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Li V, Alibhai SMH, Noel K, Fazelzad R, Haase K, Mariano C, Durbano S, Sattar S, Newton L, Dawe D, Bell JA, Hsu T, Wong ST, Lofters A, Bender JL, Manthorne J, Puts MTE. Access to cancer clinical trials for racialised older adults: an equity-focused rapid scoping review protocol. BMJ Open 2024; 14:e074191. [PMID: 38245013 PMCID: PMC10807002 DOI: 10.1136/bmjopen-2023-074191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The intersection of race and older age compounds existing health disparities experienced by historically marginalised communities. Therefore, racialised older adults with cancer are more disadvantaged in their access to cancer clinical trials compared with age-matched counterparts. To determine what has already been published in this area, the rapid scoping review question are: what are the barriers, facilitators and potential solutions for enhancing access to cancer clinical trials among racialised older adults? METHODS We will use a rapid scoping review methodology in which we follow the six-step framework of Arksey and O'Malley, including a systematic search of the literature with abstract and full-text screening to be conducted by two independent reviewers, data abstraction by one reviewer and verification by a second reviewer using an Excel data abstraction sheet. Articles focusing on persons aged 18 and over who identify as a racialised person with cancer, that describe therapies/therapeutic interventions/prevention/outcomes related to barriers, facilitators and solutions to enhancing access to and equity in cancer clinical trials will be eligible for inclusion in this rapid scoping review. ETHICS AND DISSEMINATION All data will be extracted from published literature. Hence, ethical approval and patient informed consent are not required. The findings of the scoping review will be submitted for publication in a peer-reviewed journal and presentation at international conferences.
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Affiliation(s)
- Vivian Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine and Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Kristin Haase
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline Mariano
- BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lorelei Newton
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - David Dawe
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer A Bell
- Clinical and Organizational Ethics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tina Hsu
- Department of Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Sabrina T Wong
- Division of Intramural Research, National Institute of Nursing Research, Bethesda, Maryland, USA
| | - Aisha Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada
| | - Jacqueline L Bender
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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DuMontier C, Loh KP, Bain PA, Silliman RA, Hshieh T, Abel GA, Djulbegovic B, Driver JA, Dale W. Defining Undertreatment and Overtreatment in Older Adults With Cancer: A Scoping Literature Review. J Clin Oncol 2020; 38:2558-2569. [PMID: 32250717 PMCID: PMC7392742 DOI: 10.1200/jco.19.02809] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The terms undertreatment and overtreatment are often used to describe inappropriate management of older adults with cancer. We conducted a comprehensive scoping review of the literature to clarify the meanings behind the use of the terms. METHODS We searched PubMed (National Center for Biotechnology Information), Embase (Elsevier), and CINAHL (EBSCO) for titles and abstracts that included the terms undertreatment or overtreatment with regard to older adults with cancer. We included all types of articles, cancer types, and treatments. Definitions of undertreatment and overtreatment were extracted, and categories underlying these definitions were derived through qualitative analysis. Within a random subset of articles, C.D. and K.P.L. independently performed this analysis to determine final categories and then independently assigned these categories to assess inter-rater reliability. RESULTS Articles using the terms undertreatment (n = 236), overtreatment (n = 71), or both (n = 51) met criteria for inclusion in our review (n = 256). Only 14 articles (5.5%) explicitly provided formal definitions; for the remaining, we inferred the implicit definitions from the terms' surrounding context. There was substantial agreement (κ = 0.81) between C.D. and K.P.L. in independently assigning categories of definitions within a random subset of 50 articles. Undertreatment most commonly implied less than recommended therapy (148; 62.7%) or less than recommended therapy associated with worse outcomes (88; 37.3%). Overtreatment most commonly implied intensive treatment of an older adult in whom the harms of treatment outweigh the benefits (38; 53.5%) or intensive treatment of a cancer not expected to affect an older adult in his/her remaining lifetime (33; 46.5%). CONCLUSION Undertreatment and overtreatment of older adults with cancer are imprecisely defined concepts. We propose new, more rigorous definitions that account for both oncologic factors and geriatric domains.
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Affiliation(s)
- Clark DuMontier
- Brigham and Women’s Hospital, Boston, MA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | | | | | - Tammy Hshieh
- Brigham and Women’s Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Jane A. Driver
- Brigham and Women’s Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Veterans Affairs Boston Healthcare System, New England Geriatric Research Education and Clinical Center, Boston, MA
| | - William Dale
- City of Hope Comprehensive Cancer Center, Duarte, CA
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Rodriguez Otero JC, Dagatti MS, Fernandez Bussy R, Bergero A, Gorosito M, Staffieri R, Villavicencio R, Batalles SM, Pezzotto SM. Sentinel Lymph Node Biopsy in Patients With Thick Primary Cutaneous Melanoma. World J Oncol 2019; 10:112-117. [PMID: 31068991 PMCID: PMC6497010 DOI: 10.14740/wjon1181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/31/2019] [Indexed: 01/02/2023] Open
Abstract
Background The clinical value of sentinel lymph node biopsy (SLNB) in patients with thick melanoma is uncertain. The purpose of this study was to investigate the correlations between survival and lymph node status in thick melanomas. Methods Of a total of 736 melanoma patients registered between 2000 and 2016, 50 presented with thick melanomas (≥ 4.0 mm) without distant metastatic disease. All patients were examined with a whole-body magnetic resonance imaging, or computed tomography, and positron emission tomography-computed tomography depending on the incorporation of the new technology in our medical institutions. They were studied according to the following procedure: 1) preoperative determination of regional lymph node along with the estimation and localization of sentinel lymph node (SLN) (dynamic isotope lymphography); 2) intraoperative localization and SLNB (lymphatic mapping); and 3) histopathology. Patient and tumor features were collected. Results Mean follow-up was 40 months, and 37% had a follow-up ≥ 5 years. A positive SLN was identified in 28 patients (56%). No significant difference in melanoma-specific overall survival was observed in terms of the primary tumor site. Hazard ratios (HRs) were statistically significant for SLNB-positive group and mitotic rate (MR) > 3 mm2, but not for presence of ulceration. Mortality risk in the SLN-positive group was almost fourfold greater than that in the SLN-negative group at any time of follow-up. Conclusions SLN status, along with MR, can provide valuable prognostic information in patients with thick primary cutaneous melanoma.
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Affiliation(s)
| | - Maria Susana Dagatti
- School of Medicine, National University of Rosario, Santa Fe 3100, 2000 Rosario, Argentina
| | - Ramon Fernandez Bussy
- School of Medicine, National University of Rosario, Santa Fe 3100, 2000 Rosario, Argentina
| | - Adriana Bergero
- School of Medicine, National University of Rosario, Santa Fe 3100, 2000 Rosario, Argentina
| | - Mario Gorosito
- School of Medicine, National University of Rosario, Santa Fe 3100, 2000 Rosario, Argentina
| | - Roberto Staffieri
- Rosario Cardiovascular Institute, Bv. Orono 450, 2000 Rosario, Argentina
| | | | | | - Stella Maris Pezzotto
- School of Medicine, National University of Rosario, Santa Fe 3100, 2000 Rosario, Argentina
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Chemotherapy treatment decision-making experiences of older adults with cancer, their family members, oncologists and family physicians: a mixed methods study. Support Care Cancer 2016; 25:879-886. [PMID: 27830393 PMCID: PMC5266767 DOI: 10.1007/s00520-016-3476-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/26/2016] [Indexed: 12/03/2022]
Abstract
Purpose Although comorbidities, frailty, and functional impairment are common in older adults (OA) with cancer, little is known about how these factors are considered during the treatment decision-making process by OAs, their families, and health care providers. Our aim was to better understand the treatment decision process from all these perspectives. Methods A mixed methods multi-perspective longitudinal study using semi-structured interviews and surveys with 29 OAs aged ≥70 years with advanced prostate, breast, colorectal, or lung cancer, 24 of their family members,13 oncologists, and 15 family physicians was conducted. The sample was stratified on age (70–79 and 80+). All interviews were analyzed using thematic analysis. Results There was no difference in the treatment decision-making experience based on age. Most OAs felt that they should have the final say in the treatment decision, but strongly valued their oncologists’ opinion. “Trust in my oncologist” and “chemotherapy as the last resort to prolong life” were the most important reasons to accept treatment. Families indicated a need to improve communication between them, the patient and the specialist, particularly around goals of treatment. Comorbidity and potential side-effects did not play a major role in the treatment decision-making for patients, families, or oncologists. Family physicians reported no involvement in decisions but desired to be more involved. Conclusion This first study using multiple perspectives showed neither frailty nor comorbidity played a role in the treatment decision-making process. Efforts to improve communication were identified as an opportunity that may enhance quality of care. Condensed abstract In a mixed methods study multiple perspective study with older adults with cancer, their family members, their oncologist and their family physician we explored the treatment decision making process and found that most older adults were satisfied with their decision. Comorbidity, functional status and frailty did not impact the older adult’s or their family members’ decision. Electronic supplementary material The online version of this article (doi:10.1007/s00520-016-3476-8) contains supplementary material, which is available to authorized users.
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Monroe MM, Pattisapu P, Myers JN, Kupferman ME. Sentinel Lymph Node Biopsy Provides Prognostic Value in Thick Head and Neck Melanoma. Otolaryngol Head Neck Surg 2015; 153:372-8. [DOI: 10.1177/0194599815589948] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 05/14/2015] [Indexed: 11/15/2022]
Abstract
Objectives Sentinel lymph node biopsy (SLNB) is standard practice for intermediate-thickness head and neck melanoma (HNM) but remains controversial for melanomas more than 4 mm in thickness. The objectives of this study were to evaluate (1) the diagnostic accuracy and (2) the prognostic value of SLNB in patients with thick HNM. Study Design Case series with chart review. Setting Large cancer center between June 2000 and December 2012. Subjects 77 patients undergoing SLNB for T4 HNM without in-transit, regional, or distant metastatic disease at presentation. Methods Univariate and multivariate analyses of prognostic factors were performed. Results 77 patients underwent attempted SLNB for T4 HNM without in-transit, regional, or distant metastatic disease at presentation. The mean patient age was 62 years (range, 4-87 years) and there was a male predominance (80%). Mean Breslow thickness was 6.1 mm (range, 4-21 mm). Of the 77 patients undergoing attempted SLNB, 7 had no identifiable sentinel lymph node (9%). For the remaining 91% with 1 or more identifiable sentinel lymph nodes, the mean number of nodes identified was 3.3 (range, 1-13). The sentinel lymph node positivity rate was 24%. A false-negative SLNB occurred in 2 patients (3.8%). With a median follow-up of 36 months, the estimated 5-year disease-free, disease-specific, and overall survival rates were 47%, 74%, and 69%, respectively. A positive sentinel lymph node was significantly linked to shortened disease-free survival (74 vs 36 months, P = .026) and disease-specific survival (121 vs 59 months, P = .035). Conclusion SLNB provides accurate staging of the regional node basin and important prognostic information for patients with thick HNM.
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Affiliation(s)
- Marcus M. Monroe
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | | | - Jeffrey N. Myers
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael E. Kupferman
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Sattar S, Alibhai SMH, Wildiers H, Puts MTE. How to implement a geriatric assessment in your clinical practice. Oncologist 2014; 19:1056-68. [PMID: 25187477 PMCID: PMC4200997 DOI: 10.1634/theoncologist.2014-0180] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/17/2014] [Indexed: 12/21/2022] Open
Abstract
Cancer is a disease that mostly affects older adults. Other health conditions, changes in functional status, and use of multiple medications change the risks and benefits of cancer treatment for older adults. Several international organizations, such as the International Society of Geriatric Oncology, the European Organization for Research and Treatment of Cancer, recommend the conduct of a geriatric assessment (GA) for older adults with cancer to help select the most appropriate treatment and identify any underlying undetected medical, functional, and psychosocial issues that can interfere with treatment. The aim of this review is to describe what a GA is and how to implement it in daily clinical practice for older adults with cancer in the oncology setting. We provide an overview of commonly used tools. Key considerations in performing the GA include the resources available (staff, space, and time), patient population (who will be assessed), what GA tools to use, and clinical follow-up (who will be responsible for using the GA results for developing care plans and who will provide follow-up care). Important challenges in implementing GA in clinical practice include not having easy and timely access to geriatric expertise, patient burden of the additional hospital visits, and establishing collaboration between the GA team and oncologists regarding expectations of the population referred for GA and expected outcomes of the GA. Finally, we provide some possible interventions for problems identified during the GA.
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Affiliation(s)
- Schroder Sattar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Shabbir M H Alibhai
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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