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Khan MMM, Munir MM, Thammachack R, Endo Y, Altaf A, Woldesenbet S, Rashid Z, Khalil M, Dillhoff M, Tsai S, Pawlik TM. Association of county-level provider density with hepatobiliary cancer incidence and mortality. World J Surg 2024; 48:2243-2252. [PMID: 39148145 DOI: 10.1002/wjs.12316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Access to healthcare providers is a key factor in reducing cancer incidence and mortality, underscoring the significance of provider density as a crucial metric of health quality. We sought to characterize the association of provider density on hepatobiliary cancer population-level incidence and mortality. STUDY DESIGN County-level hepatobiliary cancer incidence and mortality data from 2016 to 2020 and provider data from 2016 to 2018 were obtained from the CDC and Area Health Resource File. Multivariable logistic regression was utilized to evaluate the relationship between provider density and hepatobiliary cancer incidence and mortality. RESULTS Among 1359 counties, 851 (62.6%) and 508 (37.4%) counties were categorized as urban and rural, respectively. The median number of providers in any given county was 104 (IQR: 44-306), while provider density was 120.1 (IQR: 86.7-172.2) per 100,000 population; median household income was $51,928 (IQR: $45,050-$61,655). Low provider-density counties were more likely to have a greater proportion of residents over 65 years of age (52.7% vs. 49.6%) who were uninsured (17.4% vs. 13.2%) versus higher provider-density counties (p < 0.05). Moreover, all-stage incidence, late-stage incidence, and mortality rates were higher in counties with low provider density. On multivariable analysis, moderate, and high provider density were associated with lower odds of all-stage incidence, late-stage incidence, and mortality. CONCLUSION Higher county-level provider density was associated with lower hepatobiliary cancer-related incidence and mortality. Efforts to increase access to healthcare providers may improve healthcare equity as well as long-term cancer outcomes.
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Affiliation(s)
- Muhammad Muntazir Mehdi Khan
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Muhammad Musaab Munir
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Razeen Thammachack
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Yutaka Endo
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Abdullah Altaf
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Zayed Rashid
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mujtaba Khalil
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mary Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Susan Tsai
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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Khan MMM, Munir MM, Khalil M, Tsilimigras DI, Woldesenbet S, Endo Y, Katayama E, Rashid Z, Cunningham L, Kaladay M, Pawlik TM. Association of county-level provider density and social vulnerability with colorectal cancer-related mortality. Surgery 2024; 176:44-50. [PMID: 38729889 DOI: 10.1016/j.surg.2024.03.035] [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: 01/04/2024] [Revised: 02/15/2024] [Accepted: 03/21/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Health care providers play a crucial role in increasing overall awareness, screening, and treatment of cancer, leading to reduced cancer mortality. We sought to characterize the impact of provider density on colorectal cancer population-level mortality. METHODS County-level provider data, obtained from the Area Health Resource File between 2016 and 2018, were used to calculate provider density per county. These data were merged with county-level colorectal cancer mortality 2016-2020 data from the Centers for Disease Control and Prevention. Multivariable regression was performed to define the association between provider density and colorectal cancer mortality. RESULTS Among 2,863 counties included in the analytic cohort, 1,132 (39.5%) and 1,731 (60.5%) counties were categorized as urban and rural, respectively. The colorectal cancer-related crude mortality rate was higher in counties with low provider density versus counties with moderate or high provider density (low = 22.9, moderate = 21.6, high = 19.3 per 100,000 individuals; P < .001). On multivariable analysis, the odds of colorectal cancer mortality were lower in counties with moderate and high provider density versus counties with low provider density (moderate odds ratio 0.97, 95% confidence interval 0.94-0.99; high odds ratio 0.88, 95% confidence interval 0.86-0.91). High provider density remained associated with a lower likelihood of colorectal cancer mortality independent of social vulnerability index (low social vulnerability index and high provider density: odds ratio 0.85, 95% confidence interval 0.81-0.89; high social vulnerability index and high provider density: odds ratio 0.93, 95% confidence interval 0.89-0.98). CONCLUSION Regardless of social vulnerability index, high county-level provider density was associated with lower colorectal cancer-related mortality. Efforts to increase access to health care providers may improve health care equity, as well as long-term cancer outcomes.
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Affiliation(s)
- Muhammad Muntazir Mehdi Khan
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Muhammad Musaab Munir
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Mujtaba Khalil
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Selamawit Woldesenbet
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Yutaka Endo
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Erryk Katayama
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Zayed Rashid
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Lisa Cunningham
- Department of Surgery, Division of Colorectal Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Matthew Kaladay
- Department of Surgery, Division of Colorectal Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
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Papachristou P, Söderholm M, Pallon J, Taloyan M, Polesie S, Paoli J, Anderson CD, Falk M. Evaluation of an artificial intelligence-based decision support for the detection of cutaneous melanoma in primary care: a prospective real-life clinical trial. Br J Dermatol 2024; 191:125-133. [PMID: 38234043 DOI: 10.1093/bjd/ljae021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Use of artificial intelligence (AI), or machine learning, to assess dermoscopic images of skin lesions to detect melanoma has, in several retrospective studies, shown high levels of diagnostic accuracy on par with - or even outperforming - experienced dermatologists. However, the enthusiasm around these algorithms has not yet been matched by prospective clinical trials performed in authentic clinical settings. In several European countries, including Sweden, the initial clinical assessment of suspected skin cancer is principally conducted in the primary healthcare setting by primary care physicians, with or without access to teledermoscopic support from dermatology clinics. OBJECTIVES To determine the diagnostic performance of an AI-based clinical decision support tool for cutaneous melanoma detection, operated by a smartphone application (app), when used prospectively by primary care physicians to assess skin lesions of concern due to some degree of melanoma suspicion. METHODS This prospective multicentre clinical trial was conducted at 36 primary care centres in Sweden. Physicians used the smartphone app on skin lesions of concern by photographing them dermoscopically, which resulted in a dichotomous decision support text regarding evidence for melanoma. Regardless of the app outcome, all lesions underwent standard diagnostic procedures (surgical excision or referral to a dermatologist). After investigations were complete, lesion diagnoses were collected from the patients' medical records and compared with the app's outcome and other lesion data. RESULTS In total, 253 lesions of concern in 228 patients were included, of which 21 proved to be melanomas, with 11 thin invasive melanomas and 10 melanomas in situ. The app's accuracy in identifying melanomas was reflected in an area under the receiver operating characteristic (AUROC) curve of 0.960 [95% confidence interval (CI) 0.928-0.980], corresponding to a maximum sensitivity and specificity of 95.2% and 84.5%, respectively. For invasive melanomas alone, the AUROC was 0.988 (95% CI 0.965-0.997), corresponding to a maximum sensitivity and specificity of 100% and 92.6%, respectively. CONCLUSIONS The clinical decision support tool evaluated in this investigation showed high diagnostic accuracy when used prospectively in primary care patients, which could add significant clinical value for primary care physicians assessing skin lesions for melanoma.
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Affiliation(s)
- Panagiotis Papachristou
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Atrium Healthcare Centre, Region Stockholm, Sweden
| | - My Söderholm
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Ekholmen Primary Healthcare Centre, Region Östergötland, Linköping, Sweden
| | - Jon Pallon
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Marina Taloyan
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Atrium Healthcare Centre, Region Stockholm, Sweden
| | - Sam Polesie
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Paoli
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Chris D Anderson
- Department of Biomedical and Clinical Sciences, Division of Dermatology and Venereology, Linköping University, Linköping, Sweden
| | - Magnus Falk
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Region Östergötland, Kärna Primary Healthcare Centre, Linköping, Sweden
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Cortez JL, Fadadu RP, Konda S, Grimes B, Wei ML. Disparities in access for melanoma screening by region, specialty, and insurance: A cross-sectional audit study. JAAD Int 2022; 7:78-85. [PMID: 35373156 PMCID: PMC8968658 DOI: 10.1016/j.jdin.2022.02.008] [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] [Indexed: 11/25/2022] Open
Abstract
Background Early detection of melanoma is critical for positive outcomes. However, access for the diagnosis of melanoma remains problematic for segments of the general population. Objective To compare the rates of dermatology and family medicine practitioner acceptances for a public insurance (Medicaid) versus private insurance (Anthem Blue Cross) and clinic wait times for an appointment for a changing pigmented skin lesion concerning melanoma in rural and urban regions in California. Methods Cross-sectional audit study between June 2017 and March 2019; scripted phone calls were made to dermatology and family medicine practices (FMPs). Results Family medicine and dermatology practices in both regions had significantly decreased acceptance of Medicaid. Dermatology practices had 11.3% to 13.0% Medicaid acceptance rates that were less than FMP rates of 28% to 36%. In both regions, FMP wait times were 2.4- to 3.2-fold longer for public versus private insurance; there were little differences in wait times for the 2 insurance types in dermatology practices, in both regions. Limitations Assessment of only 2 regions in the state of California. Conclusion Delays at FMPs and insurance types limit access to melanoma screening in California for underserved segments of the general population, which has implications for melanoma outcomes and health policy.
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Affiliation(s)
- Jose Luis Cortez
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico.,Department of Dermatology, University of California, San Francisco, California.,Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Raj P Fadadu
- Department of Dermatology, University of California, San Francisco, California.,Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sailesh Konda
- Department of Dermatology, University of Florida, Gainesville, Florida
| | - Barbara Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, California.,Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
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5
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Lee JH, Shewale AR, Barthold D, Devine B. Geographic variation in the use of triptans and opioids for the acute treatment of migraine attacks. Headache 2021; 61:1499-1510. [PMID: 34841520 DOI: 10.1111/head.14238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the geographic variations in triptan and opioid prescribing patterns for patients with migraine. BACKGROUND Numerous guidelines recommend triptans as the standard of care for migraine attacks, yet opioids are still widely used for migraine treatment. Variation in the use of opioids and triptans for the treatment of migraine by geographic location is not well known. METHODS Using a US claims database, we conducted a retrospective cohort study of adults diagnosed with migraine between 2016 and 2018. We used a 12-month follow-up period to assess triptan and opioid utilization, stratified by the nine Census Bureau-designated divisions. To examine the geographic factors that affect triptan and opioid use among patients, we conducted two sets of multivariable analyses. First, we analyzed the odds of a patient being a triptan or opioid user in the follow-up period, defined as ≥1 triptan or opioid claim. We then analyzed the medication use rate among triptan or opioid users. RESULTS Overall, we had a final study population of 113,921 patients. In the follow-up period, 52.9% (60,247/113,921) [range: 48.0%-56.3%] of patients were triptan users and 41.0% (46,708/113,921) [range: 28.9%-48.4%] of patients were opioid users with significant differences across census divisions (p < 0.001). Triptan users had a mean (SD) of 4.8 (4.7) triptan claims annually with no significant differences across divisions (p = 0.188). Opioid users had a mean (SD) of 5.4 (6.8) opioid claims annually with significant differences across divisions (p < 0.001). The observed variation in opioid use stemmed from the proportion of patients using opioids in each region and not from the number of opioid prescriptions per user. CONCLUSIONS There was a significant geographic variation in the use of opioids and to a lesser degree the use of triptans. The widespread use of opioids and the large variation in use other than triptans as the standard of care suggest that improvements could be made in the acute treatment of migraine attacks.
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Affiliation(s)
- Jae Hyun Lee
- Health Economics and Outcomes Research (HEOR) Strategy, AbbVie, Irvine, California, USA.,The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Anand R Shewale
- Health Economics and Outcomes Research (HEOR) Strategy, AbbVie, Irvine, California, USA
| | - Douglas Barthold
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
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Mehta B, Brantner C, Williams N, Szymonifka J, Navarro-Millan I, Mandl LA, Bass AR, Russell LA, Parks ML, Figgie MP, Nguyen JT, Ibrahim S, Goodman SM. Primary Care Provider Density and Elective Total Joint Replacement Outcomes. Arthroplast Today 2021; 10:73-78. [PMID: 34527799 PMCID: PMC8430425 DOI: 10.1016/j.artd.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/29/2021] [Accepted: 05/15/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Primary care physicians (PCPs) are often gatekeepers to specialist care. This study assessed the relationship between PCP density and total knee (TKA) and total hip arthroplasty (THA) outcomes. METHODS We obtained patient-level data from an institutional registry on patients undergoing elective primary TKA and THA for osteoarthritis, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at baseline and 2 years. Using geocoding, we identified the number of PCPs in the patient's census tract (communities). We used Augmented Inverse Probability Weighting and Cross-validated Targeted Minimum Loss-Based Estimation to compare provider density and outcomes adjusting for potential confounders. RESULTS Our sample included 3606 TKA and 4295 THA cases. The median number of PCPs in each community was similar for both procedures: TKA 2 (interquartile range 1, 6) and for THA 2 (interquartile range 1, 7). Baseline and 2-year follow-up WOMAC pain, function, and stiffness scores were not statistically significantly different comparing communities with more than median number of PCPs to those with less than median number of PCPs. In sensitivity analyses, adding 1 PCP to a community with zero PCPs would not have statistically significantly improved baseline or 2-year follow-up WOMAC pain, function, and stiffness scores. CONCLUSIONS In this sample of patients who underwent elective TKA or THA for osteoarthritis, we found no statistically significant association between PCP density and pain, function, or stiffness outcomes at baseline or 2 years. Further studies should examine what other provider factors affect access and outcomes in THA and TKA.
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Affiliation(s)
- Bella Mehta
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Collin Brantner
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Nicholas Williams
- Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Jackie Szymonifka
- Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Iris Navarro-Millan
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lisa A. Mandl
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Anne R. Bass
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Linda A. Russell
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael L. Parks
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Mark P. Figgie
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Joseph T. Nguyen
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Said Ibrahim
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Susan M. Goodman
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Shah P, Shao Y, Geller AC, Polsky D. Late-Stage Melanoma in New York State: Associations with Socioeconomic Factors and Healthcare Access at the County Level. J Invest Dermatol 2021; 141:1699-1706.e7. [PMID: 33516743 DOI: 10.1016/j.jid.2020.12.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/24/2020] [Accepted: 12/11/2020] [Indexed: 12/26/2022]
Abstract
A diagnosis of late-stage melanoma is associated with significant mortality. From a public health perspective, the knowledge of geographic disparities in late-stage diagnoses can inform efforts to facilitate the diagnosis of the earlier stage, highly curable melanomas. We conducted a county-level analysis of melanoma in New York state to identify communities that may benefit from pilot health interventions to reduce the burden of late-stage melanoma. From 1995 to 2016, late-stage melanoma incidence increased from 1.5 to 2.8 cases per 100,000 in New York state. We found statistically significant associations between decreased county-level health system access (including physician density and resident educational status) and increased county incidence and proportion of late-stage disease among diagnosed cases (P < 0.001 for both). Increased county-level socioeconomic status, including measures of resident wealth and medical insurance status, was positively associated with greater late-stage incidence (P < 0.001). However, decreased county-level socioeconomic status was positively associated with a greater proportion of late-stage disease among cases at diagnosis (P = 0.009). Counties with reduced access to physician services and lower socioeconomic status may be suitable for pilot interventions promoting the recognition and diagnosis of early-stage melanomas to reduce late-stage diagnoses and associated mortality.
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Affiliation(s)
- Payal Shah
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Department of Environmental Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David Polsky
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA; Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA.
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8
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[Prevalence of dermatological diseases in Primary Care]. Semergen 2021; 47:434-440. [PMID: 34088599 DOI: 10.1016/j.semerg.2021.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/28/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To guide the training of Primary Care physicians in the most prevalent and relevant skin pathologies, it is necessary to study their prevalence in the Primary Care consultation and describe their characteristics. MATERIALS AND METHODS Observational cross-sectional study. It took place at the Porriño Health Center (Pontevedra, Spain). A total of 305 patients of the same quota participated, recruited in consultation during 41days between September 2018 and February 2019, selected by systematic sampling coinciding with those mentioned at the hour between 9 and 13hours and, failing that, we selected the next of those mentioned. The variables were analyzed: age, sex, educational and economic level, diagnostic means, previous diagnosis of dermatological disease, treatment, follow-up and relationship with systemic diseases. The statistical analysis performed was descriptive and bivariate by sex with chi-square and Fisher's exact tests. RESULTS 161 women and 144 men participated, age and number of consultations being non-parametric. Median age was 59years (IQR: 42-69), with no significant differences between sexes. 69.83% (95%CI: 64.46-74.71) present between 1 and 5 types of skin lesions grouped in 33 different diagnoses. The 15 most frequent pathologies account for 77.35% (95%CI: 75.80-84.48) of diagnoses. As the most relevant pathologies, we observed two basal cell carcinomas and one squamous cell carcinoma (0.98%; 95%CI: 0.34-2.85). CONCLUSIONS Dermatological diseases have a high prevalence in Primary Care.
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Kandolf-Sekulovic L, Peris K, Stratigos A, Hauschild A, Forsea AM, Lebbe C, Lallas A, Grob JJ, Harwood C, Gogas H, Rutkowski P, Olah J, Kelleners-Smeets NWJ, Paoli J, Dummer R, Moreno-Ramirez D, Bastholt L, Putnik K, Karls R, Hoeller C, Vandersleyen V, Vieira R, Arenberger P, Bylaite-Buckinskiene M, Ocvirk J, Situm M, Weinlich G, Banjin M, Todorovic V, Ymeri A, Zhukavets A, Garbe C. Which medical disciplines diagnose and treat melanoma in Europe in 2019? A survey of experts from melanoma centres in 27 European countries. J Eur Acad Dermatol Venereol 2020; 35:1119-1132. [PMID: 33326646 DOI: 10.1111/jdv.17086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The incidence of melanoma is increasing. This places significant burden on societies to provide efficient cancer care. The European Cancer Organisation recently published the essential requirements for quality melanoma care. The present study is aimed for the first time to roughly estimate the extent to which these requirements have been met in Europe. MATERIALS AND METHODS A web-based survey of experts from melanoma centres in 27 European countries was conducted from 1 February to 1 August 2019. Data on diagnostic techniques, surgical and medical treatment, organization of cancer care and education were collected and correlated with national health and economic indicators and mortality-to-incidence ratio (MIR) as a surrogate for survival. Univariate linear regression analysis was performed to evaluate the correlations. SPSS software was used. Statistical significance was set at P < 0.05. RESULTS The MIR was lower in countries with a high health expenditure per capita and with a higher numbers of general practitioners (GPs) and surgeons (SURG) per million inhabitants. In these countries, GPs and dermatologists (DER) were involved in melanoma detection; high percentage of DER used dermatoscopy and were involved in the follow-up of all melanoma stages; both medical oncologists (ONC) and dermato-oncologists administered systemic treatments; and patients had better access to sentinel lymph node biopsy and were treated within multidisciplinary tumour boards. CONCLUSION Based on these first estimates, the greater involvement of GPs in melanoma detection; the greater involvement of highly trained DER in dermatoscopy, dermatosurgery, follow-up and the systemic treatment of melanoma; and the provision of ongoing dermato-oncology training for pathologists, SURG, DER and ONC are necessary to provide an optimal melanoma care pathway. A comprehensive analysis of the melanoma care pathway based on clinical melanoma registries will be needed to more accurately evaluate these first insights.
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Affiliation(s)
- L Kandolf-Sekulovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - K Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - A Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - A-M Forsea
- Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - C Lebbe
- APHP Dermatology Department, University Paris 7 Diderot, INSERM U976, Paris, France
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - J-J Grob
- Service de Dermatologie et Cancérologie Cutanée, Hopital de la Timone, Marseille, France
| | - C Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - H Gogas
- 1st Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - P Rutkowski
- Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - J Olah
- Department of Oncotherapy, Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - N W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - R Dummer
- UniversitätsSpital Zürich-Skin Cancer Center, University Hospital, Zürich, Switzerland
| | - D Moreno-Ramirez
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - L Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - K Putnik
- North Estonia Medical Centre, Tallinn, Estonia
| | - R Karls
- Derma Clinic Riga, Riga, Latvia
| | - C Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - V Vandersleyen
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - R Vieira
- Department of Dermatology, Medical Faculty, University of Coimbra, Coimbra, Portugal
| | - P Arenberger
- Department of Dermatovenereology, Charles University 3rd Faculty of Medicine and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | - J Ocvirk
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - M Situm
- Department of Oncology, University Hospital Zagreb, Zagreb, Croatia
| | - G Weinlich
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Banjin
- Department of Oncology, University Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - V Todorovic
- Clinic for Oncology and radiotherapy, Podgorica, Montenegro
| | - A Ymeri
- University Hospital Mother Theresa, Tirana, Albania
| | - A Zhukavets
- Belarusian Medical Academy of Postgraduate Education (BelMAPE), Minsk, Belarus
| | - C Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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10
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Spada NG, Geramita EM, Zamanian M, van Londen GJ, Sun Z, Sabik LM. Changes in Disparities in Stage of Breast Cancer Diagnosis in Pennsylvania After the Affordable Care Act. J Womens Health (Larchmt) 2020; 30:324-331. [PMID: 32986501 DOI: 10.1089/jwh.2020.8478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: This study sought to determine if increased access to health insurance following the Affordable Care Act (ACA) resulted in an increased proportion of early-stage breast cancer diagnosis among women in Pennsylvania, particularly minorities, rural residents, and those of lower socioeconomic status. Materials and Methods: Data on 35,735 breast cancer cases among women 50-64 and 68-74 years of age in Pennsylvania between 2010 and 2016 were extracted from the Pennsylvania Cancer Registry and analyzed in 2019. Women 50-64 years of age were subdivided by race/ethnicity, area of residence, and socioeconomic status as measured by area deprivation index (ADI). We compared the proportions of early-stage breast cancer diagnosis pre-ACA (2010-2013) and post-ACA (2014-2016) for all women 50-64 years of age to all women 68-74 years of age. This comparison was also made between paired sociodemographic subgroups for women 50-64 years of age. Multivariable logistic regression models were constructed to assess how race, area of residence, ADI, and primary care physician (PCP) density interacted to impact breast cancer diagnosis post-ACA. Results: The proportion of early-stage breast cancer diagnosis increased by 1.71% post-ACA among women 50-64 years of age (p < 0.01), whereas women 68-74 years of age saw no change. Multivariable logistic regression analysis demonstrated that minority women had lower odds of early-stage breast cancer diagnosis pre-ACA, but not post-ACA, when controlling for ADI. Meanwhile, increased area-level socioeconomic advantage was associated with higher odds of being diagnosed with early-stage breast cancer pre- and post-ACA irrespective of controlling for race, area of residence, or PCP density. Conclusions: Enhanced access to health insurance under the ACA was associated with an increased proportion of early-stage breast cancer diagnosis in Pennsylvanian women 50-64 years of age and may have reduced racial, but not socioeconomic, disparities in breast cancer diagnosis.
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Affiliation(s)
- Neal G Spada
- Department of Medicine and University of Pittsburgh, Pennsylvania, USA
| | - Emily M Geramita
- Department of Medicine and University of Pittsburgh, Pennsylvania, USA
| | - Maryam Zamanian
- Department of Medicine and University of Pittsburgh, Pennsylvania, USA
| | - G J van Londen
- Department of Medicine and University of Pittsburgh, Pennsylvania, USA
| | - Zhaojun Sun
- Department of Health Policy and Management, University of Pittsburgh, Pennsylvania, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh, Pennsylvania, USA
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11
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Cortez JL, Vasquez J, Wei ML. The impact of demographics, socioeconomics, and health care access on melanoma outcomes. J Am Acad Dermatol 2020; 84:1677-1683. [PMID: 32783908 DOI: 10.1016/j.jaad.2020.07.125] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022]
Abstract
Disparities in melanoma care exist in the United States. Disparities in provider type, patient demographics, place of residence, insurance status, socioeconomic status, race/ethnicity, and age impact melanoma outcomes. Melanomas detected by dermatologists are thinner, at an earlier stage, and have better survival outcomes compared with detection by primary care providers or patients. Lower socioeconomic status, race/ethnicity, and place of residence are associated with decreased access to or use of dermatologists, or both, and more advanced melanomas at diagnosis. Additionally, uninsured and publicly insured individuals are more likely to present with late-stage melanomas, resulting in worse outcomes. This review provides a comprehensive overview of how structural and patient-level characteristics influence melanoma outcomes in order to inform clinical care and health care policy as it relates to addressing gaps in melanoma care.
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Affiliation(s)
- Jose L Cortez
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Juan Vasquez
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California; University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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12
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Miller R, Walker S, Shui I, Brandtmüller A, Cadwell K, Scherrer E. Epidemiology and survival outcomes in stages II and III cutaneous melanoma: a systematic review. Melanoma Manag 2020; 7:MMT39. [PMID: 32399177 PMCID: PMC7212505 DOI: 10.2217/mmt-2019-0022] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim Management of cutaneous melanoma (CM) is continually evolving with adjuvant treatment of earlier stage disease. The aim of this review was to identify published epidemiological data for stages II-III CM. Materials & methods Systematic searches of Medline and Embase were conducted to identify literature reporting country/region-specific incidence, prevalence, survival or mortality outcomes in stage II and/or III CM. Screening was carried out by two independent reviewers. Results & conclusion Of 41 publications, 14 described incidence outcomes (incidence rates per stage were only reported for US and Swedish studies), 33 reported survival or mortality outcomes and none reported prevalence data. This review summarizes relevant data from published literature and highlights an overall paucity of epidemiological data in stages II and III CM.
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Affiliation(s)
- Rachael Miller
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
| | - Sophie Walker
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
| | - Irene Shui
- Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | | | - Kevin Cadwell
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
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13
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Zhang S, McClanahan D, Khosravi H, Ferris LK. Screening and Managing Melanoma: Who Is (Should Be) Doing It? CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-00268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Becevic M. USPSTF: Skin Cancer Screening Recommendations. MISSOURI MEDICINE 2018; 115:517. [PMID: 30643340 PMCID: PMC6312178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Mirna Becevic
- Show-Me ECHO Missouri Telehealth Network, University of Missouri, Columbia, Missouri. Jonathan Dyer, MD, Pediatric Dermatology, MSMA Member since 2006 and Karen Edison, MD, Dermatolgical Cancer/Disease, MSMA Member since 1991 at the University of Missouri Department of Dermatology Columbia, Missouri
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