1
|
Gakunga R, Korir A, Bouttell J. Evaluating the impact of the National Health Insurance Fund oncology benefits package and a healthcare workers' strike on time to cancer treatment initiation in Nairobi County, Kenya: An interrupted time series analysis. PLoS One 2025; 20:e0324593. [PMID: 40402995 PMCID: PMC12097610 DOI: 10.1371/journal.pone.0324593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 04/28/2025] [Indexed: 05/24/2025] Open
Abstract
INTRODUCTION In April 2015, Kenya introduced the National Health Insurance Oncology Benefits Package and its complementary reforms (oncology insurance scheme) to alleviate financial hardship among its members upon a cancer diagnosis. In this study, we hypothesised that the time it took to start treatment would have an impact on health outcomes: the longer patients waited the worse their outcomes would be. We did not have outcomes in the data but we could compute time to treatment initiation (TTI). While assessing the impact of the oncology insurance scheme on TTI, we encountered a substantial sudden increase in average TTI in June 2018 which we needed to explore. METHODS We conducted our analysis using R, a statistical computing software, for interrupted time series analysis (ITSA) on Nairobi Cancer Registry data to assess the impact of the introduction of the oncology insurance scheme on TTI in days among Nairobi County residents diagnosed with cancer. We calculated the monthly median TTI, resulting in 120 data points (one for each of the 120 months of the observation period - January 1st 2010 to December 31st 2019). Since the oncology insurance scheme was available to the entire Kenyan population, a suitable control group was unavailable. To address this, we used auto regressive integrated moving average (ARIMA) modelling to forecast an expected trend, allowing us to estimate both sudden and gradual changes during April 2015 and June 2018 (intervention months). RESULTS After cleaning the data, 7584 (35%) cases of the original 21,464 were left for analysis. Females were more than males at 57.8%. Approximately 65% of the cases with known stage at diagnosis were in stages III and IV. No statistically significant impact was associated with the introduction of oncology insurance scheme; an additional 9.06 days (95% CI: -8.7 to 26.8) and a gradual change of 0.88 days per month (95% CI: -0.11 to 1.88). However, a statistically significant sudden increase in monthly median TTI in June 2018 of 34.6 days (95% CI 15.4 to 53.8) and the gradual change of -1.6 days (95% CI -3.5 to 0.4) per month which was not statistically significant, were associated with a healthcare workers' strike. We could not accurately analyse case trends from these data because the registry had not completed collating data for the later years (2015-2019). CONCLUSIONS These results suggest that the oncology insurance scheme may not have reduced average TTI for the cancer patients as we had hypothesized. However, a healthcare workers' strike (based on corroboration with findings from the 2018 Kenya Household Health Expenditure and Utilization Survey), increased the average TTI among these patients. Data science techniques and ITSAs using cancer registry data is a cost-effective method to answer important population-level research questions in resource-limited settings.
Collapse
Affiliation(s)
| | - Anne Korir
- Kenya Medical Research Institute, Centre of Clinical Research, Nairobi, Kenya
| | - Janet Bouttell
- University of Glasgow, School of Health & Wellbeing, Glasgow, United Kingdom
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| |
Collapse
|
2
|
Krishnamurthy S, Jazowski SA, Roberson ML, Reeder-Hayes K, Tang JJ, Dusetzina SB, Essien UR. Racial and Ethnic Disparities in Receipt of ERBB2-Targeted Therapy for Breast Cancer, 2010-2020. JAMA Netw Open 2025; 8:e258086. [PMID: 40310643 PMCID: PMC12046428 DOI: 10.1001/jamanetworkopen.2025.8086] [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: 11/27/2024] [Accepted: 02/28/2025] [Indexed: 05/02/2025] Open
Abstract
Importance Among older women (aged ≥50 years) with ERBB2 (formerly HER2 or HER2/neu)-positive breast cancer, research has shown racial and ethnic disparities in access to ERBB2-targeted therapies, with Black women receiving treatment at lower rates than their White counterparts. Objective To examine racial and ethnic disparities in receipt of ERBB2-targeted therapies and changes in receipt over time. Design, Setting, and Participants This retrospective cohort study used Surveillance, Epidemiology, and End Results-Medicare linked data from January 1, 2010, to December 31, 2020. Beneficiaries who were diagnosed with ERBB2-positive breast cancer between 2010 and 2019, were aged 66 years or older at diagnosis, were continuously enrolled in Medicare Parts A and B in the 12 months before and after diagnosis, and had localized or regional stage disease at diagnosis were included. Data were analyzed from February through September 2024. Exposure Race and ethnicity defined as non-Hispanic Black or African American, Hispanic, or non-Hispanic White. Main Outcome and Measures The primary outcome was receipt of ERBB2-targeted therapies in the 12 months after diagnosis of ERBB2-positive breast cancer. Modified Poisson regression was used to evaluate the probability of receiving ERBB2-targeted therapy by race and ethnicity. Results Among 12 765 beneficiaries with ERBB2-positive breast cancer (median [IQR] age, 74 [69-80] years; 99.2% female), 8.1% were of Black, 6.9% Hispanic, and 85.0% White race and ethnicity, and 54.2% received ERBB2-targeted therapy. The overall proportion who received ERBB2-targeted therapies increased from 41.3% in 2010-2011 to 64.3% in 2018-2019. Compared with White patients, Black patients had a lower likelihood of receiving ERBB2-targeted therapies in 2010-2011 (adjusted risk ratio [ARR], 0.81; 95% confidence limit [CL], 0.68-0.97), as did Hispanic patients (ARR, 0.75; 95% CL, 0.62-0.92). Racial and ethnic disparities in receipt of ERBB2-targeted therapies narrowed over time, with no significant differences observed across racial and ethnic groups in 2018-2019 for Black patients (ARR, 0.97; 95% CL, 0.87-1.08) and Hispanic patients (ARR, 1.05; 95% CL, 0.95-1.16). Conclusions and Relevance These findings suggest a narrowing of racial and ethnic disparities in receipt of ERBB2-targeted therapies over time among older Medicare beneficiaries with ERBB2-positive breast cancer. Future research is needed to understand the practices that contributed to the narrowing of racial and ethnic disparities and to develop implementation strategies to effectively improve the quality and equity of breast cancer care.
Collapse
Affiliation(s)
- Sudarshan Krishnamurthy
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Shelley A. Jazowski
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mya L. Roberson
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Katherine Reeder-Hayes
- Division of Oncology, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina
| | - Jasmyn J. Tang
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
| | - Stacie B. Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Utibe R. Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California
- Associate Editor, JAMA Network Open
| |
Collapse
|
3
|
Shewbridge A, Wiseman T, Richardson A. Treatment Decision-Making in West African Women With Breast Cancer: A Critical Ethnography. Semin Oncol Nurs 2025:151878. [PMID: 40268585 DOI: 10.1016/j.soncn.2025.151878] [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: 01/01/2025] [Revised: 03/11/2025] [Accepted: 03/21/2025] [Indexed: 04/25/2025]
Abstract
OBJECTIVES This study aimed to understand and characterize how culture affected behavior and decision-making about treatment and care in West African women with breast cancer living in the United Kingdom. METHODS A critical ethnographic design was used with a sample consisting of 32 West African women, 27 supporters, and 18 health care professionals. Data were collected through 263 hours of participant observation and 98 informal and 10 formal interviews in a London cancer unit. Study materials and approach were informed by patient and public involvement group recommendations. Data were analyzed using an adapted Carspecken critical ethnographic approach. RESULTS Three main themes were developed from the data: cultural knowledge, beliefs, and values; otherness; and cultural curiosity. West African women described a range of meanings and beliefs about their breast cancer diagnoses and treatments. They felt "Other" from, and were seen as "Other" by, their communities and health care teams. The clinical team exhibited varying levels of cultural curiosity, which evolved over time. CONCLUSION Cultural beliefs concerning cancer and its treatment were so strong that they led to some women refusing, delaying, or interrupting treatment. Nurses must seek to understand and value the perspectives and beliefs of people from unfamiliar cultures and consider how services might be made more flexible to meet their specific needs. IMPLICATIONS FOR NURSING PRACTICE By being culturally curious and gaining understanding about how a woman's culture affects decisions about treatment and care, health care professionals began to understand that patients are more able to accept optimum treatment if adjustments are made to the service.
Collapse
Affiliation(s)
- Amanda Shewbridge
- Faculty of Health Sciences, University of Southampton, Highfield Campus, Southampton, Hampshire, UK; Guys and St Thomas NHS Foundation Trust, Guys Hospital, London, UK.
| | - Theresa Wiseman
- Faculty of Health Sciences, University of Southampton, Highfield Campus, Southampton, Hampshire, UK; The Royal Marsden Hospital NHS Foundation Trust. London, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Highfield Campus, Southampton, Hampshire, UK; NIHR ARC Wessex, Southampton Science Park, Innovation Centre, Chilworth, Southampton, UK; University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| |
Collapse
|
4
|
Koroukian SM, Dong W, Albert JM, Kim U, Vu L, Eom KY, Rose J, Cooper GS, Hoehn RS, Tsui J. A Rising Tide Raises All Ships: Was the Effect of Medicaid Expansion on Cancer Outcomes Similar Across Subgroups of Patients With Cancer on Medicaid? AJPM FOCUS 2025; 4:100301. [PMID: 39885959 PMCID: PMC11780096 DOI: 10.1016/j.focus.2024.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2025]
Abstract
Introduction The authors determined whether certain subgroups of patients with cancer on Ohio Medicaid benefited from the program's expansion to a greater/lesser extent. Study outcomes included stage at diagnosis for screening-amenable cancers (breast [n=1,707 and 2,976], cervical [n=309 and 655], and colorectal [n=927 and 2,009] cancer, before and after expansion, respectively) and time to treatment initiation. Methods Using linked data from the 2011-2017 Ohio cancer registry and Medicaid, the authors conducted a robust Poisson regression analysis for stage at diagnosis and Cox regression analysis for time to treatment initiation to obtain the adjusted risk for earlier stage at diagnosis before to after expansion or hazard of shorter time to treatment initiation for each demographic or clinical subgroup after compared with before pre-Medicaid expansion. The authors subsequently calculated the ratio of risk (or hazard) ratios. Results The effect of Medicaid expansion on outcomes was mostly similar across subgroups of patients with cancer on Medicaid. However, those who were non-Hispanic Black or of other race had a lower probability of being diagnosed with early-stage breast cancer (ratio of risk ratio=0.85 [95% CI=0.74, 0.98] and ratio of risk ratio=0.72 [95% CI=0.55, 0.95], respectively) than non-Hispanic White women. Conclusions These findings point to differences that should be investigated to ensure that the benefits of Medicaid expansion are realized equitably.
Collapse
Affiliation(s)
- Siran M. Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Weichuan Dong
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey M. Albert
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Uriel Kim
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Long Vu
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Kirsten Y. Eom
- Public Health Research Institute, The MetroHealth System and Case Western Reserve University, Cleveland, Ohio
| | - Johnie Rose
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Gregory S. Cooper
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
- Department of Internal Medicine, University Hospitals of Cleveland, Cleveland, Ohio
| | - Richard S. Hoehn
- Department of Surgery, University Hospitals of Cleveland, Cleveland, Ohio
| | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
5
|
Zhang FG, Sheni R, Zhang C, Viswanathan S, Fiori K, Mehta V. Association Between Social Determinants of Health and Cancer Treatment Delay in an Urban Population. JCO Oncol Pract 2024; 20:1733-1743. [PMID: 38959443 DOI: 10.1200/op.24.00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/14/2024] [Accepted: 05/21/2024] [Indexed: 07/05/2024] Open
Abstract
PURPOSE Delays in oncologic time to treatment initiation (TTI) independently and adversely affect disease-specific mortality. Social Determinants of Health (SDoH) are increasingly recognized as significant contributors to patients' disease management and health outcomes. Our academic center has validated a 10-item SDoH screener, and we elucidated which specific needs may be predictive of delayed TTI. METHODS This is a retrospective cohort study at an urban academic center of patients with a SDoH screening and diagnosis of breast, colorectal, endocrine/neuroendocrine, GI, genitourinary, gynecologic, head and neck, hematologic, hepatobiliary, lung, or pancreatic cancer from 2018 to 2022. Variables of interest included household income, tumor stage, and emergency department (ED) or inpatient admission 30 days before diagnosis. Factors associated with delayed TTI ≥45 days were assessed using multivariable logistic regression. RESULTS Among 2,328 patients (mean [standard deviation] age, 64.0 (12.8) years; 66.6% female), having >1 unmet social need was associated with delayed TTI (odds ratio [OR], 1.68; 95% CI, 1.54 to 1.82). The disparities most associated with delay were legal help, transportation, housing stability, and needing to provide care for others. Those with ED (OR, 0.49; 95% CI, 0.44 to 0.54) or inpatient (OR, 0.54; 95% CI, 0.50 to 0.58) admission 30 days before diagnosis were less likely to experience delay. CONCLUSION Delays in oncologic TTI ≥45 days are independently associated with unmet social needs. ED or inpatient admissions before diagnosis increase care coordination, leading to improved TTI. Although limitations included the retrospective nature of the study and self-reporting bias, these findings more precisely identify targets for intervention that may more effectively decrease delay. Patients with SDoH barriers are at higher risk of treatment delay and could especially benefit from legal, transportation, caregiver, and housing assistance.
Collapse
Affiliation(s)
| | - Risha Sheni
- Albert Einstein College of Medicine, Bronx, NY
| | - Chenxin Zhang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Shankar Viswanathan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Kevin Fiori
- Department of Family and Social Medicine, Department of Pediatrics, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| |
Collapse
|
6
|
Lee MK, Levine NTT, Hayes LR, Shields CG, Yih Y. Navigating the cancer care continuum: A comparative study of Black and White breast cancer patients. PLoS One 2024; 19:e0312547. [PMID: 39446965 PMCID: PMC11501014 DOI: 10.1371/journal.pone.0312547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 10/06/2024] [Indexed: 10/26/2024] Open
Abstract
Despite improvements in early detection and therapeutic interventions, the mortality rate for Black breast cancer patients is still significantly higher than that of White breast cancer patients. This study seeks to understand differences in the patient experience that lead to this disparity. Semi-structured interviews were conducted to understand the breast cancer treatment process and patient experiences. This study collected health services and timeline data from medical records. Based on these two data sources, the patient's journey in breast cancer treatment was mapped and a thematic analysis was conducted to identify challenges and barriers in the process. The cancer care continuum consists of four stages-diagnosis, surgery, chemotherapy/radiation, and follow-up care. The themes contributing to patient experiences and challenges were identified and compared in each stage for both Black and White patients. Both Black and White participants faced challenges related to financial constraints, treatment changes, lack of autonomy, and insufficient emotional support. However, Black participants additionally faced significant barriers in terms of cultural concordance, effective patient-provider communication, and delay in diagnosis. This study highlights the importance of incorporating effective provider-patient communication, navigation, and emotional support, especially for Black breast cancer patients throughout the cancer care continuum to address healthcare disparities.
Collapse
Affiliation(s)
- Min K. Lee
- School of Industrial Engineering, Purdue University, West Lafayette, IN, United States of America
| | | | - Lisa R. Hayes
- Pink-4-Ever Ending Disparities, Indianapolis, IN, United States of America
| | - Cleveland G. Shields
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States of America
| | - Yuehwern Yih
- School of Industrial Engineering, Purdue University, West Lafayette, IN, United States of America
- LASER PULSE (Long-Term Assistance and SErvices for Research, Partners for University-Led Solutions Engine) Consortium, Purdue University, West Lafayette, IN, United States of America
| |
Collapse
|
7
|
Ilodianya C, Williams MS. Young Black Women's Breast Cancer Knowledge and Beliefs: A Sequential Explanatory Mixed Methods Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02208-5. [PMID: 39438416 DOI: 10.1007/s40615-024-02208-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 10/07/2024] [Accepted: 10/11/2024] [Indexed: 10/25/2024]
Abstract
INTRODUCTION Black women under the age of 50 have a 111% higher breast cancer mortality rate than their White counterparts. The breast cancer mortality disparities among young Black women may be due in part to the fact that they are more likely to be diagnosed with late-stage, invasive breast cancer tumors. Psychosocial factors, such as lack of perceived risk for breast cancer, lack of awareness of breast cancer risk factors, and ambiguity about breast cancer screening guidelines are areas that are under investigated among young Black women. The purpose of this study was to identify young Black women's cancer beliefs and level of breast cancer risk knowledge. METHODS A sequential explanatory mixed methods study was conducted using quantitative data from the Health Information Trends Survey 6 (HINTS 6) (n = 25) and qualitative data from interviews with young Black female college students (n = 13). The results of the quantitative data analysis were used to guide the development of the qualitative interview guide. Data regarding participants' cancer beliefs, cancer risk factor knowledge, perceived cancer risk, and ambiguity about cancer screening behaviors were analyzed. RESULTS The findings indicated young Black women have low perceived risk of developing cancer. Most participants were not aware of cancer recommendations that were targeted towards women under the age of 40. In addition, knowledge about lifestyle behavior risk factors for breast cancer was relatively low. CONCLUSION Our findings underscore the importance of developing, disseminating, and implementing breast cancer education interventions that are targeted towards young Black women.
Collapse
Affiliation(s)
- Chinenye Ilodianya
- Academy of Science, 42075 Loudoun Academy Drive, Leesburg, VA, 20175, USA
| | - Michelle S Williams
- Department of Global and Community Health, College of Public Health, George Mason University, Peterson Hall Room #4505, 4400 University Boulevard, Fairfax, VA, 22030, USA.
| |
Collapse
|
8
|
Planey AM, Spees LP, Biddell CB, Waters A, Jones EP, Hecht HK, Rosenstein D, Wheeler SB. The intersection of travel burdens and financial hardship in cancer care: a scoping review. JNCI Cancer Spectr 2024; 8:pkae093. [PMID: 39361410 PMCID: PMC11519048 DOI: 10.1093/jncics/pkae093] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 09/10/2024] [Accepted: 09/19/2024] [Indexed: 10/30/2024] Open
Abstract
BACKGROUND In addition to greater delays in cancer screening and greater financial hardship, rural-dwelling cancer patients experience greater costs associated with accessing cancer care, including higher cumulative travel costs. This study aimed to identify and synthesize peer-reviewed research on the cumulative and overlapping costs associated with care access and utilization. METHODS A scoping review was conducted to identify relevant studies published after 1995 by searching 5 electronic databases: PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and Healthcare Administration. Eligibility was determined using the PEO (Population, Exposure, and Outcomes) method, with clearly defined populations (cancer patients), exposures (financial hardship, toxicity, or distress; travel-related burdens), and outcomes (treatment access, treatment outcomes, health-related quality of life, and survival/mortality). Study characteristics, methods, and findings were extracted and summarized. RESULTS Database searches yielded 6439 results, of which 3366 were unique citations. Of those, 141 were eligible for full-text review, and 98 studies at the intersection of cancer-related travel burdens and financial hardship were included. Five themes emerged as we extracted from the full texts of the included articles: 1) Cancer treatment choices, 2) Receipt of guideline-concordant care, 3) Cancer treatment outcomes, 4) Health-related quality of life, and 5) Propensity to participate in clinical trials. CONCLUSIONS This scoping review identifies and summarizes available research at the intersection of cancer care-related travel burdens and financial hardship. This review will inform the development of future interventions aimed at reducing the negative effects of cancer-care related costs on patient outcomes and quality of life.
Collapse
Affiliation(s)
- Arrianna Marie Planey
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, United States
| | - Lisa P Spees
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, United States
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Austin Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Emily P Jones
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Hillary K Hecht
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, United States
| | - Donald Rosenstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, United States
- Department of Hematology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, United States
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| |
Collapse
|
9
|
Fallon J, Standring O, Vithlani N, Demyan L, Shah M, Gazzara E, Hartman S, Pasha S, King DA, Herman JM, Weiss MJ, DePeralta D, Deutsch G. Minorities Face Delays to Pancreatic Cancer Treatment Regardless of Diagnosis Setting. Ann Surg Oncol 2024; 31:4986-4996. [PMID: 38789617 PMCID: PMC11236843 DOI: 10.1245/s10434-024-15352-3] [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: 10/20/2023] [Accepted: 04/09/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Our analysis was designed to characterize the demographics and disparities between the diagnosis of pancreas cancer during emergency presentation (EP) and the outpatient setting (OP) and to see the impact of our institutions pancreatic multidisciplinary clinic (PMDC) on these disparities. METHODS Institutional review board-approved retrospective review of our institutional cancer registry and PMDC databases identified patients diagnosed/treated for pancreatic ductal adenocarcinoma between 2014 and 2022. Chi-square tests were used for categorical variables, and one-way ANOVA with a Bonferroni correction was used for continuous variables. Statistical significance was set at p < 0.05. RESULTS A total of 286 patients met inclusion criteria. Eighty-nine patients (31.1%) were underrepresented minorities (URM). Fifty-seven (64.0%) URMs presented during an EP versus 100 (50.8%) non-URMs (p = 0.037). Forty-one (46.1%) URMs were reviewed at PMDC versus 71 (36.0%) non-URMs (p = 0.10). No differences in clinical and pathologic stage between the cohorts (p = 0.28) were present. URMs took 22 days longer on average to receive treatment (66.5 days vs. 44.8 days, p = 0.003) in the EP cohort and 18 days longer in OP cohort (58.0 days vs. 40.5 days, p < 0.001) compared with non-URMs. Pancreatic Multidisciplinary Clinic enrollment in EP cohort eliminated the difference in time to treatment between cohorts (48.3 days vs. 37.0 days; p = 0.151). RESULTS Underrepresented minorities were more likely to be diagnosed via EP and showed delayed times to treatment compared with non-URM counterparts. Our PMDC alleviated some of these observed disparities. Future studies are required to elucidate the specific factors that resulted in these findings and to identify solutions.
Collapse
Affiliation(s)
- John Fallon
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Oliver Standring
- Department of General Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Nandan Vithlani
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Lyudmyla Demyan
- Department of General Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Manav Shah
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Emma Gazzara
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of General Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Sarah Hartman
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of General Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Shamsher Pasha
- Department of Surgical Oncology, Northwell Health Cancer Institute, Northwell Health, New Hyde Park, NY, USA
| | - Daniel A King
- Division of Medical Oncology/Hematology, Northwell Health, New Hyde Park, NY, USA
| | - Joseph M Herman
- Department of Radiation Oncology, Northwell Health Cancer Institute, Northwell Health, New Hyde Park, NY, USA
| | - Matthew J Weiss
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health Cancer Institute, Northwell Health, New Hyde Park, NY, USA
| | - Danielle DePeralta
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health Cancer Institute, Northwell Health, New Hyde Park, NY, USA
| | - Gary Deutsch
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health Cancer Institute, Northwell Health, New Hyde Park, NY, USA
| |
Collapse
|
10
|
Pederson HJ, Al-Hilli Z, Kurian AW. Racial disparities in breast cancer risk factors and risk management. Maturitas 2024; 184:107949. [PMID: 38652937 DOI: 10.1016/j.maturitas.2024.107949] [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: 12/12/2023] [Revised: 02/03/2024] [Accepted: 02/19/2024] [Indexed: 04/25/2024]
Abstract
Racial disparities in breast cancer outcomes are well described across the spectrum of screening, diagnosis, treatment, and survivorship. Breast cancer mortality is markedly elevated for Non-Hispanic Black women compared with other racial and ethnic groups, with multifactorial causes. Here, we aim to reduce this burden by identifying disparities in breast cancer risk factors, risk assessment, and risk management before breast cancer is diagnosed. We describe a reproductive profile and modifiable risk factors specific to the development of triple-negative breast cancer. We also propose that screening strategies should be both risk- and race-based, given the prevalence of early-onset triple-negative breast cancer in young Black women. We emphasize the importance of early risk assessment and identification of patients at hereditary and familial risk and discuss indications for a high-risk referral. We discuss the subtleties following genetic testing and highlight "uncertain" genetic testing results and risk estimation challenges in women who test negative. We trace aspects of the obesity epidemic in the Black community to infant feeding patterns and emphasize healthy eating and activity. Finally, we discuss building an environment of trust to foster adherence to recommendations, follow-up care, and participation in clinical trials. Addressing relevant social determinants of health; educating patients and clinicians on factors impacting disparities in outcomes; and encouraging participation in targeted, culturally sensitive research are essential to best serve all communities.
Collapse
Affiliation(s)
- Holly J Pederson
- Breast Center, Integrated Surgical Institute, Cleveland Clinic, 9500 Euclid Avenue, A80, OH 44195, United States of America.
| | - Zahraa Al-Hilli
- Breast Center, Integrated Surgical Institute, Cleveland Clinic, 9500 Euclid Avenue, A80, OH 44195, United States of America.
| | - Allison W Kurian
- Department of Medicine and Epidemiology and Population Health, Stanford University, 900 Blake Wilbur Drive, 1st Floor, Palo Alto, CA 94304, United States of America.
| |
Collapse
|
11
|
Martinez Leal I, Acquati C, Rogova A, Chen TA, Connors SK, Agrawal P, McNeill LH, Reitzel LR. Negotiating cancer alone: A qualitative study exploring care experiences of racially and ethnically diverse women diagnosed with breast cancer during COVID-19. J Health Psychol 2024; 29:367-381. [PMID: 38009435 PMCID: PMC11005304 DOI: 10.1177/13591053231214517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
COVID-19 has critically impacted cancer care services including reduced screenings, diagnoses, and surgeries; particularly among Black and Latina/x women who already suffer worse outcomes. This qualitative study explored the care experiences of a diverse sample of breast cancer survivors (N = 21; 7 Black, 4 Hispanic, 10 White) undergoing treatment during the pandemic via online semi-structured interviews. Grounded theory analysis yielded the core category "negotiating cancer alone," that included: (1) psychological distress, negotiating the cancer trajectory in isolation; (2) provider/healthcare system diagnostic and treatment delays; (3) heightened anxiety about treatment delays causing cancer progression; (4) supportive care limitations; and (5) disparate experiences of cancer care disruptions. Black and Latina/x women described greater delays in care, financial challenges, treatment complications, and insurance limitations than White women. The study identifies cancer patients' pandemic-related psychological, healthcare system, and health equity challenges and suggests recommendations to support their increased psychological needs during oncologic care disruptions.
Collapse
Affiliation(s)
| | - Chiara Acquati
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
| | - Anastasia Rogova
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
| | | | | | | | | | - Lorraine R Reitzel
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
| |
Collapse
|
12
|
Valencia CI, Wightman P, Morrill KE, Hsu C, Arif‐Tiwari H, Kauffman E, Gachupin FC, Chipollini J, Lee BR, Garcia DO, Batai K. Neighborhood social vulnerability and disparities in time to kidney cancer surgical treatment and survival in Arizona. Cancer Med 2024; 13:e7007. [PMID: 38400688 PMCID: PMC10891465 DOI: 10.1002/cam4.7007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/21/2023] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Hispanics and American Indians (AI) have high kidney cancer incidence and mortality rates in Arizona. This study assessed: (1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability index (SVI) experience a longer time to surgery after clinical diagnosis, and (2) whether time to surgery, race and ethnicity, and SVI are associated with upstaging to pT3/pT4, disease-free survival (DFS), and overall survival (OS). METHODS Arizona Cancer Registry (2009-2018) kidney and renal pelvis cases (n = 4592) were analyzed using logistic regression models to assess longer time to surgery and upstaging. Cox-regression hazard models were used to test DFS and OS. RESULTS Hispanic and AI patients with T1 tumors had a longer time to surgery than non-Hispanic White patients (median time of 56, 55, and 45 days, respectively). Living in neighborhoods with high (≥75) overall SVI increased odds of a longer time to surgery for cT1a (OR 1.54, 95% CI: 1.02-2.31) and cT2 (OR 2.32, 95% CI: 1.13-4.73). Race and ethnicity were not associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3/pT4 (OR 1.95, 95% CI: 0.99-3.84). A longer time to surgery was associated with PFS (HR 1.52, 95% CI: 1.17-1.99) and OS (HR 1.63, 95% CI: 1.26-2.11). Among patients with cT2 tumor, living in high SVI neighborhoods was associated with worse OS (HR 1.66, 95% CI: 1.07-2.57). CONCLUSIONS High social vulnerability was associated with increased time to surgery and poor survival after surgery.
Collapse
Affiliation(s)
- Celina I. Valencia
- Department of Family and Community Medicine, College of Medicine – TucsonThe University of ArizonaTucsonArizonaUSA
| | - Patrick Wightman
- Center for Population Health SciencesThe University of ArizonaTucsonArizonaUSA
| | - Kristin E. Morrill
- Community and Systems Health Science Division, College of NursingThe University of ArizonaTucsonArizonaUSA
| | - Chiu‐Hsieh Hsu
- Department of Epidemiology and BiostatisticsThe University of ArizonaTucsonArizonaUSA
| | - Hina Arif‐Tiwari
- Department of Medical ImagingThe University of ArizonaTucsonArizonaUSA
| | - Eric Kauffman
- Department of UrologyRoswell Park Comprehensive Cancer CenterBuffaloNew YorkUSA
| | - Francine C. Gachupin
- Department of Family and Community Medicine, College of Medicine – TucsonThe University of ArizonaTucsonArizonaUSA
| | - Juan Chipollini
- Department of UrologyThe University of ArizonaTucsonArizonaUSA
| | - Benjamin R. Lee
- Department of UrologyThe University of ArizonaTucsonArizonaUSA
| | - David O. Garcia
- Department of Health Promotion SciencesThe University of ArizonaTucsonArizonaUSA
| | - Ken Batai
- Department of Cancer Prevention and ControlRoswell Park Comprehensive Cancer CenterBuffaloNew YorkUSA
| |
Collapse
|
13
|
Dong W, Kucmanic M, Winter J, Pronovost P, Rose J, Kim U, Koroukian SM, Hoehn R. Understanding Disparities in Receipt of Complex Gastrointestinal Cancer Surgery at a Small Geographic Scale. Ann Surg 2023; 278:e1103-e1109. [PMID: 36804445 PMCID: PMC10440364 DOI: 10.1097/sla.0000000000005828] [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: 02/23/2023]
Abstract
OBJECTIVE To define neighborhood-level disparities in the receipt of complex cancer surgery. BACKGROUND Little is known about the geographic variation of receipt of surgery among patients with complex gastrointestinal (GI) cancers, especially at a small geographic scale. METHODS This study included individuals diagnosed with 5 invasive, nonmetastatic, complex GI cancers (esophagus, stomach, pancreas, bile ducts, liver) from the Ohio Cancer Incidence Surveillance System during 2009 and 2018. To preserve patient privacy, we combined US census tracts into the smallest geographic areas that included a minimum number of surgery cases (n=11) using the Max-p-regions method and called these new areas "MaxTracts." Age-adjusted surgery rates were calculated for MaxTracts, and the Hot Spot analysis identified clusters of high and low surgery rates. US Census and CDC PLACES were used to compare neighborhood characteristics between the high- and low-surgery clusters. RESULTS This study included 33,091 individuals with complex GI cancers located in 1006 MaxTracts throughout Ohio. The proportion in each MaxTract receiving surgery ranged from 20.7% to 92.3% with a median (interquartile range) of 48.9% (42.4-56.3). Low-surgery clusters were mostly in urban cores and the Appalachian region, whereas high-surgery clusters were mostly in suburbs. Low-surgery clusters differed from high-surgery clusters in several ways, including higher rates of poverty (23% vs. 12%), fewer married households (40% vs. 50%), and more tobacco use (25% vs. 19%; all P <0.01). CONCLUSIONS This improved understanding of neighborhood-level variation in receipt of potentially curative surgery will guide future outreach and community-based interventions to reduce treatment disparities. Similar methods can be used to target other treatment phases and other cancers.
Collapse
Affiliation(s)
- Weichuan Dong
- Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Matthew Kucmanic
- Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA
| | - Jordan Winter
- Division of Surgical Oncology, University Hospitals, Cleveland, OH
| | - Peter Pronovost
- Department of Anesthesia and Critical Care Medicine, University Hospitals, Cleveland, OH
| | - Johnie Rose
- Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Uriel Kim
- Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH
- Kellogg School of Management, Northwestern University, Evanston, IL
| | - Siran M Koroukian
- Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Richard Hoehn
- Division of Surgical Oncology, University Hospitals, Cleveland, OH
| |
Collapse
|
14
|
Arasaratnam RJ, Chow TG, Liu AY, Khan DA, Blumenthal KG, Wurcel AG. Penicillin Allergy Evaluation and Health Equity: A Call to Action. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:422-428. [PMID: 36521831 DOI: 10.1016/j.jaip.2022.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
Allergists have been at the forefront of addressing the burden of unverified penicillin allergy labels. Coordinated national efforts with infectious diseases, antimicrobial stewardship experts, and pharmacy societies to advocate for formal evaluation of patient-reported penicillin allergy have resulted in improvements in delabeling efforts. Given the poorer health outcomes associated with the penicillin allergy label and the potential health benefits that can be gained with delabeling, improving access to penicillin allergy evaluation is of the utmost importance. Health disparities are widely recognized to impact all aspects of health care, and multilevel interventions at the patient, clinician, and systems level are required to ensure equitable care delivery. Structural racism underpins many social determinants of health and is a key driver of racial and ethnic health disparities. In this Rostrum, we use a conceptual framework from the 2015 National Academy of Medicine report Improving Diagnosis in Health Care to explore how inequities are related to the evaluation of penicillin allergy. We use the National Institute on Minority Health and Health Disparities Strategies to Advance Health Disparities to elucidate areas of important study. Building upon existing efforts to address disparities in Allergy/Immunology, we highlight the urgent importance of understanding and eliminating health disparities in penicillin allergy evaluation and delabeling.
Collapse
Affiliation(s)
- Reuben J Arasaratnam
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center and Veterans Affairs North Texas Health Care System, Dallas, Texas.
| | - Timothy G Chow
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anne Y Liu
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, and Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Alysse G Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Mass; Tufts University School of Medicine, Boston, Mass
| |
Collapse
|