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Cordeiro de Lima VC, Gelatti A, Moura JF, Fares AF, de Castro G, Mathias C, Terra RM, Werutsky G, Corassa M, Araújo LHL, Cronenberger E, Fujiki FK, Reichow S, da Silva AVT, Reis TV, Padoan MLA, Pacheco P, Yamamura R, Kawamura C, Mascarenhas E, de Jesus RG, Gössling G, Baldotto C. Health Services Access Inequalities in Brazil Result in Poorer Outcomes for Stage III NSCLC-RELANCE/LACOG 0118. JTO Clin Res Rep 2024; 5:100646. [PMID: 38434771 PMCID: PMC10906523 DOI: 10.1016/j.jtocrr.2024.100646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Stage III NSCLC is a heterogeneous disease, representing approximately one-third of newly diagnosed lung cancers. Brazil lacks detailed information regarding stage distribution, treatment patterns, survival, and prognostic variables in locally advanced NSCLC. Methods RELANCE/LACOG 0118 is an observational, retrospective cohort study assessing sociodemographic and clinical data of patients diagnosed with having stage III NSCLC from January 2015 to June 2019, regardless of treatment received. The study was conducted across 13 cancer centers in Brazil. Disease status and survival data were collected up to June 2021. Descriptive statistics, survival analyses, and a multivariable Cox regression model were performed. p values less than 0.05 were considered significant. Results We recruited 403 patients with stage III NSCLC. Most were male (64.0%), White (31.5%), and smokers or former smokers (86.1%). Most patients had public health insurance (67.5%), had stage IIIA disease (63.2%), and were treated with concurrent chemoradiation (53.1%). The median follow-up time was 33.83 months (95% confidence interval [CI]: 30.43-37.50). Median overall survival (OS) was 27.97 months (95% CI: 21.57-31.73), and median progression-free survival was 11.23 months (95% CI: 10.70-12.77). The type of treatment was independently associated with OS and progression-free survival, whereas the types of health insurance and histology were independent predictors of OS only. Conclusions Brazilian patients with stage III NSCLC with public health insurance are diagnosed later and have poorer OS. Nevertheless, patients with access to adequate treatment have outcomes similar to those reported in the pivotal trials. Health policy should be improved to make lung cancer diagnosis faster and guarantee prompt access to adequate treatment in Brazil.
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Affiliation(s)
| | - Ana Gelatti
- CPO - Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - José F.P. Moura
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Aline F. Fares
- FUNFARME - Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brazil
| | - Gilberto de Castro
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
- Hospital das Clínicas, Faculdade de Medicina - Universidade de São Paulo (USP), São Paulo, Brazil
| | - Clarissa Mathias
- NOB - Núcleo de Oncologia da Bahia (Oncoclínicas BA), Bahia, Brazil
- Hospital Santa Izabel, Salvador, Brazil
| | - Ricardo M. Terra
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | | | | | | | | | | | | | - Tércia V. Reis
- NOB - Núcleo de Oncologia da Bahia (Oncoclínicas BA), Bahia, Brazil
| | | | | | - Rosely Yamamura
- BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | | | | | | | - Gustavo Gössling
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
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Simone CB, Bradley J, Chen AB, Daly ME, Louie AV, Robinson CG, Videtic GMM, Rodrigues G. ASTRO Radiation Therapy Summary of the ASCO Guideline on Management of Stage III Non-Small Cell Lung Cancer. Pract Radiat Oncol 2023; 13:195-202. [PMID: 37080641 DOI: 10.1016/j.prro.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To develop a radiation therapy summary of recommendations on the management of locally advanced non-small cell lung cancer (NSCLC) based on the Management of Stage III Non-Small Cell Lung Cancer: American Society of Clinical Oncology Guideline, which was endorsed by the American Society for Radiation Oncology (ASTRO). METHODS The American Society of Clinical Oncology, ASTRO, and the American College of Chest Physicians convened a multidisciplinary panel to develop a guideline based on a systematic review of the literature and a formal consensus process, that has been separately published. A new panel consisting of radiation oncologists from the original guideline as well as additional ASTRO members was formed to provide further guidance to the radiation oncology community. A total of 127 articles met the eligibility criteria to answer 5 clinical questions. This summary focuses on the 3 radiation therapy questions (neoadjuvant, adjuvant, and unresectable settings). RESULTS Radiation-specific recommendations are summarized with additional relevant commentary on specific questions regarding the management of preoperative radiation, postoperative radiation, and combined chemoradiation. CONCLUSIONS Patients with stage III NSCLC who are planned for surgical resection, should receive either neoadjuvant chemotherapy or chemoradiation. The addition of neoadjuvant treatment is particularly important in patients planned for surgery in the N2 or superior sulcus settings. Postoperatively, patients who did not receive neoadjuvant chemotherapy should be offered adjuvant chemotherapy. The use of postoperative radiation for completely resected N2 disease is not routinely recommended. Unresectable patients with stage III NSCLC should ideally be managed with combined concurrent chemoradiation using a platinum-based doublet with a standard radiation dose of 60 Gy followed by consolidation durvalumab in patients without progression after initial therapy. Patients who cannot tolerate a concurrent chemoradiation approach can be managed either by sequential chemotherapy followed by radiation or by dose-escalated or hypofractionated radiation alone.
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Affiliation(s)
- Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - Jeffrey Bradley
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Aileen B Chen
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Gregory M M Videtic
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - George Rodrigues
- Department of Radiation Oncology, London Health Sciences Cancer, London, Ontario, Canada.
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Hasan S, Lazarev S, Garg M, Mehta K, Press RH, Chhabra A, Choi JI, Simone CB, Gorovets D. Racial inequity and other social disparities in the diagnosis and management of bladder cancer. Cancer Med 2023; 12:640-650. [PMID: 35674112 PMCID: PMC9844648 DOI: 10.1002/cam4.4917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/28/2022] [Accepted: 05/04/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND We investigate the impact of gender, race, and socioeconomic status on the diagnosis and management of bladder cancer in the United States. METHODS We utilized the National Cancer Database to stratify cases of urothelial cell carcinoma of the bladder as early (Tis, Ta, T1), muscle invasive (T2-T3, N0), locally advanced (T4, N1-3), and metastatic. Multivariate binomial and multinomial logistic regression analyses identified demographic characteristics associated with stage at diagnosis and receipt of cancer-directed therapies. Odds ratios (OR) are reported with 95% confidence intervals. RESULTS After exclusions, we identified 331,714 early, 72,154 muscle invasive, 15,579 locally advanced, and 15,161 metastatic cases from 2004-2016. Relative to diagnosis at early stage, the strongest independent predictors of diagnosis at muscle invasive, locally advanced, and metastatic disease included Black race (OR = 1.19 [1.15-1.23], OR = 1.49 [1.40-1.59], OR = 1.66 [1.56-1.76], respectively), female gender (OR = 1.21 [1.18-1.21], OR = 1.16 [1.12-1.20], and OR = 1.34 [1.29-1.38], respectively), and uninsured status (OR = 1.22 [1.15-1.29], OR = 2.09 [1.94-2.25], OR = 2.57 [2.39-2.75], respectively). Additional demographic factors associated with delayed diagnosis included older age, treatment at an academic center, Medicaid insurance and patients from lower income/less educated/more rural areas (all p < 0.01). Treatment at a non-academic center, older age, women, Hispanic and Black patients, lower income and rural areas were all less likely to receive cancer-directed therapies in early stage disease (all p < 0.01). Women, older patients, and Black patients remained less likely to receive treatment in muscle invasive, locally advanced, and metastatic disease (all p < 0.01). CONCLUSION Black race was the strongest independent predictor of delayed diagnosis and substandard treatment of bladder cancer.
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Affiliation(s)
- Shaakir Hasan
- The New York Proton CenterNew YorkNew YorkUSA
- Montefiore Medical Center, Department of Radiation OncologyBronxNew YorkUSA
| | - Stanislav Lazarev
- Mount Sinai Medical Center, Department of Radiation OncologyNew YorkNew YorkUSA
| | - Madhur Garg
- Montefiore Medical Center, Department of Radiation OncologyBronxNew YorkUSA
| | - Keyur Mehta
- Montefiore Medical Center, Department of Radiation OncologyBronxNew YorkUSA
| | - Robert H. Press
- The New York Proton CenterNew YorkNew YorkUSA
- Mount Sinai Medical Center, Department of Radiation OncologyNew YorkNew YorkUSA
| | | | - J. Isabelle Choi
- The New York Proton CenterNew YorkNew YorkUSA
- Memorial Sloan Kettering Cancer Center, Department of Radiation OncologyNew YorkNew YorkUSA
| | - Charles B. Simone
- The New York Proton CenterNew YorkNew YorkUSA
- Memorial Sloan Kettering Cancer Center, Department of Radiation OncologyNew YorkNew YorkUSA
| | - Daniel Gorovets
- Memorial Sloan Kettering Cancer Center, Department of Radiation OncologyNew YorkNew YorkUSA
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Owen GS, Sullivan GA, Skertich NJ, Pillai S, Madonna MB, Shah AN, Gulack BC. Long-Term Recurrence Risk Following Pleurectomy or Pleurodesis for Primary Spontaneous Pneumothorax. J Surg Res 2022; 278:132-139. [DOI: 10.1016/j.jss.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/18/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
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Guirado M, Fernández Martín E, Fernández Villar A, Navarro Martín A, Sánchez-Hernández A. Clinical impact of delays in the management of lung cancer patients in the last decade: systematic review. Clin Transl Oncol 2022. [PMID: 35257298 DOI: 10.1007/s12094-022-02796-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/24/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Due to the importance of lung cancer early treatment because of its severity and extent worldwide a systematic literature review was conducted about the impact of delays in waiting times on the disease prognosis. MATERIALS AND METHODS We conducted a systematic search of observational studies (2010-2020) including adult patients diagnosed with lung cancer and reporting healthcare timelines and their clinical consequences. RESULTS We included 38 articles containing data on waiting times and prognosis; only 31 articles linked this forecast to a specific waiting time. We identified 41 healthcare time intervals and found medians of 6-121 days from diagnosis to treatment and 4-19.5 days from primary care to specialist visit: 37.5% of the intervals indicated better prognosis with longer waiting times. CONCLUSIONS All articles emphasized that waiting times must be reduced to achieve good management and prognosis of lung cancer. Further prospective studies are needed on the relationship between waiting times and prognosis of lung cancer.
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Wu J, Liu C, Wang F. Disparities in Hepatocellular Carcinoma Survival by Insurance Status: A Population-Based Study in China. Front Public Health 2021; 9:742355. [PMID: 34805067 PMCID: PMC8602862 DOI: 10.3389/fpubh.2021.742355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/29/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: Health disparities related to basic medical insurance in China have not been sufficiently examined, particularly among patients with hepatocellular carcinoma (HCC). This study aims to investigate the disparities in HCC survival by insurance status in Tianjin, China. Methods: This retrospective analysis used data from the Tianjin Basic Medical Insurance claims database, which consists of enrollees covered by Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Resident Basic Medical Insurance (URRBMI). Adult patients newly diagnosed with HCC between 2011 and 2016 were identified and followed until death from any cause, withdrawal from UEBMI or URRBMI, or the latest data in the dataset (censoring as of December 31st 2017), whichever occurred first. Patients' overall survival during the follow-up was assessed using Kaplan-Meier and extrapolated by six parametric models. The hazard ratio (HR) and 95% confidence intervals (CI) were calculated with the adjusted Cox proportional hazards model including age at diagnosis, sex, baseline comorbidities and complications, baseline healthcare resources utilization and medical costs, tumor metastasis at diagnosis, the initial treatment after diagnosis and antiviral therapy during the follow-up. Results: Two thousand sixty eight patients covered by UEBMI (N = 1,468) and URRBMI (N = 570) were included (mean age: 60.6 vs. 60.9, p = 0.667; female: 31.8 vs. 27.7%, p = 0.074). The median survival time for patients within the UEBMI and URRBMI were 37.8 and 12.2 months, and the 1-, 3-, 5-, 10-year overall survival rates were 63.8, 50.2, 51.0, 33.4, and 44.4, 22.8, 31.5, 13.1%, respectively. Compared with UEBMI, patients covered by URRBMI had 72% (HR: 1.72; 95% CI: 1.47–2.00) higher risk of death after adjustments for measured confounders above. The survival difference was still statistically significant (HR: 1.49; 95% CI: 1.21–1.83) in sensitivity analysis based on propensity score matching. Conclusions: This study reveals that HCC patients covered by URRBMI may have worse survival than patients covered by UEBMI. Further efforts are warranted to understand healthcare disparities for patients covered by different basic medical insurance in China.
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Affiliation(s)
- Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.,Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Chengyu Liu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.,Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Fengmei Wang
- The Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin, China
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Alpert N, van Gerwen M, Steinberg M, Ohri N, Flores R, Taioli E. Racial Disparities in Treatment Patterns and Survival Among Surgically Treated Malignant Pleural Mesothelioma Patients. J Immigr Minor Health 2020; 22:1163-71. [PMID: 32529589 DOI: 10.1007/s10903-020-01038-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Surgery may improve survival in malignant pleural mesothelioma (MPM) patients. We examined treatment and survival in black and white surgical MPM patients using the National Cancer Database (NCDB). Among patients with pleurectomy/decortication (PD) or extrapleural pneumonectomy (EPP), multivariable logistic regressions were used to evaluate racial differences in surgical extent, additional treatment, and 30-/90-day mortality. Multivariable and propensity matched models were used to assess differences in survival. We identified 2550 patients; 2462 white (96.5%), 88 black (3.5%). Black patients were significantly less likely to receive EPP (ORadj 0.36, 95% CI 0.17-0.78) and trended towards worse 30-/90-day mortality (ORadj 1.54, 95% CI 0.59-4.03; ORadj 1.59, 95% CI 0.80-3.17, respectively). There was no difference in survival (HRadj 0.94, 95% CI 0.71-1.25). Surgery conferred a survival benefit (HRadj 0.77, 95% CI 0.73-0.82), but it varied by race (HRadj[white] 0.76, 95% CI 0.72-0.81; HRadj[black] 0.93, 95% CI 0.67-1.29). With the limitation of a small proportion of surgically resected black MPM patients in this population-based analysis, black patients were noted to undergo less extensive surgery. Although there was an overall survival benefit noted with surgery, this was not consistent across races, despite trends towards worse short-term mortality in black patients.
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