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Greteman BB, Del Vecchio NJ, Garcia‐Auguste CJ, Kahl AR, Gryzlak BM, Chrischilles EA, Charlton ME, Nash SH. Identifying predictors of COVID-related delays in cancer-specific medical care. Cancer Med 2024; 13:e7183. [PMID: 38629238 PMCID: PMC11022144 DOI: 10.1002/cam4.7183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/04/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE Evidence of the impact of the COVID-19 pandemic on cancer prevention and control is growing, but little is known about patient-level factors associated with delayed care. We analyzed data from a survey focused on Iowan cancer patients' COVID-19 experiences in the early part of the pandemic. METHODS Participants were recruited from the University of Iowa Holden Comprehensive Cancer Center's Patients Enhancing Research Collaborations at Holden (PERCH) program. We surveyed respondents on demographic characteristics, COVID-19 experiences and reactions, and delays in any cancer-related health care appointment, or cancer-related treatment appointments. Two-sided significance tests assessed differences in COVID-19 experiences and reactions between those who experienced delays and those who did not. RESULTS There were 780 respondents (26% response), with breast, prostate, kidney, skin, and colorectal cancers representing the majority of respondents. Delays in cancer care were reported by 29% of respondents. In multivariable-adjusted models, rural residents (OR 1.47; 95% CI 1.03, 2.11) and those experiencing feelings of isolation (OR 2.18; 95% CI 1.37, 3.47) were more likely to report any delay, where experiencing financial difficulties predicted delays in treatment appointments (OR 5.72; 95% CI 1.96, 16.67). Health insurance coverage and concern about the pandemic were not statistically significantly associated with delays. CONCLUSION These findings may inform cancer care delivery during periods of instability when treatment may be disrupted by informing clinicians about concerns that patients have during the treatment process. Future research should assess whether delays in cancer care impact long-term cancer outcomes and whether delays exacerbate existing disparities in cancer outcomes.
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Affiliation(s)
- Breanna B. Greteman
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | | | | | | | - Brian M. Gryzlak
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | | | - Mary E. Charlton
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
- Iowa Cancer RegistryUniversity of IowaIowa CityIowaUSA
| | - Sarah H. Nash
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
- Iowa Cancer RegistryUniversity of IowaIowa CityIowaUSA
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Tsai M, Vernon M, Su S, Coughlin SS, Dong Y. Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia. Cancer Med 2024; 13:e6954. [PMID: 38348574 PMCID: PMC10904969 DOI: 10.1002/cam4.6954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The study's purpose was to examine 5-year colorectal cancer (CRC) survival rates between White and Black patients. We also determined whether regional socioeconomic status (SES) is associated with CRC survival between White and Black patients in the Clayton, West Central, East Central, Southeast, and Northeast Georgia public health districts. METHODS We performed a retrospective cohort analysis using data from the 1975 to 2016 Surveillance, Epidemiology, and End Results program. The 2015 United States Department of Agriculture Economic Research Services county typology codes were used to identify region-level SES with persistent poverty, low employment, and low education. Kaplan-Meier method and Cox proportional hazard regression were performed. RESULTS Among 10,876 CRC patients (31.1% Black patients), 5-year CRC survival rates were lower among Black patients compared to White patients (65.4% vs. 69.9%; p < 0.001). In multivariable analysis, White patients living in regions with persistent poverty had a 1.1-fold increased risk of CRC death (HR, 1.12; 95% CI, 1.00-1.25) compared to those living in non-persistent poverty regions. Among Black patients, those living in regions with low education were at a 1.2-fold increased risk of CRC death (HR, 1.19; 95% CI, 1.01-1.40) compared to those living in non-low education regions. DISCUSSION AND CONCLUSIONS Black patients demonstrated lower CRC survival rates in Georgia compared to their White counterparts. White patients living in regions with persistent poverty, and Black patients living in regions with low education had an increased risk of CRC death. Our findings provide important evidence to all relevant stakeholders in allocating health resources aimed at CRC early detection and prevention and timely referral for CRC treatment by considering the patient's regional SES in Georgia.
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Affiliation(s)
- Meng‐Han Tsai
- Cancer Prevention, Control & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Marlo Vernon
- Cancer Prevention, Control & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Shaoyong Su
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Steven S. Coughlin
- Department of Biostatistics, Data Science and EpidemiologyAugusta UniversityAugustaGeorgiaUSA
| | - Yanbin Dong
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
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Gaffley M, Hsieh MC, Li T, Yi Y, Gibbs JF, Wu XC, Gallagher J, Chu QD. Rural versus urban commuting patients with stage III colon cancer: is there a difference in treatment and outcome? Surg Endosc 2023; 37:9441-9452. [PMID: 37697118 DOI: 10.1007/s00464-023-10406-1] [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: 04/10/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND To evaluate if there are differences in outcomes for patients with stage III colon cancer in those from urban vs. rural commuting areas. METHODS Data were evaluated on patients diagnosed with stage III colon cancer between 2012 and2018 from the Louisiana Tumor Registry. Patients were classified into rural and urban groups. Data on overall survival, time from diagnosis to surgery and time from surgery to chemotherapy, and sociodemographic factors (including race, age, and poverty level) were recorded. RESULTS Of 2652 patients identified, 2159 were urban (81.4%) and 493 rural (18.6%). No age difference between rural and urban patients (p = 0.56). Stage IIIB accounted for 66.7%, followed by IIIC (21.6%) and IIIA (11%), with a significant difference between rural and urban patients based on stage (p = 0.02). There was no difference in the extent of surgery (p = 0.34) or tumor size (p = 0.72) between urban and rural settings. No difference in undergoing chemotherapy (p = 0.12). There was a statistically significant difference in receiving timely treatment for hospital volume (p < 0.0001) and poverty level (p < 0.0001), but no difference in time from diagnosis to surgery (p = 0.48), and time from surgery to chemotherapy (p = 0.27). Non-Hispanic Blacks were less likely to receive timely treatment when compared with non-Hispanic Whites for both surgery and adjuvant chemotherapy, (aHR 0.91, 95% CI 0.83-0.99) and (aHR 0.86, 95% CI 0.77-0.97), respectively. There was no difference in Kaplan-Meier overall survival curves comparing rural vs. urban patients (p = 0.77). CONCLUSIONS There was no statistical difference in overall survival, time to surgery, and time to adjuvant chemotherapy between rural and urban patients with Stage III colon cancer.
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Affiliation(s)
- Michaela Gaffley
- Orlando Health Colon and Rectal Institute, Orlando, FL, USA.
- Colorectal Surgery, Orlando Health Cancer Institute, 52 W Underwood Street, Orlando, FL, 32806, USA.
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry & Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tingting Li
- Louisiana Tumor Registry & Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Yong Yi
- Louisiana Tumor Registry & Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - John F Gibbs
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry & Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Quyen D Chu
- Orlando Health Cancer Institute, Orlando, FL, USA
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Preston MA, Cadet D, Hunley R, Retnam R, Arezo S, Sheppard VB. Health Equity and Colorectal Cancer Awareness: a Community Health Educator Initiative. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:225-230. [PMID: 34677801 PMCID: PMC8532449 DOI: 10.1007/s13187-021-02102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 06/13/2023]
Abstract
Disparities in colorectal cancer (CRC) incidence and mortality persist in rural and underserved communities. Our Community Outreach and Engagement (COE) activities are grounded in a bi-directional Community-to-Bench model in which the National Outreach Network Community Health Educator (NON CHE) Screen to Save (S2S) initiative was implemented. In this study, we assessed the impact of the NON CHE S2S in rural and underserved communities. Descriptive and comparative analyses were used to examine the role of the NON CHE S2S on CRC knowledge and CRC screening intent. Data included demographics, current CRC knowledge, awareness, and future CRC health plans. A multivariate linear regression was fit to survey scores for CRC knowledge. The NON CHE S2S engaged 441 participants with 170 surveys completed. The difference in participants' CRC knowledge before and after the NON CHE S2S intervention had an overall mean of 0.92 with a standard deviation of 2.56. At baseline, White participants had significantly higher CRC knowledge scores, correctly answering 1.94 (p = 0.007) more questions on average than Black participants. After the NON CHE S2S intervention, this difference was not statistically significant. Greater than 95% of participants agreed that the NON CHE S2S sessions impacted their intent to get screened for CRC. Equity of access to health information and the health care system can be achieved with precision public health strategies. The COE bi-directional Community-to-Bench model facilitated community connections through the NON CHE and increased awareness of CRC risk reduction, screening, treatment, and research. The NON CHE combined with S2S is a powerful tool to engage communities with the greatest health care needs and positively impact an individual's intent to "get screened" for CRC.
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Affiliation(s)
- Michael A Preston
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA.
| | - Debbie Cadet
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Rachel Hunley
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Reuben Retnam
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Sarah Arezo
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
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Leslie TF, Frankenfeld CL, Menon N. Disparities in colorectal cancer time-to-treatment and survival time associated with racial and economic residential segregation surrounding the diagnostic hospital, Georgia 2010-2015. Cancer Epidemiol 2022; 81:102267. [PMID: 36166941 DOI: 10.1016/j.canep.2022.102267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate patient-level colorectal cancer outcomes in relation to residential income and racial segregation and composition of the neighborhood surrounding the diagnosing hospitals, and characterize presence of cancer-relevant diagnosis and treatment modalities that might contribute to these associations. METHODS We utilized Georgia state cancer registry data (2010-2015), matching diagnosis information to hospital technology provided by the American Hospital Association and spatial information to the US Census. We modeled time-to-treatment and survival time, using Cox proportional hazards models, stratified by segregation. Segregation was examined as residential economic and racial evenness (Atkinson index) and isolation (isolation index) and mean income at the Census tract level. To assess possible contributing factors, analysis of hospital diagnosis and treatment technologies in relation to segregation was conducted. RESULTS Average income of the Census tract and racial residential segregation of the diagnosing hospital's neighborhood was generally unassociated with time-to-treatment or survival time. Higher income evenness around the diagnosing hospital was associated with shorter time-to-treatment, with no association with time-to-death. Higher income isolation for the diagnosing hospital, conversely, was associated with longer times to treatment, but also longer survival times. Hospitals in regions with higher level of residential income segregation were less likely to have a particular diagnosing or treatment technologies, such as virtual colonoscopy and chemotherapy. CONCLUSION Hospital resources may be a function of their immediate economic environment, and this may have influence on cancer outcomes. Future work should evaluate patient outcomes in light of technologies or therapies utilized within particular economic environments.
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Affiliation(s)
- Timothy F Leslie
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA, USA.
| | | | - Nirup Menon
- School of Business, George Mason University, Fairfax, VA, USA
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Bhatia S, Landier W, Paskett ED, Peters KB, Merrill JK, Phillips J, Osarogiagbon RU. Rural-Urban Disparities in Cancer Outcomes: Opportunities for Future Research. J Natl Cancer Inst 2022; 114:940-952. [PMID: 35148389 PMCID: PMC9275775 DOI: 10.1093/jnci/djac030] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/27/2021] [Accepted: 02/01/2022] [Indexed: 01/12/2023] Open
Abstract
Cancer care disparities among rural populations are increasingly documented and may be worsening, likely because of the impact of rurality on access to state-of-the-art cancer prevention, diagnosis, and treatment services, as well as higher rates of risk factors such as smoking and obesity. In 2018, the American Society of Clinical Oncology undertook an initiative to understand and address factors contributing to rural cancer care disparities. A key pillar of this initiative was to identify knowledge gaps and promote the research needed to understand the magnitude of difference in outcomes in rural vs nonrural settings, the drivers of those differences, and interventions to address them. The purpose of this review is to describe continued knowledge gaps and areas of priority research to address them. We conducted a comprehensive literature review by searching the PubMed (Medline), Embase, Web of Science, and Cochrane Library databases for studies published in English between 1971 and 2021 and restricted to primary reports from populations in the United States and abstracted data to synthesize current evidence and identify continued gaps in knowledge. Our review identified continuing gaps in the literature regarding the underlying causes of rural-urban disparities in cancer outcomes. Rapid advances in cancer care will worsen existing disparities in outcomes for rural patients without directed effort to understand and address barriers to high-quality care in these areas. Research should be prioritized to address ongoing knowledge gaps about the drivers of rurality-based disparities and preventative and corrective interventions.
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Affiliation(s)
- Smita Bhatia
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Wendy Landier
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Balan N, Petrie BA, Chen KT. Racial Disparities in Colorectal Cancer Care for Black Patients: Barriers and Solutions. Am Surg 2022; 88:2823-2830. [PMID: 35757937 DOI: 10.1177/00031348221111513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Racial disparities in colorectal cancer for Black patients have led to a significant mortality difference when compared to White patients, a gap which has remained to this day. These differences have been linked to poorer quality insurance and socioeconomic status in addition to lower access to high-quality health care resources, which are emblematic of systemic racial inequities. Disparities impact nearly every point along the colorectal cancer care continuum and include barriers to screening, surgical care, oncologic care, and surveillance. These critical faults are the driving forces behind the mortality difference Black patients face. Health care systems should strive to correct these disparities through both cultural competency at the provider level and public policy change at the national level.
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Affiliation(s)
- Naveen Balan
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Beverley A Petrie
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T Chen
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
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Leech MM, Weiss JE, Markey C, Loehrer AP. Influence of Race, Insurance, Rurality, and Socioeconomic Status on Equity of Lung and Colorectal Cancer Care. Ann Surg Oncol 2022; 29:3630-3639. [PMID: 34997420 DOI: 10.1245/s10434-021-11160-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study evaluated the influence that social determinants of health had on stage at diagnosis and receipt of cancer-directed surgery for patients with lung and colorectal cancer in the North Carolina Central Cancer Registry (2010-2015). METHODS This study examined non-Hispanic uninsured or privately-insured patients 18 to 64 years of age. Multivariable logistic regression models, including two-way interaction terms, assessed the influence of race, insurance status, rurality, and Social Deprivation Index on stage at diagnosis and receipt of surgery. RESULTS 6574 lung cancer patients and 5355 colorectal cancer patients were included. Among the lung cancer patients, the uninsured patients had higher odds of having stage IV disease (odds ratio [OR] = 1.46; 95 % confidence interval [CI] = 1.22-1.76) and lower odds of receiving surgery (OR = 0.48; 95 % CI = 0.34-0.69) than the privately-insured patients. Among the colorectal cancer patients, uninsured status was associated with higher odds of stage IV disease (OR = 1.53; 95 % CI = 1.17-2.00) than privately-insured status. A significant insurance status and rurality interaction (p = 0.03) was found in the colorectal model for receipt of surgery. In the privately-insured group, non-Hispanic Black and rural patients had lower odds of receiving colorectal surgery (OR = 0.69; 95 % CI = 0.50-0.94 and OR = 0.68; 95 % CI = 0.52-0.89; respectively) than their non-Hispanic White and urban counterparts. CONCLUSIONS After controlling for confounding and evaluation of interactions between patient-, community-, and geographic-level factors, uninsured status remained the strongest driver of patients' presentation with late-stage lung and colorectal cancer. As policy and care delivery transformation targets uninsured and vulnerable populations, explicit recognition, and measurement of intersectionality should be considered.
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Affiliation(s)
- Mary M Leech
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | | | - Chad Markey
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Andrew P Loehrer
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
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Montiel Ishino FA, Odame EA, Villalobos K, Whiteside M, Mamudu H, Williams F. Applying Latent Class Analysis on Cancer Registry Data to Identify and Compare Health Disparity Profiles in Colorectal Cancer Surgical Treatment Delay. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E487-E496. [PMID: 33729186 PMCID: PMC8435045 DOI: 10.1097/phh.0000000000001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Colorectal cancer (CRC) surgical treatment delay (TD) has been associated with mortality and morbidity; however, disparities by TD profiles are unknown. OBJECTIVES This study aimed to identify CRC patient profiles of surgical TD while accounting for differences in sociodemographic, health insurance, and geographic characteristics. DESIGN We used latent class analysis (LCA) on 2005-2015 Tennessee Cancer Registry data of CRC patients and observed indicators that included sex/gender, age at diagnosis, marital status (single/married/divorced/widowed), race (White/Black/other), health insurance type, and geographic residence (non-Appalachian/Appalachian). SETTING The state of Tennessee in the United States that included both Appalachian and non-Appalachian counties. PARTICIPANTS Adult (18 years or older) CRC patients (N = 35 412) who were diagnosed and surgically treated for in situ (n = 1286) and malignant CRC (n = 34 126). MAIN OUTCOME MEASURE The distal outcome of TD was categorized as 30 days or less and more than 30 days from diagnosis to surgical treatment. RESULTS Our LCA identified a 4-class solution and a 3-class solution for in situ and malignant profiles, respectively. The highest in situ CRC patient risk profile was female, White, aged 75 to 84 years, widowed, and used public health insurance when compared with respective profiles. The highest malignant CRC patient risk profile was male, Black, both single/never married and divorced/separated, resided in non-Appalachian county, and used public health insurance when compared with respective profiles. The highest risk profiles of in situ and malignant patients had a TD likelihood of 19.3% and 29.4%, respectively. CONCLUSIONS While our findings are not meant for diagnostic purposes, we found that Blacks had lower TD with in situ CRC. The opposite was found in the malignant profiles where Blacks had the highest TD. Although TD is not a definitive marker of survival, we observed that non-Appalachian underserved/underrepresented groups were overrepresented in the highest TD profiles. The observed disparities could be indicative of intervenable risk.
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Affiliation(s)
- Francisco A. Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Emmanuel A. Odame
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Kevin Villalobos
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Martin Whiteside
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Hadii Mamudu
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
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Markey C, Weiss JE, Loehrer AP. Influence of Race, Insurance, and Rurality on Equity of Breast Cancer Care. J Surg Res 2021; 271:117-124. [PMID: 34894544 DOI: 10.1016/j.jss.2021.09.042] [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: 03/01/2021] [Revised: 09/03/2021] [Accepted: 09/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Considerable gaps in knowledge remain regarding the intersectionality between race, insurance status, rurality, and community-level socioeconomic status that contribute in concert to disparities in breast cancer care delivery. METHODS Women age 18-64 y old with either private, Medicaid, or no insurance coverage and a diagnosis of breast cancer from the North Carolina Central Cancer Registry (2010-2015) were identified and reviewed. Logistic regression models examined the impact of race, insurance status, rurality, and the Social Deprivation Index (SDI) on advanced stage disease at diagnosis (III, IV) and receipt of cancer directed surgery (CDS). Models tested two-way interactions between race, insurance status, rurality, and SDI. RESULTS Of the study population (n = 23,529), 14.6% were diagnosed with advanced stage disease (III, IV), and 97.1% of women with non-metastatic breast cancer (n = 22,438) received cancer directed surgery (CDS). Twenty percent of women were non-Hispanic Black (NHB), 3.0% Hispanic, 10.9% Medicaid insured, 5.9% uninsured, 20.0% of women resided in rural areas, and 20.0% resided in communities of the highest quartile SDI. NHB race, Medicaid or uninsured status, and residence in rural or socially deprived areas were associated with advanced stage breast cancer at diagnosis. NHB and Medicaid or uninsured women were significantly less likely to receive CDS. There were no statistically significant interactions found influencing stage at diagnosis or receipt of cancer directed surgery. CONCLUSIONS In a heterogeneous population across the state of North Carolina, non-Hispanic Black race, Medicaid or uninsured status, and residence in rural or high social deprivation communities are independently associated with advanced stage breast cancer at diagnosis, while non-Hispanic Black race and Medicaid or uninsured status are associated with lower odds to receive cancer directed surgery.
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Affiliation(s)
- Chad Markey
- The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Julie E Weiss
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Andrew P Loehrer
- The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
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Luo X, Storey S, Gandhi P, Zhang Z, Metzger M, Huang K. Analyzing the symptoms in colorectal and breast cancer patients with or without type 2 diabetes using EHR data. Health Informatics J 2021; 27:14604582211000785. [PMID: 33726552 DOI: 10.1177/14604582211000785] [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] [Indexed: 11/16/2022]
Abstract
This research extracted patient-reported symptoms from free-text EHR notes of colorectal and breast cancer patients and studied the correlation of the symptoms with comorbid type 2 diabetes, race, and smoking status. An NLP framework was developed first to use UMLS MetaMap to extract all symptom terms from the 366,398 EHR clinical notes of 1694 colorectal cancer (CRC) patients and 3458 breast cancer (BC) patients. Semantic analysis and clustering algorithms were then developed to categorize all the relevant symptoms into eight symptom clusters defined by seed terms. After all the relevant symptoms were extracted from the EHR clinical notes, the frequency of the symptoms reported from colorectal cancer (CRC) and breast cancer (BC) patients over three time-periods post-chemotherapy was calculated. Logistic regression (LR) was performed with each symptom cluster as the response variable while controlling for diabetes, race, and smoking status. The results show that the CRC and BC patients with Type 2 Diabetes (T2D) were more likely to report symptoms than CRC and BC without T2D over three time-periods in the cancer trajectory. We also found that current smokers were more likely to report anxiety (CRC, BC), neuropathic symptoms (CRC, BC), anxiety (BC), and depression (BC) than non-smokers.
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Affiliation(s)
| | | | | | | | | | - Kun Huang
- Indiana University School of Medicine, USA.,Regenstrief Institute, USA
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12
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Varon ML, Baker E, Byers E, Cirolia L, Bogler O, Bouchonville M, Schmeler K, Hariprasad R, Pramesh CS, Arora S. Project ECHO Cancer Initiative: a Tool to Improve Care and Increase Capacity Along the Continuum of Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:25-38. [PMID: 34292501 DOI: 10.1007/s13187-021-02031-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
Solving health problems requires not only the development of new medical knowledge but also its dissemination, particularly to underserved communities. The barriers to effective dissemination also contribute to the disparities in cancer care experienced most everywhere. This concern is particularly acute in low and middle-income countries which already bear a disproportionate burden of cancer, a situation that is projected to worsen. Project ECHO (Extension for Community Healthcare Outcomes) is a knowledge dissemination platform that can increase workforce capacity across many fields, including cancer care by scaling best practices. Here we describe how Project ECHO works and illustrate this with existing programs that span the cancer care continuum and the globe. The examples provided combined with the explanation of how to build effective Project ECHO communities provide an accessible guide on how this education strategy can be integrated into existing work to help respond to the challenge of cancer.
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Affiliation(s)
| | - Ellen Baker
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Byers
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- UNM School of Medicine, Albuquerque, NM, USA
| | - Lucca Cirolia
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- UNM School of Medicine, Albuquerque, NM, USA
| | - Oliver Bogler
- Center for Cancer Training, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Bouchonville
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Roopa Hariprasad
- Division of Clinical Oncology, National Institute of Cancer Prevention and Research, New Delhi, India
| | | | - Sanjeev Arora
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
- UNM School of Medicine, Albuquerque, NM, USA.
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13
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Urakawa T, Saitsu A, Watanabe J, Kotani K. Rural-urban difference in colorectal cancer mortality. J Cancer 2021; 12:3391-3392. [PMID: 33976748 PMCID: PMC8100804 DOI: 10.7150/jca.59434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Tomoya Urakawa
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Akihiro Saitsu
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Jun Watanabe
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
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14
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The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041384. [PMID: 33546168 PMCID: PMC7913122 DOI: 10.3390/ijerph18041384] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/15/2022]
Abstract
One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.
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15
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Lemieux-Sarrasin D, Pelland-Marcotte MC, Simonyan D, Martineau É, Desbiens B, Michon B. Distance to the pediatric oncology center does not affect survival in children with acute lymphoblastic leukemia: a report from CYP-C. Leuk Lymphoma 2020; 62:960-966. [PMID: 33231123 DOI: 10.1080/10428194.2020.1849673] [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] [Indexed: 10/22/2022]
Abstract
Remoteness is associated with worse survival in adults with cancer. We aimed to determine whether remoteness is associated with cancer outcomes in pediatric acute lymphoblastic leukemia (ALL). Canadian children with ALL entered in the CYP-C registry were included. The predictive impact of remoteness on overall survival (OS), relapse, and treatment-related complications (infections, thrombosis, bleeding, and osteonecrosis) was estimated using multivariate regression models. We included 1383 children, of whom 277 (20.0%) lived remotely (>200 km from the pediatric oncology center). The median latency to see a pediatric oncologist was longer in children living remotely. The 5-year OS (95% CI) was similar for both groups (remote: 95.2% [93.7-96.3%] vs close: 94.1% [90.5-95.2%]). No difference was found in the relapse rate between both groups and in treatment-related complications. Remoteness did not affect survival in pediatric ALL. Further research is needed to determine which models of healthcare organization optimize cancer outcomes and patients' satisfaction.
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Affiliation(s)
- Daphné Lemieux-Sarrasin
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
| | - Marie-Claude Pelland-Marcotte
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Quebec City, Quebec, Canada
| | - David Simonyan
- Centre de recherche du CHU de Québec, Quebec City, Quebec, Canada
| | - Émilie Martineau
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
| | - Barbara Desbiens
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
| | - Bruno Michon
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Quebec City, Quebec, Canada
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16
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McGrew KM, Peck JD, Vesely SK, Janitz AE, Snider CA, Dougherty TM, Campbell JE. Effect Modification of the Association Between Race and Stage at Colorectal Cancer Diagnosis by Socioeconomic Status. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25 Suppl 5, Tribal Epidemiology Centers: Advancing Public Health in Indian Country for Over 20 Years:S29-S35. [PMID: 31348188 PMCID: PMC7043013 DOI: 10.1097/phh.0000000000000993] [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] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To compare risks of distant-stage colorectal cancer (CRC) diagnosis between whites and American Indian/Alaska Natives (AI/ANs) and to explore effect modification by area-based socioeconomic status (SES). DESIGN Retrospective cohort study using data from the Oklahoma Central Cancer Registry. SETTING Oklahoma. PARTICIPANTS White and AI/AN cases of CRC diagnosed in Oklahoma between 2001 and 2008 (N = 8 438). A subanalysis was performed on the cohort of those aged 50 years and older (N = 7 728). MAIN OUTCOME MEASURE Risk of distant-stage CRC diagnosis stratified by SES score. RESULTS Race and SES were independently associated with distant-stage diagnosis. In SES-stratified analyses, AI/ANs in the 2 lowest SES groups experienced increased risks in the overall cohort and among those aged 50 years and older. In multivariable models, risks remained significant among those aged 50 years and older in the lowest SES groups (Adjusted risk ratio SES score of 2: 1.31, 95% confidence interval: 1.06-1.63 and adjusted risk ratio SES score of 1: 1.21, 95% confidence interval: 1.01-1.44). CONCLUSION Socioeconomic status is an effect modifier in the association between race/ethnicity and stage at CRC diagnosis. Disparities in stage at CRC diagnosis exist between AI/ANs and whites with lower estimated SES. Efforts are needed to increase CRC screening among lower SES AI/ANs.
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Affiliation(s)
- Kaitlin M. McGrew
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jennifer D. Peck
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sara K. Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Amanda E. Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Cuyler A. Snider
- Oklahoma Area Tribal Epidemiology Center, Southern Plains Tribal Health Board, Oklahoma City, OK
| | - Tyler M. Dougherty
- Oklahoma Area Tribal Epidemiology Center, Southern Plains Tribal Health Board, Oklahoma City, OK
| | - Janis E. Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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17
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Fong AJ, Lafaro K, Ituarte PHG, Fong Y. Association of Living in Urban Food Deserts with Mortality from Breast and Colorectal Cancer. Ann Surg Oncol 2020; 28:1311-1319. [PMID: 32844294 DOI: 10.1245/s10434-020-09049-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Food deserts are neighborhoods with low access to healthy foods and are associated with poor health metrics. We investigated association of food desert residence and cancer outcomes. METHODS In this population-based study, data from the 2000-2012 California Cancer Registry was used to identify patients with stage II/III breast or colorectal cancer. Patient residence at time of diagnosis was linked by census tract to food desert using the USDA Food Access Research Atlas. Treatment and outcomes were compared by food desert residential status. RESULTS Among 64,987 female breast cancer patients identified, 66.8% were < 65 years old, and 5.7% resided in food deserts. Five-year survival for food desert residents was 78% compared with 80% for non-desert residents (p < 0.0001). Among 48,666 colorectal cancer patients identified, 50.4% were female, 39% were > 65 years old, and 6.4% resided in food deserts. Five-year survival for food desert residents was 60% compared with 64% for non-desert residents (p < 0.001). Living in food deserts was significantly associated with diabetes, tobacco use, poor insurance coverage, and low socioeconomic status (p < 0.05) for both cancers. There was no significant difference in rates of surgery or chemotherapy by food desert residential status for either diagnosis. Multivariable analyses showed that food desert residence was associated with higher mortality. CONCLUSION Survival, despite treatment for stage II/III breast and colorectal cancers was worse for those living in food deserts. This association remained significant without differences in use of surgery or chemotherapy, suggesting factors other than differential care access may link food desert residence and cancer outcomes.
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Affiliation(s)
- Abigail J Fong
- Department of Surgery, Cedar-Sinai Hospital, Los Angeles, CA, USA.,Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Kelly Lafaro
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.,Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Philip H G Ituarte
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
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18
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Palmer NR, Avis NE, Fino NF, Tooze JA, Weaver KE. Rural cancer survivors' health information needs post-treatment. PATIENT EDUCATION AND COUNSELING 2020; 103:1606-1614. [PMID: 32147307 PMCID: PMC7311274 DOI: 10.1016/j.pec.2020.02.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/03/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study describes the most common cancer-related health information needs among rural cancer survivors and characteristics associated with reporting more information needs. METHODS Rural breast, prostate, and colorectal cancer survivors, two to five years post-diagnosis, identified from an institutional cancer registry, completed a mailed/telephone-administered survey. Respondents were asked about 23 health information needs in eight domains (tests and treatment, side effects and symptoms, health promotion, fertility, interpersonal, occupational, emotional, and insurance). Poisson regression models were used to assess relationships between number of health information needs and demographic and cancer characteristics. RESULTS Participants (n = 170) reported an average of four health information needs, with the most common domains being: side effects and symptoms (58 %), health promotion (54 %), and tests and treatment (41 %). Participants who were younger (compared to 5-year increase, rate ratio [RR] = 1.11, 95 % CI = 1.02-1.21), ethnic minority (RR = 1.89, 95 % CI = 1.17-3.06), less educated (RR = 1.49, 95 % CI = 1.00-2.23), and financially stressed (RR = 1.87, 95 % CI = 1.25-2.81) had a greater number of information needs. CONCLUSIONS Younger, ethnic minority, less educated, and financially strained rural survivors have the greatest need for informational support. PRACTICE IMPLICATIONS The provision of health information for rural cancer survivors should consider type of cancer, treatments received, and sociocultural differences to tailor information provided.
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Affiliation(s)
- Nynikka R Palmer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nora F Fino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Janet A Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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19
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Arora S, Byers EL. Leveraging Local Expertise to Improve Rural Cancer Care Outcomes Using Project ECHO: A Response to Levit et al. JCO Oncol Pract 2020; 16:399-403. [DOI: 10.1200/op.20.00260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sanjeev Arora
- University of New Mexico Health Sciences Center, Project ECHO, Albuquerque, NM
| | - Emily L. Byers
- University of New Mexico Health Sciences Center, Project ECHO, Albuquerque, NM
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20
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Udayasiri DK, MacCallum C, Da Silva N, Skandarajah A, Hayes IP. Impact of hospital geographic remoteness on overall survival after colorectal cancer resection using state-wide administrative data. ANZ J Surg 2020; 90:1321-1327. [PMID: 32496014 DOI: 10.1111/ans.15991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aimed to use administrative data (AD) linked to the Victorian death index (VDI) to report on overall long-term survival following colorectal cancer (CRC) surgery, comparing regional to metropolitan hospitals. METHODS A retrospective cohort study using prospectively gathered AD linked to VDI. The primary outcome was overall survival (OS). Outcomes were adjusted for potential confounders via multivariable Cox proportional hazard regression analysis. RESULTS Total of 17 533 patients: 12 879 metropolitan patients, 3835 inner regional patients and 719 outer regional patients. Multivariable Cox regression, adjusted for the effects of age, ASA score, Charlson score, position of tumour, mode of access, admission type, lymph node metastases, distant metastases, return to theatre, length of stay, HDU admission and discharge destination showed no difference in OS comparing CRC resection patients from inner or outer regional hospitals to metropolitan ((HR 1.02, 95% CI 0.95-1.09, P = 0.59) and (HR 0.97, 95% CI 0.85-1.11, P = 0.68) respectively). CONCLUSION This is the largest and most detailed study concerning OS after CRC resection involving Victorian public hospitals. There was no difference in OS following CRC resection when inner or outer regional hospitals were compared to metropolitan hospitals in Victoria. The study demonstrated the utility of AD with validated algorithms, linked to death data for reporting CRC survival outcomes.
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Affiliation(s)
- Dilshan K Udayasiri
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline MacCallum
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel Da Silva
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian P Hayes
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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21
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Virgilsen LF, Hvidberg L, Vedsted P. Patient's travel distance to specialised cancer diagnostics and the association with the general practitioner's diagnostic strategy and satisfaction with the access to diagnostic procedures: an observational study in Denmark. BMC FAMILY PRACTICE 2020; 21:97. [PMID: 32475346 PMCID: PMC7262770 DOI: 10.1186/s12875-020-01169-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/17/2020] [Indexed: 11/10/2022]
Abstract
Background Research indicate that when general practitioners (GPs) refer their patients for specialist care, the patient often has long distance. This study had a twofold aim: in accordance to the GP’s suspicion of cancer, we investigated the association between: 1) cancer patient’s travel distance to the first specialised diagnostic facility and the GP’s diagnostic strategy and 2) cancer patient’s travel distance to the first specialised diagnostic facility and satisfaction with the waiting time and the availability of diagnostic investigations. Method This combined questionnaire- and registry-based study included incident cancer patients diagnosed in the last 6 months of 2016 where the GP had been involved in the diagnostic process of the patients prior to their diagnosis of cancer (n = 3455). The patient’s travel distance to the first specialised diagnostic facility was calculated by ArcGIS Network Analyst. The diagnostic strategy, cancer suspicion and the GP’s satisfaction with the waiting times and the available investigations were assessed from GP questionnaires. Results When the GP did not suspect cancer or serious illness, an insignificant tendency was seen that longer travel distance to the first specialised diagnostic facility increased the likelihood of the GP using ‘wait-and-see’ approach and ‘medical treatment’ as diagnostic strategies. The GPs of patients with travel distance longer than 49 km to the first specialised diagnostic facility were more likely to report dissatisfaction with the waiting time for requested diagnostic investigations (PR: 1.98, 95% CI: 1.20–3.28). Conclusion A insignificant tendency to use ‘wait-and-see’ and ‘medical treatment’ were seen among GPs of patients with long travel distance to the first diagnostic facility when the GP did not suspect cancer or serious illness. Long distance was associated with higher probability of GP dissatisfaction with the waiting time for diagnostic investigations.
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Affiliation(s)
- Line Flytkjær Virgilsen
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark. .,Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Line Hvidberg
- Department of Quality and Improvement, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark.,Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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22
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Tramontano AC, Chen Y, Watson TR, Eckel A, Hur C, Kong CY. Racial/ethnic disparities in colorectal cancer treatment utilization and phase-specific costs, 2000-2014. PLoS One 2020; 15:e0231599. [PMID: 32287320 PMCID: PMC7156060 DOI: 10.1371/journal.pone.0231599] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/26/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Our study analyzed disparities in utilization and phase-specific costs of care among older colorectal cancer patients in the United States. We also estimated the phase-specific costs by cancer type, stage at diagnosis, and treatment modality. METHODS We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients aged 66 or older diagnosed with colon or rectal cancer between 2000-2013, with follow-up to death or December 31, 2014. We divided the patient's experience into separate phases of care: staging or surgery, initial, continuing, and terminal. We calculated total, cancer-attributable, and patient-liability costs. We fit logistic regression models to determine predictors of treatment receipt and fit linear regression models to determine relative costs. All costs are reported in 2019 US dollars. RESULTS Our cohort included 90,023 colon cancer patients and 25,581 rectal cancer patients. After controlling for patient and clinical characteristics, Non-Hispanic Blacks were less likely to receive treatment but were more likely to have higher cancer-attributable costs within different phases of care. Overall, in both the colon and rectal cancer cohorts, mean monthly cost estimates were highest in the terminal phase, next highest in the staging phase, decreased in the initial phase, and were lowest in the continuing phase. CONCLUSIONS Racial/ethnic disparities in treatment utilization and costs persist among colorectal cancer patients. Additionally, colorectal cancer costs are substantial and vary widely among stages and treatment modalities. This study provides information regarding cost and treatment disparities that can be used to guide clinical interventions and future resource allocation to reduce colorectal cancer burden.
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Affiliation(s)
- Angela C. Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Yufan Chen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Tina R. Watson
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Andrew Eckel
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Chin Hur
- Columbia University Medical Center, New York City, New York, United States of America
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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23
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Haakenstad A, Hawkins SS, Pace LE, Cohen J. Rural-urban disparities in colonoscopies after the elimination of patient cost-sharing by the Affordable Care Act. Prev Med 2019; 129:105877. [PMID: 31669176 DOI: 10.1016/j.ypmed.2019.105877] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/02/2019] [Accepted: 10/23/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Improving the prevention and early detection of colorectal cancer is a priority for reducing rural-urban disparities in colorectal cancer mortality. By eliminating out-of-pocket (OOP) costs for preventive colonoscopies, the Affordable Care Act (ACA) could have reduced rural-urban disparities in screening. METHODS We used the Maine Health Data Organization All-Payer Claims Database including all commercially-insured and Medicare beneficiaries aged 50-75 between 2009 and 2012. Rural-urban commuting areas were used to classify rural/urban residence. ICD-9 and CPT codes identified colonoscopies. We summed all OOP payments per patient-day. An interrupted time series model estimated the impact of the ACA on trends in rural-urban disparities in colonoscopy rates and OOP costs. RESULTS Before the ACA, colonoscopy rates were 16% lower in rural than urban areas (5.1% vs. 6.1% of enrollees annually) and median OOP costs were nearly double ($195 vs. $98). The ACA reduced median OOP payments by $94 (p = .001) initially and $4 monthly (p = .038) in rural areas, and $63 (p < .001) in urban areas. The rural-urban gap in OOP payments dropped by $4 monthly (p = .007). The ACA also reduced rural-urban disparities in colonoscopy rates (disparity decrease of 0.005 (6%) monthly, p < .001). The rural-urban gap in colonoscopy rates declined 40% relative to the pre-ACA period by December 2012. CONCLUSIONS The ACA was associated with significant reductions in rural-urban disparities in colonoscopies in Maine, suggesting that OOP costs are an important barrier for rural residents. Further research is needed to determine whether increased uptake, particularly in rural areas, translated into better patient outcomes for colorectal cancer.
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Affiliation(s)
- Annie Haakenstad
- Harvard T.H. Chan School of Public Health, United States of America.
| | | | - Lydia E Pace
- Brigham and Women's Hospital, United States of America
| | - Jessica Cohen
- Harvard T.H. Chan School of Public Health, United States of America
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24
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Virgilsen LF, Møller H, Vedsted P. Travel distance to cancer-diagnostic facilities and tumour stage. Health Place 2019; 60:102208. [DOI: 10.1016/j.healthplace.2019.102208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 01/01/2023]
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25
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Andrilla CHA, Moore TE, Man Wong K, Evans DV. Investigating the Impact of Geographic Location on Colorectal Cancer Stage at Diagnosis: A National Study of the SEER Cancer Registry. J Rural Health 2019; 36:316-325. [PMID: 31454856 DOI: 10.1111/jrh.12392] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/09/2019] [Accepted: 07/25/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Early detection of colorectal cancer (CRC) is associated with decreased mortality and potential avoidance of chemotherapy. CRC screening rates are lower in rural communities and patient outcomes are poorer. This study examines the extent to which United States' rural residents present at a more advanced stage of CRC compared to nonrural residents. METHODS Using the 2010-2014 Surveillance, Epidemiology and End Results Incidence data, 132,277 patients with CRC were stratified using their county of residence and urban influence codes into 5 categories (metro, adjacent micropolitan, nonadjacent micropolitan, small rural, and remote small rural). Logistic regression was used to investigate the relationship between late stage at diagnosis and county-level characteristics including level of rurality, persistent poverty, low education and low employment, and patient characteristics. RESULTS In the adjusted analysis the rate of stage 4 CRC at diagnosis differed across geographic classification, with patients living in remote small rural counties having the highest rate of stage 4 disease (range: 19.2% in nonadjacent micropolitan counties to 22.7% in remote small rural counties). Other factors, such as patient characteristics, insurance status, and regional practice variation were also significantly associated with late-stage CRC diagnosis. CONCLUSIONS Geographic residence is associated with the rate of stage 4 disease at presentation. Additional patient factors are associated with stage 4 CRC disease at diagnosis. Cancer outcomes are worse for rural patients, and late stage at diagnosis may partially account for this disparity. These differences have persisted over time and suggest areas for further research, patient engagement, and education.
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Affiliation(s)
- C Holly A Andrilla
- WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
| | - Tessa E Moore
- WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
| | - Kit Man Wong
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - David V Evans
- WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
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Crawford-Williams F, March S, Goodwin BC, Ireland MJ, Chambers SK, Aitken JF, Dunn J. Geographic variations in stage at diagnosis and survival for colorectal cancer in Australia: A systematic review. Eur J Cancer Care (Engl) 2019; 28:e13072. [PMID: 31056787 DOI: 10.1111/ecc.13072] [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] [Received: 10/08/2018] [Revised: 02/12/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Australia has one of the highest incidence rates of colorectal cancer (CRC) in the world. Residents in rural areas of Australia experience disadvantage in health care and outcomes. This review investigates whether patients with CRC in rural areas demonstrate poorer survival and more advanced stages of disease at diagnosis. METHODS Systematic review of peer-reviewed articles and grey literature. Studies were included if they provided data on survival or stage of disease at diagnosis across multiple geographical locations; focused on CRC patients; and were conducted in Australia. RESULTS Twenty-six articles met inclusion criteria. Twenty-three studies examined survival, while five studies investigated stage at diagnosis. The evidence suggests that non-metropolitan patients are less likely to survive CRC for five years compared to patients living in metropolitan areas, yet there was limited evidence to suggest geographical disparity in stage of diagnosis. CONCLUSIONS While five-year survival disparities are apparent, these patterns appear to vary as a function of specific region and health jurisdiction, cancer type and year/s of data collection. Future research should examine current data using consistent and robust methods of reporting survival and classifying geographical location. The impact of population-level screening programmes on survival and stage at diagnosis also needs to be thoroughly explored.
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Affiliation(s)
- Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Sonja March
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,School of Psychology, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Belinda C Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Michael J Ireland
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,School of Psychology, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Suzanne K Chambers
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joanne F Aitken
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia.,Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
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27
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Yaghjyan L, Cogle CR, Deng G, Yang J, Jackson P, Hardt N, Hall J, Mao L. Continuous Rural-Urban Coding for Cancer Disparity Studies: Is It Appropriate for Statistical Analysis? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16061076. [PMID: 30917515 PMCID: PMC6466258 DOI: 10.3390/ijerph16061076] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/21/2019] [Indexed: 12/20/2022]
Abstract
Background: The dichotomization or categorization of rural-urban codes, as nominal variables, is a prevailing paradigm in cancer disparity studies. The paradigm represents continuous rural-urban transition as discrete groups, which results in a loss of ordering information and landscape continuum, and thus may contribute to mixed findings in the literature. Few studies have examined the validity of using rural-urban codes as continuous variables in the same analysis. Methods: We geocoded cancer cases in north central Florida between 2005 and 2010 collected by Florida Cancer Data System. Using a linear hierarchical model, we regressed the occurrence of late stage cancer (including breast, colorectal, hematological, lung, and prostate cancer) on the rural-urban codes as continuous variables. To validate, the results were compared to those from using a truly continuous rurality data of the same study region. Results: In term of associations with late-stage cancer risk, the regression analysis showed that the use of rural-urban codes as continuous variables produces consistent outcomes with those from the truly continuous rurality for all types of cancer. Particularly, the rural-urban codes at the census tract level yield the closest estimation and are recommended to use when the continuous rurality data is not available. Conclusions: Methodologically, it is valid to treat rural-urban codes directly as continuous variables in cancer studies, in addition to converting them into categories. This proposed continuous-variable method offers researchers more flexibility in their choice of analytic methods and preserves the information in the ordering. It can better inform how cancer risk varies, degree by degree, over a finer spectrum of rural-urban landscape.
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Affiliation(s)
- Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL 32601, USA.
| | - Christopher R Cogle
- Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32601, USA.
| | - Guangran Deng
- Department of Geography, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL 32601, USA.
| | - Jue Yang
- Department of Geography, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL 32601, USA.
| | - Pauline Jackson
- Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32601, USA.
| | - Nancy Hardt
- College of Medicine, University of Florida, Gainesville, FL 32601, USA.
| | - Jaclyn Hall
- Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL 32601, USA.
| | - Liang Mao
- Department of Geography, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL 32601, USA.
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Al-Husseini MJ, Saad AM, Jazieh KA, Elmatboly AM, Rachid A, Gad MM, Ruhban IA, Hilal T. Outcome disparities in colorectal cancer: a SEER-based comparative analysis of racial subgroups. Int J Colorectal Dis 2019; 34:285-292. [PMID: 30443675 DOI: 10.1007/s00384-018-3195-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Previous studies of ethnic disparities in colorectal cancer (CRC) have focused mainly on patients of Caucasian and African-American descent. We aimed to evaluate outcomes for a range of races, representing a broader demographic of the US population. METHODS The Surveillance, Epidemiology, and End Results database was queried to identify patients with CRC diagnosed between 1994 and 2014. We performed unadjusted Kaplan-Meier test and multivariable covariate-adjusted Cox models to calculate the overall and CRC-specific survival of patients according to their race. RESULTS We identified 401,723 patients diagnosed with CRC between 1994 and 2014. Overall survival (OS) and CRC-specific survival were compared across different races stratified by age, sex, marital status, disease stage and grade, and undergoing surgery as a treatment. Overall, Asian/Pacific Islanders and Hispanics had improved CRC-specific survival compared to Whites (HR = 0.873, 95%CI 0.853-0.893, P < .001, and HR = 0.958, 95%CI 0.937-0.979, P < .001, respectively). Blacks had the worst CRC-specific survival outcomes when compared to Whites (HR = 1.215, 95%CI 1.192-1.238, P < .001). Racial disparity persisted when looking at two different time periods (1994-2003 and 2004-2014). CONCLUSIONS Asians/Pacific Islanders have improved outcomes from CRC compared to other races. Multifactorial, including genetic, environmental, and socioeconomic factors appear to influence outcomes and need to be addressed separately in order to reduce racial disparities among patients with CRC.
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Affiliation(s)
- Muneer J Al-Husseini
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lofty Elsayed Street, Cairo, 11566, Egypt
| | - Anas M Saad
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lofty Elsayed Street, Cairo, 11566, Egypt.
| | - Khalid A Jazieh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ahmad Rachid
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lofty Elsayed Street, Cairo, 11566, Egypt
| | - Mohamed M Gad
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Inas A Ruhban
- Pathology Department, Faculty of Medicine, Damascus University, Cairo, Egypt
| | - Talal Hilal
- Division of Hematology/Oncology, Mayo Clinic Cancer Center, 5881 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
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Stone R, Stone JD, Collins T, Barletta-Sherwin E, Martin O, Crosby R. Colorectal Cancer Screening in African American HOPE VI Public Housing Residents. FAMILY & COMMUNITY HEALTH 2019; 42:227-234. [PMID: 31107734 DOI: 10.1097/fch.0000000000000229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study explores whether colorectal cancer screening outreach via home visits and follow-up calls is effective among public housing African American residents. It reports on the proportion of returned Fecal Immunochemical Test kits, on the characteristics of study participants, and on their primary reasons for returning the kit. By conducting home visits and follow-up calls, our colorectal cancer-screening outreach resulted in a higher Fecal Immunochemical Test kit return rate than anticipated. Findings suggest that a more personalized outreach approach can yield higher colorectal cancer-screening rates among urban minority populations, which are at higher risk to be diagnosed with late-stage colorectal cancer.
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Affiliation(s)
- Ramona Stone
- Department of Health, West Chester University, Sturzebecker HSC, West Chester, Pennsylvania (Dr Stone and Mss Barletta-Sherwin and Martin); Department of Geography and Geosciences, University of Louisville, Louisville, Kentucky (Mr Stone); and Department of Health, Behavior and Society, Rural Cancer Prevention Center, University of Kentucky, Lexington (Mr Collins and Dr Crosby)
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30
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McClelland S, Kaleem T, Bernard ME, Ahmed HZ, Sio TT, Miller RC. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States-Part 4: Appalachian patients. Adv Radiat Oncol 2018; 3:471-477. [PMID: 30370344 PMCID: PMC6200890 DOI: 10.1016/j.adro.2018.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose Compared with the rest of the United States, the population of Appalachia has lower education levels, higher rates of poverty, and limited access to health care. The presence of disparities in radiation therapy (RT) access for Appalachian patients with cancer has rarely been examined. Methods and materials The National Cancer Institute initiatives toward addressing disparities in treatment access for rural populations were examined. An extensive literature search was undertaken for studies investigating RT access disparities in Appalachian patients, beginning with the most common cancers in these patients (lung, colorectal, and cervical). Results Although the literature investigating RT access disparities in Appalachia is relatively sparse, studies examining lung, colorectal, cervical, prostate, head and neck, breast, and esophageal cancer, as well as lymphoma, indicate an unfortunate commonality in barriers to optimal RT access for Appalachian patients with cancer. These barriers are predominantly socioeconomic in nature (low income and lack of private insurance) but are exacerbated by paucities in both the number and quality of radiation centers that are accessible to this patient population. Conclusions Regardless of organ system, there are significant barriers for Appalachian patients with cancer to receive RT. Such diminished access is alarming and warrants resources devoted to addressing these disparities, which often go overlooked because of the assumption that the overall wealth of the United States is tangibly applicable to all of its citizens. Without intelligently targeted investments of time and finances in this arena, there is great risk of exacerbating rather than alleviating the already heavy burden facing Appalachian patients with cancer.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Tasneem Kaleem
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Mark E Bernard
- Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky
| | - Hiba Z Ahmed
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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31
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Enewold L, Penn DC, Stevens JL, Harlan LC. Black/white differences in treatment and survival among women with stage IIIB-IV breast cancer at diagnosis: a US population-based study. Cancer Causes Control 2018; 29:657-665. [PMID: 29860614 DOI: 10.1007/s10552-018-1045-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Non-Hispanic black (NHB) women with breast cancer have poorer survival than non-Hispanic white (NHW) women. Although NHB women are more often diagnosed at later stages, it is less established whether racial disparities exist among women diagnosed with late-stage breast cancer, particularly when care is provided in the community setting. METHODS Treatment and survival were examined by race/ethnicity among women diagnosed in 2012 with stage IIIB-IV breast cancer using the National Cancer Institute's population-based Patterns of Care Study. Medical records were re-abstracted and treating physicians were contacted to verify therapy. Vital status was available through 2014. RESULTS A total of 533 women with stage IIIB-C and 625 with stage IV tumors were included; NHW women comprised about 70% of each group. Among women with stage IIIB-C disease, racial/ethnicity variations in systemic treatment were not observed but there was a borderline association indicating worse all-cause mortality among NHB women (hazard ratio 1.52; 95% confidence interval (CI) 0.96-2.41). In contrast, among women with stage IV disease, borderline associations indicating NHB women were more likely to receive chemotherapy (OR 1.44, 95% CI 0.90-2.30) and, among those with hormone receptor-positive tumors, less likely to receive endocrine therapy (OR 0.60, 95% CI 0.35-1.04). All-cause mortality did not vary by race/ethnicity for stage IV disease (hazard ratio 0.92; 95% CI 0.68-1.25). CONCLUSIONS More research is needed to identify additional factors associated with the potential survival disparities among women with stage IIIB-C disease and potential treatment disparities among women with stage IV disease.
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Affiliation(s)
- Lindsey Enewold
- NCI/DCCPS/HDRP/HARB, Bethesda, MD, 20892, USA. .,NCI/HDRP, Room 3E506, 9609 Medical Center Drive, MSC 9762, Bethesda, MD, 20892-9762, USA.
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32
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Crawford-Williams F, March S, Ireland MJ, Rowe A, Goodwin B, Hyde MK, Chambers SK, Aitken JF, Dunn J. Geographical Variations in the Clinical Management of Colorectal Cancer in Australia: A Systematic Review. Front Oncol 2018; 8:116. [PMID: 29868464 PMCID: PMC5965390 DOI: 10.3389/fonc.2018.00116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/29/2018] [Indexed: 12/17/2022] Open
Abstract
Background In Australia, cancer survival is significantly lower in non-metropolitan compared to metropolitan areas. Our objective was to evaluate the evidence on geographical variations in the clinical management and treatment of colorectal cancer (CRC). Methods A systematic review of published and gray literature was conducted. Five databases (CINAHL, PubMed, Embase, ProQuest, and Informit) were searched for articles published in English from 1990 to 2018. Studies were included if they assessed differences in clinical management according to geographical location; focused on CRC patients; and were conducted in Australia. Included studies were critically appraised using a modified Newcastle–Ottawa Scale. PRISMA systematic review reporting methods were applied. Results 17 articles met inclusion criteria. All were of high (53%) or moderate (47%) quality. The evidence available may suggest that patients in non-metropolitan areas are more likely to experience delays in surgery and are less likely to receive chemotherapy for stage III colon cancer and adjuvant radiotherapy for rectal cancer. Conclusion The present review found limited information on clinical management across geographic regions in Australia and the synthesis highlights significant issues both for data collection and reporting at the population level, and for future research in the area of geographic variation. Where geographical disparities exist, these may be due to a combination of patient and system factors reflective of location. It is recommended that population-level data regarding clinical management of CRC be routinely collected to better understand geographical variations and inform future guidelines and policy.
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Affiliation(s)
- Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Sonja March
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Michael J Ireland
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Arlen Rowe
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Belinda Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Melissa K Hyde
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Suzanne K Chambers
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Prostate Cancer Foundation of Australia, St Leonards, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Joanne F Aitken
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,School of Social Science, University of Queensland, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Brisbane, QLD, Australia
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Hines RB, Jiban MJH, Choudhury K, Loerzel V, Specogna AV, Troy SP, Zhang S. Post-treatment surveillance testing of patients with colorectal cancer and the association with survival: protocol for a retrospective cohort study of the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. BMJ Open 2018; 8:e022393. [PMID: 29705770 PMCID: PMC5931281 DOI: 10.1136/bmjopen-2018-022393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Although the colorectal cancer (CRC) mortality rate has significantly improved over the past several decades, many patients will have a recurrence following curative treatment. Despite this high risk of recurrence, adherence to CRC surveillance testing guidelines is poor which increases cancer-related morbidity and potentially, mortality. Several randomised controlled trials (RCTs) with varying surveillance strategies have yielded conflicting evidence regarding the survival benefit associated with surveillance testing. However, due to differences in study protocols and limitations of sample size and length of follow-up, the RCT may not be the best study design to evaluate this relationship. An observational comparative effectiveness research study can overcome the sample size/follow-up limitations of RCT designs while assessing real-world variability in receipt of surveillance testing to provide much needed evidence on this important clinical issue. The gap in knowledge that this study will address concerns whether adherence to National Comprehensive Cancer Network CRC surveillance guidelines improves survival. METHODS AND ANALYSIS Patients with colon and rectal cancer aged 66-84 years, who have been diagnosed between 2002 and 2008 and have been included in the Surveillance, Epidemiology, and End Results-Medicare database, are eligible for this retrospective cohort study. To minimise bias, patients had to survive at least 12 months following the completion of treatment. Adherence to surveillance testing up to 5 years post-treatment will be assessed in each year of follow-up and overall. Binomial regression will be used to assess the association between patients' characteristics and adherence. Survival analysis will be conducted to assess the association between adherence and 5-year survival. ETHICS AND DISSEMINATION This study was approved by the National Cancer Institute and the Institutional Review Board of the University of Central Florida. The results of this study will be disseminated by publishing in the peer-reviewed scientific literature, presentation at national/international scientific conferences and posting through social media.
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Affiliation(s)
- Robert B Hines
- Internal medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
| | | | - Kanak Choudhury
- Statistics, University of Central Florida College of Sciences, Orlando, Florida, USA
| | - Victoria Loerzel
- University of Central Florida College of Nursing, Orlando, Florida, USA
| | - Adrian V Specogna
- University of Central Florida College of Health and Public Affairs, Orlando, Florida, USA
| | - Steven P Troy
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Shunpu Zhang
- Statistics, University of Central Florida College of Sciences, Orlando, Florida, USA
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Joseph DA, Johnson CJ, White A, Wu M, Coleman MP. Rectal cancer survival in the United States by race and stage, 2001 to 2009: Findings from the CONCORD-2 study. Cancer 2017; 123 Suppl 24:5037-5058. [PMID: 29205308 PMCID: PMC6191027 DOI: 10.1002/cncr.30882] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/22/2017] [Accepted: 06/14/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND In the first CONCORD study, 5-year survival for patients with diagnosed with rectal cancer between 1990 and 1994 was <60%, with large racial disparities noted in the majority of participating states. We have updated these findings to 2009 by examining population-based survival by stage of disease at the time of diagnosis, race, and calendar period. METHODS Data from the CONCORD-2 study were used to compare survival among individuals aged 15 to 99 years who were diagnosed in 37 states encompassing up to 80% of the US population. We estimated net survival up to 5 years after diagnosis correcting for background mortality with state-specific and race-specific life table. Survival estimates were age-standardized with the International Cancer Survival Standard weights. We present survival estimates by race (all, black, and white) for 2001 through 2003 and 2004 through 2009 to account for changes in collecting the data for Surveillance, Epidemiology, and End Results Summary Stage 2000. RESULTS There was a small increase in 1-year, 3-year, and 5-year net survival between 2001-2003 (84.6%, 70.7%, and 63.2%, respectively), and 2004-2009 (85.1%, 71.5%, and 64.1%, respectively). Black individuals were found to have lower 1-year, 3-year, and 5-year survival than white individuals in both periods; the absolute difference in survival between black and white individuals declined only for 5-year survival. Black patients had lower 5-year survival than whites at each stage at the time of diagnosis in both time periods. CONCLUSIONS There was little improvement noted in net survival for patients with rectal cancer, with persistent disparities noted between black and white individuals. Additional investigation is needed to identify and implement effective interventions to ensure the consistent and equitable use of high-quality screening, diagnosis, and treatment to improve survival for patients with rectal cancer. Cancer 2017;123:5037-58. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Djenaba A. Joseph
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chris J. Johnson
- Cancer Data Registry of Idaho, Idaho Hospital Association, Boise, ID
| | - Arica White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Manxia Wu
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michel P. Coleman
- Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK
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Fowler B, Samadder NJ, Kepka D, Ding Q, Pappas L, Kirchhoff AC. Improvements in Colorectal Cancer Incidence Not Experienced by Nonmetropolitan Women: A Population-Based Study From Utah. J Rural Health 2017; 34:155-161. [PMID: 28426915 DOI: 10.1111/jrh.12242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/01/2016] [Accepted: 02/20/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE Little is known about disparities in colorectal cancer (CRC) incidence and mortality by community-level factors such as metropolitan status. METHODS This analysis utilized data from the Surveillance, Epidemiology, and End Results (SEER) program from Utah. We included patients diagnosed with CRC from 1991 to 2010. To determine whether associations existed between metropolitan/nonmetropolitan county of residence and CRC incidence, Poisson regression models were used. CRC mortality was assessed using multivariable Cox regression models. FINDINGS CRC incidence rates did not differ between metropolitan and nonmetropolitan counties by gender (males: 46.2 per 100,000 vs 45.1 per 100,000, P = .87; females: 34.4 per 100,000 vs 36.1 per 100,000, P = .70). However, CRC incidence between the years of 2006 and 2010 in nonmetropolitan counties was significantly higher in females (metropolitan: 30.4 vs nonmetropolitan: 37.0 per 100,000, P = .002). As compared to metropolitan counties, the incidence of unstaged CRC in nonmetropolitan counties was significantly higher in both males (1.7 vs 2.8 per 100,000, P = .003) and females (1.4 vs 1.6 per 100,000, P = .002). Among patients who were diagnosed between 2006 and 2010, metropolitan counties were found to have significantly increased survival among males and females, but nonmetropolitan counties showed increased survival only for males. CONCLUSIONS While we observed a decreasing incidence of CRC among men and women in Utah, this effect was not seen in women in nonmetropolitan areas nor among those with unstaged disease. Further studies should evaluate factors that may account for these differences. This analysis can inform interventions with a focus on women in nonmetropolitan areas.
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Affiliation(s)
- Brynn Fowler
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - N Jewel Samadder
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Deanna Kepka
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.,College of Nursing, University of Utah, Salt Lake City, Utah
| | - Qian Ding
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah
| | - Lisa Pappas
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.,Department of Pediatrics, University of Utah, Salt Lake City, Utah
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Loree JM, Javaheri KR, Lefresne SV, Speers CH, Ruan JY, Chang JT, Brown CJ, Kennecke HF, Olson RA, Cheung WY. Impact of Travel Distance and Urban-Rural Status on the Multidisciplinary Management of Rectal Cancer. J Rural Health 2016; 33:393-401. [PMID: 27717002 DOI: 10.1111/jrh.12219] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/08/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Optimal treatment of rectal cancer (RC) requires multidisciplinary care. We examined whether distance to treatment center or community size impacts access to multimodality care and population-based outcomes in RC. METHODS Patients diagnosed with stage II/III RC from 1999 to 2009 and treated at 1 of 6 regional cancer centers in British Columbia were reviewed. Distance to treatment center was determined for each patient. Communities were classified as rural, small, medium, and large population centers. Logistic and Cox regression models assessed associations of distance and community size with treatment received as well as cancer-specific (CSS) and overall survival (OS). RESULTS Of 3,158 patients, 93.6% underwent surgery, 86.3% received radiotherapy, and 51.3% were treated with adjuvant chemotherapy (AC). Median time from diagnosis to oncologic consultation was longer for those >100 km from a treatment center or residing in medium/rural communities. Logistic regression demonstrated no correlation between distance or community size and receipt of treatment modality. Univariate analysis showed similar CSS (P = .18, .88) and OS (P = .36, .47) based on community size and distance, respectively. In multivariate analysis, distance >100 km had inferior CSS (Hazard Ratio [HR] 1.39, 95% CI: 1.03-1.88; P = .031). There was no consistent trend between decreasing community size and outcomes; however, living in a small center was associated with improved OS (HR 0.58, 95% CI: 0.38-0.88; P = .011) and CSS (HR 0.42, 95% CI: 0.25-0.70; P = .001). CONCLUSIONS In this population-based study, there were no urban-rural differences in access to multidisciplinary care, but increased distance may be associated with worse cancer-specific outcomes.
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Affiliation(s)
- Jonathan M Loree
- Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Khodadad R Javaheri
- Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Shilo V Lefresne
- Division of Radiation Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Caroline H Speers
- Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Jenny Y Ruan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer T Chang
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carl J Brown
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hagen F Kennecke
- Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Robert A Olson
- Division of Radiation Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Winson Y Cheung
- Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Liang PS, Mayer JD, Wakefield J, Ko CW. Temporal Trends in Geographic and Sociodemographic Disparities in Colorectal Cancer Among Medicare Patients, 1973-2010. J Rural Health 2016; 33:361-370. [PMID: 27578387 DOI: 10.1111/jrh.12209] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/08/2016] [Accepted: 07/18/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Colorectal cancer (CRC) incidence and mortality in the United States have steadily declined since the 1980s, but racial and socioeconomic disparities remain. The influence of geographic factors is poorly understood and may be affected by evolving insurance coverage and screening test uptake. We characterized temporal trends in the association between geographic and sociodemographic factors and CRC outcomes. METHODS We used the 1973-2010 SEER-Medicare files to identify patients aged ≥65 years with and without CRC. Beneficiary residential ZIP codes were used to extract local-level data. We constructed multivariable logistic regression models for CRC incidence and mortality using geographic and sociodemographic variables in 4 time periods: (1) 1973-1997; (2) 1998-2001; (3) 2002-2006; and (4) 2007-2010. FINDINGS We analyzed 1,093,758 records, including 336,321 CRC cases. Compared to urban residence, small rural residence was strongly associated with increased CRC incidence (OR 1.50, 95% CI: 1.43-1.57) and mortality (OR 1.35, 95% CI: 1.26-1.45) in 1973-1997, but the associations diminished by 2007-2010 (OR 1.09, 95% CI: 1.04-1.15 for incidence; OR 1.10, 95% CI: 1.01-1.20 for mortality). The disparity between blacks and whites increased over time for both incidence (OR 1.09, 95% CI: 1.05-1.13 in 1973-1997 vs OR 1.32, 95% CI: 1.27-1.37 in 2007-2010) and mortality (OR 1.22, 95% CI: 1.16-1.28 in 1973-1997 vs OR 1.34, 95% CI: 1.26-1.42 in 2007-2010). High socioeconomic status was associated with greater incidence and mortality in 1973-1997, but it became protective after 1998. CONCLUSIONS Although disparities persist among Medicare beneficiaries, the relationship between geographic and sociodemographic factors and CRC incidence and mortality has evolved over time.
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Affiliation(s)
- Peter S Liang
- Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York.,VA New York Harbor Healthcare System, New York, New York
| | - Jonathan D Mayer
- Departments of Epidemiology and Medical Geography, University of Washington, Seattle, Washington
| | - Jon Wakefield
- Departments of Statistics and Biostatistics, University of Washington, Seattle, Washington
| | - Cynthia W Ko
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington
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Williams R, White P, Nieto J, Vieira D, Francois F, Hamilton F. Colorectal Cancer in African Americans: An Update. Clin Transl Gastroenterol 2016; 7:e185. [PMID: 27467183 PMCID: PMC4977418 DOI: 10.1038/ctg.2016.36] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 05/09/2016] [Indexed: 12/15/2022] Open
Abstract
This review is an update to the American College of Gastroenterology (ACG) Committee on Minority Affairs and Cultural Diversity's paper on colorectal cancer (CRC) in African Americans published in 2005. Over the past 10 years, the incidence and mortality rates of CRC in the United States has steadily declined. However, reductions have been strikingly much slower among African Americans who continue to have the highest rate of mortality and lowest survival when compared with all other racial groups. The reasons for the health disparities are multifactorial and encompass physician and patient barriers. Patient factors that contribute to disparities include poor knowledge of benefits of CRC screening, limited access to health care, insurance status along with fear and anxiety. Physician factors include lack of knowledge of screening guidelines along with disparate recommendations for screening. Earlier screening has been recommended as an effective strategy to decrease observed disparities; currently the ACG and American Society of Gastrointestinal Endoscopists recommend CRC screening in African Americans to begin at age 45. Despite the decline in CRC deaths in all racial and ethnic groups, there still exists a significant burden of CRC in African Americans, thus other strategies including educational outreach for health care providers and patients and the utilization of patient navigation systems emphasizing the importance of screening are necessary. These strategies have been piloted in both local communities and Statewide resulting in notable significant decreases in observed disparities.
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Affiliation(s)
- Renee Williams
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
| | - Pascale White
- Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida, USA
| | - Dorice Vieira
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
| | - Fritz Francois
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
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Lin Y, Wimberly MC. Geographic Variations of Colorectal and Breast Cancer Late-Stage Diagnosis and the Effects of Neighborhood-Level Factors. J Rural Health 2016; 33:146-157. [DOI: 10.1111/jrh.12179] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/11/2016] [Accepted: 02/06/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Yan Lin
- Department of Geography; South Dakota State University; Brookings South Dakota
| | - Michael C. Wimberly
- Geospatial Sciences Center of Excellence; South Dakota State University; Brookings South Dakota
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Rust G, Zhang S, Yu Z, Caplan L, Jain S, Ayer T, McRoy L, Levine RS. Counties eliminating racial disparities in colorectal cancer mortality. Cancer 2016; 122:1735-48. [PMID: 26969874 DOI: 10.1002/cncr.29958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/31/2015] [Accepted: 01/25/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although colorectal cancer (CRC) mortality rates are declining, racial-ethnic disparities in CRC mortality nationally are widening. Herein, the authors attempted to identify county-level variations in this pattern, and to characterize counties with improving disparity trends. METHODS The authors examined 20-year trends in US county-level black-white disparities in CRC age-adjusted mortality rates during the study period between 1989 and 2010. Using a mixed linear model, counties were grouped into mutually exclusive patterns of black-white racial disparity trends in age-adjusted CRC mortality across 20 three-year rolling average data points. County-level characteristics from census data and from the Area Health Resources File were normalized and entered into a principal component analysis. Multinomial logistic regression models were used to test the relation between these factors (clusters of related contextual variables) and the disparity trend pattern group for each county. RESULTS Counties were grouped into 4 disparity trend pattern groups: 1) persistent disparity (parallel black and white trend lines); 2) diverging (widening disparity); 3) sustained equality; and 4) converging (moving from disparate outcomes toward equality). The initial principal component analysis clustered the 82 independent variables into a smaller number of components, 6 of which explained 47% of the county-level variation in disparity trend patterns. CONCLUSIONS County-level variation in social determinants, health care workforce, and health systems all were found to contribute to variations in cancer mortality disparity trend patterns from 1990 through 2010. Counties sustaining equality over time or moving from disparities to equality in cancer mortality suggest that disparities are not inevitable, and provide hope that more communities can achieve optimal and equitable cancer outcomes for all. Cancer 2016;122:1735-48. © 2016 American Cancer Society.
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Affiliation(s)
- George Rust
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL.,Department of Community Health And Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Shun Zhang
- Statistics and Methodology Department, NORC at the University of Chicago, Chicago, Illinois
| | - Zhongyuan Yu
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey
| | - Lee Caplan
- Deparment of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Sanjay Jain
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Turgay Ayer
- Department of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Luceta McRoy
- School of Business and Management, Southern Adventist University, Collegedale, Tennessee
| | - Robert S Levine
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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Beckmann KR, Bennett A, Young GP, Cole SR, Joshi R, Adams J, Singhal N, Karapetis C, Wattchow D, Roder D. Sociodemographic disparities in survival from colorectal cancer in South Australia: a population-wide data linkage study. BMC Health Serv Res 2016; 16:24. [PMID: 26792195 PMCID: PMC4721049 DOI: 10.1186/s12913-016-1263-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in survival from colorectal cancer (CRC) across socioeconomic groups and by area of residence have been described in various health care settings. Few population-wide datasets which include clinical and treatment information are available in Australia to investigate disparities. This study examines socio-demographic differences in survival for CRC patients in South Australia (SA), using a population-wide database derived via linkage of administrative and surveillance datasets. METHODS The study population comprised all cases of CRC diagnosed in 2003-2008 among SA residents aged 50-79 yrs in the SA Central Cancer Registry. Measures of socioeconomic status (area level), geographical remoteness, clinical characteristics, comorbid conditions, treatments and outcomes were derived through record linkage of central cancer registry, hospital-based clinical registries, hospital separations, and radiotherapy services data sources. Socio-demographic disparities in CRC survival were examined using competing risk regression analysis. RESULTS Four thousand six hundred and forty one eligible cases were followed for an average of 4.7 yrs, during which time 1525 died from CRC and 416 died from other causes. Results of competing risk regression indicated higher risk of CRC death with higher grade (HR high v low =2.25, 95% CI 1.32-3.84), later stage (HR C v A = 7.74, 95% CI 5.75-10.4), severe comorbidity (HR severe v none =1.21, 95% CI 1.02-1.44) and receiving radiotherapy (HR = 1.41, 95% CI 1.18-1.68). Patients from the most socioeconomically advantaged areas had significantly better outcomes than those from the least advantaged areas (HR =0.75, 95% 0.62-0.91). Patients residing in remote locations had significantly worse outcomes than metropolitan residents, though this was only evident for stages A-C (HR = 1.35, 95 % CI 1.01-1.80). These disparities were not explained by differences in stage at diagnosis between socioeconomic groups or area of residence. Nor were they explained by differences in patient factors, other tumour characteristics, comorbidity, or treatment modalities. CONCLUSIONS Socio-economic and regional disparities in survival following CRC are evident in SA, despite having a universal health care system. Of particular concern is the poorer survival for patients from remote areas with potentially curable CRC. Reasons for these disparities require further exploration to identify factors that can be addressed to improve outcomes.
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Affiliation(s)
- Kerri R. Beckmann
- Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Alice Bennett
- Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Graeme P. Young
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Stephen R. Cole
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Rohit Joshi
- Lyell McEwin Hospital, Elizabeth Vale, SA 5112 Australia
| | - Jacqui Adams
- Country Health SA, Adelaide, SA 5000 Australia
- Lyell McEwin Hospital, Elizabeth Vale, SA 5112 Australia
| | - Nimit Singhal
- Medical Oncologist, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA 5001 Australia
| | - Christos Karapetis
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
- South Adelaide Health Network, Medical Oncology, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042 Australia
| | - David Wattchow
- Flinders University, Flinders Medical Centre, Bedford Park, SA 5042 Australia
| | - David Roder
- Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
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Abrahão KDS, Bergmann A, Aguiar SSD, Thuler LCS. Determinants of advanced stage presentation of breast cancer in 87,969 Brazilian women. Maturitas 2015; 82:365-70. [PMID: 26358931 DOI: 10.1016/j.maturitas.2015.07.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Breast cancer is commonly diagnosed at an advanced stage in Brazil. AIM Analyze the determinants of advanced staging in Brazilian women with breast cancer. METHODS Crosssectional study, including women diagnosed with breast cancer in Brazil, between 2000 and 2009. RESULTS A total of 59,317 women were included, 53.5% being classified as advanced stage (≥IIB). Younger age (18 to 49 years old) (OR=1.61 95% CI 1.51 to 1.72) or between 40 and 49 years old (OR=1.08 95% CI 1.03 to 1.14), having low educational level (OR=1.53 95% CI 1.48 to 1.58), living in less developed geographical regions (OR=1.27 95% CI 1.21 to 1.33), having invasive ductal carcinoma (OR=2.70 95% CI 2.56 to 2.84) and invasive lobular carcinoma (OR=2.63 95% CI 2.42 to 2.86) were associated with advanced breast cancer. CONCLUSION We conclude that future interventions should focus on these high risk groups.
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Affiliation(s)
| | - Anke Bergmann
- Brazilian National Cancer Institute (INCA) and University Center Augusto Motta (UNISUAM), Rio de Janeiro, Brazil.
| | | | - Luiz Claudio Santos Thuler
- Brazilian National Cancer Institute (INCA) and Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil.
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Palmer NRA, Weaver KE, Hauser SP, Lawrence JA, Talton J, Case LD, Geiger AM. Disparities in barriers to follow-up care between African American and White breast cancer survivors. Support Care Cancer 2015; 23:3201-9. [PMID: 25821145 DOI: 10.1007/s00520-015-2706-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/16/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Despite recommendations for breast cancer survivorship care, African American women are less likely to receive appropriate follow-up care, which is concerning due to their higher mortality rates. This study describes differences in barriers to follow-up care between African American and White breast cancer survivors. METHODS We conducted a mailed survey of women treated for non-metastatic breast cancer in 2009-2011, 6-24 months post-treatment (N = 203). Survivors were asked about 14 potential barriers to follow-up care. We used logistic regression to explore associations between barriers and race, adjusting for covariates. RESULTS Our participants included 31 African American and 160 White survivors. At least one barrier to follow-up care was reported by 62 %. Compared to White survivors, African Americans were more likely to identify barriers related to out-of-pocket costs (28 vs. 51.6 %, p = 0.01), other health care costs (21.3 vs. 45.2 %, p = 0.01), anxiety/worry (29.4 vs. 51.6 %, p = 0.02), and transportation (4.4 vs. 16.1 %, p = 0.03). After adjustment for covariates, African Americans were three times as likely to report at least one barrier to care (odds ratio (OR) = 3.3, 95 % confidence interval (CI) = 1.1-10.1). CONCLUSIONS Barriers to care are common among breast cancer survivors, especially African American women. Financial barriers to care may prevent minority and underserved survivors from accessing follow-up care. Enhancing insurance coverage or addressing out-of-pocket costs may help address financial barriers to follow-up care among breast cancer survivors. Psychosocial care aimed at reducing fear of recurrence may also be important to improve access among African American breast cancer survivors.
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Affiliation(s)
- Nynikka R A Palmer
- Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
| | - Kathryn E Weaver
- Social Science and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sally P Hauser
- General Surgery, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Julia A Lawrence
- General Surgery, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Jennifer Talton
- Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - L Douglas Case
- Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ann M Geiger
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Sankaranarayanan J, Qiu F, Watanabe-Galloway S. A registry study of the association of patient's residence and age with colorectal cancer survival. Expert Rev Pharmacoecon Outcomes Res 2014; 14:301-13. [PMID: 24625041 DOI: 10.1586/14737167.2014.891441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Because of limited literature from rural states of the United States like Nebraska, we evaluated the association of patient's age, Office of Management and Budget residence-county categories (rural-nonmetro, micropolitan-nonmetro, urban), and significant interactions between confounding-variables with colorectal cancer (CRC) survival. This retrospective 1998-2003 study of 6561 CRC patients from the Nebraska Cancer Registry showed median patient survival in colon and rectal cancer in urban, rural and micropolitan counties were 33, 36, and 46 months and 41, 47, 49 months, respectively. In Cox proportional-hazards analyses, after adjusting for significant demographics (age, race, marital status in colon cancer; age, insurance status in rectal cancer), cancer stage, surgery and radiation treatments; 1) no-chemotherapy urban colon cancer patients had significantly shorter survival (rural vs urban; adjusted hazard ratio, HR: 0.78 or urban vs rural HR: 1.28; micropolitan vs urban, HR: 0.78) and 2) no-surgery urban (vs rural, HR: 1.49); micropolitan (vs rural, HR: 2.01) rectal cancer patients had significantly shorter survival. Colon cancer (≥65 years) and rectal cancer (≥75 years) elderly each versus patients aged 19-64 years old had significantly shorter survival (all p < 0.01). The association of patients' age and treatment/residence-county interactions with CRC survival warrant decision-makers' attention.
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Kang M, Shen XJ, Kim S, Araujo-Perez F, Galanko JA, Martin CF, Sandler RS, Keku TO. Somatic gene mutations in African Americans may predict worse outcomes in colorectal cancer. Cancer Biomark 2014; 13:359-66. [PMID: 24440976 DOI: 10.3233/cbm-130366] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE African Americans have worse outcomes in colorectal cancer (CRC) than Caucasians. We sought to determine if KRAS, BRAF and PIK3CA mutations might contribute to the racial differences in CRC outcome. METHODS DNA was extracted from tissue microarrays made from CRC samples from 67 African Americans and 237 Caucasians. Mutations in KRAS, BRAF, and PIK3CA were evaluated by PCR sequencing. We also examined microsatellite instability (MSI) status. Associations of mutation status with tumor stage and grade were examined using a logistic regression model. Cox proportional hazards models were used to estimate the all-cause mortality associated with mutational status, race and other clinicopathologic features. RESULTS KRAS mutations were more common in African Americans than among Caucasians (37% vs 21%, p=0.01) and were associated with advanced stage (unadjusted odds ratio (OR)=3.31, 95% confidence interval (CI) 1.03-10.61) and grade (unadjusted OR=5.60, 95% CI 1.01-31.95) among African Americans. Presence of BRAF mutations was also positively associated with advanced tumor stage (adjusted OR=3.99, 95%CI 1.43-11.12) and grade (adjusted OR=3.93, 95%CI 1.05-14.69). PIK3CA mutations showed a trend toward an association with an increased risk of death compared to absence of those mutations (adjusted for age, sex and CRC site HR=1.89, 95% CI 0.98-3.65). Among African Americans, the association was more evident (adjusted for age, sex and CRC site HR=3.92, 95% CI 1.03-14.93) and remained significant after adjustment for MSI-H status and combined education-income level, with HR of 12.22 (95%CI 1.32-121.38). CONCLUSIONS Our results suggest that African Americans may have different frequencies of somatic genetic alterations that may partially explain the worse prognosis among African Americans with CRC compared to whites.
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Affiliation(s)
- Melissa Kang
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
| | - Xiang J Shen
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
| | - Sangmi Kim
- Georgia Regents University Cancer Center, Section of Hematology/Oncology, Department of Medicine, Medical College of Georgia, Augusta, GA, USA
| | - Felix Araujo-Perez
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
| | - Joseph A Galanko
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
| | - Chris F Martin
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
| | - Robert S Sandler
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
| | - Temitope O Keku
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
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Chawla N, Yabroff KR, Mariotto A, McNeel TS, Schrag D, Warren JL. Limited validity of diagnosis codes in Medicare claims for identifying cancer metastases and inferring stage. Ann Epidemiol 2014; 24:666-72, 672.e1-2. [PMID: 25066409 DOI: 10.1016/j.annepidem.2014.06.099] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/02/2014] [Accepted: 06/17/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE Researchers are using diagnosis codes from health claims to identify metastatic disease in cancer patients. The validity of this approach has not been established. METHODS We used the linked 2005-2007 Surveillance, Epidemiology and End Results (SEER)-Medicare data to assess the validity of metastasis codes at diagnosis from claims compared with stage reported by SEER cancer registries. The cohort included 80,052 incident breast, lung, and colorectal cancer patients aged 65 years and older. Using gold-standard SEER data, we evaluated sensitivity, specificity, positive predictive value, and negative predictive value of claims-based stage, survival by stage classification, and patient factors associated with stage misclassification using multivariable regression. RESULTS For patients with a registry report of distant metastatic cancer, the sensitivity, specificity, and positive predictive value of claims never simultaneously exceeded 80% for any cancer: lung (42.7%, 94.8%, and 88.1%), breast (51.0%, 98.3%, and 65.8%), and colorectal (72.8%, 93.8%, and 68.5%). Misclassification of stage from Medicare claims was significantly associated with inaccurate estimates of stage-specific survival (P < .001). In adjusted analysis, patients who were older, black, or living in low-income areas were more likely to have their stage misclassified in claims. CONCLUSIONS Diagnosis codes in Medicare claims have limited validity for inferring cancer stage and metastatic disease.
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Affiliation(s)
- Neetu Chawla
- Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD; Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD.
| | - K Robin Yabroff
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Angela Mariotto
- Data Modeling Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | | | | | - Joan L Warren
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Lee B, Goktepe O, Hay K, Connors JM, Sehn LH, Savage KJ, Shenkier T, Klasa R, Gerrie A, Villa D. Effect of place of residence and treatment on survival outcomes in patients with diffuse large B-cell lymphoma in British Columbia. Oncologist 2014; 19:283-90. [PMID: 24569946 DOI: 10.1634/theoncologist.2013-0343] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We examined the relationship between location of residence at the time of diagnosis of diffuse large B-cell lymphoma (DLBCL) and health outcomes in a geographically large Canadian province with publicly funded, universally available medical care. PATIENTS AND METHODS The British Columbia Cancer Registry was used to identify all patients 18-80 years of age diagnosed with DLBCL between January 2003 and December 2008. Home and treatment center postal codes were used to determine urban versus rural status and driving distance to access treatment. RESULTS We identified 1,357 patients. The median age was 64 years (range: 18-80 years), 59% were male, 50% were stage III/IV, 84% received chemotherapy with curative intent, and 32% received radiotherapy. There were 186 (14%) who resided in rural areas, 141 (10%) in small urban areas, 183 (14%) in medium urban areas, and 847 (62%) in large urban areas. Patient and treatment characteristics were similar regardless of location. Five-year overall survival (OS) was 62% for patients in rural areas, 44% in small urban areas, 53% in medium urban areas, and 60% in large urban areas (p = .018). In multivariate analysis, there was no difference in OS between rural and large urban area patients (hazard ratio [HR]: 1.0; 95% confidence interval [CI]: 0.7-1.4), although patients in small urban areas (HR: 1.4; 95% CI: 1.0-2.0) and medium urban areas (HR: 1.4; 95% CI: 1.0-1.9) had worse OS than those in large urban areas. CONCLUSION Place of residence at diagnosis is associated with survival of patients with DLBCL in British Columbia, Canada. Rural patients have similar survival to those in large urban areas, whereas patients living in small and medium urban areas experience worse outcomes.
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Affiliation(s)
- Benny Lee
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplantation Program of British Columbia, Vancouver, British Columbia, Canada
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Johnson AM, Hines RB, Johnson JA, Bayakly AR. Treatment and survival disparities in lung cancer: the effect of social environment and place of residence. Lung Cancer 2014; 83:401-7. [PMID: 24491311 DOI: 10.1016/j.lungcan.2014.01.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 12/30/2013] [Accepted: 01/12/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to measure the extent to which geographic residency status and the social environment are associated with disease stage at diagnosis, receipt of treatment, and five-year survival for patients diagnosed with non-small cell lung cancer (NSCLC). METHODS AND MATERIALS This study was a retrospective cohort study of the Georgia Comprehensive Cancer Registry (GCCR) for incident cases of NSCLC diagnosed in the state. Multilevel logistic models were employed for five outcome variables: unstaged and late stage disease at diagnosis; receipt of treatment (surgery, chemotherapy, and radiation); and survival following diagnosis. The social and geographical variables of interest were census tract (CT) poverty level, CT-level educational attainment, and CT-level geographic residency status. RESULTS Compared to urban residents, rural and suburban residents had increased odds of unstaged disease (suburban OR=1.23, 95% CI: 1.11-1.37; rural OR=1.63, 95% CI: 1.45-1.83). In this study, rural participants had lower odds of receiving radiotherapy (OR=0.89, 95% CI: 0.82-0.96) and chemotherapy (OR=0.92, 95% CI: 0.85-0.99). Living in CTs with lower educational levels was associated with decreasing odds of receiving both surgery (lowest educational level OR=0.67, 95% CI: 0.59-0.75) and chemotherapy (lowest educational level OR=0.74, 95% CI: 0.68-0.81). Living in areas with higher concentration of deprivation (high level of deprivation HR=1.04, 95% CI: 1.01-1.09) and lower levels of education (lowest educational level HR=1.12, 95% CI: 1.07-1.17) was associated with poorer survival. Rural residents did not show poorer survival when treatment was controlled and they even presented a lower risk of death for early stage disease (HR=0.90, 95% CI: 0.82-0.99). CONCLUSION This study concludes that where NSCLC patients live can, to some extent, explain treatment and prognostic disparities. Public health practitioners and policy makers should be cognizant of the importance of where people live and shift their efforts to improve lung cancer outcomes in rural areas and neighborhoods with concentrated poverty.
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Affiliation(s)
- Asal Mohamadi Johnson
- Georigia Southern University, Center for International Studies, United States; Georgia Southern University, Jiann-Ping Hsu College of Public Health, United States.
| | - Robert B Hines
- University of Kansas School of Medicine-Wichita, Department of Preventive Medicine and Public Health, United States
| | - James Allen Johnson
- Georgia Southern University, Jiann-Ping Hsu College of Public Health, United States
| | - A Rana Bayakly
- Georgia Department of Public Health, Georgia Comprehensive Cancer Registry, United States
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Hines R, Markossian T, Johnson A, Dong F, Bayakly R. Geographic residency status and census tract socioeconomic status as determinants of colorectal cancer outcomes. Am J Public Health 2014; 104:e63-71. [PMID: 24432920 DOI: 10.2105/ajph.2013.301572] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the impact of geographic residency status and census tract (CT)-level socioeconomic status (SES) on colorectal cancer (CRC) outcomes. METHODS This was a retrospective cohort study of patients diagnosed with CRC in Georgia for the years 2000 through 2007. Study outcomes were late-stage disease at diagnosis, receipt of treatment, and survival. RESULTS For colon cancer, residents of lower-middle-SES and low-SES census tracts had decreased odds of receiving surgery. Rural, lower-middle-SES, and low-SES residents had decreased odds of receiving chemotherapy. For patients with rectal cancer, suburban residents had increased odds of receiving radiotherapy, but low SES resulted in decreased odds of surgery. For survival, rural residents experienced a partially adjusted 14% (hazard ratio [HR] = 1.14; 95% confidence interval [CI] = 1.07, 1.22) increased risk of death following diagnosis of CRC that was somewhat explained by treatment differences and completely explained by CT-level SES. Lower-middle- and low-SES participants had an adjusted increased risk of death following diagnosis for CRC (lower-middle: HR = 1.16; 95% CI = 1.10, 1.22; low: HR = 1.24; 95% CI = 1.16, 1.32). CONCLUSIONS Future efforts should focus on developing interventions and policies that target rural residents and lower SES areas to eliminate disparities in CRC-related outcomes.
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Affiliation(s)
- Robert Hines
- Robert Hines and Frank Dong are with the Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita. At the time of the study, Talar Markossian was with the Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Asal Johnson is with the Center for International Studies, Georgia Southern University. Rana Bayakly is with the Chronic Disease, Healthy Behaviors and Injury Epidemiology Section, Health Protection Division, Georgia Department of Public Health, Atlanta
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Gómez-de-Tejada Romero MJ, Navarro Rodríguez MDC, Saavedra Santana P, Quesada Gómez JM, Jódar Gimeno E, Sosa Henríquez M. Prevalence of osteoporosis, vertebral fractures and hypovitaminosis D in postmenopausal women living in a rural environment. Maturitas 2014; 77:282-6. [PMID: 24529318 DOI: 10.1016/j.maturitas.2013.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 12/08/2013] [Accepted: 12/22/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVES First, to study the difference between two groups of postmenopausal women living in different population centres (rural vs urban) in the prevalence of osteoporosis, fragility fractures and factors which may influence them: hypovitaminosis D, bone mineral density, coexistence of other diseases which predispose to their appearance; secondly, to observe the influence of low socioeconomic status, categorised as poverty. STUDY DESIGN 1229 postmenopausal women were studied, of whom 390 (31.7%), were living in rural areas and 839 (68.3%), in urban areas. Data regarding risk factors related to osteoporosis were obtained, and, among other biochemical measures, 25 hydroxyvitamin D and parathyroid hormone were determined. Bone densitometry was carried out in the lumbar spine and proximal femur, as well as lateral X-rays of the dorsal and lumbar spine. RESULTS The women who lived in rural areas were older, shorter, heavier and had a higher body mass index than those from urban areas. Among the women from rural areas there was a higher prevalence of poverty, and higher levels of obesity, arterial hypertension and diabetes mellitus were observed, as well as a higher prevalence of densitometric osteoporosis. The rural women had lower values of bone mineral density in the lumbar spine and a higher prevalence of vertebral fractures and hypovitaminosis D. The variables which were associated independently with living in rural areas were poverty, obesity, vertebral fractures, BMD in the lumbar spine and levels of 25 hydroxyvitamin D. CONCLUSIONS In our study, postmenopausal women who live in rural populations have more poverty, lower values of vitamin D, lower BMD in the lumbar spine and a higher prevalence of vertebral fractures and of osteoporosis. The higher prevalence of obesity, arterial hypertension and diabetes mellitus observed in these women may be adjuvant factors, all fostered by their socioeconomic state of poverty.
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Affiliation(s)
| | | | | | | | | | - Manuel Sosa Henríquez
- Research Group into Osteoporosis and Mineral Metabolism, University of Las Palmas de Gran Canaria, Spain; Bone Metabolism Unit, Internal Medicine Service, University Insular Hospital, Las Palmas de Gran Canaria, Spain.
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