1
|
Karvonen KA, Balay-Dustrude E, Do A, Bradford MC, Phipps A, Rosenberg AR. Race, ethnicity, and experienced racism are associated with adverse physical and mental health outcomes among cancer survivors. Cancer 2023; 129:3023-3033. [PMID: 37394987 DOI: 10.1002/cncr.34913] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Survivors of cancer are at risk for adverse mental and physical health outcomes. It is not well understood, however, how these outcomes are differentially experienced according to an individual's exposure to racism. This study sought to evaluate associations of race/ethnicity, and experiences of racism, with adverse health outcomes in survivors of cancer. METHODS Using the Behavioral Risk Factor Surveillance System database, data from 48,200 survivors between 2014 and 2020 were evaluated. Survey items included negative physical and emotional symptoms as a result of race-based treatment. Outcomes of interest included days of poor mental and physical health, activity limitations, depression, and inadequate sleep. Associations using prevalence ratios were evaluated. RESULTS All historically marginalized racial/ethnic groups were more likely to experience at least one adverse health outcome compared with non-Hispanic White survivors. Those who physically experienced racism were 2.1 (95% CI, 1.64-2.69) times as likely to report poor physical health, 3.51 (95% CI, 2.61-4.71) times as likely to report poor mental health, 2.14 (95% CI, 1.77-2.58) times as likely to report inadequate sleep, 2.33 (95% CI: 1.91-2.83) times as likely to report depression, and 1.42 (95% CI, 1.04-1.93) times as likely to report activity limitations compared with those who have not experienced racism. Similar associations were observed for emotionally experienced racism. DISCUSSION Racial inequities in health outcomes for survivors of cancer from marginalized racial/ethnic groups are well-established. Experienced racism contributes to adverse health outcomes and widens these disparities. Improving outcomes for survivors of cancer may require screening for experienced racism. PLAIN LANGUAGE SUMMARY Survivors of cancer from marginalized racial/ethnic populations are more likely to have poor mental and physical health than their non-Hispanic White counterparts. Whether survivors from certain racial/ethnic populations of smaller size also have poorer health is less well understood. Generally, individuals who report experienced racism also report poor health, this association has not been studied in survivors of cancer. This study, from a national survey of survivors of cancer, describes disparities in health outcomes experienced by a variety of racial and ethnic populations. Our findings suggest racism is associated with poor mental and physical health in survivors of cancer.
Collapse
Affiliation(s)
- Kristine A Karvonen
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erin Balay-Dustrude
- Division of Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Annie Do
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
- Health Economics and Outcomes Research, CHOICE Institute, University of Washington School of Pharmacy, Seattle, Washington, USA
| | - Miranda C Bradford
- Core for Biostatistics, Epidemiology, and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Amanda Phipps
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Abby R Rosenberg
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, Massachusetts, USA
- Boston Children's Hospital, Pediatric Palliative Care Program, Boston, Massachusetts, USA
- Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Roubidoux MA, Kaur JS, Rhoades DA. Health Disparities in Cancer Among American Indians and Alaska Natives. Acad Radiol 2022; 29:1013-1021. [PMID: 34802904 DOI: 10.1016/j.acra.2021.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022]
Abstract
American Indians and Alaska Natives (AI/AN) are underserved populations who suffer from several health disparities, 1 of which is cancer. Malignancies, especially cancers of the breast, liver, and lung, are common causes of death in this population. Health care disparities in this population include more limited access to diagnostic radiology because of geographic and/or health system limitations. Early detection of these cancers may be enabled by improving patient and physician access to medical imaging. Awareness by the radiology community of the cancer disparities among this population is needed to support research targeted to this specific ethnic group and to support outreach efforts to provide more imaging opportunities. Providing greater access to imaging facilities will also improve patient compliance with screening recommendations, ultimately improving mortality in these populations.
Collapse
Affiliation(s)
- Marilyn A Roubidoux
- Department of Radiology, Michigan Medicine, TC 2910, 1500 E. Medical Center Drive, Ann Arbor, Mi 48109-5326.
| | - Judith S Kaur
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Dorothy A Rhoades
- Department of Internal Medicine, Stephenson Cancer Center and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| |
Collapse
|
3
|
Erdrich J, Cordova-Marks F, Monetathchi AR, Wu M, White A, Melkonian S. Disparities in Breast-Conserving Therapy for Non-Hispanic American Indian/Alaska Native Women Compared with Non-Hispanic White Women. Ann Surg Oncol 2022; 29:1019-1030. [PMID: 34490527 PMCID: PMC8724083 DOI: 10.1245/s10434-021-10730-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about the surgical patterns of American Indian/Alaska Native (AI/AN) breast cancer patients. The purpose of this study is to determine whether there are disparities in breast cancer surgery and radiation therapy between non-Hispanic AI/AN (NH-AI/AN) women and non-Hispanic White (NHW) women. METHODS Data from the National Program of Cancer Registries of the Centers for Disease Control and Surveillance, Epidemiology, and End Results were used for this cross-sectional study. Female patients with invasive breast cancer diagnosed 2010-2015 were stratified by race/ethnicity, surgical procedure, radiation, and region. Percentage distributions of mastectomy and lumpectomy were compared overall and by region and stage. RESULTS From 2010 to 2015 there were 3292 NH-AI/AN women and 165,225 NHW women diagnosed with breast cancer. For early stage (AJCC stage 1 and 2), NH-AI/AN women had overall significantly higher percentage of mastectomy (41% vs 34.4%, p < 0.001) and significantly lower percentage of lumpectomy (59% vs 65.6%) compared with NHW women, without significant differences in post-lumpectomy radiation (71% vs 70%). There were regional variations, notably in the Northern Plains, where the percentage of mastectomy for early-stage disease was 48.9% for NH-AI/AN women versus 35.9% for NHW women, and in Alaska with 47% for NH-AI/AN women versus 33.3% for NHW women (p < 0.001). There were no overall significant differences in type of surgery or radiation for late-stage disease between groups. CONCLUSION This is the first study to show disparities in surgical management of NH-AI/AN women with breast cancer. For early-stage disease, NH-AI/AN women undergo a higher percentage of mastectomy. Future clinical directions could focus on the factors that drive awareness, decision-making, and access to breast conservation.
Collapse
Affiliation(s)
- Jennifer Erdrich
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA.
| | - Felina Cordova-Marks
- Department of Health Promotion Sciences, College of Public Health, University of Arizona, Tucson, USA
| | | | - Manxia Wu
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, USA
| | - Arica White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, USA
| | - Stephanie Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, USA
| |
Collapse
|
4
|
Lee E, Wen P. Gender and sex disparity in cancer trials. ESMO Open 2021; 5:e000773. [PMID: 32816862 PMCID: PMC7440710 DOI: 10.1136/esmoopen-2020-000773] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/27/2022] Open
Abstract
The study population within phase III clinical trials leading to approval of new cancer agents should ideally more closely mirror the population who will ultimately receive these agents. Although the number of females participating in clinical trials has increased over the past several decades, females are still under-represented in preclinical studies, in early phase clinical trials and even in some later phase cancer clinical trials. In the USA, this is particularly true for women from minority populations and elderly women. In this review, we review gender and sex disparities in cancer trials, the reasons for these disparities, the barriers to clinical trial enrolment and ways to improve diversity in cancer clinical trials.
Collapse
Affiliation(s)
- Eudocia Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Patrick Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Garvey G, Cunningham J, Mayer C, Letendre A, Shaw J, Anderson K, Kelly B. Psychosocial Aspects of Delivering Cancer Care to Indigenous People: An Overview. JCO Glob Oncol 2021; 6:148-154. [PMID: 32031444 PMCID: PMC6998016 DOI: 10.1200/jgo.19.00130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Globally, a growing body of evidence has reported significant disparities in cancer outcomes between indigenous and nonindigenous people. Although some effort is being made to address these disparities, relatively little attention has been directed toward identifying and focusing on the psychosocial aspects of cancer care for indigenous patients, which are critical components in improving cancer care and outcomes. The purpose of this article is to describe the results of a scoping review of the psychosocial aspects of cancer care for indigenous people. We highlight considerations in undertaking research in this field with indigenous people and the implications for clinical practice.
Collapse
Affiliation(s)
- Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Carole Mayer
- Health Sciences North Research Institute, Sudbury, Ontario, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angeline Letendre
- Alberta Cancer Prevention Legacy Fund, Alberta Health Services, Edmonton, Alberta, Canada
| | - Joanne Shaw
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Kate Anderson
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Brian Kelly
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
6
|
Coughlin SS, Chen J, Cortes JE. Health care access and utilization among adult cancer survivors: Results from the National Institutes of Health "All of Us" Research Program. Cancer Med 2021; 10:3646-3654. [PMID: 33942535 PMCID: PMC8178490 DOI: 10.1002/cam4.3924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 01/06/2023] Open
Abstract
Background Many cancer survivors face financial difficulties that prevent them from receiving appropriate health care. Racial/ethnic disparities in receipt of health care have been reported among cancer survivors, but recent data for important racial/ethnic subgroups of the US population are lacking. Methods To learn more about barriers to healthcare access faced by cancer survivors, we analyzed data from the NIH “All of Us” Research Program. Data were analyzed about demographic factors and other personal characteristics, personal medical history of cancer, healthcare utilization, and access to care. Results As of November 2020, a total of 5426 participants had a history of cancer (excluding skin cancer). About 88.2% were non‐Hispanic White; 3.9% were Black, African American, or African; 1.3% were Asian; 4.1% were Hispanic, Latino, or Spanish; and 1.2% reported more than one race. Just over one‐half had an annual income of $75,000 or greater. The majority of the participants (71.7%) were college graduates or had an advanced degree. About 47.0%% had private health insurance, 41.0% had Medicare, 6.0% had Medicaid, and the remainder had military, Veterans Affairs, other insurance, or no health insurance. Frequently cited reasons for delayed care in the past 12 months were “had to pay out of pocket for some or all of the procedures,” “deductible was too high/or could not afford the deductible,” “couldn't afford the copay,” “couldn't get time off work,” and “were nervous about seeing a health care provider.” Discussion A minority of cancer survivors who participated in the NIH “All of Us” Program had difficulty paying for health care in the past 12 months. Of particular concern are minorities such as African American and Hispanic cancer survivors along with those who are low income. Many cancer survivors face financial problems that prevent them from receiving timely and recommended health care. A minority of cancer survivors who participated in the NIH “All of Us” Research Program had difficulty paying for health care in the past 12 months. Of particular concern are minorities such as African American and Hispanic cancer survivors along with those who are low income.
Collapse
Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Jie Chen
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Jorge E Cortes
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Georgia Cancer Center, Augusta University, Augusta, GA, USA
| |
Collapse
|
7
|
Marmor S, Longacre CF, Altman AM, Hui JYC, Jensen EH, Tuttle TM. Genomic expression assay testing among American Indian and Alaska Native women with breast cancer. Cancer 2020; 126:5222-5229. [PMID: 32926435 DOI: 10.1002/cncr.33150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Breast cancer is one of the most common causes of cancer mortality for all women, including American Indian and Alaska Native (AI/AN) women. The use of the 21-gene recurrence score (RS) appears to be predictive of the benefit of chemotherapy for women with estrogen receptor (ER)-positive breast cancer. The objective of the current study was to compare RS testing between AI/AN and non-Hispanic White (NHW) women with breast cancer. METHODS The Surveillance, Epidemiology, and End Results program was used to identify women with ER-positive breast cancer from 2004 through 2015. Multivariable logistic regression was used to evaluate factors associated with RS use, with high-risk RS, and with chemotherapy use among those with a high-risk RS. RESULTS A total of 363,387 NHW patients and 1951 AI/AN patients with ER-positive breast cancer were identified. AI/AN women were found to be less likely to undergo RS testing and, when tested, were more likely to have a high-risk RS. In the multivariable logistic regression analysis, AI/AN women were found to be significantly more likely to have a high-risk RS (odds ratio,1.28; 95% confidence interval, 1.01-1.66). Among untested women, chemotherapy use was higher for AI/AN women; however, the use of chemotherapy was not found to be significantly different between the groups with a high-risk RS. Using Cox proportional hazards models, AI/AN race was found to be significantly associated with worse overall survival. CONCLUSIONS AI/AN women were less likely to undergo RS testing compared with NHW women and were more likely to have a high-risk RS. Reversing the disparity in genomic expression assay testing is critical to ensure guideline-based breast cancer treatment and improve survival rates for AI/AN women with breast cancer.
Collapse
Affiliation(s)
- Schelomo Marmor
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Colleen F Longacre
- Department of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Ariella M Altman
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jane Y C Hui
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Eric H Jensen
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| |
Collapse
|
8
|
Abstract
American Indians and Alaska Natives (AIANs) have been documented as a population with high rates of cancer mortality in comparison to other racial and ethnic groups in the United States. During a time when other populations in the United States are experiencing improvements in cancer outcomes, cancer disparities in AIANs persist. The disparities in cancer outcomes in this diverse population can be attributed to a complex constellation of factors, which include access-to-care, economic, medical, and individual barriers, and mistrust and disenfranchisement.
Collapse
|
9
|
Narendra A, Baade PD, Aitken JF, Fawcett J, Smithers BM. Impact of hospital resection volume and service capability on post‐operative mortality following gastrectomy. ANZ J Surg 2019; 90:86-91. [DOI: 10.1111/ans.15616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Aaditya Narendra
- Upper‐GI, Soft Tissue and Melanoma Unit, Princess Alexandra HospitalThe University of Queensland Brisbane Queensland Australia
| | | | - Joanne F. Aitken
- Cancer Council Queensland Brisbane Queensland Australia
- The University of Queensland, University of Southern Queensland Brisbane Queensland Australia
| | - Jonathan Fawcett
- Hepato‐Pancreatico‐Biliary Unit, Princess Alexandra HospitalThe University of Queensland Brisbane Queensland Australia
| | - B. Mark Smithers
- Upper‐GI, Soft Tissue and Melanoma Unit, Princess Alexandra HospitalThe University of Queensland Brisbane Queensland Australia
- Cancer Alliance QueenslandThe University of Queensland Brisbane Queensland Australia
| |
Collapse
|
10
|
Gachupin FC, Garcia CA, Romero MD. An American Indian Patient Experience. J Health Care Poor Underserved 2019; 30:62-65. [PMID: 31735719 DOI: 10.1353/hpu.2019.0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
11
|
Liu G, Xu M, Gao T, Xu L, Zeng P, Bo H, Li F, Zhang W, Wang Z. Surgical Compliance and Outcomes in Gastric Cancer: a population-based cohort study. J Cancer 2019; 10:779-788. [PMID: 30854083 PMCID: PMC6400806 DOI: 10.7150/jca.29073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/09/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Surgical resection is one of curative treatment for gastric cancer (GC), however, a set of patients show poor surgical compliance in the USA. We aimed to identify the risk factors associated with surgical compliance and investigate the difference in survival. Methods: GC patients diagnosed between 1973 and 2014 were identified from the Surveillance Epidemiology and End Results (SEER) databases. Based on different surgical compliance and treatment regimen, patients were classified into three subgroups: surgical compliance group, surgical noncompliance group, and non-surgical group. Multivariable Logistic regression analysis was adopted to identify the factors related to surgical compliance; Multivariable Cox regression was used to investigate the prognostic factors. Overall survival (OS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier estimator method. Results: Of 79374 GC patients who were recommended for surgical therapy, 15201(19.2%) cases did not perform surgery. Poor compliance of surgery was related to old age, American Indian/Alaska Native race, poor grading/late staging, single/widowed status, lower socioeconomic status and earlier time of diagnosis. As expected, GC patients of surgical compliance group showed significantly more favorable survival than the other two groups (P<0.0001); notably, the outcome of surgical noncompliance group came close to that of non-surgical group. Conclusion: GC patients of poor surgical compliance demonstrated adverse survival, which was comparable to that of non-surgical patients. The poor surgical compliance was associated with older age, American Indian/Alaska Native race, poor tissue differentiation/advanced stage of tumor, single/widowed status, lower socioeconomic status and earlier time of diagnosis.
Collapse
Affiliation(s)
- Guihua Liu
- Department of General Practice, Zhongshan Street Community Health Center of Songjiang District, Shanghai, 201600, China
| | - Ming Xu
- Department of General Surgery, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China
| | - Tingting Gao
- Department of General Practice, Zhongshan Street Community Health Center of Songjiang District, Shanghai, 201600, China
| | - Lingying Xu
- Department of General Practice, Zhongshan Street Community Health Center of Songjiang District, Shanghai, 201600, China
| | - Peijun Zeng
- Department of General Practice, Zhongshan Street Community Health Center of Songjiang District, Shanghai, 201600, China
| | - Haiying Bo
- Department of General Practice, Zhongshan Street Community Health Center of Songjiang District, Shanghai, 201600, China
| | - Fang Li
- Department of General Practice, Zhongshan Street Community Health Center of Songjiang District, Shanghai, 201600, China
| | - Wei Zhang
- Department of General Practice, Zhongshan Street Community Health Center of Songjiang District, Shanghai, 201600, China
| | - Zhengting Wang
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China
| |
Collapse
|