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Peterson KJ, Drezdzon MK, Sparapani R, Calata JF, Ridolfi TJ, Ludwig KA, Peterson CY. Traveling Long Distances for Rectal Cancer Care: Institutional Outcomes and Patient Experiences. J Surg Res 2024; 302:916-924. [PMID: 39265279 DOI: 10.1016/j.jss.2024.07.123] [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: 02/25/2024] [Revised: 07/18/2024] [Accepted: 07/24/2024] [Indexed: 09/14/2024]
Abstract
INTRODUCTION Mounting evidence supports traveling to high-volume centers for complex surgical procedures, such as a proctectomy, yet the burden of travel and outcomes of patients traveling long distances is not yet clear. Thus, we aimed to evaluate oncologic outcomes, quality of life, and travel burdens for patients treated for rectal cancer at a single tertiary-care institution. METHODS A retrospective study of patients treated with proctectomy for locally advanced rectal cancer was performed comparing long and short travel distance (STD) cohorts. Primary outcome measures included overall mortality, disease recurrence, and quality of life. Secondary outcomes included out-of-pocket expenses. The cohorts were compared using Wilcoxon rank-sum and Chi-square tests for continuous and categorical variables, respectively. Kaplan-Meier plots were created to evaluate overall and disease-free survival. RESULTS Among 102 patients, 51 (50%) were classified as long travel distance (LTD, mean 57.8 miles) and 51 (50%) were classified as STD (mean 12.8 miles). There was no statistical difference in 5-y mortality (4% LTD versus 4% STD, P = 1.000), disease recurrence (26% LTD versus 18% STD, P = 0.336), or quality of life (0.85 LTD versus 0.87 STD, P = 0.690). The LTD cohort did have significantly lower postresection compliance with surveillance (84% LTD versus 96% STD, P = 0.046). LTD cohort also had significantly more lodging ($77.1 LTD versus $0 STD, P = 0.025) and transportation expenses ($133.6 LTD versus $92.6 STD, P = 0.010). CONCLUSIONS As the surgical management of rectal cancer becomes increasingly centralized, this study found patients who traveled long-distances received comparable care with outcomes similar to those who lived locally. Higher travel costs and lower compliance with surveillance were identified as barriers to care in the long-distance population, but a number of solutions can be implemented to address these issues.
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Affiliation(s)
- Kent J Peterson
- Division of Colon and Rectal Surgery, Department of Surgery, Milwaukee, Wisconsin
| | - Melissa K Drezdzon
- Division of Colon and Rectal Surgery, Department of Surgery, Milwaukee, Wisconsin
| | - Rodney Sparapani
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jed F Calata
- Division of Colon and Rectal Surgery, Department of Surgery, Milwaukee, Wisconsin
| | - Timothy J Ridolfi
- Division of Colon and Rectal Surgery, Department of Surgery, Milwaukee, Wisconsin
| | - Kirk A Ludwig
- Division of Colon and Rectal Surgery, Department of Surgery, Milwaukee, Wisconsin
| | - Carrie Y Peterson
- Division of Colon and Rectal Surgery, Department of Surgery, Milwaukee, Wisconsin.
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Harris CS, Groman A, Sigurdson SL, Magner WJ, Singh AK, Gupta V. Retrospective Cohort Study on the Impact of Travel Distance on Late-Stage Oral Cancer Treatment and Outcomes: An NCDB Analysis. Cancers (Basel) 2024; 16:2750. [PMID: 39123477 PMCID: PMC11311623 DOI: 10.3390/cancers16152750] [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: 04/29/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
The National Comprehensive Cancer Network guidelines provide evidence-based consensus for optimal individual site- and stage-specific treatments. This is a cohort study of 11,121 late-stage oral cancer patients in the National Cancer Database from 2010 to 2016. We hypothesized that patient travel distance may affect treatment choices and impact outcome. We split travel distance (miles) into quartiles (D1-4) and assessed treatment choices, type of facility, and survival outcome in relation to distance traveled. Univariate and multivariate analyses addressed contributions of specific variables. White patients were most likely to travel farthest (D4) for treatment compared to Black patients (D1). Urban area patients traveled shorter distances than those from rural areas. Greater travel distance was associated with patients undergoing surgical-based therapies and treatment at academic centers. Patients in D1 had the lowest median survival of all distance quartiles. Surgery-based multimodality treatment (surgery and radiation) had a median survival significantly greater than for non-surgical therapy. Several factors including travel distance and treatment facility were associated with survival outcomes for late-stage oral cavity cancers. Consideration of these factors may help improve the outcome for this patient population.
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Affiliation(s)
- Courtney S. Harris
- Roswell Park Summer Research Experience Program in Cancer Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
- College of Arts and Sciences, Cornell University, Ithaca, NY 14850, USA
- Weill Medical College, Cornell University, New York, NY 10065, USA
| | - Adrienne Groman
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - S. Lynn Sigurdson
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - William J. Magner
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - Anurag K. Singh
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - Vishal Gupta
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
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Patel AM, Haleem A, Choudhry HS, Brody RM, Brant JA, Carey RM. Elective Neck Dissection in cT1-4 N0M0 Head and Neck Basaloid Carcinoma. Otolaryngol Head Neck Surg 2024; 171:457-470. [PMID: 38613196 DOI: 10.1002/ohn.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To investigate the survival benefit of elective neck dissection (END) over neck observation in surgically resected cT1-4 N0M0 head and neck basaloid carcinoma (HNBC). STUDY DESIGN Retrospective cohort study. SETTING The 2006 to 2017 hospital-based National Cancer Database. METHODS Patients with surgically resected cT1-4 N0M0 HNBC were selected. Linear, binary logistic, Kaplan-Meier, and Cox proportional hazards regression models were implemented. RESULTS Of 857 patients satisfying inclusion criteria, the majority were male (77.0%) and white (88.1%) with disease of the oral cavity (21.5%) or oropharynx (42.9%) classified as high grade (76.9%) and cT1-2 (72.9%). 389 (45.4%) patients underwent END. END utilization between 2006 and 2017 increased for cT1-2 disease (33.3% vs 56.9%, R2 = .699) but remained relatively constant for cT3-4 disease (66.7% vs 57.9%, R2 = .062). One-hundred and fifteen (29.6%) ENDs detected occult nodal metastases (ONMs). The 5-year overall survival (OS) of patients undergoing neck observation and END was 65.6% and 66.8%, respectively (P = .652). END was not associated with improved OS in survival analyses stratified by patient demographics, clinicopathologic features, and adjuvant therapy. Compared with surgery alone, adjuvant radiotherapy (adjusted hazard ratio: 0.74, 95% confidence interval [CI]: 0.57-0.97, P = .031) was associated with improved OS. END (hazard ratio [HR]: 0.96, 95% CI: 0.71-1.28, P = .770) and ONM (HR: 1.12, 95% CI: 0.78-1.61, P = .551) were not associated with OS. CONCLUSION END is performed in nearly half of patients with HNBC but is not associated with improved OS, even after stratifying survival analyses by patient demographics, clinicopathologic features, and adjuvant therapy. The rate of ONM approaching 30%, however, justifies inclusion of END in the surgical management of HNBC.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hassaam S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Vasan V, Gilja S, Kapustin D, Yun J, Roof SA, Chai RL, Khan MN, Rubin SJ. The impact of distance to facility on treatment modality, short-term outcomes, and survival of patients with HPV-positive oropharyngeal squamous cell carcinoma. Am J Otolaryngol 2024; 45:104356. [PMID: 38703611 DOI: 10.1016/j.amjoto.2024.104356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE This study compared treatment and outcomes for patients with HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) based on their travel distance to treatment facility. MATERIALS AND METHODS Patients with cT1-4, N0-3, M0 HPV-positive OPSCC in the National Cancer Database from 2010 to 2019 were identified and split into four quartiles based on distance to facility, with quartile 4 representing patients with furthest travel distances. Multivariable-adjusted logistic regression and Cox proportional hazards modeling were used to analyze the primary outcome of treatment received, and secondary outcomes of clinical stage, overall survival, surgical approach (i.e., TORS versus other), and 30-day surgical readmissions. RESULTS 17,207 patients with HPV-positive OPSCC were evenly distributed into four quartiles. Compared to patients in quartile 1, patients in quartile 4 were 40 % less likely to receive radiation versus surgery (OR = 0.60; 95 % CI = 0.54-0.66). Among the patients who received surgery, quartile 4 had a higher odds of receiving TORS treatment compared to quartile 1 (4v1: OR = 2.38; 95 % CI = 2.05-2.77), quartile 2 (4v2: OR = 2.31, 95 % CI = 2.00-2.66), and quartile 3 (4v3: OR = 1.75; 95 % CI = 1.54-1.99). Quartile 4 had a decreased odds of mortality compared to Quartile 1 (4v1: OR = 0.87; 95 % CI = 0.79-0.97). There were no differences among the quartiles in presenting stage and 30-day readmissions. CONCLUSIONS This study found that patients with furthest travel distance to facility were more often treated surgically over non-surgical management, with TORS over open surgery, and had better overall survival. These findings highlight potential disparities in access to care for patients with HPV-positive OPSCC.
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Affiliation(s)
- Vikram Vasan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shivee Gilja
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Danielle Kapustin
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun Yun
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Scott A Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mohemmed N Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel J Rubin
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Duckett KA, Kassir MF, Nguyen SA, Brennan EA, Chera BS, Sterba KR, Halbert CH, Hill EG, McCay J, Puram SV, Jackson RS, Sandulache VC, Kahmke R, Osazuwa-Peters N, Ramadan S, Nussenbaum B, Alberg AJ, Graboyes EM. Factors Associated with Head and Neck Cancer Postoperative Radiotherapy Delays: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024. [PMID: 38842034 DOI: 10.1002/ohn.835] [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: 03/03/2024] [Revised: 05/02/2024] [Accepted: 05/12/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Initiating postoperative radiotherapy (PORT) within 6 weeks of surgery for head and neck squamous cell carcinoma (HNSCC) is included in the National Comprehensive Cancer Network Clincal Practice Guidelines and is a Commission on Cancer quality metric. Factors associated with delays in starting PORT have not been systematically described nor synthesized. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS We included studies describing demographic characteristics, clinical factors, or social determinants of health associated with PORT delay (>6 weeks) in patients with HNSCC treated in the United States after 2003. Meta-analysis of odds ratios (ORs) was performed on nonoverlapping datasets. RESULTS Of 716 unique abstracts reviewed, 21 studies were included in the systematic review and 15 in the meta-analysis. Study sample size ranged from 19 to 60,776 patients. In the meta-analysis, factors associated with PORT delay included black race (OR, 1.46, 95% confidence interval [CI]: 1.28-1.67), Hispanic ethnicity (OR, 1.37, 95% CI, 1.17-1.60), Medicaid or no health insurance (OR, 2.01, 95% CI, 1.90-2.13), lower income (OR, 1.38, 95% CI, 1.20-1.59), postoperative admission >7 days (OR, 2.92, 95% CI, 2.31-3.67), and 30-day hospital readmission (OR, 1.37, 95% CI, 1.29-1.47). CONCLUSION Patients at greatest risk for a delay in initiating guideline-adherent PORT include those who are from minoritized communities, of lower socioeconomic status, and experience postoperative challenges. These findings provide the foundational evidence needed to deliver targeted interventions to enhance equity and quality in HNSCC care delivery.
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Affiliation(s)
- Kelsey A Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohamed Faisal Kassir
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- MUSC Libraries, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bhisham S Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Salma Ramadan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Brian Nussenbaum
- American Board of Otolaryngology-Head and Neck Surgery, Houston, Texas, USA
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Whitehead RA, Patel EA, Liu JC, Bhayani MK. Racial Disparities in Head and Neck Cancer: It's Not Just About Access. Otolaryngol Head Neck Surg 2024; 170:1032-1044. [PMID: 38258967 DOI: 10.1002/ohn.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Medical literature identifies stark racial disparities in head and neck cancer (HNC) in the United States, primarily between non-Hispanic white (NHW) and non-Hispanic black (NHB) populations. The etiology of this disparity is often attributed to inequitable access to health care and socioeconomic status (SES). However, other contributors have been reported. We performed a systematic review to better understand the multifactorial landscape driving racial disparities in HNC. DATA SOURCES A systematic review was conducted in Covidence following Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines. A search of PubMed, SCOPUS, and CINAHL for literature published through November 2022 evaluating racial disparities in HNC identified 2309 publications. REVIEW METHODS Full texts were screened by 2 authors independently, and inconsistencies were resolved by consensus. Three hundred forty publications were ultimately selected and categorized into themes including disparities in access/SES, treatment, lifestyle, and biology. Racial groups examined included NHB and NHW patients but also included Hispanic, Native American, and Asian/Pacific Islander patients to a lesser extent. RESULTS Of the 340 articles, 192 focused on themes of access/SES, including access to high-quality hospitals, insurance coverage, and transportation contributing to disparate HNC outcomes. Additional themes discussed in 148 articles included incongruities in surgical recommendations, tobacco/alcohol use, human papillomavirus-associated malignancies, and race-informed silencing of tumor suppressor genes. CONCLUSION Differential access to care plays a significant role in racial disparities in HNC, disproportionately affecting NHB populations. However, there are other significant themes driving racial disparities. Future studies should focus on providing equitable access to care while also addressing these additional sources of disparities in HNC.
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Affiliation(s)
- Russell A Whitehead
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Evan A Patel
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeffrey C Liu
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Mihir K Bhayani
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Daniels KJ, Gardner J, Solverson M, Davis K, King D, Rose S, Sunde J, Vural E, Moreno MA. Correlating area deprivation index with initial stage at presentation and with follow up and recurrence within an advanced practice provider-led survivorship clinic. Am J Otolaryngol 2024; 45:104095. [PMID: 38039915 DOI: 10.1016/j.amjoto.2023.104095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/29/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Living in disadvantaged neighborhoods has been shown to result in worse healthcare outcomes. The Area Deprivation Index (ADI) is a metric that ranks neighborhoods by socioeconomic disadvantage utilizing numerous factors including income, education, employment, and housing quality. METHODS A retrospective review of all patients who underwent surveillance in an APP-led head and neck cancer survivorship clinic from Dec 2016 to Oct 2020 at an academic tertiary care center were included. Tumor characteristics, visit frequency, recurrence, number of missed appointments, loss of follow up, and ADI scores were collected. RESULTS 543 patients were included in the study. A majority were male (69.9 %) and white race (84.9 %) with an average age of 64.6 years old. Average ADI national percentile score was 71.6(range: 17 to 100). ADI national percentile score was not predictive of tumor characteristics at initial presentation: lymphovascular invasion (p = 0.940; OR 1.0 [95 % CI: 0.9 to 1.1]), extranodal extension (p = 0.576; OR 1.0 [95 % CI: 0.9 to 1.2]), positive margins (p = 0.069; OR 0.9 [95 % CI: 0.9 to 1.0]). ADI national percentile score was not significantly correlated with loss to follow up (p = 0.153; OR 1.2 [95 % CI: 0.9 to 1.7] or cancer recurrence (p = 0.594; OR 1.0 [95 % CI: 0.9 to 1.1]). Missing one or more clinic visits was correlated with loss to follow up (p = 0.029; OR 13.1 [95 % CI: 1.3 to 131.7]. CONCLUSION Living in a disadvantaged neighborhood did not correlate with negative tumor characteristics, loss to follow up, or recurrence within an APP-led survivorship head and neck cancer clinic.
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Affiliation(s)
- Kacee J Daniels
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - James Gardner
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Matt Solverson
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Kyle Davis
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Deanne King
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Samantha Rose
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Jumin Sunde
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Emre Vural
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Mauricio A Moreno
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
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Choi KY, Patel SD, Lane C, Tucker J, Chan K, Pradhan S, Mahase SS, Tam SH, King TS. Elucidating survival and functional outcomes in patients with primary head and neck malignancies treated in academic versus community settings. Head Neck 2024; 46:398-407. [PMID: 38087455 DOI: 10.1002/hed.27588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/19/2023] [Accepted: 11/19/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Differences in treatment outcomes between community or academic centers are incompletely understood. METHODS Retrospective review of head and neck cancer patients between 2010 and 2020 in a rural health region. Kaplan-Meier curves and log-rank tests were used to evaluate survival outcomes, along with bivariate and multivariable Cox proportional hazards models. Linear regression was used for functional outcomes of tracheotomy and gastrostomy tube dependence. RESULTS Two hundred and forty-eight patients treated at an academic center were compared with 94 patients treated in community centers. In multivariable analysis, the risk of death (HR = 0.60, p = 0.019), and risk of recurrence were lower (HR = 0.29, p < 0.001) for patients treated in academic centers. Patients treated in community centers had longer gastrostomy tube dependence (p = 0.002). CONCLUSION Our findings suggest that treatment at an academic center was associated with a lower risk of recurrence and shorter gastrostomy tube dependence compared to treatment in the community.
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Affiliation(s)
- Karen Y Choi
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Shivam D Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ciaran Lane
- Department of Otolaryngology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jacqueline Tucker
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kimberly Chan
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sandeep Pradhan
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sean S Mahase
- Department of Radiation Oncology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Samantha H Tam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Medical Center, Detroit, Michigan, USA
| | - Tonya S King
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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Aden AA, Olawuni FO, Abdel-Halim CN, Zhu AQ, Haller TJ, O'Byrne TJ, Moore EJ, Price DL, Tasche KL, Ma DJ, Lester SC, Gamez M, Neben-Wittich MA, Price K, Fuentes-Bayne HE, Routman D, Van Abel KM. Association Between Social Determinants of Health, Distance from Treatment Center, and Treatment Type with Outcomes in Human Papillomavirus Associated Oropharyngeal cancer. Oral Oncol 2024; 149:106675. [PMID: 38211528 DOI: 10.1016/j.oraloncology.2023.106675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES Social determinants of health (SDOH) can influence access to cancer care, clinical trials, and oncologic outcomes. We investigated the association between SDOH, distance from treatment center, and treatment type with outcomes in human papillomavirus associated oropharyngeal squamous cell carcinoma [HPV(+)OPSCC] patients treated at a tertiary care center. STUDY DESIGN Retrospective review. METHODS HPV(+)OPSCC patients treated surgically from 2006 to 2021 were selected from our departmental Oropharyngeal Cancer RedCap database. Demographic data, treatment, and oncologic outcomes were extracted. Distance was calculated in miles between the centroid of each patient zip code and our hospital zip code (zipdistance). RESULTS 874 patients (89 % male; mean age: 58 years) were identified. Most patients (96 %) reported Non-Hispanic White as their primary race. 204 patients (23 %) had a high-school degree or less, 217 patients (25 %) reported some college education or a 2-year degree, 153 patients (18 %) completed a four-year college degree, and 155 patients (18 %) had post-graduate degrees. Relative to those with a high-school degree, patients with higher levels of education were more likely to live further away from our institution (p < 0.0001). Patients who received adjuvant radiation therapy elsewhere lived, on average, 104 miles further away than patients receiving radiation at our institution (Estimate 104.3, 95 % CI 14.2-194.4, p-value = 0.02). In univariable Cox PH models, oncologic outcomes did not significantly differ by zipdistance. CONCLUSIONS Education level-and access to resources-varied proportionally to a patient's distance from our center. Patients travelling further distances for surgical management of OPSCC were more likely to pursue adjuvant radiation therapy at an outside institution. Distance traveled was not associated with oncologic outcomes. Breaking down barriers to currently excluded populations may improve access to clinical trials and improve oncologic outcomes for diverse patient populations.
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Affiliation(s)
- Aisha A Aden
- Mayo Clinic Alix School of Medicine, MN, United States.
| | - Felicia O Olawuni
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Chadi N Abdel-Halim
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Agnes Q Zhu
- Mayo Clinic Alix School of Medicine, MN, United States
| | - Travis J Haller
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | | | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Kendall L Tasche
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | - Mauricio Gamez
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | | | - Katharine Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | | | - David Routman
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
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10
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Rosas Herrera AM, Haskins AD, Hanania AN, Jhaveri PM, Chapman CH, Huang Q, Hernandez DJ. Timely delivery of PORT for head and neck squamous cell carcinoma in a county hospital. Laryngoscope Investig Otolaryngol 2024; 9:e1211. [PMID: 38362185 PMCID: PMC10866599 DOI: 10.1002/lio2.1211] [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: 09/13/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024] Open
Abstract
Objectives The objective of this study was to compare the rate of post-operative radiation therapy (PORT) initiation within 6 weeks for head and neck squamous cell carcinoma patients treated at a safety net, academic institutio between 2019 and 2021 versus those treated in 2022 after implementation of a new clinical pathway. Methods A retrospective case-control study was performed at a single tertiary care, safety-net, academic institution. Patient demographics, tumor characteristics, dates of surgery, and other treatment dates were collected from the electronic medical record. The time from surgery to PORT was calculated. Patients who started radiation treatment within 42 days of surgery were regarded as having started PORT on time. The demographics, tumor characteristics, and rate of timely PORT for the two cohorts of patients were compared. Results From 2018 to 2021, our rate of PORT initiation within 6 weeks of surgery was 12% (n = 57). In 2022, our rate of timely PORT was 88% (n = 16), p < 0.5. Patient demographics and characteristics were similar with the exception of marital status and use of free-flap reconstruction. The 2022 cohort was more likely to be single (p < 0.5), and all patients underwent free-flap reconstruction in 2022 (p < 0.05). Conclusion Early referrals, frequent communication, and use of a secure registry were the key to the success found by our group despite the socioeconomic challenges of our underserved, safety-net hospital patient population. The changes made at our institution should serve as a template for other institutions seeking to improve the quality of care for their HNSCC patients.
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Affiliation(s)
- Ana Maria Rosas Herrera
- Bobby R. Alford Department of Otolaryngology – Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Angela D. Haskins
- Bobby R. Alford Department of Otolaryngology – Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Alexander N. Hanania
- Department of Radiation Oncology, Dan L. Duncan Cancer CenterBaylor College of MedicineHoustonTexasUSA
| | - Pavan M. Jhaveri
- Department of Radiation Oncology, Dan L. Duncan Cancer CenterBaylor College of MedicineHoustonTexasUSA
| | - Christina H. Chapman
- Department of Radiation Oncology, Dan L. Duncan Cancer CenterBaylor College of MedicineHoustonTexasUSA
| | - Quillan Huang
- Section of Hematology and Oncology, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - David J. Hernandez
- Bobby R. Alford Department of Otolaryngology – Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
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11
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Solsky I, Patel A, Leonard G, Russell G, Perry K, Votanopoulos KI, Shen P, Levine EA. Distance Traveled and Disparities in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2024; 31:1035-1048. [PMID: 37980711 DOI: 10.1245/s10434-023-14469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/05/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The impact of distance traveled on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) outcomes needs further investigation. METHODS This retrospective study reviewed a prospectively managed single-center CRS/HIPEC 1992-2022 database. Zip codes were used to calculate distance traveled and to obtain data on income and education via census data. Patients were separated into three groups based on distance traveled in miles (local: ≤50 miles, regional: 51-99 miles, distant: ≥100 miles). Descriptive statistics, Kaplan-Meier method, and Cox regression were performed. RESULTS The 1614 patients in the study traveled a median distance of 109.5 miles (interquartile range [IQR], 53.36-202.29 miles), with 23% traveling locally, 23.9% traveling regionally, and 53% traveling distantly. Those traveling distantly or regionally tended to be more white (distant: 87.8%, regional: 87.2%, local: 83.2%), affluent (distant: $61,944, regional: $65,014, local: $54,390), educated (% without high school diploma: distant: 10.6%, regional: 11.5%, local: 13.0%), less often uninsured (distant: 2.3%, regional: 4.6%, local: 5.2%) or with Medicaid (distant: 3.3%, regional: 1.3%, local: 9.7%). They more often had higher Peritoneal Carcinomatosis Index (PCI) scores (distant: 15.4, regional: 15.8, local: 12.7) and R2 resections (distant: 50.3%, regional: 52.2%, local: 40.5%). Median survival did not differ between the groups, and distance traveled was not a predictor of survival. CONCLUSION More than 50% of the patients traveled farther than 100 miles for treatment. Although regionalization of CRS/HIPEC may be appropriate given the lack of survival difference based on distance traveled, those who traveled further had fewer health care disparities but higher PCI scores and more R2 resections, which raises concerns about access to care for the underserved, time to treatment, and surgical quality.
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Affiliation(s)
- Ian Solsky
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Ana Patel
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Grey Leonard
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Gregory Russell
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Kathleen Perry
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | | | - Perry Shen
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Edward A Levine
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
- Division of Surgical Oncology, Department of General Surgery, Medical Center Boulevard, Winston-Salem, NC, USA.
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12
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Fei-Zhang DJ, Chelius DC, Sheyn AM, Rastatter JC. Large-data contextualizations of social determinant associations in pediatric head and neck cancers. Curr Opin Otolaryngol Head Neck Surg 2023; 31:424-429. [PMID: 37712774 DOI: 10.1097/moo.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
PURPOSE OF REVIEW Prior investigations in social determinants of health (SDoH) and their impact on pediatric head and neck cancers are limited by the narrow scope of cancer types and SDoH being studied while lacking inquiry on the interrelational contribution of varied SDoH in real-world contexts. The purpose of this review is to discuss the current research tackling these shortcomings of SDoH-based studies in head and neck cancer and to discuss means of applying these findings in prospective initiatives and implementations. RECENT FINDINGS Through leveraging contemporary, large-data analyses measuring diverse social vulnerabilities, several studies have identified comprehensive delineations of which social disparities contribute the largest quantifiable impact on the care of head and neck cancer patients. Progressing from prior SDoH-based research of the decade, these studies contextualize the effect of social vulnerabilities and have laid the foundations to begin addressing these issues in the complex, modern-day environment of interrelatedsocial factors. SUMMARY Social determinants of health markedly affect pediatric head and neck cancer care and prognosis in complex and surprising ways. Modern-day tools and analyses derived from large-data techniques have unveiled the quantifiable underpinnings of how SDoH impact these pathologies.
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Affiliation(s)
| | - Daniel C Chelius
- Department of Otolaryngology-Head and Neck Surgery, Pediatric Thyroid Tumor Program and Pediatric Head and Neck Tumor Program, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Anthony M Sheyn
- Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center
- Department of Pediatric Otolaryngology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee
| | - Jeff C Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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13
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Farquhar DR, Masood MM, Lenze NR, Tasoulas J, Sheth S, Lumley C, Blumberg J, Yarbrough WG, Zevallos J, Weissler MC, Zanation AM, Hackman TG, Olshan AF. Effect of distance of treatment center on survival for HPV-negative head and neck cancer patients. Head Neck 2023; 45:2981-2989. [PMID: 37767817 DOI: 10.1002/hed.27522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/20/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND In rural states, travel burden for complex cancer care required for head and neck squamous cell carcinoma (HNSCC) may affect patient survival, but its impact is unknown. METHODS Patients with HPV-negative HNSCC were retrospectively identified from a statewide, population-based study. Euclidian distance from the home address to the treatment center was calculated for radiation therapy, surgery, and chemotherapy. Multivariable Cox proportional hazards models were used to examine the risk of 5-year mortality with increasing travel quartiles. RESULTS There were 936 patients with HPV-negative HNSCC with a mean age of 60. Patients traveled a median distance of 10.2, 11.1, and 10.9 miles to receive radiation therapy, surgery, and chemotherapy, respectively. Patients in the fourth distance quartile were more likely to live in a rural location (p < 0.001) and receive treatment at an academic hospital (p < 0.001). Adjusted overall survival (OS) improved proportionally to distance traveled, with improved OS remaining significant for patients who traveled the furthest for care (third and fourth quartile by distance). Relative to patients in the first quartile, patients in the fourth had a reduced risk of mortality with radiation (HR 0.59, 95% CI 0.42-0.83; p = 0.002), surgery (HR 0.47, 95% CI 0.30-0.75; p = 0.001), and chemotherapy (HR 0.56, 95% CI 0.35-0.91; p = 0.020). CONCLUSION For patients in this population-based cohort, those traveling greater distances for treatment of HPV-negative HNSCC had improved OS. This analysis suggests that the benefits of coordinated, multidisciplinary care may outweigh the barriers of travel burden for these patients.
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Affiliation(s)
- Douglas R Farquhar
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Maheer M Masood
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Nicholas R Lenze
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jason Tasoulas
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Siddharth Sheth
- Department of Hematology/Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Catherine Lumley
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jeffrey Blumberg
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Wendell G Yarbrough
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jose Zevallos
- Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark C Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Trevor G Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrew F Olshan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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14
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Patel AM, Vedula S, Haleem A, Choudhry HS, Tseng CC, Park RCW. Elective Neck Dissection for cT1-4 N0M0 Head and Neck Verrucous Carcinoma. Otolaryngol Head Neck Surg 2023; 169:1187-1199. [PMID: 37278222 DOI: 10.1002/ohn.374] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/21/2023] [Accepted: 04/29/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the survival benefit of elective neck dissection (END) over neck observation in cT1-4 N0M0 head and neck verrucous carcinoma (HNVC). STUDY DESIGN Retrospective cohort study. SETTING The 2006 to 2017 National Cancer Database. METHODS Patients with surgically resected cT1-4 N0M0 HNVC were selected. Linear, binary logistic, Kaplan-Meier, and Cox proportional hazards regression models were utilized. RESULTS Of 1015 patients satisfying inclusion criteria, 223 (22.0%) underwent END. The majority of patients were male (55.4%) and white (91.0%) with disease of the oral cavity (67.6%) classified as low grade (90.0%) and cT1-2 (81.8%). The minority of ENDs (4.0%) detected occult nodal metastases. The rate of END increased from 2006 to 2017 for both cT1-2 (16.3% vs 22.0%, p = .126, R2 = 0.405) and cT3-4 (41.7% vs 70.0%, p = .424, R2 = 0.232) disease but these trends were not statistically significant. Independent predictors of undergoing END included treatment at an academic facility (adjusted odds ratio [aOR]: 1.75, 95% confidence interval [CI]: 1.19-2.55), cT3-4 disease (aOR: 3.31, 95% CI: 2.16-5.07), and tumor diameter (aOR: 1.09, 95% CI: 1.01-1.19) (p < 0.05). The 5-year overall survival (OS) of patients treated with and without END was 71.3% and 70.6%, respectively (p = .661). END did not significantly reduce the 5-year hazard of death (adjusted hazard ratio: 1.25, 95% CI: 0.91-1.71, p = .172). END did not significantly improve 5-year OS in univariate and multivariate analyses stratified by several patient, facility, tumor, and treatment characteristics. CONCLUSION END does not confer an appreciable survival benefit in HNVC, even after stratifying univariate and multivariate analyses by several patient, facility, tumor, and treatment characteristics. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sudeepti Vedula
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hassaam S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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15
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Lin CC, Hill CE, Kerber KA, Burke JF, Skolarus LE, Esper GJ, de Havenon A, De Lott LB, Callaghan BC. Patient Travel Distance to Neurologist Visits. Neurology 2023; 101:e1807-e1820. [PMID: 37704403 PMCID: PMC10634641 DOI: 10.1212/wnl.0000000000207810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/10/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The density of neurologists within a given geographic region varies greatly across the United States. We aimed to measure patient travel distance and travel time to neurologist visits, across neurologic conditions and subspecialties. Our secondary goal was to identify factors associated with long-distance travel for neurologic care. METHODS We performed a cross-sectional analysis using a 2018 Medicare sample of patients with at least 1 outpatient neurologist visit. Long-distance travel was defined as driving distance ≥50 miles 1-way to the visit. Travel time was measured as driving time in minutes. Multilevel generalized linear mixed models with logistic link function, which accounted for clustering of patients within hospital referral region and allowed modeling of region-specific random effects, were used to determine the association of patient and regional characteristics with long-distance travel. RESULTS We identified 563,216 Medicare beneficiaries with a neurologist visit in 2018. Of them, 96,213 (17%) traveled long distance for care. The median driving distance and time were 81.3 (interquartile range [IQR]: 59.9-144.2) miles and 90 (IQR: 69-149) minutes for patients with long-distance travel compared with 13.2 (IQR: 6.5-23) miles and 22 (IQR: 14-33) minutes for patients without long-distance travel. Comparing across neurologic conditions, long-distance travel was most common for nervous system cancer care (39.6%), amyotrophic lateral sclerosis [ALS] (32.1%), and MS (22.8%). Many factors were associated with long-distance travel, most notably low neurologist density (first quintile: OR 3.04 [95% CI 2.41-3.83] vs fifth quintile), rural setting (4.89 [4.79-4.99]), long-distance travel to primary care physician visit (3.6 [3.51-3.69]), and visits for ALS and nervous system cancer care (3.41 [3.14-3.69] and 5.27 [4.72-5.89], respectively). Nearly one-third of patients bypassed the nearest neurologist by 20+ miles, and 7.3% of patients crossed state lines for neurologist care. DISCUSSION We found that nearly 1 in 5 Medicare beneficiaries who saw a neurologist traveled ≥50 miles 1-way for care, and travel burden was most common for lower-prevalence neurologic conditions that required coordinated multidisciplinary care. Important potentially addressable predictors of long-distance travel were low neurologist density and rural location, suggesting interventions to improve access to care such as telemedicine or neurologic subspecialist support to local neurologists. Future work should evaluate differences in clinical outcomes between patients with long-distance travel and those without.
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Affiliation(s)
- Chun Chieh Lin
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT.
| | - Chloe E Hill
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Kevin A Kerber
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - James F Burke
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Lesli E Skolarus
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Gregory J Esper
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Adam de Havenon
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Lindsey B De Lott
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Brian C Callaghan
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
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Lorenz FJ, King TS, Engle L, Beauchamp‐Perez F, Goyal N. Predictors of Quality of Life for Head and Neck Cancer Patients at an Academic Institution. OTO Open 2023; 7:e82. [PMID: 37794985 PMCID: PMC10546382 DOI: 10.1002/oto2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/06/2023] [Accepted: 07/14/2023] [Indexed: 10/06/2023] Open
Abstract
Objective Quality of life (QOL) is an important consideration in head and neck cancer (HNC) due to lasting disease and treatment-related toxicities. We performed a comprehensive review of predictors of QOL in this population, including distance to care. Study Design Retrospective cohort study from 2017 to 2022. Setting Academic medical center. Methods QOL was quantified in patients treated for HNC utilizing the University of Washington Quality of Life and 20-Item Short Form surveys completed at subsequent clinic visits. Distance to treatment center and other demographic, socioeconomic, disease-specific, and behavioral data were analyzed. Results There were 176 patients in the cohort (69% male; mean age, 64 ± 10.8 years). There was no association between miles traveled and any of the QOL subscales. Marital status was the strongest predictor of QOL, significantly associated with 7/8 QOL domains and favoring those who were married. Other significant predictors of decreased QOL included emotional/physical abuse, current tobacco use, documented religious affiliation, and treatment involving surgery plus adjuvant therapy. A significant positive trend over time existed for multiple QOL subscales. Conclusion QOL is unchanged in patients who travel greater distances for care. QOL is more closely linked to factors such as marital status, physical/emotional abuse, tobacco use, religious affiliation, treatment intensity, and time following surgery. This highlights the importance of a strong support structure and the influence of certain socioeconomic and lifestyle factors on patients, with opportunities for screening and intervention throughout their cancer care.
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Affiliation(s)
- F. Jeffrey Lorenz
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Tonya S. King
- Department of Public Health SciencesPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Linda Engle
- Department of Public Health SciencesPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Francis Beauchamp‐Perez
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Neerav Goyal
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
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Balakrishnan K, Faucett EA, Villwock J, Boss EF, Esianor BI, Jefferson GD, Graboyes EM, Thompson DM, Flanary VA, Brenner MJ. Allyship to Advance Diversity, Equity, and Inclusion in Otolaryngology: What We Can All Do. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023; 11:201-214. [PMID: 38073717 PMCID: PMC10707492 DOI: 10.1007/s40136-023-00467-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 01/31/2024]
Abstract
Purpose of review To summarize the current literature on allyship, providing a historical perspective, concept analysis, and practical steps to advance equity, diversity, and inclusion. This review also provides evidence-based tools to foster allyship and identifies potential pitfalls. Recent findings Allies in healthcare advocate for inclusive and equitable practices that benefit patients, coworkers, and learners. Allyship requires working in solidarity with individuals from underrepresented or historically marginalized groups to promote a sense of belonging and opportunity. New technologies present possibilities and perils in paving the pathway to diversity. Summary Unlocking the power of allyship requires that allies confront unconscious biases, engage in self-reflection, and act as effective partners. Using an allyship toolbox, allies can foster psychological safety in personal and professional spaces while avoiding missteps. Allyship incorporates goals, metrics, and transparent data reporting to promote accountability and to sustain improvements. Implementing these allyship strategies in solidarity holds promise for increasing diversity and inclusion in the specialty.
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Affiliation(s)
- Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Erynne A. Faucett
- Department of Otolaryngology-Head and Neck Surgery, University of CA-Davis , Sacramento, USA
| | - Jennifer Villwock
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Emily F. Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Brandon I. Esianor
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gina D. Jefferson
- Department of Otolaryngology-Head and Neck Surgery, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Dana M. Thompson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA
| | - Valerie A. Flanary
- Division of Pediatric Otolaryngology, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael J. Brenner
- Department of Otolaryngology–Head & Neck Surgery, University of Michigan medical School, 1500 East Medical Center Drive, 48108 Ann Arbor, MI, USA
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18
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Sawaf T, Virgen CG, Renslo B, Farrokhian N, Yu KM, Somani SN, Bur AM, Kakarala K, Shnayder Y, Gan GN, Graboyes EM, Sykes KJ. Association of Social-Ecological Factors With Delay in Time to Initiation of Postoperative Radiation Therapy: A Prospective Cohort Study. JAMA Otolaryngol Head Neck Surg 2023; 149:477-484. [PMID: 37079327 PMCID: PMC10119772 DOI: 10.1001/jamaoto.2023.0308] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/14/2023] [Indexed: 04/21/2023]
Abstract
Importance Timely initiation of postoperative radiation therapy (PORT) is associated with reduced recurrence rates and improved overall survival in patients with head and neck squamous cell carcinoma (HNSCC). Measurement of the association of social-ecological variables with PORT delays is lacking. Objective To assess individual and community-level factors associated with PORT delay among patients with HNSCC. Design, Setting, and Participants This prospective cohort study carried out between September 2018 and June 2022 included adults with untreated HNSCC who were enrolled in a prospective registry at a single academic tertiary medical center. Demographic information and validated self-reported measures of health literacy were obtained at baseline visits. Clinical data were recorded, and participant addresses were used to calculate the area deprivation index (ADI), a measure of community-level social vulnerability. Participants receiving primary surgery and PORT were analyzed. Univariable and multivariable regression analysis was performed to identify risk factors for PORT delays. Exposures Surgical treatment and PORT. Main Outcomes and Measures The primary outcome was PORT initiation delay (>42 days from surgery). Risk of PORT initiation delay was evaluated using individual-level (demographic, health literacy, and clinical data) and community-level information (ADI and rural-urban continuum codes). Results Of 171 patients, 104 patients (60.8%) had PORT delays. Mean (SD) age of participants was 61.0 (11.2) years, 161 were White (94.2%), and 105 were men (61.4%). Insurance was employer-based or public among 65 (38.5%) and 75 (44.4%) participants, respectively. Mean (SD) ADI (national percentile) was 60.2 (24.4), and 71 (41.8%) resided in rural communities. Tumor sites were most commonly oral cavity (123 [71.9%]), with 108 (63.5%) classified as stage 4 at presentation. On multivariable analysis, a model incorporating individual-level factors with health literacy in addition to community-level factors was most predictive of PORT delay (AOC= 0.78; R2, 0.18). Conclusions and Relevance This cohort study provides a more comprehensive assessment of predictors of PORT delays that include health literacy and community-level measures. Predictive models that incorporate multilevel measures outperform models with individual-level factors alone and may guide precise interventions to decrease PORT delay for at-risk patients with HNSCC.
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Affiliation(s)
- Tuleen Sawaf
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Celina G. Virgen
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Bryan Renslo
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Nathan Farrokhian
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Katherine M. Yu
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Shaan N. Somani
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Andrés M. Bur
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Kiran Kakarala
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Yelizaveta Shnayder
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Gregory N. Gan
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City
| | - Evan M. Graboyes
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Kevin J. Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
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19
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Debick N, Gemmiti A, Ryan J. The impact of distance traveled and rurality on the clinical course of head and neck cancer. Laryngoscope Investig Otolaryngol 2023; 8:651-658. [PMID: 37342104 PMCID: PMC10278113 DOI: 10.1002/lio2.1056] [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: 02/09/2023] [Revised: 03/26/2023] [Accepted: 04/05/2023] [Indexed: 06/22/2023] Open
Abstract
Objective To explore the relationship between distance traveled and rurality to clinical timepoints and 2-year disease free survival (DFS) in newly diagnosed HNC patients. Methods This study was conducted through retrospective analysis, with key independent variables including distance to academic medical center and rurality score. To better understand delays in care, the sample was divided into two groups based on an optimal treatment timeline. We then assessed for the impact of distance traveled. Results A higher proportion of patients in the optimal treatment timeline group resided in metropolitan areas, which also had a lower mean index of medically underserviced score. Patients in this group had a shorter duration from first presentation for HNC to presentation to an academic medical center and a shorter duration from referral to presentation. However, there was no significant difference in 2-year DFS between the groups. Those who lived closest to Upstate were more likely to identify as Black. Those who live in suburban communities around Upstate were most likely to initiate treatment within 1 month of presentation. Those who live farthest from Upstate were the least likely to have an HPV-negative cancer of the head and neck, and more likely to receive surgery as part of treatment and to receive a biopsy prior to presenting to Upstate. Conclusions Despite differences in distance traveled and rurality between communities, there was no impact on 2-year DFS. Together, we suggest that these findings support that socioeconomic and patient factors, instead of travel distance alone, impact HNC workup patterns. Level of Evidence Level III.
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Affiliation(s)
- Nadia Debick
- Norton College of MedicineSUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | - Amanda Gemmiti
- Department of Otolaryngology and Communication SciencesSUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | - Jesse Ryan
- Department of Otolaryngology and Communication SciencesSUNY Upstate Medical UniversitySyracuseNew YorkUSA
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20
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Contrera KJ, Tam S, Pytynia K, Diaz EM, Hessel AC, Goepfert RP, Lango M, Su SY, Myers JN, Weber RS, Eguia A, Pisters PWT, Adair DK, Nair AS, Rosenthal DI, Mayo L, Chronowski GM, Zafereo ME, Shah SJ. Impact of Cancer Care Regionalization on Patient Volume. Ann Surg Oncol 2023; 30:2331-2338. [PMID: 36581726 DOI: 10.1245/s10434-022-13029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cancer centers are regionalizing care to expand patient access, but the effects on patient volume are unknown. This study aimed to compare patient volumes before and after the establishment of head and neck regional care centers (HNRCCs). METHODS This study analyzed 35,394 unique new patient visits at MD Anderson Cancer Center (MDACC) before and after the creation of HNRCCs. Univariate regression estimated the rate of increase in new patient appointments. Geospatial analysis evaluated patient origin and distribution. RESULTS The mean new patients per year in 2006-2011 versus 2012-2017 was 2735 ± 156 patients versus 3155 ± 207 patients, including 464 ± 78 patients at HNRCCs, reflecting a 38.4 % increase in overall patient volumes. The rate of increase in new patient appointments did not differ significantly before and after HNRCCs (121.9 vs 95.8 patients/year; P = 0.519). The patients from counties near HNRCCs, showed a 210.8 % increase in appointments overall, 33.8 % of which were at an HNRCC. At the main campus exclusively, the shift in regional patients to HNRCCs coincided with a lower rate of increase in patients from the MDACC service area (33.7 vs. 11.0 patients/year; P = 0.035), but the trend was toward a greater increase in out-of-state patients (25.7 vs. 40.3 patients/year; P = 0.299). CONCLUSIONS The creation of HNRCCs coincided with stable increases in new patient volume, and a sizeable minority of patients sought care at regional centers. Regional patients shifted to the HNRCCs, and out-of-state patient volume increased at the main campus, optimizing access for both local and out-of-state patients.
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Affiliation(s)
- Kevin J Contrera
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samantha Tam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Kristen Pytynia
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo M Diaz
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Miriam Lango
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arturo Eguia
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | | | - Deborah K Adair
- Department of Global Business Development, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ajith S Nair
- Department of Global Business Development, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren Mayo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory M Chronowski
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Shalin J Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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21
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Contrera KJ, Tam S, Shah SJ, Zafereo ME. ASO Author Reflections: Cancer Center Regionalization to Optimize Patient Access. Ann Surg Oncol 2023; 30:2339-2340. [PMID: 36645539 DOI: 10.1245/s10434-022-13086-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Kevin J Contrera
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX, 77030, USA
| | - Samantha Tam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Shalin J Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX, 77030, USA.
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22
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Rygalski CJ, Huttinger ZM, Zhao S, Brock G, VanKoevering K, Old MO, Teknos TN, Rocco JW, Puram SV, Seim NB, Swendseid B, Haring CT, Eskander A, Kang SY. High surgical volume is associated with improved survival in head and neck cancer. Oral Oncol 2023; 138:106333. [PMID: 36746098 DOI: 10.1016/j.oraloncology.2023.106333] [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: 11/01/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Examine the relationship between hospital volume and overall mortality in a surgical cohort of head and neck squamous cell carcinoma (HNSCC) patients. MATERIALS & METHODS A retrospective review of the NCDB was completed for adults with previously untreated HNSCC diagnosed between 2004 and 2016. Mean annual hospital volume was calculated using the number of head and neck cancer cases treated at a given facility divided by the number of years the facility reported to the NCDB. Facilities were separated into three categories based on their volume percentile, informed by inflection points from a natural cubic spline: Hospital Group 1 (<50%); Hospital Group 2 (50-90%); Hospital Group 3 (90%+). Cox proportional hazard models were used to examine the association between volume percentiles (continuous or categorical) with patient overall survival, adjusting for important patient and facility variables known to impact survival. RESULTS Risk of death decreased by 2.97% for every 10% increase in facility percentile after adjusting for other risk factors. Patients treated at facilities in Hospital Group 1 had a 23.1% increase in risk of mortality (HR 1.231 [95% CI 1.12-1.35]) relative those at facilities in Hospital Group 3. No significant difference in mortality risk was found between Hospital Group 2 versus Hospital Group 3 (HR 1.031 [95% CI 0.97-1.10]). CONCLUSIONS Survival of HNSCC patients is significantly improved when treated at facilities >50th percentile in annual hospital volume. This may support the regionalization of care to high volume head and neck centers with comprehensive facilities and supportive services to maximize patient outcomes.
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Affiliation(s)
- Chandler J Rygalski
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 W 10(th) Avenue, 5(th) floor, Columbus, OH 43210, United States
| | - Zachary M Huttinger
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 W 10(th) Avenue, 5(th) floor, Columbus, OH 43210, United States
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, 320 Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43210, United States
| | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, 320 Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43210, United States
| | - Kyle VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 W 10(th) Avenue, 5(th) floor, Columbus, OH 43210, United States
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 W 10(th) Avenue, 5(th) floor, Columbus, OH 43210, United States
| | - Theodoros N Teknos
- UH Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, United States
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 W 10(th) Avenue, 5(th) floor, Columbus, OH 43210, United States
| | - Sidharth V Puram
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, 4921 Parkway Place, 11(th) Floor, St. Louis, MO 63110, United States
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 W 10(th) Avenue, 5(th) floor, Columbus, OH 43210, United States
| | - Brian Swendseid
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 W 10(th) Avenue, 5(th) floor, Columbus, OH 43210, United States
| | - Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 W 10(th) Avenue, 5(th) floor, Columbus, OH 43210, United States
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, 2075 Bayview Avenue, Suite M1-102, Toronto, ON M4N 3M5, Canada
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 W 10(th) Avenue, 5(th) floor, Columbus, OH 43210, United States.
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23
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Gopalani SV, Dao HD, Ford L, Campbell JE, Peck JD, Chen S, Comiford A, Etzold N, Janitz AE. The Relation Between Travel Distance and Overall Survival for HPV-Associated Cancers in a High-Burden State. JOURNAL OF REGISTRY MANAGEMENT 2023; 50:11-18. [PMID: 37577287 PMCID: PMC10414199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Purpose To assess the association between travel distance to an academic health system and overall survival for patients with human papillomavirus (HPV)-associated cancers. Methods Using hospital-based cancer registry data from 2005-2019, we calculated unidirectional travel distance from each patient's geocoded address to our academic health center through network analysis. We categorized distance as short (<25 miles), intermediate (25-74.9 miles), or long (≥75 miles). The primary outcome was time from the date of initial diagnosis to the date of death or last contact. We used multivariable Cox proportional hazards regression to evaluate the association between travel distance and overall survival. We also estimated the adjusted observed 5-year survival rate. Results Patients with HPV-associated cancers traveling distances that were intermediate (hazard ratio [HR], 1.23; 95% CI, 1.06-1.43) and long (HR, 1.15; 95% CI, 1.01-1.32) had a higher hazard of death than the short-distance group. The adjusted 5-year observed survival rates for HPV-associated cancers were lowest in the intermediate-distance group (60.4%) compared with the long-(62.6%) and short-distance (66.2%) groups. Conclusions Our findings indicate that travel distance to an academic health center was associated with overall survival for patients with HPV-associated cancers, reflecting the importance of considering travel burden in improving patient outcomes.
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Affiliation(s)
- Sameer Vali Gopalani
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Hanh Dung Dao
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Lance Ford
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Janis E. Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Jennifer D. Peck
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Ashley Comiford
- Cherokee Nation Public Health, Cherokee Nation, Tahlequah, OK 74464
| | - Nancy Etzold
- University of Oklahoma Medicine Cancer Registry, Oklahoma City, OK 73104, USA
| | - Amanda E Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
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Weaver B, Lidofsky S, Scriver G, Lester-Coll N. Insurance Status Correlates with Access to Procedural Therapy for Patients with Early-Stage Hepatocellular Carcinoma: A Retrospective Cohort Study of the National Cancer Database. J Vasc Interv Radiol 2022; 34:824-831.e1. [PMID: 36596321 DOI: 10.1016/j.jvir.2022.12.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/15/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To compare access to specific procedural therapies across insurance types for patients with American Joint Commission on Cancer (AJCC) Stage I or II hepatocellular carcinoma (HCC). MATERIALS AND METHODS Using the National Cancer Database, patients diagnosed with Stage I or II HCC between 2004 and 2019 were identified. Parametric and nonparametric testing was used to compare the rates of procedural modalities and time to therapy across insurance types. Univariate and multivariate logistic regression analyses were used to identify the likelihood of receiving specific procedural therapy based on insurance status. RESULTS In total, 105,703 patients with AJCC Stage I or II HCC were identified. The rates of ablative therapy were similar across insurance types (18.1% total, 17.2% private insurance, 15.3% uninsured, 18.1% Medicaid, and 18.8% Medicare). In the logistic regression analysis, patients with private insurance were more likely to receive a transplant or undergo resection or procedural therapy of any kind. Patients with Medicare insurance were more likely to undergo ablation (odds ratio, 1.11; 95% confidence interval, 1.07-1.15; P < .001) than those with private insurance. CONCLUSIONS Patients with private insurance were more likely to receive most forms of procedural therapy for early-stage HCC, with the notable exception of ablative therapy, which patients with Medicare were slightly more likely to receive.
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Affiliation(s)
- Benjamin Weaver
- Larner College of Medicine at the University of Vermont, University of Vermont, Burlington, Vermont.
| | - Steven Lidofsky
- Larner College of Medicine at the University of Vermont, University of Vermont, Burlington, Vermont; University of Vermont Medical Center, Burlington, Vermont
| | - Geoffrey Scriver
- Larner College of Medicine at the University of Vermont, University of Vermont, Burlington, Vermont; University of Vermont Medical Center, Burlington, Vermont
| | - Nataniel Lester-Coll
- Larner College of Medicine at the University of Vermont, University of Vermont, Burlington, Vermont; University of Vermont Medical Center, Burlington, Vermont
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25
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Cousins MM, Van Til M, Steppe E, Ng S, Ellimoottil C, Sun Y, Schipper M, Evans JR. Age, race, insurance type, and digital divide index are associated with video visit completion for patients seen for oncologic care in a large hospital system during the COVID-19 pandemic. PLoS One 2022; 17:e0277617. [PMID: 36395112 PMCID: PMC9671352 DOI: 10.1371/journal.pone.0277617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic drove rapid adoption of telehealth across oncologic specialties. This revealed barriers to telehealth access and telehealth-related disparities. We explored disparities in telehealth access in patients with cancer accessing oncologic care. MATERIALS/METHODS Data for all unique patient visits at a large academic medical center were acquired pre- and intra-pandemic (7/1/2019-12/31/2020), including visit type (in-person, video, audio only), age, race, ethnicity, rural/urban (per zip code by Federal Office of Rural Health Policy), distance from medical facility, insurance, and Digital Divide Index (DDI; incorporates technology/internet access, age, disability, and educational attainment metrics by geographic area). Pandemic phases were identified based on visit dynamics. Multivariable logistic regression models were used to examine associations of these variables with successful video visit completion. RESULTS Data were available for 2,398,633 visits for 516,428 patients across all specialties. Among these, there were 253,880 visits from 62,172 patients seen in any oncology clinic. Dramatic increases in telehealth usage were seen during the pandemic (after 3/16/2020). In multivariable analyses, patient age [OR: 0.964, (95% CI 0.961, 0.966) P<0.0001], rural zip code [OR: 0.814 (95% CI 0.733, 0.904) P = 0.0001], Medicaid enrollment [OR: 0.464 (95% CI 0.410, 0.525) P<0.0001], Medicare enrollment [OR: 0.822 (95% CI 0.761, 0.888) P = 0.0053], higher DDI [OR: 0.903 (95% CI 0.877, 0.930) P<0.0001], distance from the facility [OR: 1.028 (95% CI 1.021, 1.035) P<0.0001], black race [OR: 0.663 (95% CI 0.584, 0.753) P<0.0001], and Asian race [OR: 1.229 (95% CI 1.022, 1.479) P<0.0001] were associated with video visit completion early in the pandemic. Factors related to video visit completion later in the pandemic and within sub-specialties of oncology were also explored. CONCLUSIONS Patients from older age groups, those with minority backgrounds, and individuals from areas with less access to technology (high DDI) as well as those with Medicare or Medicaid insurance were less likely to use video visits. With greater experience through the pandemic, disparities were not mitigated. Further efforts are required to optimize telehealth to benefit all patients and avoid increasing disparities in care delivery.
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Affiliation(s)
- Matthew M. Cousins
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail: ,
| | - Monica Van Til
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Emma Steppe
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sophia Ng
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Chandy Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Urology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yilun Sun
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Joseph R. Evans
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
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Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand. PLoS One 2022; 17:e0269593. [PMID: 35951652 PMCID: PMC9371338 DOI: 10.1371/journal.pone.0269593] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/24/2022] [Indexed: 11/19/2022] Open
Abstract
In New Zealand, there are known disparities between the Indigenous Māori and the majority non-Indigenous European populations in access to cancer treatment, with resulting disparities in cancer survival. There is international evidence of ethnic disparities in the distance travelled to access cancer treatment; and as such, the aim of this paper was to examine the distance and time travelled to access surgical care between Māori and European liver and stomach cancer patients. We used national-level data and Geographic Information Systems (GIS) analysis to describe the distance travelled by patients to receive their first primary surgery for liver or stomach cancer, as well as the estimated time to travel this distance by road, and the surgical volume of hospitals performing these procedures. All cases of liver (ICD-10-AM 3rd edition code: C22) and stomach (C16) cancer that occurred in New Zealand (2007–2019) were drawn from the New Zealand Cancer Registry (liver cancer: 866 Māori, 2,460 European; stomach cancer: 953 Māori, 3,192 European), and linked to national inpatient hospitalisation records to examine access to surgery. We found that Māori on average travel 120km for liver cancer surgery, compared to around 60km for Europeans, while a substantial minority of both Māori and European liver cancer patients must travel more than 200km for their first primary liver surgery, and this situation appears worse for Māori (36% vs 29%; adj. OR 1.48, 95% CI 1.09–2.01). No such disparities were observed for stomach cancer. This contrast between cancers is likely driven by the centralisation of liver cancer surgery relative to stomach cancer. In order to support Māori to access liver cancer care, we recommend that additional support is provided to Māori patients (including prospective financial support), and that efforts are made to remotely provide those clinical services that can be decentralised.
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Ross-Driscoll K, Gunasti J, Lynch RJ, Massie A, Segev DL, Snyder J, Axelrod D, Patzer RE. Listing at non-local transplant centers is associated with increased access to deceased donor kidney transplantation. Am J Transplant 2022; 22:1813-1822. [PMID: 35338697 PMCID: PMC9580509 DOI: 10.1111/ajt.17044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 01/25/2023]
Abstract
The ability of kidney transplant candidates to travel outside of their usual place of care varies by sociodemographic factors, potentially exacerbating disparities in access. We used Transplant Referral Regions (TRRs) to overcome previous methodological barriers of using geographic distance to assess the characteristics and outcomes of patients listed for kidney transplant at centers in neighboring TRR or beyond neighboring TRRs. Among listed kidney transplant candidates, 20.9% traveled to a neighbor and 5.6% beyond a neighbor. A higher proportion of travelers were White, had some college education, and lived in ZIP codes with lower poverty. Travel to a neighbor was associated with a 7% increase in likelihood of deceased donor transplant (cHR: 1.07, 95% CI: 1.05, 1.09) and traveling beyond a neighbor with a 19% increase (cHR: 1.19, 95% CI: 1.15, 1.24). Travelers had similar rates of living donor transplant and waitlist mortality as patients who did not travel; those who traveled beyond a neighbor had slightly lower posttransplant mortality (HR: 0.91, 95% CI: 0.83, 0.99). In conclusion, the ability to travel outside of the recipient's assigned TRR increases access to transplantation and improves long-term survival.
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Affiliation(s)
- Katherine Ross-Driscoll
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathan Gunasti
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia,Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Raymond J. Lynch
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Allan Massie
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Jon Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota,Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - David Axelrod
- Solid Organ Transplant Center, Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Rachel E. Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Emerging Disparities in Prevention and Survival Outcomes for Patients with Head and Neck Cancer and Recommendations for Health Equity. Curr Oncol Rep 2022; 24:1153-1161. [PMID: 35420396 PMCID: PMC9008381 DOI: 10.1007/s11912-022-01273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/05/2022]
Abstract
Purpose of Review The aim of this review is to describe less known and emerging disparities found in the prevention and survival outcomes for patients with head and neck cancer (HNC) that are likely to play an increasingly important role in HNC outcomes and health inequities. Recent Findings The following factors contribute to HNC incidence and outcomes: (1) the effect of rurality on prevention and treatment of HNC, (2) dietary behavior and nutritional factors influencing the development of and survival from HNC, and (3) barriers and benefits of telehealth for patients with HNC. Summary Rurality, nutrition and diet, and telehealth usage and access are significant contributors to the existing health disparities associated with HNC. Population and culturally specific interventions are urgently needed as well as more research to further define the issues and develop appropriate population and individual level solutions.
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Nogueira LM, Sineshaw HM, Jemal A, Pollack CE, Efstathiou JA, Yabroff KR. Association of Race With Receipt of Proton Beam Therapy for Patients With Newly Diagnosed Cancer in the US, 2004-2018. JAMA Netw Open 2022; 5:e228970. [PMID: 35471569 PMCID: PMC9044116 DOI: 10.1001/jamanetworkopen.2022.8970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Black patients are less likely than White patients to receive guideline-concordant cancer care in the US. Proton beam therapy (PBT) is a potentially superior technology to photon radiotherapy for tumors with complex anatomy, tumors surrounded by sensitive tissues, and childhood cancers. OBJECTIVE To evaluate whether there are racial disparities in the receipt of PBT among Black and White individuals diagnosed with all PBT-eligible cancers in the US. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study evaluated Black and White individuals diagnosed with PBT-eligible cancers between January 1, 2004, and December 31, 2018, in the National Cancer Database, a nationwide hospital-based cancer registry that collects data on radiation treatment, even when it is received outside the reporting facility. American Society of Radiation Oncology model policies were used to classify patients into those for whom PBT is the recommended radiation therapy modality (group 1) and those for whom evidence of PBT efficacy is still under investigation (group 2). Propensity score matching was used to ensure comparability of Black and White patients' clinical characteristics and regional availability of PBT according to the National Academy of Medicine's definition of disparities. Data analysis was performed from October 4, 2021, to February 22, 2022. EXPOSURE Patients' self-identified race was ascertained from medical records. MAIN OUTCOMES AND MEASURES The main outcome was receipt of PBT, with disparities in this therapy's use evaluated with logistic regression analysis. RESULTS Of the 5 225 929 patients who were eligible to receive PBT and included in the study, 13.6% were Black, 86.4% were White, and 54.3% were female. The mean (SD) age at diagnosis was 63.2 (12.4) years. Black patients were less likely to be treated with PBT than their White counterparts (0.3% vs 0.5%; odds ratio [OR], 0.67; 95% CI, 0.64-0.71). Racial disparities were greater for group 1 cancers (0.4% vs 0.8%; OR, 0.49; 95% CI, 0.44-0.55) than group 2 cancers (0.3% vs 0.4%; OR, 0.75; 95% CI, 0.70-0.80). Racial disparities in PBT receipt among group 1 cancers increased over time (annual percent change = 0.09, P < .001) and were greatest in 2018, the most recent year of available data. CONCLUSIONS AND RELEVANCE In this cross-sectional study, Black patients were less likely to receive PBT than their White counterparts, and disparities were greatest for cancers for which PBT was the recommended radiation therapy modality. These findings suggest that efforts other than increasing the number of facilities that provide PBT will be needed to eliminate disparities.
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Affiliation(s)
- Leticia M. Nogueira
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Helmneh M. Sineshaw
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Craig E. Pollack
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing, Baltimore, Maryland
| | | | - K. Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Nallani R, Subramanian TL, Ferguson-Square KM, Smith JB, White J, Chiu AG, Francis CL, Sykes KJ. A Systematic Review of Head and Neck Cancer Health Disparities: A Call for Innovative Research. Otolaryngol Head Neck Surg 2022; 166:1238-1248. [PMID: 35133913 DOI: 10.1177/01945998221077197] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE (1) Describe the existing head and neck cancer health disparities literature. (2) Contextualize these studies by using the NIMHD research framework (National Institute on Minority Health and Health Disparities). (3) Explore innovative ideas for further study and intervention. DATA SOURCES Ovid MEDLINE, Embase, Web of Science, and Google Scholar. REVIEW METHODS Databases were systematically searched from inception to April 20, 2020. The PRISMA checklist was followed (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Two authors reviewed all articles for inclusion. Extracted data included health disparity population and outcomes, study details, and main findings and recommendations. Articles were also classified per the NIMHD research framework. RESULTS There were 148 articles included for final review. The majority (n = 104) focused on health disparities related to at least race/ethnicity. Greater than two-thirds of studies (n = 105) identified health disparities specific to health behaviors or clinical outcomes. Interaction between the individual domain of influence and the health system level of influence was most discussed (n = 99, 66.9%). Less than half of studies (n = 61) offered specific recommendations or interventions. CONCLUSIONS There has been extensive study of health disparities for head and neck cancer, largely focusing on individual patient factors or health care access and quality. This review identifies gaps in this research, with large numbers of retrospective database studies and little discussion of potential contributors and explanations for these disparities. We recommend shifting research on disparities upstream toward a focus on community and societal factors, rather than individual, and an evaluation of interventions to promote health equity.
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Affiliation(s)
- Rohit Nallani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | - Joshua B Smith
- Department of Otolaryngology-Head and Neck Surgery, St Louis University, St Louis, Missouri, USA
| | - Jacob White
- Research and Learning, A.R. Dykes Library, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Carrie L Francis
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Gao J, Tseng CC, Barinsky GL, Fang CH, Hsueh WD, Grube JG, Eloy JA. Factors associated with postoperative radiotherapy at a different facility in sinonasal squamous cell carcinoma. Int Forum Allergy Rhinol 2022; 12:1204-1207. [PMID: 34997951 DOI: 10.1002/alr.22969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Jeff Gao
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher C Tseng
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gregory L Barinsky
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christina H Fang
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Wayne D Hsueh
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jordon G Grube
- Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, Albany Medical Center, Albany, New York, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJBarnabas Health, Livingston, New Jersey, USA
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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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Osazuwa-Peters N, Barnes JM, Okafor SI, Taylor DB, Hussaini AS, Adjei Boakye E, Simpson MC, Graboyes EM, Lee WT. Incidence and Risk of Suicide Among Patients With Head and Neck Cancer in Rural, Urban, and Metropolitan Areas. JAMA Otolaryngol Head Neck Surg 2021; 147:1045-1052. [PMID: 34297790 PMCID: PMC8304170 DOI: 10.1001/jamaoto.2021.1728] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 01/13/2023]
Abstract
Importance Patients with head and neck cancer (HNC) are known to be at increased risk of suicide compared with the general population, but there has been insufficient research on whether this risk differs based on patients' rural, urban, or metropolitan residence status. Objective To evaluate whether the risk of suicide among patients with HNC differs by rural vs urban or metropolitan residence status. Design, Setting, and Participants This cross-sectional study uses data from the Surveillance, Epidemiology, and End Results database on patients aged 18 to 74 years who received a diagnosis of HNC from January 1, 2000, to December 31, 2016. Statistical analysis was conducted from November 27, 2020, to June 3, 2021. Exposures Residence status, assessed using 2013 Rural Urban Continuum Codes. Main Outcomes and Measures Death due to suicide was assessed by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes (U03, X60-X84, and Y87.0) and the cause of death recode (50220). Standardized mortality ratios (SMRs) of suicide, assessing the suicide risk among patients with HNC compared with the general population, were calculated. Suicide risk by residence status was compared using Fine-Gray proportional hazards regression models. Results Data from 134 510 patients with HNC (101 142 men [75.2%]; mean [SE] age, 57.7 [10.3] years) were analyzed, and 405 suicides were identified. Metropolitan residents composed 86.6% of the sample, urban residents composed 11.7%, and rural residents composed 1.7%. The mortality rate of suicide was 59.2 per 100 000 person-years in metropolitan counties, 64.0 per 100 000 person-years in urban counties, and 126.7 per 100 000 person-years in rural counties. Compared with the general population, the risk of suicide was markedly higher among patients with HNC in metropolitan (SMR, 2.78; 95% CI, 2.49-3.09), urban (SMR, 2.84; 95% CI, 2.13-3.71), and rural (SMR, 5.47; 95% CI, 3.06-9.02) areas. In Fine-Gray competing-risk analyses that adjusted for other covariates, there was no meaningful difference in suicide risk among urban vs metropolitan residents. However, compared with rural residents, residents of urban (subdistribution hazard ratio, 0.52; 95% CI, 0.29-0.94) and metropolitan counties (subdistribution hazard ratio, 0.55; 95% CI, 0.32-0.94) had greatly lower risk of suicide. Conclusions and Relevance The findings of this cross-sectional study suggest that suicide risk is elevated in general among patients with HNC but is significantly higher for patients residing in rural areas. Effective suicide prevention strategies in the population of patients with HNC need to account for rural health owing to the high risk of suicide among residents with HNC in rural areas.
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Affiliation(s)
- Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Editorial Board Member, JAMA Otolaryngology–Head & Neck Surgery
| | - Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Somtochi I. Okafor
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Adnan S. Hussaini
- Department of Otolaryngology–Head and Neck Surgery, Georgetown University Medical Center, Washington, DC
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
- Simmons Cancer Institute, Springfield, Illinois
| | - Matthew C. Simpson
- Department of Otolaryngology–Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
- Advanced Health Data Research Institute, St Louis University, St Louis, Missouri
| | - Evan M. Graboyes
- Editorial Board Member, JAMA Otolaryngology–Head & Neck Surgery
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Walter T. Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
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Clohessy J, Hoffman G, Cope D. Geographic remoteness from a multidisciplinary team is associated with an increased clinical staging of head and neck cancer: a Newcastle (Australia) study. Int J Oral Maxillofac Surg 2021; 51:862-868. [PMID: 34598849 DOI: 10.1016/j.ijom.2021.09.005] [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: 10/13/2020] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to investigate the relationship between a patient's residential distance from a tertiary referral regional multidisciplinary team (MDT) and the clinical staging of their head and neck cancer (HNC) at presentation. A retrospective cohort study was performed of all attendees with HNC who had undergone an MDT assessment. The period of study was January 2016 to January 2017. The primary predictor variable was the patient's residential distance from the MDT. Demographic and clinicopathological factors were recorded. The primary outcome variable was the clinical staging conferred by the MDT. Descriptive and ordinal logistical regression analyses were conducted to examine the data. There were 286 observations; 230 patients were male and 56 were female. The mean age of the cohort was 66.52 years. The average residential distance from the MDT was 68.16 km. Regression analysis, while not statistically significant, indicated that those living more than 100 km (range 102-592 km) from the MDT had a 1.49 times increased risk of being diagnosed with an advanced stage of cancer when compared to those living less than 100 km away. This study provides insights into the potential adverse effect geographic remoteness has on initial staging of HNC and the need for further strategies to serve this at-risk population.
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Affiliation(s)
- J Clohessy
- Department of Oral and Maxillofacial Surgery, John Hunter Hospital, Hunter New England Health District, Newcastle, NSW, Australia.
| | - G Hoffman
- Department of Oral and Maxillofacial Surgery, John Hunter Hospital, Hunter New England Health District, Newcastle, NSW, Australia; Medical School, University of Newcastle, Callaghan, NSW, Australia
| | - D Cope
- Department of Otolaryngology/Head and Neck Surgery, John Hunter Hospital, Hunter New England Health District, Newcastle, NSW, Australia
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Access to Chimeric Antigen Receptor T Cell Therapy for Diffuse Large B Cell Lymphoma. Adv Ther 2021; 38:4659-4674. [PMID: 34302277 PMCID: PMC8408091 DOI: 10.1007/s12325-021-01838-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/21/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Geographic access to novel oncology therapies, and the extent to which it may vary by potential sites of care, regions, and population characteristics, is poorly understood. We examined how expanding access to chimeric antigen receptor (CAR) T cell therapy administration sites impacts patient travel distances and time. METHODS We used geographic information system techniques to calculate shortest travel distance and time between patients with relapsed/refractory diffuse large B cell lymphoma (DLBCL) and the nearest CAR T cell therapy administration site in three scenarios: academic hospitals; academic and community multispecialty hospitals; and academic and community multispecialty hospitals plus nonacademic specialty oncology network centers. Main outcome measures were differences in travel distance and time among the scenarios and the relationship between travel time and socioeconomic status, race, rural-urban areas, and non-Hodgkin lymphoma clusters. Non-Hodgkin lymphoma incidence, socioeconomic status, and administration centers were derived from governmental/publicly available data sources. RESULTS Of 3922 patients eligible for CAR T cell therapy, more than 37% had to travel more than 1 h to the nearest academic hospital. Average travel time and distance were significantly reduced by 23% and 30% (P < 0.001), respectively, when access was expanded to include community hospitals plus a broader range of oncology specialty treatment centers. Compared to academic hospitals alone, increasing access to include community hospitals decreased time and distance by 7% and 8% (P < 0.01), respectively. In addition, there would be a lower proportion of sites operating as the only care provider within 25 miles if access was expanded outside of academic hospitals only. Longer travel time was associated with lower socioeconomic status. CONCLUSION Many patients with DLBCL have long travel times to an academic hospital that administers CAR T cell therapy. Expanding access to care through site-of-care planning will help address regional, rural-urban, and sociodemographic equity in the geographic allocation of CAR T cell therapy.
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Morse E, Lohia S, Dooley LM, Gupta P, Roman BR. Travel distance is associated with stage at presentation and laryngectomy rates among patients with laryngeal cancer. J Surg Oncol 2021; 124:1272-1283. [PMID: 34390494 DOI: 10.1002/jso.26643] [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: 03/14/2021] [Revised: 07/18/2021] [Accepted: 08/03/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The impact of travel distance on stage at presentation and management strategies of laryngeal squamous cell carcinoma (SCC) is unknown. We investigated this relationship. METHODS Retrospective review of patients with laryngeal SCC in the National Cancer Data Base from 2004 to 2016. Multivariate analysis determined relationships between travel distance, sociodemographic, geographic, and hospital factors. Logistic regression determined the influence of travel distance on T-stage and overall stage at presentation, and receipt of total laryngectomy. RESULTS Sixty thousand four hundred and thirty-nine patients were divided into groups based on distance to treatment: short (<12.5 miles); intermediate (12.5-49.9 miles); and long (>50 miles). Increased travel was associated with T4-stage (intermediate vs. short OR 1.11, CI 1.04-1.18, p = 0.001; long vs. short OR 1.5, CI 1.36-1.65, p < 0.001), and total laryngectomy (intermediate vs. short OR 1.40, CI 1.3-1.5, p ≤ 0.001; long vs. short OR 2.52, CI 2.28-2.79, p ≤ 0.001). In T4 disease, total laryngectomy was associated with improved survival compared to nonsurgical treatment (HR 0.75, CI 0.70-0.80, p < 0.001) regardless of travel distance. CONCLUSION Longer travel distance to care is associated with increased stage at presentation, rate of laryngectomy, and improved survival in advanced laryngeal SCC. Health policy efforts should be directed towards improving early access to diagnosis and care.
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Affiliation(s)
- Elliot Morse
- Department of Otolaryngology, Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Shivangi Lohia
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, USA
| | - Laura M Dooley
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, USA
| | - Piyush Gupta
- Department of Otolaryngology, University of Missouri, Columbia, Missouri, USA
| | - Benjamin R Roman
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Johnson KJ, Wang X, Barnes JM, Delavar A. Associations between geographic residence and US adolescent and young adult cancer stage and survival. Cancer 2021; 127:3640-3650. [PMID: 34236080 DOI: 10.1002/cncr.33667] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/19/2021] [Accepted: 03/04/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiple studies have indicated that place of residence can influence cancer survival; however, few studies have specifically focused on geographic factors and outcomes in adolescents and young adults (AYAs) with cancer. The objective of this study was to evaluate evidence for geographic disparities in cancer diagnosis stage and overall survival in AYAs and to examine whether stage mediated survival associations. METHODS National Cancer Database data on AYAs aged 15 to 39 years who were diagnosed with cancer from 2010 to 2014 were obtained. Residence in Metropolitan (metro), urban, or rural counties at the time of diagnosis was defined using Rural-Urban Continuum Codes. Distance between the patient's residence and the reporting hospital was classified as short (≤2.5 miles), intermediate (>12.5 to <50 miles), or long (≥50 miles). Logistic and Cox proportional hazards regression models were used for analyses. RESULTS The stage and survival analyses included 146,418 and 178,688 AYAs, respectively. The odds of a late versus early stage at diagnosis (stages III and IV vs I and II) were 1.16 (95% CI, 1.05-1.29) times greater for AYAs living in rural versus metro counties and 1.20 (95% CI, 1.16-1.25) times greater for AYAs living at long versus short distances to the reporting hospital. The hazard of death was 1.17 (95% CI, 1.05-1.31) and 1.30 (95% CI, 1.25-1.36) times greater for those living in rural versus metro counties, respectively, and for long versus short distances to the reporting hospital, respectively. Disease stage mediated 54% and 31% of the associations between metro, urban, or rural residence and residential distance categories and survival. CONCLUSIONS Rural residence and living long distances from the reporting hospital were associated with later stage diagnoses and lower survival in AYAs with cancer. Further research is needed to understand mechanisms. LAY SUMMARY Adolescents and young adults (AYAs) with cancer are a vulnerable population because cancer is of low suspicion in this population and may not be diagnosed in a timely manner. The authors evaluated evidence for geographic disparities in cancer stage at diagnosis and survival in the AYA population. The findings indicate that AYAs living in rural versus metropolitan US counties and those living farther from the diagnosis reporting hospital are more likely to be diagnosed at a later cancer stage, when it is generally less treatable, and have lower survival compared with AYAs living in metropolitan counties.
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Affiliation(s)
| | - Xiaoyan Wang
- Brown School, Washington University in St Louis, St Louis, Missouri
| | - Justin M Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Arash Delavar
- University of California San Diego School of Medicine, La Jolla, California
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Vahl JM, von Witzleben A, Welke C, Doescher J, Theodoraki MN, Brand M, Schuler PJ, Greve J, Hoffmann TK, Laban S. Influence of travel burden on tumor classification and survival of head and neck cancer patients. Eur Arch Otorhinolaryngol 2021; 278:4535-4543. [PMID: 33877433 DOI: 10.1007/s00405-021-06816-3] [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: 03/17/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Cancer patients have to overcome various barriers to obtain diagnostics and treatment at head and neck cancer centers. Travel distance to a specialized hospital may result in psychosocial and financial distress, thus interfering with diagnostics, treatment, and follow-up care. In this study, we have aimed to analyze the association of travel distance with cTNM status, UICC stage at primary diagnosis, and survival outcomes of head and neck cancer (HNC) patients. METHODS We have analyzed data of 1921 consecutive HNC patients diagnosed between 2014 and 2019 at the head and neck cancer center of the Comprehensive Cancer Center Ulm (CCCU), Germany. Postal code-based travel distance calculation in kilometers, TNM status, and UICC stage were recorded at initial diagnosis. The assembly of travel distance-related groups (short, intermediate, long-distance) has been investigated. Moreover, group-related survival and recurrence analysis have been performed. RESULTS In contrast to observations from overseas, no association of travel distance and higher cTNM status or UICC stage at primary diagnosis has been observed. Furthermore, no significant differences for recurrence-free survival and overall survival by travel distance were detected. CONCLUSION In southern Germany, travel distance to head and neck cancer centers seems to be tolerable. Travel burden is not synonymous with travel distance alone but also involves sociodemographic, monetary, and disease-specific aspects as well as accessibility to proper infrastructure of transport and health care system.
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Affiliation(s)
- J M Vahl
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany.
| | - A von Witzleben
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany
| | - C Welke
- Clinical Cancer Registry Comprehensive Cancer Center Ulm, Ulm University Medical Center, 89081, Ulm, Germany
| | - J Doescher
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany
| | - M N Theodoraki
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany
| | - M Brand
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany
| | - P J Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany
| | - J Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany
| | - T K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany
| | - S Laban
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany
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Thomas GR. Racial disparity in head and neck cancer. Cancer 2021; 127:2612-2613. [PMID: 33799316 DOI: 10.1002/cncr.33555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/08/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Giovana R Thomas
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Fagan JJ, Noronha V, Graboyes EM. Making the Best of Limited Resources: Improving Outcomes in Head and Neck Cancer. Am Soc Clin Oncol Educ Book 2021; 41:1-11. [PMID: 33793315 PMCID: PMC8059263 DOI: 10.1200/edbk_320923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The overwhelming majority of head and neck cancers and related deaths occur in low- and middle-income countries, which have challenges related to burden of disease versus access to care. Yet the additional health care burden of the COVID-19 pandemic has also impacted access to care for patients with head and neck cancer in the United States. This article focuses on challenges and innovation in prioritizing head and neck cancer care in Sub-Saharan Africa, the Indian experience of value-added head and neck cancer care in busy and densely populated regions, and strategies to optimize the management of head and neck cancer in the United States during the COVID-19 pandemic.
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Affiliation(s)
- Johannes J. Fagan
- Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Evan Michael Graboyes
- Departments of Otolaryngology-Head and Neck Surgery and Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Freedman RL, Sibley H, Williams AM, Chang SS. Race, not socioeconomic disparities, correlates with survival in human papillomavirus-negative oropharyngeal cancer: A retrospective study. Am J Otolaryngol 2021; 42:102816. [PMID: 33161259 DOI: 10.1016/j.amjoto.2020.102816] [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: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Investigate the impact of black versus white race, socioeconomic status (SES), and comorbidity burden on oropharyngeal cancer (OPC) survival. MATERIALS AND METHODS This study retrospectively analyzed patients diagnosed between 1991 and 2012 at an urban tertiary care center with a high volume of head and neck cancer referrals. Data gathered included demographics, human papilloma virus (HPV) status, follow-up time, comorbidities, smoking history, and overall survival. SES was extrapolated from the 2000 and 2010 censuses. Analysis of variance, chi-square tests, multivariable Cox proportional hazards models, Cox proportional hazards regression, Kaplan Meier curves and the log-rank test were utilized. RESULTS Of 208 charts reviewed, 192 patients met inclusion criteria. Black patients had significantly (p < 0.001) poorer survival at 1, 2, and 5 years than white patients (5-year survival: 32% vs 64%); this discrepancy persisted in only HPV-negative disease (20% vs 50%). In the HPV-negative subgroup, there was no racial difference in treatment modality received, Charlson Comorbidity Index, and proportion receiving inadequate, noncurative or no treatment. Univariate analysis identified significant differences in median household income, education level, and stage at presentation between black and white subgroups. Multivariate analysis identified white race and HPV-positive status as independent predictors of overall survival, but SES and stage at presentation were not. CONCLUSION SES did not explain the greater survival in HPV-negative white versus black patients. This indicates that race is an independent predictor of survival; future studies should examine more accurate indicators of SES and genetic differences in tumors of black and white patients.
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Moten AS, von Mehren M, Reddy S, Howell K, Handorf E, Farma JM. Treatment Patterns and Distance to Treatment Facility for Soft Tissue Sarcoma of the Extremity. J Surg Res 2020; 256:492-501. [PMID: 32798997 PMCID: PMC10034971 DOI: 10.1016/j.jss.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/14/2020] [Accepted: 07/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The impact that distance traveled to receive treatment has on treatments and outcomes among patients with soft tissue sarcoma (STS) of the extremity has yet to be thoroughly investigated. METHODS Information on patients treated for STS of the extremity between 2006 and 2015 was obtained from the National Cancer Database. Patients were stratified into two groups based on median distance traveled to receive treatment. Chi-square tests assessed associations between categorical variables and distance to treatment. Kaplan-Meier survival estimates and Cox regression were used to estimate survival. RESULTS The sample included 21,763 patients. The mean age was 59.3 y, 54.6% were men, and 83.2% were white. The median distance traveled to the treating facility was 15.6 miles. Compared with patients who traveled <15 miles, those who traveled ≥15 miles were more likely to have undifferentiated rather than well-differentiated tumors (odds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.10-1.37), and stage II rather than stage I disease (OR, 1.14; 95% CI, 1.04-1.24). They were also more likely to undergo limb-sparing resection (OR, 1.58; 95% CI, 1.39-1.79) or amputation (OR, 1.72; 95% CI, 1.44-2.07) rather than no surgery and less likely to have positive margins (OR, 0.86; 95% CI, 0.79-0.93). There was no difference in the risk of death between patients who traveled ≥15 miles and those who did not (hazard ratio, 1.00; 95% CI, 0.94-1.07). CONCLUSIONS Although clinical characteristics and treatments may differ based on distance traveled, survival appears equivalent. Further research into reasons why greater distance traveled is associated with more advanced disease, but comparable survival is warranted.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
| | - Margaret von Mehren
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sanjay Reddy
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey M Farma
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Impact of payer status and hospital volume on outcomes after head and neck oncologic reconstruction. Am J Surg 2020; 222:173-178. [PMID: 33223075 DOI: 10.1016/j.amjsurg.2020.11.026] [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: 07/05/2020] [Revised: 10/28/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND High-volume centers improve outcomes in head and neck cancer (HNCA) reconstruction, yet it is unknown whether patients of all payer status benefit equally. METHODS We identified patients undergoing HNCA surgery between 2002 and 2015 using the National Inpatient Sample. Outcomes included receipt of care at high-volume centers, receipt of reconstruction, and post-operative complications. Multivariate regression analysis was stratified by payer status. RESULTS 37,442 patients received reconstruction out of 101,204 patients who underwent HNCA surgery (37.0%). Privately-insured and Medicaid patients had similar odds of receiving high-volume care (OR = 0.99, 95% CI = 0.87-1.11) and undergoing reconstruction (OR = 0.96, 95% CI = 0.86-1.05). Medicaid beneficiaries had higher odds of complication (OR = 1.36, 95% CI = 1.22-1.51). The discrepancy in complication odds was significant at low-volume (OR = 1.44, 95% CI = 1.12-1.84) and high-volume centers (OR = 1.30, 95% CI = 1.15-1.47). CONCLUSIONS Medicaid beneficiaries are as likely to receive care at high-volume centers and undergo reconstruction as privately-insured individuals. However, they have poorer outcomes than privately-insured individuals at both low- and high-volume centers.
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Jassal JS, Cramer JD. Explaining Racial Disparities in Surgically Treated Head and Neck Cancer. Laryngoscope 2020; 131:1053-1059. [PMID: 33107610 DOI: 10.1002/lary.29197] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES/HYPOTHESIS To assess the causative factors that contribute to racial disparities in head and neck squamous cell carcinoma (HNSCC) and establish the role of hospital factors in racial disparities. STUDY DESIGN Retrospective database analysis. METHODS Patients with surgically treated HNSCC were identified using the National Cancer Database (2004-2014). Logistic and proportional-hazard regression models were used to characterize the factors that contribute to racial disparities. Differences in quality of care received were compared among black and white patients using previously validated metrics. RESULTS We identified 69,186 eligible patients. Black patients had a 48% higher mortality than white patients (HR 1.48; 95% confidence interval [CI], 1.41-1.54). Black patients had a lower mean quality score (67.6%; 95% CI, 66.8%-69.4%) compared with white patients (71.2%: 95% CI, 71.0%-71.4%) for five quality metrics. After adjusting for differences in patient, oncologic, and hospital factors we were able to explain 60% of the excess mortality for black patients. Oncologic factors at presentation accounted for 57.7% of observed mortality differences, whereas hospital characteristics and quality of care accounted for 11.5%. After adjusting for these factors, black patients still had a 19% higher mortality (HR 1.19; 95% CI, 1.14-1.24). CONCLUSIONS Oncologic factors at presentation are a major contributor to racial disparities in outcomes for HNSCC. Hospital factors, such as quality, volume, and safety-net status, constitute a minor factor in the mortality difference. Resolving existing disparities will require detecting head and neck cancer at an earlier stage and improving the quality of care for black patients. LEVEL OF EVIDENCE 3. Laryngoscope, 131:1053-1059, 2021.
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Affiliation(s)
- Japnam S Jassal
- Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - John D Cramer
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
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Massa ST, Pipkorn P, Jackson RS, Zevallos JP, Mazul AL. Access to a regular medical provider among head and neck cancer survivors. Head Neck 2020; 42:2267-2276. [DOI: 10.1002/hed.26182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 03/24/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
- Sean T. Massa
- Department of Otolaryngology—Head and Neck Surgery Washington University School of Medicine St Louis Missouri USA
| | - Patrik Pipkorn
- Department of Otolaryngology—Head and Neck Surgery Washington University School of Medicine St Louis Missouri USA
| | - Ryan S. Jackson
- Department of Otolaryngology—Head and Neck Surgery Washington University School of Medicine St Louis Missouri USA
| | - Jose P. Zevallos
- Department of Otolaryngology—Head and Neck Surgery Washington University School of Medicine St Louis Missouri USA
| | - Angela L. Mazul
- Department of Otolaryngology—Head and Neck Surgery Washington University School of Medicine St Louis Missouri USA
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Zhan KY, Puram SV, Li MM, Silverman DA, Agrawal AA, Ozer E, Old MO, Carrau RL, Rocco JW, Higgins KM, Enepekides DJ, Husain Z, Kang SY, Eskander A. National treatment trends in human papillomavirus–positive oropharyngeal squamous cell carcinoma. Cancer 2019; 126:1295-1305. [DOI: 10.1002/cncr.32654] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Kevin Y. Zhan
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Sidharth V. Puram
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Michael M. Li
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Dustin A. Silverman
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Amit A. Agrawal
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Enver Ozer
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Matthew O. Old
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Ricardo L. Carrau
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - James W. Rocco
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Kevin M. Higgins
- Department of Otolaryngology–Head and Neck Surgery Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada
| | - Danny J. Enepekides
- Department of Otolaryngology–Head and Neck Surgery Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada
| | - Zain Husain
- Department of Radiation Oncology Sunnybrook Health Sciences Centre and Odette Cancer Centre University of Toronto Toronto Ontario Canada
| | - Stephen Y. Kang
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
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Massa ST, Liebendorfer AP, Zevallos JP, Mazul AL. Distance Traveled to Head and Neck Cancer Provider: A Measure of Socioeconomic Status and Access. Otolaryngol Head Neck Surg 2019; 162:193-203. [DOI: 10.1177/0194599819892015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective Improved head and neck cancer survival has been associated with traveling farther distances for treatment, potentially due to patients seeking higher-quality facilities. This study investigates the role of both facility and confounding patient factors on this relationship. Study Design Review of national registry data. Setting National Cancer Database. Subjects and Methods Adults with head and neck cancer diagnosed from 2004 to 2014 were identified. Overall survival was compared among distance-to-facility quartiles via univariate and multivariate survival models. Then, the analysis was stratified by facility and patient factors, and the association between distance and survival was compared among strata. Results Overall survival was worst in the shortest-distance quartile (<5 miles; median survival, 80.7 months; 95% CI, 79.2-82.3), while other distance groups showed similar survival (range, 96.4-104 months). This finding remained in the multivariate model (adjusted hazard ratio vs first distance quartile: 0.88; 95% CI, 0.87-0.89). The association between survival and distance persisted in all subgroups when stratified by facility volume and type (adjusted hazard ratio range, 0.82-0.91), suggesting that facility quality does not fully account for this association. When stratified by income, distance remained statistically associated with survival but with a smaller effect size than that of income. Conclusion The association between distance to treating facility and head and neck cancer survival is limited to patients with worse survival outcomes living within 5 miles of the facility and is not fully explained by measures of facility quality.
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Affiliation(s)
- Sean T. Massa
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Jose P. Zevallos
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Angela L. Mazul
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Toubat O, Farias AJ, Atay SM, McFadden PM, Kim AW, David EA. Disparities in the surgical management of early stage non-small cell lung cancer: how far have we come? J Thorac Dis 2019; 11:S596-S611. [PMID: 31032078 DOI: 10.21037/jtd.2019.01.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
It is currently estimated that nearly one-third of patients with newly diagnosed non-small cell lung cancer (NSCLC) have stage I-II disease on clinical evaluation. Curative-intent surgical resection has been a cornerstone of the therapeutic management of such patients, offering the best clinical and oncologic outcomes in the long-term. In 1999, Peter Bach and colleagues brought attention to racial disparities in the receipt of curative-intent surgery in the NSCLC population. In the time since this seminal study, there is accumulating evidence to suggest that disparities in the receipt of definitive surgery continue to persist for patients with early stage NSCLC. In this review, we sought to provide an up-to-date assessment of 20 years of surgical disparities literature in the NSCLC population. We summarized common and unrecognized disparities in the receipt of surgical resection for early stage NSCLC and demonstrated that demographic and socioeconomic factors such as race/ethnicity, special patient groups, income and insurance continue to impact the receipt of definitive resection. Additionally, we found that discrepancies in patient and provider perceptions of and attitudes toward surgery, access to invasive staging, distance to treatment centers and negative stigmas about lung cancer that patients experience may act to perpetuate disparities in surgical treatment of early stage lung cancer.
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Affiliation(s)
- Omar Toubat
- Keck School of Medicine of USC, Los Angeles, CA, USA.,Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Scott M Atay
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - P Michael McFadden
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth A David
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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Osazuwa‐Peters N, Christopher KM, Cass LM, Massa ST, Hussaini AS, Behera A, Walker RJ, Varvares MA. What's Love Got to do with it? Marital status and survival of head and neck cancer. Eur J Cancer Care (Engl) 2019; 28:e13022. [DOI: 10.1111/ecc.13022] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/10/2018] [Accepted: 01/17/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Nosayaba Osazuwa‐Peters
- Department of Otolaryngology‐Head and Neck Surgery Saint Louis University School of Medicine St. Louis Missouri
- Saint Louis University Cancer Center St. Louis Missouri
- Department of Epidemiology College of Public Health and Social Justice Saint Louis University St. Louis Missouri
| | | | - Lauren M. Cass
- Department of Otolaryngology‐Head and Neck Surgery Saint Louis University School of Medicine St. Louis Missouri
| | - Sean T. Massa
- Department of Otolaryngology‐Head and Neck Surgery Saint Louis University School of Medicine St. Louis Missouri
| | - Adnan S. Hussaini
- Department of Otolaryngology‐Head and Neck Surgery Georgetown University Medical Center Washington District of Columbia
| | - Anit Behera
- Saint Louis University Center for Outcomes Research St. Louis Missouri
- Saint Louis University School of Medicine St. Louis Missouri
| | - Ronald J. Walker
- Department of Otolaryngology‐Head and Neck Surgery Saint Louis University School of Medicine St. Louis Missouri
| | - Mark A. Varvares
- Department of Otolaryngology, The Massachusetts Eye and Ear Infirmary Harvard Medical School Boston Massachusetts
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Racial and socioeconomic disparities associated with 90-day mortality among patients with head and neck cancer in the United States. Oral Oncol 2018; 89:95-101. [PMID: 30732966 DOI: 10.1016/j.oraloncology.2018.12.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/11/2018] [Accepted: 12/22/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To quantify head and neck cancer (HNC) mortality rates and identify racial and socioeconomic factors associated with 90-day mortality. METHODS The National Cancer Database (2004-2014) was queried for eligible HNC cases (n = 260,011) among adults treated with curative intent. Outcome of interest was any-cause 90-day mortality. Kaplan-Meier curves (Log-rank tests) estimated crude survival differences. A Cox proportional hazards model with further adjustments using the Šidák multiple comparison method adjusted for racial, socioeconomic and clinical factors. RESULTS There were 9771 deaths (90-day mortality rate = 3.8%). There were crude differences in sex, race/ethnicity, comorbidity, distance, income, and insurance (Log-rank p-value < 0.0001). In the final model, blacks (aHR = 1.10, 95% CI 1.00, 1.21) and males (aHR = 1.07; 95% CI 1.00, 1.15) had greater 90-day mortality hazard, as did those uninsured (aHR = 1.72; 95% CI 1.48, 1.99), covered by Medicaid (aHR = 1.72; 95% CI 1.53, 1.93) or Medicare (aHR = 1.40; 95% CI 1.27, 1.53). Residence in lower median income zip code was associated with greater 90-day mortality [(aHR <$30,000 = 1.30; 95% CI 1.18, 1.44); (aHR $30,000-$34,999 = 1.24; 95% CI 1.13, 1.36); (aHR $35,000-$45,999 = 1.18; 95% CI 1.08, 1.27)]; and farther travel distance for treatment was associated with decreased 90-day mortality [(aHR 50-249.9 miles = 0.86; 95% CI 0.77, 0.97); (aHR > 250 miles = 0.70; 95% CI 50, 0.99)]. CONCLUSIONS There are significant race and socioeconomic disparities among patients with HNC, and these disparities impact mortality within 90 days of treatment.
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