted in an increasing number of older, racially diverse cancer survivors. Potential black/white disparities in cancer incidence, stage, and survival among the oldest old (≥85 years) were examined using data from the SEER Program of the National Cancer Institute. METHODS Differences in cancer incidence and stage at diagnosis were examined for cases diagnosed within the most recent 5-year period, and changes in these differences over time were examined for white and black cases aged ≥85 years. Five-year relative cancer survival rate was also examined by race. RESULTS Among those aged ≥85 years, black men had higher colorectal, lung and bronchus, and prostate cancer incidence rates than white men, respectively. From 1973 to 2012, lung and bronchus and female breast cancer incidence increased, while colorectal and prostate cancer incidence decreased among this population. Blacks had higher rates of unstaged cancer compared with whites. The 5-year relative survival rate for all invasive cancers combined was higher for whites than blacks. Notably, whites had more than three times the relative survival rate of lung and bronchus cancer when diagnosed at localized (35.1% vs. 11.6%) and regional (12.2% vs. 3.2%) stages than blacks, respectively. CONCLUSIONS White and black differences in cancer incidence, stage, and survival exist in the ≥85 population. IMPACT Continued efforts are needed to reduce white and black differences in cancer prevention and treatment among the ≥85 population. Cancer Epidemiol Biomarkers Prev; 25(11); 1517-23. ©2016 AACR.
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Affiliation(s)
| | - James L Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Ryan D Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
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Akinyemiju T, Sakhuja S, Vin-Raviv N. Racial and socio-economic disparities in breast cancer hospitalization outcomes by insurance status. Cancer Epidemiol 2016; 43:63-9. [PMID: 27394678 PMCID: PMC5321053 DOI: 10.1016/j.canep.2016.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/15/2016] [Accepted: 06/27/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Breast cancer remains a major cause of morbidity and mortality among women in the US, and despite numerous studies documenting racial disparities in outcomes, the survival difference between Black and White women diagnosed with breast cancer continues to widen. Few studies have assessed whether observed racial disparities in outcomes vary by insurance type e.g. Medicare/Medicaid versus private insurance. Differences in coverage, availability of networked physicians, or cost-sharing policies may influence choice of treatment and treatment outcomes, even after patients have been hospitalized, effects of which may be differential by race. PURPOSE The aim of this analysis was to examine hospitalization outcomes among patients with a primary diagnosis of breast cancer and assess whether differences in outcome exist by insurance status after adjusting for age, race/ethnicity and socio-economic status. METHODS We obtained data on over 67,000 breast cancer patients with a primary diagnosis of breast cancer for this cross-sectional study from the 2007-2011 Healthcare Cost and Utilization project Nationwide Inpatient Sample (HCUP-NIS), and examined breast cancer surgery type (mastectomy vs. breast conserving surgery or BCS), post-surgical complications and in-hospital mortality. Multivariable regression models were used to compute estimates, odds ratios and 95% confidence intervals. RESULTS Black patients were less likely to receive mastectomies compared with White women (OR: 0.80, 95% CI: 0.71-0.90), regardless of whether they had Medicare/Medicaid or Private insurance. Black patients were also more likely to experience post-surgical complications (OR: 1.41, 95% CI: 1.12-1.78) and higher in-hospital mortality (OR: 1.57, 95%: 1.21-2.03) compared with White patients, associations that were strongest among women with Private insurance. Women residing outside of large metropolitan areas were significantly more likely to receive mastectomies (OR: 1.89, 95% CI: 1.54-2.31) and experience higher in-hospital mortality (OR: 1.74, 95% CI: 1.40-2.16) compared with those in metropolitan areas, regardless of insurance type. CONCLUSION Among hospitalized patients with breast cancer, racial differences in hospitalization outcomes existed and worse outcomes were observed among Black women with private insurance. Future studies are needed to determine factors associated with poor outcomes in this group of women, as well as to examine contributors to low BCS adoption in non-metropolitan areas.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham Alabama, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham Alabama, USA.
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham Alabama, USA
| | - Neomi Vin-Raviv
- Rocky Mountain Cancer Rehabilitation Institute, School of Sport and Exercise Science, University of Northern Colorado, Greeley, CO, USA; School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
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The Challenge of Improving Breast Cancer Care Coordination in Safety-net Hospitals: Barriers, Facilitators, and Opportunities. Med Care 2016; 54:147-54. [PMID: 26565530 DOI: 10.1097/mlr.0000000000000458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minority breast cancer patients tend to have higher rates of adjuvant treatment underuse. We implemented a web-based intervention that closes referral loops between surgeons and oncologists at inner-city safety-net hospitals serving high volumes of minority breast cancer patients to assist these hospitals and improve care coordination. RESEARCH DESIGN Following intervention implementation, we conducted interviews with key personnel to improve our understanding of the implementation process and to identify barriers, facilitators, and opportunities for improvement. We used the constant comparative method of analysis to code interview transcripts and identify common themes regarding intervention implementation. SUBJECTS We interviewed 64 administrative and clinical key informants from 10 inner-city safety-net hospitals with high volumes of minority breast cancer patients. RESULTS We found substantial barriers to implementing an intervention designed to support care coordination efforts, despite initial feedback that the intervention itself was both easy to use and in line with organizational goals. We also characterized facilitators and challenges of breast cancer care coordination in the safety-net environment, as well as opportunities to improve intervention design to support increased quality of breast cancer care. CONCLUSIONS Coordination of care for women with breast cancer is extremely important, but safety-net hospitals face considerable resource constraints from lack of time, support, and information systems. As safety-net hospital networks grow across numerous care sites, the challenge of care coordination will likely increase, highlighting the importance of interventions that can be successfully implemented and used to promote better care.
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Farias AJ, Du XL. Ethnic differences in initiation and timing of adjuvant endocrine therapy among older women with hormone receptor-positive breast cancer enrolled in Medicare Part D. Med Oncol 2016; 33:19. [PMID: 26786154 PMCID: PMC4934890 DOI: 10.1007/s12032-016-0732-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 01/07/2016] [Indexed: 01/08/2023]
Abstract
The aim of this study was to determine whether there are racial/ethnic differences in initiation and timing of adjuvant endocrine therapy (AET) after Medicare Part D drug coverage. We conducted a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results-Medicare-linked data to assess ethnic, socio-demographic, and tumor characteristic variations in the initiation of AET among patients ≥65 with hormone receptor-positive breast cancer in 2007-2009 enrolled in Medicare Part D through 2010. Logistic regression models were performed to assess the association between race/ethnicity and the initiation of tamoxifen, aromatase inhibitors (AIs), and overall AET (tamoxifen or AIs) within the first 12 months of diagnosis. Of the 12,198 women with hormone receptor-positive breast cancer, 74.8 % received AET within 12 months of diagnosis, of which 17.3 % received tamoxifen and 82.8 % received AIs. After controlling for all variables, only Asian women were found to have a greater odds of initiation of overall AET compared to non-Hispanic white women (odds ratio (OR): 1.28, 95 % CI: 1.03-1.58). Hispanic Mexicans and non-Hispanic black patients had a significantly lower odds of tamoxifen initiation (0.70, 0.54-0.91; 0.25, 0.10-0.62). For AI initiation, Hispanic Mexicans and Asians had a higher odds compared to non-Hispanic white women (2.06, 1.34-3.10; 1.33, 1.11-1.61). A suboptimal proportion of women (25.2 %) did not initiate AET within 12 months of diagnosis and therefore did not receive the full benefits of treatment to reduce the risk of breast cancer recurrence and mortality. Racial/ethnic differences in the initiation of tamoxifen and AIs have important implications that require further investigation.
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Affiliation(s)
- Albert J Farias
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler Street, Houston, TX, 77030, USA.
| | - Xianglin L Du
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler Street, Houston, TX, 77030, USA
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Racial and geographic disparities in the patterns of care and costs at the end of life for patients with lung cancer in 2007–2010 after the 2006 introduction of bevacizumab. Lung Cancer 2015; 90:442-50. [DOI: 10.1016/j.lungcan.2015.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/14/2015] [Accepted: 09/17/2015] [Indexed: 11/22/2022]
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Goldberg M, Calderon-Margalit R, Paltiel O, Abu Ahmad W, Friedlander Y, Harlap S, Manor O. Socioeconomic disparities in breast cancer incidence and survival among parous women: findings from a population-based cohort, 1964-2008. BMC Cancer 2015; 15:921. [PMID: 26585765 PMCID: PMC4653946 DOI: 10.1186/s12885-015-1931-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 11/13/2015] [Indexed: 11/08/2022] Open
Abstract
Background Socioeconomic position (SEP) has been associated with breast cancer incidence and survival. We examined the associations between two socioeconomic indicators and long-term breast cancer incidence and survival in a population-based cohort of parous women. Methods Residents of Jerusalem who gave birth between 1964–1976 (n = 40,586) were linked to the Israel Cancer Registry and Israel Population Registry to determine breast cancer incidence and vital status through mid-2008. SEP was assessed by husband’s occupation and the woman’s education. We used log ranks tests to compare incidence and survival curves by SEP, and Cox proportional hazard models to adjust for demographic, reproductive and diagnostic factors and assess effect modification by ethnic origin. Results In multivariable models, women of high SEP had a greater risk of breast cancer compared to women of low SEP (Occupation: HR 1.18, 95 % CI 1.03-1.35; Education: HR 1.39, 95 % CI 1.21-1.60) and women of low SEP had a greater risk of mortality after a breast cancer diagnosis (Occupation: HR 1.33, 95 % CI 1.04-1.70; Education: HR 1.37, 95 % CI 1.06-1.76). The association between education and survival was modified by ethnic origin, with a gradient effect observed only among women of European origin. Women of Asian, North African and Israeli origin showed no such trend. Conclusions SEP was associated with long-term breast cancer incidence and survival among Israeli Jews. Education had a stronger effect on breast cancer outcomes than occupation, suggesting that a behavioral mechanism may underlie disparities. More research is needed to explain the difference in the effect of education on survival among European women compared to women of other ethnicities.
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Affiliation(s)
- Mandy Goldberg
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W. 168th St., 7th floor, New York, NY, 10032, USA. .,Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel.
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel.
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel. .,Department of Hematology, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel.
| | - Wiessam Abu Ahmad
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel.
| | - Yechiel Friedlander
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel.
| | - Susan Harlap
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA. .,Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA. .,Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA.
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel.
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The Influence of Socioeconomic Status on Racial/Ethnic Disparities among the ER/PR/HER2 Breast Cancer Subtypes. J Cancer Epidemiol 2015; 2015:813456. [PMID: 26339244 PMCID: PMC4539118 DOI: 10.1155/2015/813456] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/30/2015] [Accepted: 07/08/2015] [Indexed: 01/10/2023] Open
Abstract
Background. The eight ER/PR/HER2 breast cancer subtypes vary widely in demographic and clinicopathologic characteristics and survival. This study assesses the contribution of SES to the risk of mortality for blacks, Hispanics, Asian/Pacific Islanders, and American Indians when compared with white women for each ER/PR/HER2 subtype. Methods. We identified 143,184 cases of first primary female invasive breast cancer from the California Cancer Registry between 2000 and 2012. The risk of mortality was computed for each race/ethnicity within each ER/PR/HER2 subtype. Models were adjusted for tumor grade, year of diagnosis, and age. SES was added to a second set of models. Analyses were conducted separately for each stage. Results. Race/ethnicity did not contribute to the risk of mortality for any subtype in stage 1 when adjusted for SES. In stages 2, 3, and 4, race/ethnicity was associated with risk of mortality and adjustment for SES changed the risk only in some subtypes. SES reduced the risk of mortality by over 45% for American Indians with stage 2 ER+/PR+/HER2− cancer, but it decreased the risk of mortality for blacks with stage 2 triple negative cancer by less than 4%. Conclusions. Racial/ethnic disparities do not exist in all ER/PR/HER2 subtypes and, in general, SES modestly alters these disparities.
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Roseland ME, Pressler ME, Lamerato LE, Krajenta R, Ruterbusch JJ, Booza JC, Schwartz K, Simon MS. Racial differences in breast cancer survival in a large urban integrated health system. Cancer 2015; 121:3668-75. [PMID: 26110691 DOI: 10.1002/cncr.29523] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/01/2015] [Accepted: 05/18/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND African American (AA) women are known to have poorer breast cancer survival than whites, and the differences may be related to underlying disparities in their clinical presentation or access to care. This study evaluated the relationship between demographic, treatment, and socioeconomic factors and breast cancer survival among women in southeast Michigan. METHODS The population included 2387 women (34% AA) with American Joint Committee on Cancer stage I to III breast cancer who were treated at the Henry Ford Health System (HFHS) from 1996 through 2005. Linked data sets from the HFHS, the Metropolitan Detroit Cancer Surveillance System, and the US Census Bureau were used to obtain demographic and clinical information. Comorbidities were classified with the modified Charlson comorbidity index (CCI). Economic deprivation was categorized with a census tract-based deprivation index (DI), which was stratified into 5 quintiles of increasing socioeconomic disadvantage. RESULTS Compared with whites, AA women were significantly more likely to have larger, hormone receptor-negative tumors and more comorbidities and to reside in an economically deprived area. In an unadjusted analysis, AAs had a significantly higher risk of death (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.16-1.59); however, after adjustments for clinical (age, stage, hormone receptor, and CCI) and societal factors (DI), the effect of race was not significant (HR, 1.13 [95% CI, 0.96-1.34] , and HR, 0.97 [0.80-1.19] respectively). CONCLUSIONS Racial differences in breast cancer survival can be explained by clinical and socioeconomic factors. Nonetheless, AA women with breast cancer remain disproportionately affected by unfavorable tumor characteristics and economic deprivation, which likely contribute to their increased overall mortality.
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Affiliation(s)
| | - Mary E Pressler
- Columbia St. Mary's Family Health Center, Milwaukee, Wisconsin
| | - Lois E Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Rick Krajenta
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Julie J Ruterbusch
- Karmanos Cancer Institute/Department of Oncology, Wayne State University, Detroit, Michigan
- Population Studies and Prevention Program, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Jason C Booza
- Wayne State University School of Medicine, Detroit, Michigan
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - Kendra Schwartz
- Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Prevention Program, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - Michael S Simon
- Karmanos Cancer Institute/Department of Oncology, Wayne State University, Detroit, Michigan
- Population Studies and Prevention Program, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
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Cheng I, Shariff-Marco S, Koo J, Monroe KR, Yang J, John EM, Kurian AW, Kwan ML, Henderson BE, Bernstein L, Lu Y, Sposto R, Vigen C, Wu AH, Gomez SL, Keegan THM. Contribution of the neighborhood environment and obesity to breast cancer survival: the California Breast Cancer Survivorship Consortium. Cancer Epidemiol Biomarkers Prev 2015; 24:1282-90. [PMID: 26063477 DOI: 10.1158/1055-9965.epi-15-0055] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/26/2015] [Indexed: 12/25/2022] Open
Abstract
Little is known about neighborhood attributes that may influence opportunities for healthy eating and physical activity in relation to breast cancer mortality. We used data from the California Breast Cancer Survivorship Consortium and the California Neighborhoods Data System (CNDS) to examine the neighborhood environment, body mass index, and mortality after breast cancer. We studied 8,995 African American, Asian American, Latina, and non-Latina white women with breast cancer. Residential addresses were linked to the CNDS to characterize neighborhoods. We used multinomial logistic regression to evaluate the associations between neighborhood factors and obesity and Cox proportional hazards regression to examine associations between neighborhood factors and mortality. For Latinas, obesity was associated with more neighborhood crowding [quartile 4 (Q4) vs. Q1: OR, 3.24; 95% confidence interval (CI), 1.50-7.00]; breast cancer-specific mortality was inversely associated with neighborhood businesses (Q4 vs. Q1: HR, 0.46; 95% CI, 0.25-0.85) and positively associated with multifamily housing (Q3 vs. Q1: HR, 1.98; 95% CI, 1.20-3.26). For non-Latina whites, lower neighborhood socioeconomic status (SES) was associated with obesity [quintile 1 (Q1) vs. Q5: OR, 2.52; 95% CI, 1.31-4.84], breast cancer-specific (Q1 vs. Q5: HR, 2.75; 95% CI, 1.47-5.12), and all-cause (Q1 vs. Q5: HR, 1.75; 95% CI, 1.17-2.62) mortality. For Asian Americans, no associations were seen. For African Americans, lower neighborhood SES was associated with lower mortality in a nonlinear fashion. Attributes of the neighborhood environment were associated with obesity and mortality following breast cancer diagnosis, but these associations differed across racial/ethnic groups.
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Affiliation(s)
- Iona Cheng
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California.
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, California
| | - Kristine R Monroe
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Juan Yang
- Cancer Prevention Institute of California, Fremont, California
| | - Esther M John
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Allison W Kurian
- Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Brian E Henderson
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | | | - Yani Lu
- City of Hope, Duarte, California
| | - Richard Sposto
- University of Southern California, Children's Hospital, Los Angeles, California
| | - Cheryl Vigen
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Anna H Wu
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
| | - Theresa H M Keegan
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California
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Du XL, Zhang Y. Risks of Venous Thromboembolism, Stroke, Heart Disease, and Myelodysplastic Syndrome Associated With Hematopoietic Growth Factors in a Large Population-Based Cohort of Patients With Colorectal Cancer. Clin Colorectal Cancer 2015; 14:e21-31. [PMID: 26119923 DOI: 10.1016/j.clcc.2015.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/29/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the relationship between the receipt of colony-stimulating factors (CSFs) with erythropoiesis-stimulating agents (ESAs) and the risk of developing venous thromboembolism (VTE), stroke, heart disease, and myelodysplastic syndrome (MDS) in patients with colorectal cancer. METHODS We studied 80,925 patients diagnosed with colorectal cancer at age ≥ 65 years in 1992-2009 from the nationwide 16 areas of the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. Cumulative incidence and the time to events Cox hazard regressions were used to explore the risks of outcomes in association with the receipt of CSFs and ESAs. RESULTS Patients who received chemotherapy (CT) with both CSF and ESA were 58% more likely to develop VTE than those who received CT without CSF and ESA (hazard ratio, 1.58; 95% confidence interval, 1.43-1.76). The risk of stroke appeared to be not associated with the use of CSF and ESA, whereas the risk of heart disease was only significantly elevated in those patients who did not receive CT but received ESA. The risk of acute myeloid leukemia or MDS was significantly increased 4- to 9-fold in patients who received ESA, regardless of receipt of CT or CSF. CONCLUSION The use of ESAs was significantly associated with a substantially increased risk of MDS in patients with colorectal cancer. The use of CSFs and ESAs was also significantly associated with a moderately increased risk of VTE and a slightly elevated risk of heart disease.
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Affiliation(s)
- Xianglin L Du
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX; Center for Health Services Research, University of Texas School of Public Health, Houston, TX.
| | - Yefei Zhang
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX; Department of Biostatistics, University of Texas School of Public Health, Houston, TX
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Rizzo JA, Sherman WE, Arciero CA. Racial disparity in survival from early breast cancer in the department of defense healthcare system. J Surg Oncol 2015; 111:819-23. [PMID: 25711959 DOI: 10.1002/jso.23884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/15/2014] [Indexed: 07/13/2024]
Abstract
BACKGROUND Racial disparity is often identified as a factor in survival from breast cancer in the United States. Current data regarding survival in patients treated in the Department of Defense Military Healthcare System is lacking. METHODS The Department of Defense Automated Central Tumor Registry (ACTUR) was queried for all women diagnosed with Stage I or II breast cancer from January 1, 1996 through December 31, 2008. Statistical analyses evaluated demographics, surgical treatment, tumor stage, and survival rates. RESULTS There were 8,890 patients meeting inclusion criteria. Patients who were younger, Asian American (versus white or black), lower T and/or N stage had significantly improved survival rates. Interestingly, white and black patients demonstrated similar survival in this study. Patients with a longer period of time between diagnosis and treatment had no decrement in survival. As would be expected, patients with a longer recurrence free period enjoyed longer survival. CONCLUSIONS Survival from early stage breast cancer is equivalent between white and black patients in the Department of Defense Healthcare System. This finding is contrary to reports from our civilian counterparts and may be indicative of improved access to care and overall improved cancer surveillance.
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Affiliation(s)
- Julie A Rizzo
- U.S. Institute of Surgical Research, Fort Sam Houston, Texas
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Sineshaw HM, Freedman RA, Ward EM, Flanders WD, Jemal A. Black/White Disparities in Receipt of Treatment and Survival Among Men With Early-Stage Breast Cancer. J Clin Oncol 2015; 33:2337-44. [PMID: 25940726 DOI: 10.1200/jco.2014.60.5584] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the extent of black/white disparities in receipt of treatment and survival for early-stage breast cancer in men age 18 to 64 and ≥ 65 years. PATIENTS AND METHODS We identified 725 non-Hispanic black (black) and 5,247 non-Hispanic white (white) men diagnosed with early-stage breast cancer from 2004 to 2011 in the National Cancer Data Base. We used multivariable logistic regression and calculated standardized risk ratios to predict receipt of treatment and a proportional hazards model to estimate overall hazard ratios (HRs) in black versus white men age 18 to 64 and ≥ 65 years, separately. RESULTS Receipt of treatment was remarkably similar between blacks and whites in both age groups. Black and white older men had lower receipt of chemotherapy (39.2% and 42.0%, respectively) compared with younger patients (76.7% and 79.3%, respectively). Younger black men had a 76% higher risk of death than younger white men after adjustment for clinical factors only (HR, 1.76; 95% CI, 1.11 to 2.78), but this difference significantly diminished after subsequent adjustment for insurance and income (HR, 1.37; 95% CI, 0.83 to 2.24). In those age ≥ 65 years, the excess risk of death in blacks versus whites was nonsignificant and not affected by adjustment for covariates. CONCLUSION The excess risk of death in black versus white men diagnosed with early-stage breast cancer was largely confined to those age 18 to 64 years and became nonsignificant after adjustment for differences in insurance and income. These findings suggest the importance of improving access to care in reducing racial disparities in male breast cancer mortality.
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Affiliation(s)
- Helmneh M Sineshaw
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA.
| | - Rachel A Freedman
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - Elizabeth M Ward
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - W Dana Flanders
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - Ahmedin Jemal
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
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Keegan THM, Kurian AW, Gali K, Tao L, Lichtensztajn DY, Hershman DL, Habel LA, Caan BJ, Gomez SL. Racial/ethnic and socioeconomic differences in short-term breast cancer survival among women in an integrated health system. Am J Public Health 2015; 105:938-46. [PMID: 25790426 PMCID: PMC4386534 DOI: 10.2105/ajph.2014.302406] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We examined the combined influence of race/ethnicity and neighborhood socioeconomic status (SES) on short-term survival among women with uniform access to health care and treatment. METHODS Using electronic medical records data from Kaiser Permanente Northern California linked to data from the California Cancer Registry, we included 6262 women newly diagnosed with invasive breast cancer. We analyzed survival using multivariable Cox proportional hazards regression with follow-up through 2010. RESULTS After consideration of tumor stage, subtype, comorbidity, and type of treatment received, non-Hispanic White women living in low-SES neighborhoods (hazard ratio [HR] = 1.28; 95% confidence interval [CI] = 1.07, 1.52) and African Americans regardless of neighborhood SES (high SES: HR = 1.44; 95% CI = 1.01, 2.07; low SES: HR = 1.88; 95% CI = 1.42, 2.50) had worse overall survival than did non-Hispanic White women living in high-SES neighborhoods. Results were similar for breast cancer-specific survival, except that African Americans and non-Hispanic Whites living in high-SES neighborhoods had similar survival. CONCLUSIONS Strategies to address the underlying factors that may influence treatment intensity and adherence, such as comorbidities and logistical barriers, should be targeted at low-SES non-Hispanic White and all African American patients.
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Affiliation(s)
- Theresa H M Keegan
- Theresa H. M. Keegan, Li Tao, Daphne Y. Lichtensztajn, and Scarlett L. Gomez are with the Cancer Prevention Institute of California, Fremont. Allison W. Kurian is with the Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA. Kathleen Gali is with the School of Social Sciences, Humanities and Arts, University of California, Merced. Dawn L. Hershman is with the Columbia University Medical Center, New York, NY. Laurel A. Habel and Bette J. Caan are with the Division of Research, Kaiser Permanente, Oakland, CA
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Akinyemiju TF, Genkinger JM, Farhat M, Wilson A, Gary-Webb TL, Tehranifar P. Residential environment and breast cancer incidence and mortality: a systematic review and meta-analysis. BMC Cancer 2015; 15:191. [PMID: 25885593 PMCID: PMC4396806 DOI: 10.1186/s12885-015-1098-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/20/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Factors beyond the individual level such as those characterizing the residential environment may be important to breast cancer outcomes. We provide a systematic review and results of meta-analysis of the published empirical literature on the associations between breast cancer risk and mortality and features of the residential environment. METHODS Using PRISMA guidelines, we searched four electronic databases and manually searched the references of selected articles for studies that were published before June 2013. We selected English language articles that presented data on adult breast cancer incidence or mortality in relation to at least one area-based residential (ABR) independent variable. RESULTS We reviewed 31 eligible studies, and observed variations in ABR construct definition and measurement, study design, and analytic approach. The most common ABR measures were indicators of socioeconomic status (SES) (e.g., income, education, summary measures of several SES indicators or composite SES). We observed positive associations between breast cancer incidence and urbanization (Pooled RR for urban vs. rural: 1.09. 95% CI: 1.01, 1.19), ABR income (Pooled RR for highest vs. lowest ABR income: 1.17, 95% CI: 1.15, 1.19) and ABR composite SES (Pooled RR for highest vs. lowest ABR composite SES: 1.25, 95% CI: 1.08, 1.44). We did not observe consistent associations between any ABR measures and breast cancer mortality. CONCLUSIONS The findings suggest modest positive associations between urbanization and residential area socioeconomic environment and breast cancer incidence. Further studies should address conceptual and methodological gaps in the current publications to enable inference regarding the influence of the residential environment on breast cancer.
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Affiliation(s)
- Tomi F Akinyemiju
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Jeanine M Genkinger
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
| | - Maggie Farhat
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Adrienne Wilson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Tiffany L Gary-Webb
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Departments of Community and Behavioral Sciences and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
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Comorbidities and Their Management: Potential Impact on Breast Cancer Outcomes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:155-75. [DOI: 10.1007/978-3-319-16366-6_11] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hershman DL, Ganz PA. Quality of Care, Including Survivorship Care Plans. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:255-69. [PMID: 26059941 DOI: 10.1007/978-3-319-16366-6_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
With the expectation of prolonged survival in the vast majority of women diagnosed with breast cancer, making initial treatment decisions that minimize or prevent late complications, and maximize the quality as well as quantity of life, is absolutely critical. Unfortunately, such care is not uniformly delivered. Patient, provider, and system barriers contribute to delays in cancer care, lower quality of care, and poorer outcomes in vulnerable populations, including low income, underinsured, and racial/ethnic minority populations. Covering the costs of cancer care is a major concern for many cancer survivors, and as a result, a major challenge will be to provide cost-effective follow-up care by reducing overuse of unnecessary tests and procedures so that access to effective medications can be preserved. One of the recently promoted means of improving the coordination of care for breast cancer survivors has been the use of survivorship care planning, as coordination of care will be absolutely essential to deliver high-quality care. Patient navigation is another approach to help overcome healthcare system barriers and facilitate timely access to quality medical care. Understanding the challenges and opportunities in delivering high-quality cancer care is one of the most critical issues of the day. With the large numbers of breast cancer patients and the tremendous advances in our understanding of the disease and treatments (leading to large numbers of survivors), breast cancer will likely be the focus of new models for the delivery of better and more efficient cancer care.
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Affiliation(s)
- Dawn L Hershman
- Medicine and Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University, 161 Fort Washington, 1068, New York, NY, 10032, USA,
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Sharrocks K, Spicer J, Camidge DR, Papa S. The impact of socioeconomic status on access to cancer clinical trials. Br J Cancer 2014; 111:1684-7. [PMID: 25093493 PMCID: PMC4453719 DOI: 10.1038/bjc.2014.108] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/02/2014] [Accepted: 02/03/2014] [Indexed: 11/22/2022] Open
Abstract
Cancer clinical trials enable the development of novel agents for the potential benefit of cancer patients. Enrolment in a trial offers patients the chance of superior efficacy coupled to the risk of unanticipated toxicity. For trial results to be generalisable, the data need to be collected in patients' representative of the general cancer population. Socioeconomic deprivation is associated with poor cancer outcomes. In the developed world, the gap between the most and least deprived is widening. This mini-review explores the evidence regarding socioeconomics and access to cancer trials, highlighting the underrepresentation of deprived patients, and exploring reasons for this disparity.
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Affiliation(s)
- K Sharrocks
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - J Spicer
- Department of Medicine, King's College London, Guy's Hospital, 3rd Floor Bermondsey Wing, Great Maze Pond, London SE1 9RT, UK
| | - D R Camidge
- Developmental Therapeutics Program, University of Colorado Cancer Center, Aurora, CO 80045, USA
| | - S Papa
- Department of Medicine, King's College London, Guy's Hospital, 3rd Floor Bermondsey Wing, Great Maze Pond, London SE1 9RT, UK
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