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Bizuayehu HM, Belachew SA, Jahan S, Diaz A, Baxi S, Griffiths K, Garvey G. Utilisation of endocrine therapy for cancer in Indigenous peoples: a systematic review and meta-analysis. BMC Cancer 2024; 24:882. [PMID: 39039483 PMCID: PMC11264465 DOI: 10.1186/s12885-024-12627-6] [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: 11/30/2023] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Indigenous peoples worldwide experience inequitable cancer outcomes, and it is unclear if this is underpinned by differences in or inadequate use of endocrine treatment (ET), often used in conjunction with other cancer treatments. Previous studies examining ET use in Indigenous peoples have predominately focused on the sub-national level, often resulting in small sample sizes with limited statistical power. This systematic review aimed to collate the findings ofarticles on ET utilisation for Indigenous cancer patients and describe relevant factors that may influence ET use. METHODS We conducted a systematic review and meta-analysis of studies reporting ET use for cancer among Indigenous populations worldwide. PubMed, Scopus, CINAHL, Web of Science, and Embase were searched for relevant articles. A random-effect meta-analysis was used to pool proportions of ET use. We also performed a subgroup analysis (such as with sample sizes) and a meta-regression to explore the potential sources of heterogeneity. A socio-ecological model was used to present relevant factors that could impact ET use. RESULTS Thirteen articles reported ET utilisation among Indigenous populations, yielding a pooled estimate of 67% (95% CI:54 - 80), which is comparable to that of Indigenous populations 67% (95% CI: 53 - 81). However, among studies with sufficiently sized study sample/cohorts (≥ 500), Indigenous populations had a 14% (62%; 95% CI:43 - 82) lower ET utilisation than non-Indigenous populations (76%; 95% CI: 60 - 92). The ET rate in Indigenous peoples of the USA (e.g., American Indian) and New Zealand (e.g., Māori) was 72% (95% CI:56-88) and 60% (95% CI:49-71), respectively. Compared to non-Indigenous populations, a higher proportion of Indigenous populations were diagnosed with advanced cancer, at younger age, had limited access to health services, lower socio-economic status, and a higher prevalence of comorbidities. CONCLUSIONS Indigenous cancer patients have lower ET utilisation than non-Indigenous cancer patients, despite the higher rate of advanced cancer at diagnosis. While reasons for these disparities are unclear, they are likely reflecting, at least to some degree, inequitable access to cancer treatment services. Strengthening the provision of and access to culturally appropriate cancer care and treatment services may enhance ET utilisation in Indigenous population. This study protocol was registered on Prospero (CRD42023403562).
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Affiliation(s)
- Habtamu Mellie Bizuayehu
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Sewunet Admasu Belachew
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Shafkat Jahan
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Abbey Diaz
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia
- Menzies School of Health Research, Darwin, Australia
| | - Siddhartha Baxi
- GenesisCare Australia, Griffith University, Gold Coast, Australia
| | - Kalinda Griffiths
- Poche SA+NT, Flinders University, Darwin, Australia
- Menzies School of Health Research, Darwin, Australia
- Centre for Big Data Research in Health, UNSW, Sydney, Australia
| | - Gail Garvey
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia
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Weaver A, Twine S, Bather M, Dowley A, Slough CM. Ethnic Disparities for Survival and Mortality in New Zealand Patients With Head and Neck Cancer. JAMA Netw Open 2024; 7:e2413004. [PMID: 38833253 DOI: 10.1001/jamanetworkopen.2024.13004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
Importance It is essential to identify inequitable cancer care for ethnic minority groups, which may allow policy change associated with improved survival and decreased mortality and morbidity. Objective To investigate ethnic disparities in survival and mortality among New Zealand (NZ) patients with head and neck cancer (HNC) and the association of other variables, including socioeconomic status, tumor stage, and age at diagnosis, with survival rates. Design, Setting, and Participants This retrospective cohort study was conducted among NZ patients diagnosed with specific HNCs from 2010 to 2020. Anonymized data were obtained from the NZ Cancer Registry, including patients diagnosed from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes C00-C14 and C30-C32. Data were analyzed from July 2020 through January 2024. Main Outcomes and Measures Censored Kaplan-Meier estimates were used to analyze survival distribution. Cox regression models were used to estimate the association of age, tumor stage at diagnosis, and socioeconomic status with survival rates. Age-standardized mortality rates were assessed. Results Among 6593 patients with HNCs (4590 males [69.6%]; 4187 patients aged 51-75 years [63.5%]), there were 706 Māori individuals (10.7%) and 5887 individuals with other ethnicity (89.3%), including 4327 NZ European individuals (65.6%; defined as New Zealanders of European descent). Māori individuals had a decreased survival proportion at all years after diagnosis compared with individuals with other ethnicity (eg, 66.1% [95% CI, 62.6%% to 69.8%] vs 71.2% [95% CI, 70.0% to 72.4%] at 2 years). At 1 year after diagnosis, Māori individuals did not have a significantly increased mortality rate compared with 5795 individuals with other ethnicity with data (193 deaths [27.3%] vs 1400 deaths [24.2%]; P = .06), but the rate was significantly increased at 5 years after diagnosis (277 deaths [39.3%] vs 2034 deaths [35.1%]; P = .03); there was greater disparity compared with NZ European individuals (1 year: 969 deaths [22.4%]; P = .003; 5 years: 1441 deaths [33.3%]; P = .002). There were persistent age-adjusted mortality rate disparities: 40.1% (95% CI, -25.9% to 71.2%) for Māori individuals and 18.8% (95% CI, -15.4% to 24.4%) for individuals with other ethnicity. Māori individuals were diagnosed at a mean age of 58.0 years (95% CI, 57.1-59.1 years) vs 64.3 years. (95% CI, 64.0-64.7 years) for individuals with other ethnicity, or 5 to 7 years younger, and died at mean age of 63.5 years (95% CI, 62.0-64.9 years) compared with 72.3 years (95% CI, 71.8-72.9 years) for individuals with other ethnicity, or 7 to 10 years earlier. Māori individuals presented with proportionally more advanced disease (only localized disease, 102 patients [14.5%; 95% CI, 12.0%-17.4%] vs 1413 patients [24.0%; 95% CI, 22.9%-25.1%]; P < .001) and showed an increase in regional lymph nodes (276 patients [39.1%; 95% CI, 35.5%-42.9%] vs 1796 patients [30.5%; 95% CI, 29.3%-31.8%]; P < .001) at diagnosis compared with individuals with other ethnicity. Socioeconomic status was not associated with survival. Conclusions and Relevance This study found that Māori individuals experienced worse survival outcomes and greater mortality rates from HNC in NZ and presented with more advanced disease at a younger age. These findings suggest the need for further research to alleviate these disparities, highlight the importance of research into minority populations with HNC globally, and may encourage equity research for all cancers.
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Affiliation(s)
- Abigail Weaver
- Otolaryngology Department, Hawkes Bay District Health Board, Hastings Hospital, Hasting, New Zealand
| | - Sarah Twine
- Otolaryngology Department, Hawkes Bay District Health Board, Hastings Hospital, Hasting, New Zealand
| | - Melissa Bather
- University of Auckland, Auckland Central Business District, Auckland, New Zealand
| | - Andrew Dowley
- Otolaryngology Department, Hawkes Bay District Health Board, Hastings Hospital, Hasting, New Zealand
| | - Cristian M Slough
- Otolaryngology Department, Hawkes Bay District Health Board, Hastings Hospital, Hasting, New Zealand
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Boyle L, Lawrenson R, Ronald M, Campbell I, Nosa V, Tin ST. Ethnic differences in time to surgery for women with early stage breast cancer in Aotearoa/New Zealand: a population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 47:101091. [PMID: 38948165 PMCID: PMC11214407 DOI: 10.1016/j.lanwpc.2024.101091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/16/2024] [Accepted: 04/30/2024] [Indexed: 07/02/2024]
Abstract
Background This study evaluates whether there are ethnic differences in time to surgery in women with early-stage (1-3a) breast cancer in four NZ urban regions between 2000 and 2020 pre- and post- Faster Cancer Treatment (FCT) implementation, which was introduced to address inequities in cancer outcomes. Methods This retrospective analysis used Te Rēhita Mate Ūtaetae (Breast Cancer Foundation National Register), a prospectively maintained database of breast cancers from 2000 to 2020. Women with stage 3b, 3c, metastatic or bilateral cancers were excluded. Logistic regression models evaluated ethnic differences in time to surgery (≤31/>31 days as per FCT plan) with sequential adjustment for potential contributing factors (demographic, mode of diagnosis, tumour, treatment facility type and treatment). Subgroup analyses by pre- and post-FCT implementation date were undertaken. Findings Of the 16,365 women included, 74.1% were NZ European (NZE), 10.2% were Māori, 6.1% were Pacific, and 9.2% were Asian. Wāhine Māori (Māori women) and Pacific women were more likely to experience delays in surgery >31 days, compared to NZE (maximally adjusted OR: 1.18; 95% CI:1.05, 1.33 and OR:1.42; 95% CI:1.22, 1.65, respectively)-deprivation and treatment facility type contributed most to this. Wāhine Māori experienced delay in the public system only. The associations did not differ between the pre- and post- FCT periods. Interpretation Ethnic inequities exist with respect to time to surgery for women with early-stage breast cancer and these differences persist after FCT implementation. Funding LB is supported by the Richard Stewart scholarship, the Royal Australasian College of Surgeons and Oxford Population Health.
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Affiliation(s)
- Leah Boyle
- Cancer Epidemiology Unit, Oxford Population Health, The University of Oxford, United Kingdom
| | - Ross Lawrenson
- University of Waikato, Hamilton, New Zealand
- Waikato District Health Board, Hamilton, New Zealand
| | - Maxine Ronald
- Department of General Surgery, Whangarei Hospital, New Zealand
| | - Ian Campbell
- Department of Surgery, Faculty of Health Sciences, University of Auckland, New Zealand
| | - Vili Nosa
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Sandar Tin Tin
- Cancer Epidemiology Unit, Oxford Population Health, The University of Oxford, United Kingdom
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
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Boyle L, Lawrenson R, Nosa V, Campbell I, Tin Tin S. Ethnic inequities in use of breast conserving surgery and radiation therapy in Aotearoa/New Zealand: which factors contribute? Breast Cancer Res Treat 2024; 205:641-653. [PMID: 38536575 PMCID: PMC11101543 DOI: 10.1007/s10549-024-07289-8] [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: 12/18/2023] [Accepted: 02/08/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE Aotearoa/New Zealand (NZ) faces ethnic inequities with respect to breast cancer survival and treatment. This study establishes if there are ethnic differences in (i) type of surgery and (ii) receipt of radiotherapy (RT) following breast conserving surgery (BCS), among women with early-stage breast cancer in NZ. METHODS This analysis used Te Rēhita Mata Ūtaetae (Breast Cancer Foundation National Register), a prospectively maintained database of breast cancers from 2000 to 2020. Logistic regression models evaluated ethnic differences in type of surgery (mastectomy or BCS) and receipt of RT with sequential adjustment for potential contributing factors. Subgroup analyses by treatment facility type were undertaken. RESULTS Of the 16,228 women included, 74% were NZ European (NZE), 10.3% were Māori, 9.4% were Asian and 6.2% were Pacific. Over one-third of women with BCS-eligible tumours received mastectomy. Asian women were more likely to receive mastectomy than NZE (OR 1.62; 95% CI 1.39, 1.90) as were wāhine Māori in the public system (OR 1.21; 95% CI 1.02, 1.44) but not in the private system (OR 0.78; 95% CI 0.51, 1.21). In women undergoing BCS, compared to NZE, Pacific women overall and wāhine Māori in the private system were, respectively, 36 and 38% less likely to receive RT (respective OR 0.64; 95% CI 0.50, 0.83 and 0.62; 95% CI 0.39, 0.98). CONCLUSION A significant proportion of women with early-stage breast cancer underwent mastectomy and significant ethnic inequities exist. Recently developed NZ Quality Performance Indicators strongly encourage breast conservation and should facilitate more standardized and equitable surgical management of early-stage breast cancer.
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Affiliation(s)
- Leah Boyle
- Cancer Epidemiology Unit, Oxford Population Health, The University of Oxford, Oxford, UK.
| | - Ross Lawrenson
- University of Waikato, Hamilton, New Zealand
- Waikato District Health Board, Hamilton, New Zealand
| | - Vili Nosa
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ian Campbell
- Department of Surgery, Faculty of Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sandar Tin Tin
- Cancer Epidemiology Unit, Oxford Population Health, The University of Oxford, Oxford, UK
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
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Lawrenson R, Lao C, Stanley J, Teng A, Kuper‐Hommel M, Campbell I, Krebs J, Sika‐Paotonu D, Koea J, Meredith I, Gurney J. Does diabetes affect breast cancer survival? Cancer Rep (Hoboken) 2024; 7:e2040. [PMID: 38507264 PMCID: PMC10953831 DOI: 10.1002/cnr2.2040] [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: 11/23/2023] [Revised: 01/24/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The objective of this study is to investigate the influence of diabetes on breast cancer-specific survival among women with breast cancer in Aotearoa/New Zealand. METHODS This study included women diagnosed with invasive breast cancer between 2005 and 2020, with their information documented in the Te Rēhita Mate Ūtaetae-Breast Cancer Foundation National Register. Breast cancer survival curves for women with diabetes and those without diabetes were generated using the Kaplan-Meier method. The hazard ratio (HR) of breast cancer-specific mortality for women with diabetes compared to women without diabetes was estimated using the Cox proportional hazards model. RESULTS For women with diabetes, the 5-year and 10-year of cancer-specific survival were 87% (95% CI: 85%-88%) and 79% (95% CI: 76%-81%) compared to 89% (95% CI: 89%-90%) and 84% (95% CI: 83%-85%) for women without diabetes. The HR of cancer-specific mortality for patients with diabetes compared to those without diabetes was 0.99 (95% CI: 0.89-1.11) after adjustment for patient demographics, tumor characteristics, and treatments. Age at cancer diagnosis and cancer stage had the biggest impact on the survival difference between the two groups. When stratified by cancer stage, the cancer-specific mortality between the two groups was similar. CONCLUSIONS While differences in survival have been identified for women with diabetes when compared to women without diabetes, these are attributable to age and the finding that women with diabetes tend to present with more advanced disease at diagnosis. We did not find any difference in survival between the two groups due to differences in treatment.
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Affiliation(s)
- Ross Lawrenson
- Medical Research CentreThe University of WaikatoHamiltonNew Zealand
- CommissioningTe Whatu Ora WaikatoHamiltonNew Zealand
| | - Chunhuan Lao
- Medical Research CentreThe University of WaikatoHamiltonNew Zealand
| | - James Stanley
- Department of Public HealthUniversity of OtagoWellingtonNew Zealand
| | - Andrea Teng
- Department of Public HealthUniversity of OtagoWellingtonNew Zealand
| | | | - Ian Campbell
- Department of Surgery, Faculty of Health SciencesThe University of AucklandAucklandNew Zealand
| | - Jeremy Krebs
- Department of MedicineUniversity of OtagoWellingtonNew Zealand
| | - Dianne Sika‐Paotonu
- Dean's Department UOW & Division of Health SciencesUniversity of OtagoNew Zealand
| | - Jonathan Koea
- General SurgeryWaitakere HospitalAucklandNew Zealand
- Medical SurgeryThe University of AucklandAucklandNew Zealand
| | | | - Jason Gurney
- Department of Public HealthUniversity of OtagoWellingtonNew Zealand
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Akmal A, Podgorodnichenko N, Gauld R, Stokes T. New Zealand Pae Ora Healthcare Reforms 2022: Viable by Design? A Qualitative Study Using the Viable System Model. Int J Health Policy Manag 2023; 12:7906. [PMID: 38618773 PMCID: PMC10843487 DOI: 10.34172/ijhpm.2023.7906] [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: 12/22/2022] [Accepted: 11/20/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND The New Zealand (NZ) Pae Ora (Healthy Futures) health reforms came into effect in July 2022 with the establishment of Health New Zealand (HNZ) (Te Whatu Ora) and the Māori Health Authority (MHA) (Te Aka Whai Ora) - the organisations charged for healthcare provision and delivery. Given these changes represent major health system reform, we aimed to conduct an early evaluation of the design of the reforms to determine if they can deliver a viable and sustainable NZ health system going forward. METHODS The evaluation was informed by Beer's viable system model (VSM). A qualitative exploratory design with semi-structured interviews and documents analysis using thematic analysis was used. We conducted 28 interviews with senior healthcare managers and reviewed over 300 official documents and news analyses. RESULTS The VSM posits that for a system to be viable, all its five sub-systems (operations; co-ordination; operational control; development and governance) need to be strong. Our analysis suggests that the health reforms, despite their strengths, do not satisfy this requirement. The reforms do appreciate the complexity of the healthcare environment: multiple stakeholders, social inequalities, interdependencies. However, our analysis suggests a severe lack of detail regarding the implementation and operationalisation of the reforms. Furthermore, resourcing and coordination within the reformed system is also unclear. CONCLUSION The health system reforms may not lead to a viable future NZ health system. Poor communication of the reform implementation and operationalisation will likely result in system failure and inhibit the ability of frontline health organisations to deliver care.
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Affiliation(s)
- Adeel Akmal
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Business Studies, University of Iceland, Reykjavik, Iceland
| | | | - Robin Gauld
- Department of Management, Otago Business School, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Bayir B, Ünal E, Küçükköseler AD. The effects of women's insight levels on breast cancer prevention behaviors: a cross-sectional study. Women Health 2023; 63:828-836. [PMID: 37933087 DOI: 10.1080/03630242.2023.2276146] [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: 11/10/2022] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
The aim of this study is to determine the effect of women's insight levels on their breast cancer prevention behaviors in primary health care services. A systematic sampling method was used to select a sample of 393 women in a province in Turkey. Socio-demographic Characteristics Form, Insight Scale and Scale for Determining Factors Affecting Women's Breast Cancer Prevention Behaviour were used as data collection tools. Data were collected face-to-face and then analyzed statistically using Student's t-test, one-way analysis of variance, Tukey HSD, Spearman correlation test and multiple regression analysis. The results showed that those who felt "healthy" had significantly higher mean breast cancer prevention behavior (p < .05). It was determined that there was a weak positive correlation between the level of insight and breast cancer prevention behaviors, and the increase in the level of insight had a significant positive effect of 0.37 ± 0.051 points on breast cancer prevention behaviors. It was found that there was a significant negative effect on prevention behaviors with 1.66 ± 0.796 points in those with a high education level and 1.58 ± 0.505 points in those with suspected disease. In conclusion, in this study, it was determined that insight level, education level, and awareness of early diagnosis affected the prevention behaviors of breast cancer.
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Affiliation(s)
- Berna Bayir
- School of Health Sciences, Department of Nursing, kto Karatay University, Konya, Turkey
| | - Esra Ünal
- School of Health Sciences, Department of Nursing, kto Karatay University, Konya, Turkey
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Herbach EL, Nash SH, Lizarraga IM, Carnahan RM, Wang K, Ogilvie AC, Curran M, Charlton ME. Patterns of Evidence-Based Care for the Diagnosis, Staging, and First-line Treatment of Breast Cancer by Race-Ethnicity: A SEER-Medicare Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1312-1322. [PMID: 37436422 PMCID: PMC10592343 DOI: 10.1158/1055-9965.epi-23-0218] [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: 03/10/2023] [Revised: 05/18/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in guideline-recommended breast cancer treatment are well documented, however studies including diagnostic and staging procedures necessary to determine treatment indications are lacking. The purpose of this study was to characterize patterns in delivery of evidence-based services for the diagnosis, clinical workup, and first-line treatment of breast cancer by race-ethnicity. METHODS SEER-Medicare data were used to identify women diagnosed with invasive breast cancer between 2000 and 2017 at age 66 or older (n = 2,15,605). Evidence-based services included diagnostic procedures (diagnostic mammography and breast biopsy), clinical workup (stage and grade determination, lymph node biopsy, and HR and HER2 status determination), and treatment initiation (surgery, radiation, chemotherapy, hormone therapy, and HER2-targeted therapy). Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (CI) for each service. RESULTS Black and American Indian/Alaska Native (AIAN) women had significantly lower rates of evidence-based care across the continuum from diagnostics through first-line treatment compared to non-Hispanic White (NHW) women. AIAN women had the lowest rates of HER2-targeted therapy and hormone therapy initiation. While Black women also had lower initiation of HER2-targeted therapy than NHW, differences in hormone therapy were not observed. CONCLUSIONS Our findings suggest patterns along the continuum of care from diagnostic procedures to treatment initiation may differ across race-ethnicity groups. IMPACT Efforts to improve delivery of guideline-concordant treatment and mitigate racial-ethnic disparities in healthcare and survival should include procedures performed as part of the diagnosis, clinical workup, and staging processes.
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Affiliation(s)
- Emma L. Herbach
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Sarah H. Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Ingrid M. Lizarraga
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Ryan M. Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Kai Wang
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA
| | - Amy C. Ogilvie
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Michaela Curran
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA
| | - Mary E. Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
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Bartholomew K, Ghafel M, Tin Tin S, Aye PS, Elwood JM, Hardie C, Scott N, Kidd J, Ramsaroop R, Campbell I. Receipt of mastectomy and adjuvant radiotherapy following breast conserving surgery (BCS) in New Zealand women with BCS-eligible breast cancer, 2010-2015: an observational study focusing on ethnic differences. BMC Cancer 2023; 23:766. [PMID: 37592208 PMCID: PMC10436661 DOI: 10.1186/s12885-023-11248-9] [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: 06/01/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Women with early breast cancer who meet guideline-based criteria should be offered breast conserving surgery (BCS) with adjuvant radiotherapy as an alternative to mastectomy. New Zealand (NZ) has documented ethnic disparities in screening access and in breast cancer treatment pathways. This study aimed to determine whether, among BCS-eligible women, rates of receipt of mastectomy or radiotherapy differed by ethnicity and other factors. METHODS The study assessed management of women with early breast cancer (ductal carcinoma in situ [DCIS] and invasive stages I-IIIA) registered between 2010 and 2015, extracted from the recently consolidated New Zealand Breast Cancer Registry (now Te Rēhita Mate Ūtaetae NZBCF National Breast Cancer Register). Specific criteria were applied to determine women eligible for BCS. Uni- and multivariable analyses were undertaken to examine differences by demographic and clinicopathological factors with a primary focus on ethnicity (Māori, Pacific, Asian, and Other; the latter is defined as NZ European, Other European, and Middle Eastern Latin American and African). RESULTS Overall 22.2% of 5520 BCS-eligible women were treated with mastectomy, and 91.1% of 3807 women who undertook BCS received adjuvant radiotherapy (93.5% for invasive cancer, and 78.3% for DCIS). Asian ethnicity was associated with a higher mastectomy rate in the invasive cancer group (OR 2.18; 95%CI 1.72-2.75), compared to Other ethnicity, along with older age, symptomatic diagnosis, advanced stage, larger tumour, HER2-positive, and hormone receptor-negative groups. Pacific ethnicity was associated with a lower adjuvant radiotherapy rate, compared to Other ethnicity, in both invasive and DCIS groups, along with older age, symptomatic diagnosis, and lower grade tumour in the invasive group. Both mastectomy and adjuvant radiotherapy rates decreased over time. For those who did not receive radiotherapy, non-referral by a clinician was the most common documented reason (8%), followed by patient decline after being referred (5%). CONCLUSION Rates of radiotherapy use are high by international standards. Further research is required to understand differences by ethnicity in both rates of mastectomy and lower rates of radiotherapy after BCS for Pacific women, and the reasons for non-referral by clinicians.
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MESH Headings
- Female
- Humans
- Breast Neoplasms/epidemiology
- Breast Neoplasms/ethnology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/ethnology
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Maori People/statistics & numerical data
- Mastectomy/statistics & numerical data
- Mastectomy, Segmental/statistics & numerical data
- New Zealand/epidemiology
- Radiotherapy, Adjuvant/statistics & numerical data
- Pacific Island People/statistics & numerical data
- Asian/statistics & numerical data
- European People/statistics & numerical data
- Middle Eastern People/statistics & numerical data
- African People/statistics & numerical data
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Affiliation(s)
- Karen Bartholomew
- Te Whatu Ora Waitematā, Auckland, New Zealand
- Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Mazin Ghafel
- Te Whatu Ora Waitematā, Auckland, New Zealand
- Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Sandar Tin Tin
- University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Phyu S Aye
- Te Whatu Ora Waitematā, Auckland, New Zealand.
- University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - J Mark Elwood
- University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Claire Hardie
- Te Whatu Ora MidCentral, Palmerston North, New Zealand
| | - Nina Scott
- University of Auckland, Waikato Campus, Hamilton, New Zealand
| | - Jacquie Kidd
- Auckland University of Technology, Auckland, New Zealand
| | | | - Ian Campbell
- University of Auckland, Waikato Campus, Hamilton, New Zealand
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Boyle L, Lumley T, Cumin D, Campbell D, Merry AF. Using days alive and out of hospital to measure surgical outcomes in New Zealand: a cross-sectional study. BMJ Open 2023; 13:e063787. [PMID: 37491100 PMCID: PMC10373692 DOI: 10.1136/bmjopen-2022-063787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES To measure differences at various deciles in days alive and out of hospital to 90 days (DAOH90) and explore its utility for identifying outliers of performance among district health boards (DHBs). METHODS Days in hospital and mortality within 90 days of surgery were extracted by linking data from the New Zealand National Minimum Data Set and the births and deaths registry between 1 January 2011 and 31 December 2021 for all adults in New Zealand undergoing acute laparotomy (AL-a relatively high-risk group), elective total hip replacement (THR-a medium risk group) or lower segment caesarean section (LSCS-a low-risk group). DAOH90 was calculated without censoring to zero in cases of mortality. For each DHB, direct risk standardisation was used to adjust for potential confounders and presented in deciles according to baseline patient risk. The Mann-Whitney U test assessed overall DAOH90 differences between DHBs, and comparisons are presented between selected deciles of DAOH90 for each operation. RESULTS We obtained national data for 35 175, 52 032 and 117 695 patients undergoing AL, THR and LSCS procedures, respectively. We have demonstrated that calculating DAOH without censoring zero allows for differences between procedures and DHBs to be identified. Risk-adjusted national mean DAOH90 Scores were 64.0 days, 79.0 days and 82.0 days at the 0.1 decile and 75.0 days, 82.0 days and 84.0 days at the 0.2 decile for AL, THR and LSCS, respectively, matching to their expected risk profiles. Differences between procedures and DHBs were most marked at lower deciles of the DAOH90 distribution, and outlier DHBs were detectable. Corresponding 90-day mortality rates were 5.45%, 0.78% and 0.01%. CONCLUSION In New Zealand after direct risk adjustment, differences in DAOH90 between three types of surgical procedure reflected their respective risk levels and associated mortality rates. Outlier DHBs were identified for each procedure. Thus, our approach to analysing DAOH90 appears to have considerable face validity and potential utility for contributing to the measurement of perioperative outcomes in an audit or quality improvement setting.
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Affiliation(s)
- Luke Boyle
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - David Cumin
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
| | - Doug Campbell
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Alan Forbes Merry
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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11
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Effect of sleep disorders on the risks of cancers and site-specific cancers. Sleep Med 2022; 100:254-261. [PMID: 36122507 DOI: 10.1016/j.sleep.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/03/2022] [Accepted: 08/21/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Whether preexisting sleep disorder is an independent risk factor for cancer remains unclear. Therefore, we performed this propensity score-matched population-based cohort study to compare the incidence rate ratios (IRRs) of specific cancers between patients with and without sleep disorders. PATIENTS AND METHODS Patients were categorized into two groups on the basis of the presence or absence of sleep disorders and matched at a 1:1 ratio. RESULTS Propensity score matching yielded a final cohort of 289,162 patients (i.e., 144,581 and 144,581 in the sleep disorder and nonsleep disorder groups, respectively) who were eligible for further analysis. In multivariate Cox regression analysis, the adjusted hazard ratio (aHR; 95% confidence interval [CI]) of cancer risk in the sleep disorder group compared with the nonsleep disorder group was 1.07 (1.04-1.12; P = 0.0001). Furthermore, the adjusted IRRs (95% CIs) for all cancers, breast cancer, and ovarian cancer in the patients with sleep disorders were 1.08 (1.02-1.18), 1.20 (1.08-1.32), and 1.30 (1.10-1.52), respectively. CONCLUSION The results suggested that sleep disorders are a significant risk factor for all cancers, breast cancer, and ovarian cancer.
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12
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Chen YC, Chen WM, Chiang MF, Shia BC, Wu SY. Association between Pre-Existing Sleep Disorders and Survival Rates of Patients with Breast Cancer. Cancers (Basel) 2022; 14:cancers14030798. [PMID: 35159065 PMCID: PMC8834375 DOI: 10.3390/cancers14030798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE: To investigate the effects of pre-existing sleep disorders on the survival outcomes of women receiving standard treatments for breast invasive ductal carcinoma (IDC). METHODS: We recruited patients from the Taiwan Cancer Registry Database who had received surgery for clinical stage I–III breast IDC. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into those with and without sleep disorders (Groups 1 and 2, respectively) through propensity score matching. RESULTS: In the multivariate Cox regression analysis, the adjusted hazard ratio for all-cause mortality for Group 1 compared with Group 2 was 1.51 (95% confidence interval: 1.19, 1.91; p < 0.001). CONCLUSION: Our study demonstrated that the sleep disorder group had poorer survival rates than the non-sleep disorder group in breast cancer. Therefore, patients should be screened and evaluated for pre-existing sleep disorders prior to breast surgery, with such disorders serving as a predictor of survival in patients with breast cancer. Future studies may investigate the survival benefits of pharmacological and behavioral treatments for sleep problems in patients with breast cancer.
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Affiliation(s)
- Yen-Chang Chen
- Division of Chest Medicine, Department of Internal Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan;
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei 242062, Taiwan;
| | - Ming-Feng Chiang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan;
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei 242062, Taiwan;
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei 242062, Taiwan
- Correspondence: (B.-C.S.); (S.-Y.W.)
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei 242062, Taiwan;
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei 242062, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (B.-C.S.); (S.-Y.W.)
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13
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Lindsay D, Bates N, Diaz A, Watt K, Callander E. Quantifying the hospital and emergency department costs for women diagnosed with breast cancer in Queensland. Support Care Cancer 2021; 30:2141-2150. [PMID: 34676449 DOI: 10.1007/s00520-021-06570-6] [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: 02/17/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE With increasing rates of cancer survival due to advances in screening and treatment options, the costs of breast cancer diagnoses are attracting interest. However, limited research has explored the costs to the Australian healthcare system associated with breast cancer. We aimed to describe the cost to hospital funders for hospital episodes and emergency department (ED) presentations for Queensland women with breast cancer, and whether costs varied by demographic characteristics. METHODS We used a linked administrative dataset, CancerCostMod, limited to all breast cancer diagnoses aged 18 years or over in Queensland between July 2011 and June 2015 (n = 13,285). Each record was linked to Queensland Health Admitted Patient Data Collection and Emergency Department Information Systems records between July 2011 and June 2018. The cost of hospital episodes and ED presentations were determined, with mean costs per patient modelled using generalised linear models with a gamma distribution and log link function. RESULTS The total cost to the Queensland healthcare system from hospital episodes for female breast cancer was AUD$309 million and AUD$12.6 million for ED presentations during the first 3 years following diagnosis. High levels of costs and service use were identified in the first 6 months following diagnosis. Some significant differences in cost of hospital and ED episodes were identified based on demographic characteristics, with Indigenous women and those from lower socioeconomic backgrounds having higher costs. CONCLUSION Hospitalisation costs for breast cancer in Queensland exert a high burden on the healthcare system. Costs are higher for women during the first 6 months from diagnosis and for Indigenous women, as well as those with underlying comorbidities and lower socioeconomic position.
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Affiliation(s)
- Daniel Lindsay
- School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Nicole Bates
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Abbey Diaz
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Emily Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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14
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An Artificial Intelligence-Enabled Pipeline for Medical Domain: Malaysian Breast Cancer Survivorship Cohort as a Case Study. Diagnostics (Basel) 2021; 11:diagnostics11081492. [PMID: 34441426 PMCID: PMC8395030 DOI: 10.3390/diagnostics11081492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/09/2022] Open
Abstract
Automated artificial intelligence (AI) systems enable the integration of different types of data from various sources for clinical decision-making. The aim of this study is to propose a pipeline to develop a fully automated clinician-friendly AI-enabled database platform for breast cancer survival prediction. A case study of breast cancer survival cohort from the University Malaya Medical Centre was used to develop and evaluate the pipeline. A relational database and a fully automated system were developed by integrating the database with analytical modules (machine learning, automated scoring for quality of life, and interactive visualization). The developed pipeline, iSurvive has helped in enhancing data management as well as to visualize important prognostic variables and survival rates. The embedded automated scoring module demonstrated quality of life of patients whereas the interactive visualizations could be used by clinicians to facilitate communication with patients. The pipeline proposed in this study is a one-stop center to manage data, to automate analytics using machine learning, to automate scoring and to produce explainable interactive visuals to enhance clinician-patient communication along the survivorship period to modify behaviours that relate to prognosis. The pipeline proposed can be modelled on any disease not limited to breast cancer.
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15
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Azriful A, Mallapiang F, Kurniati Y. Literature Review: Social Determinant of Health in Breast Cancer Patients Survival. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Social determinants have an important role in the survival of breast cancer patients.
AIM: This article aims to reviews the social determinants that affect the survival of breast cancer patient.
METHODS: We searched PubMed and Google Scholar for identifying studies related to this review using free-text terms and Medical Subject Headings terms. Both experimental and observational studies on social determinants of breast cancer patient survival which were published in the English language have been included in this review except expert opinions, commentaries, editorials, and review articles. Ten studies were eligible to be included in review.
RESULTS: Social health determinants that play a role in the survival of breast cancer patients are education level, place of residence, socioeconomic status, social environment, racial discrimination, and access to health services.
CONCLUSION: Social determinants have an influence on the survival of breast cancer patients, so it is important to pay attention to these factors.
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16
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Gurney J, Stanley J, McLeod M, Koea J, Jackson C, Sarfati D. Disparities in Cancer-Specific Survival Between Māori and Non-Māori New Zealanders, 2007-2016. JCO Glob Oncol 2021; 6:766-774. [PMID: 32511067 PMCID: PMC7328125 DOI: 10.1200/go.20.00028] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE While cancer survival is improving across most developed nations, those improvements are not shared equally within their population. Using high-quality national data, we have reviewed the extent to which cancer survival inequities are persisting for indigenous Māori compared with non-Māori New Zealanders and the extent to which these disparities are driven by deprivation, comorbidity, and stage of disease. METHODS Incident cases of cancer (2007-2016) were extracted from the New Zealand Cancer Registry and linked to mortality and hospitalization data. Descriptive, Kaplan-Meier, and Cox regression methods were used to compare survival outcomes between Māori and non-Māori. RESULTS Māori continue to have poorer survival than non-Māori for 23 of the 24 most common causes of Māori cancer death, with the extent of this disparity ranging from 12% to 156%. The magnitude of these disparities varies according to deprivation, comorbidity, and stage. Of note, there was a tendency for survival disparities to be largest among those with no comorbidity. CONCLUSION Māori continue to experience substantial cancer survival inequities. These observations are in keeping with reports from previous decades, which suggest that these disparities persist despite heightened attention. Reduction of the cancer burden on Māori and achievement of equitable survival outcomes require us to prevent cancer for Māori where we can, diagnose Māori patients early when we cannot, and once diagnosed, deliver equitable care to Māori patients at each step along the treatment path.
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Affiliation(s)
- Jason Gurney
- Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Melissa McLeod
- Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- Waitemata District Health Board, Auckland, New Zealand
| | - Chris Jackson
- Southern District Health Board, Dunedin, New Zealand.,Cancer Society of New Zealand, Wellington, New Zealand
| | - Diana Sarfati
- Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
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17
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Singh S, Sridhar P. A narrative review of sociodemographic risk and disparities in screening, diagnosis, treatment, and outcomes of the most common extrathoracic malignancies in the United States. J Thorac Dis 2021; 13:3827-3843. [PMID: 34277073 PMCID: PMC8264686 DOI: 10.21037/jtd-21-87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/20/2021] [Indexed: 11/06/2022]
Abstract
There is a well-established association between multiple sociodemographic risk factors and disparities in cancer care. These risk factors include minority race and ethnicity, low socioeconomic status (SES) including low income and education level, non-English primary language, immigrant status, and residential segregation, and distance to facilities that deliver cancer care. As cancer care advances, existing disparities in screening, treatment, and outcomes have become more evident. Lung cancer remains the most common and fatal malignancy in the United States, with breast, colorectal, and prostate cancer being the three most common and deadly extrathoracic malignancies. Achieving the best outcomes for patients with these malignancies relies on strong physician-patient relationships leading to robust screening, early diagnosis, and early referral to facilities that can deliver multidisciplinary care and multimodal therapy. It is likely that challenges experienced in developing patient trust and understanding, providing access to screening, and building referral pipelines for definitive therapy in lung cancer care to vulnerable populations are paralleled by those in extrathoracic malignancies. Likewise, progress made in delivering optimal care to all patients across sociodemographic and geographic barriers can serve as a roadmap. Therefore, we provide a narrative review of current disparities in screening, treatment, and outcomes for patients with breast, prostate, and colorectal malignancies.
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Affiliation(s)
- Sarah Singh
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Praveen Sridhar
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
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18
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Assessing health disparities in breast cancer incidence burden in Tennessee: geospatial analysis. BMC WOMENS HEALTH 2021; 21:186. [PMID: 33941168 PMCID: PMC8091807 DOI: 10.1186/s12905-021-01274-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/18/2021] [Indexed: 12/22/2022]
Abstract
Background Tennessee women experience the 12th highest breast cancer mortality in the United States. We examined the geographic differences in breast cancer incidence in Tennessee between Appalachian and non-Appalachian counties from 2005 to 2015. Methods We used ArcGIS 10.7 geospatial analysis and logistic regression on the Tennessee Cancer Registry incidence data for adult women aged ≥ 18 years (N = 59,287) who were diagnosed with breast cancer from 2005 to 2015 to evaluate distribution patterns by Appalachian county designation. The Tennessee Cancer Registry is a population-based, central cancer registry serving the citizens of Tennessee and was established by Tennessee law to collect and monitor cancer incidence. The main outcome was breast cancer stage at diagnosis. Independent variables were age, race, marital status, type of health insurance, and county of residence. Results Majority of the sample were White (85.5%), married (58.6%), aged ≥ 70 (31.3%) and diagnosed with an early stage breast cancer (69.6%). More than half of the women had public health insurance (54.2%), followed by private health insurance coverage (44.4%). Over half of the women resided in non-Appalachian counties, whereas 47.6% were in the Appalachian counties. We observed a significant association among breast cancer patients with respect to marital status and type of health insurance coverage (p = < 0.0001). While the logistic regression did not show a significant result between county of residence and breast cancer incidence, the spatial analysis revealed geographic differences between Appalachian and non-Appalachian counties. The highest incidence rates of 997.49–1164.59/100,000 were reported in 6 Appalachian counties (Anderson, Blount, Knox, Rhea, Roane, and Van Buren) compared to 3 non-Appalachian counties (Fayette, Marshall, and Williamson). Conclusions There is a need to expand resources in Appalachian Tennessee to enhance breast cancer screening and early detection. Using geospatial techniques can further elucidate disparities that may be overlooked in conventional linear analyses to improve women’s cancer health and associated outcomes.
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19
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Brice SN, Harper P, Crosby T, Gartner D, Arruda E, England T, Aspland E, Foley K. Factors influencing the delivery of cancer pathways: a summary of the literature. J Health Organ Manag 2021; 35:121-139. [PMID: 33818048 PMCID: PMC9136872 DOI: 10.1108/jhom-05-2020-0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/16/2020] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The study aims to summarise the literature on cancer care pathways at the diagnostic and treatment phases. The objectives are to find factors influencing the delivery of cancer care pathways; to highlight any interrelating factors; to find gaps in the literature concerning areas of research; to summarise the strategies and recommendations implemented in the studies. DESIGN/METHODOLOGY/APPROACH The study used a qualitative approach and developed a causal loop diagram to summarise the current literature on cancer care pathways, from screening and diagnosis to treatment. A total of 46 papers was finally included in the analysis, which highlights the recurring themes in the literature. FINDINGS The study highlights the myriad areas of research applied to cancer care pathways. Factors influencing the delivery of cancer care pathways were classified into different albeit interrelated themes. These include access barriers to care, hospital emergency admissions, fast track diagnostics, delay in diagnosis, waiting time to treatment and strategies to increase system efficiency. ORIGINALITY/VALUE As far as the authors know, this is the first study to present a visual representation of the complex relationship between factors influencing the delivery of cancer care pathways.
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Affiliation(s)
| | - Paul Harper
- School of Mathematics
,
Cardiff University
, Cardiff,
UK
| | | | - Daniel Gartner
- School of Mathematics
,
Cardiff University
, Cardiff,
UK
| | - Edilson Arruda
- Department of Decision Analytics and Risk,
Southampton Business School
,
University of Southampton
, Southampton,
UK
- Alberto Luiz Coimbra Institute-Graduate School and Research in Engineering
,
Federal University of Rio de Janeiro
, Rio de Janeiro,
Brazil
| | - Tracey England
- Department of Decision Analytics and Risk,
Southampton Business School
,
University of Southampton
, Southampton,
UK
| | - Emma Aspland
- School of Mathematics
,
Cardiff University
, Cardiff,
UK
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20
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Hikaka J, Jones R, Hughes C, Connolly MJ, Martini N. Ethnic Variations in the Quality Use of Medicines in Older Adults: Māori and Non-Māori in Aotearoa New Zealand. Drugs Aging 2021; 38:205-217. [PMID: 33432516 DOI: 10.1007/s40266-020-00828-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 11/28/2022]
Abstract
In Aotearoa New Zealand (NZ), ethnic inequities in health outcomes exist. Non-Māori experience better access to healthcare than Māori, including access to the quality use of medicines. Quality medicines use requires that medicines provide maximal therapeutic benefit with minimal harm. As older adults are more at risk of harm from medicines, and, because inequities are compounded with age, Māori older adults may be at more risk of medicines-related harm than younger and non-Māori populations. This narrative review examined ethnic variation in the quality use of medicines, including medicines utilisation and associated clinical outcomes, between Māori and non-Māori older adult populations in NZ. The review was structured around prevalence of medicine utilisation by medicine class and in particular disease states; high-risk medicines; polypharmacy; prevalence of potentially inappropriate prescribing (PIP); and association between PIP and clinical outcomes. 22 studies were included in the review. There is ethnic variation in the access to medicines in NZ, with Māori older adults often having reduced access to particular medicine types, or in particular disease states, compared with non-Māori older adults. Māori older adults are less likely than non-Māori to be prescribed medicines inappropriately, as defined by standardised tools; however, PIP is more strongly associated with adverse outcomes for Māori than non-Māori. This review identifies that inequities in quality medicines use exist and provides a starting point to develop pro-equity solutions. The aetiology of inequities in the quality use of medicines is multifactorial and our approaches to addressing the inequitable ethnic variation also need to be.
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Affiliation(s)
- Joanna Hikaka
- School of Pharmacy, University of Auckland, Auckland, New Zealand. .,Waitematā District Health Board, Auckland, New Zealand. .,Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand.
| | - Rhys Jones
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | | | - Martin J Connolly
- Waitematā District Health Board, Auckland, New Zealand.,Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Nataly Martini
- School of Pharmacy, University of Auckland, Auckland, New Zealand
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21
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Ginsburg O, Yip CH, Brooks A, Cabanes A, Caleffi M, Dunstan Y. J, Gyawali B, McCormack V, de Anderson MM, Mehrotra R, Mohar A, Murillo R, Pace LE, Paskett ED, Romanoff A, Rositch AF, Scheel J, Schneidman M, Unger-Saldana K, Vanderpuye V, Wu TY, Yuma S, Dvaladze A, Duggan C, Anderson BO. Breast cancer early detection: A phased approach to implementation. Cancer 2020; 126 Suppl 10:2379-2393. [PMID: 32348566 PMCID: PMC7237065 DOI: 10.1002/cncr.32887] [Citation(s) in RCA: 203] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022]
Abstract
When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered.
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Affiliation(s)
- Ophira Ginsburg
- Perlmutter Cancer Center, Section for Global Health, Division of Health and Behavior, Department of Population Health, New York University Langone Health, NY, USA
| | - Cheng-Har Yip
- University of Malaya, Kuala Lumpur, Malaysia
- Ramsay Sime Darby Health Care Kuala Lumpur, Malaysia
| | - Ari Brooks
- Dept. of Surgery, University of Pennsylvania, PA, USA
| | | | - Maira Caleffi
- Breast Center Hospital Moinhos de Vento Porto Alegre, Brazil
| | - Jorge Dunstan Y.
- Department of Breast, Skin and Soft Tissue Sarcomas Surgery Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Bishal Gyawali
- Department of Oncology, Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Ontario, Canada
| | | | | | | | - Alejandro Mohar
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Raul Murillo
- Centro Javeriano de Oncología – Hospital Universitario San Ignacio. Colombia
- Facultad de Medicina – Pontificia Universidad Javeriana, Colombia
| | - Lydia E. Pace
- Division of Women’s Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Electra D. Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Anya Romanoff
- Department of Surgery, Division of Surgical Oncology, Breast Surgery, The Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Scheel
- Dept. of Radiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington Seattle, WA, USA
| | - Miriam Schneidman
- Health, Nutrition and Population Global Practice, The World Bank Group
| | - Karla Unger-Saldana
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Verna Vanderpuye
- National Center for Oncology, Radiotherapy and Nuclear Medicine, Accra, Ghana
| | - Tsu-Yin Wu
- Center for Health Disparities Innovation and Studies, Eastern Michigan University, MI, USA
| | - Safina Yuma
- Dept. of Reproductive and Child Health, Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania
| | - Allison Dvaladze
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Catherine Duggan
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Benjamin O. Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, Washington, USA
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Gurney JK, Campbell S, Turner S, Scott N. Addressing cancer inequities for indigenous populations: The New Zealand story. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2019.100209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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23
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Gurney JK, Sarfati D, Lawrence B, Jackson C, Findlay M, McPherson K. Cancer research in the New Zealand context: Challenges and advantages. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2019.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Management of patients with early stage lung cancer - why do some patients not receive treatment with curative intent? BMC Cancer 2020; 20:109. [PMID: 32041572 PMCID: PMC7011272 DOI: 10.1186/s12885-020-6580-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/27/2020] [Indexed: 12/25/2022] Open
Abstract
Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment. Methods Patients included those diagnosed with early stage lung cancer in 2011–2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8–91.8%) and 5-year survival of 69.6% (95% CI: 63.2–76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37–1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori. Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.
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Kim DH, Chepulis L, Keenan R, Lao C, Hodgson F, Bullen C, Lawrenson R. Prevalence of invasive cancer in a large general practice patient population in New Zealand. J Prim Health Care 2020; 12:215-224. [DOI: 10.1071/hc19113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONThe prevalence of cancer in the community is likely to be increasing due to an ageing population, implementation of cancer screening programmes and advances in cancer treatment.
AIMTo determine the prevalence of primary invasive cancers in a large general practice patient population in New Zealand and to characterise the health-care status of these cancer patients.
METHODSData were sourced from the patient management system of a large general practice (n=11,374 patients) in a medium-sized Waikato town and from the New Zealand Cancer Registry dataset to identify patients diagnosed with cancer between January 2009 and December 2018.
RESULTSThere were 206 cancer diagnoses in 201 patients; 35 cancers were diagnosed in 1887 Māori patients (1.9%) and 171 in 9487 non-Māori patients (1.8%). The age-standardised prevalence was 3092/100,000 in Māori patients and 1971/100,000 in non-Māori patients. The most prevalent cancers were breast, male genital organ, digestive organ and skin cancers. In May 2019, 81 of 201 (40.8%) patients with cancer were receiving only usual care from their general practitioner, whereas 66 (32.8%) were having their cancer managed in secondary care. Comorbidities were common, including hypertension (38.8%), gastrointestinal disorders (29.9%) and mood disorders (24.4%).
DISCUSSIONResults suggest that there may be disparities in cancer prevalence between Māori and non-Māori patients, although this needs to be confirmed in other general practices. Furthermore, primary care appears to be responsible for most of the care in this patient cohort and workloads should be planned accordingly, particularly with the high incidence of comorbidities.
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Van Hemelrijck WMJ, De Schutter H, de Valk HAG, Silversmit G, Rosskamp M, Vandenheede H. Breast cancer by migrant background in Belgium: Lower risk, but worse survival in women of non-European origin. Int J Cancer 2019; 147:350-360. [PMID: 31597195 DOI: 10.1002/ijc.32726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 01/05/2023]
Abstract
Foreign and native populations differ in terms of breast cancer outcomes. Studies rarely distinguish between premenopausal and postmenopausal breast cancer, although the risk profile is different; nor between migrants of the first and second generation (FG and SG), which is crucial to examine genetic and environmental influences on breast cancer. This research fills these gaps by investigating patterns in breast cancer incidence and survival in different migrant groups by menopausal and migrant generational status, taking various risk factors into account. To this end, individually linked data from the 2001 census, the Belgian Cancer Registry and the Crossroads Bank for Social Security are used. Age-standardised incidence rates and incidence rate ratios are calculated by migrant background group, stratified according to ages 30-50 (premenopausal) and 50-70 (postmenopausal). Incidence rate ratios are examined with and without taking reproductive factors and socioeconomic position (SEP) into account. Relative survival percentages and relative excess risks of dying among premenopausal and postmenopausal patients are computed with and without controlling for the stage at diagnosis and SEP. Premenopausal breast cancer is further examined by migrant generational status. Breast cancer incidence is lower among non-European migrants compared to Belgians. Keeping SEP and known risk factors constant reduces much, but not all of the observed discrepancies. A risk convergence between SG migrants and Belgians for the development of premenopausal breast cancer is observed. Premenopausal breast cancer survival is worse among Moroccan patients due to a higher stage at diagnosis. This disadvantage is concentrated in the FG.
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Affiliation(s)
| | | | - Helga A G de Valk
- Netherlands Interdisciplinary Demographic Institute/KNAW, University of Groningen, Groningen, The Netherlands
| | | | | | - Hadewijch Vandenheede
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
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27
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Bergin PS, Brockington A, Jayabal J, Scott S, Litchfield R, Roberts L, Timog J, Beilharz E, Dalziel SR, Jones P, Yates K, Thornton V, Walker EB, Davis S, Te Ao B, Parmar P, Beghi E, Rossetti AO, Feigin V. Status epilepticus in Auckland, New Zealand: Incidence, etiology, and outcomes. Epilepsia 2019; 60:1552-1564. [PMID: 31260104 DOI: 10.1111/epi.16277] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/18/2019] [Accepted: 06/12/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine the incidence, etiology, and outcome of status epilepticus (SE) in Auckland, New Zealand, using the latest International League Against Epilepsy (ILAE) SE semiological classification. METHODS We prospectively identified patients presenting to the public or major private hospitals in Auckland (population = 1.61 million) between April 6, 2015 and April 5, 2016 with a seizure lasting 10 minutes or longer, with retrospective review to confirm completeness of data capture. Information was recorded in the EpiNet database. RESULTS A total of 477 episodes of SE occurred in 367 patients. Fifty-one percent of patients were aged <15 years. SE with prominent motor symptoms comprised 81% of episodes (387/477). Eighty-four episodes (18%) were nonconvulsive SE. Four hundred fifty episodes occurred in 345 patients who were resident in Auckland. The age-adjusted incidence of 10-minute SE episodes and patients was 29.25 (95% confidence interval [CI] = 27.34-31.27) and 22.22 (95% CI = 20.57-23.99)/100 000/year, respectively. SE lasted 30 minutes or longer in 250 (56%) episodes; age-adjusted incidence was 15.95 (95% CI = 14.56-17.45) SE episodes/100 000/year and 12.92 (95% CI = 11.67-14.27) patients/100 000/year. Age-adjusted incidence (10-minute SE) was 25.54 (95% CI = 23.06-28.24) patients/100 000/year for males and 19.07 (95% CI = 16.91-21.46) patients/100 000/year for females. The age-adjusted incidence of 10-minute SE was higher in Māori (29.31 [95% CI = 23.52-37.14]/100 000/year) and Pacific Islanders (26.55 [95% CI = 22.05-31.99]/100 000/year) than in patients of European (19.13 [95% CI = 17.09-21.37]/100 000/year) or Asian/other descent (17.76 [95% CI = 14.73-21.38]/100 000/year). Seventeen of 367 patients in the study died within 30 days of the episode of SE; 30-day mortality was 4.6%. SIGNIFICANCE In this population-based study, incidence and mortality of SE in Auckland lie in the lower range when compared to North America and Europe. For pragmatic reasons, we only included convulsive SE if episodes lasted 10 minutes or longer, although the 2015 ILAE SE classification was otherwise practical and easy to use.
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Affiliation(s)
- Peter S Bergin
- Auckland District Health Board, Grafton, Auckland, New Zealand.,Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Alice Brockington
- Auckland District Health Board, Grafton, Auckland, New Zealand.,Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Jayaganth Jayabal
- Auckland District Health Board, Grafton, Auckland, New Zealand.,Pantai-Gleneagles Hospital, Penang and Sungai Petani, Malaysia
| | - Shona Scott
- Auckland District Health Board, Grafton, Auckland, New Zealand.,Western General Hospital, Edinburgh, UK
| | | | - Lynair Roberts
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Jerelyn Timog
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Erica Beilharz
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Stuart R Dalziel
- Auckland District Health Board, Grafton, Auckland, New Zealand.,Department of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Peter Jones
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Kim Yates
- Waitematā District Health Board, Auckland, New Zealand
| | | | | | - Suzanne Davis
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Braden Te Ao
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Ettore Beghi
- Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Andrea O Rossetti
- Department of Clinical Neurosciences, Vaud University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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Banham D, Roder D, Keefe D, Farshid G, Eckert M, Howard N, Canuto K, Brown A. Disparities in breast screening, stage at diagnosis, cancer treatment and the subsequent risk of cancer death: a retrospective, matched cohort of aboriginal and non-aboriginal women with breast cancer. BMC Health Serv Res 2019; 19:387. [PMID: 31200700 PMCID: PMC6570827 DOI: 10.1186/s12913-019-4147-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/08/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Australia's Aboriginal and Torres Strait Islander women have poorer survival and twice the disease burden from breast cancer compared to other Australian women. These disparities are influenced, but not fully explained, by more diagnoses at later stages. Incorporating breast screening, hospital and out of hospital treatment and cancer registry records into a person-linked data system can improve our understanding of breast cancer outcomes. We focussed one such system on a population-based cohort of Aboriginal women in South Australia diagnosed with breast cancer and a matched cohort of non-Aboriginal women with breast cancer. We quantify Aboriginal and non-Aboriginal women's contact with publicly funded screening mammograms; quantify exposure to a selection of cancer treatment modalities; then assess the relationship between screening, treatment and the subsequent risk of breast cancer death. METHODS Breast cancers registered among Aboriginal women in South Australia in 1990-2010 (N = 77) were matched with a random selection of non-Aboriginal women by birth and diagnostic year, then linked to screening records, and treatment 2 months before and 13 months after diagnosis. Competing risk regression summarised associations of Aboriginality, breast screening, cancer stage and treatment with risk of breast cancer death. RESULTS Aboriginal women were less likely to have breast screening (OR = 0.37, 95%CIs 0.19-0.73); systemic therapies (OR = 0.49, 95%CIs 0.24-0.97); and, surgical intervention (OR = 0.35, 95%CIs 0.15-0.83). Where surgery occurred, mastectomy was more common among Aboriginal women (OR = 2.58, 1.22-5.46). Each of these factors influenced the risk of cancer death, reported as sub-hazard ratios (SHR). Regional spread disease (SHR = 34.23 95%CIs 6.76-13.40) and distant spread (SHR = 49.67 95%CIs 6.79-363.51) carried more risk than localised disease (Reference SHR = 1). Breast screening reduced the risk (SHR = 0.07 95%CIs 0.01-0.83). So too did receipt of systemic therapy (SHR = 0.06 95%CIs 0.01-0.41) and surgical treatments (SHR = 0.17 95%CIs 0.04-0.74). In the presence of adjustment for these factors, Aboriginality did not further explain the risk of breast cancer death. CONCLUSION Under-exposure to screening and treatment of Aboriginal women with breast cancers in South Australia contributed to excess cancer deaths. Improved access, utilisation and quality of effective treatments is needed to improve survival after breast cancer diagnosis.
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Affiliation(s)
- David Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000 Australia
| | - David Roder
- School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Dorothy Keefe
- SA Cancer Services, SA Health, Hindmarsh Square, Adelaide, SA 5000 Australia
- Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Gelareh Farshid
- Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Marion Eckert
- School of Nursing and Midwifery, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Natasha Howard
- School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000 Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000 Australia
- School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- School of Health Sciences, Aboriginal Health Research Group, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - for the CanDAD Aboriginal Community Reference Group and other CanDAD investigators
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000 Australia
- School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- SA Cancer Services, SA Health, Hindmarsh Square, Adelaide, SA 5000 Australia
- Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
- School of Nursing and Midwifery, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- School of Health Sciences, Aboriginal Health Research Group, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
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29
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Lao C, Lawrenson R, Edwards M, Campbell I. Treatment and survival of Asian women diagnosed with breast cancer in New Zealand. Breast Cancer Res Treat 2019; 177:497-505. [DOI: 10.1007/s10549-019-05310-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/29/2019] [Indexed: 12/24/2022]
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Lawrenson R, Lao C, Jacobson G, Seneviratne S, Scott N, Sarfati D, Elwood M, Campbell I. Outcomes in different ethnic groups of New Zealand patients with screen-detected vs. non-screen-detected breast cancer. J Med Screen 2019; 26:197-203. [PMID: 31068074 DOI: 10.1177/0969141319844801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To compare characteristics and survival of New Zealand European, Māori, and Pacific women with screen-detected vs. non-screen-detected breast cancer. Methods Women aged 45–69 diagnosed with invasive breast cancer between January 2005 and May 2013 were identified from the Waikato and Auckland Breast Cancer Registries. Patient demographics and tumour characteristics were described by detection mode and ethnicity. Kaplan–Meier method was used to estimate the five-year breast cancer-specific survival of women with stage I–III breast cancer by ethnicity and detection mode. Results Women with screen-detected cancers were older, had smaller tumours, fewer stage IV (0.8% vs. 7.6%), fewer high grade (16.8% vs. 39.0%), and fewer lymph node positive diseases (26.3% vs. 51.5%) than women with non-screen-detected cancers. There were more Luminal A (70.0% vs. 54.0%), fewer human epidermal growth factor receptor 2 positive non-Luminal (4.4% vs. 8.8%), and fewer triple negative cases (7.0% vs. 13.8%) in screen-detected than non-screen-detected cancers. If not screen detected, 22.7% of breast cancers in Pacific women were stage IV compared with 2.4% if screen detected. If not screen detected, the five-year breast cancer-specific survival was 91.1% for New Zealand European women, 84.2% for Māori women, and 80.2% for Pacific women (p-value <0.001). For screen-detected breast cancer, survival between different ethnic groups was similar. Conclusions Breast cancers detected through screening are diagnosed at an earlier stage and have a greater proportion of subtypes, with better outcome. Variations in survival for Māori and Pacific women are only found in women with non-screen-detected breast cancer.
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Affiliation(s)
- Ross Lawrenson
- Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | - Chunhuan Lao
- Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | - Gregory Jacobson
- Department of Biological Science, The University of Waikato, Hamilton, New Zealand
| | | | - Nina Scott
- Waikato District Health Board, Hamilton, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Mark Elwood
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Ian Campbell
- School of Medicine, The University of Auckland, Auckland, New Zealand
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Elwood JM, Tawfiq E, TinTin S, Marshall RJ, Phung TM, Campbell I, Harvey V, Lawrenson R. Development and validation of a new predictive model for breast cancer survival in New Zealand and comparison to the Nottingham prognostic index. BMC Cancer 2018; 18:897. [PMID: 30223800 PMCID: PMC6142675 DOI: 10.1186/s12885-018-4791-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/03/2018] [Indexed: 01/21/2023] Open
Abstract
Background The only available predictive models for the outcome of breast cancer patients in New Zealand (NZ) are based on data in other countries. We aimed to develop and validate a predictive model using NZ data for this population, and compare its performance to a widely used overseas model, the Nottingham Prognostic Index (NPI). Methods We developed a model to predict 10-year breast cancer-specific survival, using data collected prospectively in the largest population-based regional breast cancer registry in NZ (Auckland, 9182 patients), and assessed its performance in this data set (internal validation) and in an independent NZ population-based series of 2625 patients in Waikato (external validation). The data included all women with primary invasive breast cancer diagnosed from 1 June 2000 to 30 June 2014, with follow up to death or Dec 31, 2014. We used multivariate Cox proportional hazards regression to assess predictors and to calculate predicted 10-year breast cancer mortality, and therefore survival, probability for each patient. We assessed observed survival by the Kaplan Meier method. We assessed discrimination by the C statistic, and calibration by comparing predicted and observed survival rates for patients in 10 groups ordered by predicted 10-year survival. We compared this NZ model with the Nottingham Prognostic Index (NPI) in this validation data set. Results Discrimination was good: C statistics were 0.84 for internal validity and 0.83 for an independent external validity. For calibration, for both internal and external validity the predicted 10-year survival probabilities in all groups of patients, ordered by predicted survival, were within the 95% confidence intervals (CI) of the observed Kaplan-Meier survival probabilities. The NZ model showed good discrimination even within the prognostic groups defined by the NPI. Conclusions These results for the New Zealand model show good internal and external validity, transportability, and potential clinical value of the model, and its clear superiority over the NPI. Further research is needed to assess other potential predictors, to assess the model’s performance in specific subgroups of patients, and to compare it to other models, which have been developed in other countries and have not yet been tested in NZ. Electronic supplementary material The online version of this article (10.1186/s12885-018-4791-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Mark Elwood
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, 261 Morrin Road, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.
| | - Essa Tawfiq
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, 261 Morrin Road, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Sandar TinTin
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, 261 Morrin Road, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Roger J Marshall
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, 261 Morrin Road, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Tung M Phung
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, 261 Morrin Road, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Ian Campbell
- Waikato Clinical Campus, Department of Surgery, University of Auckland, Hamilton, New Zealand.,Waikato District Health Board, Hamilton, New Zealand
| | - Vernon Harvey
- Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, New Zealand
| | - Ross Lawrenson
- Waikato Clinical Campus, Department of Surgery, University of Auckland, Hamilton, New Zealand.,The University of Waikato, Hamilton, 3240, New Zealand.,Waikato District Health Board, Hamilton, New Zealand
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