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Eisfeld AK. Disparities in acute myeloid leukemia treatments and outcomes. Curr Opin Hematol 2024; 31:58-63. [PMID: 38059809 DOI: 10.1097/moh.0000000000000797] [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] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize different contributors to survival disparities in acute myeloid leukemia (AML) patients. The focus is set on African-American (hereafter referred to as Black) patients, with separate consideration of self-reported race and ancestry. It aims to also highlight the interconnectivity of the different features that impact on despair survival. RECENT FINDINGS The main themes in the literature covered in this article include the impact of social deprivation, clinical trial enrollment and biobanking, structural racism and ancestry-associated differences in genetic features on survival outcomes. SUMMARY An increasing number of studies have not only shown persistent survival disparities between Black and non-Hispanic White AML patients, but uncovered a multitude of contributors that have additive adverse effects on patient outcomes. In addition to potentially modifiable features, such as socioeconomic factors and trial enrollment odds that require urgent interventions, there is emerging data on differences in disease biology with respect to genetic ancestry, including frequencies of known AML-driver mutations and their associated prognostic impact.
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Affiliation(s)
- Ann-Kathrin Eisfeld
- The Ohio State University Comprehensive Cancer Center
- Division of Hematology, Department of Internal Medicine
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University, Comprehensive Cancer Center, Columbus, Ohio, USA
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Higgason N, Nguyen L, Le YC, Juliet Ezeigwe O, Han Chung T, Williams N, Olguin XK, Zamorano AS. Facilitators to cervical cancer screening in a minority, urban, underserved population. Gynecol Oncol Rep 2024; 51:101315. [PMID: 38205237 PMCID: PMC10776919 DOI: 10.1016/j.gore.2023.101315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024] Open
Abstract
Objectives Cervical cancer has markedly declined due to widespread use of screening, but Hispanic women continue to bear a disproportionate amount of the cervical cancer burden due to under-screening. Previous studies have explored barriers to screening but have failed to identify targetable facilitators in this group. We aimed to assess facilitators to cervical cancer screening among a predominantly urban, Hispanic population who presented to a no-cost, community-based clinic. Methods Patients completed demographic and health information, a validated social determinants of health (SDOH) screen, and a self-reported facilitators survey on factors which enabled them to present to clinic. Descriptive statistics were conducted to assess patients' sociodemographic characteristics, SDOH, and perceived facilitators. Results 124 patients were included. 98 % were Hispanic, 90 % identified Spanish as their preferred language, and 94 % had no insurance. Median age was 41. 31 % of patients reported a history of abnormal screening. On SDOH, over 80 % of patients screened positive in at least one domain, with the most common being food insecurity (53 %) and stress (46 %). The most frequently reported facilitator was encouragement from a family member/friend (30 %). 26 % of patients reported time off from work and 25 % reported availability of child/elder care as facilitators. Conclusions Identifying facilitators among patients who present for cervical cancer screening is critical to designing care plans to reach all populations. Our survey showed that the single greatest facilitator to patients presenting for cervical cancer screening was encouragement from a family member/friend. These findings suggest that increasing community involvement and awareness may help to improve cervical cancer screening in a minority, urban, underserved population.
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Affiliation(s)
- Noel Higgason
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Linh Nguyen
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yen-Chi Le
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ogochukwu Juliet Ezeigwe
- UTHealth School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, Houston, TX, USA
| | - Tong Han Chung
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Natalia Williams
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xochitl K. Olguin
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Abigail S. Zamorano
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Wassie M, Beshah DT, Tiruneh YM. Advanced stage presentation and its determinant factors among colorectal cancer patients in Amhara regional state Referral Hospitals, Northwest Ethiopia. PLoS One 2022; 17:e0273692. [PMID: 36206231 PMCID: PMC9543633 DOI: 10.1371/journal.pone.0273692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/14/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Nowadays, the burden of colorectal cancer (CRC) has been increasing in the world, particularly in developing nations. This could be related to the poor prognosis of the disease due to late presentation at diagnosis and poor treatment outcomes. In Ethiopia, studies related to the stage of colorectal cancer at diagnosis and its determinants are limited. Therefore, the study was intended to assess advanced stage presentation and its associated factors among colorectal cancer patients in northwest Ethiopia. METHODS An institution-based retrospective study was conducted among 367 CRC patients at two oncologic centers (the University of Gondar and Felege Hiwot comprehensive specialized hospitals) from January 1, 2017, to December 31, 2020. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for analysis. Binary logistic regression was used to identify factors associated with the outcome variable. All variables with P-value < 0.2 during bi-variable analysis were considered for multivariable logistic regression. The level of statistical significance was declared at P-value <0.05. RESULTS The magnitude of advanced stage presentation of colorectal cancer was 83.1%. Being rural dwellers (Adjusted odds ratio (AOR) = 3.6; 95% CI: 1.8,7.2), not medically insured (AOR = 3.9; 95% CI: 1.9,7.8), patients delay (AOR = 6.5; 95% CI:3.2, 13.3), recurrence of the disease (AOR = 2.3; 95% CI: 1.1,4.7), and no comorbidity illness (AOR = 4.4; 95% CI: 2.1, 9.1) were predictors of advanced stage presentation of CRC. CONCLUSION The current study revealed that the advanced-stage presentation of colorectal cancer patients was high. It is recommended that the community shall be aware of the signs and symptoms of the disease using different media, giving more emphasis to the rural community, expanding health insurance, and educating patients about the recurrence chance of the disease. Moreover, expansion of colorectal treatment centers and screening of colorectal cancer should be given emphasis.
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Affiliation(s)
- Mulugeta Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Debrework Tesgera Beshah
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yenework Mulu Tiruneh
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Obrochta CA, Parada H, Murphy JD, Nara A, Trinidad D, Araneta MR(H, Thompson CA. The impact of patient travel time on disparities in treatment for early stage lung cancer in California. PLoS One 2022; 17:e0272076. [PMID: 36197902 PMCID: PMC9534452 DOI: 10.1371/journal.pone.0272076] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 07/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Travel time to treatment facilities may impede the receipt of guideline-concordant treatment (GCT) among patients diagnosed with early-stage non-small cell lung cancer (ES-NSCLC). We investigated the relative contribution of travel time in the receipt of GCT among ES-NSCLC patients. METHODS We included 22,821 ES-NSCLC patients diagnosed in California from 2006-2015. GCT was defined using the 2016 National Comprehensive Cancer Network guidelines, and delayed treatment was defined as treatment initiation >6 versus ≤6 weeks after diagnosis. Mean-centered driving and public transit times were calculated from patients' residential block group centroid to the treatment facilities. We used logistic regression to estimate risk ratios and 95% confidence intervals (CIs) for the associations between patients' travel time and receipt of GCT and timely treatment, overall and by race/ethnicity and neighborhood socioeconomic status (nSES). RESULTS Overall, a 15-minute increase in travel time was associated with a decreased risk of undertreatment and delayed treatment. Compared to Whites, among Blacks, a 15-minute increase in driving time was associated with a 24% (95%CI = 8%-42%) increased risk of undertreatment, and among Filipinos, a 15-minute increase in public transit time was associated with a 27% (95%CI = 13%-42%) increased risk of delayed treatment. Compared to the highest nSES, among the lowest nSES, 15-minute increases in driving and public transit times were associated with 33% (95%CI = 16%-52%) and 27% (95%CI = 16%-39%) increases in the risk of undertreatment and delayed treatment, respectively. CONCLUSION The benefit of GCT observed with increased travel times may be a 'Travel Time Paradox,' and may vary across racial/ethnic and socioeconomic groups.
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Affiliation(s)
- Chelsea A. Obrochta
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
| | - Humberto Parada
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
| | - James D. Murphy
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
| | - Atsushi Nara
- Department of Geography, San Diego State University, San Diego, California, United States of America
| | - Dennis Trinidad
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
| | | | - Caroline A. Thompson
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- * E-mail:
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Fujiwara T, Ogura K, Alaqeel M, Healey JH. Geographic Access to High-Volume Care Providers and Survival in Patients with Bone Sarcomas: Nationwide Patterns in the United States. J Bone Joint Surg Am 2022; 104:1426-1437. [PMID: 35730765 PMCID: PMC10855024 DOI: 10.2106/jbjs.21.01140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical practice guidelines recommend centralized care for patients with bone sarcoma. However, the relationship between the distance that patients travel to obtain care, institutional treatment volume, and survival is unknown. METHODS We used the National Cancer Database to examine associations between travel distance and survival among 8,432 patients with bone sarcoma diagnosed from 2004 to 2015. Associations were identified using multivariable Cox regression analyses that controlled for sociodemographic, clinical, and hospital-level factors; subgroup analyses stratified patients by histological diagnosis, tumor stage, and pediatric or adult status. RESULTS Mortality risk was lower among patients who traveled ≥50 miles (≥80.5 km) than among patients who traveled ≤10 miles (≤16.1 km) (hazard ratio [HR], 0.69 [95% confidence interval (CI), 0.63 to 0.76]). Among hospital-level factors, facility volume independently affected survival: mortality risk was lower among patients at high-volume facilities (≥20 cases per year) than at low-volume facilities (≤5 cases per year), with an HR of 0.72 (95% CI, 0.66 to 0.80). The proportion of patients who received care at high-volume facilities varied by distance traveled (p < 0.001); it was highest among patients who traveled ≥50 miles (53%) and lower among those who traveled 11 to 49 miles (17.7 to 78.9 km) (32%) or ≤10 miles (18%). Patients who traveled ≥50 miles to a high-volume facility had a lower risk of mortality (HR, 0.65 [95% CI, 0.56 to 0.77]) than those who traveled ≤10 miles to a low-volume facility. In subgroup analyses, this association was evident among patients with all 3 major histological subtypes; those with stage-I, II, and IV tumors; and adults. CONCLUSIONS This national study showed that greater travel burden was associated with higher survival rates in adults, a finding attributable to patients traveling to receive care at high-volume facilities. Despite the burdens associated with travel, modification of referral pathways to specialized centers may improve survival for patients with bone sarcoma. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tomohiro Fujiwara
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koichi Ogura
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Motaz Alaqeel
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John H Healey
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Bhatia S, Landier W, Paskett ED, Peters KB, Merrill JK, Phillips J, Osarogiagbon RU. Rural-Urban Disparities in Cancer Outcomes: Opportunities for Future Research. J Natl Cancer Inst 2022; 114:940-952. [PMID: 35148389 PMCID: PMC9275775 DOI: 10.1093/jnci/djac030] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/27/2021] [Accepted: 02/01/2022] [Indexed: 01/12/2023] Open
Abstract
Cancer care disparities among rural populations are increasingly documented and may be worsening, likely because of the impact of rurality on access to state-of-the-art cancer prevention, diagnosis, and treatment services, as well as higher rates of risk factors such as smoking and obesity. In 2018, the American Society of Clinical Oncology undertook an initiative to understand and address factors contributing to rural cancer care disparities. A key pillar of this initiative was to identify knowledge gaps and promote the research needed to understand the magnitude of difference in outcomes in rural vs nonrural settings, the drivers of those differences, and interventions to address them. The purpose of this review is to describe continued knowledge gaps and areas of priority research to address them. We conducted a comprehensive literature review by searching the PubMed (Medline), Embase, Web of Science, and Cochrane Library databases for studies published in English between 1971 and 2021 and restricted to primary reports from populations in the United States and abstracted data to synthesize current evidence and identify continued gaps in knowledge. Our review identified continuing gaps in the literature regarding the underlying causes of rural-urban disparities in cancer outcomes. Rapid advances in cancer care will worsen existing disparities in outcomes for rural patients without directed effort to understand and address barriers to high-quality care in these areas. Research should be prioritized to address ongoing knowledge gaps about the drivers of rurality-based disparities and preventative and corrective interventions.
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Affiliation(s)
- Smita Bhatia
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Wendy Landier
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Fujiwara T, Evans S, Stevenson J, Tsuda Y, Gregory J, Grimer RJ, Abudu S. Regional variation in the survival of patients with a soft-tissue sarcoma of the extremity and trunk wall under a centralized care system : what has been the impact of national policies in the UK? Bone Joint J 2021; 103-B:1541-1549. [PMID: 34465152 DOI: 10.1302/0301-620x.103b9.bjj-2020-2554.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS While a centralized system for the care of patients with a sarcoma has been advocated for decades, regional variations in survival remain unclear. The aim of this study was to investigate regional variations in survival and the impact of national policies in patients with a soft-tissue sarcoma (STS) in the UK. METHODS The study included 1,775 patients with a STS who were referred to a tertiary sarcoma centre. The geographical variations in survival were evaluated according to the periods before and after the issue of guidance by the National Institute for Health and Care Excellence (NICE) in 2006 and the relevant evolution of regional management. RESULTS There had been a significant difference in survival between patients referred from the North East, North West, East Midlands, West Midlands, South West, and Wales in the pre-NICE era (five-year disease-specific survival (DSS); South West, 74% vs North East, 47% (p = 0.045) or West Midlands, 54% (p = 0.049)), which was most evident for patients with a high-grade STS. However, this variation disappeared in the post-NICE era, in which the overall DSS for high-grade STS improved from 47% to 68% at five years (p < 0.001). Variation in the size of the tumour closely correlated with the variation in DSS, and the overall size of the tumour and incidence of metastasis at the time of diagnosis also decreased after the national policies were issued. CONCLUSION The survival of patients with a STS improved and regional variation corrected after the introduction of national policies, as a result of a decreasing size of tumour and incidence of metastasis at the time of diagnosis, particularly in patients with a high-grade STS. This highlights the positive impact of national guidelines on regional variation in the presentation, management, and outcome in patients with a STS. Cite this article: Bone Joint J 2021;103-B(9):1541-1549.
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Affiliation(s)
- Tomohiro Fujiwara
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Birmingham, UK
| | - Scott Evans
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Yusuke Tsuda
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Gregory
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert J Grimer
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Seggy Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Freedland AR, Muller RL, Hoyo C, Turner EL, Moorman PG, Faria EF, Carvalhal GF, Reis RB, Mauad EC, Carvalho AL, Freedland SJ. Implications of Regionalizing Care in the Developing World: Impact of Distance to Referral Center on Compliance to Biopsy Recommendations in a Brazilian Prostate Cancer Screening Cohort. Prostate Cancer 2021; 2021:6614838. [PMID: 34239732 PMCID: PMC8241493 DOI: 10.1155/2021/6614838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/09/2021] [Indexed: 11/18/2022] Open
Abstract
Given growing specialization in medical care, optimal care may require regionalization, which may create access barriers. We tested this within a large prostate cancer (PC) screening program in Brazil. In 2004-2007, Barretos Cancer Hospital prospectively screened men for PC throughout rural Brazil. Men with abnormal screen were referred for follow-up and possible biopsy. We tested the link between distance from screening site to Barretos Cancer Hospital and risk of noncompliance with showing up for biopsy, PC on biopsy and, among those with PC, PC grade using crude and multivariable logistic regression analysis. Among 10,467 men undergoing initial screen, median distance was 257 km (IQR: 135-718 km). On crude and multivariable analyses, farther distance was significantly linked with biopsy noncompliance (OR/100 km: 0.83, P < 0.001). Among men who lived within 150 km of Barretos Cancer Hospital, distance was unrelated to compliance (OR/100 km: 1.09, P=0.87). There was no association between distance and PC risk or PC grade (all P > 0.25). In Brazil, where distances to referral centers can be large, greater distance was related to reduced biopsy compliance in a PC screening cohort. Among men who lived within 150 km, distance was unrelated to compliance. Care regionalization may reduce access when distances are large.
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Affiliation(s)
- Alexis R. Freedland
- Department of Epidemiology, UCI School of Medicine, University of California, Irvine, CA, USA
| | - Roberto L. Muller
- Division of Urology, Center of Oncologic Research, Florianopolis, Santa Catarina, Brazil
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Elizabeth L. Turner
- Global Health Institute, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University Graduate School, Durham, NC, USA
| | - Patricia G. Moorman
- Department of Community and Family Medicine, Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Eliney F. Faria
- Division of Urologic Oncology and Laparoscopy, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | - Rodolfo B. Reis
- Division of Urology, Ribeirao Preto Medical School of Sao Paulo University (USP), Ribeirao Preto, São Paulo, Brazil
| | - Edmundo C. Mauad
- Department of Preventative Medicine, Barretos Cancer Hospital and Pio XII Foundation, Barretos, São Paulo, Brazil
| | - Andre L. Carvalho
- Research Support Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Stephen J. Freedland
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Fujiwara T, Ogura K, Healey J. Greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns. PLoS One 2021; 16:e0252381. [PMID: 34086725 PMCID: PMC8177553 DOI: 10.1371/journal.pone.0252381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/15/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose The survival impact of geographic access to specialized care remains unknown in patients with soft-tissue sarcomas (STS). This study aimed to clarify the association between the patient travel distance and survival outcome and investigate the factors lying behind it. Methods A total of 34 528 patients with STS registered in the National Cancer Data Base, diagnosed from 2004–2016, were investigated. Results Tumor stage correlated with travel distance: patients with metastatic disease stayed closer to home. However, the type of facility showed greatest variation: 37.0%, 51.0%, 73.5%, and 75.9% of patients with ≤10 miles, 10.1–50 miles, 50.1–100 miles, and >100 miles, respectively (P<0.001), had a sarcoma care at academic/research centers. On a multivariable analysis, reduced mortality risk was associated with longer (versus short) travel distance (>100 miles: HR = 0.877; P = 0.001) and management at academic/research (versus non-academic/research) centers (HR = 0.857; P<0.001). The greatest divergence was seen in patients traveling very long distance (>100 miles) to an academic/research center, with a 26.9% survival benefit (HR = 0.731; P<0.001), compared with those traveling short distance (≤10 miles; 95.4% living in metropolitan area) to a non-academic/research center. There was no significant correlation between travel distance and survival in patients who had care at academic/research centers, whereas a survival benefit of management at academic/research centers was observed in every group of travel distance, regardless of tumor stage. Conclusions This national study demonstrated that increased travel distance was associated with superior survival, attributable to a higher proportion of patients receiving sarcoma care at distant academic/research centers. These data support centralized care for STS. Overcoming referral and travel barriers may enable more patients to be treated at specialized centers and may further improve survival rates for patients with STS, even when it imposes an increased travel burden.
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Affiliation(s)
- Tomohiro Fujiwara
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koichi Ogura
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - John Healey
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * E-mail:
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10
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Andrilla CHA, Moore TE, Man Wong K, Evans DV. Investigating the Impact of Geographic Location on Colorectal Cancer Stage at Diagnosis: A National Study of the SEER Cancer Registry. J Rural Health 2019; 36:316-325. [PMID: 31454856 DOI: 10.1111/jrh.12392] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/09/2019] [Accepted: 07/25/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Early detection of colorectal cancer (CRC) is associated with decreased mortality and potential avoidance of chemotherapy. CRC screening rates are lower in rural communities and patient outcomes are poorer. This study examines the extent to which United States' rural residents present at a more advanced stage of CRC compared to nonrural residents. METHODS Using the 2010-2014 Surveillance, Epidemiology and End Results Incidence data, 132,277 patients with CRC were stratified using their county of residence and urban influence codes into 5 categories (metro, adjacent micropolitan, nonadjacent micropolitan, small rural, and remote small rural). Logistic regression was used to investigate the relationship between late stage at diagnosis and county-level characteristics including level of rurality, persistent poverty, low education and low employment, and patient characteristics. RESULTS In the adjusted analysis the rate of stage 4 CRC at diagnosis differed across geographic classification, with patients living in remote small rural counties having the highest rate of stage 4 disease (range: 19.2% in nonadjacent micropolitan counties to 22.7% in remote small rural counties). Other factors, such as patient characteristics, insurance status, and regional practice variation were also significantly associated with late-stage CRC diagnosis. CONCLUSIONS Geographic residence is associated with the rate of stage 4 disease at presentation. Additional patient factors are associated with stage 4 CRC disease at diagnosis. Cancer outcomes are worse for rural patients, and late stage at diagnosis may partially account for this disparity. These differences have persisted over time and suggest areas for further research, patient engagement, and education.
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Affiliation(s)
- C Holly A Andrilla
- WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
| | - Tessa E Moore
- WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
| | - Kit Man Wong
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - David V Evans
- WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
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Fang CY, Tseng M. Ethnic density and cancer: A review of the evidence. Cancer 2018; 124:1877-1903. [PMID: 29411868 PMCID: PMC5920546 DOI: 10.1002/cncr.31177] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/24/2017] [Accepted: 11/13/2017] [Indexed: 01/04/2023]
Abstract
Accumulating data suggest that factors in the social environment may be associated with cancer-related outcomes. Ethnic density, defined as the proportion of racial/ethnic minority individuals residing in a given geographic area, is 1 of the most frequently studied social environment factors, but studies on ethnic density and cancer have yielded inconsistent findings. Thus, the objective of the current review was to summarize the extant data on ethnic density and cancer-related outcomes (cancer risk, stage at diagnosis, and mortality) with the aim of identifying pathways by which ethnic density may contribute to outcomes across populations. In general, the findings indicated an association between ethnic density and increased risk for cancers of infectious origin (eg, liver, cervical) but lower risk for breast and colorectal cancers, particularly among Hispanic and Asian Americans. Hispanic ethnic density was associated with greater odds of late-stage cancer diagnosis, whereas black ethnic density was associated with greater mortality. In addition, this review highlights several methodological and conceptual issues surrounding the measurement of ethnic neighborhoods and their available resources. Clarifying the role of neighborhood ethnic density is critical to developing a greater understanding of the health risks and benefits accompanying these environments and how they may affect racial and ethnic disparities in cancer-related outcomes. Cancer 2018;124:1877-903. © 2018 American Cancer Society.
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Affiliation(s)
- Carolyn Y Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Marilyn Tseng
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California
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Lin Y, Wimberly MC. Geographic Variations of Colorectal and Breast Cancer Late-Stage Diagnosis and the Effects of Neighborhood-Level Factors. J Rural Health 2016; 33:146-157. [DOI: 10.1111/jrh.12179] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/11/2016] [Accepted: 02/06/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Yan Lin
- Department of Geography; South Dakota State University; Brookings South Dakota
| | - Michael C. Wimberly
- Geospatial Sciences Center of Excellence; South Dakota State University; Brookings South Dakota
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Ambroggi M, Biasini C, Del Giovane C, Fornari F, Cavanna L. Distance as a Barrier to Cancer Diagnosis and Treatment: Review of the Literature. Oncologist 2015; 20:1378-85. [PMID: 26512045 DOI: 10.1634/theoncologist.2015-0110] [Citation(s) in RCA: 312] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/16/2015] [Indexed: 11/17/2022] Open
Abstract
The burden of travel from a patient's residence to health care providers is an important issue that can influence access to diagnosis and treatment of cancer. Although several studies have shown that the travel burden can result in delays in diagnosis and treatment of many common cancers, its role appears underestimated in the treatment of patients in clinical practice. Therefore, we performed a review of the published data on the role of travel burden influencing four items: delay of diagnosis, adequate treatment of cancer, outcome, and quality of life of cancer patients. Forty-seven studies published up to December 2014 were initially identified. Twenty studies were excluded because they did not regard specifically the four items of our review. Twenty-seven studies formed the basis of our study and involved 716,153 patients. The associations between travel burden and (a) cancer stage at diagnosis (12 studies), (b) appropriate treatment (8 studies), (c) outcome (4 studies), and (d) quality of life (1 study) are reported. In addition, in two studies, the relation between travel burden and compliance with treatment was examined. The results of our review show that increasing travel requirements are associated with more advanced disease at diagnosis, inappropriate treatment, a worse prognosis, and a worse quality of life. These results suggest that clinical oncologists should remember the specific travel burden problem for cancer patients, who often need health care services every week or every month for many years.
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Affiliation(s)
- Massimo Ambroggi
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy
| | - Claudia Biasini
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy
| | - Cinzia Del Giovane
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Fornari
- Department of Medicine, G. da Saliceto Hospital, Piacenza, Italy
| | - Luigi Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy
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The Relationship between Neighborhood Immigrant Composition, Limited English Proficiency, and Late-Stage Colorectal Cancer Diagnosis in California. BIOMED RESEARCH INTERNATIONAL 2015; 2015:460181. [PMID: 26504808 PMCID: PMC4609354 DOI: 10.1155/2015/460181] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/25/2015] [Indexed: 11/18/2022]
Abstract
Despite the availability of effective early detection technologies, more than half (61%) of colorectal cancers in the United States and 55% in California are identified at an advanced stage. Data on colorectal cancer patients (N = 35,030) diagnosed from 2005 to 2007 were obtained from the California Cancer Registry. Multivariate analyses found a relationship among neighborhood concentration of recent immigrants, neighborhood rates of limited English proficiency, and late-stage colorectal cancer diagnosis. Hispanics living in neighborhoods with a greater percentage of recent immigrants (compared to the lowest percentage) had greater odds (OR 1.57, 95% CI 1.22, 2.02) of late-stage diagnosis whereas Hispanics living in neighborhoods with the highest percentage of limited English proficiency (compared to the lowest percentage) had lower odds (OR .71, 95% CI .51, .99) of late-stage diagnosis. These relationships were not observed for other ethnic groups. Results highlight the complex relationship among race/ethnicity, neighborhood characteristics, and colorectal cancer stage at diagnosis.
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Gomez SL, Shariff-Marco S, DeRouen M, Keegan THM, Yen IH, Mujahid M, Satariano WA, Glaser SL. The impact of neighborhood social and built environment factors across the cancer continuum: Current research, methodological considerations, and future directions. Cancer 2015; 121:2314-30. [PMID: 25847484 DOI: 10.1002/cncr.29345] [Citation(s) in RCA: 227] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 12/13/2022]
Abstract
Neighborhood social and built environments have been recognized as important contexts in which health is shaped. The authors reviewed the extent to which these neighborhood factors have been addressed in population-level cancer research by scanning the literature for research focused on specific social and/or built environment characteristics and their association with outcomes across the cancer continuum, including incidence, diagnosis, treatment, survivorship, and survival. The commonalities and differences in methodologies across studies, the current challenges in research methodology, and future directions in this research also were addressed. The assessment of social and built environment factors in relation to cancer is a relatively new field, with 82% of the 34 reviewed articles published since 2010. Across the wide range of social and built environment exposures and cancer outcomes considered by the studies, numerous associations were reported. However, the directions and magnitudes of associations varied, in large part because of the variation in cancer sites and outcomes studied, but also likely because of differences in study populations, geographic regions, and, importantly, choice of neighborhood measures and geographic scales. The authors recommend that future studies consider the life-course implications of cancer incidence and survival, integrate secondary and self-report data, consider work neighborhood environments, and further develop analytical and statistical approaches appropriate to the geospatial and multilevel nature of the data. Incorporating social and built environment factors into research on cancer etiology and outcomes can provide insights into disease processes, identify vulnerable populations, and generate results with translational impact of relevance for interventionists and policy makers.
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Affiliation(s)
- Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California
- Department of Health Research and Policy (Epidemiology), School of Medicine, and Stanford Cancer Institute, Stanford, California
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, Fremont, California
- Department of Health Research and Policy (Epidemiology), School of Medicine, and Stanford Cancer Institute, Stanford, California
| | - Mindy DeRouen
- Cancer Prevention Institute of California, Fremont, California
| | - Theresa H M Keegan
- Cancer Prevention Institute of California, Fremont, California
- Department of Health Research and Policy (Epidemiology), School of Medicine, and Stanford Cancer Institute, Stanford, California
| | - Irene H Yen
- School of Medicine, University of California-San Francisco, San Francisco, California
| | - Mahasin Mujahid
- School of Public Health, University of California-Berkeley, Berkeley, California
| | - William A Satariano
- School of Public Health, University of California-Berkeley, Berkeley, California
| | - Sally L Glaser
- Cancer Prevention Institute of California, Fremont, California
- Department of Health Research and Policy (Epidemiology), School of Medicine, and Stanford Cancer Institute, Stanford, California
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Associations of census-tract poverty with subsite-specific colorectal cancer incidence rates and stage of disease at diagnosis in the United States. J Cancer Epidemiol 2014; 2014:823484. [PMID: 25165475 PMCID: PMC4137551 DOI: 10.1155/2014/823484] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/16/2014] [Accepted: 06/23/2014] [Indexed: 02/08/2023] Open
Abstract
Background. It remains unclear whether neighborhood poverty contributes to differences in subsite-specific colorectal cancer (CRC) incidence. We examined associations between census-tract poverty and CRC incidence and stage by anatomic subsite and race/ethnicity. Methods. CRC cases diagnosed between 2005 and 2009 from 15 states and Los Angeles County (N = 278,097) were assigned to 1 of 4 groups based on census-tract poverty. Age-adjusted and stage-specific CRC incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Analyses were stratified by subsite (proximal, distal, and rectum), sex, race/ethnicity, and poverty. Results. Compared to the lowest poverty areas, CRC IRs were significantly higher in the most impoverished areas for men (IRR = 1.14 95% CI 1.12-1.17) and women (IRR = 1.06 95% CI 1.05-1.08). Rate differences between high and low poverty were strongest for distal colon (male IRR = 1.24 95% CI 1.20-1.28; female IRR = 1.14 95% CI 1.10-1.18) and weakest for proximal colon. These rate differences were significant for non-Hispanic whites and blacks and for Asian/Pacific Islander men. Inverse associations between poverty and IRs of all CRC and proximal colon were found for Hispanics. Late-to-early stage CRC IRRs increased monotonically with increasing poverty for all race/ethnicity groups. Conclusion. There are differences in subsite-specific CRC incidence by poverty, but associations were moderated by race/ethnicity.
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Bailey BA, Manning T, Peiris AN. The impact of living in rural and urban areas: vitamin D and medical costs in veterans. J Rural Health 2013; 28:356-63. [PMID: 23017006 DOI: 10.1111/j.1748-0361.2012.00407.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Living in a rural region is associated with significant health disparities and increased medical costs. Vitamin D deficiency, which is increasingly common, is also associated with many adverse health outcomes. The purpose of this study was to determine whether rural-urban residence status of veterans was related to vitamin D levels, and to determine if this factor also influenced medical costs/service utilization. Additionally explored was whether vitamin D differences accounted for part of the association between area of residence and medical costs/service utilization. METHODS Medical records of 9,396 veterans from 6 Veterans Administration Medical Centers were reviewed for variables of interest including county of residence, vitamin D level, medical costs and service utilization, and background variables. Rurality status was classified as large metropolitan, urban, and rural. FINDINGS The 3 rurality status groups differed significantly in vitamin D levels, with the highest levels observed for urban residents, followed by rural residents, and the lowest for large metro residents. Compared with urban residents, large metro residents were 49% more likely, while rural residents were 20% more likely, to be vitamin D deficient. Both rural and large metro residents had higher medical costs, and they were significantly more likely to be hospitalized. Vitamin D levels explained a statistically significant amount of the relationship between rurality status and medical costs/service utilization. CONCLUSIONS Vitamin D deficiency may be an additional health disparity experienced by both rural and inner-city veterans, and patients residing in these locations should be considered at increased risk for deficiency and routinely tested.
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Affiliation(s)
- Beth A Bailey
- Department of Family Medicine, East Tennessee State University, Johnson City, Tennessee 37684, USA.
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Davis TC, Rademaker A, Bailey SC, Platt D, Esparza J, Wolf MS, Arnold CL. Contrasts in rural and urban barriers to colorectal cancer screening. Am J Health Behav 2013; 37:289-98. [PMID: 23985175 DOI: 10.5993/ajhb.37.3.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To contrast barriers to colon cancer (CRC) screening and Fecal Occult Blood Test (FOBT) completion between rural and urban safety-net patients. METHODS Interviews were administered to 972 patients who were not up-to-date with screening. RESULTS Rural patients were more likely to believe it was helpful to find CRC early (89.7% vs 66.1%, p < .0001), yet were less likely to have received a screening recommendation (36.4% vs. 45.8%, p = .03) or FOBT information (14.5% vs 32.3%, p < .0001) or to have completed an FOBT (22.0% vs 45.8%, p < .0001). CONCLUSIONS Interventions are needed to increase screening recommendation, education and completion, particularly in rural areas.
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Affiliation(s)
- Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
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Green MA, Kim MM, Barber S, Odulana AA, Godley PA, Howard DL, Corbie-Smith GM. Connecting communities to health research: development of the Project CONNECT minority research registry. Contemp Clin Trials 2013; 35:1-7. [PMID: 23340183 DOI: 10.1016/j.cct.2013.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 01/09/2013] [Accepted: 01/11/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Prevention and treatment standards are based on evidence obtained in behavioral and clinical research. However, racial and ethnic minorities remain relatively absent from the science that develops these standards. While investigators have successfully recruited participants for individual studies using tailored recruitment methods, these strategies require considerable time and resources. Research registries, typically developed around a disease or condition, serve as a promising model for a targeted recruitment method to increase minority participation in health research. This study assessed the tailored recruitment methods used to populate a health research registry targeting African-American community members. METHODS We describe six recruitment methods applied between September 2004 and October 2008 to recruit members into a health research registry. Recruitment included direct (existing studies, public databases, community outreach) and indirect methods (radio, internet, and email) targeting the general population, local universities, and African American communities. We conducted retrospective analysis of the recruitment by method using descriptive statistics, frequencies, and chi-square statistics. RESULTS During the recruitment period, 608 individuals enrolled in the research registry. The majority of enrollees were African American, female, and in good health. Direct and indirect methods were identified as successful strategies for subgroups. Findings suggest significant associations between recruitment methods and age, presence of existing health condition, prior research participation, and motivation to join the registry. CONCLUSIONS A health research registry can be a successful tool to increase minority awareness of research opportunities. Multi-pronged recruitment approaches are needed to reach diverse subpopulations.
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Affiliation(s)
- Melissa A Green
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27599-7590, USA.
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Wang F, Guo D, McLafferty S. Constructing Geographic Areas for Cancer Data Analysis: A Case Study on Late-stage Breast Cancer Risk in Illinois. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2012; 35:1-11. [PMID: 22736875 PMCID: PMC3379893 DOI: 10.1016/j.apgeog.2012.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Fahui Wang
- Fred B. Kniffen Professor, Department of Geography & Anthropology, Louisiana State University, Baton Rouge, LA 70803
| | - Diansheng Guo
- Associate Professor, Department of Geography, University of South Carolina, Columbia, SC 29208
| | - Sara McLafferty
- Professor, Department of Geography, University of Illinois at Urbana-Champaign, Urbana, IL 61801-3671
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Roetzheim RG, Ferrante JM, Lee JH, Chen R, Love-Jackson KM, Gonzalez EC, Fisher KJ, McCarthy EP. Influence of primary care on breast cancer outcomes among Medicare beneficiaries. Ann Fam Med 2012; 10:401-11. [PMID: 22966103 PMCID: PMC3438207 DOI: 10.1370/afm.1398] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We used the Surveillance Epidemiology and End Results (SEER)-Medicare database to explore the association between primary care and breast cancer outcomes. METHODS Using a retrospective cohort study of 105,105 female Medicare beneficiaries with a diagnosis of breast cancer in SEER registries during the years 1994-2005, we examined the total number of office visits to primary care physicians and non-primary care physicians in a 24-month period before cancer diagnosis. For women with invasive cancers, we examined the odds of diagnosis of late-stage disease, according to the American Joint Commission on Cancer (AJCC) (stages III and IV vs stages I and II), and survival (breast cancer specific and all cause) using logistic regression and proportional hazards models, respectively. We also explored whether including noninvasive cancers, such as ductal carcinoma in situ (DCIS), would alter results and whether prior mammography was a potential mediator of associations. RESULTS Primary care physician visits were associated with improved breast cancer outcomes, including greater use of mammography, reduced odds of late-stage diagnosis, and lower breast cancer and overall mortality. Prior mammography (and resultant earlier stage diagnosis) mediated these associations in part, but not completely. Similar results were seen for non-primary care physician visits. Results were similar when women with DCIS were included in the analysis. CONCLUSIONS Medicare beneficiaries with breast cancer had better outcomes if they made greater use of a primary care physician's ambulatory services. These findings suggest adequate primary medical care may be an important factor in achieving optimal breast cancer outcomes.
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Affiliation(s)
- Richard G Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida 33612, USA.
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Hines RB, Markossian TW. Differences in Late-Stage Diagnosis, Treatment, and Colorectal Cancer-Related Death Between Rural and Urban African Americans and Whites in Georgia. J Rural Health 2011; 28:296-305. [DOI: 10.1111/j.1748-0361.2011.00390.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Scoggins JF, Fedorenko CR, Donahue SMA, Buchwald D, Blough DK, Ramsey SD. Is distance to provider a barrier to care for medicaid patients with breast, colorectal, or lung cancer? J Rural Health 2011; 28:54-62. [PMID: 22236315 DOI: 10.1111/j.1748-0361.2011.00371.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Distance to provider might be an important barrier to timely diagnosis and treatment for cancer patients who qualify for Medicaid coverage. Whether driving time or driving distance is a better indicator of travel burden is also of interest. METHODS Driving distances and times from patient residence to primary care provider were calculated for 3,917 breast, colorectal (CRC) and lung cancer Medicaid patients in Washington State from 1997 to 2003 using MapQuest.com. We fitted regression models of stage at diagnosis and time-to-treatment (number of days between diagnosis and surgery) to test the hypothesis that travel burden is associated with timely diagnosis and treatment of cancer. FINDINGS Later stage at diagnosis for breast cancer Medicaid patients is associated with travel burden (OR = 1.488 per 100 driving miles, P= .037 and OR = 1.270 per driving hour, P= .016). Time-to-treatment after diagnosis of CRC is also associated with travel burden (14.57 days per 100 driving miles, P= .002 and 5.86 days per driving hour, P= .018). CONCLUSIONS Although travel burden is associated with timely diagnosis and treatment for some types of cancer, we did not find evidence that driving time was, in general, better at predicting timeliness of cancer diagnosis and treatment than driving distance. More intensive efforts at early detection of breast cancer and early treatment of CRC for Medicaid patients who live in remote areas may be needed.
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Affiliation(s)
- John F Scoggins
- Research and Economic Assessment in Cancer and Healthcare (REACH) Group, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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Sankaranarayanan J, Watanabe-Galloway S, Sun J, Qiu F, Boilesen E, Thorson AG. Rurality and other determinants of early colorectal cancer diagnosis in Nebraska: a 6-year cancer registry study, 1998-2003. J Rural Health 2009; 25:358-65. [PMID: 19780915 DOI: 10.1111/j.1748-0361.2009.00244.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are no studies of rurality, and other determinants of colorectal cancer (CRC) stage at diagnosis with population-based data from the Midwest. METHODS This retrospective study identified, incident CRC patients, aged 19 years and older, from 1998-2003 Nebraska Cancer Registry (NCR) data. Using federal Office of Management and Budget classifications, we grouped patients by residence in metropolitan, micropolitan nonmetropolitan, or rural nonmetropolitan counties (non-core based statistical areas). In univariate and multivariate logistic regression analyses, we examined the association of the county classification and of other determinants with early (in situ/local) versus late (regional/distant) stage at CRC diagnosis. RESULTS Of the 6,561 CRC patients identified, 45% were from metropolitan counties, 24% from micropolitan nonmetropolitan counties and 31% from rural nonmetropolitan counties, with 32%, 38%, and 33%, respectively, being diagnosed at an early stage. Multivariate analysis showed micropolitan nonmetropolitan residents were significantly more likely than rural nonmetropolitan residents to be diagnosed at an early stage (adjusted OR, 1.22; 95% CI: 1.05-1.42, P < .05). However, rural nonmetropolitan and metropolitan residents did not significantly differ in the likelihood of early diagnosis. Residents with Medicare rather than those with private insurance (P < .0001), married rather than unmarried residents (P < .01), and residents with rectal cancer rather than those with colon cancer (P < .0001) were more likely to be diagnosed at an early stage. CONCLUSIONS Early CRC diagnosis needs to be increased in rural (non-core) non-metropolitan residents, unmarried residents, and those with private insurance.
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Halpern MT, Pavluck AL, Ko CY, Ward EM. Factors associated with colon cancer stage at diagnosis. Dig Dis Sci 2009; 54:2680-93. [PMID: 19117126 DOI: 10.1007/s10620-008-0669-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 12/08/2008] [Indexed: 12/12/2022]
Abstract
We analyzed data from 1998-2004 from the National Cancer Data Base to evaluate associations between patient/treatment facility factors and stage at diagnosis for all colon cancers combined and by anatomic location. Compared to patients with private insurance, uninsured patients were significantly more likely to present with advanced-stage disease; Medicaid patients had likelihoods of advanced-stage colon cancer in-between those of privately insured and uninsured patients. Increased odds of advanced-stage colon cancer at diagnosis were also observed among Black (vs. White) patients, women (vs. men), and patients from low socioeconomic status (SES) regions (vs. those from higher SES regions). While the likelihood of advanced-stage disease at diagnosis decreased in later years overall, this decrease was not observed among patients with ascending colon cancers. Screening disparities may lead to more advanced stage at diagnosis among colon cancer patients; programs to improve access to screening among underserved populations may address this disparity.
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Affiliation(s)
- Michael T Halpern
- Division of Health Services and Social Policy Research, RTI International, 701 13th Street NW, Suite 750, Washington, DC 20005, USA.
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Overholser L, Zittleman L, Kempe A, Bublitz Emsermann C, Froshaug DB, Main DS, Araya-Guerra R, Felzien M, Westfall JM. Use of colon cancer testing in rural Colorado primary care practices. J Gen Intern Med 2009; 24:1095-100. [PMID: 19711136 PMCID: PMC2762502 DOI: 10.1007/s11606-009-1063-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 05/22/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND People living in rural areas may be less likely to be up to date (UTD) with screening guidelines for colorectal cancer (CRC). OBJECTIVES To determine (1) rates of being UTD with screening or ever having had a test for CRC and (2) correlates for testing among patients living in a rural area who visit a provider. DESIGN Cross-sectional survey. PARTICIPANTS Five hundred seventy patients aged 50 years and older who visited their health-care provider in High Plains Research Network (HPRN) practices. MEASUREMENTS (1) Ever having had a CRC screening test, (2) being UTD with CRC screening, and (3) intention to get tested. RESULTS The survey completion rate was 65%; 71% of patients had ever had any CRC screening test, while 52% of patients were UTD. Correlates of intending to get tested included having a family history of CRC, having a doctor recommend a test, knowing somebody who got tested, and believing that testing for CRC gives one a feeling of being in control of their health. Of those who had never had a CRC screening test, 12% planned on getting tested in the future, while 55% of those who were already up to date intended to be tested again (p < 0.001). CONCLUSIONS Prevalence of being UTD with CRC testing in the HPRN was on par with statewide CRC testing rates, but over three quarters of patients who had not yet been screened had no intention of getting tested for CRC, despite having a medical home.
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Affiliation(s)
- Linda Overholser
- Department of Internal Medicine, Division of General Internal Medicine, University of Colorado-Denver, 360 S. Garfield Street, Denver, CO 80209, USA.
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Colorectal cancer stage at diagnosis and area socioeconomic characteristics in New Jersey. Health Place 2008; 15:505-513. [PMID: 19028134 DOI: 10.1016/j.healthplace.2008.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 06/06/2008] [Accepted: 09/08/2008] [Indexed: 11/22/2022]
Abstract
Despite effective screening methods, research suggests consistently higher rates of late stage colorectal cancer (CRC) among persons living in low socioeconomic areas compared to those living in affluent areas. This population-based study evaluated the association between area-based socioeconomic measures (ABSMs) and CRC stage at diagnosis in New Jersey. Cases of CRC among persons 50 years and older, diagnosed from 2000-2005, were obtained from the New Jersey State Cancer Registry. Associations between census tract-level ABSMs and CRC stage at diagnosis were evaluated using logistic regression and geographic variation assessed using a spatial scan statistic. After adjusting for covariates, including individual-level health insurance, ABSMs were significantly associated with stage at diagnosis. As area socioeconomic conditions worsened, the odds of being diagnosed at a late stage increased. While increasing CRC screening services for all New Jersey populations is warranted, this study suggests that persons living in low socioeconomic areas could benefit the most from enhanced CRC education, screening efforts, and guided interventions.
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Bentley R, Kavanagh AM, Subramanian SV, Turrell G. Area disadvantage, individual socio-economic position, and premature cancer mortality in Australia 1998 to 2000: a multilevel analysis. Cancer Causes Control 2007; 19:183-93. [PMID: 18027094 DOI: 10.1007/s10552-007-9084-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 10/16/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine associations between area and individual socio-economic characteristics and premature cancer mortality using multilevel analysis. METHODS We modeled cancer mortality among 25-64-year-old men and women (n = 16,340) between 1998 and 2000 in Australia. Socio-economic characteristics of Statistical Local Areas (n = 1,317) were measured using an Index of Relative Socio-economic Disadvantage (quintiles), and individual socio-economic position was measured by occupation (professionals, white and blue collar). RESULTS After adjustment for within-area variation in age and occupation, the probability of premature cancer mortality was highest in the most disadvantaged areas for all-cancer mortality for men (RR 1.48 95% CI 1.35-1.63) and women (RR 1.30 95% CI 1.18-1.43) and for lung cancer mortality for men (1.91 95% CI 1.63-2.25) and women (1.51 95% CI 1.04-2.18). Men in blue collar occupations had a higher rate of cancer mortality (RR 1.57 95% CI 1.50-1.65) and lung cancer mortality (RR 2.31 95 % CI 2.09-2.56), whereas men in white collar occupations had a lower all-cancer mortality rate (RR 0.78 95% CI 0.72-0.85). Compared with professionals, women in white collar occupations had an all-cancer mortality rate that was lower (RR 0.85 95% CI 0.80-0.90). When deaths from breast cancer were excluded, women in blue collar occupations had a significantly higher all-cancer mortality rate than professionals (RR 1.12 95% CI 1.02-1.22). CONCLUSIONS Area disadvantage and individual socio-economic position were independently associated with premature cancer mortality, suggesting that interventions to reduce inequalities should focus on places and people.
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Affiliation(s)
- Rebecca Bentley
- Key Center for Women's Health in Society, School of Population Health, University of Melbourne, Melbourne, Australia.
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Parsons MA, Askland KD. Determinants of prostate cancer stage in northern New England: USA Franco-American contextual effects. Soc Sci Med 2007; 65:2018-30. [PMID: 17689162 DOI: 10.1016/j.socscimed.2007.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Indexed: 11/23/2022]
Abstract
Despite screening for prostate cancer, mortality in the United States remains substantial. In northern New England, we know little about either determinants of stage at diagnosis--an important predictor of survival--or health outcomes for Franco-Americans, the region's largest ethnic minority. The objective of this investigation was to identify predictors of late prostate cancer stage in a rural, predominantly white state with a large Franco-American population. The Maine Cancer Registry provided incident cases from 1995 to 1998. We modeled individual-level variables (age, sex, race, French ethnicity by surname, and payer) and contextual/town-level variables (socioeconomic measures, population density, Franco ancestry proportion, distance to health care, and weather severity) with multiple logistic regression for late stage. We found that age categories 50-64, 65-74, and 75-84 years--but not 40-49 years--(versus 85+) were protective for late stage, as was residence in higher snowfall areas. Diagnosis in the earlier years of the study, particularly for French-surnamed men, and residence in a high-Franco area conferred greater risk for late disease. However, in a two-way interaction, residence in towns with high Franco ancestry proportion protected French-surnamed men (OR=0.09, type 3 p<0.0593). Using an established framework for social network theory we explore the potential reasons for this interaction, including: high social cohesion, a wide range of strong ties of long duration, and frequent contact, which might have facilitated access to resources as well as social support and normative influences toward health care seeking. The absence of an association of cancer stage with socioeconomic variables may stem from the mixed sociodemographic profiles in rural and urban regions of Maine. We feel that further research should therefore refine these and other contextual measures to elucidate effects on preventable morbidity and mortality; expand our knowledge of Franco-American health outcomes and social networks; and evaluate the utility of assigning French ethnicity by surname.
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Affiliation(s)
- Margaret A Parsons
- MaineGeneral Medical Center, MaineGeneral Health Associates, 152 Dresden Avenue, Gardiner, ME 04345, USA.
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