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Suda T, Shirota Y, Takimoto H, Tsukada Y, Takishita K, Nadamura T, Miyazawa M, Hodo Y, Wakabayashi T. Image quality of abdominal ultrasonography after esophagogastroduodenoscopy is preserved by using carbon dioxide insufflation: A non-inferiority test in the same subject. PLoS One 2022; 17:e0275257. [PMID: 36173985 PMCID: PMC9521841 DOI: 10.1371/journal.pone.0275257] [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: 04/12/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Because bowel gas deteriorates the image quality of abdominal ultrasonography (AUS), it is common to perform AUS prior to esophagogastroduodenoscopy (EGD). This one-way order limits the availability of examination appointments. To evaluate whether EGD using insufflation of carbon dioxide (CO2), which is rapidly absorbed by the gastrointestinal mucosa, preserves the image quality of AUS performed subsequently, we designed a non-inferiority test in which each subject underwent AUS, EGD with CO2 insufflation, and a second AUS, in that order. All saved AUS moving images were randomized and imaging quality was evaluated at 16 organs using a four-point Likert-like scale that divides the depiction rate by 25%. Sample size was calculated to be 26 using the following: non-inferiority margin of –0.40 corresponding to depiction rate of –10%, difference of means of 0.40, common standard deviation of 1.25, power of 90%, and 1-sided α-level of 0.025. We enrolled 30 subjects. The mean and 95% confidence interval (CI) of the image quality score of all 16 organs at pre- and post-EGD AUS in the 30 subjects were 3.54 [3.48–3.60] and 3.46 [3.39–3.52], respectively. The difference in the means was 0.08 of the scores, corresponding to a 2% depiction rate. The effect size was 0.172. The image quality of post-EGD AUS was not inferior, as demonstrated by the 97.5% CI of the difference, which did not cross the non-inferiority margin of –0.40. In conclusion, the use of CO2 for insufflation in EGD does not cause much deterioration in the image quality of AUS performed subsequently. Therefore, it is permissible to perform EGD prior to AUS, which is expected to improve the efficiency of examination setup.
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Affiliation(s)
- Tsuyoshi Suda
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Yukihiro Shirota
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
- * E-mail:
| | - Hiroaki Takimoto
- Medical Examination Center, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Yasunori Tsukada
- Department of Radiology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Kensaku Takishita
- Department of Radiology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Takahiro Nadamura
- Department of Radiology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Masaki Miyazawa
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Yuji Hodo
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Tokio Wakabayashi
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
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Suh K, Shankaran V, Bansal A. Assessing surveillance utilization and value in commercially insured patients with colorectal cancer. THE AMERICAN JOURNAL OF MANAGED CARE 2022; 28:e163-e169. [PMID: 35546589 PMCID: PMC9316744 DOI: 10.37765/ajmc.2022.89147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Real-world patterns of surveillance testing in colorectal cancer (CRC) and the effects on health and cost outcomes are largely unknown. Our objectives were to (1) assess trends in carcinoembryonic antigen (CEA) testing, CT scans, and colonoscopy utilization and (2) examine the value of CEA testing intensity by characterizing receipt of curative treatment for recurrence and measuring direct medical costs. STUDY DESIGN Prospective cohort study. METHODS We used an IBM MarketScan database to identify patients with a diagnosis of and treatment for CRC between 2008 and 2015. We used a negative binomial model to assess utilization of CEA testing and logistic models to assess utilization of CT scans and colonoscopies. We used a Cox proportional hazards model to assess surveillance intensity and time to curative treatment. We estimated direct medical costs using the Kaplan-Meier sample average estimator to account for censored costs. RESULTS We identified 3197 eligible patients. The mean numbers of CEA tests, CT scans, and colonoscopies remained relatively constant in the study period, but adherence to guidelines varied by surveillance. When categorizing individuals by their CEA utilization adherence to guidelines (perfect utilizers and overutilizers), overutilizers had an HR for curative treatment of 2.11 (95% CI, 1.46-3.05) relative to perfect utilizers. Although overutilizers underwent potentially curative procedures for recurrence at higher rates compared with perfect utilizers, direct medical costs were much higher in the overutilizer group. CONCLUSIONS Higher intensity of surveillance, beyond what is recommended by guidelines, may lead to earlier recurrence detection and subsequent treatment, but this is associated with significantly higher direct medical costs.
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Affiliation(s)
| | | | - Aasthaa Bansal
- University of Washington, 1959 NE Pacific St, 375-B, Seattle, WA 98195-7630.
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3
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Pellegrino SA, Chan S, Simons K, Kinsella R, Gibbs P, Faragher IG, Deftereos I, Yeung JM. Patterns of surveillance for colorectal cancer: Experience from a single large tertiary institution. Asia Pac J Clin Oncol 2020; 17:343-349. [PMID: 33079492 DOI: 10.1111/ajco.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/19/2020] [Indexed: 11/27/2022]
Abstract
AIM Colorectal cancer surveillance is an essential part of care and should include clinical review and follow-up investigations. There is limited information regarding postoperative surveillance and survivorship care in the Australian context. This study investigated patterns of colorectal cancer surveillance at a large tertiary institution. METHODS A retrospective review of hospital records was conducted for all patients treated with curative surgery between January 2012 and June 2017. Provision of clinical surveillance, colonoscopy, computed tomography (CT), and carcinoembryonic antigen (CEA) within 24 months postoperatively were recorded. Kaplan-Meier estimates were used to evaluate time-to-surveillance review and associated investigations. RESULTS A total of 675 patients were included in the study. Median time to first postoperative clinical review was 20 days (95% confidence interval (CI), 18-21) with only 31% of patients having their first postoperative clinic review within 2 weeks. Median time to first CEA was 100 days (95% CI, 92-109), with 47% of patients having their CEA checked within the first 3 months, increasing to 68% at 6 months. Median time to first follow-up CT scan was 262 days (95% CI, 242-278) and for colonoscopy, 560 days (95% CI, 477-625). Poor uptake of surveillance testing was more prevalent in patients from older age groups, those with multiple comorbidities, and higher stage cancers. CONCLUSION Colorectal cancer surveillance is multi-disciplinary and involves several parallel processes, many of which lead to inconsistent follow-up. Further prospective work is required to identify the reasons for variation in care and which aspects are most important to cancer patients.
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Affiliation(s)
| | - Steven Chan
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Australia
| | - Koen Simons
- Centre for Epidemiology and Biostatistics, Melbourne school of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Office for Research, Western Health, St Albans, Australia
| | - Rita Kinsella
- Department of Physiotherapy, St Vincent's Hospital, Fitzroy, Australia
| | - Peter Gibbs
- Department of Medical Oncology, Western Health, St Albans, Australia.,The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Ian G Faragher
- Department of Colorectal Surgery, Western Health, Melbourne, Australia.,Department of Surgery, Western Health, The University of Melbourne, Melbourne, Australia
| | - Irene Deftereos
- Department of Nutrition and Dietetics, Western Health, Footscray, Australia
| | - Justin Mc Yeung
- Department of Colorectal Surgery, Western Health, Melbourne, Australia.,Department of Surgery, Western Health, The University of Melbourne, Melbourne, Australia.,Western Health Chronic Disease Alliance, Western Health, St Albans, Australia
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Escobar KM, Murariu D, Munro S, Gorey KM. Care of acute conditions and chronic diseases in Canada and the United States: Rapid systematic review and meta-analysis. J Public Health Res 2019; 8:1479. [PMID: 30997359 PMCID: PMC6444377 DOI: 10.4081/jphr.2019.1479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/22/2019] [Indexed: 01/19/2023] Open
Abstract
This study tested the hypothesis that socioeconomically vulnerable Canadians with diverse acute conditions or chronic diseases have health care access and survival advantages over their counterparts in the USA. A rapid systematic review retrieved 25 studies (34 independent cohorts) published between 2003 and 2018. They were synthesized with a streamlined meta-analysis. Very low-income Canadian patients were consistently and highly advantaged in terms of health care access and survival compared with their counterparts in the USA who lived in poverty and/or were uninsured or underinsured. In aggregate and controlling for specific conditions or diseases and typically 4 to 9 comorbid factors or biomarkers, Canadians' chances of receiving better health care were estimated to be 36% greater than their American counterparts (RR=1.36, 95% CI 1.35-1.37). This estimate was significantly larger than that based on general patient or non-vulnerable population comparisons (RR=1.09, 95% CI 1.08-1.10). Contrary to prevalent political rhetoric, three studies observed that Americans experience more than twice the risk of long waits for breast or colon cancer care or of dying while they wait for an organ transplant (RR=2.36, 95% CI 2.09-2.66). These findings were replicated across externally valid national studies and more internally valid, metropolitan or provincial/state comparisons. Socioeconomically vulnerable Canadians are consistently and highly advantaged on health care access and outcomes compared to their American counterparts. Less vulnerable comparisons found more modest Canadian advantages. The Affordable Care Act ought to be fully supported including the expansion of Medicaid across all states. Canada's single payer system ought to be maintained and strengthened, but not through privatization.
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Affiliation(s)
| | | | - Sharon Munro
- Leddy Library, University of Windsor, ON, Canada
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Brennan K, Hall S, Owen T, Griffiths R, Peng Y. Variation in routine follow-up care after curative treatment for head-and-neck cancer: a population-based study in Ontario. Curr Oncol 2018; 25:e120-e131. [PMID: 29719436 PMCID: PMC5927791 DOI: 10.3747/co.25.3892] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The actual practices of routine follow-up after curative treatment for head-and-neck cancer are unknown, and existing guidelines are not evidence-based. Methods This retrospective population-based study used administrative data to describe 5 years of routine follow-up care in 3975 head-and-neck cancer patients diagnosed between 2007 and 2012 in Ontario. Results The mean number of visits per year declined during the follow-up period (from 7.8 to 1.9, p < 0.001). The proportion of patients receiving visits in concordance with guidelines ranged from 80% to 45% depending on the follow-up year. In at least 50% of patients, 1 head, neck, or chest imaging test was performed in the first follow-up year; that proportion subsequently declined (p < 0.001). Factors associated with follow-up practices included comorbidity, tumour site, treatment, geographic region, and physician specialty (p < 0.05). Conclusions Given current practice variation and the absence of an evidence-based standard, the challenge in identifying a single optimal follow-up strategy might be better addressed with a harmonized approach to providing individualized follow-up care.
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Affiliation(s)
| | - S.F. Hall
- Department of Otolaryngology
- Department of Oncology
| | | | | | - Y. Peng
- Department of Public Health Sciences, Queen’s University, Kingston, ON
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6
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Emre A, Akbulut S, Sertkaya M, Bitiren M, Kale IT, Bulbuloglu E. Assessment of risk factors affecting mortality in patients with colorectal cancer. PRZEGLAD GASTROENTEROLOGICZNY 2018; 13:109-117. [PMID: 30002769 PMCID: PMC6040099 DOI: 10.5114/pg.2018.73348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The most important risk factors for colorectal cancer are age, high ASA score, anemia, low albumin, tumor stage, histopathological properties, tumor's relationship with adjacent tissues, positivity of surgical borders and timing of the surgical procedure. AIM To determine possible risk factors for mortality in patients undergoing colorectal cancer surgery. MATERIAL AND METHODS The medical records of 101 consecutive patients who underwent colorectal cancer surgery at the Department of Surgery, Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey between January 2008 and November 2015 were retrospectively reviewed. The patients were divided into two groups: surviving (n = 76) and deceased (n = 25) groups. The groups were compared in terms of several demographic, clinical, biochemical, and histopathological parameters. In addition, risk factors for mortality were analyzed with multivariate analysis. SPSS 22.2, PAST 3, and MedCalc 14 software packages were used for statistical analyses. RESULTS The surviving and deceased groups significantly differed with respect to age (p = 0.001), hemoglobin (p = 0.001), lymph node positivity (p = 0.009), positive lymph node/total lymph node ratio (p = 0.012), thrombocyte count (p = 0.047), lymphovascular invasion (p = 0.028), urgency of admission (emergency/elective) (p = 0.036), and postoperative carcinoembryonic antigen (CEA) level (p = 0.002). A receiver operating characteristics curve was drawn to determine the cut-off values of various parameters including age (63), hemoglobin (12.8), node positivity (3), positive/total lymph node ratio (0.435) and thrombocyte count (308), with age (p < 0.001), hemoglobin (p < 0.001), node positivity (p = 0.025) and positive/total lymph node ratio (p = 0.024) being significantly different. A multivariate analysis revealed that age (p = 0.049), hemoglobin (p = 0.045), and positive/total lymph node ratio (p = 0.025) were independent risk factors for mortality. CONCLUSIONS This study shows that older age, lower hemoglobin level, and high positive/total lymph node ratio were independent risk factors for mortality among colorectal cancer patients.
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Affiliation(s)
- Arif Emre
- Department of Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Mehmet Sertkaya
- Department of Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Muharrem Bitiren
- Department of Pathology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Ilhami Taner Kale
- Department of Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Ertan Bulbuloglu
- Department of Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Kagedan DJ, Abraham L, Goyert N, Li Q, Paszat LF, Kiss A, Earle CC, Mittmann N, Coburn NG. Beyond the dollar: Influence of sociodemographic marginalization on surgical resection, adjuvant therapy, and survival in patients with pancreatic cancer. Cancer 2016; 122:3175-3182. [DOI: 10.1002/cncr.30148] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/02/2016] [Accepted: 05/18/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Daniel J. Kagedan
- Division of General Surgery, Department of Surgery; University of Toronto; Toronto Ontario Canada
| | - Liza Abraham
- Faculty of Medicine; University of Toronto; Toronto Ontario Canada
| | - Nik Goyert
- Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | - Qing Li
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Lawrence F. Paszat
- Faculty of Medicine; University of Toronto; Toronto Ontario Canada
- Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Alexander Kiss
- Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
| | - Craig C. Earle
- Faculty of Medicine; University of Toronto; Toronto Ontario Canada
- Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Nicole Mittmann
- Health Outcomes and PharmacoEconomic (HOPE) Research Centre; Sunnybrook Research Institute; Toronto Ontario Canada
| | - Natalie G. Coburn
- Division of General Surgery, Department of Surgery; University of Toronto; Toronto Ontario Canada
- Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
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8
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Kagedan DJ, Raju RS, Dixon ME, Shin E, Li Q, Liu N, Elmi M, El-Sedfy A, Paszat L, Kiss A, Earle CC, Mittmann N, Coburn NG. The association of adjuvant therapy with survival at the population level following pancreatic adenocarcinoma resection. HPB (Oxford) 2016; 18:339-47. [PMID: 27037203 PMCID: PMC4814617 DOI: 10.1016/j.hpb.2015.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Using a retrospective observational cohort approach, the overall survival (OS) following curative-intent resection of pancreatic adenocarcinoma (PC) was defined at the population level according to adjuvant treatment, and predictors of OS were identified. METHODS Patients undergoing resection of PC in the province of Ontario between 2005 and 2010 were identified using the provincial cancer registry, and linked to databases that include all treatments received and outcomes experienced in the province. Pathology reports were abstracted for staging and margin status. Patients were identified as having received chemotherapy (CT), chemoradiation therapy (CRT), or no adjuvant treatment (NAT). Kaplan-Meier survival analysis of patients surviving ≥ 6 months was performed, and predictors of OS identified by log-rank test. Cox multivariable analysis was used to define independent predictors of OS. RESULTS Among the 473 patients undergoing PC resection, the median survival was 17.8 months; for the 397 who survived ≥ 6 months following surgery, the 5-year OS for the CT, CRT, and NAT groups was 21%, 16%, and 17%, respectively (p = 0.584). Lymph node-negative patients demonstrated improved OS associated with chemotherapy on multivariable analysis (HR = 2.20, 95% CI = 1.25-3.83 for NAT vs. CT). CONCLUSIONS Following PC resection, only patients with negative lymph nodes demonstrated improved OS associated with adjuvant chemotherapy.
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Affiliation(s)
- Daniel J Kagedan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ravish S Raju
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Matthew E Dixon
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Elizabeth Shin
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Qing Li
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Maryam Elmi
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Abraham El-Sedfy
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Lawrence Paszat
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Alexander Kiss
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Craig C Earle
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Nicole Mittmann
- Health Outcomes and PharmacoEconomic (HOPE) Research Centre, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Natalie G Coburn
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.
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9
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Gorey KM, Kanjeekal SM, Wright FC, Hamm C, Luginaah IN, Bartfay E, Zou G, Holowaty EJ, Richter NL. Colon cancer care and survival: income and insurance are more predictive in the USA, community primary care physician supply more so in Canada. Int J Equity Health 2015; 14:109. [PMID: 26511360 PMCID: PMC4625439 DOI: 10.1186/s12939-015-0246-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/15/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Our research group advanced a health insurance theory to explain Canada's cancer care advantages over America. The late Barbara Starfield theorized that Canada's greater primary care-orientation also plays a critically protective role. We tested the resultant Starfield-Gorey theory by examining the effects of poverty, health insurance and physician supplies, primary care and specialists, on colon cancer care in Ontario and California. METHODS We analyzed registry data for people with non-metastasized colon cancer from Ontario (n = 2,060) and California (n = 4,574) diagnosed between 1996 and 2000 and followed to 2010. We obtained census tract-based socioeconomic data from population censuses and data on county-level physician supplies from national repositories: primary care physicians, gastroenterologists and other specialists. High poverty neighborhoods were oversampled and the criterion was 10 year survival. Hypotheses were explored with standardized rate ratios (RR) and tested with logistic regression models. RESULTS Significant inverse associations of poverty (RR = 0.79) and inadequate health insurance (RR = 0.80) with survival were observed in the California, while they were non-significant or non-existent in Ontario. The direct associations of primary care physician (RRs of 1.32 versus 1.11) and gastroenterologist (RRs of 1.56 versus 1.15) supplies with survival were both stronger in Ontario than California. The supply of primary care physicians took precedence. Probably mediated through the initial course of treatment, it largely explained the Canadian advantage. CONCLUSIONS Poverty and health insurance were more predictive in the USA, community physician supplies more so in Canada. Canada's primary care protections were greatest among the most socioeconomically vulnerable. The protective effects of Canadian health care prior to enactment of the Affordable Care Act (ACA) clearly suggested the following. Notwithstanding the importance of insuring all, strengthening America's system of primary care will probably be the best way to ensure that the ACA's full benefits are realized. Finally, Canada's strong primary care system ought to be maintained.
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Affiliation(s)
- Kevin M Gorey
- School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor, Ontario, N9B 3P4, Canada.
| | - Sindu M Kanjeekal
- Department of Oncology, Windsor Regional Cancer Center and Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Frances C Wright
- Division of General Surgery, Sunnybrook Health Sciences Center and cross appointed Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Caroline Hamm
- Department of Oncology, Windsor Regional Cancer Center and Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Isaac N Luginaah
- Department of Geography, Western University, London, Ontario, Canada.
| | - Emma Bartfay
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics and Robarts Research Institute, Western University, London, Ontario, Canada.
| | - Eric J Holowaty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Nancy L Richter
- School of Social Work, University of Windsor, Ontario, Canada.
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Cadarette SM, Wong L. An Introduction to Health Care Administrative Data. Can J Hosp Pharm 2015; 68:232-7. [PMID: 26157185 DOI: 10.4212/cjhp.v68i3.1457] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Suzanne M Cadarette
- PhD, is Associate Professor with the Leslie Dan Faculty of Pharmacy, University of Toronto, and Senior Adjunct Scientist with the Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Lindsay Wong
- BScPhm, PharmD, was, at the time of writing, a student in the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario. She is currently a pharmacy intern at St Michael's Hospital, Toronto, Ontario
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