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Samuel D, Kwon D, Huang M, Zhao W, Roy M, Tabuyo-Martin A, Siemon J, Schlumbrecht MP, Pearson JM, Sinno AK. Disparities in refusal of surgery for gynecologic cancer. Gynecol Oncol 2023; 174:1-10. [PMID: 37141816 DOI: 10.1016/j.ygyno.2023.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To identify sociodemographic and clinical factors associated with refusal of gynecologic cancer surgery and to estimate its effect on overall survival. METHODS The National Cancer Database was surveyed for patients with uterine, cervical or ovarian/fallopian tube/primary peritoneal cancer treated between 2004 and 2017. Univariate and multivariate logistic regression were used to assess associations between clinico-demographic variables and refusal of surgery. Overall survival was estimated using the Kaplan-Meier method. Trends in refusal over time were evaluated using joinpoint regression. RESULTS Of 788,164 women included in our analysis, 5875 (0.75%) patients refused surgery recommended by their treating oncologist. Patients who refused surgery were older at diagnosis (72.4 vs 60.3 years, p < 0.001) and more likely Black (OR 1.77 95% CI 1.62-1.92). Refusal of surgery was associated with uninsured status (OR 2.94 95% CI 2.49-3.46), Medicaid coverage (OR 2.79 95% CI 2.46-3.18), low regional high school graduation (OR 1.18 95% CI 1.05-1.33) and treatment at a community hospital (OR 1.59 95% CI 1.42-1.78). Patients who refused surgery had lower median overall survival (1.0 vs 14.0 years, p < 0.01) and this difference persisted across disease sites. Between 2008 and 2017, there was a significant increase in refusal of surgery annually (annual percent change +1.41%, p < 0.05). CONCLUSIONS Multiple social determinants of health are independently associated with refusal of surgery for gynecologic cancer. Given that patients who refuse surgery are more likely from vulnerable, underserved populations and have inferior survival, refusal of surgery should be considered a surgical healthcare disparity and tackled as such.
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Affiliation(s)
- David Samuel
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America.
| | - Deukwoo Kwon
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York, NY, United States of America
| | - Marilyn Huang
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America; Sylvester Comprehensive Cancer Center, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, Biostatistics and Bioinformatics Shared Resource, Miami, FL, United States of America
| | - Molly Roy
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - Angel Tabuyo-Martin
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - John Siemon
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - Matthew P Schlumbrecht
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America; Sylvester Comprehensive Cancer Center, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - J Matt Pearson
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America; Sylvester Comprehensive Cancer Center, Division of Gynecologic Oncology, Miami, FL, United States of America
| | - Abdulrahman K Sinno
- University of Miami, Miller School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Miami, FL, United States of America; Sylvester Comprehensive Cancer Center, Division of Gynecologic Oncology, Miami, FL, United States of America
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Aslanyan S, Gumeniuk K, Lysenko D. Modern views on skin biopsy in the diagnostic algorithm of dermatooncological diseases. УКРАЇНСЬКИЙ РАДІОЛОГІЧНИЙ ТА ОНКОЛОГІЧНИЙ ЖУРНАЛ 2022. [DOI: 10.46879/ukroj.2.2022.62-71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background. Malignant neoplasms of the skin are fairly common tumors in the world population and among the population of Ukraine. The main method of diagnosing skintumors is a biopsy, which allows establishing a diagnosis at an early stage and ensures the cure of most patients.
Purpose. To evaluate modern recommendations for skin biopsy in the diagnosis of dermato-onсological diseases.
Materials and methods. The search for sources of information was conducted using the MEDLINE/PubMed, EMBASE/ExcerptaMedica, CochraneLibrary, PubMed та Google Scholar databases using the following keywords: skin biopsy, skin tumors, diagnosis, melanoma. Among the identified sources, works without statistical analysis, descriptions of individual cases, articles without conclusions, and sources with duplicate results were excluded. The search depth was 10 years.
Results. As a result of the conducted search, 57 publications were found that corresponded to the declared purpose. The most common methods are: puncture, shaving, excisional and incisional biopsy. Most guidelines recommend full-thickness excisional biopsy as the preferred procedure for the diagnosis of suspected melanoma. It is indicated that a statistically significant mortality rate was found in the puncture biopsy group. Most observations showed no significant differences in melanoma recurrence between excisional biopsy and puncture groups. Given the clinical diversity of melanoma, there is no uniformity in the types of biopsies performed to diagnose melanoma. The most inaccurate method turned out to be the punch biopsy method, which is associated with an increased risk of underdiagnosis of melanoma.
Conclusions. A skin biopsy is a mandatory first step to establish a definitive diagnosis of a skin tumor. Excisional complete biopsy is the most justified in most cases of diagnosis. Rational biopsy technique remains an issue that needs further study.
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