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Chase DM, Shukla S, Moore J, Boyle TAC, Lim J, Perhanidis J, Hurteau JA, Schilder JM. Patient Characteristics Associated with Time to Next Treatment in Patients with Ovarian Cancer Treated with Niraparib: The PRED1CT Real-World Study. Oncol Ther 2024; 12:599-607. [PMID: 39097531 PMCID: PMC11333773 DOI: 10.1007/s40487-024-00294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/16/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Niraparib first-line maintenance (1LM) therapy has demonstrated clinical benefit for patients with ovarian cancer (OC) in clinical trial and real-world settings, but data on factors associated with real-world patient outcomes remain limited. This analysis identified patient characteristics associated with time to next treatment (TTNT), a proxy for real-world progression-free survival, in patients with OC treated with 1LM niraparib monotherapy. METHODS This retrospective observational study used a USA nationwide electronic health record-derived deidentified database and included adult patients diagnosed with OC who initiated 1LM niraparib monotherapy after first-line platinum-based chemotherapy. Patients were followed until the earliest occurrence of last clinical activity, death, or end of study period. TTNT was measured from 1LM niraparib initiation to the start of second-line treatment or death. Cox proportional hazards models assessed univariable and multivariable associations between baseline characteristics and TTNT. RESULTS Of 7872 patients diagnosed with OC, 526 met the eligibility criteria and were included in this analysis. Median (IQR) duration of follow-up was 14.1 (7.4-23.6) months. In univariable analyses, age, BRCA/homologous recombination deficiency (HRD) status, socioeconomic status, stage at initial diagnosis, cytoreductive surgery type, and residual disease status were significantly associated with observed TTNT and were introduced into the multivariable model with other clinically relevant variables. In the multivariable analysis, BRCA/HRD status, cytoreductive surgery type, and residual disease status were significantly associated with observed TTNT after covariate adjustment. Conversely, age, Eastern Cooperative Oncology Group performance status, disease stage, niraparib starting dose status, and first-line bevacizumab use were not associated with observed TTNT. CONCLUSION This real-world, retrospective, observational analysis offers valuable insights on prognostic factors associated with TTNT in patients with OC treated with 1LM niraparib monotherapy after first-line platinum-based chemotherapy. Future studies are needed to examine how additional patient characteristics associated with clinical outcomes may guide treatment decisions and improve outcomes.
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Affiliation(s)
- Dana M Chase
- David Geffen School of Medicine at UCLA, 855 Tiverton Dr, Los Angeles, CA, 90024, USA.
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Lee MW, Vallejo A, Furey KB, Woll SM, Klar M, Roman LD, Wright JD, Matsuo K. Racial and ethnic differences in early death among gynecologic malignancy. Am J Obstet Gynecol 2024; 231:231.e1-231.e11. [PMID: 38460831 DOI: 10.1016/j.ajog.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Racial and ethnic differences in early death after cancer diagnosis have not been well studied in gynecologic malignancy. OBJECTIVE This study aimed to assess population-level trends and characteristics of early death among patients with gynecologic malignancy based on race and ethnicity in the United States. STUDY DESIGN The National Cancer Institute's Surveillance, Epidemiology, and End Results Program was queried to examine 461,300 patients with gynecologic malignancies from 2000 to 2020, including uterine (n=242,709), tubo-ovarian (n=119,989), cervical (n=68,768), vulvar (n=22,991), and vaginal (n=6843) cancers. Early death, defined as a mortality event within 2 months of the index cancer diagnosis, was evaluated per race and ethnicity. RESULTS At the cohort level, early death occurred in 21,569 patients (4.7%), including 10.5%, 5.5%, 2.9%, 2.5%, and 2.4% for tubo-ovarian, vaginal, cervical, uterine, and vulvar cancers, respectively (P<.001). In a race- and ethnicity-specific analysis, non-Hispanic Black patients with tubo-ovarian cancer had the highest early death rate (14.5%). Early death racial and ethnic differences were the largest in tubo-ovarian cancer (6.4% for Asian vs 14.5% for non-Hispanic Black), followed by uterine (1.6% for Asian vs 4.9% for non-Hispanic Black) and cervical (1.8% for Hispanic vs 3.8% to non-Hispanic Black) cancers (all, P<.001). In tubo-ovarian cancer, the early death rate decreased over time by 33% in non-Hispanic Black patients from 17.4% to 11.8% (adjusted odds ratio, 0.67; 95% confidence interval, 0.53-0.85) and 23% in non-Hispanic White patients from 12.3% to 9.5% (adjusted odds ratio, 0.77; 95% confidence interval, 0.71-0.85), respectively. The early death between-group difference diminished only modestly (12.3% vs 17.4% for 2000-2002 [adjusted odds ratio for non-Hispanic White vs non-Hispanic Black, 0.54; 95% confidence interval, 0.45-0.65] and 9.5% vs 11.8% for 2018-2020 [adjusted odds ratio, 0.65; 95% confidence interval, 0.54-0.78]). CONCLUSION Overall, approximately 5% of patients with gynecologic malignancy died within the first 2 months from cancer diagnosis, and the early death rate exceeded 10% in non-Hispanic Black individuals with tubo-ovarian cancer. Although improving early death rates is encouraging, the difference among racial and ethnic groups remains significant, calling for further evaluation.
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Affiliation(s)
- Matthew W Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Andrew Vallejo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Katelyn B Furey
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Sabrina M Woll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
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LaRaja A, Connor Y, Poulson MR. The effect of urban racial residential segregation on ovarian cancer diagnosis, treatment, and survival. Gynecol Oncol 2024; 187:163-169. [PMID: 38788513 DOI: 10.1016/j.ygyno.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To investigate the effect of racial residential segregation on disparities between Black and White patients in stage at diagnosis, receipt of surgery, and survival. METHODS Subjects included Black and White patients diagnosed with ovarian cancer between 2005 and 2015 obtained from the Surveillance, Epidemiology, and End Results Program. Demographic data were obtained from the 2010 decennial census and 2013 American Community Survey. The exposure of interest was the index of dissimilarity (IOD), a validated measure of segregation. The outcomes of interest included relative risk of advanced stage at diagnosis and surgery for localized disease, 5-year overall and cancer-specific survival. RESULTS Black women were more likely to present with Stage IV ovarian cancer when compared to White (32% vs 25%, p < 0.001) and less often underwent surgical resection overall (64% vs 75%, p < 0.001). Increasing IOD was associated with a 25% increased risk of presenting at advanced stage for Black patients (RR 1.25, 95% CI 1.08, 1.45), and a 15% decrease for White patients (RR 0.85, 95% CI 0.73, 0.99). Increasing IOD was associated with an 18% decreased likelihood of undergoing surgical resection for black patients (RR 0.82, 95% CI 0.77, 0.87), but had no significant association for White patients (RR 1.01, 95% CI 0.96, 1.08). When compared to White patients in the lowest level of segregation, Black patients in the highest level of segregation had a 17% higher subhazard of death (HR 1.17, 95% CI 1.07, 1.27), while Black patients in the lowest level of segregation had no significant difference (HR 1.13, 95% CI 0.99, 1.29). CONCLUSION Our findings demonstrate the direct harm of historical government mandated segregation on Black women with ovarian cancer.
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Affiliation(s)
- Alexander LaRaja
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
| | - Yamicia Connor
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Michael R Poulson
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
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Mahoney DE, Mukherjee R, Thompson J. Elucidating the influences of social determinants of health on perceived overall health among African American/Black and Hispanic ovarian cancer survivors using the NIH All of Us Research Program. Gynecol Oncol 2024; 189:24-29. [PMID: 38986176 DOI: 10.1016/j.ygyno.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/20/2024] [Accepted: 06/27/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To evaluate the influences of social determinants of health (SDOH) on perceived health and well-being among African American (AA)/Black and Hispanic ovarian cancer survivors. METHODS A cross-sectional study was conducted using overall health and SDOH survey data collected by the National Institutes of Health All of Us Research Program from May 2017 to September 2023. RESULTS While 1250 enrolled participants with ovarian cancer met the inclusion criteria, 414 (33%) completed SDOH surveys: 29 (7%) AA/Black, 33 (8%) Hispanic, and 352 (85%) White. In the ordinal logistic regression models, for every unit increase in the SDOH neighborhood characteristics score, the odds of having a poor perception of general health decreased by 0.96 times. For every unit increase in the SDOH day-to-day discrimination score, the odds of having a poor perception of general health, general mental health, social satisfaction decreased by 0.95, 0.94 and 0.93 times respectively. For every unit increase in the SDOH food and housing security score, the odds of having a poor perception of general health decreased by 0.57 times. Compared to White ovarian cancer survivors, AA/Black and Hispanic ovarian cancer survivors were significantly more likely to have a poor perception of general health, general mental health, and social satisfaction even when adjusting for these SDOH. CONCLUSIONS Unfavorable SDOH conditions negatively influence the overall perception of health. These findings signal an urgency for healthcare professionals and scientists to partner together with local communities in designing feasible and imaginative interventions to overcome cancer care disparities in an equitable manner.
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Affiliation(s)
- Diane E Mahoney
- School of Nursing, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Rishav Mukherjee
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jeffrey Thompson
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Wang H, Reid BM, Richmond RC, Lane JM, Saxena R, Gonzalez BD, Fridley BL, Redline S, Tworoger SS, Wang X. Impact of insomnia on ovarian cancer risk and survival: a Mendelian randomization study. EBioMedicine 2024; 104:105175. [PMID: 38823087 PMCID: PMC11169961 DOI: 10.1016/j.ebiom.2024.105175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Insomnia is the most common sleep disorder in patients with epithelial ovarian cancer (EOC). We investigated the causal association between genetically predicted insomnia and EOC risk and survival through a two-sample Mendelian randomization (MR) study. METHODS Insomnia was proxied using genetic variants identified in a genome-wide association study (GWAS) meta-analysis of UK Biobank and 23andMe. Using genetic associations with EOC risk and overall survival from the Ovarian Cancer Association Consortium (OCAC) GWAS in 66,450 women (over 11,000 cases with clinical follow-up), we performed Iterative Mendelian Randomization and Pleiotropy (IMRP) analysis followed by a set of sensitivity analyses. Genetic associations with survival and response to treatment in ovarian cancer study of The Cancer Genome Atlas (TCGA) were estimated controlling for chemotherapy and clinical factors. FINDINGS Insomnia was associated with higher risk of endometrioid EOC (OR = 1.60, 95% CI 1.05-2.45) and lower risk of high-grade serous EOC (HGSOC) and clear cell EOC (OR = 0.79 and 0.48, 95% CI 0.63-1.00 and 0.27-0.86, respectively). In survival analysis, insomnia was associated with shorter survival of invasive EOC (OR = 1.45, 95% CI 1.13-1.87) and HGSOC (OR = 1.4, 95% CI 1.04-1.89), which was attenuated after adjustment for body mass index and reproductive age. Insomnia was associated with reduced survival in TCGA HGSOC cases who received standard chemotherapy (OR = 2.48, 95% CI 1.13-5.42), but was attenuated after adjustment for clinical factors. INTERPRETATION This study supports the impact of insomnia on EOC risk and survival, suggesting treatments targeting insomnia could be pivotal for prevention and improving patient survival. FUNDING National Institutes of Health, National Cancer Institute. Full funding details are provided in acknowledgments.
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Affiliation(s)
- Heming Wang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Brett M Reid
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Rebecca C Richmond
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Jacqueline M Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Brooke L Fridley
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA; Children's Mercy Hospital, Kansas City, MO, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA.
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Osazuwa-Peters OL, Deveaux A, Muehlbauer MJ, Ilkayeva O, Bain JR, Keku T, Berchuck A, Huang B, Ward K, Gates Kuliszewski M, Akinyemiju T. Racial Differences in Vaginal Fluid Metabolites and Association with Systemic Inflammation Markers among Ovarian Cancer Patients: A Pilot Study. Cancers (Basel) 2024; 16:1259. [PMID: 38610937 PMCID: PMC11011195 DOI: 10.3390/cancers16071259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
The vaginal microbiome differs by race and contributes to inflammation by directly producing or consuming metabolites or by indirectly inducing host immune response, but its potential contributions to ovarian cancer (OC) disparities remain unclear. In this exploratory cross-sectional study, we examine whether vaginal fluid metabolites differ by race among patients with OC, if they are associated with systemic inflammation, and if such associations differ by race. Study participants were recruited from the Ovarian Cancer Epidemiology, Healthcare Access, and Disparities Study between March 2021 and September 2022. Our study included 36 study participants with ovarian cancer who provided biospecimens; 20 randomly selected White patients and all 16 eligible Black patients, aged 50-70 years. Acylcarnitines (n = 45 species), sphingomyelins (n = 34), and ceramides (n = 21) were assayed on cervicovaginal fluid, while four cytokines (IL-1β, IL-10, TNF-α, and IL-6) were assayed on saliva. Seven metabolites showed >2-fold differences, two showed significant differences using the Wilcoxon rank-sum test (p < 0.05; False Discovery Rate > 0.05), and 30 metabolites had coefficients > ±0.1 in a Penalized Discriminant Analysis that achieved two distinct clusters by race. Arachidonoylcarnitine, the carnitine adduct of arachidonic acid, appeared to be consistently different by race. Thirty-eight vaginal fluid metabolites were significantly correlated with systemic inflammation biomarkers, irrespective of race. These findings suggest that vaginal fluid metabolites may differ by race, are linked with systemic inflammation, and hint at a potential role for mitochondrial dysfunction and sphingolipid metabolism in OC disparities. Larger studies are needed to verify these findings and further establish specific biological mechanisms that may link the vaginal microbiome with OC racial disparities.
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Affiliation(s)
- Oyomoare L. Osazuwa-Peters
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA; (A.D.); (T.A.)
| | - April Deveaux
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA; (A.D.); (T.A.)
| | - Michael J. Muehlbauer
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, NC 27701, USA; (M.J.M.); (O.I.); (J.R.B.)
| | - Olga Ilkayeva
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, NC 27701, USA; (M.J.M.); (O.I.); (J.R.B.)
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - James R. Bain
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, NC 27701, USA; (M.J.M.); (O.I.); (J.R.B.)
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Temitope Keku
- Division of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Andrew Berchuck
- Duke Division of Gynecologic Oncology, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Bin Huang
- Kentucky Cancer Registry, University of Kentucky, Lexington, KY 40506, USA;
| | - Kevin Ward
- Georgia Cancer Registry, Emory University, Atlanta, GA 30322, USA;
| | | | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA; (A.D.); (T.A.)
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC 27710, USA
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Washington CJ, Karanth SD, Wheeler M, Aduse-Poku L, Braithwaite D, Akinyemiju TF. Racial and socioeconomic disparities in survival among women with advanced-stage ovarian cancer who received systemic therapy. Cancer Causes Control 2024; 35:487-496. [PMID: 37874478 PMCID: PMC10838826 DOI: 10.1007/s10552-023-01810-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/29/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The purpose of this study was to assess the association between race/ethnicity and all-cause mortality among women with advanced-stage ovarian cancer who received systemic therapy. METHODS We analyzed data from the National Cancer Database on women diagnosed with advanced-stage ovarian cancer from 2004 to 2015 who received systemic therapy. Race/ethnicity was categorized as Non-Hispanic (NH) White, NH-Black, Hispanic, NH-Asian/Pacific Islander, and Other. Income and education were combined to form a composite measure of socioeconomic status (SES) and categorized into low-, mid-, and high-SES. Multivariable Cox proportional hazards models were used to assess whether race/ethnicity was associated with the risk of death after adjusting for sociodemographic, clinical, and treatment factors. Additionally, subgroup analyses were conducted by SES, age, and surgery receipt. RESULTS The study population comprised 53,367 women (52.4% ages ≥ 65 years, 82% NH-White, 8.7% NH-Black, 5.7% Hispanic, and 2.7% NH-Asian/Pacific Islander) in the analysis. After adjusting for covariates, the NH-Black race was associated with a higher risk of death versus NH-White race (aHR: 1.12; 95% CI: 1.07,1.18), while Hispanic ethnicity was associated with a lower risk of death compared to NH-White women (aHR: 0.87; 95% CI: 0.80, 0.95). Furthermore, NH-Black women versus NH-White women had an increased risk of mortality among those with low-SES characteristics (aHR:1.12; 95% CI:1.03-1.22) and mid-SES groups (aHR: 1.13; 95% CI:1.05-1.21). CONCLUSIONS Among women with advanced-stage ovarian cancer who received systemic therapy, NH-Black women experienced poorer survival compared to NH-White women. Future studies should be directed to identify drivers of ovarian cancer disparities, particularly racial differences in treatment response and surveillance.
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Affiliation(s)
- Caretia J Washington
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Shama D Karanth
- University of Florida Health Cancer Center, Gainesville, FL, USA
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Meghann Wheeler
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Livingstone Aduse-Poku
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Dejana Braithwaite
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Tomi F Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27708, USA.
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA.
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Kantor ED, O'Connell K, Ergas IJ, Valice E, Roh JM, Bhimani J, Heon N, Griggs JJ, Lee J, Bowles EJ, Rivera DR, Kolevska T, Bandera EV, Kushi LH. Assessment of breast cancer chemotherapy dose reduction in an integrated healthcare delivery system. Breast Cancer Res Treat 2024; 203:565-574. [PMID: 37923962 PMCID: PMC10885738 DOI: 10.1007/s10549-023-07126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/09/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Most cytotoxic drugs are dosed using body surface area (BSA), yet not all cancer patients receive the full BSA-determined dose. Prior work suggests that breast cancer patients who are obese are more likely to experience dose reduction than normal weight patients. However, the factors driving dose reduction remain unclear. METHODS In 452 women diagnosed with stage I-IIIA primary breast cancer at Kaiser Permanente Northern California, we evaluated the association between obesity and dose reduction, and further explored other factors in relation to dose reduction, including various sociodemographic characteristics, tumor characteristics, and comorbidities. Study participants were a part of the Pathways Study, diagnosed between 2006 and 2013 and treated with cyclophosphamide + doxorubicin, followed by paclitaxel (ACT). Dose reduction was assessed using first cycle dose proportion (FCDP) and average relative dose intensity (ARDI), a metric of dose intensity over the course of chemotherapy. RESULTS Overall, 8% of participants received a FCDP < 90% and 21.2% had an ARDI < 90%, with dose reduction increasing with body mass index. In adjusted logistic regression models, obese women had 4.1-fold higher odds of receiving an ARDI < 90% than normal weight women (95% CI: 1.9-8.9; p-trend = 0.0006). Increasing age was positively associated with an ADRI < 90%, as was the presence of comorbidity. Dose reduction was less common in later calendar years. CONCLUSION Results offer insight on factors associated with chemotherapy dosing for a common breast cancer regimen. Larger studies are required to evaluate relevance to other regimens, and further work will be needed to determine whether dose reductions impact outcomes in obese women.
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Affiliation(s)
- Elizabeth D Kantor
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, 3rd Floor, New York, NY, 10017, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Kelli O'Connell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, 3rd Floor, New York, NY, 10017, USA
| | - Isaac J Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emily Valice
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jenna Bhimani
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, 3rd Floor, New York, NY, 10017, USA
| | - Narre Heon
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, 3rd Floor, New York, NY, 10017, USA
- Office of Faculty Professional Development, Diversity & Inclusion, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer J Griggs
- Department of Medicine (Hematology/Oncology) and Health Management and Policy, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Jean Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Erin Ja Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Donna R Rivera
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Tatjana Kolevska
- Kaiser Permanente Vallejo Medical Center, Kaiser Permanente Northern California, Vallejo, CA, USA
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, the State University of New Jersey, Rutgers, New Brunswick, NJ, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Ryu J, Boylan KLM, Twigg CAI, Evans R, Skubitz APN, Thomas SN. Quantification of putative ovarian cancer serum protein biomarkers using a multiplexed targeted mass spectrometry assay. Clin Proteomics 2024; 21:1. [PMID: 38172678 PMCID: PMC10762856 DOI: 10.1186/s12014-023-09447-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Ovarian cancer is the most lethal gynecologic malignancy in women, and high-grade serous ovarian cancer (HGSOC) is the most common subtype. Currently, no clinical test has been approved by the FDA to screen the general population for ovarian cancer. This underscores the critical need for the development of a robust methodology combined with novel technology to detect diagnostic biomarkers for HGSOC in the sera of women. Targeted mass spectrometry (MS) can be used to identify and quantify specific peptides/proteins in complex biological samples with high accuracy, sensitivity, and reproducibility. In this study, we sought to develop and conduct analytical validation of a multiplexed Tier 2 targeted MS parallel reaction monitoring (PRM) assay for the relative quantification of 23 putative ovarian cancer protein biomarkers in sera. METHODS To develop a PRM method for our target peptides in sera, we followed nationally recognized consensus guidelines for validating fit-for-purpose Tier 2 targeted MS assays. The endogenous target peptide concentrations were calculated using the calibration curves in serum for each target peptide. Receiver operating characteristic (ROC) curves were analyzed to evaluate the diagnostic performance of the biomarker candidates. RESULTS We describe an effort to develop and analytically validate a multiplexed Tier 2 targeted PRM MS assay to quantify candidate ovarian cancer protein biomarkers in sera. Among the 64 peptides corresponding to 23 proteins in our PRM assay, 24 peptides corresponding to 16 proteins passed the assay validation acceptability criteria. A total of 6 of these peptides from insulin-like growth factor-binding protein 2 (IBP2), sex hormone-binding globulin (SHBG), and TIMP metalloproteinase inhibitor 1 (TIMP1) were quantified in sera from a cohort of 69 patients with early-stage HGSOC, late-stage HGSOC, benign ovarian conditions, and healthy (non-cancer) controls. Confirming the results from previously published studies using orthogonal analytical approaches, IBP2 was identified as a diagnostic biomarker candidate based on its significantly increased abundance in the late-stage HGSOC patient sera compared to the healthy controls and patients with benign ovarian conditions. CONCLUSIONS A multiplexed targeted PRM MS assay was applied to detect candidate diagnostic biomarkers in HGSOC sera. To evaluate the clinical utility of the IBP2 PRM assay for HGSOC detection, further studies need to be performed using a larger patient cohort.
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Affiliation(s)
- Joohyun Ryu
- Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Kristin L M Boylan
- Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Carly A I Twigg
- Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Richard Evans
- Clinical and Translational Research Institute, University of Minnesota, Minneapolis, MN, USA
| | - Amy P N Skubitz
- Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Stefani N Thomas
- Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, MN, USA.
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10
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Arter ZL, Desmond D, Berenberg JL, Killeen JL, Bunch K, Merritt MA. Epithelial ovarian cancer survival by race and ethnicity in an equal-access healthcare population. Br J Cancer 2024; 130:108-113. [PMID: 38057396 PMCID: PMC10781944 DOI: 10.1038/s41416-023-02471-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/27/2023] [Accepted: 10/17/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Previous studies in the general population observed that compared with non-Hispanic White women, Pacific Islander and Black women have higher age-adjusted mortality rates from epithelial ovarian cancer (EOC), while Asian American patients have lower mortality. We investigated whether race and ethnicity is associated with differences in EOC survival in a United States Military population where patients have equal access to healthcare. METHODS This retrospective study included women diagnosed with EOC between 2001 and 2018 among Department of Defense beneficiaries. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models adjusting for age and year of diagnosis, histology and stage. RESULTS In our study population of 1230 invasive EOC cases (558 non-Hispanic White, 74 non-Hispanic Black, 73 Asian, 30 Pacific Islander and 36 Hispanic cases), 63% of the women died (all-cause death) after a mean = 4.8 years (SD = 4.1) of follow-up following diagnosis. Compared with non-Hispanic White cases, Asian cases had better overall survival, HR = 0.76 (95% CI = 0.58-0.98), whereas there were no differences in survival for other racial and ethnic groups. CONCLUSIONS These findings highlight the need to investigate how differences in access to healthcare may influence observed racial and ethnic disparities for EOC.
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Affiliation(s)
- Zhaohui L Arter
- University of California, Irvine Medical Center, Irvine, CA, USA
| | - Daniel Desmond
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jeffrey L Berenberg
- Tripler Army Medical Center, Honolulu, HI, USA
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Jeffrey L Killeen
- Department of Pathology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
- Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | | | - Melissa A Merritt
- University of Hawaii Cancer Center, Honolulu, HI, USA.
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia.
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11
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Algera MD, Morton R, Sundar SS, Farrell R, van Driel WJ, Brennan D, Rijken MJ, Sfeir S, Allen L, Eiken M, Coleman RL. Exploring international differences in ovarian cancer care: a survey report on global patterns of care, current practices, and barriers. Int J Gynecol Cancer 2023; 33:1612-1620. [PMID: 37591611 PMCID: PMC10579489 DOI: 10.1136/ijgc-2023-004563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE Although global disparities in survival rates for patients with ovarian cancer have been described, variation in care has not been assessed globally. This study aimed to evaluate global ovarian cancer care and barriers to care. METHODS A survey was developed by international ovarian cancer specialists and was distributed through networks and organizational partners of the International Gynecologic Cancer Society, the Society of Gynecologic Oncology, and the European Society of Gynecological Oncology. Respondents received questions about care organization. Outcomes were stratified by World Bank Income category and analyzed using descriptive statistics and logistic regressions. RESULTS A total of 1059 responses were received from 115 countries. Respondents were gynecological cancer surgeons (83%, n=887), obstetricians/gynecologists (8%, n=80), and other specialists (9%, n=92). Income category breakdown was as follows: high-income countries (46%), upper-middle-income countries (29%), and lower-middle/low-income countries (25%). Variation in care organization was observed across income categories. Respondents from lower-middle/low-income countries reported significantly less frequently that extensive resections were routinely performed during cytoreductive surgery. Furthermore, these countries had significantly fewer regional networks, cancer registries, quality registries, and patient advocacy groups. However, there is also scope for improvement in these components in upper-middle/high-income countries. The main barriers to optimal care for the entire group were patient co-morbidities, advanced presentation, and social factors (travel distance, support systems). High-income respondents stated that the main barriers were lack of surgical time/staff and patient preferences. Middle/low-income respondents additionally experienced treatment costs and lack of access to radiology/pathology/genetic services as main barriers. Lack of access to systemic agents was reported by one-third of lower-middle/low-income respondents. CONCLUSIONS The current survey report highlights global disparities in the organization of ovarian cancer care. The main barriers to optimal care are experienced across all income categories, while additional barriers are specific to income levels. Taking action is crucial to improve global care and strive towards diminishing survival disparities and closing the care gap.
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Affiliation(s)
- Marc Daniël Algera
- Gynecology Oncology, Maastricht UMC+, Maastricht, The Netherlands
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- GROW- School for Oncology and Reproduction, Maastricht, The Netherlands
| | - Rhett Morton
- Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sudha S Sundar
- Department of Gynaecology Oncology, University of Birmingham, West Midlands, UK
| | - Rhonda Farrell
- Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Willemien J van Driel
- Gynecologic Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Donal Brennan
- Gynaecology Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Marcus J Rijken
- Gynecologic Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Selina Sfeir
- Department of Gynaecology Oncology, University of Birmingham, Birmingham, UK
| | - Lucy Allen
- Department of Gynaecology Oncology, University of Birmingham, Birmingham, UK
| | - Mary Eiken
- International Gynecologic Cancer Society, Austin, Texas, USA
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12
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Doddi S, Salichs O, Mushuni M, Kunte S. Demographic disparities in trend of gynecological cancer in the United States. J Cancer Res Clin Oncol 2023; 149:11541-11547. [PMID: 37395844 DOI: 10.1007/s00432-023-05030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE This study aimed to analyze the age-adjusted mortality rates (AAMR) per 100,000 for gynecological cancer-related deaths in the United States from 1999 to 2020. We compare trends by different demographic groups to identify significant disparities in these rates between populations within the United States. METHODS The National Cancer Institute's Joinpoint Regression Program was used to calculate the average Annual Percent Change (AAPC) to identify trends over the study period using data from the CDC Wonder database, which comprises of demographic information for all causes of mortality in the United States from death certificate records. RESULTS From 1999 to 2020, the African American population exhibited a significant downtrend (AAPC, -0.8% [95% CI, - 1.0% to - 0.6%]; p < 0.01), while the white population also demonstrated a notable downtrend (AAPC, - 1.0% [95% CI, - 1.2% to - 0.8%]; p < 0.01). Similarly, the AI/AN population experienced a decline (AAPC, - 1.6% [95% CI, - 2.4% to - 0.9%]; p < 0.01). The AAPI population did not observe a significant trend (AAPC, - 0.2% [95% CI, - 0.5% to 0.5%]; p = 0.127). In addition, the Hispanic/LatinX population experiencing a lower rate of decline compared to non-Hispanics (p = 0.025). CONCLUSIONS We found that the AI/AN population to observe the greatest downtrend in mortality rates, while the AAPI observed the least and that the African American population observed a smaller downtrend when compared to the white population. In addition, the Hispanic/LatinX community are significantly being underserved by developing therapies compared to the non-Hispanic/LatinX population. These findings provide valuable insights into the impact of gynecological cancers on specific demographic groups, emphasizing the urgency of targeted interventions to address disparities and improve outcomes.
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Affiliation(s)
- Sishir Doddi
- University of Toledo College of Medicine, Toledo, OH, USA.
| | - Oscar Salichs
- University of Toledo College of Medicine, Toledo, OH, USA
| | - Mahika Mushuni
- Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
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13
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Rousseau A, Riggan KA, Halyard M, James SE, Kelly M, Phillips D, Allyse MA. Cancer Screening Experiences of Black Breast and Ovarian Cancer Patients and Family Members. J Community Health 2023; 48:882-888. [PMID: 37219788 PMCID: PMC10203662 DOI: 10.1007/s10900-023-01233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 05/24/2023]
Abstract
Black women experience disproportionate rates of advanced breast cancer diagnoses and mortality. Mammography is a proven and effective tool in early breast cancer detection and impacts patient outcomes. We interviewed Black women with a personal or family history of breast and/or ovarian cancer to understand their screening experiences and views. N = 61 individuals completed an interview. Interview transcripts were qualitatively analyzed for themes regarding clinical experiences, guideline adherence, and family sharing specific to Black women and their families. Most participants were college educated with active health insurance. Women in this cohort were knowledgeable about the benefits of mammography and described few barriers to adhering to annual mammogram guidelines. Some with first-degree family history were frustrated at insurance barriers to mammography before the age of 40. Participants were generally comfortable encouraging family and friends to receive mammograms and expressed a desire for a similar screening tool for ovarian cancer. However, they expressed concern that factors such as screening awareness and education, lack of insurance coverage, and other systematic barriers might prevent other Black women from receiving regular screening. Black women in this cohort reported high adherence to mammography guidelines, but expressed concern about cultural and financial barriers that may impact cancer screening access in the population more generally and contribute to disparities. Participants noted the importance of frank and open discussions of breast cancer screening in their families and community as a means of improving awareness.
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Affiliation(s)
- Abigail Rousseau
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Michele Halyard
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
- ADVANCE Community Advisory Board, Phoenix, AZ, USA
| | - Sarah E James
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
| | - Marion Kelly
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
- Department of Community Engagement, Mayo Clinic, Scottsdale, AZ, USA
- ADVANCE Community Advisory Board, Phoenix, AZ, USA
| | - Daphne Phillips
- Department of Speech Pathology, Mayo Clinic, Phoenix, AZ, USA
- ADVANCE Community Advisory Board, Phoenix, AZ, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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14
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Gomez SL, Chirikova E, McGuire V, Collin LJ, Dempsey L, Inamdar PP, Lawson-Michod K, Peters ES, Kushi LH, Kavecansky J, Shariff-Marco S, Peres LC, Terry P, Bandera EV, Schildkraut JM, Doherty JA, Lawson A. Role of neighborhood context in ovarian cancer survival disparities: current research and future directions. Am J Obstet Gynecol 2023; 229:366-376.e8. [PMID: 37116824 PMCID: PMC10538437 DOI: 10.1016/j.ajog.2023.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/01/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
Ovarian cancer is the fifth leading cause of cancer-associated mortality among US women with survival disparities seen across race, ethnicity, and socioeconomic status, even after accounting for histology, stage, treatment, and other clinical factors. Neighborhood context can play an important role in ovarian cancer survival, and, to the extent to which minority racial and ethnic groups and populations of lower socioeconomic status are more likely to be segregated into neighborhoods with lower quality social, built, and physical environment, these contextual factors may be a critical component of ovarian cancer survival disparities. Understanding factors associated with ovarian cancer outcome disparities will allow clinicians to identify patients at risk for worse outcomes and point to measures, such as social support programs or transportation aid, that can help to ameliorate such disparities. However, research on the impact of neighborhood contextual factors in ovarian cancer survival and in disparities in ovarian cancer survival is limited. This commentary focuses on the following neighborhood contextual domains: structural and institutional context, social context, physical context represented by environmental exposures, built environment, rurality, and healthcare access. The research conducted to date is presented and clinical implications and recommendations for future interventions and studies to address disparities in ovarian cancer outcomes are proposed.
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Affiliation(s)
- Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.
| | - Ekaterina Chirikova
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Valerie McGuire
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Lauren Dempsey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Pushkar P Inamdar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Katherine Lawson-Michod
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Edward S Peters
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Juraj Kavecansky
- Department of Hematology and Oncology, Kaiser Permanente Northern California, Antioch, CA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Paul Terry
- Department of Medicine, University of Tennessee, Knoxville, TN
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jennifer A Doherty
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Andrew Lawson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC; Usher Institute, School of Medicine, University of Edinburgh, Edinburgh, United Kingdom
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15
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Ali AT, Al-ani O, Al-ani F. Epidemiology and risk factors for ovarian cancer. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2023; 22:93-104. [PMID: 37674925 PMCID: PMC10477765 DOI: 10.5114/pm.2023.128661] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/01/2023] [Indexed: 09/08/2023]
Abstract
Ovarian cancer is a complex disease, mostly observed in postmenopausal women, and is associated with poor survival rates. It is the sixth most common cancer and the fifth most common cause of death due to cancer among women in developed countries. Thus, despite representing less than one third of all gynaecologic cancers, deaths due to ovarian cancer account for more than two thirds of deaths due to gynaecologic cancers. Its prevalence is higher in Western Europe and Northern America than Asia and Africa. In sub-Saharan Africa, there is a considerably lower prevalence of ovarian cancer than other parts of Africa. Ovarian cancer is multifaceted, involving many factors, complex biological processes and unpredictable consequences. Unlike other female cancers that have early warning symptoms, ovarian cancer's symptoms are non-specific. As a result, ovarian cancers are normally undetected until advanced stages (III or IV). The major risk factors for ovarian cancer include older age, genetics, family history, hormone replacement therapy, nulliparity, and dietary fat. Controversial factors include obesity, infertility, talc powder, radiation exposure, fertility medications and in vitro fertilization. The current review discusses the aetiology, epidemiology and risk factors for ovarian cancer. Nevertheless, identification of the main risk factors for ovarian cancer may increase the awareness among women of the general population. This should help to decrease the incidence rate of ovarian cancer and increase the five-year survival rate.
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Affiliation(s)
- Aus Tariq Ali
- Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Osamah Al-ani
- Faculty of Medicine, Odessa National Medical University, Odessa, Ukraine
| | - Faisal Al-ani
- Faculty of Medicine, Odessa National Medical University, Odessa, Ukraine
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16
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Riggan KA, Rousseau A, Halyard M, James SE, Kelly M, Phillips D, Allyse MA. "There's not enough studies": Views of black breast and ovarian cancer patients on research participation. Cancer Med 2023; 12:8767-8776. [PMID: 36647342 PMCID: PMC10134334 DOI: 10.1002/cam4.5622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Black breast and ovarian cancer patients are underrepresented in clinical cancer trials disproportionate to the prevalence of these cancers in Black females. Historically, lower enrollment has been attributed to individualized factors, including medical mistrust, but more recently structural factors, including systemic racism, have received additional scrutiny. We interviewed Black women with a personal or family history of breast and ovarian cancer to understand their views and experiences related to research participation. METHODS Qualitative interviews were conducted via telephone or video conference and transcribed verbatim. Transcripts were qualitatively analyzed for iterative themes related to the offer and participation in cancer clinical trials and research studies, impact on cancer care, and recommendations to increase enrollment of Black patients. RESULTS Sixty-one Black women completed an interview. Participants expressed that Black women are underrepresented in cancer research, and that this negatively impacted their own care. Many cited past historical abuses, including the Tuskegee syphilis trial, as a potential factor for lower enrollment but suggested that lower enrollment was better understood in the context of the entirety of their healthcare experiences, including present-day examples of patient mistreatment or dismissal. Participants suggested that proactive community engagement, transparency, and increased representation of Black research team members were strategies likely to foster trust and bolster research participation. CONCLUSION(S) Medical mistrust is only a partial factor in the lower participation of Black patients in cancer research. Researchers should implement the strategies identified by our participants to promote diverse enrollment and ensure that Black patients are included in future therapeutic advances.
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Affiliation(s)
| | - Abigail Rousseau
- Biomedical Ethics Research ProgramMayo ClinicRochesterMinnesotaUSA
| | - Michele Halyard
- Department of Radiation OncologyMayo ClinicPhoenixArizonaUSA
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
| | - Sarah E. James
- Department of Radiation OncologyMayo ClinicPhoenixArizonaUSA
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
| | - Marion Kelly
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
- Department of Community EngagementMayo ClinicScottsdaleArizonaUSA
| | - Daphne Phillips
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
- Department of Speech PathologyMayo ClinicPhoenixArizonaUSA
| | - Megan A. Allyse
- Biomedical Ethics Research ProgramMayo ClinicRochesterMinnesotaUSA
- Department of Obstetrics & GynecologyMayo ClinicRochesterMinnesotaUSA
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17
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Alimena S, Fallah P, Stephenson B, Feltmate C, Feldman S, Elias KM. Comparison of Enhanced Recovery After Surgery (ERAS) metrics by race among gynecologic oncology patients: Ensuring equitable outcomes. Gynecol Oncol 2023; 171:31-38. [PMID: 36804619 DOI: 10.1016/j.ygyno.2023.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES Race and ethnicity are not routinely audited in Enhanced Recovery After Surgery (ERAS) pathways. Given known racial disparities in outcomes in gynecologic oncology, the purpose of this study was to compare differences in ERAS implementation and outcomes by race. METHODS A cohort study was performed among gynecologic oncology patients enrolled in an ERAS pathway at one academic institution from March 2017 to December 2021. Compliance with ERAS metrics, postoperative complications, 30-day survival, reoperations, intensive care unit (ICU) transfers, and readmissions within 30 days were compared by race. RESULTS Of 1083 patients (17.0% non-white), non-white women were younger (54.2 years ±13.1 vs. 60.7 years ±13.6, p < 0.001) and proportionally fewer spoke English (75.0% vs. 97.8%, p < 0.001). Fewer non-white women received preadmission ERAS education (73.4% vs. 79.9%, p = 0.05). There were no differences in ERAS implementation by race, including similar rates of preoperative nutritional assessment, carbohydrate loading, antibiotic and thrombosis prophylaxis, and unplanned surgeries by race. There were no differences in complications, reoperations, ICU transfers, or readmissions by race on univariate and multivariate analysis. Four non-white (2.2%) and two white women (0.2%, p = 0.009) died within 30 days of surgery. CONCLUSIONS Fewer non-white women received preadmission education, possibly due to language barriers. ERAS compliance, postoperative complications, readmissions, reoperations, and ICU transfers did not differ by race. There were two additional deaths within 30 days postoperatively among non-white women compared to white women - which is difficult to interpret given the rarity of perioperative mortality - but appeared unlikely to be related to differences in ERAS protocol implementation. ERAS programs should ensure educational materials are translated into various languages and audit metrics by race to ensure equitable outcomes.
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Affiliation(s)
- Stephanie Alimena
- Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Boston, MA, USA.
| | - Parisa Fallah
- Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Boston, MA, USA; Massachusetts General Hospital, Department of Obstetrics and Gynecology, Boston, MA, USA
| | | | - Colleen Feltmate
- Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sarah Feldman
- Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Kevin M Elias
- Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA
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18
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Montes de Oca MK, Chen Q, Howell E, Wilson LE, Meernik C, Previs RA, Huang B, Pisu M, Liang MI, Ward KC, Schymura MJ, Berchuck A, Akinyemiju T. Health-care access dimensions and ovarian cancer survival: SEER-Medicare analysis of the ORCHiD study. JNCI Cancer Spectr 2023; 7:pkad011. [PMID: 36794910 PMCID: PMC10066801 DOI: 10.1093/jncics/pkad011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in ovarian cancer (OC) survival are well-documented. However, few studies have investigated how health-care access (HCA) contributes to these disparities. METHODS To evaluate the influence of HCA on OC mortality, we analyzed 2008-2015 Surveillance, Epidemiology, and End Results-Medicare data. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between HCA dimensions (affordability, availability, accessibility) and OC-specific and all-cause mortality, adjusting for patient characteristics and treatment receipt. RESULTS The study cohort included 7590 OC patients: 454 (6.0%) Hispanic, 501 (6.6%) Non-Hispanic (NH) Black, and 6635 (87.4%) NH White. Higher affordability (HR = 0.90, 95% CI = 0.87 to 0.94), availability (HR = 0.95, 95% CI = 0.92 to 0.99), and accessibility scores (HR = 0.93, 95% CI = 0.87 to 0.99) were associated with lower risk of OC mortality after adjusting for demographic and clinical factors. Racial disparities were observed after additional adjustment for these HCA dimensions: NH Black patients experienced a 26% higher risk of OC mortality compared with NH White patients (HR = 1.26, 95% CI = 1.11 to 1.43) and a 45% higher risk among patients who survived at least 12 months (HR = 1.45, 95% CI = 1.16 to 1.81). CONCLUSIONS HCA dimensions are statistically significantly associated with mortality after OC and explain some, but not all, of the observed racial disparity in survival of patients with OC. Although equalizing access to quality health care remains critical, research on other HCA dimensions is needed to determine additional factors contributing to disparate OC outcomes by race and ethnicity and advance the field toward health equity.
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Affiliation(s)
| | - Quan Chen
- Division of Cancer Biostatistics and Kentucky Cancer Registry, University of Kentucky, Lexington, KY, USA
| | - Elizabeth Howell
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Lauren E Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Clare Meernik
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca A Previs
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Bin Huang
- Division of Cancer Biostatistics and Kentucky Cancer Registry, University of Kentucky, Lexington, KY, USA
| | - Maria Pisu
- Division of Preventive Medicine and O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kevin C Ward
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Maria J Schymura
- New York State Department of Health, New York State Cancer Registry, Albany, NY, USA
| | - Andrew Berchuck
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
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19
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Ogobuiro I, Collier AL, Khan K, de Castro Silva I, Kwon D, Wilson GC, Schwartz PB, Parikh AA, Hammill C, Kim HJ, Kooby DA, Abbott D, Maithel SK, Snyder RA, Ahmad SA, Merchant NB, Datta J. Racial Disparity in Pathologic Response following Neoadjuvant Chemotherapy in Resected Pancreatic Cancer: A Multi-Institutional Analysis from the Central Pancreatic Consortium. Ann Surg Oncol 2023; 30:1485-1494. [PMID: 36316508 DOI: 10.1245/s10434-022-12741-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Major pathologic response (MPR) following neoadjuvant therapy (NAT) in pancreatic ductal adenocarcinoma (PDAC) patients undergoing resection is associated with improved survival. We sought to determine whether racial disparities exist in MPR rates following NAT in patients with PDAC undergoing resection. METHODS Patients with potentially operable PDAC receiving at least 2 cycles of neoadjuvant FOLFIRINOX or gemcitabine/nab-paclitaxel ± radiation followed by pancreatectomy (2010-2019) at 7 high-volume centers were reviewed. Self-reported race was dichotomized as Black and non-Black, and multivariable models evaluated the association between race and MPR (i.e., pathologic complete response [pCR] or near-pCR). Cox regression evaluated the association between race and disease-free (DFS) and overall survival (OS). RESULTS Results of 486 patients who underwent resection following NAT (mFOLFIRINOX 56%, gemcitabine/nab-paclitaxel 25%, radiation 29%), 67 (13.8%) patients were Black. Black patients had lower CA19-9 at diagnosis (median 67 vs. 204 U/mL; P = 0.003) and were more likely to undergo mild/moderate chemotherapy dose modification (40 vs. 20%; P = 0.005) versus non-Black patients. Black patients had significantly lower rates of MPR compared with non-Black patients (13.4 vs. 25.8%; P = 0.039). Black race was independently associated with worse MPR (OR 0.26, 95% confidence interval [CI] 0.10-0.69) while controlling for NAT duration, CA19-9 dynamics, and chemotherapy modifications. There was no significant difference in DFS or OS between Black and non-Black cohorts. CONCLUSIONS Black patients undergoing pancreatectomy appear less likely to experience MPR following NAT. The contribution of biologic and nonbiologic factors to reduced chemosensitivity in Black patients warrants further investigation.
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Affiliation(s)
- Ifeanyichukwu Ogobuiro
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 410, Miami, FL, 33136, USA
| | - Amber L Collier
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 410, Miami, FL, 33136, USA
| | - Khadeja Khan
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 410, Miami, FL, 33136, USA
| | - Iago de Castro Silva
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 410, Miami, FL, 33136, USA
| | - Deukwoo Kwon
- Department of Surgery, Icahn School of Medicine at Mount Sinai Department of Population Health Science and Policy, New York, NY, USA
| | - Gregory C Wilson
- Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Patrick B Schwartz
- Department of Surgery, Carbone Cancer Center, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Alexander A Parikh
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Chet Hammill
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Hong J Kim
- Department of Surgery, Lineberger Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - David A Kooby
- Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Daniel Abbott
- Department of Surgery, Carbone Cancer Center, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Shishir K Maithel
- Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Rebecca A Snyder
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Syed A Ahmad
- Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Nipun B Merchant
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 410, Miami, FL, 33136, USA
| | - Jashodeep Datta
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 410, Miami, FL, 33136, USA.
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20
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Amin SA, Collin LJ, Setoguchi S, Satagopan JM, Buckley de Meritens A, Bandera EV. Neoadjuvant Chemotherapy in Ovarian Cancer: Are There Racial Disparities in Use and Survival? Cancer Epidemiol Biomarkers Prev 2023; 32:175-182. [PMID: 36409506 PMCID: PMC9905268 DOI: 10.1158/1055-9965.epi-22-0758] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/05/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We investigated racial and ethnic disparities in treatment sequence [i.e., neoadjuvant chemotherapy (NACT) plus interval debulking surgery (IDS) versus primary debulking surgery (PDS) plus adjuvant chemotherapy] among patients with ovarian cancer and its contribution to disparities in mortality. METHODS Study included 37,566 women ages ≥18 years, diagnosed with stage III/IV ovarian cancer from the National Cancer Database (2004-2017). Logistic regression was used to compute ORs and 95% confidence intervals (CI) for racial and ethnic disparities in treatment sequence. Cox proportional hazards regression was used to estimate HRs and 95% CI for racial and ethnic disparities in all-cause mortality. RESULTS Non-Hispanic Black (NHB) and Asian women were more likely to receive NACT plus IDS relative to PDS plus adjuvant chemotherapy than non-Hispanic White (NHW) women (OR: 1.12; 95% CI: 1.02-1.22 and OR: 1.12; 95% CI: 0.99-1.28, respectively). Compared with NHW women, NHB women had increased hazard of all-cause mortality (HR: 1.14; 95% CI: 1.09-1.20), whereas Asian and Hispanic women had a lower hazard of all-cause mortality (HR: 0.81; 95% CI: 0.74-0.88 and HR: 0.83; 95% CI: 0.77-0.88, respectively), which did not change after accounting for treatment sequence. CONCLUSIONS NHB women were more likely to receive NACT plus IDS and experience a higher all-cause mortality rates than NHW women. IMPACT Differences in treatment sequence did not explain racial disparities in all-cause mortality. Further evaluation of racial and ethnic differences in treatment and survival in a cohort of patients with detailed treatment information is warranted.
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Affiliation(s)
- Saber A Amin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Soko Setoguchi
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jaya M Satagopan
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Alexandre Buckley de Meritens
- Division of Gynecologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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21
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Gupta A, Chen Q, Wilson LE, Huang B, Pisu M, Liang M, Previs RA, Moss HA, Ward KC, Schymura MJ, Berchuck A, Akinyemiju TF. Factor Analysis of Health Care Access With Ovarian Cancer Surgery and Gynecologic Oncologist Consultation. JAMA Netw Open 2023; 6:e2254595. [PMID: 36723938 PMCID: PMC9892953 DOI: 10.1001/jamanetworkopen.2022.54595] [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: 02/02/2023] Open
Abstract
IMPORTANCE Poor health care access (HCA) is associated with racial and ethnic disparities in ovarian cancer (OC) survival. OBJECTIVE To generate composite scores representing health care affordability, availability, and accessibility via factor analysis and to evaluate the association between each score and key indicators of guideline-adherent care. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from patients with OC diagnosed between 2008 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. The SEER Medicare database uses cancer registry data and linked Medicare claims from 12 US states. Included patients were Hispanic, non-Hispanic Black, and non-Hispanic White individuals aged 65 years or older diagnosed from 2008 to 2015 with first or second primary OC of any histologic type (International Classification of Diseases for Oncology, 3rd Edition [ICD-O-3] code C569). Data were analyzed from June 2020 to June 2022. EXPOSURES The SEER-Medicare data set was linked with publicly available data sets to obtain 35 variables representing health care affordability, availability, and accessibility. A composite score was created for each dimension using confirmatory factor analysis followed by a promax (oblique) rotation on multiple component variables. MAIN OUTCOMES AND MEASURES The main outcomes were consultation with a gynecologic oncologist for OC and receipt of OC-related surgery in the 2 months prior to or 6 months after diagnosis. RESULTS The cohort included 8987 patients, with a mean (SD) age of 76.8 (7.3) years and 612 Black patients (6.8%), 553 Hispanic patients (6.2%), and 7822 White patients (87.0%). Black patients (adjusted odds ratio [aOR], 0.75; 95% CI, 0.62-0.91) and Hispanic patients (aOR, 0.81; 95% CI, 0.67-0.99) were less likely to consult a gynecologic oncologist compared with White patients, and Black patients were less likely to receive surgery after adjusting for demographic and clinical characteristics (aOR, 0.76; 95% CI, 0.62-0.94). HCA availability and affordability were each associated with gynecologic oncologist consultation (availability: aOR, 1.16; 95% CI, 1.09-1.24; affordability: aOR, 1.13; 95% CI, 1.07-1.20), while affordability was associated with receipt of OC surgery (aOR, 1.08; 95% CI, 1.01-1.15). In models mutually adjusted for availability, affordability, and accessibility, Black patients remained less likely to consult a gynecologic oncologist (aOR, 0.80; 95% CI, 0.66-0.97) and receive surgery (aOR, 0.80; 95% CI, 0.65-0.99). CONCLUSIONS AND RELEVANCE In this cohort study of Hispanic, non-Hispanic Black, and non-Hispanic White patients with OC, HCA affordability and availability were significantly associated with receiving surgery and consulting a gynecologic oncologist. However, these dimensions did not fully explain racial and ethnic disparities.
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Affiliation(s)
- Anjali Gupta
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Quan Chen
- Department of Biostatistics and Kentucky Cancer Registry, University of Kentucky, Lexington
| | - Lauren E Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Bin Huang
- Department of Biostatistics and Kentucky Cancer Registry, University of Kentucky, Lexington
| | - Maria Pisu
- O'Neal Comprehensive Cancer Center, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham
| | - Margaret Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham
| | - Rebecca A Previs
- Duke Cancer Institute, Division of Gynecologic Oncology, Duke University School of Medicine, Durham, North Carolina
- Labcorp Oncology, Durham, North Carolina
| | - Haley A Moss
- Duke Cancer Institute, Division of Gynecologic Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Kevin C Ward
- Georgia Cancer Registry, Emory University, Atlanta
| | - Maria J Schymura
- New York State Cancer Registry, New York State Department of Health, Albany
| | - Andrew Berchuck
- Duke Cancer Institute, Division of Gynecologic Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Tomi F Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
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22
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Akinyemiju T, Chen Q, Wilson LE, Previs RA, Joshi A, Liang M, Pisu M, Ward KC, Berchuck A, Schymura MJ, Huang B. Healthcare Access Domains Mediate Racial Disparities in Ovarian Cancer Treatment Quality in a US Patient Cohort: A Structural Equation Modelling Analysis. Cancer Epidemiol Biomarkers Prev 2023; 32:74-81. [PMID: 36306380 PMCID: PMC9839516 DOI: 10.1158/1055-9965.epi-22-0650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/07/2022] [Accepted: 10/25/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Ovarian cancer survival disparities have persisted for decades, driven by lack of access to quality treatment. We conducted structural equation modeling (SEM) to define latent variables representing three healthcare access (HCA) domains: affordability, availability, and accessibility, and evaluated the direct and indirect associations between race and ovarian cancer treatment mediated through the HCA domains. METHODS Patients with ovarian cancer ages 65 years or older diagnosed between 2008 and 2015 were identified from the SEER-Medicare dataset. Generalized SEM was used to estimate latent variables representing HCA domains by race in relation to two measures of ovarian cancer-treatment quality: gynecologic oncology consultation and receipt of any ovarian cancer surgery. RESULTS A total of 8,987 patients with ovarian cancer were included in the analysis; 7% were Black. The affordability [Ω: 0.876; average variance extracted (AVE) = 0.689], availability (Ω: 0.848; AVE = 0.636), and accessibility (Ω: 0.798; AVE = 0.634) latent variables showed high composite reliability in SEM analysis. Black patients had lower affordability and availability, but higher accessibility compared with non-Black patients. In fully adjusted models, there was no direct effect observed between Black race to receipt of surgery [β: -0.044; 95% confidence interval (CI), -0.264 to 0.149]; however, there was an inverse total effect (β: -0.243; 95% CI, -0.079 to -0.011) that was driven by HCA affordability (β: -0.025; 95% CI, -0.036 to -0.013), as well as pathways that included availability and consultation with a gynecologist oncologist. CONCLUSIONS Racial differences in ovarian cancer treatment appear to be driven by latent variables representing healthcare affordability, availability, and accessibility. IMPACT Strategies to mitigate disparities in multiple HCA domains will be transformative in advancing equity in cancer treatment.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham NC
- Duke Cancer Institute, Duke University School of Medicine, Durham NC
| | - Quan Chen
- Division of Cancer Biostatistics and Kentucky Cancer Registry, Univ of Kentucky, Lexington KY
| | - Lauren E. Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham NC
| | - Rebecca A. Previs
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham NC
| | - Ashwini Joshi
- Department of Population Health Sciences, Duke University School of Medicine, Durham NC
| | - Margaret Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Maria Pisu
- Division of Preventive Medicine and O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Kevin C. Ward
- Georgia Cancer Registry, Emory University, Atlanta GA
| | - Andrew Berchuck
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham NC
| | - Maria J. Schymura
- New York State Cancer Registry, New York State Department of Health, Albany NY
| | - Bin Huang
- Division of Cancer Biostatistics and Kentucky Cancer Registry, Univ of Kentucky, Lexington KY
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23
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Montes de Oca MK, Wilson LE, Previs RA, Gupta A, Joshi A, Huang B, Pisu M, Liang M, Ward KC, Schymura MJ, Berchuck A, Akinyemiju TF. Healthcare Access Dimensions and Guideline-Concordant Ovarian Cancer Treatment: SEER-Medicare Analysis of the ORCHiD Study. J Natl Compr Canc Netw 2022; 20:1255-1266.e11. [PMID: 36351338 DOI: 10.6004/jnccn.2022.7055] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/14/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Racial disparities exist in receipt of guideline-concordant treatment of ovarian cancer (OC). However, few studies have evaluated how various dimensions of healthcare access (HCA) contribute to these disparities. METHODS We analyzed data from non-Hispanic (NH)-Black, Hispanic, and NH-White patients with OC diagnosed in 2008 to 2015 from the SEER-Medicare database and defined HCA dimensions as affordability, availability, and accessibility, measured as aggregate scores created with factor analysis. Receipt of guideline-concordant OC surgery and chemotherapy was defined based on the NCCN Guidelines for Ovarian Cancer. Multivariable-adjusted modified Poisson regression models were used to assess the relative risk (RR) for guideline-concordant treatment in relation to HCA. RESULTS The study cohort included 5,632 patients: 6% NH-Black, 6% Hispanic, and 88% NH-White. Only 23.8% of NH-White patients received guideline-concordant surgery and the full cycles of chemotherapy versus 14.2% of NH-Black patients. Higher affordability (RR, 1.05; 95% CI, 1.01-1.08) and availability (RR, 1.06; 95% CI, 1.02-1.10) were associated with receipt of guideline-concordant surgery, whereas higher affordability was associated with initiation of systemic therapy (hazard ratio, 1.09; 95% CI, 1.05-1.13). After adjusting for all 3 HCA scores and demographic and clinical characteristics, NH-Black patients remained less likely than NH-White patients to initiate systemic therapy (hazard ratio, 0.86; 95% CI, 0.75-0.99). CONCLUSIONS Multiple HCA dimensions predict receipt of guideline-concordant treatment but do not fully explain racial disparities among patients with OC. Acceptability and accommodation are 2 additional HCA dimensions which may be critical to addressing these disparities.
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Affiliation(s)
| | - Lauren E Wilson
- 2Department of Population Health Sciences, Duke University School of Medicine, and
| | - Rebecca A Previs
- 3Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Anjali Gupta
- 2Department of Population Health Sciences, Duke University School of Medicine, and
| | - Ashwini Joshi
- 2Department of Population Health Sciences, Duke University School of Medicine, and
| | - Bin Huang
- 4Department of Biostatistics and Kentucky Cancer Registry, University of Kentucky, Lexington, Kentucky
| | | | - Margaret Liang
- 6Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kevin C Ward
- 7Georgia Cancer Registry, Emory University, Atlanta, Georgia
| | - Maria J Schymura
- 8New York State Cancer Registry, New York State Department of Health, Albany, New York; and
| | - Andrew Berchuck
- 3Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Tomi F Akinyemiju
- 2Department of Population Health Sciences, Duke University School of Medicine, and
- 9Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
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24
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Harris HR, Guertin KA, Camacho TF, Johnson CE, Wu AH, Moorman PG, Myers E, Bethea TN, Bandera EV, Joslin CE, Ochs-Balcom HM, Peres LC, Rosenow WT, Setiawan VW, Beeghly-Fadiel A, Dempsey LF, Rosenberg L, Schildkraut JM. Racial disparities in epithelial ovarian cancer survival: An examination of contributing factors in the Ovarian Cancer in Women of African Ancestry consortium. Int J Cancer 2022; 151:1228-1239. [PMID: 35633315 PMCID: PMC9420829 DOI: 10.1002/ijc.34141] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/07/2022]
Abstract
Black women diagnosed with epithelial ovarian cancer have poorer survival compared to white women. Factors that contribute to this disparity, aside from socioeconomic status and guideline-adherent treatment, have not yet been clearly identified. We examined data from the Ovarian Cancer in Women of African Ancestry (OCWAA) consortium which harmonized data on 1074 Black women and 3263 white women with ovarian cancer from seven US studies. We selected potential mediators and confounders by examining associations between each variable with race and survival. We then conducted a sequential mediation analysis using an imputation method to estimate total, direct, and indirect effects of race on ovarian cancer survival. Black women had worse survival than white women (HR = 1.30; 95% CI 1.16-1.47) during study follow-up; 67.9% of Black women and 69.8% of white women died. In our final model, mediators of this disparity include college education, nulliparity, smoking status, body mass index, diabetes, diabetes/race interaction, postmenopausal hormone (PMH) therapy duration, PMH duration/race interaction, PMH duration/age interaction, histotype, and stage. These mediators explained 48.8% (SE = 12.1%) of the overall disparity; histotype/stage and PMH duration accounted for the largest fraction. In summary, nearly half of the disparity in ovarian cancer survival between Black and white women in the OCWAA consortium is explained by education, lifestyle factors, diabetes, PMH use, and tumor characteristics. Our findings suggest that several potentially modifiable factors play a role. Further research to uncover additional mediators, incorporate data on social determinants of health, and identify potential avenues of intervention to reduce this disparity is urgently needed.
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Affiliation(s)
- Holly R. Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Kristin A. Guertin
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Tareq F Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Courtney E. Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Anna H. Wu
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California, USA
| | - Patricia G. Moorman
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Traci N. Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington, D.C., USA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Charlotte E. Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine and Division of Epidemiology and Biostatistics, School of Public Health, Chicago, Illinois, USA
| | - Heather M. Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Lauren C. Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Will T. Rosenow
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Veronica W. Setiawan
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California, USA
| | - Alicia Beeghly-Fadiel
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lauren F. Dempsey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts, USA
| | - Joellen M. Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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25
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León-Rodríguez E, Rivera-Franco MM. Conditioning Regimens in Allogeneic Hematopoietic Stem Cell Transplantation Do Not Fit All: Adjusting BuCy2 in Mexico to Improve Outcomes in Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS). Int J Hematol Oncol Stem Cell Res 2022; 16:189-197. [PMID: 36883113 PMCID: PMC9985810 DOI: 10.18502/ijhoscr.v16i4.10876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/29/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Conditioning regimens are critical for allogeneic hematopoietic cell transplantation (allo-HCT). After unfavorable results using BuCy2 at the beginning of our HCT Program, a restructuring was made with the consequent development of a modified HCT method including a reduced conditioning regimen. The objective of this study was to describe the outcomes using Reduced BuCy2 (rBuCy2) in allo-HCT. Materials and Methods: Data from 38 consecutive patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) who underwent allo-HCT conditioned with rBuCy2 in a 21-year period were retrospectively analyzed. Results: Most patients were males (53%) and the median age was 35 years. The most common disease was myelodysplastic syndrome (55%). Toxicity grades III-IV were observed in 44%; and acute and chronic graft-versus-host disease were observed in 26% and 34%, respectively; the median follow-up was 26 months; 30-day non-relapse mortality (NRM) was 3%, and 1 and 2-year NRM were 8%. Ten-year overall survival (OS) was 60%, and 86%, for AML and MDS, respectively. Conclusion: Our rBuCy2 maintains a myeloablative effect, along with immunosuppression for fast engraftment and more importantly, this regimen reduces grades III-IV acute GVHD and NRM in allo-HCT and improves the OS and it appears to be an option for low and middle-income countries.
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Affiliation(s)
- Eucario León-Rodríguez
- Hematopoietic Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Monica M Rivera-Franco
- Hematopoietic Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Ponce SEB, Thomas CR, Diaz DA. Social determinants of health, workforce diversity, and financial toxicity: A review of disparities in cancer care. Curr Probl Cancer 2022; 46:100893. [DOI: 10.1016/j.currproblcancer.2022.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
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Towner M, Kim JJ, Simon MA, Matei D, Roque D. Disparities in gynecologic cancer incidence, treatment, and survival: a narrative review of outcomes among black and white women in the United States. Int J Gynecol Cancer 2022; 32:931-938. [PMID: 35523443 PMCID: PMC9509411 DOI: 10.1136/ijgc-2022-003476] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
For patients diagnosed with ovarian, uterine, or cervical cancer, race impacts expected outcome, with black women suffering worse survival than white women for all three malignancies. Moreover, outcomes for black women have largely worsened since the 1970s. In this narrative review, we first provide an updated summary of the incidence and survival of ovarian, uterine, and cervical cancer, with attention paid to differences between white and black patients. We then offer a theoretical framework detailing how racial disparities in outcomes for each of the gynecologic malignancies can be explained as the sum result of smaller white-black differences in experience of preventive strategies, implementation of screening efforts, early detection of symptomatic disease, and appropriate treatment. Much research has been published regarding racial disparities in each of these domains, and with this review, we seek to curate the relevant literature and present an updated understanding of disparities between black and white women with gynecologic malignancies.
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Affiliation(s)
- Mary Towner
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - J Julie Kim
- Obstetrics and Gynecology, Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Melissa A Simon
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniela Matei
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dario Roque
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Akinyemiju TF, Wilson LE, Diaz N, Gupta A, Huang B, Pisu M, Deveaux A, Liang M, Previs RA, Moss HA, Joshi A, Ward KC, Schymura MJ, Berchuck A, Potosky AL. Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer. Cancer Epidemiol Biomarkers Prev 2022; 31:1383-1393. [PMID: 35477150 PMCID: PMC9250633 DOI: 10.1158/1055-9965.epi-21-1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/02/2022] [Accepted: 04/18/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Differential access to quality care is associated with racial disparities in ovarian cancer survival. Few studies have examined the association of multiple healthcare access (HCA) dimensions with racial disparities in quality treatment metrics, that is, primary debulking surgery performed by a gynecologic oncologist and initiation of guideline-recommended systemic therapy. METHODS We analyzed data for patients with ovarian cancer diagnosed from 2008 to 2015 in the Surveillance, Epidemiology, and End Results-Medicare database. We defined HCA dimensions as affordability, availability, and accessibility. Modified Poisson regressions with sandwich error estimation were used to estimate the relative risk (RR) for quality treatment. RESULTS The study cohort was 7% NH-Black, 6% Hispanic, and 87% NH-White. Overall, 29% of patients received surgery and 68% initiated systemic therapy. After adjusting for clinical variables, NH-Black patients were less likely to receive surgery [RR, 0.83; 95% confidence interval (CI), 0.70-0.98]; the observed association was attenuated after adjusting for healthcare affordability, accessibility, and availability (RR, 0.91; 95% CI, 0.77-1.08). Dual enrollment in Medicaid and Medicare compared with Medicare only was associated with lower likelihood of receiving surgery (RR, 0.86; 95% CI, 0.76-0.97) and systemic therapy (RR, 0.94; 95% CI, 0.92-0.97). Receiving treatment at a facility in the highest quartile of ovarian cancer surgical volume was associated with higher likelihood of surgery (RR, 1.12; 95% CI, 1.04-1.21). CONCLUSIONS Racial differences were observed in ovarian cancer treatment quality and were partly explained by multiple HCA dimensions. IMPACT Strategies to mitigate racial disparities in ovarian cancer treatment quality must focus on multiple HCA dimensions. Additional dimensions, acceptability and accommodation, may also be key to addressing disparities.
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Affiliation(s)
- Tomi F. Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham NC
- Duke Cancer Institute, Duke University School of Medicine, Durham NC
| | - Lauren E. Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham NC
| | - Nicole Diaz
- Department of Population Health Sciences, Duke University School of Medicine, Durham NC
| | - Anjali Gupta
- Department of Population Health Sciences, Duke University School of Medicine, Durham NC
| | - Bin Huang
- Department of Biostatistics and Kentucky Cancer Registry, Univ of Kentucky, Lexington KY
| | - Maria Pisu
- Division of Preventive Medicine and O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - April Deveaux
- Department of Population Health Sciences, Duke University School of Medicine, Durham NC
| | - Margaret Liang
- Division of Preventive Medicine and O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Rebecca A. Previs
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham NC
| | - Haley A. Moss
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham NC
| | - Ashwini Joshi
- Department of Population Health Sciences, Duke University School of Medicine, Durham NC
| | - Kevin C. Ward
- Georgia Cancer Registry, Emory University, Atlanta GA
| | - Maria J. Schymura
- New York State Cancer Registry, New York State Department of Health, Albany NY
| | - Andrew Berchuck
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham NC
| | - Arnold L. Potosky
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC
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Peres LC, Colin-Leitzinger C, Sinha S, Marks JR, Conejo-Garcia JR, Alberg AJ, Bandera EV, Berchuck A, Bondy ML, Christensen BC, Cote ML, Doherty JA, Moorman PG, Peters ES, Segura CM, Nguyen JV, Schwartz AG, Terry PD, Wilson CM, Fridley BL, Schildkraut JM. Racial Differences in the Tumor Immune Landscape and Survival of Women with High-Grade Serous Ovarian Carcinoma. Cancer Epidemiol Biomarkers Prev 2022; 31:1006-1016. [PMID: 35244678 PMCID: PMC9081269 DOI: 10.1158/1055-9965.epi-21-1334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Tumor-infiltrating lymphocytes (TIL) confer a survival benefit among patients with ovarian cancer; however, little work has been conducted in racially diverse cohorts. METHODS The current study investigated racial differences in the tumor immune landscape and survival of age- and stage-matched non-Hispanic Black and non-Hispanic White women with high-grade serous ovarian carcinoma (HGSOC) enrolled in two population-based studies (n = 121 in each racial group). We measured TILs (CD3+), cytotoxic T cells (CD3+CD8+), regulatory T cells (CD3+FoxP3+), myeloid cells (CD11b+), and neutrophils (CD11b+CD15+) via multiplex immunofluorescence. Multivariable Cox proportional hazard regression was used to estimate the association between immune cell abundance and survival overall and by race. RESULTS Overall, higher levels of TILs, cytotoxic T cells, myeloid cells, and neutrophils were associated with better survival in the intratumoral and peritumoral region, irrespective of tissue compartment (tumor, stroma). Improved survival was noted for T-regulatory cells in the peritumoral region and in the stroma of the intratumoral region, but no association for intratumoral T-regulatory cells. Despite similar abundance of immune cells across racial groups, associations with survival among non-Hispanic White women were consistent with the overall findings, but among non-Hispanic Black women, most associations were attenuated and not statistically significant. CONCLUSIONS Our results add to the existing evidence that a robust immune infiltrate confers a survival advantage among women with HGSOC; however, non-Hispanic Black women may not experience the same survival benefit as non-Hispanic White women with HGSOC. IMPACT This study contributes to our understanding of the immunoepidemiology of HGSOC in diverse populations.
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Affiliation(s)
- Lauren C. Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Sweta Sinha
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jeffrey R. Marks
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Jose R. Conejo-Garcia
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Elisa V. Bandera
- Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Andrew Berchuck
- Department of Gynecologic Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Melissa L. Bondy
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Brock C. Christensen
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
- Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
- Department of Molecular and Systems Biology, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Michele L. Cote
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Jennifer Anne Doherty
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Patricia G. Moorman
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
| | - Edward S. Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Carlos Moran Segura
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jonathan V. Nguyen
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ann G. Schwartz
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Paul D. Terry
- Department of Medicine, University of Tennessee Medical Center – Knoxville, Knoxville, Tennessee
| | - Christopher M. Wilson
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Brooke L. Fridley
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Joellen M. Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Karia PS, Tehranifar P, Visvanathan K, Wright JD, Genkinger JM. Cancer-Specific Mortality in Asian American Women Diagnosed with Gynecologic Cancer: A Nationwide Population-Based Analysis. Cancer Epidemiol Biomarkers Prev 2022; 31:578-587. [PMID: 34933960 PMCID: PMC8901555 DOI: 10.1158/1055-9965.epi-21-0829] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/07/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer is the leading cause of death in Asian Americans (AA), the fastest-growing U.S. population group. Despite heterogeneity in socioeconomic status and health behaviors by ethnicity, few studies have assessed cancer outcomes across AA ethnic groups. We examined differences in gynecologic cancer mortality between AA ethnic groups and non-Hispanic Whites (NHW). METHODS Using the Surveillance, Epidemiology, and End Results database, we identified ovarian (n = 69,113), uterine (n = 157,340), and cervical cancer cases (n = 41,460) diagnosed from 1991-2016. Competing risk regression was used to compare cancer-specific mortality for AAs by ethnicity, using NHW as the reference population. RESULTS In adjusted analyses, AAs had a lower risk of ovarian [HR, 0.90; 95% confidence interval (CI), 0.86-0.94] and cervical cancer death (HR, 0.80; 95% CI, 0.75-0.87) than NHWs, with stronger associations among those ≥50 years at diagnosis [(HRovary, 0.87; 95% CI, 0.82-0.92); (HRcervix, 0.74; 95% CI, 0.67-0.81)]. No overall difference was noted for uterine cancer death (HR, 1.03; 95% CI, 0.97-1.10); however, AAs <50 years at diagnosis had a higher risk of uterine cancer death than NHWs (HR, 1.26; 95% CI, 1.08-1.46). Patterns of cancer mortality were heterogeneous, with Filipino and Chinese women at the highest risk of uterine cancer death and Indian/Pakistani women at the lowest risk of ovarian and cervical cancer death. CONCLUSIONS There are significant differences in gynecologic cancer mortality between AAs and NHWs, with heterogeneity by AA ethnicity. IMPACT Disaggregated analysis of AA is needed to better understand the burden of gynecologic cancer and identify high-risk groups for cancer prevention efforts.
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Affiliation(s)
- Pritesh S. Karia
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Jason D. Wright
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Jeanine M. Genkinger
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
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Hibler EA, Fought AJ, Kershaw KN, Molsberry R, Nowakowski V, Lindner D. Novel Interactive Tool for Breast and Ovarian Cancer Risk Assessment (Bright Pink Assess Your Risk): Development and Usability Study. J Med Internet Res 2022; 24:e29124. [PMID: 35200148 PMCID: PMC8914739 DOI: 10.2196/29124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/23/2021] [Accepted: 12/02/2021] [Indexed: 12/04/2022] Open
Abstract
Background The lifetime risk of breast and ovarian cancer is significantly higher among women with genetic susceptibility or a strong family history. However, current risk assessment tools and clinical practices may identify only 10% of asymptomatic carriers of susceptibility genes. Bright Pink developed the Assess Your Risk (AYR) tool to estimate breast and ovarian cancer risk through a user-friendly, informative web-based quiz for risk assessment at the population level. Objective This study aims to present the AYR tool, describe AYR users, and present evidence that AYR works as expected by comparing classification using the AYR tool with gold standard genetic testing guidelines. Methods The AYR is a recently developed population-level risk assessment tool that includes 26 questions based on the National Comprehensive Cancer Network (NCCN) guidelines and factors from other commonly used risk assessment tools. We included all women who completed the AYR between November 2018 and January 2019, with the exception of self-reported cancer or no knowledge of family history. We compared AYR classifications with those that were independently created using NCCN criteria using measures of validity and the McNemar test. Results There were 143,657 AYR completions, and most participants were either at increased or average risk for breast cancer or ovarian cancer (137,315/143,657, 95.59%). Using our estimates of increased and average risk as the gold standard, based on the NCCN guidelines, we estimated the sensitivity and specificity for the AYR algorithm–generated risk categories as 100% and 89.9%, respectively (P<.001). The specificity improved when we considered the additional questions asked by the AYR to define increased risk, which were not examined by the NCCN criteria. By race, ethnicity, and age group; we found that the lowest observed specificity was for the Asian race (85.9%) and the 30 to 39 years age group (87.6%) for the AYR-generated categories compared with the NCCN criteria. Conclusions These results demonstrate that Bright Pink’s AYR is an accurate tool for use by the general population to identify women at increased risk of breast and ovarian cancer. We plan to validate the tool longitudinally in future studies, including the impact of race, ethnicity, and age on breast and ovarian cancer risk assessment.
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Affiliation(s)
- Elizabeth A Hibler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Angela J Fought
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Rebecca Molsberry
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Virginia Nowakowski
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Asare A, Yao H, Lara OD, Wang Y, Zhang L, Sood AK. Race-associated molecular changes in gynecologic malignancies. CANCER RESEARCH COMMUNICATIONS 2022; 2:99-109. [PMID: 35992327 PMCID: PMC9390975 DOI: 10.1158/2767-9764.crc-21-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The difference in cancer morbidity and mortality between individuals of different racial groups is complex. Health disparities provide a framework to explore potential connections between poor outcomes and individuals of different racial backgrounds. This study identifies genomic changes in African-American patients with gynecologic malignancies, a population with well-established disparities in outcomes. Our data explore whether social health disparities might mediate interactions between the environment and tumor epigenomes and genomes that can be identified. Using The Cancer Genetic Ancestry Atlas, which encodes data from The Cancer Genome Atlas by ancestry and allows for systematic analyses of sequencing data by racial group, we performed large-scale, comparative analyses to identify novel targets with alterations in methylation, transcript, and microRNA expression between tumors from women of European American or African American racial groups across all gynecologic malignancies. We identify novel discrete genomic changes in these complex malignancies and suggest a framework for identifying novel therapeutic targets for future investigation.
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Affiliation(s)
- Amma Asare
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Hui Yao
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Olivia D. Lara
- Department of Obstetrics and Gynecology, NYU Langone Health, New York
| | - Ying Wang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lin Zhang
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anil K. Sood
- Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Corresponding Author: Anil K. Sood, Department of Gynecologic Oncology and Reproductive Medicine, Unit 1362, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030. Phone: 713-745-5266; E-mail:
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Delgado C, Baweja M, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, Mendu ML, Miller WG, Moxey-Mims MM, Roberts GV, St Peter WL, Warfield C, Powe NR. A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. Am J Kidney Dis 2022; 79:268-288.e1. [PMID: 34563581 DOI: 10.1053/j.ajkd.2021.08.003] [Citation(s) in RCA: 326] [Impact Index Per Article: 163.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In response to a national call for re-evaluation of the use of race in clinical algorithms, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a Task Force to reassess inclusion of race in the estimation of glomerular filtration rate (GFR) in the United States and its implications for diagnosis and management of patients with, or at risk for, kidney diseases. PROCESS & DELIBERATIONS The Task Force organized its activities over 10 months in phases to (1) clarify the problem and evidence regarding GFR estimating equations in the United States (described previously in an interim report), and, in this final report, (2) evaluate approaches to address use of race in GFR estimation, and (3) provide recommendations. We identified 26 approaches for the estimation of GFR that did or did not consider race and narrowed our focus, by consensus, to 5 of those approaches. We holistically evaluated each approach considering 6 attributes: assay availability and standardization; implementation; population diversity in equation development; performance compared with measured GFR; consequences to clinical care, population tracking, and research; and patient centeredness. To arrive at a unifying approach to estimate GFR, we integrated information and evidence from many sources in assessing strengths and weaknesses in attributes for each approach, recognizing the number of Black and non-Black adults affected. RECOMMENDATIONS (1) For US adults (>85% of whom have normal kidney function), we recommend immediate implementation of the CKD-EPI creatinine equation refit without the race variable in all laboratories in the United States because it does not include race in the calculation and reporting, included diversity in its development, is immediately available to all laboratories in the United States, and has acceptable performance characteristics and potential consequences that do not disproportionately affect any one group of individuals. (2) We recommend national efforts to facilitate increased, routine, and timely use of cystatin C, especially to confirm estimated GFR in adults who are at risk for or have chronic kidney disease, because combining filtration markers (creatinine and cystatin C) is more accurate and would support better clinical decisions than either marker alone. If ongoing evidence supports acceptable performance, the CKD-EPI eGFR-cystatin C (eGFRcys) and eGFR creatinine-cystatin C (eGFRcr-cys_R) refit without the race variables should be adopted to provide another first-line test, in addition to confirmatory testing. (3) Research on GFR estimation with new endogenous filtration markers and on interventions to eliminate race and ethnic disparities should be encouraged and funded. An investment in science is needed for newer approaches that generate accurate, unbiased, and precise GFR measurement and estimation without the inclusion of race, and that promote health equity and do not generate disparate care. IMPLEMENTATION This unified approach, without specification of race, should be adopted across the United States. High-priority and multistakeholder efforts should implement this solution.
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Affiliation(s)
- Cynthia Delgado
- Nephrology Section, San Francisco Veterans Affairs Medical Center and Division of Nephrology, University of California San Francisco, San Francisco, California.
| | - Mukta Baweja
- Nephrology Division, Department of Medicine and Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Crystal A Gadegbeku
- Department of Nephrology and Hypertension, Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Mallika L Mendu
- Division of Renal Medicine and Office of the Chief Medical Officer, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Marva M Moxey-Mims
- Division of Nephrology, Children's National Hospital, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Glenda V Roberts
- External Relations and Patient Engagement, Kidney Research Institute and Center for Dialysis Innovation, University of Washington, Seattle, Washington
| | - Wendy L St Peter
- College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | | | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and University of California San Francisco, San Francisco, California.
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Delgado C, Powe NR. Resolving the Debate: The Future of Using Race in Estimating Kidney Function. Adv Chronic Kidney Dis 2022; 29:5-16. [PMID: 35690404 DOI: 10.1053/j.ackd.2022.02.001] [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: 11/22/2021] [Revised: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 11/11/2022]
Abstract
Racial and social unrest witnessed during 2020 ignited a national conversation about the appropriateness of the use of race in health care algorithms and in the estimation of kidney function in particular. The growing concerns over the use of race in kidney function-estimating equations prompted the National Kidney Foundation (NKF) and American Society of Nephrology to launch an effort for change by establishing a task force on reassessing the use of race in diagnosing kidney disease. After nearly a year examining the evidence and obtaining testimony from experts and stakeholders, the task force recommended the immediate implementation of the 2020 Chronic Kidney Disease-Epidemiology creatinine equation refit without race in all US laboratories; increased routine use of cystatin C for confirmation of estimated glomerular filtration rate in clinical decision-making and a call for research on glomerular filtration rate estimation with new endogenous filtration markers and on addressing disparities in health and health care. The NKF and American Society of Nephrology strongly encouraged rapid adoption of these new recommendations. Leadership efforts of the NKF have begun to lay the foundation for national implementation through laboratory engagement, clinician awareness, and patient education.
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Affiliation(s)
- Cynthia Delgado
- Nephrology Section, San Francisco VA Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA.
| | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA
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Delgado C, Baweja M, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, Mendu ML, Miller WG, Moxey-Mims MM, Roberts GV, St. Peter WL, Warfield C, Powe NR. A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. J Am Soc Nephrol 2021; 32:2994-3015. [PMID: 34556489 PMCID: PMC8638402 DOI: 10.1681/asn.2021070988] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/05/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND In response to a national call for re-evaluation of the use of race in clinical algorithms, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a Task Force to reassess inclusion of race in the estimation of GFR in the United States and its implications for diagnosis and management of patients with, or at risk for, kidney diseases. PROCESS DELIBERATIONS The Task Force organized its activities over 10 months in phases to ( 1 ) clarify the problem and evidence regarding eGFR equations in the United States (described previously in an interim report), and, in this final report, ( 2 ) evaluate approaches to address use of race in GFR estimation, and ( 3 ) provide recommendations. We identified 26 approaches for the estimation of GFR that did or did not consider race and narrowed our focus, by consensus, to five of those approaches. We holistically evaluated each approach considering six attributes: assay availability and standardization; implementation; population diversity in equation development; performance compared with measured GFR; consequences to clinical care, population tracking, and research; and patient centeredness. To arrive at a unifying approach to estimate GFR, we integrated information and evidence from many sources in assessing strengths and weaknesses in attributes for each approach, recognizing the number of Black and non-Black adults affected. RECOMMENDATIONS ( 1 ) For US adults (>85% of whom have normal kidney function), we recommend immediate implementation of the CKD-EPI creatinine equation refit without the race variable in all laboratories in the United States because it does not include race in the calculation and reporting, included diversity in its development, is immediately available to all laboratories in the United States, and has acceptable performance characteristics and potential consequences that do not disproportionately affect any one group of individuals. ( 2 ) We recommend national efforts to facilitate increased, routine, and timely use of cystatin C, especially to confirm eGFR in adults who are at risk for or have CKD, because combining filtration markers (creatinine and cystatin C) is more accurate and would support better clinical decisions than either marker alone. If ongoing evidence supports acceptable performance, the CKD-EPI eGFR-cystatin C (eGFRcys) and eGFR creatinine-cystatin C (eGFRcr-cys_R) refit without the race variables should be adopted to provide another first-line test, in addition to confirmatory testing. ( 3 ) Research on GFR estimation with new endogenous filtration markers and on interventions to eliminate race and ethnic disparities should be encouraged and funded. An investment in science is needed for newer approaches that generate accurate, unbiased, and precise GFR measurement and estimation without the inclusion of race, and that promote health equity and do not generate disparate care. IMPLEMENTATION This unified approach, without specification of race, should be adopted across the United States. High-priority and multistakeholder efforts should implement this solution.
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Affiliation(s)
- Cynthia Delgado
- Nephrology Section, San Francisco Veterans Affairs Medical Center and Division of Nephrology, University of California San Francisco, San Francisco, California
| | - Mukta Baweja
- Nephrology Division, Department of Medicine and Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nwamaka D. Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Crystal A. Gadegbeku
- Department of Nephrology and Hypertension, Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Lesley A. Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Mallika L. Mendu
- Division of Renal Medicine and Office of the Chief Medical Officer, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - W. Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Marva M. Moxey-Mims
- Division of Nephrology, Children’s National Hospital, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Glenda V. Roberts
- External Relations and Patient Engagement, Kidney Research Institute and Center for Dialysis Innovation, University of Washington, Seattle, Washington
| | | | | | - Neil R. Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and University of California San Francisco, San Francisco, California
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Liu L, Zhao J, Du X, Zhao Y, Zou C, Zhou H, Li W, Yan X. Construction and validation of a novel aging-related gene signature and prognostic nomogram for predicting the overall survival in ovarian cancer. Cancer Med 2021; 10:9097-9114. [PMID: 34825509 PMCID: PMC8683552 DOI: 10.1002/cam4.4404] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Ovarian cancer (OC) is the most lethal gynecological malignancy. The objective of this study was to establish and validate an individual aging-related gene signature and a clinical nomogram that can powerfully predict independently the overall survival rate of patients with ovarian cancer. METHODS Data on transcriptomic profile and relevant clinical information were retrieved from The Cancer Genome Atlas (TCGA) database as a training group, and the same data from three public Gene Expression Omnibus (GEO) databases as validation groups. Univariate Cox regression analysis, lasso regression analysis, and multiple multivariate Cox analysis were analyzed sequentially to select the genes to be included in the aging-associated signature. A risk scoring model was established and verified, the predictive value of the model was evaluated, and a clinical nomogram was established. RESULTS We found eight genes that were most relevant to prognosis and constructed an eight-mRNA signature. Based on the model, each OC patient's risk score was able to be calculated and patients were split into groups of low and high risks with a distinct outcome. Survival analysis confirmed that the outcome of patients in the high-risk group was dramatically shorter than that of those in the low-risk group, and the eight-mRNA signature can be considered as a powerful and independent predictor that could predict the outcome of OC patient. Additionally, the risk score and age can be used to construct a clinical nomogram as a simpler tool for predicting prognosis. We also explored the association between the risk score and immunity and drug sensitivity. CONCLUSION This study suggested that the aging-related gene signature could be used as an intervention point and latent prognostic predictor in OC, which may provide new perceptions for postoperative treatment strategies.
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Affiliation(s)
- Lixiao Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinduo Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xuedan Du
- Department of Chemoradiation Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ye Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengyang Zou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Heling Zhou
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Wenzhou, China
| | - Wenfeng Li
- Department of Chemoradiation Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaojian Yan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Temkin SM, Smeltzer MP, Dawkins MD, Boehmer LM, Senter L, Black DR, Blank SV, Yemelyanova A, Magliocco AM, Finkel MA, Moore TE, Thaker PH. Improving the quality of care for patients with advanced epithelial ovarian cancer: Program components, implementation barriers, and recommendations. Cancer 2021; 128:654-664. [PMID: 34787913 PMCID: PMC9298928 DOI: 10.1002/cncr.34023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
The high lethality of ovarian cancer in the United States and associated complexities of the patient journey across the cancer care continuum warrant an assessment of current practices and barriers to quality care in the United States. The objectives of this study were to identify and assess key components in the provision of high‐quality care delivery for patients with ovarian cancer, identify challenges in the implementation of best practices, and develop corresponding quality‐related recommendations to guide multidisciplinary ovarian cancer programs and practices. This multiphase ovarian cancer quality‐care initiative was guided by a multidisciplinary expert steering committee, including gynecologic oncologists, pathologists, a genetic counselor, a nurse navigator, social workers, and cancer center administrators. Key partnerships were also established. A collaborative approach was adopted to develop comprehensive recommendations by identifying ideal quality‐of‐care program components in advanced epithelial ovarian cancer management. The core program components included: care coordination and patient education, prevention and screening, diagnosis and initial management, treatment planning, disease surveillance, equity in care, and quality of life. Quality‐directed recommendations were developed across 7 core program components, with a focus on ensuring high‐quality ovarian cancer care delivery for patients through improved patient education and engagement by addressing unmet medical and supportive care needs. Implementation challenges were described, and key recommendations to overcome barriers were provided. The recommendations emerging from this initiative can serve as a comprehensive resource guide for multidisciplinary cancer practices, providers, and other stakeholders working to provide quality‐directed cancer care for patients diagnosed with ovarian cancer and their families. Quality‐directed recommendations for ovarian cancer care delivery are developed across 7 core program components, with a focus on ensuring high‐quality care delivery by addressing unmet medical and supportive care needs. These recommendations can serve as a comprehensive resource guide for multidisciplinary cancer practices, providers, and other stakeholders working to provide quality‐directed cancer care for patients diagnosed with ovarian cancer and their families.
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Affiliation(s)
- Sarah M Temkin
- Office of Research for Women's Health, National Institutes of Health, Bethesda, Maryland
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, Tennessee
| | | | - Leigh M Boehmer
- Association of Community Cancer Centers, Rockville, Maryland
| | - Leigha Senter
- Division of Human Genetics, College of Medicine, The Ohio State University and Ohio State Comprehensive Cancer Center, Columbus, Ohio
| | - Destin R Black
- Division of Gynecologic Oncology, Willis-Knighton Medical Center, Shreveport, Louisiana
| | | | - Anna Yemelyanova
- Department of Pathology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | | | - Mollie A Finkel
- Division of Gynecologic Oncology, Mount Sinai Medical Center-Chelsea, New York, New York
| | - Tracy E Moore
- Ovarian Cancer Research Alliance, New York, New York
| | - Premal H Thaker
- Washington University Siteman Cancer Center, St Louis, Missouri
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Levey AS, Powe NR. eGFR and chemotherapy: will removing race create disparities? Lancet Oncol 2021; 22:1208-1209. [PMID: 34399095 DOI: 10.1016/s1470-2045(21)00391-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, MA 02111, USA.
| | - Neil R Powe
- Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
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Huepenbecker SP, Sun CC, Fu S, Zhao H, Primm K, Giordano SH, Meyer LA. Factors impacting the time to ovarian cancer diagnosis based on classic symptom presentation in the United States. Cancer 2021; 127:4151-4160. [PMID: 34347287 DOI: 10.1002/cncr.33829] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with ovarian cancer often present with late-stage disease and nonspecific symptoms, but little is known about factors affecting the time to diagnosis (TTD) in the United States. METHODS A retrospective, population-based study of the Surveillance, Epidemiology, and End Results-Medicare database was conducted. It included women 66 years old or older with stage II to IV epithelial ovarian cancer with at least 1 code for abdominal/pelvic pain, bloating, difficulty eating, or urinary symptoms within 1 year of the cancer diagnosis. TTD was defined from the first claim with a prespecified symptom to the ovarian cancer diagnosis. Kruskal-Wallis tests were used to assess for differences in TTD by group medians. Univariate and generalized linear models with a log-link function evaluated TTD by covariables. RESULTS For the 13,872 women analyzed, the mean and median times to diagnosis were 2.9 and 1.1 months, respectively. The median TTD differed significantly by first symptom (P < .001), number of symptoms (P < .001), and first physician specialty seen (P < .001). In a multivariable analysis, TTD differed significantly according to race/ethnicity (P < .001), geographic region (P = .001), urban-rural location (P = .031), emergency room presentation (P < .001), and number of specialties seen (P < .001). A shorter TTD was associated with a diagnosis in 2006-2010 (relative risk [RR], 0.92; 95% confidence interval [CI], 0.87-0.98) or 2011-2015 (RR, 0.87; 95% CI, 0.81-0.93) in comparison with 1992-1999. CONCLUSIONS The time from a symptomatic presentation to care to a diagnosis of ovarian cancer is influenced by clinical and demographic variables. This study's findings reinforce the importance of educating all physicians on ovarian cancer symptoms to aid in diagnosis. LAY SUMMARY Ovarian cancer is often diagnosed once disease has spread because the classic symptoms of ovarian cancer-abdominal or pelvic pain, bloating, difficulty eating, and urinary issues-can be mistaken for other problems. This study examined the time between when women with classic ovarian cancer symptoms went to a physician and when they received a cancer diagnosis in a large database population. The authors found that the time to diagnosis differed according to the type and number of symptoms and what type of physician a woman saw as well as factors such as race, geographic location, and year of diagnosis.
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Affiliation(s)
- Sarah P Huepenbecker
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charlotte C Sun
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shuangshuang Fu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristin Primm
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Racial-Ethnic Comparison of Guideline-Adherent Gynecologic Cancer Care in an Equal-Access System. Obstet Gynecol 2021; 137:629-640. [PMID: 33706355 DOI: 10.1097/aog.0000000000004325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare receipt of National Comprehensive Cancer Network Guideline-adherent treatment for gynecologic cancers, inclusive of uterine, cervical, and ovarian cancer, between non-Hispanic White women and racial-ethnic minority women in the equal-access Military Health System. METHODS We accessed MilCanEpi, which links data from the Department of Defense Central Cancer Registry and Military Health System Data Repository administrative claims data, to identify a cohort of women aged 18-79 years who were diagnosed with uterine, cervical, or ovarian cancer between January 1, 1998, and December 31, 2014. Information on tumor stage, grade, and histology was used to determine which treatment(s) (surgery, chemotherapy, radiotherapy) was indicated for each patient according to the National Comprehensive Cancer Network Guidelines during the period of the data (1998-2014). We compared non-Hispanic Black, Asian, and Hispanic women with non-Hispanic White women in their likelihood to receive guideline-adherent treatment using multivariable logistic regression models given as adjusted odds ratios (aORs) and 95% CIs. RESULTS The study included 3,354 women diagnosed with a gynecologic cancer of whom 68.7% were non-Hispanic White, 15.6% Asian, 9.0% non-Hispanic Black, and 6.7% Hispanic. Overall, 77.8% of patients received guideline-adherent treatment (79.1% non-Hispanic White, 75.9% Asian, 69.3% non-Hispanic Black, and 80.5% Hispanic). Guideline-adherent treatment was similar in Asian compared with non-Hispanic White patients (aOR 1.18, 95% CI 0.84-1.48) or Hispanic compared with non-Hispanic White women (aOR 1.30, 95% CI 0.86-1.96). Non-Hispanic Black patients were marginally less likely to receive guideline-adherent treatment compared with non-Hispanic White women (aOR 0.73, 95% CI 0.53-1.00, P=.011) and significantly less likely to receive guideline-adherent treatment than either Asian (aOR 0.65, 95% CI 0.44-0.97) or Hispanic patients (aOR 0.56, 95% CI 0.34-0.92). CONCLUSION Racial-ethnic differences in guideline-adherent care among patients in the equal-access Military Health System suggest factors other than access to care contributed to the observed disparities.
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Delgado C, Baweja M, Burrows NR, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, Mendu ML, Miller WG, Moxey-Mims MM, Roberts GV, St Peter WL, Warfield C, Powe NR. Reassessing the Inclusion of Race in Diagnosing Kidney Diseases: An Interim Report From the NKF-ASN Task Force. Am J Kidney Dis 2021; 78:103-115. [PMID: 33845065 PMCID: PMC8238889 DOI: 10.1053/j.ajkd.2021.03.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For almost 2 decades, equations that use serum creatinine, age, sex, and race to estimate glomerular filtration rate (GFR) have included "race" as Black or non-Black. Given considerable evidence of disparities in health and health care delivery in African American communities, some regard keeping a race term in GFR equations as a practice that differentially influences access to care and kidney transplantation. Others assert that race captures important non-GFR determinants of serum creatinine and its removal from the calculation may perpetuate other disparities. The National Kidney Foundation (NKF) and American Society of Nephrology (ASN) established a task force in 2020 to reassess the inclusion of race in the estimation of GFR in the United States and its implications for diagnosis and subsequent management of patients with, or at risk for, kidney diseases. This interim report details the process, initial assessment of evidence, and values defined regarding the use of race to estimate GFR. We organized activities in phases: (1) clarify the problem and examine evidence, (2) evaluate different approaches to address use of race in GFR estimation, and (3) make recommendations. In phase 1, we constructed statements about the evidence and defined values regarding equity and disparities; race and racism; GFR measurement, estimation, and equation performance; laboratory standardization; and patient perspectives. We also identified several approaches to estimate GFR and a set of attributes to evaluate these approaches. Building on evidence and values, the attributes of alternative approaches to estimate GFR will be evaluated in the next phases and recommendations will be made.
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Affiliation(s)
- Cynthia Delgado
- Nephrology Section, San Francisco Veterans Affairs Medical Center, Division of Nephrology, University of California San Francisco, San Francisco, CA.
| | - Mukta Baweja
- Nephrology Division, Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Crystal A Gadegbeku
- Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University, Philadelphia, PA
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Mallika L Mendu
- Division of Renal Medicine and Office of the Chief Medical Officer, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA
| | - Marva M Moxey-Mims
- Division of Nephrology, Children's National Hospital, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Glenda V Roberts
- External Relations and Patient Engagement, Kidney Research Institute, Center for Dialysis Innovation, University of Washington, Seattle, WA
| | | | | | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA.
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Delgado C, Baweja M, Burrows NR, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, Mendu ML, Miller WG, Moxey-Mims MM, Roberts GV, St. Peter WL, Warfield C, Powe NR. Reassessing the Inclusion of Race in Diagnosing Kidney Diseases: An Interim Report from the NKF-ASN Task Force. J Am Soc Nephrol 2021; 32:1305-1317. [PMID: 33837122 PMCID: PMC8259639 DOI: 10.1681/asn.2021010039] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
For almost two decades, equations that use serum creatinine, age, sex, and race to eGFR have included "race" as Black or non-Black. Given considerable evidence of disparities in health and healthcare delivery in African American communities, some regard keeping a race term in GFR equations as a practice that differentially influences access to care and kidney transplantation. Others assert that race captures important non GFR determinants of serum creatinine and its removal from the calculation may perpetuate other disparities. The National Kidney Foundation (NKF) and American Society of Nephrology (ASN) established a task force in 2020 to reassess the inclusion of race in the estimation of GFR in the United States and its implications for diagnosis and subsequent management of patients with, or at risk for, kidney diseases. This interim report details the process, initial assessment of evidence, and values defined regarding the use of race to estimate GFR. We organized activities in phases: (1) clarify the problem and examine evidence, (2) evaluate different approaches to address use of race in GFR estimation, and (3) make recommendations. In phase one, we constructed statements about the evidence and defined values regarding equity and disparities; race and racism; GFR measurement, estimation, and equation performance; laboratory standardization; and patient perspectives. We also identified several approaches to estimate GFR and a set of attributes to evaluate these approaches. Building on evidence and values, the attributes of alternative approaches to estimate GFR will be evaluated in the next phases and recommendations will be made.
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Affiliation(s)
- Cynthia Delgado
- Nephrology Section, San Francisco Veterans Affairs Medical Center, Division of Nephrology, University of California San Francisco, San Francisco, California
| | - Mukta Baweja
- Nephrology Division, Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nwamaka D. Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Crystal A. Gadegbeku
- Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University, Philadelphia, Pennsylvania
| | - Lesley A. Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Mallika L. Mendu
- Division of Renal Medicine and Office of the Chief Medical Officer, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - W. Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Marva M. Moxey-Mims
- Division of Nephrology, Children’s National Hospital, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Glenda V. Roberts
- External Relations and Patient Engagement, Kidney Research Institute, Center for Dialysis Innovation, University of Washington, Seattle, Washington
| | | | | | - Neil R. Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California
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Kakarla M, ChallaSivaKanaka S, Hayward SW, Franco OE. Race as a Contributor to Stromal Modulation of Tumor Progression. Cancers (Basel) 2021; 13:cancers13112656. [PMID: 34071280 PMCID: PMC8197868 DOI: 10.3390/cancers13112656] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 02/07/2023] Open
Abstract
Stromal cells play crucial roles in tumor development and are increasingly attractive targets for therapy. There are considerable racial disparities in the incidence and progression of many tumors, reflecting both environmental exposure and genetic differences existing between races. Tumorigenesis and tumor progression are linked to both the propensity to suffer an initiating event and the host response to such an event once it occurs, contributing to incidence and outcomes. In this review, we focused on racial disparities in the tumor microenvironment (TME) of different cancers as potential modulators of growth, metastasis, and response to treatment. Several studies suggest that the TME in AA has a distinct tumor biology and may facilitate both early onset and aggressive tumor growth while inhibiting anti-tumorigenic properties. The TME of AA patients often exhibits an immunosuppressive microenvironment with a substantial enrichment of immune inflammatory pathways and genes. As a result, AA patients can potentially benefit more from treatment strategies that modulate the immune system. Focusing on TME components for diagnostic and therapeutic purposes to address racial disparities is a promising area of investigation. Future basic and clinical research studies on personalized cancer diagnosis and treatment should acknowledge the significance of TME in racial disparities.
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Wenzel L, Osann K, McKinney C, Cella D, Fulci G, Scroggins MJ, Lankes HA, Wang V, Nephew KP, Maxwell GL, Mok SC, Conrads TP, Miller A, Mannel RS, Gray HJ, Hanjani P, Huh WK, Spirtos N, Leitao MM, Glaser G, Sharma SK, Santin AD, Sperduto P, Lele SB, Burger RA, Monk BJ, Birrer M. Quality of Life and Adverse Events: Prognostic Relationships in Long-Term Ovarian Cancer Survival. J Natl Cancer Inst 2021; 113:1369-1378. [PMID: 33729494 DOI: 10.1093/jnci/djab034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/15/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a critical need to identify patient characteristics associated with long-term ovarian cancer survival. METHODS Quality of life (QOL), measured by the Functional Assessment of Cancer Therapy-Ovarian-Trial Outcome Index (FACT-O-TOI), including physical, functional and ovarian-specific subscales, was compared between long-term (LTS) (8+ years) and short-term (STS) (<5 years) survivors of GOG 218 at baseline, before cycles 4, 7, 13, 21, and 6 months post-treatment using linear and longitudinal mixed models adjusted for covariates. Adverse events (AEs) were compared between survivor groups at each assessment using generalized linear models. All p-values are two-sided. RESULTS QOL differed statistically significantly between STS (N = 1115) and LTS (N = 260) (p < .001). Baseline FACT-O-TOI and FACT-O-TOI change were independently associated with long-term survival (OR = 1.05, 95% CI = 1.03-1.06 and OR = 1.06, 95% CI = 1.05-1.07, respectively). A 7-point increase in baseline QOL was associated with a 38.0% increase in probability of LTS, while a 9-point increase in QOL change was associated with a 67.0% increase in odds for LTS. QOL decreased statistically significantly with increasing AE quartiles (cycle 4 quartiles: 0-5 v. 6-8 v. 9-11 v. ≥12 AEs, p = .01; cycle 21 quartiles: 0-2 v. 3 v. 4-5 v. ≥6 AEs, p = .001). Further, LTS reported statistically significantly better QOL compared to STS (p = .03 and p = .01, cycles 4 and 21, respectively), with similar findings across higher AE grades. CONCLUSION Baseline and longitudinal QOL change scores distinguished long versus short-term survivors and are robust prognosticators for long term survival. Results have trial design and supportive care implications, providing meaningful prognostic value in this understudied population.
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Affiliation(s)
- Lari Wenzel
- Department of Medicine and Program in Public Health, University of California, Irvine
| | - Kathryn Osann
- Department of Medicine and Program in Public Health, University of California, Irvine
| | - Chelsea McKinney
- Department of Medicine and Program in Public Health, University of California, Irvine
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Health System
| | | | | | | | - Victoria Wang
- Dana-Farber Cancer Institute, Department of Data Science
| | - Kenneth P Nephew
- Medical Sciences Program, Indiana University School of Medicine-Bloomington
| | - George L Maxwell
- Women's Health Integrated Research Center at Inova Health System, Women's Service Line, Inova Health System
| | - Samuel C Mok
- Department of Gynecological Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center
| | - Thomas P Conrads
- Women's Health Integrated Research Center at Inova Health System, Women's Service Line, Inova Health System
| | | | - Robert S Mannel
- Stephenson Cancer Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma
| | - Heidi J Gray
- Gynecologic Oncology, University of Washington Medical Center
| | | | | | | | - Mario M Leitao
- Memorial Sloan Kettering Cancer and Weill Cornell Medical Center
| | | | | | - Alessandro D Santin
- Department of Obstetrics, Gynecology & Reproductive Services, Yale University School of Medicine
| | - Paul Sperduto
- Minneapolis Radiation Oncology and Metro-Minnesota Community Oncology Research Consortium
| | | | | | - Bradley J Monk
- Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), University of Arizona College of Medicine
| | - Michael Birrer
- Winthrop P. Rockefeller Cancer Institute University of Arkansas for Medical Sciences
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Rodriguez VE, LeBrón AMW, Chang J, Bristow RE. Guideline-adherent treatment, sociodemographic disparities, and cause-specific survival for endometrial carcinomas. Cancer 2021; 127:2423-2431. [PMID: 33721357 DOI: 10.1002/cncr.33502] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/20/2021] [Accepted: 02/05/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adherence to National Comprehensive Cancer Network guidelines have been adopted as the standard of care for various cancers and have been cited to have survival benefits. Few studies have examined the association of adherent treatment and endometrial cancer survival among various racial/ethnic groups and socioeconomic statuses. METHODS Between January 1, 2006 and December 31, 2015, 83,673 women diagnosed with endometrial carcinomas were identified from the Surveillance, Epidemiology, and End Results database. Descriptive statistics of demographic and clinical characteristics were performed. Cox-proportional hazards models were used to examine the effect on cause-specific survival for adherence to guidelines across racial/ethnic and socioeconomic groups. RESULTS Within our sample, 59.5% were treated according to guidelines. Nonadherence to treatment guidelines was significantly associated with decreased survival compared with adherent care (adjusted hazard ratio [HR], 1.59; 95% CI, 1.52-1.67). Being of Black (adjusted HR, 1.41; 95% CI, 1.32-1.51) or Native Hawaiian/Pacific Islander (adjusted HR, 1.44; 95% CI, 1.19-1.73) race/ethnicity compared with White women was significantly associated with worse survival. Being of Asian race/ethnicity (adjusted HR, 0.86, 95% CI, 0.78-0.94) was significantly associated with improved survival compared with White women. Lower neighborhood socioeconomic status was associated with a negative effect on survival relative to women in the highest socioeconomic status category. CONCLUSIONS Findings from this study suggest treatment adherence is an independent predictor of improved survival; however, improved survival was not observed equally among all racial/ethnic and socioeconomic status groups. LAY SUMMARY The National Comprehensive Cancer Network (NCCN) has developed guidelines for physicians to follow in treating various cancers. Within this study of 83,673 women with endometrial cancer, 59.5% of women were treated according to the NCCN guidelines. The findings suggest following NCCN guidelines for treatment of endometrial cancer improves survival. Black or Native Hawaiian/Pacific Islander race and lower neighborhood socioeconomic status has worse survival rates compared with other groups, indicating the importance of exploring other factors that may shape treatment across racial/ethnic and socioeconomic status groups.
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Affiliation(s)
- Victoria E Rodriguez
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, California
| | - Alana M W LeBrón
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, California.,Department of Chicano/Latino Studies, University of California, Irvine, Irvine, California
| | - Jenny Chang
- Department of Medicine, University of California, Irvine, School of Medicine, Irvine, California
| | - Robert E Bristow
- Department of Obstetrics & Gynecology, University of California, Irvine, School of Medicine, Orange, California
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Underrepresented minority representation trends in gynecologic oncology fellowships in the United States. Gynecol Oncol 2020; 160:485-491. [PMID: 33276987 DOI: 10.1016/j.ygyno.2020.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate representation trends of historically underrepresented minority (URM) groups in gynecologic oncology fellowships in the United States using a nationwide database collected by the Accreditation Council for Graduate Medical Education (ACGME). METHODS Data on self-reported ethnicity/race of filled residency positions was collected from ACGME Database Books across three academic years from 2016 to 2019. Primary chi-square analysis compared URM representation in gynecologic oncology to obstetrics and gynecology, other surgical specialties, and other medical specialties. Secondary analysis examined representation of two URM subgroups: 1) Asian/Pacific Islander, and 2) Hispanic, Black, Native American, Other (HBNO), across specialty groups. RESULTS A total of 528 gynecologic oncology positions, 12,559 obstetrics and gynecology positions, 52,733 other surgical positions, and 240,690 other medical positions from ACGME accredited medical specialties were included in analysis. Primary comparative analysis showed a statistically significant lower proportion (P < 0.05) of URM trainees in gynecologic oncology in comparison to each of obstetrics and gynecology, other surgical fields, and other medical fields. Secondary analysis also demonstrated a significantly lower proportion (P < 0.05) of HBNO physicians in gynecologic oncology in comparison to obstetrics and gynecology, as well as all other medical and surgical specialties. CONCLUSIONS This study illustrates the disparities in URM representation, especially those who identify as HBNO, in gynecologic oncology fellowship training in comparison to obstetrics and gynecology as well as other medical and surgical fields. Improvements to the current recruitment and selection practices in gynecologic oncology fellowships in the United States are necessary in order to ensure a diverse and representative workforce.
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Shukla P, Singh KK. Uncovering Mitochondrial Determinants of Racial Disparities in Ovarian Cancer. Trends Cancer 2020; 7:93-97. [PMID: 33246874 DOI: 10.1016/j.trecan.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 01/13/2023]
Abstract
Ovarian cancer (OC) incidence and mortality rates differ between racial groups. Mitochondrial genetic factors are now emerging as determinants of racial disparities in OC. A comprehensive understanding of the role of mitochondria in OC health disparities will help in developing novel therapeutic strategies targeting mitochondria to reduce or eliminate racial health disparities.
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Affiliation(s)
- Pallavi Shukla
- Department of Genetics, University of Alabama at Birmingham, Kaul Genetics Building Room, 630, 720 20th Street South, Birmingham, AL 35294, USA; Department of Molecular Endocrinology, Indian Council of Medical Research-National Institute for Research in Reproductive Health (ICMR-NIRRH), Jehangir Merwanji Street, Parel, Mumbai 400012, India.
| | - Keshav K Singh
- Department of Genetics, University of Alabama at Birmingham, Kaul Genetics Building Room, 630, 720 20th Street South, Birmingham, AL 35294, USA.
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Adherence to treatment guidelines as a major determinant of survival disparities between black and white patients with ovarian cancer. Gynecol Oncol 2020; 160:10-15. [PMID: 33208254 DOI: 10.1016/j.ygyno.2020.10.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/31/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate whether non-adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines and other factors related to treatment access contribute to racial disparities in ovarian cancer survival. METHODS This large cohort study included patients from the National Cancer Database who were diagnosed with ovarian cancer between 2004 and 2014, with follow-up data up to 2017. The multivariable Cox regression was used to assess the effect of study variables on five-year overall survival. The proportion contributions of prognostic factors to the survival disparities were estimated using individual and sequential adjustment of these factors based on the Cox proportional hazards models. RESULTS Of the 120,712 patients eligible for this study, 110,032 (91.1%) were whites and 10,680 (8.9%) were blacks. Black patients, compared with their white counterparts, had a lower adherence to NCCN guidelines (60.8% vs. 70.4%, respectively, P < 0.001), and a higher five-year mortality after cancer diagnosis (age- and tumor characteristics- adjusted hazard ratio: 1.22, 95% confidence interval: 1.19-1.25). Non-adherence to NCCN treatment guidelines was the most significant contributor to racial disparity in ovarian cancer survival, followed by access to care and comorbidity, each explaining 36.4%, 22.7%, and 18.2% of the racial differences in five-year overall survival, respectively. These factors combined explain 59.1% of racial survival disparities. Risk factors identified for non-adherence to treatment guidelines among blacks include insurance status, treatment facility type, educational attainment, age, and comorbidity. CONCLUSIONS Adherence status to NCCN treatment guidelines is the most important contributor to the survival disparities between black and white patients with ovarian cancer. Our findings call for measures to promote equitable access to guideline-adherence care to improve the survival of black women with ovarian cancer.
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Mukand NH, Zolekar A, Ko NY, Calip GS. Risks of Second Primary Gynecologic Cancers following Ovarian Cancer Treatment in Asian Ethnic Subgroups in the United States, 2000-2016. Cancer Epidemiol Biomarkers Prev 2020; 29:2220-2229. [PMID: 32856609 PMCID: PMC10772992 DOI: 10.1158/1055-9965.epi-20-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/03/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The differential occurrence of second primary cancers by race following ovarian cancer is poorly understood. Our objective was to determine the incidence of second primary gynecologic cancers (SPGC) following definitive therapy for ovarian cancer. Specifically, we aimed to determine differences in SPGC incidence by Asian ethnic subgroups. METHODS We identified 27,602 women ages 20 years and older and diagnosed with first primary epithelial ovarian cancer between 2000 and 2016 who received surgery and chemotherapy in 18 population-based Surveillance, Epidemiology and End Results Program registries. We compared the incidence of SPGC with expected incidence rates in the general population of women using estimated standardized incidence ratios (SIR) and 95% confidence intervals (CI). RESULTS The incidence of SPGC was lower among White women (SIR = 0.73; 95% CI, 0.59-0.89), and higher among Black (SIR = 1.80; 95% CI, 0.96-3.08) and Asian/Pacific Islander (API) women (SIR = 1.83; 95% CI, 1.07-2.93). Increased risk of vaginal cancers was observed among all women, although risk estimates were highest among API women (SIR = 26.76; 95% CI, 5.52-78.2) and were also significant for risk of uterine cancers (SIR = 2.53; 95% CI, 1.35-4.33). Among API women, only Filipinas had significantly increased incidence of SPGC overall including both uterine and vaginal cancers. CONCLUSIONS Risk of SPGC following treatment of ovarian cancer differs by race and ethnicity, with Filipina women having the highest rates of second gynecologic cancers among Asian women. IMPACT Ensuring access and adherence to surveillance may mitigate ethnic differences in the early detection and incidence of second gynecologic cancers.
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Affiliation(s)
- Nita H Mukand
- University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois
- University of Illinois Cancer Center, Chicago, Illinois
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ashwini Zolekar
- University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois
| | - Naomi Y Ko
- Section of Hematology Oncology, Boston University School of Medicine, Boston, Massachusetts
| | - Gregory S Calip
- University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois.
- University of Illinois Cancer Center, Chicago, Illinois
- Flatiron Health, New York, New York
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Pellarin I, Belletti B, Baldassarre G. RNA splicing alteration in the response to platinum chemotherapy in ovarian cancer: A possible biomarker and therapeutic target. Med Res Rev 2020; 41:586-615. [PMID: 33058230 DOI: 10.1002/med.21741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/09/2020] [Accepted: 10/02/2020] [Indexed: 12/18/2022]
Abstract
Since its discovery, alternative splicing has been recognized as a powerful way for a cell to amplify the genetic information and for a living organism to adapt, evolve, and survive. We now know that a very high number of genes are regulated by alternative splicing and that alterations of splicing have been observed in different types of human diseases, including cancer. Here, we review the accumulating knowledge that links the regulation of alternative splicing to the response to chemotherapy, focusing our attention on ovarian cancer and platinum-based treatments. Moreover, we discuss how expanding information could be exploited to identify new possible biomarkers of platinum response, to better select patients, and/or to design new therapies able to overcome platinum resistance.
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Affiliation(s)
- Ilenia Pellarin
- Molecular Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, National Cancer Institute, Aviano, Italy
| | - Barbara Belletti
- Molecular Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, National Cancer Institute, Aviano, Italy
| | - Gustavo Baldassarre
- Molecular Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, National Cancer Institute, Aviano, Italy
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