Disparities in Cancer Stage Outcomes by Catchment Areas for a Comprehensive Cancer Center

Importance

The National Cancer Institute comprehensive cancer centers (CCCs) lack spatial and temporal evaluation of their self-designated catchment areas.

Objective

To identify disparities in cancer stage at diagnosis within and outside a CCC's catchment area across a 10-year period using spatial and statistical analyses.

Design, Setting, and Participants

This cross-sectional, population-based study conducted between 2010 and 2019 utilized cancer registry data for the Johns Hopkins Sidney Kimmel CCC (SKCCC). Eligible participants included patients with cancer in the contiguous US who received treatment for cancer, a diagnosis of cancer, or both at SKCCC. Patients were geocoded to zip code tabulation areas (ZCTAs). Individual-level variables included sociodemographic characteristics, smoking and alcohol use, treatment type, cancer site, and insurance type. Data analysis was performed between March and July 2023.

Exposures

Distance between SKCCC and ZCTAs were computed to generate a catchment area of the closest 75% of patients and outer zones in 5% increments for comparison.

Main Outcomes and Measures

The primary outcome was cancer stage at diagnosis, defined as early-stage, late-stage, or unknown stage. Multinomial logistic regression was used to determine associations of catchment area with stage at diagnosis.

Results

This study had a total of 94 007 participants (46 009 male [48.94%] and 47 998 female [51.06%]; 30 195 aged 22-45 years [32.12%]; 4209 Asian [4.48%]; 2408 Hispanic [2.56%]; 16 004 non-Hispanic Black [17.02%]; 69 052 non-Hispanic White [73.45%]; and 2334 with other or unknown race or ethnicity [2.48%]), including 47 245 patients (50.26%) who received a diagnosis of early-stage cancer, 19 491 (20.73%) who received a diagnosis of late-stage cancer , and 27 271 (29.01%) with unknown stage. Living outside the main catchment area was associated with higher odds of late-stage cancers for those who received only a diagnosis (odds ratio [OR], 1.50; 95% CI, 1.10-2.05) or only treatment (OR, 1.44; 95% CI, 1.28-1.61) at SKCCC. Non-Hispanic Black patients (OR, 1.16; 95% CI, 1.10-1.23) and those with Medicaid (OR, 1.65; 95% CI, 1.46-1.86) and no insurance at time of treatment (OR, 2.12; 95% CI, 1.79-2.51) also had higher odds of receiving a late-stage cancer diagnosis.

Conclusions and Relevance

In this cross-sectional study of CCC data from 2010 to 2019, patients residing outside the main catchment area, non-Hispanic Black patients, and patients with Medicaid or no insurance had higher odds of late-stage diagnoses. These findings suggest that disadvantaged populations and those living outside of the main catchment area of a CCC may face barriers to screening and treatment. Care-sharing agreements among CCCs could address these issues.

Monitoring laboratory-scale bioventing using synchronous scan fluorescence spectroscopy: analysis of the vapor phase

Bioventing is an improved method of soil remediation that is being used with increasing frequency. In this paper, we refine techniques to measure the progress of petroleum hydrocarbon decomposition by monitoring vapor phase composition with synchronous scan fluorescence spectroscopy (SSFS). Analysis of the vapor phase has advantages compared to standard extraction techniques that require extensive sample handling and clean up. For comparison, hydrocarbon contamination in the soil was measured by analysis of Soxhlet extractions with gas chromatography-mass spectrometry (GC-MS). Comparison of the GC-MS and SSFS data showed that changes in hydrocarbon composition measured in the vapor phase provide an accurate measure of decomposition reactions taking place in the soil.

A university's response to a need for school nurse education

This study examined the need for program development that allows school nurses the opportunity to receive advanced practice education while continuing to work in their school settings. Findings suggest that school nurses can advocate for greater access to undergraduate, graduate, and practitioner programs by influencing academic institutions to provide appropriate professional education to their members.

Postpartum ovarian vein thrombophlebitis: etiology, diagnosis, treatment, and nursing implications

This article presents a review of the literature on postpartum ovarian vein thrombophlebitis with special emphasis of nursing implications. The technology of real time ultrasound, duplex Doppler ultrasound, computerized axial tomography, and magnetic resonance imaging now offer reliable methods for confirming a suspected diagnosis of postpartum ovarian vein thrombophlebitis. However, it may well be nurses in clinical settings who assess the often vague signs and be the first to alert the physician. Nurses have an important role in the prevention of postpartum ovarian vein thrombophlebitis. Prevention may be successful by teaching women holistic prenatal care including how to avoid infections during pregnancy and postpartum, and by practicing meticulous technique during pregnancy, labor and delivery, and postpartum.

High-altitude pulmonary edema among visitors to Summit County, Colorado

Twenty-nine cases of high-altitude pulmonary edema (HAPE) affecting visitors to Summit County, Colorado, were analyzed. The mean age of the group was 37.8 years, and all the patients were male. These results differ from previous studies and suggest that there are two varieties of HAPE. The first type (type 1, or nonresident-ascent HAPE) affects visitors to altitudes above 8,000 ft (2,439 m). At altitudes up to 11,000 ft (3,354 m), it is a disease that affects primarily adult men. The second variety (type 2, or resident-reascent HAPE) affects residents of high altitudes when they descend to an elevation below 8,000 ft (2,430 m) and then return to high altitude. This type of HAPE affects male and female residents almost equally and is a disease of childhood and adolescence.

Smoking cessation in patients with cardiopulmonary disease: an initial study

Thirty-five smokers, all with current, long-standing, cardiovascular or pulmonary disease, were randomly assigned to either health motivation treatment, or to aversive smoking. The former included self-management skills, a film model, verbal commitment, and discussion of the costs and benefits of smoking and abstinence. The latter included normally paced (every 30 sec.) aversive smoking, relaxation training, role playing high risk situations, and discussion of maladaptive thought patterns. Strong differences between the conditions in abstinence rate and reduction from baseline did not emerge; however, the data generally favored the health motivation condition both in attrition rates and in outcome immediately posttreatment and at six month follow-up. Negative mood states were found to be related to minimal reduction in smoking; and consistent mood dysphoria at pre and posttreatment predicted relapse at three month follow-up.

Puff volume increases when low-nicotine cigarettes are smoked

Variables of smoking were measured when subjects smoked the first cigarette of the day after an eight- to 10-hour period of abstinence. The cigarettes smoked had high, medium, or low nicotine yields but the tar and carbon monoxide yields, taste, and draw characteristics remained constant. The number of puffs and interval between puffs did not differ between nicotine doses. The smokers took larger puffs, however, when smoking cigarettes delivering lower nicotine yields than their normal brands. This change in the size of puff must be attributed to the change in nicotine yield since all other characteristics of the cigarettes remained constant. Thus encouraging the smoking of low-nicotine cigarettes may increase exposure to combustion products and not appreciably decrease exposure to nicotine, since the smokers increased the size of their puffs in response to the decreased nicotine yield.

Evidence that cannabidiol does not significantly alter the pharmacokinetics of tetrahydrocannabinol in man

The pharmacokinetics of delta 9-tetrahydrocannabinol (THC) administered intravenously was evaluated in four subjects after oral administration of placebo and 1500 mg of cannabidiol (CBD) according to a crossover design. The cannabidiol pretreatment had no apparent effect on THC pharmacokinetics, yet there may have been minimal effect on the formation and excretion of metabolites. The total (metabolic) blood clearance of THC averaged 17.4 ml/min/kg without CBD and 20.9 ml/min/kg with CBD, and was probably hepatic blood flow limited. The apparent steady-state volume of distribution averaged 9.86 (with CBD, 10.54) liters/kg. Irrespective of CBD pretreatment, the renal clearance of THC metabolites ranged from 17 ml/min after approximately 1 hr to 1.13 ml/min 3.5 days after dosing with THC. The apparent terminal halflife for metabolites averaged 8.2 days.

Metabolic and psychophysiologic studies of cannabidiol-hexobarbital interaction

Cannabidiol (CBD), 600 mg/day orally for 5 to 12 days, inhibited hexobarbital metabolism in ten subjects. Hexobarbital oral clearance was 36% lower and apparent volume of distribution was 35% smaller, with no change in half-life during CBD. In four subjects who received intravenous and oral hexobarbital, systemic clearance was 36% lower while bioavailability was 10% greater during CBD. Hexobarbital increased fatigue and tremor, impaired eye-tracking performance, and altered the electroencephalogram. Hexobarbital effects were not affected by CBD. Inhibition of metabolism of other drugs should be considered when large amounts of CBD are taken or when CBD is used for therapy.

Cardiovascular effects of intravenous delta-9-tetrahydrocannabinol: autonomic nervous mechanisms

The contribution of autonomic nervous system activity to the cardiovascular effects of delta-9-tetrahydrocannabinol (THC) was evaluated in 4 normal subjects. The peak heart rate rise after THC was attenuated by atropine and by propranolol, and nearly abolished by atropine-propranolol pretreatment. Blocking drugs also attenuated THC-induced changes in forearm blood flow and vascular resistance but did not affect changes in fingertip temperature. The data suggest that THC acts to induce sympathetic stimulation and parasympathetic inhibition of cardiovascular control pathways. Cardiovascular responses in an additional subject who developed hypertension after either intravenous or smoked marijuana are described.

The therapeutic community as a research ward: myths and facts

The clinical research ward run as a therapeutic community has been criticized as inefficient and scientifically unsound. This article discusses the therapeutic community as a research ward and identifies certain misconceptions which underlie many criticisms. The following myths are discussed and refuted: (1) There is an insurmountable community-research chasm. (2) The therapeutic community induces stress that interferes with research. (3) Patient passivity is engendered by research and this is destructive to the therapeutic community. (4) Symptoms are exacerbated by a research ward that is disruptive to the community. (5) Normal research subjects cannot live in a therapeutic community without pathologic psychic changes. These inaccurate myths are seen as a reflection of attempts to oversimplify very complex clinical and research issues. The use of mythology to simplify experiments, to artificially "clarify" complex issues, or to "protect" patients is seen as a disservice. The therapeutic community and research are syntonic when both receive appropriate support.