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Tosetti I, Kuper H. Do people with disabilities experience disparities in cancer care? A systematic review. PLoS One 2023; 18:e0285146. [PMID: 38091337 PMCID: PMC10718463 DOI: 10.1371/journal.pone.0285146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Over 1.3 billion people, or 16% of the world's population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. METHODS A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of adult patients with disabilities and a sample without disabilities were included. Studies focused on cancer screening and not treatment were excluded, as well as editorials, commentaries, opinion papers, reviews, case reports, case series under 10 patients and conference abstracts. Studies were evaluated by one reviewer for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding. RESULTS Thirty-one studies were included in the systematic review. Compared to people without disabilities, PwD had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that PwD received poorer quality cancer care, including lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care. DISCUSSION Limitations of this work include the exclusion of qualitative research, no assessment of publication bias, selection performed by only one reviewer, results from high-income countries only, no meta-analysis and a high risk of bias in 15% of included studies. In spite of these limitations, our results show that PwD often experience severe disparities in cancer care with less guideline-consistent care and higher mortality than people without disabilities. These findings raise urgent questions about how to ensure equitable care for PwD; in order to prevent avoidable morbidity and mortality, cancer care programs need to be evaluated and urgently improved, with specific training of clinical staff, more disability inclusive research, better communication and shared decision-making with patients and elimination of physical, social and cultural barriers.
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Affiliation(s)
- Irene Tosetti
- M.Sc. Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Camanni G, Ciccone O, Lepri A, Tinarelli C, Bedetti C, Cicuttin S, Murgia N, Elisei S. 'Being disabled' as an exclusion criterion for clinical trials: a scoping review. BMJ Glob Health 2023; 8:e013473. [PMID: 37918873 PMCID: PMC10626873 DOI: 10.1136/bmjgh-2023-013473] [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: 07/19/2023] [Accepted: 10/01/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND People with disabilities (PWDs) are often excluded from biomedical research, but comprehensive data regarding their participation in clinical trials are not available. The objective of this study was to assess the rates of exclusion of PWDs from recent medical scientific research. METHODS The protocol of the study was designed according to PRISMA-ScR (PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for Scoping Reviews) guidelines. All completed interventional clinical trials registered on ClinicalTrials.gov between 2010 and 2020 regarding the 10 leading causes of global disability-adjusted life-years according to the Global Burden of Disease Study were analysed. An exclusion criterion from the study was considered explicit if it could be associated with one of the following seven categories: disability, physical impairment, cognitive impairment, behavioural or psychiatric disorders, language and communication impairment, sensory impairment. Comorbidities not more clearly defined and researcher discretion regarding exclusion of study participants were considered to be 'implicit exclusion criteria'. We assessed the appropriateness of explicit exclusion criteria in relation to the primary objectives of the trials and labelled them as 'absolute', 'relative' or 'questionable'. RESULTS The total number of trials analysed was 2710; 170 were paediatric trials (6.3%), 2374 were adult trials (87.6%) and 166 were trials including subjects of all ages (6.1%). Explicit exclusion criteria were found in 958 trials (35.3%). The disability category most frequently excluded was behavioural or psychiatric disorders, present in 588 trials (61.4%). In only 3% and 1% of the trials, the exclusion criteria were considered either 'absolute' or 'questionable', while in 96% the exclusion criteria were judged as 'relative'. Implicit exclusion criteria were present in 1205 trials (44.5%). CONCLUSIONS This study highlights the high rate of exclusion of PWDs from biomedical research and the widespread use of ill-defined exclusion criteria in clinical trials. It underscores the importance of more inclusive study designs so that PWDs can become active participants in research.
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Affiliation(s)
- Guido Camanni
- Rehabilitation Unit, Istituto Serafico, Assisi; Perugia, Italy
| | - Ornella Ciccone
- Rehabilitation Unit, Istituto Serafico, Assisi; Perugia, Italy
| | | | | | - Chiara Bedetti
- Department of Neurology, Città di Castello Hospital, Citta di Castello, Italy
| | - Sandra Cicuttin
- Rehabilitation Unit, Istituto Serafico, Assisi; Perugia, Italy
| | - Nicola Murgia
- Department of Environmental Science and Prevention, University of Ferrara, Ferrara, Italy
| | - Sandro Elisei
- Rehabilitation Unit, Istituto Serafico, Assisi; Perugia, Italy
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Roy E, Chino F, King B, Madu C, Mattes M, Morrell R, Pollard-Larkin J, Siker M, Takita C, Ludwig M. Increasing Diversity of Patients in Radiation Oncology Clinical Trials. Int J Radiat Oncol Biol Phys 2023; 116:103-114. [PMID: 36526234 PMCID: PMC10414211 DOI: 10.1016/j.ijrobp.2022.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/21/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
Radiation oncology clinical trials lack full representation of the ethnic and racial diversity present in the general United States and in the cancer patient population. There are low rates of both recruitment and enrollment of individuals from underrepresented ethnic and racial backgrounds, especially Black and Hispanic patients, people with disabilities, and patients from underrepresented sexual and gender groups. Even if approached for enrollment, barriers such as mistrust in medical research stemming from historical abuse and contemporary biased systems, low socioeconomic status, and lack of awareness prohibit historically marginalized populations from participating in clinical trials. In this review, we reflect on these specific barriers and detail approaches to increase diversity of the patient population in radiation oncology clinical trials to better reflect the communities we serve. We hope that implementation of these approaches will increase the diversity of clinical trials patient populations in not only radiation oncology but also other medical specialties.
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Affiliation(s)
- Emily Roy
- Baylor College of Medicine, Houston, Texas
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin King
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chika Madu
- Department of Radiation Oncology, Staten Island University Hospital, Staten Island, New York
| | - Malcolm Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Rosalyn Morrell
- Advanced Radiation Center of Beverly Hills, Beverly Hills, California
| | | | - Malika Siker
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christiane Takita
- Department of Radiation Oncology, Miami University School of Medicine, Miami, Florida
| | - Michelle Ludwig
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas.
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Bailie J, Fortune N, Plunkett K, Gordon J, Llewellyn G. A call to action for more disability-inclusive health policy and systems research. BMJ Glob Health 2023; 8:bmjgh-2022-011561. [PMID: 36958749 PMCID: PMC10040021 DOI: 10.1136/bmjgh-2022-011561] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/27/2023] [Indexed: 03/25/2023] Open
Abstract
To date, the exclusion of people with disability participating in research has limited the evidence base informing health system strengthening policy and practice more generally, and addressing disability-related inequalities in access to health services and better health outcomes more particularly. Given that more than 1 billion people, or 16% of the world's population, have a disability, we may fail to respond to the needs of a large proportion of the population unless we are purposeful with inclusion. Our research in this area indicates that online qualitative methods can be effective in engaging under-represented groups and are essential to ensure their input into health policy and systems research. This has important implications for researchers whose responsibility it is to make all health research disability inclusive, for ethical and methodological reasons, so they do not perpetuate the under-representation of people with disability in health policy and systems research. Our paper puts forward several recommendations to facilitate more people with disability participating in health policy and systems research. By critically reflecting on a health system strengthening research project, in which we purposefully aimed to support the participation of people with disability, we identify lessons learnt and issues to consider when planning and conducting accessible research. We also propose a set of actions for moving the agenda forward.
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Affiliation(s)
- Jodie Bailie
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Nicola Fortune
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
- Centre of Research Excellence in Disability and Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karleen Plunkett
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Julie Gordon
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
- Centre of Research Excellence in Disability and Health, The University of Melbourne, Melbourne, Victoria, Australia
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Blakely ML. Call to Integrate Content Related to Disabilities Into Contemporary Pharmacy Curricula. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:ajpe8876. [PMID: 34785502 PMCID: PMC10159375 DOI: 10.5688/ajpe8876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/08/2021] [Indexed: 05/06/2023]
Abstract
The curricula of US schools and colleges of pharmacy provide students with only a cursory introduction to patients with disabilities, and this is usually achieved through didactic content. These brief introductions are considered helpful; however, pedagogical approaches do not provide comprehensive content for mastery of skills and strategies for delivering accessible healthcare services to patients with disabilities. Student pharmacists' need to obtain the requisite education, knowledge, and skills to provide effective healthcare to patients with disabilities. Accordingly, it is essential that schools and colleges of pharmacy prepare student pharmacists to be competent and confident in providing effective and accessible care to this underserved patient population.
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Affiliation(s)
- Michelle L Blakely
- University of Wyoming, School of Pharmacy, Laramie, Wyoming
- Editorial Board Member, American Journal of Pharmaceutical Education, Arlington, Virginia
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DeCormier Plosky W, Ne’eman A, Silverman BC, Strauss DH, Francis LP, Stein MA, Bierer BE. Excluding People With Disabilities From Clinical Research: Eligibility Criteria Lack Clarity And Justification. Health Aff (Millwood) 2022; 41:1423-1432. [DOI: 10.1377/hlthaff.2022.00520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Ari Ne’eman
- Ari Ne’eman, Harvard University, Cambridge, Massachusetts
| | | | | | | | | | - Barbara E. Bierer
- Barbara E. Bierer , Brigham and Women’s Hospital and Harvard University
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Mintz KT, Gammer B, Khan AJ, Shaub G, Levine S, Sisti D. Physical Disability and Psychedelic Therapies: An Agenda for Inclusive Research and Practice. Front Psychiatry 2022; 13:914458. [PMID: 35693959 PMCID: PMC9174510 DOI: 10.3389/fpsyt.2022.914458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022] Open
Abstract
Over the past decade, there has been an increase in the number of clinical trials for psychedelic therapies as treatments for a wide range of psychiatric conditions. We are concerned that research organizations overseeing these trials have neglected the inclusion of individuals with physical and sensory disabilities. We suggest that psychedelic research organizations should prioritize and plan for the inclusion of individuals with physical and sensory disabilities to address the mental health burdens they confront. Not doing so risks reinforcing structural ableism in healthcare: the discriminatory manifestation of lowered expectations toward people with disabilities on the part of medical providers. Drawing on scholarship from disability studies and medical ethics, we offer four recommendations for disability inclusion in research. We recognize particular populations shoulder significant mental health burdens; these populations deserve priority and should be given a range of accommodations. We emphasize the need for extensive disability awareness training for those facilitating psychedelic therapies and encourage psychedelic researchers and therapists to exercise cultural humility toward individuals with physical and sensory disabilities. This article should be the impetus for further scholarship and debate about how psychedelic research and therapies can be made accessible to members of disability communities who might benefit.
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Affiliation(s)
- Kevin T Mintz
- Stanford University, Center for Biomedical Ethics, Stanford, CA, United States
| | - Brinn Gammer
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, PA, United States
| | - Amanda J Khan
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.,Sage Integrative Health, Berkeley, CA, United States
| | | | | | - Dominic Sisti
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, PA, United States
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