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Desjardins MR, Kanarek NF, Nelson WG, Bachman J, Curriero FC. Disparities in Cancer Stage Outcomes by Catchment Areas for a Comprehensive Cancer Center. JAMA Netw Open 2024; 7:e249474. [PMID: 38696166 PMCID: PMC11066700 DOI: 10.1001/jamanetworkopen.2024.9474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/04/2024] [Indexed: 05/05/2024] Open
Abstract
Importance The National Cancer Institute comprehensive cancer centers (CCCs) lack spatial and temporal evaluation of their self-designated catchment areas. Objective To identify disparities in cancer stage at diagnosis within and outside a CCC's catchment area across a 10-year period using spatial and statistical analyses. Design, Setting, and Participants This cross-sectional, population-based study conducted between 2010 and 2019 utilized cancer registry data for the Johns Hopkins Sidney Kimmel CCC (SKCCC). Eligible participants included patients with cancer in the contiguous US who received treatment for cancer, a diagnosis of cancer, or both at SKCCC. Patients were geocoded to zip code tabulation areas (ZCTAs). Individual-level variables included sociodemographic characteristics, smoking and alcohol use, treatment type, cancer site, and insurance type. Data analysis was performed between March and July 2023. Exposures Distance between SKCCC and ZCTAs were computed to generate a catchment area of the closest 75% of patients and outer zones in 5% increments for comparison. Main Outcomes and Measures The primary outcome was cancer stage at diagnosis, defined as early-stage, late-stage, or unknown stage. Multinomial logistic regression was used to determine associations of catchment area with stage at diagnosis. Results This study had a total of 94 007 participants (46 009 male [48.94%] and 47 998 female [51.06%]; 30 195 aged 22-45 years [32.12%]; 4209 Asian [4.48%]; 2408 Hispanic [2.56%]; 16 004 non-Hispanic Black [17.02%]; 69 052 non-Hispanic White [73.45%]; and 2334 with other or unknown race or ethnicity [2.48%]), including 47 245 patients (50.26%) who received a diagnosis of early-stage cancer, 19 491 (20.73%) who received a diagnosis of late-stage cancer , and 27 271 (29.01%) with unknown stage. Living outside the main catchment area was associated with higher odds of late-stage cancers for those who received only a diagnosis (odds ratio [OR], 1.50; 95% CI, 1.10-2.05) or only treatment (OR, 1.44; 95% CI, 1.28-1.61) at SKCCC. Non-Hispanic Black patients (OR, 1.16; 95% CI, 1.10-1.23) and those with Medicaid (OR, 1.65; 95% CI, 1.46-1.86) and no insurance at time of treatment (OR, 2.12; 95% CI, 1.79-2.51) also had higher odds of receiving a late-stage cancer diagnosis. Conclusions and Relevance In this cross-sectional study of CCC data from 2010 to 2019, patients residing outside the main catchment area, non-Hispanic Black patients, and patients with Medicaid or no insurance had higher odds of late-stage diagnoses. These findings suggest that disadvantaged populations and those living outside of the main catchment area of a CCC may face barriers to screening and treatment. Care-sharing agreements among CCCs could address these issues.
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Affiliation(s)
- Michael R. Desjardins
- Department of Epidemiology and Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Norma F. Kanarek
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - William G. Nelson
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jamie Bachman
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Frank C. Curriero
- Department of Epidemiology and Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Huh KY, Yu KS, Song I. Analysis of the distribution of trial sites in South Korea using social network analysis. Transl Clin Pharmacol 2023; 31:1-12. [PMID: 37034125 PMCID: PMC10079509 DOI: 10.12793/tcp.2023.31.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/05/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023] Open
Abstract
Location of trial sites can be a potential source of study bias. Considering that clinical trials have been mostly conducted in urban areas, the distribution of trial sites need to be evaluated. We analyzed clinical trial approval data using social network analysis to quantitatively assess the site-by-site connections. The approval list of clinical trials from the Ministry of Food and Drug Safety database between 2014 and 2021 was analyzed. The number of clinical trials per trial site was counted according to the approval year and study phase and evaluated for distribution using empirical cumulative distribution function plots. Trial sites and conducts of a clinical trial were mapped into nodes and edges in the social network analysis, and basic network parameters were obtained. The clinical trials were concentrated at several trial sites. Forty-nine to 60.6% of phase 1 and up to 30% of the other study phases of clinical trials were at the top 5 trial sites. The annual distribution of the number of clinical trials per site was comparable across the study period. Connections among the trial sites in the metropolitan area were prominent. Graph size and density were higher in phase 3 trials than in the other phases. We demonstrated that the conduct of clinical trials was concentrated in the Seoul Metropolitan Area in both number of trials and connections using social network analysis.
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Affiliation(s)
- Ki Young Huh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - Ildae Song
- Department of Pharmaceutical Science and Technology, Kyungsung University, Busan 48434, Korea
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3
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Díaz Cao JM, Kent MS, Rupasinghe R, Martínez-López B. Application of Bayesian Regression for the Identification of a Catchment Area for Cancer Cases in Dogs and Cats. Front Vet Sci 2022; 9:937904. [PMID: 35958313 PMCID: PMC9359078 DOI: 10.3389/fvets.2022.937904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Research on cancer in dogs and cats, among other diseases, finds an important source of information in registry data collected from hospitals. These sources have proved to be decisive in establishing incidences and identifying temporal patterns and risk factors. However, the attendance of patients is not random, so the correct delimitation of the hospital catchment area (CA) as well as the identification of the factors influencing its shape is relevant to prevent possible biases in posterior inferences. Despite this, there is a lack of data-driven approaches in veterinary epidemiology to establish CA. Therefore, our aim here was to apply a Bayesian method to estimate the CA of a hospital. We obtained cancer (n = 27,390) and visit (n = 232,014) registries of dogs and cats attending the Veterinary Medical Teaching Hospital of the University of California, Davis from 2000 to 2019 with 2,707 census tracts (CTs) of 40 neighboring counties. We ran hierarchical Bayesian models with different likelihood distributions to define CA for cancer cases and visits based on the exceedance probabilities for CT random effects, adjusting for species and period (2000-2004, 2005-2009, 2010-2014, and 2015-2019). The identified CAs of cancer cases and visits represented 75.4 and 83.1% of the records, respectively, including only 34.6 and 39.3% of the CT in the study area. The models detected variation by species (higher number of records in dogs) and period. We also found that distance to hospital and average household income were important predictors of the inclusion of a CT in the CA. Our results show that the application of this methodology is useful for obtaining data-driven CA and evaluating the factors that influence and predict data collection. Therefore, this could be useful to improve the accuracy of analysis and inferences based on registry data.
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Affiliation(s)
- José Manuel Díaz Cao
- Center for Animal Disease Modeling and Surveillance (CADMS), Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Michael S. Kent
- Center for Companion Animal Health and the Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Ruwini Rupasinghe
- Center for Animal Disease Modeling and Surveillance (CADMS), Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Beatriz Martínez-López
- Center for Animal Disease Modeling and Surveillance (CADMS), Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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4
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Huh KY, Yu KS, Lim HS, Kim H. Trends of clinical trials from 2017 to 2019 in Korea: an integrated analysis based on the Ministry of Food and Drug Safety (MFDS) and the Clinical Research Information Service (CRIS) registries. Transl Clin Pharmacol 2022; 29:186-196. [PMID: 35024359 PMCID: PMC8718355 DOI: 10.12793/tcp.2021.29.e24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/28/2021] [Accepted: 12/16/2021] [Indexed: 12/03/2022] Open
Abstract
Public disclosure of approved clinical trials in a reliable registry can provide the transparency of the study. Although the registration of clinical trials has increased remarkably, the integrity of the data is not always satisfactory. In this study, we analyzed public clinical trial databases updated by the Ministry of Food and Drug Safety (MFDS) and Clinical Research Information Service (CRIS) registry to provide an overview of the trends of clinical trials approved between 2017 and 2019 in Korea. Information on clinical trials approved between January 1, 2017 and December 31, 2019 was collected from two databases. Trial information was categorized and summarized by study phase, therapeutic area, and location of the participating centers. A total of 655 to 715 clinical trials were newly approved annually by MFDS during the period from 2017 to 2019. Phase 1 clinical trials accounted for the largest proportion (31.0%), followed by phase 3 (29.5%), investigator-initiated trials (24.1%), phase 2 (14.6%), and phase 4 (0.5%). The number of clinical trials classified as an Antineoplastic and immunomodulating agent was the greatest (40.1%) regardless of the study phase. The similar result was obtained from CRIS registry where therapeutic area Neoplasms (15.9%) accounted for the largest number. The number of clinical trials performed in Seoul and Gyeonggi-do was approximately 70% of the total trials. In conclusion, our study provided a comprehensive overview of clinical trials in Korea from 2017 to 2019. The discrepancy between clinical trial registries could be resolved by introducing standardized database and guidelines.
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Affiliation(s)
- Ki Young Huh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - Hyeong-Seok Lim
- Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Hyungsub Kim
- Department of Emergency Medical Services, College of Health Sciences, Eulji University, Seongnam 13135, Korea
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Clougherty JE, Kinnee EJ, Cardet JC, Mauger D, Bacharier L, Beigelman A, Blake KV, Cabana MD, Castro M, Chmiel JF, Covar R, Fitzpatrick A, Gaffin JM, Gentile D, Israel E, Jackson DJ, Kraft M, Krishnan JA, Kumar HV, Lang JE, Lazarus SC, Lemanske RF, Lima J, Martinez FD, Morgan W, Moy J, Myers R, Naureckas ET, Ortega VE, Peters SP, Phipatanakul W, Pongracic JA, Ross K, Sheehan WJ, Smith LJ, Solway J, Sorkness CA, Wechsler ME, Wenzel S, White SR, Holguin F. Geography, generalisability, and susceptibility in clinical trials. THE LANCET RESPIRATORY MEDICINE 2021; 9:330-332. [PMID: 33539731 PMCID: PMC8009610 DOI: 10.1016/s2213-2600(21)00046-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Jane E Clougherty
- Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA.
| | - Ellen J Kinnee
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan Carlos Cardet
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - David Mauger
- Department of Public Health Sciences, Penn State University, Hershey, PA, USA
| | - Leonard Bacharier
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Avraham Beigelman
- The Kipper Institute of Allergy and Immunology, Schneider Children's Medical Center of Israel, Tel Aviv University, Tel Aviv, Israel
| | - Kathryn V Blake
- Biomedical Research Department, Nemours Children's Health System, Jacksonville, FL, USA
| | - Michael D Cabana
- Department of Pediatrics, Children's Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - James F Chmiel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ronina Covar
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | | | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard University, Boston MA, USA
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Monica Kraft
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jerry A Krishnan
- Breathe Chicago Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Harsha Vardhan Kumar
- Division of Allergy/Immunology/Pulmonology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jason E Lang
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Stephen C Lazarus
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Robert F Lemanske
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John Lima
- Pharmacogenomics & Translational Research, Nemours Children's Health System, Jacksonville, FL, USA
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Wayne Morgan
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - James Moy
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Ross Myers
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Victor E Ortega
- Department of Internal Medicine, Winston-Salam, NC, USA; Center for Precision Medicine at the Wake Forest School of Medicine, Winston-Salam, NC, USA
| | | | - Wanda Phipatanakul
- Division of Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacqueline A Pongracic
- Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kristie Ross
- Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - William J Sheehan
- Division of Allergy/Immunology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Lewis J Smith
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Julian Solway
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Christine A Sorkness
- Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Sally Wenzel
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven R White
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Fernando Holguin
- Division of Pulmonary Sciences & Critical Care, University of Colorado, Denver, CO, USA
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Bae HJ, Kang JE, Lim YR. Assessment of Relative Asthma Risk in Populations Living Near Incineration Facilities in Seoul, Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207448. [PMID: 33066152 PMCID: PMC7601977 DOI: 10.3390/ijerph17207448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 11/29/2022]
Abstract
While incineration is among the most commonly used technologies for waste disposal, there is ongoing public concern regarding the adverse health impact. The aim of this study is thus to use health statistics to assess the relative risk of asthma-related hospitalization for those living in close proximity to incineration facilities. We also examine differences in asthma risk related to age demographics. The spatial relationship between incineration facilities and asthma-related hospital admissions in Seoul is analyzed for the period of 2009–2011 using the Rapid Inquiry Facility (RIF) and SaTScan software. The relative risk of asthma-related hospitalization decreased with increasing distance from incinerators, but increased among those living within a 2-km radius. The relative risks of asthma-related hospitalization were 1.13 (95% confidence interval (CI): 1.10–1.17), 1.12 (95% CI: 1.08–1.17), and 1.18 (95% CI: 1.10–1.27) for all ages, those aged below 15 years, and those aged 65 years and older, respectively. This study is the first to observe an increased risk of asthma-related hospitalization in relation to a person’s distance from an incinerator in Seoul, Korea. It is clear that asthma should be considered an adverse health outcome during health impact assessments of incineration plants.
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Affiliation(s)
- Hyun-Joo Bae
- Climate, Air Quality and Safety Research Group, Korea Environment Institute, Bldg B, 370 Sicheong-daero, Sejongsi 30147, Korea;
| | - Jung Eun Kang
- Department of Urban Planning and Engineering, Pusan National University, 2 Busandaehak-ro63, Geumjeong-gu, Busan 46241, Korea
- Correspondence: ; Tel.: +82-51-510-2451
| | - Yu-Ra Lim
- Institute of Environmental Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea;
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Reed D, Raina K, Agarwal R. Nutraceuticals in prostate cancer therapeutic strategies and their neo-adjuvant use in diverse populations. NPJ Precis Oncol 2018; 2:15. [PMID: 30062144 PMCID: PMC6060229 DOI: 10.1038/s41698-018-0058-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 12/17/2022] Open
Abstract
Prostate cancer (PCa) is the most frequently diagnosed malignancy and second leading cause of cancer mortality in American males. Notably, men of African descent in the United States and Caribbean have the highest PCa mortality rates compared to men with European ancestry. Although current therapeutics are quite potent and effective, disease resistance, progression to metastasis, therapy-associated toxicities and efficacy-related issues in diverse populations develop over time. Thus, non-toxic and efficacious therapeutic strategies are needed to address these major obstacles for the clinical treatment and management of PCa. In this regard, preclinical and population-based efficacy studies have shown the potential of natural non-toxic nutraceuticals as potent anti-PCa agents. Accordingly, the implementation of nutraceutical intervention and genetic testing in diverse populations might aid in the development and design of precision medicine strategies to reduce the burden of chemotherapy-associated toxicities, suppress disease resistance, and treat both localized and advanced PCa. Consequently, additional large-scale and inclusive clinical studies are required to fully assess efficacy and therapeutic limitations of these agents in PCa. This review discusses the most current clinical research on selected nutraceutical agents and their efficacy in the context of clinico-pathological outcomes and disease susceptibility in diverse PCa clinical and epidemiological studies.
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Affiliation(s)
- Dominique Reed
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO USA
| | - Komal Raina
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO USA
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Rajesh Agarwal
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO USA
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO USA
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Hiatt RA. New Directions in Cancer Control and Population Sciences. Cancer Epidemiol Biomarkers Prev 2018; 26:1165-1169. [PMID: 28765336 DOI: 10.1158/1055-9965.epi-16-1022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/03/2017] [Accepted: 03/09/2017] [Indexed: 11/16/2022] Open
Abstract
Cancer control science has been evolving since it first became a focus for cancer research and program activities a century ago. The evolution of the field has responded to historical megatrends along the way that keep it relevant to the cancer-related needs of society. This commentary describes some of the key trends and developments now influencing cancer control and population sciences that reflect societal change and new tools and concepts in modern biomedical science. New directions include the impact of climate change, health care delivery research, the growth of population health science, data science, precision medicine, data sharing, implementation science, and new technologies, including social media and new geospatial methodologies. Cancer Epidemiol Biomarkers Prev; 26(8); 1165-9. ©2017 AACR.
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Affiliation(s)
- Robert A Hiatt
- University of California, San Francisco, San Francisco, California.
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9
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Tai CG, Hiatt RA. The Population Burden of Cancer: Research Driven by the Catchment Area of a Cancer Center. Epidemiol Rev 2018; 39:108-122. [PMID: 28472310 DOI: 10.1093/epirev/mxx001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/09/2017] [Indexed: 11/14/2022] Open
Abstract
Cancer centers, particularly those supported by the National Cancer Institute, are charged with reducing the cancer burden in their catchment area. However, methods to define both the catchment area and the cancer burden are diverse and range in complexity often based on data availability, staff resources, or confusion about what is required. This article presents a review of the current literature identifying 4 studies that have defined various aspects of the cancer burden in a defined geographical area and highlights examples of how some cancer centers and other health institutions have defined their catchment area and characterized the cancer burden within it. We then present a detailed case study of an approach applied by the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center to define its catchment area and its population cancer burden. We cite examples of how the Cancer Center research portfolio addresses the defined cancer burden. Our case study outlines a systematic approach to using publicly available data, such as cancer registry data, that are accessible by all cancer centers. By identifying gaps and formulating future research directions based on the needs of the population within the catchment area, epidemiologic studies and other types of cancer research can be directed to the population served. This review can help guide cancer centers in developing an approach to defining their own catchment area as mandated and applying research findings to this defined population.
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10
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Besse KL, Preussler JM, Murphy EA, Denzen EM, Lill MC, Chell JW, Senneka MK, Majhail NS, Williams EP. Estimating demand and unmet need for allogeneic hematopoietic cell transplantation in the United States using geographic information systems. J Oncol Pract 2016; 11:e120-30. [PMID: 25784576 DOI: 10.1200/jop.2014.000794] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Allogeneic hematopoietic cell transplantation (HCT) is an increasingly used therapy for many patients with hematologic malignancies and other marrow failure or immune system disorders. The purpose of this study was to quantify and visualize both the demand and unmet need for HCT. METHODS HCT use for 2012 was described using the Center for International Blood and Marrow Transplant Research registry. Potential demand for HCT was calculated using 2012 SEER data and published literature for HCT-treatable conditions. Point locations of transplant centers were geocoded using geographic information system (GIS) software; Thiessen polygons were created to establish adult (age 20 to 74 years) and pediatric (age 0 to 19 years) market areas. Market-area population estimates were calculated using 2012 population estimates by age aggregated by census block. RESULTS US market areas for HCTs were identified separately for transplant centers treating adult (n = 62) and pediatric patients (n = 52). Overall HCT demand among adults was 16,096, with an unmet need for HCTs of 10,276 patients. For pediatric patients, the total demand was 4,561, with an unmet need of 3,213 potential recipients. Evaluation of adult and pediatric market areas indicated that the largest unmet needs tended to be in areas with large populations. CONCLUSION Market-area maps and statistics developed using GIS will help communicate the unmet need for HCT, inform policy, and assist transplant centers in planning for the anticipated growth in HCT use.
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Affiliation(s)
- Kelsey L Besse
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Jaime M Preussler
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Elizabeth A Murphy
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Ellen M Denzen
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Michael C Lill
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Jeffrey W Chell
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Mary K Senneka
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Navneet S Majhail
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Eric P Williams
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
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11
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Wang A, Wheeler DC. Catchment area analysis using bayesian regression modeling. Cancer Inform 2015; 14:71-9. [PMID: 25983542 PMCID: PMC4403915 DOI: 10.4137/cin.s17297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 11/12/2022] Open
Abstract
A catchment area (CA) is the geographic area and population from which a cancer center draws patients. Defining a CA allows a cancer center to describe its primary patient population and assess how well it meets the needs of cancer patients within the CA. A CA definition is required for cancer centers applying for National Cancer Institute (NCI)-designated cancer center status. In this research, we constructed both diagnosis and diagnosis/treatment CAs for the Massey Cancer Center (MCC) at Virginia Commonwealth University. We constructed diagnosis CAs for all cancers based on Virginia state cancer registry data and Bayesian hierarchical logistic regression models. We constructed a diagnosis/treatment CA using billing data from MCC and a Bayesian hierarchical Poisson regression model. To define CAs, we used exceedance probabilities for county random effects to assess unusual spatial clustering of patients diagnosed or treated at MCC after adjusting for important demographic covariates. We used the MCC CAs to compare patient characteristics inside and outside the CAs. Among cancer patients living within the MCC CA, patients diagnosed at MCC were more likely to be minority, female, uninsured, or on Medicaid.
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Affiliation(s)
- Aobo Wang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - David C Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
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Lim YR, Bae HJ, Lim YH, Yu S, Kim GB, Cho YS. Spatial analysis of PM10 and cardiovascular mortality in the Seoul metropolitan area. ENVIRONMENTAL HEALTH AND TOXICOLOGY 2014; 29:e2014005. [PMID: 25116367 PMCID: PMC4152940 DOI: 10.5620/eht.2014.29.e2014005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 05/29/2014] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Numerous studies have revealed the adverse health effects of acute and chronic exposure to particulate matter less than 10 μm in aerodynamic diameter (PM10). The aim of the present study was to examine the spatial distribution of PM10 concentrations and cardiovascular mortality and to investigate the spatial correlation between PM10 and cardiovascular mortality using spatial scan statistic (SaTScan) and a regression model. METHODS From 2008 to 2010, the spatial distribution of PM10 in the Seoul metropolitan area was examined via kriging. In addition, a group of cardiovascular mortality cases was analyzed using SaTScan-based cluster exploration. Geographically weighted regression (GWR) was applied to investigate the correlation between PM10 concentrations and cardiovascular mortality. RESULTS An examination of the regional distribution of the cardiovascular mortality was higher in provincial districts (gu) belonging to Incheon and the northern part of Gyeonggido than in other regions. In a comparison of PM10 concentrations and mortality cluster (MC) regions, all those belonging to MC 1 and MC 2 were found to belong to particulate matter (PM) 1 and PM 2 with high concentrations of air pollutants. In addition, the GWR showed that PM10 has a statistically significant relation to cardiovascular mortality. CONCLUSIONS To investigate the relation between air pollution and health impact, spatial analyses can be utilized based on kriging, cluster exploration, and GWR for a more systematic and quantitative analysis. It has been proven that cardiovascular mortality is spatially related to the concentration of PM10.
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Affiliation(s)
- Yu-Ra Lim
- Korea Environment Institute, Seoul, Korea
| | | | - Youn-Hee Lim
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Seungdo Yu
- Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| | - Geun-Bae Kim
- Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| | - Yong-Sung Cho
- Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
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Kanarek NF, Hooker CM, Mathieu L, Tsai HL, Rudin CM, Herman JG, Brock MV. Survival after community diagnosis of early-stage non-small cell lung cancer. Am J Med 2014; 127:443-9. [PMID: 24486286 PMCID: PMC4601577 DOI: 10.1016/j.amjmed.2013.12.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 12/10/2013] [Accepted: 12/20/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND "Rush to surgery" among patients with worse symptoms, delays related to morbidity, and inclusion of patients with advanced disease in study populations have produced a mixed picture of importance of time to treatment to survival of non-small cell lung cancer. Our objective was to assess the contribution of diagnosis to first surgery interval to survival among patients diagnosed in the community with early-stage non-small cell lung cancer. METHODS Patients with early-stage lung cancer (N = 174) at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins who were diagnosed and treated from 2003 to 2009 and followed through 2011 made up a prospective study of overall survival. Diagnosis to first surgery interval was examined overall, as 2 segments (referral interval and treatment interval), as short and longer intervals, and as a continuous variable. RESULTS The majority of patients were female (55%) and aged more than 65 years (61%). The average mean referral and treatment delays were 61.2 and 5.9 days, respectively. Cox method hazard analysis revealed that older age (years) at diagnosis (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00-1.05), stage IIB (HR, 2.17; 95% CI, 1.12-4.21), large (>4 cm) (HR, 3.68; 95% CI, 1.05-12.93) or unknown tumor size (HR, 4.45; 95% CI, 1.21-16.38), and weeks from diagnosis to first surgery interval (HR, 1.04; 95% CI, 1.00-1.09) predicted worse overall survival. The threshold period of less than 42 days from diagnosis to surgery did not reach statistical significance. CONCLUSIONS Patients seem to benefit from rapid reduction of tumor burden with surgery. Reasons for delay were not available. Nevertheless, referral delay experienced in the community is unduly long. In addition to patient choices, an unconscious patient or physician bias that lung cancer is untreatable or an inevitable consequence of smoking may be operating and needs further investigation.
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Affiliation(s)
- Norma F Kanarek
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Craig M Hooker
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Luckson Mathieu
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Hua-Ling Tsai
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Charles M Rudin
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - James G Herman
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Malcolm V Brock
- Department of Surgery, Johns Hopkins University School of Medicine, Bunting Blaustein Cancer Research Building, Baltimore, Md
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Kanarek NF, Kanarek MS, Olatoye D, Carducci MA. Removing barriers to participation in clinical trials, a conceptual framework and retrospective chart review study. Trials 2012; 13:237. [PMID: 23227880 PMCID: PMC3551829 DOI: 10.1186/1745-6215-13-237] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 11/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enrollment in interventional therapeutic clinical trials is a small fraction of all patients who might participate given reasonable access. METHODS A hierarchical approach is utilized in measuring staged participation from trial availability to patient enrollment. Our framework suggests that concern for justice comes in the design and eligibility criteria for clinical trials; attention to beneficence is given in the eligibility and physician triage stages. The remaining four stages rely on respect for persons. An example is given where reasons for nonparticipation or barriers to participation in prostate cancer clinical trials are examined within the framework. In addition, medical oncology patients with an initial six month consultation are tracked from one stage to the next by race using the framework to assess participation comparability. RESULTS We illustrated seven transitions from being a patient to enrollment in a clinical trial in a small study of prostate cancer cases who consulted SKCCC Medical Oncology Department in early 2010. Pilot data suggest transition probabilities as follows: 65% availability, 84% eligibility, 92% patient triage, 89% trials discussed, 45% patient interested, 63% patient consented, and 92% patient enrolled. The average transition probability was 77.7%. The average transition probability, patient-trial-fit was 50%; opportunity was 51%, and acceptance was 66.7%. Trial availability, patient interest and patient consented were three transitions that were below the average; none were statistically significant. CONCLUSIONS The framework may serve to streamline comprehensive reporting of clinical trial participation to the benefit of patients and the ethical conduct of clinical trials.
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Affiliation(s)
- Norma F Kanarek
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
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Muñoz A, Chen JG, Egner PA, Marshall ML, Johnson JL, Schneider MF, Lu JH, Zhu YR, Wang JB, Chen TY, Kensler TW, Groopman JD. Predictive power of hepatitis B 1762T/1764A mutations in plasma for hepatocellular carcinoma risk in Qidong, China. Carcinogenesis 2011; 32:860-5. [PMID: 21474708 DOI: 10.1093/carcin/bgr055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality with nearly 700,000 deaths occurring annually. Hepatitis B virus (HBV) is a major contributor to HCC and acquired mutations in the HBV genome may accelerate its pathogenesis. In this study, a matched case-control investigation of 345 men who died of HCC and 625 controls were nested within a cohort of male hepatitis B surface antigen (HBsAg) carriers from Qidong, China. Matched preserving odds ratios (ORs) were used as a measure of association and 95% confidence intervals (CIs) as a measure of precision. Real-time polymerase chain reaction allowed for a quantitative comparison of the levels of the HBV 1762(T)/1764(A) mutation in cases and controls. A total of 278 (81%) of the cases were positive for the HBV 1762(T)/1764(A) mutation compared with 250 (40%) of the controls. The matched preserving OR of 6.72 (95% CI: 4.66 to 9.68) strongly indicated that cases were significantly more probably than controls to have the mutation. Plasma levels of DNA harboring the HBV mutation were on average 15-fold higher in cases compared with controls (P < 0.001). Most strikingly, the level of the mutation in the 20 controls who later developed and died of HCC were on average 274-fold higher than controls who did not develop HCC. Thus, within this cohort of HBsAg carriers at high risk of developing HCC, individuals positive for the HBV 1762(T)/1764(A) mutation at enrollment were substantially more probably to subsequently develop HCC, with a higher concentration of the mutation in plasma enhancing predisposition for cancer development.
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Affiliation(s)
- Alvaro Muñoz
- Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
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