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Beatrici E, Paciotti M, Nguyen DD, Filipas DK, Qian Z, Lughezzani G, Daniels D, Lipsitz SR, Kibel AS, Cole AP, Trinh QD. Estimating the impact of enhanced care at minority-serving hospitals on disparities in the treatment of breast, prostate, lung, and colon cancers. Cancer 2024. [PMID: 38798127 DOI: 10.1002/cncr.35328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The objective of this study was to quantify disparities in cancer treatment delivery between minority-serving hospitals (MSHs) and non-MSHs for breast, prostate, nonsmall cell lung, and colon cancers from 2010 to 2019 and to estimate the impact of improving care at MSHs on national disparities. METHODS Data from the National Cancer Database (2010-2019) identified patients who were eligible for definitive treatments for the specified cancers. Hospitals in the top decile by minority patient proportion were classified as MSHs. Multivariable logistic regression adjusted for patient and hospital characteristics compared the odds of receiving definitive treatment at MSHs versus non-MSHs. A simulation was used to estimate the increase in patients receiving definitive treatment if MSH care matched the levels of non-MSH care. RESULTS Of 2,927,191 patients from 1330 hospitals, 9.3% were treated at MSHs. MSHs had significant lower odds of delivering definitive therapy across all cancer types (adjusted odds ratio: breast cancer, 0.83; prostate cancer, 0.69; nonsmall cell lung cancer, 0.73; colon cancer, 0.81). No site of care-race interaction was significant for any of the cancers (p > .05). Equalizing treatment rates at MSHs could result in 5719 additional patients receiving definitive treatment over 10 years. CONCLUSIONS The current findings underscore systemic disparities in definitive cancer treatment delivery between MSHs and non-MSHs for breast, prostate, nonsmall cell lung, and colon cancers. Although targeted improvements at MSHs represent a critical step toward equity, this study highlights the need for integrated, system-wide efforts to address the multifaceted nature of racial and ethnic health disparities. Enhancing care at MSHs could serve as a pivotal strategy in a broader initiative to achieve health care equity for all.
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Affiliation(s)
- Edoardo Beatrici
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marco Paciotti
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - David-Dan Nguyen
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Dejan K Filipas
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zhiyu Qian
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Danesha Daniels
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Stuart R Lipsitz
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam S Kibel
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Abrahão R, Brunson A, Chubak J, Wernli KJ, Nichols HB, Chao C, Ruddy KJ, Hahn EE, Li Q, Malogolowkin MH, Sauder CAM, Kushi LH, Wun T, Keegan THM. Late venous thromboembolism in survivors of adolescent and young adult cancer: A population-based study in California. Thromb Res 2024; 235:1-7. [PMID: 38244373 PMCID: PMC10989999 DOI: 10.1016/j.thromres.2024.01.002] [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: 09/19/2023] [Revised: 12/24/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Venous thromboembolism (VTE), a common complication in cancer patients, occurs more often during the initial phase of treatment. However, information on VTE beyond the first two years after diagnosis ('late VTE') is scarce, particularly in young survivors. METHODS We examined the risk of, and factors associated with, late VTE among adolescents and young adults (AYA, 15-39 years) diagnosed with cancer (2006-2018) who survived ≥2 years. Data were obtained from the California Cancer Registry linked to hospitalization, emergency department and ambulatory surgery data. We used non-parametric models and Cox proportional hazard regression for analyses. RESULTS Among 59,343 survivors, the 10-year cumulative incidence of VTE was 1.93 % (CI 1.80-2.07). The hazard of VTE was higher among those who had active cancer, including progression from lower stages to metastatic disease (Hazard Ratio (HR) = 10.41, 95 % confidence interval (CI): 8.86-12.22), second primary cancer (HR = 2.58, CI:2.01-3.31), or metastatic disease at diagnosis (HR = 2.38, CI:1.84-3.09). The hazard of late VTE was increased among survivors who underwent hematopoietic cell transplantation, those who received radiotherapy, had a VTE history, public insurance (vs private) or non-Hispanic Black/African American race/ethnicity (vs non-Hispanic White). Patients with leukemias, lymphomas, sarcoma, melanoma, colorectal, breast, and cervical cancers had a higher VTE risk than those with thyroid cancer. CONCLUSIONS VTE risk remained elevated ≥2 years following cancer diagnosis in AYA survivors. Active cancer is a significant risk factor for VTE. Future studies might determine if late VTE should prompt evaluation for recurrence or second malignancy, if not already known.
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Affiliation(s)
- Renata Abrahão
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America.
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
| | - Hazel B Nichols
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Chun Chao
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Erin E Hahn
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Marcio H Malogolowkin
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California Davis School of Medicine, Sacramento, CA, United States of America
| | - Candice A M Sauder
- Division of Surgical Oncology, Department of Surgery, University of California Davis, Sacramento, CA, United States of America; University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
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Ritter AR, Yildiz VO, Koirala N, Baliga S, Gogineni E, Konieczkowski DJ, Grecula J, Blakaj DM, Jhawar SR, VanKoevering KK, Mitchell D. Factors Associated with Total Laryngectomy Utilization in Patients with cT4a Laryngeal Cancer. Cancers (Basel) 2023; 15:5447. [PMID: 38001708 PMCID: PMC10670908 DOI: 10.3390/cancers15225447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Despite recommendations for upfront total laryngectomy (TL), many patients with cT4a laryngeal cancer (LC) instead undergo definitive chemoradiation, which is associated with inferior survival. Sociodemographic and oncologic characteristics associated with TL utilization in this population are understudied. METHODS This retrospective cohort study utilized hospital registry data from the National Cancer Database to analyze patients diagnosed with cT4a LC from 2004 to 2017. Patients were stratified by receipt of TL, and patient and facility characteristics were compared between the two groups. Logistic regression analyses and Cox proportional hazards methodology were performed to determine variables associated with receipt of TL and with overall survival (OS), respectively. OS was estimated using the Kaplan-Meier method and compared between treatment groups using log-rank testing. TL usage over time was assessed. RESULTS There were 11,149 patients identified. TL utilization increased from 36% in 2004 to 55% in 2017. Treatment at an academic/research program (OR 3.06) or integrated network cancer program (OR 1.50), male sex (OR 1.19), and Medicaid insurance (OR 1.31) were associated with increased likelihood of undergoing TL on multivariate analysis (MVA), whereas age > 61 (OR 0.81), Charlson-Deyo comorbidity score ≥ 3 (OR 0.74), and clinically positive regional nodes (OR 0.78 [cN1], OR 0.67 [cN2], OR 0.21 [cN3]) were associated with decreased likelihood. Those undergoing TL with post-operative radiotherapy (+/- chemotherapy) had better survival than those receiving chemoradiation (median OS 121 vs. 97 months; p = 0.003), and TL + PORT was associated with lower risk of death compared to chemoradiation on MVA (HR 0.72; p = 0.024). CONCLUSIONS Usage of TL for cT4a LC is increasing over time but remains below 60%. Patients seeking care at academic/research centers are significantly more likely to undergo TL, highlighting the importance of decreasing barriers to accessing these centers. Increased focus should be placed on understanding and addressing the additional patient-, physician-, and system-level factors that lead to decreased utilization of surgery.
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Affiliation(s)
- Alex R. Ritter
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Vedat O. Yildiz
- Department of Biomedical Informatics, Center for Biostatistics, Ohio State University, 1800 Cannon Dr., Columbus, OH 43210, USA
| | - Nischal Koirala
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Sujith Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - David J. Konieczkowski
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - John Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Dukagjin M. Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Sachin R. Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Kyle K. VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Darrion Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
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Frego N, D'Andrea V, Labban M, Trinh QD. An ecological framework for racial and ethnic disparities in surgery. Curr Probl Surg 2023; 60:101335. [PMID: 37316107 DOI: 10.1016/j.cpsurg.2023.101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Nicola Frego
- Department of Urology, Istituto Clinico Humanitas IRCCS, Milan, Italy
| | - Vincent D'Andrea
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, MA
| | - Muhieddine Labban
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, MA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, MA; Brigham and Women's Faulkner Hospital, Jamaica Plain, MA.
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Access to definitive treatment and survival for intermediate-risk and high-risk prostate cancer at hospital systems serving health disparity populations. Urol Oncol 2023; 41:252.e9-252.e17. [PMID: 36759298 DOI: 10.1016/j.urolonc.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/14/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Although socioeconomic and racial disparities in prostate cancer (CaP) have been attributed to patient-level and physician-level factors, there is growing interest in investigating the role of the facility of care in driving cancer disparities. We sought to examine the receipt of guideline-concordant definitive treatment, time to treatment initiation (TTI), and overall survival (OS) for men with CaP receiving care at hospital systems serving health disparity populations (HSDPs). METHODS We retrospective analyzed the National Cancer Database (2004-2016). We identified men with intermediate-risk or high-risk CaP eligible for definitive treatment. The primary outcomes were receipt of definitive treatment and TTI within 90 days of diagnosis. The secondary outcome was OS. We defined HSDPs as minority-serving hospitals-facilities in the highest decile of proportion of non-Hispanic Black (NHB) or Hispanic cancer patients-and/or high-burden safety-net hospitals-facilities in the highest quartile of proportion of underinsured patients. We used mixed-effect models with facility-level random intercept to compare outcomes between HSDPs and non-HSDPs among the entire cohort and among men who received definitive treatment. RESULTS We included 968 non-HSDPs (72.2%) and 373 HSDPs (27.8%) facilities. Treatment at HSDPs was associated with lower adjusted odds of receipt of definitive treatment (aOR 0.64; 95% CI 0.57-0.71; P < 0.001), lower odds of TTI within 90 days of diagnosis (aOR 0.74; 95% CI 0.68-0.79; P < 0.001), and worse OS (aHR 1.05; 95% CI 1.02-1.09; P = .003) when accounting for covariates. However, no difference was found in OS if patients received definitive treatment (aHR 1.03; 95% CI 0.99-1.07; P = 0.1). NHB men at HSDPs had worse outcomes than NHB men treated at non-HSDPs as well as NHW men treated at HSDPs. CONCLUSION Patients treated at HSDPs were less likely to receive timely definitive treatment and had worse OS, independent of their race. NHB men have worse outcomes than NHW at HSDPs. Thus, NHB men with CaP are doubly disadvantaged since they are more likely to be treated at hospitals with worse outcomes and have worse outcomes than other patients at those same institutions.
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Nguyen DD, Bouhadana D, Murad L, Stoddard M, Zheng X, Mao J, Zorn KC, Elterman DS, Bhojani N, Chughtai B. Effect of Surgeon and Facility Volume on Outcomes of Benign Prostatic Hyperplasia Surgery: Implications of Disparities in Access to Care at High-Volume Centers. Urology 2023; 172:97-104. [PMID: 36410527 DOI: 10.1016/j.urology.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report the effect of surgeon and facility volume on outcomes of transurethral resection of the prostate (TURP) and laser treatment of benign prostatic hyperplasia (BPH). We also investigate disparities in access to care by identifying demographic predictors of receipt of treatment at high-volume facilities. METHODS We used New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) data. We included 18,041 (41.4%) and 25,577 (58.6%) adult patients that underwent TURP and laser procedures in the outpatient setting between January 2005 and December 2018, respectively. Average annual surgeon and facility volumes were broken down by tertile. The effect of volume on short-term outcomes (30-day and 90-day readmission) was examined using mixed-effect logistic regression models. Cox-proportional-hazard models were used to assess the association between volume and long-term stricture development and reoperation. Demographic predictors of treatment at high-volume facilities were assessed using multinomial logistic regression. RESULTS High-volume facilities were more likely to offer laser procedures compared to low-volume facilities. Higher facility and surgeon volume were associated with lower odds of 30 and 90-day readmissions compared to low-volume facilities. There was no difference in reoperation and stricture development between surgeon volume groups. Medicaid insurance, Hispanic ethnicity, and Black race were inversely associated with treatment at high-volume facilities. CONCLUSION Higher surgeon and facility volumes were associated with lower odds of readmission. Higher facility volume was associated with lower hazards of reoperation and developing strictures. Medicaid insurance and non-white race were associated with lower odds of treatment at high-volume facilities, highlighting racial and socioeconomic disparities in access to high-volume BPH surgery facilities.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Liam Murad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Michelina Stoddard
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Kevin C Zorn
- Division of Urology, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network (UHN), Toronto, Ontario, Canada
| | - Naeem Bhojani
- Division of Urology, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York-Presbyterian, New York, NY.
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Grosso AA, Di Maida F, Tellini R, Viola L, Lambertini L, Valastro F, Mari A, Masieri L, Carini M, Minervini A. Assessing the impact of socio-economic determinants on access to care, surgical treatment options and outcomes among patients with renal mass: Insight from the universal healthcare system. Eur J Cancer Care (Engl) 2022; 31:e13666. [PMID: 35869594 PMCID: PMC9787702 DOI: 10.1111/ecc.13666] [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: 07/14/2021] [Revised: 04/07/2022] [Accepted: 07/05/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess whether socio-economic disparities exist on access to care, treatment options and outcomes among patients with renal mass amenable of surgical treatment within the universal healthcare system. METHODS Data of consecutive patients submitted to partial nephrectomy (PN) or radical nephrectomy (RN) at our Institution between 2017 and 2020 were retrospectively evaluated. Patients were grouped according to their income level (low, intermediate, and high) based on the Indicator of Equivalent Economic Situation national criterion. Survival analysis was performed. Cox regression models were employed to analyse the impact of socio-economic variables on survival outcomes. RESULTS One thousand forty-two patients were included (841 PN and 201 RN). Patients at the lowest income level were found more likely symptomatic and with a higher pathological tumour stage in the RN cohort (p > 0.05). The guidelines adherence on surgical indication rate as well as the access to minimally invasive surgery did not differ according to patient's income level in both cohorts (p > 0.05). Survival curves were comparable among the groups. Cox regression analysis showed that none of the included socio-economic variables was associated with survival outcomes in our series. CONCLUSIONS Universal healthcare system may increase the possibility to ensure egalitarian treatment modalities for patients with renal cancer.
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Affiliation(s)
- Antonio Andrea Grosso
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Fabrizio Di Maida
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Riccardo Tellini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Lorenzo Viola
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Luca Lambertini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Francesca Valastro
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Andrea Mari
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Lorenzo Masieri
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Marco Carini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Andrea Minervini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
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Synchronous Telemedicine Model in Urogynecology: Are Patients Willing to Continue Telemedicine in the Post-COVID-19 Pandemic Era? UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:679-686. [PMID: 35703276 PMCID: PMC9512138 DOI: 10.1097/spv.0000000000001223] [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] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Following the recent expansion of telemedicine during the COVID-19 pandemic, this remote model of care in female pelvic medicine and reconstructive surgery will likely remain and continue to evolve. OBJECTIVE This study was conducted to assess patients' perceptions of and willingness to participate in a synchronous telemedicine visit beyond the COVID-19 pandemic for women with pelvic floor disorders. STUDY DESIGN We conducted a cross-sectional study of women who completed a synchronous telemedicine visit from March 16 through May 22, 2020, at a urogynecology practice in an academic medical center. An electronic survey was distributed to women after all telemedicine visits. Demographic data, visit type, and survey responses were analyzed. RESULTS Two hundred two women received the survey, and 135 women completed it (response rate of 66.8%). The mean age of the respondents was 62.9 ± 16.4 years, and the 3 most common visit diagnoses were overactive bladder (43.7%), stress urinary incontinence (22.2%), and pelvic organ prolapse (21.4%). Most survey participants (88.9%) found that the quality of their telemedicine visits was better than expected, and 89.6% reported that they would like to continue telemedicine care. Our survey showed that 19.4% of women reported difficulty with technology. CONCLUSIONS We found that most women presenting for synchronous telemedicine urogynecology care had a positive visit experience and would continue to use telemedicine for their care. Further developmental work needs to be done on improving the ease of technology as well as availability of telemedicine in the care of women affected by pelvic floor disorders.
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Palmer NR, Smith AN, Campbell BA, Andemeskel G, Tahir P, Felder TM, Cicerelli B. Navigation programs relevant for African American men with prostate cancer: a scoping review protocol. Syst Rev 2022; 11:122. [PMID: 35701771 PMCID: PMC9195379 DOI: 10.1186/s13643-022-01993-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The excess incidence and mortality due to prostate cancer that impacts African American men constitutes the largest of all cancer disparities. Patient navigation is a patient-centered healthcare system intervention to eliminate barriers to timely, high-quality care across the cancer continuum and improves health outcomes among vulnerable patients. However, little is known regarding the extent to which navigation programs include cultural humility to address prostate cancer disparities among African American men. We present a scoping review protocol of an in-depth examination of navigation programs in prostate cancer care-including navigation activities/procedures, training, and management-with a special focus on cultural context and humility for African American men to achieve health equity. METHODS We will conduct comprehensive searches of the literature in PubMed, Embase, Web of Science, and CINAHL Complete, using keywords and index terms (Mesh and Emtree) within the three main themes: prostate cancer, patient navigation, and African American men. We will also conduct a search of the gray literature, hand-searching, and reviewing references of included papers and conference abstracts. In a two-phase approach, two authors will independently screen titles and abstracts, and full-text based on inclusion/exclusion criteria. All study designs will be included that present detailed data about the elements of navigation programs, including intervention content, navigator training, and/or management. Data will be extracted from included studies, and review findings will be synthesized and summarized. DISCUSSION A scoping review focused on cultural humility in patient navigation within the context of eliminating disparities in PCa care among African American men does not yet exist. This review will synthesize existing evidence of patient navigation programs for African American prostate cancer patients and the inclusion of cultural humility. Results will inform the development and implementation of future programs to meet the unique needs of vulnerable prostate cancer patients in safety net settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2021 CRD42021221412.
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Affiliation(s)
- Nynikka R Palmer
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, UCSF mailbox 1364, San Francisco, CA, 94143, USA.
| | - Ashley Nicole Smith
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, UCSF mailbox 1364, San Francisco, CA, 94143, USA
| | - Brittany A Campbell
- University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94143, USA
| | | | - Peggy Tahir
- UCSF Library, University of California San Francisco, 530 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Tisha M Felder
- College of Nursing, University of South Carolina, 1601 Greene Street, Room 620, Columbia, SC, 29208, USA
| | - Barbara Cicerelli
- Zuckerberg San Francisco General Hospital, 995 Potrero Ave, Building 80, Room 8000N Lower Level, San Francisco, CA, 94110, USA
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Mabeza RM, Chervu N, Sanaiha Y, Hadaya J, Tran Z, de Virgilio C, Benharash P. Demystifying the outcome disparities in carotid revascularization: Utilization of experienced centers. Surgery 2022; 172:766-771. [DOI: 10.1016/j.surg.2022.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/18/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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11
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Cole AP, Langbein BJ, Giganti F, Fennessy FM, Tempany CM, Emberton M. Is perfect the enemy of good? Weighing the evidence for biparametric MRI in prostate cancer. Br J Radiol 2022; 95:20210840. [PMID: 34826223 PMCID: PMC8978228 DOI: 10.1259/bjr.20210840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The role of multiparametric MRI in diagnosis, staging and treatment planning for prostate cancer is well established. However, there remain several challenges to widespread adoption. One such challenge is the duration and cost of the examination. Abbreviated exams omitting contrast-enhanced sequences may help address this challenge. In this review, we will discuss the rationale for biparametric MRI for detection and characterization of clinically significant prostate cancer prior to biopsy and synthesize the published literature. We will weigh up the advantages and disadvantages to this approach and lay out a conceptual cost/benefit analysis regarding adoption of biparametric MRI.
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Affiliation(s)
| | | | | | | | - Clare M. Tempany
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Wallace BK, Miles CH, Anderson CB. Effects of race and socioeconomic status on treatment for localized renal masses in New York City. Urol Oncol 2021; 40:65.e19-65.e26. [PMID: 34876349 DOI: 10.1016/j.urolonc.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/21/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Partial nephrectomy (PN) is the preferred treatment for localized renal masses (LRM), however its use is not uniform across patient socioeconomic (SES) factors. Our hypothesis is that the effect of increased SES on surgical management of LRMs in New York City (NYC) will not be the same for Black and White patients. PATIENTS AND METHODS Patients were identified from the New York State Cancer Registry (NYSPACED) treated for LRMs with PN or radical nephrectomy from 2004 to 2016. We identified patients' home neighborhoods through Public Use Microdata Areas (PUMA) in NYSCAPED and used a US Census SES index. Logistic regression was used to determine the association of race and SES on receipt of PN, controlling for age, ethnicity, gender, and diagnosis year. RESULTS On unadjusted analyses, patients from higher PUMA SES quartiles were more likely to receive PN (OR = 1.07, P < 0.05), while Black patients were less likely to receive PN as compared to White patients (OR = 0.66, P < 0.001). Multivariable analysis showed a significant interaction between race and SES quartile (interaction P = 0.005) such that the effect of PUMA SES on receipt of PN was modified by race. PN receipt for Black vs. White patients was significantly different within the highest SES quartile (OR = 0.44, P < 0.001), but not within the lowest. CONCLUSION In NYC, patients from higher SES quartile neighborhoods had significantly increased odds for receipt of PN for LRMs. As neighborhood SES quartile increased, White patients were significantly more likely to receive PN, while Black patients were not.
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Affiliation(s)
- Brendan K Wallace
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Caleb H Miles
- Department of Biostatistics, Mailman School of Public Health, Columbia University, NY
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13
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Ufuah S, Tallman JE, Moses KA. The Pursuit of Health Equity and Equality in Urologic Oncology: Where We Have Been and Where We Are Going. Eur Urol Focus 2021; 7:929-936. [PMID: 34556454 DOI: 10.1016/j.euf.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/07/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Advances in urologic oncology have improved early detection, treatment options, and health outcomes; however, racial/ethnic minorities continue to experience disparities in cancer incidence and survival. Research evaluating the optimal methods for closing these disparity gaps is under-reported. OBJECTIVE To highlight critical disparities in equity and equality in urologic oncology and identify ways in which health care professionals can reduce these disparities among disproportionately affected groups through a health equity-focused framework. EVIDENCE ACQUISITION A literature search was performed using EMBASE, MEDLINE, and PubMed. Articles were included if they were published in English from 1980 to 2021 and addressed barriers and health care disparities in urologic cancer care in racial/ethnic minorities. The same search was conducted to look at barriers and disparities according to gender and to lesbian, gay, bisexual, transgender, questioning, intersex, or asexual (LGBTQIA) identity, and among immigrant populations. EVIDENCE SYNTHESIS Racial/ethnic minorities in the USA are less likely to be screened for urologic cancers, are less likely to have an early diagnosis of cancer, and have a higher mortality rate than their white counterparts. In addition, major European and North American clinical trials lack proper representation of diverse populations, leading to a knowledge gap regarding effective methods for addressing cancer health disparities. CONCLUSIONS Continued medical advances have increased the efficacy of screening, diagnosis, and treatment of urologic cancers, but there remain significant well-documented disparities in the receipt of these advances among racial/ethnic minorities, women, LGBTQIA individuals, and immigrant populations. Multidisciplinary efforts are needed to address and ultimately eliminate these gaps. PATIENT SUMMARY We analyzed several studies to understand current disparities in cancer screening, diagnosis, and health outcomes across under-represented populations. We found that under-represented populations have worse outcomes than their white counterparts diagnosed with cancer. We conclude that the best way to address these disparities is through a multidisciplinary approach that involves engagement at the individual, community, research, and institutional levels to provide the best care possible to each individual patient.
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Affiliation(s)
- Samuel Ufuah
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kelvin A Moses
- Vanderbilt University Medical Center, Nashville, TN, USA
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14
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Robotic surgery for cT2 kidney cancer: analysis of the National Cancer Database. J Robot Surg 2021; 16:723-729. [PMID: 34435278 DOI: 10.1007/s11701-021-01300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
Robotic surgery for renal cell carcinoma (RCC) is increasingly adopted for cT1 disease, but its utilization for cT2 disease remains unexplored. We aimed to characterize the trend in robotic approach for cT2 RCC. The National Cancer Database was queried for patients who were diagnosed with cT2N0M0 RCC from 2010 to 2016 and underwent subsequent radical (RN) or partial (PN) nephrectomy. Analysis of treatment trends was performed and logistic regression (LR) undertaken for predictors of surgical approach. 21,258 patients met inclusion criteria for analysis; 1698 (8%) underwent a PN and 19,560 (92%) underwent RN. Use of robotics in PN increased 346% (12.3-42.6%) and 351% (6.2-21.8%) for RN during the studied time period. Robotic PN or RN was associated with shorter hospital stay compared to non-robotic approaches (p < 0.001). Academic institutions were more likely to perform a robotic procedure and the uninsured were less likely to receive robotic approach. There was no association between age, sex, race, or income and surgical approach. On LR, robotic approach was independently associated with academic institutions and a more recent year of diagnosis. There was no significant difference in the rate of positive margins, 30-day readmission, or 30/90-day mortality between approaches. Robotic PN and RN is becoming an increasingly popular approach in the treatment of cT2 RCC. Utilization of robotics is associated with academic institutions and results in a shorter hospital stay without significant differences rate of positive margins, readmission rates, or 30/90-day mortality.
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15
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Nguyen DD, Paciotti M, Marchese M, Cole AP, Cone EB, Kibel AS, Ortega G, Lipsitz SR, Weissman JS, Trinh QD. Effect of Medicaid Expansion on Receipt of Definitive Treatment and Time to Treatment Initiation by Racial and Ethnic Minorities and at Minority-Serving Hospitals: A Patient-Level and Facility-Level Analysis of Breast, Colon, Lung, and Prostate Cancer. JCO Oncol Pract 2021; 17:e654-e665. [PMID: 33974827 DOI: 10.1200/op.21.00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We sought to investigate the association between Medicaid expansion under the Affordable Care Act and access to stage-appropriate definitive treatment for breast, colon, non-small-cell lung, and prostate cancer for underserved racial and ethnic minorities and at minority-serving hospitals (MSHs). METHODS We conducted a retrospective, difference-in-differences study including minority patients with nonmetastatic breast, colon, non-small-cell lung, and prostate cancer and patients treated at MSHs between the age of 40 and 64, with tumors at stages eligible for definitive treatment from the National Cancer Database. We not only defined non-Hispanic Black and Hispanic cancer patients as racial and ethnic minorities but also report findings for non-Hispanic Black cancer patients separately. We examined the effect of Medicaid expansion on receipt of stage-appropriate definitive therapy, time to treatment initiation (TTI) within 30 days of diagnosis, and TTI within 90 days of diagnosis. RESULTS Receipt of definitive treatment for minorities in expansion states did not change compared with minority patients in nonexpansion states. The proportion of racial and ethnic minorities in expansion states receiving treatment within 30 days increased (difference-in-differences: +3.62%; 95% CI, 1.63 to 5.61; P < .001) compared with minority patients in nonexpansion states; there was no change for TTI within 90 days. Analysis focused on Black cancer patients yielded similar results. In analyses stratified by MSH status, there was no change in receipt of definitive therapy, TTI within 30 days, and TTI within 90 days when comparing MSHs in expansion states with MSHs in nonexpansion states. CONCLUSION In our cohort of cancer patients with treatment-eligible disease, we found no significant association between Medicaid expansion and changes in receipt of definitive treatment for breast, prostate, lung, and colon cancer for racial and ethnic minorities and at MSHs. Medicaid expansion was associated with improved TTI at the patient level for racial and ethnic minorities, but not at the facility level for MSHs. Targeted interventions addressing the needs of MSHs are still needed to continue mitigating national facility-level disparities in cancer outcomes.
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Affiliation(s)
- David-Dan Nguyen
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marco Paciotti
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Maya Marchese
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexander P Cole
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Eugene B Cone
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Adam S Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gezzer Ortega
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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16
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Cole AP, Herzog P, Iyer HS, Marchese M, Mahal BA, Lipsitz SR, Nyambose J, Gershman ST, Kennedy M, Merriam G, Rebbeck TR, Trinh QD. Racial differences in the treatment and outcomes for prostate cancer in Massachusetts. Cancer 2021; 127:2714-2723. [PMID: 33999405 DOI: 10.1002/cncr.33564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Massachusetts is a northeastern state with universally mandated health insurance since 2006. Although Black men have generally worse prostate cancer outcomes, emerging data suggest that they may experience equivalent outcomes within a fully insured system. In this setting, the authors analyzed treatments and outcomes of non-Hispanic White and Black men in Massachusetts. METHODS White and Black men who were 20 years old or older and had been diagnosed with localized intermediate- or high-risk nonmetastatic prostate cancer in 2004-2015 were identified in the Massachusetts Cancer Registry. Adjusted logistic regression models were used to assess predictors of definitive therapy. Adjusted and unadjusted survival models compared cancer-specific mortality. Interaction terms were then used to assess whether the effect of race varied between counties. RESULTS A total of 20,856 men were identified. Of these, 19,287 (92.5%) were White. There were significant county-level differences in the odds of receiving definitive therapy and survival. Survival was worse for those with high-risk cancer (adjusted hazard ratio [HR], 1.50; 95% CI, 1.4-1.60) and those with public insurance (adjusted HR for Medicaid, 1.69; 95% CI, 1.38-2.07; adjusted HR for Medicare, 1.2; 95% CI, 1.14-1.35). Black men were less likely to receive definitive therapy (adjusted odds ratio, 0.78; 95% CI, 0.74-0.83) but had a 17% lower cancer-specific mortality (adjusted HR, 0.83; 95% CI, 0.7-0.99). CONCLUSIONS Despite lower odds of definitive treatment, Black men experience decreased cancer-specific mortality in comparison with White men in Massachusetts. These data support the growing body of research showing that Black men may achieve outcomes equivalent to or even better than those of White men within the context of a well-insured population. LAY SUMMARY There is a growing body of evidence showing that the excess risk of death among Black men with prostate cancer may be caused by disparities in access to care, with few or no disparities seen in universally insured health systems such as the Veterans Affairs and US Military Health System. Therefore, the authors sought to assess racial disparities in prostate cancer in Massachusetts, which was the earliest US state to mandate universal insurance coverage (in 2006). Despite lower odds of definitive treatment, Black men with prostate cancer experience reduced cancer-specific mortality in comparison with White men in Massachusetts. These data support the growing body of research showing that Black men may achieve outcomes equivalent to or even better than those of White men within the context of a well-insured population.
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Affiliation(s)
- Alexander P Cole
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter Herzog
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hari S Iyer
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Maya Marchese
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brandon A Mahal
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua Nyambose
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Susan T Gershman
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Mark Kennedy
- Boston Public Health Commission, Boston, Massachusetts
| | - Gail Merriam
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Timothy R Rebbeck
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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17
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Chi D, Chen AD, Bucknor A, Seyidova N, Bletsis P, Chattha A, Egeler S, Del Valle D, Lin SJ. Hospital volume is associated with cost and outcomes variation in 2,942 pelvic reconstructions. J Plast Reconstr Aesthet Surg 2021; 74:2645-2653. [PMID: 33888434 DOI: 10.1016/j.bjps.2021.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 12/14/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Complex pelvic reconstruction is challenging for plastic and reconstructive surgeons following surgical resection of the lower gastrointestinal or genitourinary tract. Complication rates and hospital costs are variable and may be linked to the hospital case volume of pelvic reconstructions performed. A comprehensive examination of these factors has yet to be performed. METHODS Data were retrieved for patients undergoing pedicled flap reconstruction after pelvic resections in the American National Inpatient Sample database between 2010 and 2014. Patients were then separated into three groups based on hospital case volume for pelvic reconstruction. Multivariate logistic regression and gamma regression with log-link function were used to analyze associations between hospital case volume, surgical outcomes, and cost. RESULTS In total, 2,942 patients underwent pelvic flap reconstruction with surgical complications occurring in 1,466 patients (49.8%). Total median cost was $38,469.40. Pelvic reconstructions performed at high-volume hospitals were significantly associated with fewer surgical complications (low: 51.4%, medium: 52.8%, high: 34.8%; p < 0.001) and increased costs (low: $35,645.14, medium: $38,714.92, high: $44,967.29; p < 0.001). After regression adjustment, high hospital volume was the strongest independently associated factor for decreased surgical complications (Exp[β], 0.454; 95% Confidence Interval, 0.346-0.596; p < 0.001) and increased hospital cost (Exp[β], 1.351; 95% Confidence Interval, 1.285-1.421; p < 0.001). CONCLUSIONS Patients undergoing pelvic flap reconstruction after oncologic resections experience high complication rates. High case volume hospitals were independently associated with significantly fewer surgical complications but increased hospital costs. Reconstructive surgeons may approach these challenging patients with greater awareness of these associations to improve outcomes and address cost drivers.
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Affiliation(s)
- David Chi
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, Washington University Medical Center, Saint Louis, MO, USA
| | - Austin D Chen
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alexandra Bucknor
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Patrick Bletsis
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anmol Chattha
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sabine Egeler
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Diana Del Valle
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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18
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Lam MB, Raphael K, Mehtsun WT, Phelan J, Orav EJ, Jha AK, Figueroa JF. Changes in Racial Disparities in Mortality After Cancer Surgery in the US, 2007-2016. JAMA Netw Open 2020; 3:e2027415. [PMID: 33270126 PMCID: PMC7716190 DOI: 10.1001/jamanetworkopen.2020.27415] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Racial disparities are well documented in cancer care. Overall, in the US, Black patients historically have higher rates of mortality after surgery than White patients. However, it is unknown whether racial disparities in mortality after cancer surgery have changed over time. OBJECTIVE To examine whether and how disparities in mortality after cancer surgery have changed over 10 years for Black and White patients overall and for 9 specific cancers. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, national Medicare data were used to examine the 10-year (January 1, 2007, to November 30, 2016) changes in postoperative mortality rates in Black and White patients. Data analysis was performed from August 6 to December 31, 2019. Participants included fee-for-service beneficiaries enrolled in Medicare Part A who had a major surgical resection for 9 common types of cancer surgery: colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung, or prostate cancer. EXPOSURES Cancer surgery among Black and White patients. MAIN OUTCOMES AND MEASURES Risk-adjusted 30-day, all-cause, postoperative mortality overall and for 9 specific types of cancer surgery. RESULTS A total of 870 929 cancer operations were performed during the 10-year study period. In the baseline year, a total of 103 446 patients had cancer operations (96 210 White patients and 7236 Black patients). Black patients were slightly younger (mean [SD] age, 73.0 [6.4] vs 74.5 [6.8] years), and there were fewer Black vs White men (3986 [55.1%] vs 55 527 [57.7%]). Overall national mortality rates following cancer surgery were lower for both Black (-0.12%; 95% CI, -0.17% to -0.06% per year) and White (-0.14%; 95% CI, -0.16% to -0.13% per year) patients. These reductions were predominantly attributable to within-hospital mortality improvements (Black patients: 0.10% annually; 95% CI, -0.15% to -0.05%; P < .001; White patients: 0.13%; 95% CI, -0.14% to -0.11%; P < .001) vs between-hospital mortality improvements. Across the 9 different cancer surgery procedures, there was no significant difference in mortality changes between Black and White patients during the period under study (eg, prostate cancer: 0.35; 95% CI, 0.02-0.68; lung cancer: 0.61; 95% CI, -0.21 to 1.44). CONCLUSIONS AND RELEVANCE These findings offer mixed news for policy makers regarding possible reductions in racial disparities following cancer surgery. Although postoperative cancer surgery mortality rates improved for both Black and White patients, there did not appear to be any narrowing of the mortality gap between Black and White patients overall or across individual cancer surgery procedures.
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Affiliation(s)
- Miranda B. Lam
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Katherine Raphael
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Winta T. Mehtsun
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women’s Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jessica Phelan
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - E. John Orav
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ashish K. Jha
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jose F. Figueroa
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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19
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Hoang CM, Maykel JA, Davids JS, Crawford AS, Sturrock PR, Alavi K. Distribution of Elective Ileal Pouch-Anal Anastomosis Cases for Ulcerative Colitis: a Study Utilizing the University Health System Consortium Database. J Gastrointest Surg 2020; 24:2613-2619. [PMID: 31768826 DOI: 10.1007/s11605-019-04443-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/21/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Trends and distribution of ileal pouch-anal anastomosis (IPAA) procedures for patients with ulcerative colitis (UC) are unknown. We examined the frequency, distribution, and volume-outcome relationship for this relatively infrequent procedure using a large national data source. METHODS Data were obtained from the University HealthSystem Consortium (UHC) for patients with a primary diagnosis of UC admitted electively and who underwent surgical intervention between 2012 and 2015. RESULTS The mean age of the study population (n = 6875) was 43 years and 57% were men. Among these, one-third (n = 2307) underwent an IPAA, while 24% (n = 1160) underwent total abdominal colectomy, 16% (n = 1134) underwent proctectomy, and 2% (n = 108) underwent total proctocolectomy with end ileostomy. The frequency of IPAA cases among all elective surgical cases was relatively stable at 33-35% over the study period. A total of 131 hospitals, out of 279 hospitals participating in the UHC (47%), performed IPAA. UHC contains all inpatient data on more than 140 (> 90%) academic medical centers in the US and their affiliates. Most hospitals (101) performed < 5 cases annually. The median number of IPAA cases performed annually was 1.8 [IQR 0.8 - 4.3]. The top 10 hospitals performed one-half (48%) of IPAA cases, but only 18% of another type of complex pelvic dissection cases such as low anterior resection. Short-term postoperative complications after IPAA, however, were similar regardless of IPAA volume. CONCLUSIONS Nearly one-half of IPAA cases were performed at only 10 hospitals out of the 131 hospitals performing IPAA in the study. IPAA procedures are infrequently performed by most academic medical centers in the US. The redistribution of IPAA procedures, likely a result of previously established referral patterns and centralization, has a potential impact on the training of future colorectal fellows as well as access to care.
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Affiliation(s)
- Chau M Hoang
- Mark Kusek Colorectal Cancer Research Fellowship 2016-2018, Division of Colon and Rectal Surgery, University of Massachusetts Medical School, Worcester, MA, USA. .,General Surgery Residency, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Justin A Maykel
- Division of Colon and Rectal Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jennifer S Davids
- Division of Colon and Rectal Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Allison S Crawford
- Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Paul R Sturrock
- Division of Colon and Rectal Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karim Alavi
- Division of Colon and Rectal Surgery, University of Massachusetts Medical School, Worcester, MA, USA
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20
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Nabi J, Tully KH, Cole AP, Marchese M, Cone EB, Melnitchouk N, Kibel AS, Trinh QD. Access denied: The relationship between patient insurance status and access to high-volume hospitals. Cancer 2020; 127:577-585. [PMID: 33084023 DOI: 10.1002/cncr.33237] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/27/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Underinsured patients face significant barriers in accessing high-quality care. Evidence of whether access to high-volume surgical care is mediated by disparities in health insurance coverage remains wanting. METHODS The authors used the National Cancer Data Base to identify all adult patients who had a confirmed diagnosis of breast, prostate, lung, or colorectal cancer during 2004 through 2016. The odds of receiving surgical care at a high-volume hospital were estimated according to the type of insurance using multivariable logistic regression analyses for each malignancy. Then, the interactions between study period and insurance status were assessed. RESULTS In total, 1,279,738 patients were included in the study. Of these, patients with breast cancer who were insured by Medicare (odds ratio [OR], 0.75; P < .001), Medicaid (OR, 0.55; P < .001), or uninsured (OR, 0.50; P < .001); patients with prostate cancer who were insured by Medicare (OR, 0.87; P = .003), Medicaid (OR, 0.58; P = .001), or uninsured (OR, 0.36; P < .001); and patients with lung cancer who were insured by Medicare (OR, 0.84; P = .020), Medicaid (OR, 0.74; P = .001), or uninsured (OR, 0.48; P < .001) were less likely to receive surgical care at high-volume hospitals compared with patients who had private insurance. For patients with colorectal cancer, the effect of insurance differed by study period, and improved since 2011. For those on Medicaid, the odds of receiving care at a high-volume hospital were 0.51 during 2004 through 2007 and 0.99 during 2014 through 2016 (P for interaction = .001); for uninsured patients, the odds were 0.45 during 2004 through 2007 and 1.19 during 2014 through 2016 (P for interaction < .001) compared with patients who had private insurance. CONCLUSIONS Uninsured, Medicare-insured, and Medicaid-insured patients are less likely to receive surgical care at high-volume hospitals. For uninsured and Medicaid-insured patients with colorectal cancer, the odds of receiving care at high-volume hospitals have improved since implementation of the Patient Protection and Affordable Care Act of 2010.
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Affiliation(s)
- Junaid Nabi
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karl H Tully
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander P Cole
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maya Marchese
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eugene B Cone
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nelya Melnitchouk
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Gastrointestinal and General Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam S Kibel
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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21
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Ravivarapu KT, Omidele O, Pfail J, Tomer N, Small AC, Palese MA. Robotic-assisted simple prostatectomy versus open simple prostatectomy: a New York statewide analysis of early adoption and outcomes between 2009 and 2017. J Robot Surg 2020; 15:627-633. [PMID: 33009988 DOI: 10.1007/s11701-020-01152-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Abstract
The factors driving early adoption of robotic-assisted simple prostatectomy (RASP) for large gland BPH have not yet been identified. This study aims to determine the patient, provider, and facility level differences and predictors in undergoing RASP versus OSP. This population-based cohort study used data from the all-payer New York State Statewide Planning and Research Cooperative System (SPARCS) database. Patient, provider, and facility characteristics for each cohort were analyzed, and a multivariate analysis was conducted to identify predictive factors associated with undergoing RASP versus OSP. From 2009 to 2017, 1881 OSP and 216 RASP cases were identified. RASP utilization increased from 2.6% of all cases in 2009 to 16.8% in 2017. Patient demographics were similar between both cohorts. Median length of stay was shorter for RASP patients (3 vs. 4 days, p < 0.001), and OSP was associated with a long length of stay (> 7 days) (p < 0.001). There were no significant differences in 30- and 90-day readmission rates or 1-year mortality. More OSP patients were discharged to continued care facilities than RASP patients (p = 0.049), and more RASP patients were discharged to home compared to OSP patients (p = 0.035). Positive predictors for undergoing RASP included teaching hospital status, medium and high hospital bed volume, high hospital operative volume, high surgeon volume, and surgeons that graduated within 15 years of surgery. As RASP shows favorable perioperative outcomes, the diffusion of robotic technology and newer graduates entering the workforce may augment the upward trend of RASP utilization.
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Affiliation(s)
- Krishna T Ravivarapu
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Olamide Omidele
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - John Pfail
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Nir Tomer
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Alexander C Small
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Michael A Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA.
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22
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Berg S, Tully KH, Sahraoui A, Tan WS, Krimphove MJ, Marchese M, Lipsitz SR, Noldus J, Trinh QD. Inequity in selective referral to high-volume hospitals for genitourinary malignancies. Urol Oncol 2020; 38:582-589. [PMID: 32217041 DOI: 10.1016/j.urolonc.2020.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/02/2020] [Accepted: 02/11/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Compared to low-volume hospitals, high-volume hospitals are associated with lower rates of perioperative morbidity and mortality. However, access to high-volume hospitals is unequal. We investigated racial and socioeconomic disparities among patients undergoing surgery for genitourinary malignancies at high-volume hospitals. MATERIAL AND METHODS We queried the National Cancer Database from 2004-2015 to identify patients who underwent radical prostatectomy, radical cystectomy, and nephrectomy for nonmetastatic prostate cancer, muscle-invasive urothelial bladder cancer, and kidney cancer, respectively. Hospitals were ranked based on their annual volume for the given procedure. The endpoint of our study was receipt of treatment at a high-volume hospital. Multivariable logistic regression models were used to identify predictors of treatment at a high-volume hospital. RESULTS Our final cohort consisted of 397,242 prostate cancer patients, 39,480 bladder cancer patients, and 292,095 kidney cancer patients. For prostate and bladder cancer, Black race was associated with lower odds of treatment at a high-volume hospital (Odds Ratio [OR] 0.83, 95% confidence interval [CI] 0.79-0.87 and 0.71, 95%CI 0.58-0.87; reference: White). Higher education level and private insurance status were associated with greater odds of treatment across all 3 procedures (strongest effect for prostate cancer; higher education level: OR 1.63 [1.58-1.68]; private insurance 1.86 [1.77-1.97]). Moreover, an interaction was found between race and study period for all cancers examined (P < 0.001). Subgroup analyses revealed that Black patients were more likely to undergo radical prostatectomy at high-volume hospitals in 2013-2015 (OR 0.98, 95%CI 0.94-1.02) compared to 2004-2006 (OR 0.83, 95%CI 0.79-0.87). CONCLUSION Across all procedures, patients with lower education status and lack of insurance were less likely to be treated at high-volume hospitals. For prostate cancer and bladder cancer, Black race was a negative predictor of treatment at high-volume hospitals. Further studies are needed to understand the root causes for this inequity.
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Affiliation(s)
- Sebastian Berg
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Karl H Tully
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Aliya Sahraoui
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Wei Shen Tan
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Surgery and Interventional Science, Department of Urology, University College London, London, United Kingdom
| | - Marieke J Krimphove
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maya Marchese
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joachim Noldus
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Quoc-Dien Trinh
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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23
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Hale NE, Macleod LC, Yabes JG, Turner RM, Fam MM, Gingrich JR, Skolarus TA, Borza T, Sabik LM, Davies BJ, Jacobs BL. Implications of Cystectomy Travel Distance for Hospital Readmission and Survival. Clin Genitourin Cancer 2019; 17:e1171-e1180. [DOI: 10.1016/j.clgc.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/03/2019] [Accepted: 08/10/2019] [Indexed: 12/19/2022]
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24
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The Impact of Surgical Volume on Outcomes and Cost in Cleft Repair: A Kids' Inpatient Database Analysis. Ann Plast Surg 2019; 80:S174-S177. [PMID: 29672335 DOI: 10.1097/sap.0000000000001388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Centralization of specialist services, including cleft service delivery, is occurring worldwide with the aim of improving the outcomes. This study examines the relationship between hospital surgical volume in cleft palate repair and outcomes. METHODS A retrospective analysis of the Kids' Inpatient Database was undertaken. Children 3 years or younger undergoing cleft palate repair in 2012 were identified. Hospital volume was categorized by cases per year as low volume (LV; 0-14), intermediate volume (IV; 15-46), or high volume (HV; 47-99); differences in complications, hospital costs, and length of stay (LOS) were determined by hospital volume. RESULTS Data for 2389 children were retrieved: 24.9% (n = 595) were LV, 50.1% (n = 1196) were IV, and 25.0% (n = 596) were HV. High-volume centers were more frequently located in the West (71.9%) compared with LV (19.9%) or IV (24.5%) centers (P < 0.001 for hospital region). Median household income was more commonly highest quartile in HV centers compared with IV or LV centers (32.3% vs 21.7% vs 18.1%, P < 0.001). There was no difference in complications between different volume centers (P = 0.74). Compared with HV centers, there was a significant decrease in mean costs for LV centers ($9682 vs $,378, P < 0.001) but no significant difference in cost for IV centers ($9260 vs $9682, P = 0.103). Both IV and LV centers had a significantly greater LOS when compared with HV centers (1.97 vs 2.10 vs 1.74, P < 0.001). CONCLUSIONS Despite improvement in LOS in HV centers, we did not find a reduction in cost in HV centers. Further research is needed with analysis of outpatient, long-term outcomes to ensure widespread cost-efficiency.
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25
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Omidele OO, Finkelstein M, Omorogbe A, Palese M. Radical Prostatectomy Sociodemographic Disparities Based on Hospital and Physician Volume. Clin Genitourin Cancer 2019; 17:e1011-e1019. [PMID: 31239239 DOI: 10.1016/j.clgc.2019.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/22/2019] [Accepted: 05/26/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of this study was to assess the impact of volume status on socio-demographic disparities for radical prostatectomy (RP) in New York State. PATIENTS AND METHODS All patients undergoing RP from 2006 to 2014 with an admitting or principal diagnosis of prostate cancer were identified. All 40,533 cases were separated into volume groups stratified by hospital and physician quartiles with a goal of maintaining consistent numbers between the 4 volume groups. Patient-level data included race, ethnicity, Charlson Comorbidity Index (CCI), median income by zip code, and source of payment. Hospital-level data included hospital location, teaching status, health service area, and facility number. Continuous and categorical variables were compared between cohorts using the Mann-Whitney-Wilcoxon test and Pearson χ2 tests, respectively. Multivariate regression analysis was conducted to assess predictors of access to very high-volume facilities and physician groups as well as predictors of receiving a minimally invasive RP. RESULTS Of 40,533 total cases, 9602 (24%) were conducted at low-volume hospitals, 9208 (22%) were conducted at medium-volume hospitals, 8478 (21%) were conducted at high-volume hospitals, and 13,245 (33%) were conducted at very high-volume hospitals. Negative predictors of receiving care from a very high-volume physician include increased CCI, Asian race, black race, unknown race, Medicaid status, age 65 to 79 years, and age 80 to 130 years (P < .001). Negative predictors of receiving care from a very high-volume facility include Asian race, black race, unknown race, Medicaid status, and self-payment status (P < .001). CONCLUSION Socioeconomic disparities exist in New York State for RP and are associated with disadvantaged groups being overrepresented in low-volume hospital and physician groups.
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Affiliation(s)
- Olamide O Omidele
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Mark Finkelstein
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aisosa Omorogbe
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
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26
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Walton EL, Deebajah M, Keeley J, Fakhouri S, Yaguchi G, Pantelic M, Rogers C, Park H, Menon M, Peabody JO, Dabaja A, Alanee S. Barriers to obtaining prostate multi-parametric magnetic resonance imaging in African-American men on active surveillance for prostate cancer. Cancer Med 2019; 8:3659-3665. [PMID: 31111654 PMCID: PMC6639171 DOI: 10.1002/cam4.2149] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose Magnetic resonance imaging is playing an ever‐bigger role in the management of prostate cancer. This study investigated barriers to obtaining multi‐parametric MRI (mpMRI) in African‐American men on active surveillance for prostate cancer in comparison to white men affected by the same type of cancer. Materials and Methods Retrospective review of prostate mpMRI orders from August 2015 to October 2017 at a single health organization treating a diverse population was performed. Data was extracted from the electronic medical records and cancellations were examined based on the documented reason for mpMRI cancellation, race, median zip code household income, and distance from healthcare facility. Results Out of 793 prostate mpMRI orders, 201 (25%) went unscanned. Access to care issues accounted for 46% of unscanned orders. Patient cancellations were the most common, followed by difficulty contacting patients, and insurance denials. African‐American patients disproportionately went unscanned because institution staff were unable to contact patients (29% vs 10% in white men, P = 0.0015). Median zip code household income was significantly different between racial groups but did not vary between indication for cancellation. Conclusions African‐American prostate cancer patients' access to mpMRI is hindered more by barriers to care than White patients. Urology providers must consider these issues before using prostate mpMRI within their active surveillance pathways.
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Affiliation(s)
- Eric L Walton
- Wayne State University School of Medicine, Detroit, Michigan
| | - Mustafa Deebajah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Jacob Keeley
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Shadi Fakhouri
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Grace Yaguchi
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Milan Pantelic
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Hakmin Park
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - James O Peabody
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Ali Dabaja
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Shaheen Alanee
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
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Kamel MH, Bimali M, Khalil MI, Eltahawy E, Su LJ, Bissada NK, Davis R. Regional trends in average years of potential life lost (AYPLL) secondary to prostate cancer deaths among Caucasians and African Americans treated by surgery or radiation. Int Urol Nephrol 2019; 51:561-569. [PMID: 30840195 DOI: 10.1007/s11255-019-02116-2] [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: 12/17/2018] [Accepted: 02/23/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To study regional trends in average years of potential life lost (AYPLL) among Caucasians (CA) and African Americans (AA) with prostate cancer (Pca) who received radical prostatectomy or radiation therapy among four different regions in the US as well as across different tumor grades. Years of potential life lost is defined as the difference between a predetermined end-point age and the age at death for a death that occurred prior to that end age, hence the AYPLL is calculated by dividing the total YPLL by the total number of patients died. METHODS The surveillance epidemiology and end results (SEER) database was used to identify Pca patients who were CA or AA and who have received radical prostatectomy or radiation therapy. Study duration was divided into four decades; 1973-1982 (D1), 1983-1992 (D2), 1993-2002 (D3), 2003-2012 (D4). Examined regions were; North East (NE), North central (NC), South and West. Tumor grade was classified into; well/moderately differentiated (WD/MD) and poorly/undifferentiated (PD/UD) groups. Differences in AYPLL among CA and AA in each of these variables were compared. RESULTS Overall, compared to CA, AA were diagnosed and died earlier from Pca. AA had higher AYPLL to Pca than CA. In both tumor grade groups, progressive increase in AYPLL among AA compared to CA was noted over the last three decades. In the WD/MD group, except for the South region, the highest recorded difference in AYPLL between AA and CA was in D4. In the PD/UD group, a similar difference in AYPLL between AA and CA was noted in all regions. The difference in AYPLL was higher in the PD/UD group than the WD/MD group. CONCLUSIONS Racial disparity between AA and CA existed across the examined regions. It is more pronounced in advanced tumor grades. The differences were more significant in the last decade.
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Affiliation(s)
- Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA. .,Department of Urology, Ain Shams University, Cairo, Egypt.
| | - Milan Bimali
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Ehab Eltahawy
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - LJoseph Su
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nabil K Bissada
- Department of Urology, Baylor School of Medicine and Michael E. De Bakey VA Medical center, Houston, TX, USA
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA
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28
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Cole AP, Nguyen DD, Meirkhanov A, Golshan M, Melnitchouk N, Lipsitz SR, Kilbridge KL, Kibel AS, Cooper Z, Weissman J, Trinh QD. Association of Care at Minority-Serving vs Non-Minority-Serving Hospitals With Use of Palliative Care Among Racial/Ethnic Minorities With Metastatic Cancer in the United States. JAMA Netw Open 2019; 2:e187633. [PMID: 30707230 PMCID: PMC6484582 DOI: 10.1001/jamanetworkopen.2018.7633] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE It is not known whether racial/ethnic differences in receipt of palliative care are attributable to different treatment of minorities or lower utilization of palliative care at the relatively small number of hospitals that treat a large portion of minority patients. OBJECTIVE To assess the association of receipt of palliative care among patients with metastatic cancer with receipt of treatment at minority-serving hospitals (MSHs) vs non-MSHs. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used Participant Use Files of the National Cancer Database, a prospectively maintained, hospital-based cancer registry consisting of all patients treated at more than 1500 US hospitals, to collect data from individuals older than 40 years with metastatic prostate, lung, colon, and breast cancer, diagnosed from January 1, 2004, to December 31, 2015. Data were accessed in October 2017, and the analysis was performed in July 2018. EXPOSURES Hospitals in the top decile in terms of the proportion of black and Hispanic patients for each cancer type were defined as MSHs. MAIN OUTCOMES AND MEASURES A multilevel logistic regression model that estimated the odds of palliative care was fit, adjusting for year of diagnosis, sex, race/ethnicity, insurance, income, educational level, and cancer type, with an interaction term between cancer type and MSH status and a hospital-level random intercept to account for unmeasured hospital characteristics. RESULTS A total of 601 680 individuals (mean [SD] age, 67.4 [11.4] years; 95% CI, 67.2-67.6 years; 314 279 [52.2%] male; 475 039 [78.9%] white) were studied. In total, 130 813 patients (21.7%) received palliative care, ranging from 102 019 (25.4%) with lung cancer to 9966 (11.1%) with colon cancer. In total, 16 435 black individuals (20.0%) and 3551 Hispanic individuals (15.9%) received palliative care vs 106 603 non-Hispanic white individuals (22.5%) (P < .001). The MSH patients were less likely than the non-MSH patients to receive palliative care, regardless of race/ethnicity (12 692 [18.0%] vs 118 121 [22.3%]; P = .002). In an adjusted analysis, treatment at an MSH had a statistically significant association with lower odds of receiving palliative care (odds ratio, 0.67; 95% CI, 0.53-0.84). CONCLUSIONS AND RELEVANCE Although the factors associated with minority patients' receipt of palliative care are complex, in this study, treatment at MSHs was associated with significantly lower odds of receiving any palliative care in an adjusted analysis, but black and Hispanic race/ethnicity was not. These findings suggest that the site of care is associated with race/ethnicity-based differences in palliative care.
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Affiliation(s)
- Alexander P. Cole
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - David-Dan Nguyen
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Akezhan Meirkhanov
- Nazarbayev Intellectual School of Physics and Mathematics, Almaty, Kazakhstan
| | - Mehra Golshan
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nelya Melnitchouk
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kerry L. Kilbridge
- Lank Center for Genitourinary Malignancies, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Adam S. Kibel
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joel Weissman
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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29
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Cole AP, Fletcher SA, Berg S, Nabi J, Mahal BA, Sonpavde GP, Nguyen PL, Lipsitz SR, Sun M, Choueiri TK, Preston MA, Kibel AS, Trinh QD. Impact of tumor, treatment, and access on outcomes in bladder cancer: Can equal access overcome race-based differences in survival? Cancer 2019; 125:1319-1329. [PMID: 30633323 DOI: 10.1002/cncr.31926] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND There are race-based differences in bladder cancer survival. To better understand this phenomenon, this study was designed to assess the statistical contributions of tumor, treatment, and access variables to race-based differences in survival. METHODS Data were extracted from the National Cancer Data Base on black and white adults with muscle-invasive bladder cancer from 2004 to 2015. The impact of tumor, access, and treatment variables on differences in survival was inferred by the performance of sequential propensity score-weighted analyses in which black and white patients were balanced with respect to demographics and health status (comorbidities) tumor characteristics, treatment, and access-related variables. The propensity score-weighted hazard of death (black vs white) was calculated after each iteration. RESULTS This study identified 44,577 patients with a median follow-up of 77 months. After demographics and health status were balanced, black race was associated with 18% worse mortality (hazard ratio, 1.18; 95% confidence interval [CI], 1.12-1.25; P < .001). Balancing by tumor characteristics reduced this to 16%, balancing by treatment reduced this to 10%, and balancing by access-related variables resulted in no difference. Access-related variables explained 40% (95% CI, 22.9%-57.0%) of the excess risk of death in blacks, whereas treatment factors explained 35% (95% CI, 22.2%-46.9%). The contribution of tumor characteristics was not significant. CONCLUSIONS In the models, differences in survival for black and white patients with bladder cancer are best explained by disparities in access and treatment, not tumor characteristics. Access to care is likely a key factor in racial disparities in cancer.
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Affiliation(s)
- Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sean A Fletcher
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sebastian Berg
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Urology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Junaid Nabi
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brandon A Mahal
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Guru P Sonpavde
- Lank Center for Genitourinary Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Stuart R Lipsitz
- Division of General Internal Medicine and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maxine Sun
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Lank Center for Genitourinary Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Toni K Choueiri
- Division of General Internal Medicine and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark A Preston
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam S Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Gabriel E, Narayanan S, Attwood K, Hochwald S, Kukar M, Nurkin S. Disparities in major surgery for esophagogastric cancer among hospitals by case volume. J Gastrointest Oncol 2018; 9:503-516. [PMID: 29998016 DOI: 10.21037/jgo.2018.01.18] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The purpose of this study was to characterize disparities among centers performing major surgery for esophageal or gastric cancer stratified by case volume. Methods The National Cancer Data Base (NCDB) was queried for cases of esophagectomy or total gastrectomy. Centers were compared based on number of cases during 2004-2013: low volume [1-99], middle [100-200], and high [>200]. Results For esophagectomy, 17,547 patients were included; 73.5% were treated in low volume centers, 14.6% in middle, and 11.9% in high. For gastrectomy, 20,059 patients were included, with 87.5%, 8.3%, and 4.3%, respectively. Patients treated at low volume centers were more likely to be of racial/ethnic minorities, uninsured, and have lower socioeconomic status. Overall survival (OS) was superior for patients treated at high volume centers. On multivariable analysis for either procedure, a higher number of disparate factors was identified in the low and middle volume centers compared to the high volume centers, which were associated with poorer OS. Conclusions This study identified higher numbers of disparate patient factors associated with low/middle volume centers compared to high volume centers, which were associated with worse OS, and further makes the case for performance of esophagectomy and total gastrectomy at high volume centers.
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Affiliation(s)
- Emmanuel Gabriel
- Department of Surgery, Section on Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Sumana Narayanan
- Department of Surgical Oncology, Roswell Park Cancer Institute Buffalo, Buffalo, NY, USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Cancer Institute Buffalo, Buffalo, NY, USA
| | - Steven Hochwald
- Department of Surgical Oncology, Roswell Park Cancer Institute Buffalo, Buffalo, NY, USA
| | - Moshim Kukar
- Department of Surgical Oncology, Roswell Park Cancer Institute Buffalo, Buffalo, NY, USA
| | - Steven Nurkin
- Department of Surgical Oncology, Roswell Park Cancer Institute Buffalo, Buffalo, NY, USA
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Rehmani SS, Liu B, Al-Ayoubi AM, Raad W, Flores RM, Bhora F, Taioli E. Racial Disparity in Utilization of High-Volume Hospitals for Surgical Treatment of Esophageal Cancer. Ann Thorac Surg 2018; 106:346-353. [PMID: 29684373 DOI: 10.1016/j.athoracsur.2018.03.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/06/2018] [Accepted: 03/19/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Utilization of high-volume hospitals (HVH) for esophagectomy has been associated with improved perioperative outcomes and reduced mortality. We aimed to test the hypothesis that black-white racial disparities exist in HVH utilization and identify predictors of in-hospital surgical outcomes of esophageal cancer while adjusting for HVH utilization patterns. METHODS We queried the New York Statewide Planning and Research Cooperative System database (1995 to 2012) for esophageal cancer patients who underwent surgical resection exclusively. Only records for patients with self-reported white or black race and a valid New York State ZIP code were included (n = 2,895). Analysis was performed to identify factors associated with HVH hospital (≥20 esophagectomies/year) utilization and determine predictors of complications and in-hospital mortality. RESULTS Black patients (361 [12.5%]) were significantly different (p < 0.001) than their white counterparts in the proportion of women, Medicaid, income distribution, and privately insured individuals. Although 55% patients overall utilized an HVH, blacks were significantly less likely to utilize an HVH than whites (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.14 to 0.24), even though 74.5% resided within 8.9 miles of one. Operations performed at HVHs were associated with lower in-hospital mortality (OR, 0.48; 95% CI, 0.35 to 0.65); however, mortality remained higher for blacks (OR, 2.04; 95% CI, 1.65 to 3.30; propensity matched OR, 2.45; 95% CI, 1.5 to 4.03). CONCLUSIONS Black patients were less likely to undergo esophagectomy at an HVH and experienced higher mortality. Efforts should be made to understand factors influencing patients' decision process and improve referral practices to ensure optimal care is provided across all segments of the population, irrespective of race, insurance, or income status.
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Affiliation(s)
- Sadiq S Rehmani
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bian Liu
- Institute for Translational Epidemiology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adnan M Al-Ayoubi
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Wissam Raad
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raja M Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Faiz Bhora
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
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Alameddine M, Koru-Sengul T, Moore KJ, Miao F, Sávio LF, Nahar B, Prakash NS, Venkatramani V, Jue JS, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Trends in Utilization of Robotic and Open Partial Nephrectomy for Management of cT1 Renal Masses. Eur Urol Focus 2018; 5:482-487. [PMID: 29325761 DOI: 10.1016/j.euf.2017.12.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/27/2017] [Accepted: 12/18/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Partial nephrectomy is widely used for surgical management of small renal masses. Use of robotic (RPN) versus open partial nephrectomy (OPN) among various populations is not well characterized. OBJECTIVE To analyze trends in utilization of RPN and disparities that may be associated with this procedure for management of cT1 renal masses in the USA. DESIGN, SETTING, AND PARTICIPANTS Patients who underwent RPN or OPN for clinical stage T1N0M0 renal masses in the USA from 2010 to 2013 were identified in the National Cancer Data Base. A total of 23 154 patients fulfilled the inclusion criteria. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Univariable and multivariable logistic regression analyses were performed to evaluate differences in receiving RPN or OPN across various patient groups. RESULTS AND LIMITATIONS Utilization of RPN increased from 41% in 2010 to 63% in 2013. Black patients (adjusted odds ratio [aOR] 0.91, 95% confidence interval [CI] 0.84-0.98) and Hispanic patients (aOR 0.85, 95% CI 0.77-0.95) were less likely to undergo RPN. RPN was less likely to be performed in rural counties (aOR 0.80, 95% CI 0.66-0.98) and in patients with no insurance (aOR 0.52, 95% CI 0.44-0.61) or patients covered by Medicaid (aOR 0.81, 95% CI 0.73-0.90). There was no significant difference in RPN utilization between academic and non-academic facilities. Patients with higher clinical stage (aOR 0.58, 95% CI 0.55-0.62) and comorbidities (aOR 0.79, 95% CI 0.71-0.88) were also less likely to undergo RPN. CONCLUSIONS Utilization of RPN has continued to increase over time; however, there are significant disparities in its utilization according to race and socioeconomic status. Black and Hispanic patients and patients in rural communities and with limited insurance were more likely to be treated with OPN instead of RPN. PATIENT SUMMARY The use of robotic surgery in partial nephrectomy for management of small renal masses has increased over time. We found a significant disparity across different racial and socioeconomic groups in use of robotic partial nephrectomy compared to open surgery. Patients living in rural areas, with limited insurance, and multiple medical comorbidities were more likely to undergo open than robotic partial nephrectomy.
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Affiliation(s)
- Mahmoud Alameddine
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kevin J Moore
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Feng Miao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Luís Felipe Sávio
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruno Nahar
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Vivek Venkatramani
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua S Jue
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
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Parikh-Patel A, Morris CR, Kizer KW. Disparities in quality of cancer care: The role of health insurance and population demographics. Medicine (Baltimore) 2017; 96:e9125. [PMID: 29390313 PMCID: PMC5815725 DOI: 10.1097/md.0000000000009125] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Escalating costs and concerns about quality of cancer care have increased calls for quality measurement and performance accountability for providers and health plans. The purpose of the present cross-sectional study was to assess variability in the quality of cancer care by health insurance type in California.Persons with breast, ovary, endometrium, cervix, colon, lung, or gastric cancer during the period 2004 to 2014 were identified in the California Cancer Registry. Individuals were stratified into 5 health insurance categories: private insurance, Medicare, Medicaid, dual Medicare and Medicaid eligible, and uninsured. Quality of care was evaluated using Commission on Cancer quality measures. Logistic regression models were generated to assess the independent effect of health insurance type on stage at diagnosis, quality of care and survival after adjusting for age, sex, race/ethnicity, and socioeconomic status (SES).A total of 763,884 cancer cases were evaluated. Individuals with Medicaid or Medicare-Medicaid dual-eligible coverage and the uninsured had significantly lower odds of receiving recommended radiation and/or chemotherapy after diagnosis or surgery for breast, endometrial, and colon cancer, relative to those with private insurance. Dual eligible patients with gastric cancer had 21% lower odds of having the recommended number of lymph nodes removed and examined compared to privately insured patients.After adjusting for known demographic confounders, substantial and consistent disparities in quality of cancer care exist according to type of health insurance in California. Further study is needed to identify particular factors and mechanisms underlying the identified treatment disparities across sources of health insurance.
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Affiliation(s)
- Arti Parikh-Patel
- California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, Institute for Population Health Improvement, University of California Davis Health
| | - Cyllene R. Morris
- California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, Institute for Population Health Improvement, University of California Davis Health
| | - Kenneth W. Kizer
- California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, Institute for Population Health Improvement, University of California Davis Health
- University of California, Davis, School of Medicine and Betty Irene Moore School of Nursing, Sacramento, CA, USA
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Loehrer AP, Chang DC, Song Z, Chang GJ. Health Reform and Utilization of High-Volume Hospitals for Complex Cancer Operations. J Oncol Pract 2017; 14:e42-e50. [PMID: 29155612 DOI: 10.1200/jop.2017.025684] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Underinsured patients are less likely to receive complex cancer operations at hospitals with high surgical volumes (high-volume hospitals, or HVHs), which contributes to disparities in care. To date, the impact of insurance coverage expansion on site of complex cancer surgery remains unknown. METHODS Using the 2006 Massachusetts coverage expansion as a natural experiment, we searched the Hospital Cost and Utilization Project state inpatient databases for Massachusetts and control states (New York, New Jersey, and Florida) between 2001 and 2011 to evaluate changes in the utilization of HVHs for resections of bladder, esophageal, stomach, pancreatic, rectal, or lung cancer after the expansion of insurance coverage. We studied nonelderly, adult patients with private insurance and those with government-subsidized or self-pay (GSSP) coverage with a difference-in-differences framework. RESULTS We studied 11,687 patients in Massachusetts and 56,300 patients in control states. Compared with control states, the 2006 Massachusetts insurance expansion was associated with a 14% increased rate of surgical intervention for GSSP patients (incident rate ratio, 1.14; P = .015), but there was no significant change in the probability of GSSP patients undergoing surgery at an HVH (1.0 percentage-point increase; P = .710). The reform was associated with no change in the uninsured payer-mix at HVHs (0.6 percentage-point increase; P = .244) and with a 5.1 percentage-point decrease for the uninsured payer mix at low-volume hospitals ( P < .001). CONCLUSION The 2006 Massachusetts insurance expansion, a model for the Affordable Care Act, was associated with increased rates of complex cancer operations and increased insurance coverage but with no change in utilization of HVH for complex cancer operations.
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Affiliation(s)
- Andrew P Loehrer
- The University of Texas MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital; and Harvard Medical School, Boston, MA
| | - David C Chang
- The University of Texas MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital; and Harvard Medical School, Boston, MA
| | - Zirui Song
- The University of Texas MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital; and Harvard Medical School, Boston, MA
| | - George J Chang
- The University of Texas MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital; and Harvard Medical School, Boston, MA
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Xiao D, Zheng C, Jindal M, Johnson LB, DeLeire T, Shara N, Al-Refaie WB. Medicaid Expansion and Disparity Reduction in Surgical Cancer Care at High-Quality Hospitals. J Am Coll Surg 2017; 226:22-29. [PMID: 28987635 DOI: 10.1016/j.jamcollsurg.2017.09.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 09/13/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Affordable Care Act's Medicaid expansion has been heavily debated due to skepticism about Medicaid's ability to provide high-quality care. Particularly, little is known about whether Medicaid expansion improves access to surgical cancer care at high-quality hospitals. To address this question, we examined the effects of the 2001 New York Medicaid expansion, the largest in the pre-Affordable Care Act era, on this disparity measure. STUDY DESIGN We identified 67,685 nonelderly adults from the New York State Inpatient Database who underwent select cancer resections. High-quality hospitals were defined as high-volume or low-mortality hospitals. Disparity was defined as model-adjusted difference in percentage of patients receiving operations at high-quality hospitals by insurance type (Medicaid/uninsured vs privately insured) or by race (African American vs white). Levels of disparity were calculated quarterly for each comparison pair and then analyzed using interrupted time series to evaluate the impact of Medicaid expansion. RESULTS Disparity in access to high-volume hospitals by insurance type was reduced by 0.97 percentage points per quarter after Medicaid expansion (p < 0.0001). Medicaid/uninsured beneficiaries had similar access to low-mortality hospitals as the privately insured; no significant change was detected around expansion. Conversely, racial disparity increased by 0.87 percentage points per quarter (p < 0.0001) in access to high-volume hospitals and by 0.48 percentage points per quarter (p = 0.005) in access to low-mortality hospitals after Medicaid expansion. CONCLUSIONS Pre-Affordable Care Act Medicaid expansion reduced the disparity in access to surgical cancer care at high-volume hospitals by payer. However, it was associated with increased racial disparity in access to high-quality hospitals. Addressing racial barriers in access to high-quality hospitals should be prioritized.
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Affiliation(s)
- David Xiao
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC
| | - Chaoyi Zheng
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC
| | - Manila Jindal
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC
| | - Lynt B Johnson
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC
| | - Thomas DeLeire
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Georgetown McCourt School of Public Policy, Washington, DC
| | - Nawar Shara
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC; MedStar Health Research Institute, Hyattsville, MD
| | - Waddah B Al-Refaie
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC; MedStar Health Research Institute, Hyattsville, MD.
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Regionalization of radical cystectomy in the United States. Urol Oncol 2017; 35:528.e7-528.e13. [DOI: 10.1016/j.urolonc.2017.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/19/2017] [Accepted: 03/22/2017] [Indexed: 11/20/2022]
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Wang EH, Yu JB, Abouassally R, Meropol NJ, Cooper G, Shah ND, Williams SB, Gonzalez C, Smaldone MC, Kutikov A, Zhu H, Kim SP. Disparities in Treatment of Patients With High-risk Prostate Cancer: Results From a Population-based Cohort. Urology 2016; 95:88-94. [PMID: 27318264 DOI: 10.1016/j.urology.2016.06.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/19/2016] [Accepted: 06/08/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the variation in primary treatment of high-risk prostate cancer (PCa) by different hospital characteristics in the United States. MATERIALS AND METHODS We used the National Cancer Data Base to identify patients diagnosed with pretreatment high-risk PCa from 2004 to 2011. The primary outcomes were different forms of primary therapy or watchful waiting (WW) across different types of hospitals (community, comprehensive cancer community, and academic hospitals). Multivariable logistic regression analyses were used to test for differences in treatment by hospital type. RESULTS During the study period, we identified 102,701 men diagnosed with high-risk PCa. Overall, the most common treatment was radical prostatectomy (37.0%) followed by radiation therapy (33.2%) and WW (8.5%). Compared with white men with high-risk PCa, black men had lower adjusted odds ratios (OR) for surgery at comprehensive community (OR: 0.64; P <.001) and academic (OR: 0.62; P <.001) hospitals. Similarly, black men were also more likely to be managed with WW at community (OR: 1.49; P <.001), comprehensive cancer community (OR: 1.24; P <.001), and academic (OR: 1.55; P <.001) hospitals, as well as with radiation therapy at comprehensive cancer community (OR: 1.27; P <.001) and academic hospitals (OR: 1.23; P <.001). CONCLUSION Disparities in the use of WW and different primary treatments among patients with high-risk PCa persisted across different types of hospitals and over time. Our findings highlight a significant racial disparity in the use of curative therapy for high-risk PCa that should be urgently addressed to ensure that all men with PCa receive appropriate care across all racial groups and cancer care facilities.
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Affiliation(s)
- Elyn H Wang
- School of Medicine, Yale University, New Haven, CT
| | - James B Yu
- Department of Radiation Oncology, Yale University, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Robert Abouassally
- Urology Institute, Center of Outcomes and Health Care Quality, University Hospitals Case Medical Center, Cleveland, OH; University Hospitals Case Medical Center, Seidman Cancer Center, University Hospital, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Neal J Meropol
- University Hospitals Case Medical Center, Seidman Cancer Center, University Hospital, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Gregory Cooper
- University Hospitals Case Medical Center, Department of Gastroenterology, University Hospital, Cleveland, OH
| | - Nilay D Shah
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN
| | - Stephen B Williams
- Department of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Christopher Gonzalez
- Urology Institute, Center of Outcomes and Health Care Quality, University Hospitals Case Medical Center, Cleveland, OH
| | - Marc C Smaldone
- Department of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | | | - Hui Zhu
- Louis Stokes VA, Cleveland, OH
| | - Simon P Kim
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT; Urology Institute, Center of Outcomes and Health Care Quality, University Hospitals Case Medical Center, Cleveland, OH; University Hospitals Case Medical Center, Seidman Cancer Center, University Hospital, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH.
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Pneumonia after Major Cancer Surgery: Temporal Trends and Patterns of Care. Can Respir J 2016; 2016:6019416. [PMID: 27445554 PMCID: PMC4906186 DOI: 10.1155/2016/6019416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/03/2016] [Indexed: 11/17/2022] Open
Abstract
Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS). Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS), a Healthcare Cost and Utilization Project (HCUP) subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC) of mortality after MCS was −2.4% (95% CI: −2.9 to −2.0, P < 0.001); the EAPC of mortality associated with pneumonia after MCS was −2.2% (95% CI: −3.6 to 0.9, P = 0.01). Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality.
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Ihemelandu C, Zheng C, Hall E, Langan RC, Shara N, Johnson L, Al-Refaie W. Multimorbidity and access to major cancer surgery at high-volume hospitals in a regionalized era. Am J Surg 2016; 211:697-702. [PMID: 26926527 DOI: 10.1016/j.amjsurg.2015.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/14/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Institute of Medicine has recently prioritized access of quality cancer care to vulnerable persons including multimorbid patients. Despite promotional efforts to regionalize major surgical procedures to high-volume hospitals (HVHs), little is known about change in access to HVH over time among multimorbid patients in need of major cancer surgery. We performed a time-trend appraisal of access of multimorbid persons to HVH for major cancer surgery within a large nationally representative cohort. METHODS We identified 168,934 patients who underwent 6 major cancer surgeries from the Nationwide Inpatient Sample (1998 to 2010). Comorbidities were identified using Elixhauser's method. HVHs were defined as hospitals of highest procedure volumes that treated 1/3 of all the patients. Logistic regression models and predictive margins were used to assess the adjusted effects of comorbidity on receiving major cancer surgeries at HVH. RESULTS Of all, 45.7% of the patients had 2 comorbidities or more. Multimorbidity predicted decreased access to HVH for esophagectomy, total gastrectomy, pancreatectomy, hepatectomy, and proctectomy, but not for distal gastrectomy, after controlling for covariates. A comorbidity level by year interaction analysis also showed that little disparity existed for receiving distal gastrectomy at an HVH, whereas the predicted difference in probability of receiving any of the other 5 major cancer procedures remained prominent between the years 1998 and 2010. CONCLUSIONS In this large 12-year time-trend study, multimorbid cancer patients have sustained low access to HVH for major cancer surgery across many oncologic resections. These results continue to reinforce and highlight the need for policy targeted research and intervention aimed at improving these access gaps.
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Affiliation(s)
- Chukwuemeka Ihemelandu
- Department of General Surgery, MedStar Washington Hospital Center, 106 Irving St, NW, POB Suite 3900, Washington, DC, 20010, USA.
| | - Chaoyi Zheng
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC, USA
| | - Erin Hall
- Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC, USA
| | - Russell C Langan
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC, USA
| | - Nawar Shara
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC, USA; MedStar Health Research Institute, Hyattsville, Maryland, USA
| | - Lynt Johnson
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC, USA; Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC, USA; Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Waddah Al-Refaie
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC, USA; MedStar Health Research Institute, Hyattsville, Maryland, USA; Lombardi Comprehensive Cancer Center, Washington, DC, USA
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Basto M, Sathianathen N, Te Marvelde L, Ryan S, Goad J, Lawrentschuk N, Costello AJ, Moon DA, Heriot AG, Butler J, Murphy DG. Patterns-of-care and health economic analysis of robot-assisted radical prostatectomy in the Australian public health system. BJU Int 2015; 117:930-9. [PMID: 26350758 DOI: 10.1111/bju.13317] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To compare patterns of care and peri-operative outcomes of robot-assisted radical prostatectomy (RARP) with other surgical approaches, and to create an economic model to assess the viability of RARP in the public case-mix funding system. PATIENTS AND METHODS We retrospectively reviewed all radical prostatectomies (RPs) performed for localized prostate cancer in Victoria, Australia, from the Victorian Admitted Episode Dataset, a large administrative database that records all hospital inpatient episodes in Victoria. The first database, covering the period from July 2010 to April 2013 (n = 5 130), was used to compare length of hospital stay (LOS) and blood transfusion rates between surgical approaches. This was subsequently integrated into an economic model. A second database (n = 5 581) was extracted to cover the period between July 2010 and June 2013, three full financial years, to depict patterns of care and make future predictions for the 2014-2015 financial year, and to perform a hospital volume analysis. We then created an economic model to evaluate the incremental cost of RARP vs open RP (ORP) and laparoscopic RP (LRP), incorporating the cost-offset from differences in LOS and blood transfusion rate. The economic model constructs estimates of the diagnosis-related group (DRG) costs of ORP and LRP, adds the gross cost of the surgical robot (capital, consumables, maintenance and repairs), and manipulates these DRG costs to obtain a DRG cost per day, which can be used to estimate the cost-offset associated with RARP in comparison with ORP and LRP. Economic modelling was performed around a base-case scenario, assuming a 7-year robot lifespan and 124 RARPs performed per financial year. One- and two-way sensitivity analyses were performed for the four-arm da Vinci SHD, Si and Si dual surgical systems (Intuitive Surgical Ltd, Sunnyvale, CA, USA). RESULTS We identified 5 581 patients who underwent RP in 20 hospitals in Victoria with an open, laparoscopic or robot-assisted surgical approach in the public and private sector. The majority of RPs (4 233, 75.8%), in Victoria were performed in the private sector, with an overall 11.5% decrease in the total number of RPs performed over the 3-year study period. In the most recent financial year, 820 (47%), 765 (44%) and 173 patients (10%) underwent RARP, ORP and LRP, respectively. In the same timeframe, RARP accounted for 26 and 53% of all RPs in the public and private sector, respectively. Public hospitals in Victoria perform a median number of 14 RPs per year and 40% of hospitals perform <10 RPs per year. In the public system, RARP was associated with a mean (±sd) LOS of 1.4 (±1.3) days compared with 3.6 (±2.7) days for LRP and 4.8 (±3.5) days for ORP (P < 0.001). The mean blood transfusion rates were 0, 6 and 15% for RARP, LRP and ORP, respectively (P < 0.001). The incremental cost per RARP case compared with ORP and LRP was A$442 and A$2 092, respectively, for the da Vinci S model, A$1 933 and A$3 583, respectively, for the da Vinci Si model and A$3 548 and A$5 198, respectively for the da Vinci Si dual. RARP can become cost-equivalent with ORP where ~140 cases per year are performed in the base-case scenario. CONCLUSIONS Over the period studied, RARP has become the dominant approach to RP, with significantly shorter LOS and lower blood transfusion rate. This translates to a significant cost-offset, which is further enhanced by increasing the case volume, extending the lifespan of the robot and reductions in the cost of consumables and capital.
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Affiliation(s)
- Marnique Basto
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Niranjan Sathianathen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Luc Te Marvelde
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Vic., Australia
| | - Shane Ryan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Jeremy Goad
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Urology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Surgery, Austin Hospital, Heidelberg, Germany
| | - Anthony J Costello
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Australian Prostate Cancer Research Centre, Epworth Healthcare, Richmond, Melbourne, Vic., Australia
| | - Daniel A Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Australian Prostate Cancer Research Centre, Epworth Healthcare, Richmond, Melbourne, Vic., Australia.,Cabrini Healthcare, Melbourne, Vic., Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Jim Butler
- Australian Centre for Economic Research on Health, Australian National University, Canberra, ACT, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Australian Prostate Cancer Research Centre, Epworth Healthcare, Richmond, Melbourne, Vic., Australia
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Singh JA, Ramachandran R. Persisting Racial Disparities in Total Shoulder Arthroplasty Utilization and Outcomes. J Racial Ethn Health Disparities 2015; 2015:1-8. [PMID: 26413459 PMCID: PMC4581980 DOI: 10.1007/s40615-015-0138-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/19/2015] [Accepted: 05/29/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose was to study whether racial disparities in total shoulder arthroplasty (TSA) utilization and outcomes have declined over time. METHODS We used the US Nationwide Inpatient Sample from 1998 to 2011.We used chi-squared test to compare characteristics, Cochran-Armitage test to compare utilization rates, and Cochran-Armitage test and logistic regression to compare time-trends in outcomes by race. RESULTS From 1998 to 2011, 176,141 Whites and 7694 Blacks underwent TSA. Compared to Whites, Blacks who underwent TSA were younger (69.1 vs. 64.2 years; p<0.0001), more likely to be female (54.9 vs. 71.0 %; p<0.0001), and have rheumatoid arthritis or avascular necrosis as the underlying diagnosis (1.7 vs. 3.0%and 1.7 vs. 6.1 %; p<0.0001 for both) and a Deyo-Charlson index of 2 or higher (8.5 vs. 16.7 %; p<0.0001). Compared to Whites, Blacks had much lower TSA utilization rate/100,000 in 1998 (2.97 vs. 0.83; p<0.0001) and in 2011 (12.27 vs. 3.33; p<0.0001); racial disparities increased from 1998 to 2011 (p<0.0001). A higher proportion of Blacks than Whites had a hospital stay greater than median in 1998-2000, 62 vs. 51.4 % (p=0.02), and in 2009-2011, 34.4 vs. 27.3 % (p<0.0001); disparities did not change over time (p=0.31). These disparities in utilization were borderline significant in adjusted analyses. There were no racial differences in proportion discharged to inpatient medical facility in 1998-2000, 15.2 vs. 15.0 % (p=0.95), and in 2009-2011, 12.3 vs. 11.1%(p=0.37), respectively. CONCLUSIONS We found increasing racial disparities in TSA utilization. Some disparities in outcomes exist as well. Patients, surgeons, and policy-makes should be aware of these findings and take action to reduce racial disparities.
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Affiliation(s)
- Jasvinder A. Singh
- Birmingham VA Medical Center, Birmingham, AL, USA
- Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rekha Ramachandran
- Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA
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Sukumar S, Ravi P, Sood A, Gervais MK, Hu JC, Kim SP, Menon M, Roghmann F, Sammon JD, Sun M, Trinh VQ, Trinh QD. Racial disparities in operative outcomes after major cancer surgery in the United States. World J Surg 2015; 39:634-43. [PMID: 25409836 DOI: 10.1007/s00268-014-2863-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Numerous studies have recorded racial disparities in access to care for major cancers. We investigate contemporary national disparities in the quality of perioperative surgical oncological care using a nationally representative sample of American patients and hypothesize that disparities in the quality of surgical oncological care also exists. METHODS A retrospective, serial, and cross-sectional analysis of a nationally representative cohort of 3,024,927 patients, undergoing major surgical oncological procedures (colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, pneumonectomy, pancreatectomy, and prostatectomy), between 1999 and 2009. RESULTS After controlling for multiple factors (including socioeconomic status), Black patients undergoing major surgical oncological procedures were more likely to experience postoperative complications (OR: 1.24; p < 0.001), in-hospital mortality (OR: 1.24; p < 0.001), homologous blood transfusions (OR: 1.52; p < 0.001), and prolonged hospital stay (OR: 1.53; p < 0.001). Specifically, Black patients have higher rates of vascular (OR: 1.24; p < 0.001), wound (OR: 1.10; p = 0.004), gastrointestinal (OR: 1.38; p < 0.001), and infectious complications (OR: 1.29; p < 0.001). Disparities in operative outcomes were particularly remarkable for Black patients undergoing colectomy, prostatectomy, and hysterectomy. Importantly, substantial attenuation of racial disparities was noted for radical cystectomy, lung resection, and pancreatectomy relative to earlier reports. Finally, Hispanic patients experienced no disparities relative to White patients in terms of in-hospital mortality or overall postoperative complications for any of the eight procedures studied. CONCLUSIONS Considerable racial disparities in operative outcomes exist in the United States for Black patients undergoing major surgical oncological procedures. These findings should direct future health policy efforts in the allocation of resources for the amelioration of persistent disparities in specific procedures.
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Affiliation(s)
- Shyam Sukumar
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
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Ellimoottil C, Roghmann F, Blackwell R, Kadlec A, Greco K, Quek ML, Sun M, Trinh QD, Gupta G. Open Versus Robotic Radical Prostatectomy in Obese Men. Curr Urol 2015; 8:156-61. [PMID: 26889136 DOI: 10.1159/000365708] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/29/2014] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Robotic-assisted radical prostatectomy (RARP) has been shown to reduce blood loss, peri-operative complications and length of stay when compared to open radical prostatectomy (ORP). We sought to determine whether the reported benefits of RARP over ORP translate to obese patients. PATIENTS AND METHODS We utilized the 2009-2010 Nationwide Inpatient Sample to identify all obese men with prostate cancer who underwent ORP and RARP. Our primary outcome was the presence of a peri-operative adverse event (i.e. blood transfusion, complication, prolonged length of stay). We fit multivariable logistic regression models to examine whether RARP in obese patients was independently associated with decreased odds of all three outcomes. RESULTS We identified 9,108 obese patients who underwent radical prostatectomy. On multivariable analysis, the use of RARP in the obese population was not independently associated with decreased odds of developing a peri-operative complication (OR = 0.81, CI: 0.58-1.13, p = 0.209). RARP was, however, associated with decreased odds of blood transfusion (OR = 0.17, CI: 0.10-0.30, p < 0.001) and prolonged length of stay (OR = 0.28, CI: 0.20-0.40, p < 0.001). CONCLUSION Our findings suggest that in obese patients, the use of RARP may reduce length of stay and blood transfusions compared to ORP. Both approaches, however, are associated with similar odds of developing a complication.
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Affiliation(s)
| | - Florian Roghmann
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany
| | | | - Adam Kadlec
- Loyola University Medical Center, Maywood, IL., USA
| | | | | | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Quoc-Dien Trinh
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Division of Urologic Surgery and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA., USA
| | - Gopal Gupta
- Loyola University Medical Center, Maywood, IL., USA
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Gabriel E, Thirunavukarasu P, Al-Sukhni E, Attwood K, Nurkin SJ. National disparities in minimally invasive surgery for rectal cancer. Surg Endosc 2015; 30:1060-7. [PMID: 26092020 DOI: 10.1007/s00464-015-4296-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/01/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Social and racial disparities have been identified as factors contributing to differences in access to care and oncologic outcomes in patients with colorectal cancer. The aim of this study was to investigate national disparities in minimally invasive surgery (MIS), both laparoscopic and robotic, across different racial, socioeconomic and geographic populations of patients with rectal cancer. METHODS We utilized the American College of Surgeons National Cancer Database to identify patients with rectal cancer from 2004 to 2011 who had undergone definitive surgical procedures through either an open, laparoscopic or robotic approach. Inclusion criteria included only one malignancy and no adjuvant therapy. Multivariate analysis was performed to investigate differences in age, gender, race, income, education, insurance coverage, geographic setting and hospital type in relation to the surgical approach. RESULTS A total of 8633 patients were identified. The initial surgical approach included 46.5% open (4016), 50.9% laparoscopic (4393) and 2.6% robotic (224). In evaluating type of insurance coverage, patients with private insurance were most likely to undergo laparoscopic surgery [OR (odds ratio) 1.637, 95% CI 1.178-2.275], although there was a less statistically significant association with robotic surgery (OR 2.167, 95% CI 0.663-7.087). Patients who had incomes greater than $46,000 and received treatment at an academic center were more likely to undergo MIS (either laparoscopic or robotic). Race, education and geographic setting were not statistically significant characteristics for surgical approach in patients with rectal cancer. CONCLUSIONS Minimally invasive approaches for rectal cancer comprise approximately 53% of surgical procedures in patients not treated with adjuvant therapy. Robotics is associated with patients who have higher incomes and private insurance and undergo surgery in academic centers.
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Affiliation(s)
- Emmanuel Gabriel
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA.
| | - Pragatheeshwar Thirunavukarasu
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA
| | - Eisar Al-Sukhni
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Steven J Nurkin
- Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm and Carlton Streets, Buffalo, NY, 14216, USA
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Trinh QD, Nguyen PL, Leow JJ, Dalela D, Chao GF, Mahal BA, Nayak M, Schmid M, Choueiri TK, Aizer AA. Cancer-specific mortality of Asian Americans diagnosed with cancer: a nationwide population-based assessment. J Natl Cancer Inst 2015; 107:djv054. [PMID: 25794888 DOI: 10.1093/jnci/djv054] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Racial disparities in cancer survival outcomes have been primarily attributed to underlying biologic mechanisms and the quality of cancer care received. Because prior literature shows little difference exists in the socioeconomic status of non-Hispanic whites and Asian Americans, any difference in cancer survival is less likely to be attributable to inequalities of care. We sought to examine differences in cancer-specific survival between whites and Asian Americans. METHODS The Surveillance, Epidemiology, and End Results Program was used to identify patients with lung (n = 130 852 [16.9%]), breast (n = 313 977 [40.4%]), prostate (n = 166 529 [21.4%]), or colorectal (n = 165 140 [21.3%]) cancer (the three leading causes of cancer-related mortality within each sex) diagnosed between 1991 and 2007. Fine and Gray's competing risks regression compared the cancer-specific mortality (CSM) of eight Asian American groups (Chinese, Filipino, Hawaiian/Pacific Islander, Japanese, Korean, other Asian, South Asian [Indian/Pakistani], and Vietnamese) to non-Hispanic white patients. All P values were two-sided. RESULTS In competing risks regression, the receipt of definitive treatment was an independent predictor of CSM (hazard ratio [HR] = 0.37, 95% confidence interval [CI] = 0.35 to 0.40; HR = 0.55, 95% CI = 0.53 to 0.58; HR = 0.61, 95% CI = 0.60 to 0.62; and HR = 0.27, 95% CI = 0.25 to 0.29) for prostate, breast, lung, and colorectal cancers respectively, all P < .001). In adjusted analyses, most Asian subgroups (except Hawaiians and Koreans) had lower CSM relative to white patients, with hazard ratios ranging from 0.54 (95% CI = 0.38 to 0.78) to 0.88 (95% CI = 0.84 to 0.93) for Japanese patients with prostate and Chinese patients with lung cancer, respectively. CONCLUSIONS Despite adjustment for potential confounders, including the receipt of definitive treatment and tumor characteristics, most Asian subgroups had better CSM than non-Hispanic white patients. These findings suggest that underlying genetic/biological differences, along with potential cultural variations, may impact survival in Asian American cancer patients.
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Affiliation(s)
- Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Paul L Nguyen
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Jeffrey J Leow
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Deepansh Dalela
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Grace F Chao
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Brandon A Mahal
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Manan Nayak
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Marianne Schmid
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Toni K Choueiri
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Ayal A Aizer
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
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Monn MF, Bahler CD, Flack CK, Dube HT, Sundaram CP. The Impact of Hospital Volume on Postoperative Complications Following Robot-Assisted Partial Nephrectomy. J Endourol 2014; 28:1231-6. [DOI: 10.1089/end.2014.0265] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M. Francesca Monn
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| | - Clinton D. Bahler
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| | - Chandra K. Flack
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| | - Hitesh T. Dube
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| | - Chandru P. Sundaram
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
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Receipt of best care according to current quality of care measures and outcomes in men with prostate cancer. J Urol 2014; 193:500-4. [PMID: 25108275 DOI: 10.1016/j.juro.2014.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE We evaluated whether patients with prostate cancer who received best care according to a set of 5 nationally endorsed quality measures had decreased treatment related morbidity and improved cancer control. MATERIALS AND METHODS In this retrospective cohort study we included 38,055 men from the SEER (Surveillance, Epidemiology and End Results)-Medicare database treated for localized prostate cancer between 2004 and 2010. We determined whether each patient received best care, defined as care adherent to all applicable measures. We measured associations of best care with the need for interventions, addressing treatment related morbidity, and with the need for secondary cancer therapy using Cox proportional hazards models. RESULTS Only 3,412 men (9.0%) received best care. Five years after treatment these men and men who did not receive best care had a similar likelihood of undergoing procedures for urinary morbidity (prostatectomy subset 10.7% vs 12.9%, p = 0.338) and secondary cancer therapy (prostatectomy for high risk prostate cancer subset 40.9% vs 37.3%, p = 0.522). However, they were more likely to be treated with a procedure for sexual morbidity (prostatectomy 17.3% vs 10.8%, p <0.001). Similar trends were observed in men treated with radiotherapy. CONCLUSIONS Overall men who received best care did not fare better in regard to treatment related morbidity or cancer control. Collectively our findings suggest that the current process of care measures are not tightly linked to outcomes and further research is needed to identify better measures that are meaningful and important to patients.
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Bhojani N, Gandaglia G, Sood A, Rai A, Pucheril D, Chang SL, Karakiewicz PI, Menon M, Olugbade K, Ruhotina N, Sammon JD, Sukumar S, Sun M, Ghani KR, Schmid M, Varda B, Kibel AS, Zorn KC, Trinh QD. Morbidity and Mortality After Benign Prostatic Hyperplasia Surgery: Data from the American College of Surgeons National Surgical Quality Improvement Program. J Endourol 2014; 28:831-40. [DOI: 10.1089/end.2013.0805] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Naeem Bhojani
- Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Giorgio Gandaglia
- Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Akshay Sood
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arun Rai
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Daniel Pucheril
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Steven L. Chang
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Kola Olugbade
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Nedim Ruhotina
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse D. Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Shyam Sukumar
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | | - Marianne Schmid
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Briony Varda
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam S. Kibel
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin C. Zorn
- Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Sun M, Karakiewicz PI, Sammon JD, Sukumar S, Gervais MK, Nguyen PL, Choueiri TK, Menon M, Trinh QD. Disparities in selective referral for cancer surgeries: implications for the current healthcare delivery system. BMJ Open 2014; 4:e003921. [PMID: 24657917 PMCID: PMC3963094 DOI: 10.1136/bmjopen-2013-003921] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Among considerable efforts to improve quality of surgical care, expedited measures such as a selective referral to high-volume institutions have been advocated. Our objective was to examine whether racial, insurance and/or socioeconomic disparities exist in the use of high-volume hospitals for complex surgical oncological procedures within the USA. DESIGN, SETTING AND PARTICIPANTS Patients undergoing colectomy, cystectomy, oesophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy or prostatectomy were identified retrospectively, using the Nationwide Inpatient Sample, between years 1999 and 2009. This resulted in a weighted estimate of 2 508 916 patients. PRIMARY OUTCOME MEASURES Distribution of patients according to race, insurance and income characteristics was examined according to low-volume and high-volume hospitals (highest 20% of patients according to the procedure-specific mean annual volume). Generalised linear regression models for prediction of access to high-volume hospitals were performed. RESULTS Insurance providers and county income levels varied differently according to patients' race. Most Caucasians resided in wealthier counties, regardless of insurance types (private/Medicare), while most African Americans resided in less wealthy counties (≤$24 999), despite being privately insured. In general, Caucasians, privately insured, and those residing in wealthier counties (≥$45 000) were more likely to receive surgery at high-volume hospitals, even after adjustment for all other patient-specific characteristics. Depending on the procedure, some disparities were more prominent, but the overall trend suggests a collinear effect for race, insurance type and county income levels. CONCLUSIONS Prevailing disparities exist according to several patient and sociodemographic characteristics for utilisation of high-volume hospitals. Efforts should be made to directly reduce such disparities and ensure equal healthcare delivery.
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Affiliation(s)
- Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
| | - Shyam Sukumar
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
| | - Mai-Kim Gervais
- Division of General Surgery, University of Montreal Health Center, Montreal, Canada
| | - Paul L Nguyen
- Department of Radiation Oncology Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
| | - Quoc-Dien Trinh
- Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Ghani KR, Sukumar S, Sammon JD, Rogers CG, Trinh QD, Menon M. Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample. J Urol 2013; 191:907-12. [PMID: 24184365 DOI: 10.1016/j.juro.2013.10.099] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE We determined practice patterns and perioperative outcomes of open and minimally invasive partial nephrectomy in the United States since the introduction of a robot-assisted modifier in the Nationwide Inpatient Sample. MATERIALS AND METHODS We identified all patients with nonmetastatic disease treated with open, laparoscopic or robotic partial nephrectomy in the Nationwide Inpatient Sample between October 2008 and December 2010. Utilization rates were assessed by year, patient and hospital characteristics. We evaluated the perioperative outcomes of open vs robotic and open vs laparoscopic partial nephrectomy using binary logistic regression models adjusted for patient and hospital covariates. RESULTS In a weighted sample of 38,064 partial nephrectomies 66.9%, 23.9% and 9.2% of the procedures were open, robotic and laparoscopic operations, respectively. In 2010 the relative annual increase in open, robotic and laparoscopic partial nephrectomy was 7.9%, 45.4% and 6.1%, respectively. Compared to open partial nephrectomy patients treated with minimally invasive partial nephrectomy were less likely to receive blood transfusion (robotic vs laparoscopic OR 0.56, p <0.001 vs OR 0.68, p = 0.016), postoperative complication (OR 0.63, p <0.001 vs OR 0.78, p <0.009) or prolonged length of stay (OR 0.27 vs OR 0.41, each p <0.001). Only patients who underwent the robotic procedure were less likely to experience an intraoperative complication (robotic vs laparoscopic OR 0.69, p = 0.014 vs OR 0.67, p = 0.069). Excess hospital charges were higher after robotic surgery (OR 1.35, p <0.001). CONCLUSIONS The dissemination of robotic surgery for partial nephrectomy in the United States has been rapid and safe. Compared to open partial nephrectomy the robotic procedure had lower odds than laparoscopic partial nephrectomy for most study outcomes except hospital charges. Robotic partial nephrectomy has now supplanted laparoscopic partial nephrectomy as the most common minimally invasive approach for partial nephrectomy.
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Affiliation(s)
- Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan.
| | - Shyam Sukumar
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Quoc-Dien Trinh
- Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
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