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DiPeri TP, Manguso N, Gong J, Atkins KM, Hendifar AE, Gangi A. Socioeconomic disparities in patients with small bowel neuroendocrine tumors. J Surg Oncol 2023; 128:1278-1284. [PMID: 37668060 DOI: 10.1002/jso.27437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/22/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Demographic and socioeconomic disparities affect cancer specific outcomes in numerous malignancies, but the impact of these for patients with small bowel neuroendocrine tumors (SBNETs) is not well understood. The primary objective was to investigate the impact of demographic and socioeconomic factors on overall survival (OS) for patients with SBNETs. METHODS We performed a retrospective cohort study utilizing the National Cancer Database to assess patients diagnosed with SBNET between 2004 and 2015. Patients were stratified by demographics, socioeconomic factors, insurance status, and place of living. RESULTS The 5-year OS for the entire cohort was 78.5%. The 5-year survival was worse in patients with lower income (p < 0.0001), lower education (p < 0.0001), not in proximity to a metro area (p = 0.0004), and treatment at a community cancer center (p < 0.0001). Adjusting for age and sex, factors associated with worse OS were lower income (<$38 000) (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.04-1.28), lower education (>20% no HSD) (HR: 1.14, 95% CI: 1.02-1.26), no insurance (HR: 1.66, 95% CI: 1.33-2.06), and not living in proximity to a metro area (HR: 1.27, 95% CI: 1.10-1.47). CONCLUSIONS Patient demographics and socioeconomic factors play an important role in survival of patients with SBNETs, specifically proximity to a metro area, median income, education level, and type of treatment center. Strategies to improve access to care must be considered in this at-risk population.
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Affiliation(s)
- Timothy P DiPeri
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Nicholas Manguso
- Division of Surgical Oncology and Hepatobiliary Surgery, Pennington Cancer Institute, Renown Health, Reno, Nevada, USA
| | - Jun Gong
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Katelyn M Atkins
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Andrew E Hendifar
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Alexandra Gangi
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
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Sandström N, Johansson M, Jekunen A, Andersén H. Socioeconomic status and lifestyle patterns in the most common cancer types-community-based research. BMC Public Health 2023; 23:1722. [PMID: 37670311 PMCID: PMC10478285 DOI: 10.1186/s12889-023-16677-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION As the global burden of chronic cancer increases, its correlation to lifestyle, socioeconomic status (SES) and health equity becomes more important. The aim of the present study was to provide a snapshot of the socioeconomic and lifestyle patterns for different cancer types in patients at a Nordic tertiary cancer clinic. MATERIALS AND METHODS In a descriptive observational study, questionnaires addressed highest-attained educational level, occupational level, economy, relationship status, exposures, and lifestyle habits. The questionnaire was distributed to all cancer patients attending the cancer clinic. Treating physicians added further information about the cancer disease, including primary origin, pathology report, TNM-classification and stage. RESULTS Patients with lung cancer had the lowest SES, and patients with gastrointestinal (GI) cancer, other cancer types and prostate cancer had the second, third and fourth lowest SES, respectively. However, breast cancer patients had the highest SES. Lifestyle and exposure patterns differed among the major cancer types. Lung cancer patients reported the highest proportion of unfavourable lifestyle and exposure patterns, and patients with GI cancer, prostate cancer and other cancer types had the second, third and fourth highest proportion of unfavourable lifestyle and exposure patterns, respectively. The most favourable exposure and lifestyle patterns were observed in breast cancer patients. CONCLUSIONS The present study indicated significant socioeconomic and lifestyle differences among cancer types at a Nordic cancer centre, with differences in lifestyle being more prominent than socioeconomic differences.
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Affiliation(s)
- Niclas Sandström
- Cancer Clinic, Vaasa Central Hospital, Sandviksgatan 2-4, 65130, Vaasa, Finland
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Mikael Johansson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Antti Jekunen
- Cancer Clinic, Vaasa Central Hospital, Sandviksgatan 2-4, 65130, Vaasa, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Heidi Andersén
- Cancer Clinic, Vaasa Central Hospital, Sandviksgatan 2-4, 65130, Vaasa, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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Sharma A, Fierro ME, Pak S, Thallapureddy K, Awobajo M, Hui D, Otchere P. Late-stage diagnosis of carcinoid heart disease due to lack of access to health care. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:28. [PMID: 37277819 DOI: 10.1186/s40959-023-00176-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/12/2023] [Indexed: 06/07/2023]
Abstract
Carcinoid syndrome (CS) is a unique constellation of symptoms caused by release of vasoactive substances from neuroendocrine tumors (Pandit et al., StatPearls, 2022). Neuroendocrine tumors are rare with an annual incidence of 2 in 100,000 people (Ram et al., 46:21-27, 2019). Up to 50% of patients with these tumors will develop carcinoid syndrome, which is characterized by symptoms caused by elevated levels of serotonin and most commonly include fatigue, flushing, wheezing, and non-specific gastrointestinal symptoms such as diarrhea and malabsorption (Pandit et al., StatPearls, 2022) (Fox et.al., 90:1224-1228, 2004). Over time, patients with carcinoid syndrome can develop carcinoid heart disease (CHD). CHD refers to the cardiac complications that occur when the vasoactive substances, such as serotonin, tachykinins, and prostaglandins, secreted from the carcinoid tumors. These complications most commonly include valvular abnormalities, but can also present as coronary artery damage, arrhythmias or direct myocardial injury (Ram et al., 46:21-27, 2019). While CHD is not typically an initial feature of carcinoid syndrome, it does eventually occur in up to 70% of patients with carcinoid tumors (Ram et al., 46:21-27, 2019) (Jin et.al., 146:65-73, 2021) (Macfie et.al., 224:665-669, 2022). CHD is associated with significant morbidity and mortality due to the risk of progressive heart failure (Bober et.al., 14:1179546820968101, 2020). In this case, we describe a 35-year-old Hispanic woman in South Texas with undiagnosed carcinoid syndrome for over 10 years that eventually progressed to severe CHD. In this patient's case, we emphasize how lack of access to healthcare resulted in delay of diagnosis, appropriate treatment, and worsened prognosis in this young patient.
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Affiliation(s)
- Aditi Sharma
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
| | - Maria E Fierro
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
| | - Stella Pak
- Department of Neurology, Albany Medical College, 43 New Scotland Ave, Albany, NY, 12208, 518-262-5521, USA.
| | - Keerthi Thallapureddy
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
| | - Moyosore Awobajo
- Department of Pathology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
| | - Dawn Hui
- Department of Cardio-Thoraic Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
| | - Prince Otchere
- Department of Cardio-Oncology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
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Dureja S, McDonnell M, Van Genechten D, Bouvier C, Kolarova T, O'Toole D, Singh H, Chen J, Howe J, Singh S, Rodien-Louw C, Leyden S, Gellerman E, Herman J, Pavel M. Global challenges in access to diagnostics and treatment for neuroendocrine tumor (NET) patients. J Neuroendocrinol 2023; 35:e13310. [PMID: 37351944 DOI: 10.1111/jne.13310] [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: 03/13/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 06/24/2023]
Abstract
SCAN, an online survey, measured access to diagnosis, treatments and monitoring of neuroendocrine tumor (NET) patients globally. Between September and November 2019, NET patients and healthcare professionals (HCPs) completed an online, semi-standardized survey with 54 patient questions and 33 HCP questions. A total of 2359 patients with NETs and 436 HCPs responded. Misdiagnosis was common (44% [1043/2359]). Mean time to diagnosis was 4.8 years (standard deviation [SD], 6.2). Compared with global figures (60% [1407/2359]), the availability of 68 Ga-DOTA positron emission tomography (PET)/computed tomography (CT) was significantly lower in Asia (45% [126/280]) and higher in Oceania (86% [171/200]). HCPs reported that 68 Ga-DOTA PET/CT was free/affordable to fewer patients in Emerging and Developing Economies (EDE) than Advanced Economies (AE; 17% [26/150] and 59% [84/142], respectively). Compared with global data (52% [1234/2359]), patient-reported availability of peptide receptor radionuclide therapy (PRRT) was significantly lower in Asia (31% [88/280]) and higher in Oceania (61% [122/200]). Significant differences were observed in average annual NET specialist costs between AE and EDE ($1081 and $2915, respectively). Compared with AE, patients in EDE traveled further for NET specialists (1032 [SD, 1578] and 181 [SD, 496] km, respectively). Patients and HCPs both recommended referral to HCPs that were more knowledgeable in the field of NETs and had better access to NET experts/specialist centers. National care pathways, enhancing HCP NET knowledge and ensuring effective diagnostics and access to appropriate treatments are crucial to improving patient survival and NET care worldwide.
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Affiliation(s)
| | | | | | | | | | - Dermot O'Toole
- National Center for Neuroendocrine Tumors, St. Vincent's University and Department of Clinical Medicine, St. James Hospital and Trinity College, Dublin, Ireland
| | - Harjit Singh
- Prince Court Medical Center, Kuala Lumpur, Malaysia
| | - Jie Chen
- The First Affiliated Hospital, Sun Yat-sen University, Guangdong, China
| | - James Howe
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Simron Singh
- Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | | | - Simone Leyden
- NeuroEndocrine Cancer Australia, Blairgowrie, Victoria, Australia
| | | | | | - Marianne Pavel
- Department of Medicine 1, Endocrinology, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Hallet J, Law C, Singh S, Mahar A, Myrehaug S, Zuk V, Zhao H, Chan W, Assal A, Coburn N. Risk of Cancer-Specific Death for Patients Diagnosed With Neuroendocrine Tumors: A Population-Based Analysis. J Natl Compr Canc Netw 2021; 19:935-944. [PMID: 34087785 DOI: 10.6004/jnccn.2020.7666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although patients with neuroendocrine tumors (NETs) are known to have prolonged overall survival, the contribution of cancer-specific and noncancer deaths is undefined. This study examined cancer-specific and noncancer death after NET diagnosis. METHODS We conducted a population-based retrospective cohort study of adult patients with NETs from 2001 through 2015. Using competing risks methods, we estimated the cumulative incidence of cancer-specific and noncancer death and stratified by primary NET site and metastatic status. Subdistribution hazard models examined prognostic factors. RESULTS Among 8,607 included patients, median follow-up was 42 months (interquartile range, 17-82). Risk of cancer-specific death was higher than that of noncancer death, at 27.3% (95% CI, 26.3%-28.4%) and 5.6% (95% CI, 5.1%-6.1%), respectively, at 5 years. Cancer-specific deaths largely exceeded noncancer deaths in synchronous and metachronous metastatic NETs. Patterns varied by primary tumor site, with highest risks of cancer-specific death in bronchopulmonary and pancreatic NETs. For nonmetastatic gastric, small intestine, colonic, and rectal NETs, the risk of noncancer death exceeded that of cancer-specific deaths. Advancing age, higher material deprivation, and metastases were independently associated with higher hazards, and female sex and high comorbidity burden with lower hazards of cancer-specific death. CONCLUSIONS Among all NETs, the risk of dying of cancer was higher than that of dying of other causes. Heterogeneity exists by primary NET site. Some patients with nonmetastatic NETs are more likely to die of noncancer causes than of cancer causes. This information is important for counseling, decision-making, and design of future trials. Cancer-specific mortality should be included in outcomes when assessing treatment strategies.
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Affiliation(s)
- Julie Hallet
- Faculty of Medicine, University of Toronto, Toronto, Ontario.,Susan Leslie Clinic for Neuroendocrine Tumors-Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario.,ICES, Toronto, Ontario.,Cancer Program-Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario; and
| | - Calvin Law
- Faculty of Medicine, University of Toronto, Toronto, Ontario.,Susan Leslie Clinic for Neuroendocrine Tumors-Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario.,Cancer Program-Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario; and
| | - Simron Singh
- Faculty of Medicine, University of Toronto, Toronto, Ontario.,Susan Leslie Clinic for Neuroendocrine Tumors-Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario.,ICES, Toronto, Ontario.,Cancer Program-Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario; and
| | - Alyson Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sten Myrehaug
- Faculty of Medicine, University of Toronto, Toronto, Ontario.,Susan Leslie Clinic for Neuroendocrine Tumors-Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario.,Cancer Program-Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario; and
| | - Victoria Zuk
- Cancer Program-Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario; and
| | | | | | - Angela Assal
- Faculty of Medicine, University of Toronto, Toronto, Ontario.,Susan Leslie Clinic for Neuroendocrine Tumors-Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Natalie Coburn
- Faculty of Medicine, University of Toronto, Toronto, Ontario.,Susan Leslie Clinic for Neuroendocrine Tumors-Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario.,ICES, Toronto, Ontario.,Cancer Program-Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario; and
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A Comparison of Liver-Directed Therapy and Systemic Therapy for the Treatment of Liver Metastases in Patients with Gastrointestinal Neuroendocrine Tumors: Analysis of the California Cancer Registry. J Vasc Interv Radiol 2021; 32:393-402. [PMID: 33358144 DOI: 10.1016/j.jvir.2020.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To compare the outcomes of patients with gastrointestinal neuroendocrine tumor liver metastases treated with liver-directed therapy (LDT) to those treated with systemic therapy (ST) in a statewide cancer database. MATERIALS AND METHODS A retrospective study was performed of patients with metastatic gastrointestinal tract neuroendocrine tumors treated with either LDT or ST alone between the years 2000-2012 in the California Cancer Registry. Overall survival and disease-specific survival were assessed using multivariable Cox proportional hazards analysis and propensity score matching. RESULTS A total of 154 patients (ST, n = 87 and LDT, n = 67) were studied. The median overall survival and disease-specific survival for patients that received ST was 29 and 35 months versus 51 and >60 months for patients that received LDT. On multivariate analysis, LDT and the resection of the primary tumor were associated with improved survival (hazard ratio [HR] 0.52, P = .002; HR 0.43, P = .001). Non-white race, Medicaid/uninsured status, and the presence of lung metastases were associated with poor survival (HR 1.76, P = .014; HR 2.29, P = .009; and HR 1.79, P = .031). Propensity score matching demonstrated an improvement in disease-specific survival for LDT compared to ST (HR 0.53, P = .036). The improvement in overall survival on propensity score matching did not achieve statistical significance (HR 0.70, P = .199). CONCLUSIONS LDT is associated with improved overall and disease-specific survival as compared to ST in patients with gastrointestinal neuroendocrine tumor liver metastases. Further investigation is needed to determine whether combination or sequential treatment can improve outcomes in this population.
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Woodhouse B, Pattison S, Segelov E, Singh S, Parker K, Kong G, Macdonald W, Wyld D, Meyer-Rochow G, Pavlakis N, Conroy S, Gordon V, Koea J, Kramer N, Michael M, Wakelin K, Asif T, Lo D, Price T, Lawrence B. Consensus-Derived Quality Performance Indicators for Neuroendocrine Tumour Care. J Clin Med 2019; 8:jcm8091455. [PMID: 31547431 PMCID: PMC6780732 DOI: 10.3390/jcm8091455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/05/2019] [Accepted: 09/07/2019] [Indexed: 12/16/2022] Open
Abstract
Quality performance indicators (QPIs) are used to monitor the delivery of cancer care. Neuroendocrine tumours (NETs) are a family of individually uncommon cancers that derive from neuroendocrine cells or their precursors, and can occur in most organs. There are currently no QPIs available for NETs and their heterogeneity makes QPI development difficult. CommNETs is a collaboration between NET clinicians, researchers and advocates in Canada, Australia and New Zealand. We created QPIs for NETs using a three-step consensus process. First, a multidisciplinary team used the nominal group technique to create candidates (n = 133) which were then curated into appropriateness statements (62 statements, 44 sub-statements). A two-stage modified RAND/UCLA Delphi consensus process was conducted: an online survey rated the statement appropriateness then the top-ranked statements (n = 20) were assessed in a face-to-face meeting. Finally, 10 QPIs met consensus criteria; documentation of primary site, proliferative index, differentiation, tumour board review, use of a structured pathology report, presence of distant metastasis, 5- and 10-year disease-free and overall survival. These NET QPIs will be trialed as a method to monitor and improve care for people with NETs and to facilitate international comparison.
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Affiliation(s)
- Braden Woodhouse
- Discipline of Oncology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland 1023, New Zealand.
| | - Sharon Pattison
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand.
| | - Eva Segelov
- Department of Medical Oncology, Monash University and Monash Health, Melbourne 3800, Australia.
| | - Simron Singh
- Department of Medical Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Kate Parker
- Discipline of Oncology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland 1023, New Zealand.
| | - Grace Kong
- Department of Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.
| | - William Macdonald
- Department of Nuclear Medicine, Fiona Stanley Hospital, Perth 6150, Australia.
| | - David Wyld
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane 4029, Australia.
- School of Medicine, University of Queensland, Brisbane 4072, Australia.
| | - Goswin Meyer-Rochow
- Department of General Surgery, Waikato Hospital, Hamilton 3204, New Zealand.
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney 2065, Australia.
| | | | - Vallerie Gordon
- Department of Medical Oncology, Cancer Care Manitoba, Winnipeg, MB R3E 0V9, Canada.
| | - Jonathan Koea
- Department of General Surgery, North Shore Hospital, Auckland 0620, New Zealand.
| | - Nicole Kramer
- Department of Pathology, North Shore Hospital, Auckland 0620, New Zealand.
| | - Michael Michael
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne 3000, Australia.
| | | | - Tehmina Asif
- Department of Medical Oncology, Saskatchewan Cancer Agency, Saskatoon, SK S4W 0G3, Canada.
| | - Dorothy Lo
- Department of Medical Oncology, St Joseph's Health Care, Toronto, ON M6R 1B5, Canada.
| | - Timothy Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide 5011, Australia.
| | - Ben Lawrence
- Discipline of Oncology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland 1023, New Zealand.
- Department of Medical Oncology, Auckland City Hospital, Auckland 1023, New Zealand.
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