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Gilmore N, Grant SJ, Bethea TN, Schiaffino MK, Klepin HD, Dale W, Hardi A, Mandelblatt J, Mohile S. A scoping review of racial, ethnic, socioeconomic, and geographic disparities in the outcomes of older adults with cancer. J Am Geriatr Soc 2024; 72:1867-1900. [PMID: 38593225 PMCID: PMC11187671 DOI: 10.1111/jgs.18881] [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: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Cancer health disparities are widespread. Nevertheless, the disparities in outcomes among diverse survivors of cancer ages 65 years and older ("older") have not been systematically evaluated. METHODS We conducted a scoping review of original research articles published between January 2016 and September 2023 and indexed in Medline (Ovid), Embase, Scopus, and CINAHL databases. We included studies evaluating racial, ethnic, socioeconomic disadvantaged, geographic, sexual and gender, and/or persons with disabilities disparities in treatment, survivorship, and mortality among older survivors of cancer. We excluded studies with no a priori aims related to a health disparity, review articles, conference proceedings, meeting abstracts, studies with unclear methodologies, and articles in which the disparity group was examined only as an analytic covariate. Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines. RESULTS After searching and removing duplicates, 2573 unique citations remained and after screening 59 articles met the inclusion criteria. Many investigated more than one health disparity, and most focused on racial and ethnic (n = 44) or socioeconomic (n = 25) disparities; only 10 studies described geographic disparities, and none evaluated disparities in persons with disabilities or due to sexual and gender identity. Research investigating disparities in outcomes among diverse older survivors of cancer is increasing gradually-68% of eligible articles were published between 2020 and 2023. Most studies focused on the treatment phase of care (n = 28) and mortality (n = 26), with 16 examined disparities in survivorship, symptoms, or quality of life. Most research was descriptive and lacked analyses of potential underlying mechanisms contributing to the reported disparities. CONCLUSION Little research has evaluated the effect of strategies to reduce health disparities among older patients with cancer. This lack of evidence perpetuates cancer inequities and leaves the cancer care system ill equipped to address the unique needs of the rapidly growing and increasingly diverse older adult cancer population.
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Uttam Chandani K, Agrawal SP, Raval M, Siddiq S, Nadeem A, Chintakuntlawar AV, Hashmi SK. Racial Disparities in Cardiovascular and Cerebrovascular Adverse Events in Patients with Non-Hodgkin Lymphoma: A Nationwide Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:800. [PMID: 38792983 PMCID: PMC11123259 DOI: 10.3390/medicina60050800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Non-Hodgkin lymphoma (NHL) has the sixth-highest malignancy-related mortality in the United States (US). However, inequalities exist in access to advanced care in specific patient populations. We aim to study the racial disparities in major adverse cardiovascular and cerebrovascular events (MACCEs) in NHL patients. Materials and Methods: Using ICD-10 codes, patients with NHL were identified from the US National Inpatient Sample 2016-2019 database. Baseline characteristics, comorbidities, and MACCE outcomes were studied, and results were stratified based on the patient's race. Results: Of the 777,740 patients with a diagnosis of NHL, 74.22% (577,215) were White, 9.15% (71,180) were Black, 9.39% (73,000) were Hispanic, 3.33% (25,935) were Asian/Pacific Islander, 0.36% (2855) were Native American, and 3.54% (27,555) belonged to other races. When compared to White patients, all-cause mortality (ACM) was significantly higher in Black patients (aOR 1.27, 95% CI 1.17-1.38, p < 0.001) and in Asian/Pacific Islander patients (aOR 1.27, 95% CI 1.12-1.45, p < 0.001). Sudden cardiac death was found to have a higher aOR in all racial sub-groups as compared to White patients; however, it was statistically significant in Black patients only (aOR 1.81, 95% CI 1.52-2.16, p < 0.001). Atrial fibrillation (AF) risk was significantly lower in patients who were Black, Hispanic, and of other races compared to White patients. Acute myocardial infarction (AMI) was noted to have a statistically significantly lower aOR in Black patients (0.70, 95% CI 0.60-0.81, p < 0.001), Hispanic patients (0.69, 95% CI 0.59-0.80, p < 0.001), and patients of other races (0.57, 95% CI 0.43-0.75, p < 0.001) as compared to White patients. Conclusions: Racial disparities are found in MACCEs among NHL patients, which is likely multifactorial, highlighting the need for healthcare strategies stratified by race to mitigate the increased risk of MACCEs. Further research involving possible epigenomic influences and social determinants of health contributing to poorer outcomes in Black and Asian/Pacific Islander patients with NHL is imperative.
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Affiliation(s)
- Kanishka Uttam Chandani
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI 02895, USA;
| | | | - Maharshi Raval
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI 02895, USA;
| | - Sajid Siddiq
- Department of Cardiology, New York Medical College/Landmark Medical Center, Woonsocket, RI 02895, USA
| | - Ahmed Nadeem
- Department of Hematology-Oncology, New York Medical College/Landmark Medical Center, Woonsocket, RI 02895, USA
| | | | - Shahrukh K. Hashmi
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Computer Vision, MBZ University of Artificial Intelligence, Abu Dhabi, United Arab Emirates
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Moore AM, Nooruddin Z, Reveles KR, Koeller JM, Whitehead JM, Franklin K, Datta P, Alkadimi M, Brannman L, Cotarla I, Frankart AJ, Mulrooney T, Jones X, Frei CR. Health Equity in Patients Receiving Durvalumab for Unresectable Stage III Non-Small Cell Lung Cancer in the US Veterans Health Administration. Oncologist 2023; 28:804-811. [PMID: 37335901 PMCID: PMC10485300 DOI: 10.1093/oncolo/oyad172] [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: 01/09/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Real-world evidence is limited regarding the relationship between race and use of durvalumab, an immunotherapy approved for use in adults with unresectable stage III non-small cell lung cancer (NSCLC) post-chemoradiotherapy (CRT). This study aimed to evaluate if durvalumab treatment patterns differed by race in patients with unresectable stage III NSCLC in a Veterans Health Administration (VHA) population. MATERIALS AND METHODS This was a retrospective analysis of White and Black adults with unresectable stage III NSCLC treated with durvalumab presenting to any VHA facility in the US from January 1, 2017, to June 30, 2020. Data captured included baseline characteristics and durvalumab treatment patterns, including treatment initiation delay (TID), interruption (TI), and discontinuation (TD); defined as CRT completion to durvalumab initiation greater than 42 days, greater than 28 days between durvalumab infusions, and more than 28 days from the last durvalumab dose with no new durvalumab restarts, respectively. The number of doses, duration of therapy, and adverse events were also collected. RESULTS A total of 924 patients were included in this study (White = 726; Black = 198). Race was not a significant factor in a multivariate logistic regression model for TID (OR, 1.39; 95% CI, 0.81-2.37), TI (OR, 1.58; 95% CI, 0.90-2.76), or TD (OR, 0.84; 95% CI, 0.50-1.38). There were also no significant differences in median (interquartile range [IQR]) number of doses (White: 15 [7-24], Black: 18 [7-25]; P = .25) or median (IQR) duration of therapy (White: 8.7 months [2.9-11.8], Black: 9.8 months [3.6-12.0]; P = .08), although Black patients were less likely to experience an immune-related adverse event (28% vs. 36%, P = .03) and less likely to experience pneumonitis (7% vs. 14%, P < .01). CONCLUSION Race was not found to be linked with TID, TI, or TD in this real-world study of patients with unresectable stage III NSCLC treated with durvalumab at the VHA.
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Affiliation(s)
- Amanda M Moore
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Zohra Nooruddin
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Kelly R Reveles
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Jim M Koeller
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jennifer M Whitehead
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Kathleen Franklin
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Paromita Datta
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Munaf Alkadimi
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Lance Brannman
- Oncology Business Unit, Global Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, MD, USA
| | - Ion Cotarla
- Oncology Business Unit, US Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, MD, USA
| | - Andrew J Frankart
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Tiernan Mulrooney
- Oncology Business Unit, US Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, MD, USA
| | - Xavier Jones
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Christopher R Frei
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
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Holt HK, Peterson CE, MacLaughlan David S, Abdelaziz A, Sawaya GF, Guadamuz JS, Calip GS. Mediation of Racial and Ethnic Inequities in the Diagnosis of Advanced-Stage Cervical Cancer by Insurance Status. JAMA Netw Open 2023; 6:e232985. [PMID: 36897588 PMCID: PMC10726717 DOI: 10.1001/jamanetworkopen.2023.2985] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Importance Black and Hispanic or Latina women are more likely than White women to receive a diagnosis of and to die of cervical cancer. Health insurance coverage is associated with diagnosis at an earlier stage of cervical cancer. Objective To evaluate the extent to which racial and ethnic differences in the diagnosis of advanced-stage cervical cancer are mediated by insurance status. Design, Setting, and Participants This retrospective, cross-sectional population-based study used data from the Surveillance, Epidemiology, and End Results (SEER) program on an analytic cohort of 23 942 women aged 21 to 64 years who received a diagnosis of cervical cancer between January 1, 2007, and December 31, 2016. Statistical analysis was performed from February 24, 2022, to January 18, 2023. Exposures Health inusurance status (private or Medicare insurance vs Medicaid or uninsured). Main Outcomes and Measures The primary outcome was a diagnosis of advanced-stage cervical cancer (regional or distant stage). Mediation analyses were performed to assess the proportion of observed racial and ethnic differences in the stage at diagnosis that were mediated by health insurance status. Results A total of 23 942 women (median age at diagnosis, 45 years [IQR, 37-54 years]; 12.9% were Black, 24.5% were Hispanic or Latina, and 52.9% were White) were included in the study. A total of 59.4% of the cohort had private or Medicare insurance. Compared with White women, patients of all other racial and ethnic groups had a lower proportion with a diagnosis of early-stage cervical cancer (localized) (American Indian or Alaska Native, 48.7%; Asian or Pacific Islander, 49.9%; Black, 41.7%; Hispanic or Latina, 51.6%; and White, 53.3%). A larger proportion of women with private or Medicare insurance compared with women with Medicaid or uninsured received a diagnosis of an early-stage cancer (57.8% [8082 of 13 964] vs 41.1% [3916 of 9528]). In models adjusting for age, year of diagnosis, histologic type, area-level socioeconomic status, and insurance status, Black women had higher odds of receiving a diagnosis of advanced-stage cervical cancer compared with White women (odds ratio, 1.18 [95% CI, 1.08-1.29]). Health insurance was associated with mediation of more than half (ranging from 51.3% [95% CI, 51.0%-51.6%] for Black women to 55.1% [95% CI, 53.9%-56.3%] for Hispanic or Latina women) the racial and ethnic inequities in the diagnosis of advanced-stage cervical cancer across all racial and ethnic minority groups compared with White women. Conclusions and Relevance This cross-sectional study of SEER data suggests that insurance status was a substantial mediator of racial and ethnic inequities in advanced-stage cervical cancer diagnoses. Expanding access to care and improving the quality of services rendered for uninsured patients and those covered by Medicaid may mitigate the known inequities in cervical cancer diagnosis and related outcomes.
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Affiliation(s)
- Hunter K Holt
- Department of Family and Community Medicine, University of Illinois at Chicago, Chicago
| | - Caryn E Peterson
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago
| | | | - Abdullah Abdelaziz
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago
| | - George F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Jenny S Guadamuz
- Flatiron Health, New York, New York
- Program on Medicines and Public Health, University of Southern California, Los Angeles
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago
- Flatiron Health, New York, New York
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Wang Y, Song J, Wen S, Zhang X. A visual model for prognostic estimation in patients with primary diffuse large B-cell lymphoma of small intestine and colon: analysis of 1,613 cases from the SEER database. Transl Cancer Res 2022; 10:1842-1855. [PMID: 35116506 PMCID: PMC8798054 DOI: 10.21037/tcr-20-3086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment modalities for primary diffuse large B-cell lymphoma of Small intestine and colon (PIC-DLBCL) have changed significantly during the past decades. However, limited information on the trends of clinical outcome of PIC-DLBCL patients has been reported, and the influence of marital status and medical insurance on prognosis is ignored. METHODS This was a retrospective analysis the survival of PIC-DLBCL patients using the Surveillance, Epidemiology, and End Results (SEER) database between 2002 and 2016. The patients were divided into the training and validation cohort. In the training cohort, univariate and multivariable Cox regression analysis, Log-rank test and the Kaplan-Meier method were used to find out the independent prognostic factors, from which the visual prognostic model (nomogram and graphical web page) was established. C-index and calibration plots were used to evaluate the prediction accuracy of the model. In the validation cohort, both Decision curve analysis (DCA) and Receiver operating characteristic (ROC) curve was performed to compare the model with the International Prognostic Index (IPI) scoring model which is universally used to estimate prognosis of PIC-DLBCL. RESULTS A total of 1,613 patients were collected, and the 5-year overall survival of all cases was 64.5%. Age at diagnosis (HR =2.58, 95% CI: 2.29-2.91), Ann Arbo stage (HR =1.34, 95% CI: 1.24-1.44), Divorced or Separated (HR=1.21, 95% CI: 1.06-1.38), Uninsured (HR =1.32, 95% CI: 1.19-1.45) and Primary colon (HR =1.23, 95% CI: 1.08-1.40) were associated with prognosis and were used to build up the visual model (nomogram and graphical web page). Both DCA and ROC curve showed that the model had better authentication capability than the IPI scoring model (AUC 0.820 vs. 0.714). The calibration plots showed that the model could accurately predict patient prognosis. CONCLUSIONS The visual model could output individual estimate prognosis simply and correctly, including marital status and medical insurance for the first time. Consideration of both medical and social factors, this study provided a new way to explore the improving prognosis of PIC-DLBCL.
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Affiliation(s)
- Yang Wang
- Department of Gastroentology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jia Song
- Department of Gastroentology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shupeng Wen
- Department of Haematology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaolan Zhang
- Department of Gastroentology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
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