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Patel TA, Jain B, Vapiwala N, Chino F, Tringale KR, Mahal BA, Yamoah K, McBride SN, Lam MB, Hubbard A, Nguyen PL, Dee EC. Trends in Utilization and Medicare Spending on Short-Course Radiation Therapy for Breast and Prostate Cancer: An Episode-Based Analysis From 2015 to 2019. Int J Radiat Oncol Biol Phys 2024; 119:17-22. [PMID: 38072324 DOI: 10.1016/j.ijrobp.2023.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE Evidence supports the value of shorter, similarly efficacious, and potentially more cost-effective hypofractionated radiation therapy (RT) regimens in many clinical scenarios for breast cancer (BC) and prostate cancer (PC). However, practice patterns vary considerably. We used the most recent Centers for Medicare and Medicaid Services data to assess trends in RT cost and practice patterns among episodes of BC and PC. METHODS AND MATERIALS We performed a retrospective cohort analysis of all external beam RT episodes for BC and PC from 2015 to 2019 to assess predictors of short-course RT (SCRT) use and calculated spending differences. Multivariable logistic regression defined adjusted odds ratios of receipt of SCRT over longer-course RT (LCRT) by treatment modality, age, year of diagnosis, type of practice, and the interaction between year and treatment setting. Medicare spending was evaluated using multivariable linear regression controlling for duration of RT regimen (SCRT vs LCRT) in addition to the above covariables. RESULTS Of 143,729 BC episodes and 114,214 PC episodes, 63,623 (44.27%) and 25,955 (22.72%) were SCRT regimens, respectively. Median total spending for SCRT regimens among BC episodes was $9418 (interquartile range [IQR], $7966-$10,983) versus $13,602 (IQR, $11,814-$15,499) for LCRT. Among PC episodes, median total spending was $6924 (IQR, $4,509-$12,905) for stereotactic body RT, $18,768 (IQR, $15,421-$20,740) for moderate hypofractionation, and $27,319 (IQR, $25,446-$29,421) for LCRT. On logistic regression, receipt of SCRT was associated with older age among both BC and PC episodes as well as treatment at hospital-affiliated over freestanding sites (P < .001 for all). CONCLUSIONS In this evaluation of BC and PC RT episodes from 2015 to 2019, we found that shorter-course RT resulted in lower costs than longer-course RT. SCRT was also more common in hospital-affiliated sites. Future research focusing on potential payment incentives encouraging SCRT when clinically appropriate in the 2 most common cancers treated with RT will be valuable as the field continues to prospectively evaluate cost-effective hypofractionation in other disease sites.
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Affiliation(s)
- Tej A Patel
- Department of Healthcare Management and Policy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bhav Jain
- Department of Health Policy, Stanford University School of Medicine, Stanford, California
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn R Tringale
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Radiation Medicine and Applied Sciences, University of California, San Diego, School of Medicine, San Diego, California
| | - Brandon A Mahal
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Sean N McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miranda B Lam
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anne Hubbard
- Department of Health Policy, American Society for Radiation Oncology, Arlington, Virgnia
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Kazzi B, Mankuzhy NP, Swami N, Jain B, Patel TA, Chan JSK, Lam MB, Tian S, Dee EC. Surgical Resection Delays among Patients with Stage 1 Lung Cancer: A Study with Disaggregated Ethnic Groups. Ann Surg Oncol 2024; 31:2818-2823. [PMID: 38282026 DOI: 10.1245/s10434-024-14952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Bahaa Kazzi
- Hope Clinic of the Emory Vaccine Center, Emory University School of Medicine Decatur, Atlanta, GA, USA
| | - Nikhil P Mankuzhy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nishwant Swami
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Bhav Jain
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Tej A Patel
- Department of Healthcare Management and Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, China
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute, Atlanta, GA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Chan JSK, Chan RNC, Lee YHA, Satti DI, Dee EC, Ng K, Achim A, Ng CF, Liu T, Matthews GDK, Tse G, Vassiliou VS. Cardiovascular health of patients with cancer: challenges abound. Trends Cardiovasc Med 2024:S1050-1738(24)00036-7. [PMID: 38657744 DOI: 10.1016/j.tcm.2024.04.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
Patients with cancer have elevated cardiovascular risks compared to those without cancer. As cancer incidence increases and cancer-related mortality decreases, cardiovascular diseases in patients with a history of cancer will become increasingly important. This in turn is reflected by the exponentially increasing amount of cardio-oncology research in recent years. This narrative review aims to summarize the key existing literature in several main areas of cardio-oncology, including the epidemiology, natural history, prevention, management, and determinants of the cardiovascular health of patients with cancer, and identify relevant gaps in evidence for further research.
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Affiliation(s)
- Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Raymond Ngai Chiu Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Yan Hiu Athena Lee
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China; Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Danish Iltaf Satti
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Kenrick Ng
- Department of Medical Oncology, Barts Cancer Centre, London, UK; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Alexandru Achim
- Department of Internal Medicine, Invasive Cardiology Division, University of Szeged, Szeged, Hungary; Department of Cardiology, "Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Chi Fai Ng
- Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Gareth D K Matthews
- Norwich Medical School, University of East Anglia, Norwich Research Park, Rosalind Franklin Road, Norwich, UK; Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Colney Lane, Norwich, UK; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Gary Tse
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China; Kent and Medway Medical School, Canterbury, Kent, CT2 7NT, UK; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Norwich Research Park, Rosalind Franklin Road, Norwich, UK; Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Colney Lane, Norwich, UK; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
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Dee EC, Ng K, Shamash J, Nguyen PL. Prostate Cancer Survivorship and Global Health-Related Quality of Life. JCO Oncol Pract 2024:OP2400173. [PMID: 38626365 DOI: 10.1200/op.24.00173] [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: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 04/18/2024] Open
Abstract
Dee, Ng, Shamash, and Nguyen respond to the work of Potosky et al, highlighting the importance of global quality of life in prostate cancer care. Factors such as companionship and spirituality must be considered in providing equitable and whole-person care.
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Affiliation(s)
| | - Kenrick Ng
- Department of Medical Oncology, St Bartholomew's Hospital, Bart's Health NHS Trust, London, United Kingdom
| | - Jonathan Shamash
- Department of Medical Oncology, St Bartholomew's Hospital, Bart's Health NHS Trust, London, United Kingdom
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Ranganathan S, Dee EC, Debnath N, Patel TA, Jain B, Murthy V. Access and barriers to genomic classifiers for breast cancer and prostate cancer in India. Int J Cancer 2024; 154:1335-1339. [PMID: 37962056 DOI: 10.1002/ijc.34784] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
The incidence of cancer in general, including breast and prostate cancer specifically, is increasing in India. Breast and prostate cancers have genomic classifiers developed to guide therapy decisions. However, these genomic classifiers are often inaccessible in India due to high cost. These classifiers may also be less suitable to the Indian population, as data primarily from patients in wealthy Western countries were used in developing these genomic classifiers. In addition to the limitations in using these existing genomic classifiers, developing and validating new genomic classifiers for breast and prostate cancer in India is challenging due to the heterogeneity in the Indian population. However, there are steps that can be taken to address the various barriers that currently exist for accurate, accessible genomic classifiers for cancer in India.
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Affiliation(s)
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neha Debnath
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Morningside/West), New York, New York, USA
| | - Tej A Patel
- Department of Healthcare Management & Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bhav Jain
- Department of Health Policy, Stanford University School of Medicine, Stanford, California, USA
| | - Vedang Murthy
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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6
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Jacomina LE, Agas RAF, Dee EC, Panda PK, Mejia MBA. Proton therapy in Asia Pacific: current resources, international disparities and steps forward. J Med Radiat Sci 2024; 71 Suppl 2:6-9. [PMID: 38425125 PMCID: PMC11011585 DOI: 10.1002/jmrs.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
The burden of cancer in Asia Pacific, a region home to over four billion people, is growing. Because of sheer demographics alone, the Asia Pacific region arguably has the highest number of patients who can benefit from protons over conventional x-rays. However, only 39 out of 113 proton facilities globally are in Asia Pacific, and 11 of them are in low- and middle-income countries where 95% of the regional population reside. We draw attention to present resource distribution of proton therapy in Asia Pacific, highlight disparities in access, and suggest steps forward.
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Affiliation(s)
- Luisa E. Jacomina
- Division of Radiation OncologyThe University of Texas MD Anderson Cancer CentreHoustonTexasUSA
- Department of Radiation Oncology, Benavides Cancer InstituteUniversity of Santo Tomas HospitalManilaPhilippines
| | - Ryan Anthony F. Agas
- Department of Radiation Oncology, Benavides Cancer InstituteUniversity of Santo Tomas HospitalManilaPhilippines
| | - Edward Christopher Dee
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CentreNew YorkNew YorkUSA
| | | | - Michael Benedict A. Mejia
- Department of Radiation Oncology, Benavides Cancer InstituteUniversity of Santo Tomas HospitalManilaPhilippines
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7
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Ho FDV, De Luna DV, Cubarrubias DLPF, Ong EP, Abello RMR, Ansay MFM, Taliño MKV, Robredo JPG, Eala MAB, Dee EC. Palliative and Supportive Care in the Philippines: Systems, Barriers, and Steps Forward. J Palliat Care 2024; 39:87-91. [PMID: 36740938 DOI: 10.1177/08258597231153381] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although integral to alleviating serious health-related suffering, global palliative care remains systemically and culturally inaccessible to many patients living in low- and middle-income countries. In the Philippines, a lower-middle income country in Southeast Asia of over 110 million people, up to 75% of patients with cancer suffer from inadequate pain relief. We reviewed factors that preclude access to basic palliative care services in the Philippines. PubMed and Google Scholar were searched thoroughly; search terms included but were not limited to "palliative care," "supportive care," "end-of-life care," and "Philippines." We found that a limited palliative care workforce, high out-of-pocket healthcare costs, and low opioid availability all hinder access to palliative care in the archipelago. Religious fatalism, strong family-orientedness, and physician reluctance to refer to palliative care providers represent contributory sociocultural factors. Efforts to improve palliative care accessibility in the country must address health systems barriers while encouraging clinicians to discuss end-of-life options in a timely manner that integrates patients' unique individual, familial, and spiritual values. Research is needed to elucidate how Filipinos-and other global populations-view end-of-life, and how palliative care strategies can be individualised accordingly.
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Affiliation(s)
| | | | | | - Erika P Ong
- College of Medicine, University of the Philippines, Manila, Philippines
| | | | | | | | | | - Michelle Ann B Eala
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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8
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Dee EC, Swami N, Kazzi B, Lapen K, Franco I, Jain B, Patel TA, Mahal BA, Rimner A, Wu A, Iyengar P, Li B, Florez N, Gomez DR. Disparities in Stage at Presentation Among Hispanic and Latinx Patients With Non-Small-Cell Lung Cancer in the United States. JCO Oncol Pract 2024; 20:525-537. [PMID: 38252900 DOI: 10.1200/op.23.00474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/12/2023] [Accepted: 11/02/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Hispanic and Latinx people in the United States are the fastest-growing ethnic group. However, previous studies in non-small-cell lung cancer (NSCLC) often analyze these diverse communities in aggregate. We aimed to identify differences in NSCLC stage at diagnosis in the US population, focusing on disaggregated Hispanic/Latinx individuals. METHODS Data from the National Cancer Database from 2004 to 2018 identified patients with primary NSCLC. Individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression adjusting for age, facility type, income, educational attainment, comorbidity index, insurance, and year of diagnosis was used to create adjusted odds ratios (aORs), with higher odds representing diagnosis at later-stage NSCLC. RESULTS Of 1,565,159 patients with NSCLC, 46,616 were Hispanic/Latinx (3.0%). When analyzed in the setting of race and ethnicity, Hispanic patients were more likely to be diagnosed with metastatic disease compared with non-Hispanic White (NHW) patients: 47.0% for Hispanic Black, 46.0% Hispanic White, and 44.3% of Hispanic other patients versus 39.1% of non-Hispanic White patients (P < .001 for all). By country of origin, 51.4% of Mexican, 41.7% of Puerto Rican, 44.6% of Cuban, 50.8% of South or Central American, 48.4% of Dominican, and 45.6% of other Hispanic patients were diagnosed with metastatic disease, compared with 39.1% of NHWs. Conversely, 20.2% of Mexican, 26.9% of Puerto Rican, 24.2% of Cuban, 22.5% of South or Central American, 23.7% of Dominican, and 24.5% of other Hispanic patients were diagnosed with stage I disease, compared with 30.0% of NHWs. All Hispanic groups were more likely to present with later-stage NSCLC than NHW patients (greatest odds for Mexican patients, aOR, 1.44; P < .001). CONCLUSION Hispanic/Latinx patients with non-small-cell lung cancer were more likely to be diagnosed with advanced disease compared with NHWs. Disparities persisted upon disaggregation by both race and country of origin, with over half of Mexican patients with metastatic disease at diagnosis. Disparities among Hispanic/Latinx groups by race and by country of origin highlight the shortcomings of treating these groups as a monolith and underscore the need for disaggregated research and targeted interventions.
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Affiliation(s)
| | - Nishwant Swami
- University of Massachusetts Chan Medical School, Worcester, MA
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Bahaa Kazzi
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, Decatur, GA
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Idalid Franco
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Bhav Jain
- Stanford School of Medicine, Palo Alto, CA
| | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Cancer Center, Miami, FL
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Abraham Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Puneeth Iyengar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bob Li
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Narjust Florez
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY
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Kohli K, Jain B, Dee EC, Ho BL. Addressing cultural and political drivers of vaccine hesitancy: Considerations for the African and Asian contexts. Vaccine 2024; 42:1411-1413. [PMID: 38326129 DOI: 10.1016/j.vaccine.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Affiliation(s)
| | - Bhav Jain
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Beverly Lorraine Ho
- National Institutes of Health, University of the Philippines, Manila, Philippines
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10
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Sonal S, Jain B, Bajaj SS, Dee EC, Boudreau C, Cusack JC, Kunitake H, Goldstone R, Bordeianou LG, Cauley Md CE, Francone TD, Ricciardi R, Qadan M, Berger DL. Trends and Determinants of Location of Death Due to Colorectal Cancer in the United States : A Nationwide Study. Ann Surg Oncol 2024; 31:1447-1454. [PMID: 37907701 DOI: 10.1245/s10434-023-14337-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/09/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the United States (US); however, there are limited data on location of death in patients who die from CRC. We examined the trends in location of death and determinants in patients dying from CRC in the US. METHODS We utilized the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database to extract nationwide data on underlying cause of death as CRC. A multinomial logistic regression was performed to assess associations between clinico-sociodemographic characteristics and location of death. RESULTS There were 850,750 deaths due to CRC from 2003 to 2019. There was a gradual decrease in deaths in hospital, nursing home, or outpatient facility/emergency department over time and an increase in deaths at home and in hospice. Relative to White decedents, Black, Asian, and American Indian/Alaska Native decedents were less likely to die at home and in hospice compared with hospitals. Individuals with lower educational status also had a lower risk of dying at home or in hospice compared with in hospitals. CONCLUSIONS The gradual shift in location of death of patients who die of CRC from institutionalized settings to home and hospice is a promising trend and reflects the prioritization of patient goals for end-of-life care by healthcare providers. However, there are existing sociodemographic disparities in access to deaths at home and in hospice, which emphasizes the need for policy interventions to reduce health inequity in end-of-life care for CRC.
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Affiliation(s)
- Swati Sonal
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chloe Boudreau
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- University of Oxford, Oxford, UK
| | - James C Cusack
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Hiroko Kunitake
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Robert Goldstone
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Liliana G Bordeianou
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Christy E Cauley Md
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Todd D Francone
- Department of Surgery, Newton-Wellesley Hospital, Newton, MA, USA
- Department of Surgery, Tufts University School of Medicine, Boston, MA, USA
| | - Rocco Ricciardi
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Motaz Qadan
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
- Department of Surgery, Harvard Medical School, Boston, MA, USA.
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11
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Patel TA, Jain B, Cho HL, Corti C, Vapiwala N, Chino F, Leeman JE, Dee EC. Second Malignancy Probabilities in Patients With Breast Cancer Treated With Conventional Versus Hypofractionated External Beam Radiation Therapy in the Adjuvant Setting. Clin Oncol (R Coll Radiol) 2024; 36:183-192. [PMID: 38184401 DOI: 10.1016/j.clon.2023.12.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/12/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024]
Abstract
AIMS For women with breast cancer, seminal studies have shown that adjuvant hypofractionated external beam radiation therapy (hEBRT) maintains similar outcomes and may reduce overall costs compared with conventionally fractionated external beam radiation therapy (cEBRT). However, it is unclear whether hEBRT may be associated with differential risk of development of radiation-induced second malignancies compared with cEBRT. Because the occurrence of second malignancies is small, large databases may improve our understanding of the relative risk of second malignancies between hEBRT and cEBRT. MATERIALS AND METHODS Using the National Cancer Database, we carried out a retrospective cohort analysis of women diagnosed with non-metastatic, stage 0-III breast cancer from 2004 to 2017. All patients had a lumpectomy or mastectomy and a follow-up time of at least 60 months after diagnosis. The probability of second malignancies in women receiving adjuvant cEBRT or hEBRT was compared using multivariable logistic regression adjusting for sociodemographic, geographical, clinical and treatment factors, allowing for relative (but not absolute) comparison of second malignancy risk. Temporal sensitivity analyses stratified by year of diagnosis and length of follow-up time were also conducted. RESULTS Of the 125 228 women in our study, 115 576 (92.3%) received cEBRT and 9652 (7.71%) received hEBRT. The median age of the cohort was 60 (interquartile range 51-68) years at diagnosis and the median follow-up time was 99.61 (interquartile range 77.5-128.49) months. Upon adjusting for sociodemographic and clinical factors, patients who received hEBRT had no difference in relative risk than patients who received cEBRT (odds ratio 0.937, 95% confidence interval 0.869-1.010, P = 0.091). In analyses stratified by year of diagnosis, and stratified by length of follow-up, there was no difference in second malignancy probability between patients who completed hEBRT and patients who completed cEBRT. CONCLUSIONS In this analysis of over 120 000 women with non-metastatic breast cancer, hEBRT was not associated with different odds of developing second malignancies compared with cEBRT. Our findings may inform patient counselling in the choice of radiation regimens for breast cancer and further support the safety of hypofractionated regimens for breast cancer.
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Affiliation(s)
- T A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - B Jain
- Stanford School of Medicine, Stanford, CA, USA
| | - H L Cho
- Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - C Corti
- Breast Oncology Program, Dana-Farber Cancer Centre, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology-Oncology (DIPO), University of Milan, Milan, Italy
| | - N Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - F Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J E Leeman
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - E C Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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12
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Sonal S, Jain B, Bajaj SS, Dee EC, Boudreau C, Cusack JC, Kunitake H, Goldstone RN, Bordeianou LG, Cauley CE, Francone TD, Ricciardi R, Qadan M, Berger DL. ASO Visual Abstract: Trends and Determinants of Location of Death Due to Colorectal Cancer in the USA: A Nationwide Study. Ann Surg Oncol 2024; 31:1491-1492. [PMID: 37899416 DOI: 10.1245/s10434-023-14380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- Swati Sonal
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Wang Ambulatory Care Center (WACC) 460, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, USA
| | | | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chloe Boudreau
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Wang Ambulatory Care Center (WACC) 460, Massachusetts General Hospital, Boston, MA, USA
- University of Oxford, Oxford, UK
| | - James C Cusack
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Wang Ambulatory Care Center (WACC) 460, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, USA
| | - Hiroko Kunitake
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Wang Ambulatory Care Center (WACC) 460, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, USA
| | - Robert N Goldstone
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Wang Ambulatory Care Center (WACC) 460, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, USA
- Department of Surgery, Newton-Wellesley Hospital, Newton, USA
| | - Liliana G Bordeianou
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Wang Ambulatory Care Center (WACC) 460, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, USA
| | - Christy E Cauley
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Wang Ambulatory Care Center (WACC) 460, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, USA
| | - Todd D Francone
- Department of Surgery, Newton-Wellesley Hospital, Newton, USA
- Department of Surgery, Tufts University School of Medicine, Boston, USA
| | - Rocco Ricciardi
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Wang Ambulatory Care Center (WACC) 460, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, USA
| | - Motaz Qadan
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Wang Ambulatory Care Center (WACC) 460, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, USA
| | - David L Berger
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Wang Ambulatory Care Center (WACC) 460, Massachusetts General Hospital, Boston, MA, USA.
- Department of Surgery, Harvard Medical School, Boston, USA.
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13
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Chan JSK, Chou OHI, Lee TTL, Lee YHA, Chan RNC, Dee EC, Ng K, Liu T, Tse G. Temporal trends in guideline-recommended cardiometabolic testing completeness before initiating immune checkpoint inhibitors: A cohort study. J Intern Med 2024; 295:375-378. [PMID: 38013596 DOI: 10.1111/joim.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Oscar Hou In Chou
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Teddy Tai Loy Lee
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Yan Hiu Athena Lee
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Raymond Ngai Chiu Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kenrick Ng
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, Kent, UK
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
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14
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Jain P, Jain B, Dee EC. Corporate Social Responsibility Framework: An Innovative Solution to Social Determinants of Health in the USA. J Racial Ethn Health Disparities 2024; 11:7-22. [PMID: 36689122 DOI: 10.1007/s40615-022-01493-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Expand firms' corporate social responsibility (CSR) framework to systematically address social determinants of health (SDOH) in their communities and improve firms' performance (FP). GAP: The U.S. healthcare system has struggled to improve population health outcomes while enhancing delivery performance. An oft-overlooked contributor to this deficit is SDOH inequities, accounting for 25-60% of deaths in the USA annually. Ironically, most healthcare firms do not view investment in SDOH, a neglected phenomenon, to develop sustainable healthy communities as their direct responsibility due to the "wrong pocket problem." Although extant literature theorizes the CSR construct, there is a paucity of research on SDOH integration with the CSR framework. DESIGN We integrate a quantitative and qualitative study with supplementary literature on CSR and SDOH using the grounded theory method by researching fourteen health plan firms across the USA. FINDINGS Research reveals early efforts undertaken by top-performing healthcare insurers to address SDOH and provides evidence that such measures can be integrated profitably under CSR as a competitive advantage. ORIGINALITY Contributes to CSR theory and practice by providing an empirical model and expanding its framework to address SDOH systematically. Key implications are as follows: (1) healthcare firms to link with unconventional partners, such as housing authorities, food banks, employment agencies, and schools; (2) the entire healthcare supply chain to collaborate with social enterprises and regulators to develop sustainable communities; (3) policymakers must incentivize firms to align social equity and corporate goals; and (4) long-term view on CSR, SDOH, and healthy living (HL) will in-turn eliminate social inequities while enhancing FP.
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Affiliation(s)
- Pankaj Jain
- Health Plan Customer and Provider Experience, Highmark Health, Pittsburgh, PA, USA.
- Department of Marketing, Eberly College of Business & Information Technology, Indiana University of Pennsylvania, Indiana, PA, USA.
| | - Bhav Jain
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Co LMB, Puno FLMA, Ong EP, Ho FDV, Eala MAB, Dee EC, Maslog EAS, Barroso RT, Kingham TP, Ang SD, Ang CDU. Access to surgical treatment for hepatopancreaticobiliary cancer in the Philippines. Surgery 2024; 175:561-563. [PMID: 37953137 DOI: 10.1016/j.surg.2023.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/05/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023]
Abstract
Hepatopancreaticobiliary cancers are among the most diagnosed cancers in the world. However, although high-income countries have the highest incidence rates, low- and middle-income countries have the highest mortality rates. In this article, we describe the geographic distribution of board-certified hepatopancreaticobiliary surgeons who provide surgical management for patients with these diseases in the Philippines. We draw attention to the geographic disparities in the distribution of these surgeons and the other factors that contribute to the lack of access. Lastly, we suggest ways forward.
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Affiliation(s)
- Luis Miguel B Co
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | | | - Erika P Ong
- College of Medicine, University of the Philippines, Manila, Philippines
| | | | - Michelle Ann B Eala
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | | | | | - Ryan T Barroso
- Hepato-Pancreato-Biliary Unit, Rizal Medical Center, Pasig, Bago Bantay, Quezon City, Metro Manila
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel D Ang
- Department of Surgery, Chinese General Hospital and Medical Center, Santa Cruz, Manila
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16
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Mathew A, Jain B, Patel TA, Hammond A, Dee EC, Chino F. Trends in Location of Death for Individuals With Ovarian Cancer in the United States. Obstet Gynecol 2024; 143:101-103. [PMID: 37944156 PMCID: PMC10842215 DOI: 10.1097/aog.0000000000005439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/02/2023] [Indexed: 11/12/2023]
Abstract
Using the publicly available Centers for Disease Control and Prevention's WONDER (Wide-ranging Online Data for Epidemiologic Research) database from 2003 to 2019, we evaluated associations between decedent characteristics and location of death for patients with ovarian malignancy. We found that Black, Native American, Asian American, and Hispanic patients were more likely to die in hospitals than White patients, despite an overall reduction in hospital deaths and an overall increase in hospice facility deaths. Additionally, patients with lesser educational attainment were more likely to die in nursing facilities and less likely to die in hospice facilities. Although there may be some contribution from cultural preferences, these findings may represent disparities in access to palliative care affecting people with cancer from racial and ethnic minoritized groups.
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Affiliation(s)
| | - Bhav Jain
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
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17
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Lee YHA, Chan JSK, Hui JMH, Tang P, Liu K, Dee EC, Ng K, Tse G, Ng CF. Statin use and mortality risk in Asian patients with prostate cancer receiving androgen deprivation therapy: A population-based cohort study. Cancer Med 2023; 13:e6826. [PMID: 38140773 PMCID: PMC10807587 DOI: 10.1002/cam4.6826] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/31/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND This study aimed to examine the associations between the use of statins concurrent with androgen deprivation therapy (ADT) and the risks of mortality in Asian patients diagnosed with prostate cancer (PCa). METHODS Adult patients (≥18 years old) diagnosed with PCa who were receiving any form of ADT and were being treated at public hospitals in Hong Kong from December 1999 to March 2021 were retrospectively identified, with follow-up conducted until September 2021. Patients who had received medical castration for <180 days without subsequent bilateral orchidectomy, those who had used statins concurrently with ADT for <180 days, and those with missing baseline total cholesterol levels were excluded. Statin users were defined as individuals who had used statins for ≥180 days concurrent with ADT, while non-users were those who had not used any statins. PCa-related mortality was the primary outcome, while all-cause mortality served as the secondary outcome. Inverse probability treatment weighting was employed to balance the covariates. RESULTS A total of 4920 patients were included, consisting of 2578 statin users and 2342 non-users (mean age 76.1 ± 8.2 years). Over a mean follow-up period of 4.2 ± 3.3 years, it was observed that statin users had significantly lower risks of both PCa-related mortality (weighted hazard ratio [wHR] 0.56 [95% confidence interval (CI) 0.48, 0.65], p < 0.001) and all-cause mortality (wHR 0.57 [95% CI 0.51, 0.63], p < 0.001), regardless of the type of ADT used. Notably, these associations were more pronounced among patients with less advanced PCa, as indicated by the absence of androgen receptor antagonist or chemotherapy usage (p value for interaction <0.001 for both outcomes). CONCLUSION(S) The use of statins concurrent with ADT was associated with reduced mortality risks among Asian patients with PCa. These findings suggest the need for additional research to explore the potential role of statins in the treatment of PCa patients.
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Affiliation(s)
- Yan Hiu Athena Lee
- Division of Urology, Department of Surgery, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
- Cardio‐Oncology Research Unit, Cardiovascular Analytics GroupPowerHealth LimitedHong KongChina
| | - Jeffrey Shi Kai Chan
- Cardio‐Oncology Research Unit, Cardiovascular Analytics GroupPowerHealth LimitedHong KongChina
- Quest Genomics LimitedLondonUnited Kingdom
| | - Jeremy Man Ho Hui
- Cardio‐Oncology Research Unit, Cardiovascular Analytics GroupPowerHealth LimitedHong KongChina
- Quest Genomics LimitedLondonUnited Kingdom
| | - Pias Tang
- Cardio‐Oncology Research Unit, Cardiovascular Analytics GroupPowerHealth LimitedHong KongChina
- Quest Genomics LimitedLondonUnited Kingdom
| | - Kang Liu
- Division of Urology, Department of Surgery, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Edward Christopher Dee
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Kenrick Ng
- Department of Medical OncologyUniversity College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Gary Tse
- Department of Cardiology, Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular DiseaseTianjin Institute of Cardiology, Second Hospital of Tianjin Medical UniversityTianjinChina
- Kent and Medway Medical SchoolCanterburyUnited Kingdom
- School of Nursing and Health StudiesHong Kong Metropolitan UniversityHong KongChina
| | - Chi Fai Ng
- Division of Urology, Department of Surgery, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
- SH Ho Urology CentreThe Chinese University of Hong KongHong KongChina
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18
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Lee YHA, Hui JMH, Leung CH, Tsang CTW, Hui K, Tang P, Chan JSK, Dee EC, Ng K, McBride S, Nguyen PL, Tse G, Ng CF. Major adverse cardiovascular events of enzalutamide versus abiraterone in prostate cancer: a retrospective cohort study. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00757-0. [PMID: 38049634 DOI: 10.1038/s41391-023-00757-0] [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: 06/08/2023] [Revised: 11/02/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND While the cardiovascular risks of androgen receptor pathway inhibitors have been studied, they were seldom compared directly. This study compares the risks of major adverse cardiovascular events (MACE) between enzalutamide and abiraterone among prostate cancer (PCa) patients. METHODS Adult PCa patients receiving either enzalutamide or abiraterone in addition to androgen deprivation therapy in Hong Kong between 1 December 1999 and 31 March 2021 were identified in this retrospective cohort study. Patients who switched between enzalutamide and abiraterone, initiated abiraterone used without steroids, or experienced prior cardiac events were excluded. Patients were followed-up until 30 September 2021. The primary outcomes were MACE, a composite of stroke, myocardial infarction (MI), Heart failure (HF), or all-cause mortality and a composite of adverse cardiovascular events (CACE) not including all-cause mortality. The secondary outcomes were individual components of MACE. Inverse probability treatment weighting was used to balance covariates between treatment groups. RESULTS In total, 1015 patients were analyzed (456 enzalutamide users and 559 abiraterone users; mean age 70.6 ± 8.8 years old) over a median follow-up duration of 11.3 (IQR: 5.3-21.3) months. Enzalutamide users had significantly lower risks of 4P-MACE (weighted hazard ratio (wHR) 0.71 [95% confidence interval (CI) 0.59-0.86], p < 0.001) and CACE (wHR 0.63 [95% CI: 0.42-0.96], p = 0.031), which remained consistent in multivariable analysis. Such an association may be stronger in patients aged ≥65 years or without diabetes mellitus and was independent of bilateral orchidectomy. Enzalutamide users also had significantly lower risks of MI (wHR 0.57 [95% CI: 0.33-0.97], p = 0.040) and all-cause mortality (wHR 0.71 [95% CI: 0.59-0.85], p < 0.001). CONCLUSION Enzalutamide was associated with lower cardiovascular risks than abiraterone in PCa patients.
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Affiliation(s)
- Yan Hiu Athena Lee
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
- Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremy Man Ho Hui
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Chi Ho Leung
- Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Christopher Tze Wei Tsang
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Kyle Hui
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Pias Tang
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kenrick Ng
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
- Kent and Medway Medical School, Canterbury, Kent, CT2 7NT, UK.
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
| | - Chi Fai Ng
- Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
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Feliciano EJG, Ho FDV, Yee K, Paguio JA, Eala MAB, Robredo JPG, Ng K, Lim J, Pyone KT, Peralta CA, Flores JA, Yao JS, Santos PMG, Ang CDU, Lasco G, Chan JSK, Tse G, Tangco ED, Kingham TP, Chitapanarux I, Bhoo-Pathy N, Legaspi GD, Dee EC. Cancer disparities in Southeast Asia: intersectionality and a call to action. Lancet Reg Health West Pac 2023; 41:100971. [PMID: 38053740 PMCID: PMC10694578 DOI: 10.1016/j.lanwpc.2023.100971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/27/2023] [Accepted: 11/05/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Erin Jay G. Feliciano
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Department of Medicine, NYC H+H/Elmhurst, Icahn School of Medicine at Mt. Sinai, Queens, NY, USA
| | | | - Kaisin Yee
- SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
| | - Joseph A. Paguio
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Michelle Ann B. Eala
- University of the Philippines College of Medicine, Manila, Philippines
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Janine Patricia G. Robredo
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | - Kenrick Ng
- Department of Medical Oncology, St Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Jasmine Lim
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khin Thuzar Pyone
- Radiation Oncology Department, Yangon General Hospital Yangon, Myanmar
| | | | | | - J. Seth Yao
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Patricia Mae G. Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Daniel U. Ang
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Gideon Lasco
- Development Studies Program, Ateneo de Manila University, Quezon City, Philippines
- Department of Anthropology, University of the Philippines Diliman, Quezon City, Philippines
| | | | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- Kent and Medway Medical School, Canterbury, UK
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Enrico D. Tangco
- Department of Radiation Oncology, The Medical City, Pasig City, Philippines
| | - T. Peter Kingham
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence Based Practice, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gerardo D. Legaspi
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines Manila, Philippine General Hospital, Metro Manila, Philippines
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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20
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Chan JSK, Satti DI, Dee EC, Sharma G, Virani SS, Liu T, Tse G. Association between psychological distress and cardiovascular health amongst cancer survivors in the United States: findings from nationally representative data. Eur J Prev Cardiol 2023; 30:e74-e77. [PMID: 37178316 DOI: 10.1093/eurjpc/zwad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/15/2023]
Affiliation(s)
| | - Danish Iltaf Satti
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, USA
- Michael E. DeBakey Veterans Affair Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, USA
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, Kent CT2 7NT, United Kingdom
- School of Nursing and Health Studies, 11th Floor, Jockey Club Institute of Healthcare, Hong Kong Metropolitan University, 1 Sheung Shing Street, Homantin, Kowloon, Hong Kong, China
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Swami N, Dee EC, Florez N. Medical Travel for Immigrant Patients With Cancer-Returning Home. JAMA Oncol 2023; 9:1493-1494. [PMID: 37733362 DOI: 10.1001/jamaoncol.2023.3508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
This Viewpoint describes motivations for and barriers to travel to the country of origin among immigrant patients with cancer and recommends strategies to address these motivations and barriers.
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Affiliation(s)
- Nishwant Swami
- University of Massachusetts Chan Medical School, Worcester
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Narjust Florez
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Dee EC, Eala MAB, Robredo JPG, Ramiah D, Hubbard A, Ho FDV, Sullivan R, Aggarwal A, Booth CM, Legaspi GD, Nguyen PL, Pramesh CS, Grover S. Leveraging national and global political determinants of health to promote equity in cancer care. J Natl Cancer Inst 2023; 115:1157-1163. [PMID: 37402623 PMCID: PMC10560599 DOI: 10.1093/jnci/djad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
Health and politics are deeply intertwined. In the context of national and global cancer care delivery, political forces-the political determinants of health-influence every level of the cancer care continuum. We explore the "3-I" framework, which structures the upstream political forces that affect policy choices in the context of actors' interests, ideas, and institutions, to examine how political determinants of health underlie cancer disparities. Borrowing from the work of PA Hall, M-P Pomey, CJ Ho, and other thinkers, interests are the agendas of individuals and groups in power. Ideas represent beliefs or knowledge about what is or what should be. Institutions define the rules of play. We provide examples from around the world: Political interests have helped fuel the establishment of cancer centers in India and have galvanized the 2022 Cancer Moonshot in the United States. The politics of ideas underlie global disparities in cancer clinical trials-that is, in the distribution of epistemic power. Finally, historical institutions have helped perpetuate disparities related to racist and colonialist legacies. Present institutions have also been used to improve access for those in greatest need, as exemplified by the Butaro Cancer Center of Excellence in Rwanda. In providing these global examples, we demonstrate how interests, ideas, and institutions influence access to cancer care across the breadth of the cancer continuum. We argue that these forces can be leveraged to promote cancer care equity nationally and globally.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Janine Patricia G Robredo
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Duvern Ramiah
- Division of Radiation Oncology, University of the Witwatersrand, Johannesburg and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Anne Hubbard
- American Society for Radiation Oncology, Arlington, VA, USA
| | | | - Richard Sullivan
- Kings Health Partners Comprehensive Cancer Centre, King's College London, Institute of Cancer Policy, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Institute of Cancer Policy, King’s College London, London, UK
| | - Christopher M Booth
- Department of Oncology, Queen’s University, Kingston, ON, Canada
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
| | - Gerardo D Legaspi
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, MA, USA
| | - C S Pramesh
- Tata Memorial Hospital, Thoracic Surgery (Surgical Oncology) at Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Patel TA, Jain B, Vapiwala N, Chino F, Tringale KR, Mahal BA, Yamoah K, McBride S, Hubbard A, Nguyen PL, Dee EC. Trends in Utilization and Medicare Spending on Shorter vs. Longer Radiotherapy Courses for Breast and Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e614. [PMID: 37785845 DOI: 10.1016/j.ijrobp.2023.06.1990] [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] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Evidence based research supports shorter, similarly efficacious, and potentially more cost-effective hypofractionated treatment regimens in many clinical scenarios for breast cancer (BC) and prostate cancer (PC). However, practice patterns of hospital-affiliated and standalone facilities vary considerably. We used the most recent Centers for Medicare and Medicaid Services data to assess trends in radiotherapy (RT) costs and practice patterns among episodes of BC and PC. MATERIALS/METHODS We performed a retrospective cohort analysis of all external beam episodes for BC and PC from 2015-2019. For patients with BC, receipt of shorter-course RT (SCRT) was defined as receiving 11-20 fractions of external beam radiation therapy (including IMRT), and conventional RT as >20 fractions. For patients with PC, SBRT was defined as receipt of <10 fractions and moderate hypofractionation as 10-30 fractions (SCRT defined as SBRT and moderate hypofractionation), and >30 fractions for conventional RT. Total Medicare spending were defined as the sum of winsorized payment for professional and technical services furnished during the episode in 2019 dollars. Multivariable logistic regression defined adjusted odds ratios (ORs) of receipt of SCRT over conventional RT by treatment modality, age, year of diagnosis, type of practice, as well as a time*treatment setting interaction term. Medicare spending was evaluated using multivariable linear regression controlling for duration of RT regimen (SCRT vs conventional) in addition to the covariables above. RESULTS Of 47,283 BC episodes and 45,917 PC episodes, 23,705 (50.13%) and 9,125 (19.87%) were SCRT, respectively. Median total spending for SCRT among BC episodes was $9,324 (IQR, $7,916-$10,921) vs. $13,372 (IQR, $11,511-$15,283) for conventional RT. Among PC episodes, median total spending was $12,917 (IQR, $9,551-$15,271) for SBRT, $18,944 (IQR, $16,530-$20,615) for moderate hypofractionation, and $26,935 (IQR, $25,062-$28,959) for conventional RT. For both cancers, total episode spending was reduced with SCRT utilization [(BC adjusted β, -$4,200; p<0.001), (PC adjusted β, -$8,747; p<0.001)], older age, and non-IMRT-based treatment. On logistic regression, receipt of SCRT was associated with older age among both BC and PC episodes (p<0.001), as well as treatment at hospital-affiliated over freestanding sites [(BC OR [95% CI], 1.41 [1.29-1.54], p<0.001), (PC OR, 1.64 [1.39-1.94], p<0.001)]. CONCLUSION In this evaluation of all BC and PC RT episodes from 2015-2019, we found that shorter-course RT resulted in increased cost-savings vs. conventional RT. SCRT was also more common in hospital-affiliated sites. Further research is needed to devise payment incentives that encourage SCRT when clinically applicable in the two most common sites treated with RT, and to prospectively study cost-effective hypofractionation in other disease sites.
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Affiliation(s)
- T A Patel
- University of Pennsylvania, Philadelphia, PA
| | - B Jain
- Massachusetts Institute of Technology, Cambridge, MA
| | - N Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - F Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - K R Tringale
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - B A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - K Yamoah
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - S McBride
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Hubbard
- American Society for Radiation Oncology, Arlington, VA
| | - P L Nguyen
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - E C Dee
- Memorial Sloan Kettering Cancer Center, New York, NY
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Dee EC, Goglia A, Swami N, Nguyen B, Hougen HY, Khan A, Kishan AU, Punnen S, Nguyen PL, Mahal BA, Alshalalfa M. Determinants of Widespread Metastases and of Metastatic Tropism in Patients with Prostate Cancer: A Genomic Analysis of Primary and Metastatic Tumors. Int J Radiat Oncol Biol Phys 2023; 117:e375-e376. [PMID: 37785276 DOI: 10.1016/j.ijrobp.2023.06.2481] [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] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A growing body of evidence suggests that metastatic cancer is better described as a spectrum of disease rather than a binarily defined state, ranging from oligometastatic cancer to widespread metastases. Widespread metastases represent the most common cause of cancer-related death among patients with prostate cancer. Therefore, a greater understanding of the genomic features that determine the extent and location of metastatic spread may inform risk stratification, treatment, and monitoring. We identify genomic alterations from primary prostate tumors that are predictive of widespread metastatic potential. MATERIALS/METHODS Genomic and clinical data for 1,312 patients with primary prostate adenocarcinomas were extracted from the MSK-MET cohort through cBioPortal. Metastatic site counts and overall survival (OS) data were publicly available for all patients. All samples from primary tumors were profiled using the MSK-IMPACT targeted sequencing platform. Our study focused on 58 genes frequently altered in prostate cancer. Cox proportional hazard analyses defined hazard ratios (HRs) and 95% confidence intervals (CIs) for overall mortality in patients with different metastatic outcomes. Patterns of genomic alterations of the primary tumor associated with metastatic extent and location were compared. RESULTS Out of 1,312 patients, 939 (71%) developed metastases, and 113 (8.6%) had metastases to 5 or more distinct anatomical sites (defining wide-spread metastases, WSM). Bone was the most common site of metastasis (36%), and 80% of patients with liver metastases had 4 or more additional sites of metastasis. Among patients with metastases, increasing number of metastatic sites was associated with increased risk of death (HR:1.8, 95% CI:1.63-1.99, p<0.001). To define genomic determinants of WSM, we characterized genomic alterations in 58 prostate cancer related genes. Alterations in the following genes were enriched in tumors from patients with WSM vs others: TP53 mutation (40% vs 20%, p<0.0001), FOXA1-amplification (8% vs 3%, p = 0.02), AR-amplification (4.4% vs 1%, p = 0.01), RB1-deletion (5.3% vs 0.7%, p = 0.001), and BRCA2-deletion (4.4% vs 0.7%, p = 0.01). In a univariable survival analysis, all these alterations were predictive of OS (p<0.05). However, on multivariable analysis, only TP53 mutations, and FOXA1 and AR amplifications were independent prognostic factors. Amplifications of FOXA1 (n = 37) and AR (n = 13) were mutually exclusive (0 overlap), and we found that patients who have either AR or FOXA1 amplifications experienced very poor OS (HR:3.57, 95% CI:2.26-5.6, p p<0.001]. CONCLUSION We identified genomic alterations (TP53 mutations, FOXA1 and AR amplification, RB1 and BRCA2 deletions) from primary prostate tumors that are predictive of wide-spread metastases and poor outcomes.
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Affiliation(s)
- E C Dee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Goglia
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - N Swami
- University of Massachusetts Chan Medical School, Worcester, MA
| | - B Nguyen
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - H Y Hougen
- University of Miami Miller School of Medicine, Miami, FL
| | - A Khan
- University of Miami Miller School of Medicine, Miami, FL
| | - A U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - S Punnen
- Department of Urology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - P L Nguyen
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - B A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - M Alshalalfa
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Dee EC, Freret ME, Brennan VS, Yamada Y, Gomez DR, McBride S, Xu AJ, Yerramilli D. Inpatient Simulation Resource Utilization for Inpatient Radiation Oncology Consults. Int J Radiat Oncol Biol Phys 2023; 117:e98. [PMID: 37786227 DOI: 10.1016/j.ijrobp.2023.06.864] [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] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Previous data have shown that inpatient radiation oncology consult services result in high-value care, with decreased length of stay, adoption and delivery of shorter fractionation schedules, and lower hospital costs. As such, institutions are increasingly creating inpatient radiation oncology services, although little is known about the allocation of limited resources for patients who may have limited prognosis, complex simulation requirements, and may have difficulty tolerating treatment. Thus, we sought to examine the utilization of simulation appointments for inpatient emergencies. MATERIALS/METHODS At our institution, inpatient consults are placed to a specialized inpatient palliative radiation oncology service, consisting of radiation oncologists specialized in metastatic and palliative RT, dedicated advanced practitioners, and nurses who specifically assess patients for medical appropriateness prior to simulation, including changes in disposition, medical stability, and adequate premedication. Electronic health record data was used to explore utilization trends of a single-institution inpatient radiation oncology consult service in 2020. Data regarding the nature and timing of consults, subsequent simulations and treatments, and patient outcomes including 14-day mortality and 30-day mortality from radiation (RT) start were assessed. Descriptive statistics are presented. RESULTS From 1/1/2020-12/31/2020, 1557 consults were placed. These consults led to 220 (14.1%) inpatient simulations. Of these planned simulations, 210 (95.5%) simulations occurred (of which 10 [4.8%] were rescheduled and eventually completed) and 179 (85.2%) completed treatment. Of 169 with mortality data available, 16 (9.5%) died within 14 days of RT start, and 41 (24.5%) died within 30 days of RT start. Of those with scheduling data (N = 193), 122 were same-day simulations (63.2%), and 507 (93.8%) occurred within 7 days or fewer. CONCLUSION Of 1557 inpatient consultations in one year, with appropriate metastatic and palliative experience, only a minority of consultations required inpatient simulation (14.1%). With appropriate nursing assessment, over 95% were able to complete simulation, with nearly two-thirds completing simulation on the same day, and nearly all patients completing simulation within a week of consultation. Most of these patients completed treatment and survived 30 days from treatment start. Thus, with highly specialized radiation oncologist clinical judgment in conjunction with appropriate nursing assessment prior to simulation scheduling, patients booked for simulation represent high-value utilization of resources.
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Affiliation(s)
- E C Dee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - M E Freret
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - V S Brennan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Y Yamada
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - D R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S McBride
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A J Xu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Patel AM, Dee EC, Hubbard A, Milligan MG, Ebner DK, Alcorn SR, LaVigne A, Kudner RF, Mayo C, Adler D, Suggs K, Greathouse A, Ludwig MS, Nguyen PL, Waddle MR, Thompson RF, Mahal BA, Yamoah K. Health Equity Achievement in Radiation Therapy (HEART) Score: A Social Prognosis. Int J Radiat Oncol Biol Phys 2023; 117:e612-e613. [PMID: 37785841 DOI: 10.1016/j.ijrobp.2023.06.1988] [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] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The aim of this study was to develop a Health Equity Achievement in Radiation Therapy (HEART) score that can help identify patients at risk of experiencing suboptimal quality-of-care (QoC) early on in the patient-provider encounter and prior to initiation of treatment. Such a score may improve shared decision making to improve QoC. MATERIALS/METHODS A retrospective analysis was conducted using the National Cancer Database (NCDB) for prostate cancer cases between 2004-2017. Sociodemographic factors, clinical characteristics, and treatment information were collected. A composite HEART score was built to predict suboptimal QoC, defined as treatment refusal, incomplete treatment, or treatment delay. 70% of the data was allocated to training and 30% to validating a logistic regression model through which a nomogram was constructed. RESULTS A total of 1,599,785 patients were included in the analysis, of whom 126,917 (7.9%) had at least one suboptimal QoC. The strongest predictors were Black race, uninsured status, lower educational status, geographic location, and nodal disease (Table). The nomogram demonstrated a fair ability to predict quality metrics, with an area under the receiver operating characteristic curve (AUC) of 0.57 in the test group. The nomogram facilitated graphic interpretation of systemic factors in contributing to suboptimal QoC. CONCLUSION With observed potential for predicting suboptimal QoC outcomes in patients with prostate cancer by considering systemic barriers, this NCDB-based nomogram has potential utility as a tool for identifying patients who may benefit from additional social support, including the financial resources associated with these services, to improve access to care. Further validation in diverse datasets is needed to improve performance and generalizability to broader patient populations and different disease sites.
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Affiliation(s)
- A M Patel
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - E C Dee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Hubbard
- American Society for Radiation Oncology, Arlington, VA
| | | | - D K Ebner
- Rhode Island Hospital, Providence, RI
| | - S R Alcorn
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A LaVigne
- Johns Hopkins University School of Medicine, Baltimore, MA
| | - R F Kudner
- American Society for Radiation Oncology, Arlington, VA
| | - C Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - D Adler
- American Society for Radiation Oncology, Arlington, VA
| | - K Suggs
- American Society for Radiation Oncology, Arlington, VA
| | - A Greathouse
- American Society for Radiation Oncology, Arlington, VA
| | - M S Ludwig
- Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | - P L Nguyen
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - M R Waddle
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - R F Thompson
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - B A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - K Yamoah
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
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Patel TA, Dee EC, Jain B, Vapiwala N, Fayanju O, Santos P. Disparities in Breast-Conserving Therapy vs. Mastectomy among Asian American and Pacific Islander Women. Int J Radiat Oncol Biol Phys 2023; 117:e198-e199. [PMID: 37784843 DOI: 10.1016/j.ijrobp.2023.06.1071] [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] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Multiple randomized trials support the use of breast-conserving therapy (BCT), defined as lumpectomy followed by adjuvant radiotherapy, as an alternative to mastectomy for definitive treatment of early-stage (T1-2N0) breast cancer. However, data suggest that Asian American, Native Hawaiian, and Pacific Islander (AANHPI) may undergo mastectomy at higher rates than BCT and may experience barriers to receipt of BCT. The purpose of this study was to examine BCT utilization by disaggregated AANHPI groups to identify differences in receipt of mastectomy versus BCT. MATERIALS/METHODS The 2004-2017 National Cancer Database was queried to identify women age ≥18 years old diagnosed with cT1-2N0M0 breast cancer treated with either BCT or mastectomy without post-mastectomy radiation therapy. Women were classified based on self-reported race. Multivariable logistic regression defined adjusted odds ratios (OR) assessing the association between race and receipt of BCT versus mastectomy for all patients and separately by cT1-2 stage. All models were adjusted for relevant sociodemographic and clinical factors. RESULTS Of 794,403 women with cT1-2N0M0 breast cancer, 239,801 (30%) received mastectomy and 554,602 (70%) received BCT. After adjusting for clinical and sociodemographic factors, AANHPI women had greater odds of receiving mastectomy over BCT, compared to White women (OR [95% CI], 1.35 [1.30-1.39]; p<0.001). In contrast, Black women were less likely than White women to receive mastectomy (0.86 [0.84-0.87]; p<0.001). Upon disaggregation, Chinese, Japanese, Filipino, Korean, Vietnamese, and Asian Indian & Pakistani women were more likely to receive mastectomy over BCT compared to White women (p<0.001 for all). Treatment at academic (1.30 [1.27-1.32]), integrated (1.24 [1.21-1.27]), and comprehensive community cancer centers (1.15 [1.13-1.17]) were all associated with greater odds of mastectomy compared to treatment at community cancer programs (all p<0.001). Greater distance from treatment facility (≥50 mi. vs. 0 to <10 mi. [reference], OR 1.50 [1.47-1.53]) and cT2 disease (1.85 [1.82-1.87]) were also associated with greater odds of receiving mastectomy (all p<0.001). CONCLUSION In this evaluation of women with early-stage breast cancer, women from several AANHPI groups were more likely to receive mastectomy (as opposed to BCT) compared to White women. While sociocultural preferences, differences in access to and interest in reconstruction, as well as prevalent tumor-to-breast ratios may partially explain the disparities, collectively our data suggest an ongoing need for greater patient involvement in shared-decision making, particularly in vulnerable and understudied Asian populations.
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Affiliation(s)
- T A Patel
- University of Pennsylvania, Philadelphia, PA
| | - E C Dee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - B Jain
- Massachusetts Institute of Technology, Cambridge, MA
| | - N Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - O Fayanju
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - P Santos
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Dee EC, Swami N, Li BT, Florez N, Gomez DR. Disparities in Stage at Presentation among Hispanic and Latinx Patients with Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e14. [PMID: 37784710 DOI: 10.1016/j.ijrobp.2023.06.677] [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] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Hispanic and Latinx people in the United States comprise 19% of the population and are the fastest-growing ethnic group. However, prior studies in non-small cell lung cancer (NSCLC) often analyze these diverse communities in aggregate. We aimed to identify differences in NSCLC stage at diagnosis in the US population, with a particular focus on disaggregated Hispanic populations. MATERIALS/METHODS Data from the National Cancer Database (NCDB) from 2004 to 2018 were used to identify patients with primary NSCLC. Individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression adjusting for age, facility type, income, educational attainment, comorbidity index, insurance, and year of diagnosis was used to create adjusted odds ratios (aORs), with higher odds representing diagnosis at later-stage NSCLC. RESULTS Out of 1,773,177 patients with NSCLC, 50,512 were Hispanic/Latinx (2.8%). Hispanic patients were less likely to be insured (χ2 P<0.001) and were more likely to live in lower-income ZIP codes (χ2 P<0.001). Hispanic patients were more likely to be diagnosed with metastatic disease compared to non-Hispanic White (NHW) patients: 47% for Hispanic Black (HB), 46% Hispanic White (HW), and 44.3% of Hispanic other (HO) patients vs. 39.1% of NHW patients (aORs for later-stage disease with NHW as reference: HW 1.23, HB 1.26, HO 1.14, P<0.001 for all). Upon disaggregation by country of origin, 51.4% of Mexican, 41.7% of Puerto Rican, 44.6% of Cuban, 50.8% of South or Central American, 48.4% of Dominican, and 45.6% of Other Hispanic patients were diagnosed with metastatic disease, compared with 39.1% of NHW patients. Conversely, 20.2% of Mexican, 26.9% of Puerto Rican, 24.2% of Cuban, 22.5% of South or Central American, 23.7% of Dominican, and 24.5% of Other Hispanic patients were diagnosed with stage I disease, compared with 30.0% of NHW patients. On multivariable analysis, all Hispanic groups were more likely to present with later-stage NSCLC than NHW patients, with the greatest odds for Mexican patients (aOR 1.45, P<0.001). CONCLUSION Hispanic/Latinx patients with non-small cell lung cancer were more likely to be diagnosed with more advanced disease compared with non-Hispanic White patients. Disparities persisted upon disaggregation by both race and country of origin, with over half of Mexican patients with metastatic disease at diagnosis. Disparities amongst Hispanic groups by race and by country of origin highlight the shortcomings of treating these groups as a monolith and underscore the need for disaggregated research and targeted interventions. Further work should explore differences in exposures, behaviors, and access to care that may underlie these disparities.
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Affiliation(s)
- E C Dee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Swami
- University of Massachusetts Chan Medical School, Worcester, MA
| | - B T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Florez
- Dana-Farber Cancer Institute, Boston, MA
| | - D R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Jain B, Bajaj SS, Patel TA, Vapiwala N, Lam MB, Mahal BA, Muralidhar V, Amen TB, Nguyen PL, Sanford NN, Dee EC. Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups. Ann Surg Oncol 2023; 30:5495-5505. [PMID: 37017832 PMCID: PMC10075171 DOI: 10.1245/s10434-023-13339-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/19/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Vast differences in barriers to care exist among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups and may manifest as disparities in stage at presentation and access to treatment. Thus, we characterized AANHPI patients with stage 0-IV colon cancer and examined differences in (1) stage at presentation and (2) time to surgery relative to white patients. PATIENTS AND METHODS We assessed all patients in the National Cancer Database (NCDB) with stage 0-IV colon cancer from 2004 to 2016 who identified as white, Chinese, Japanese, Filipino, Native Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, and Pacific Islander. Multivariable ordinal logistic regression defined adjusted odds ratios (AORs), with 95% confidence intervals (CI), of (1) patients presenting with advanced stage colon cancer and (2) patients with stage 0-III colon cancer receiving surgery at ≥ 60 days versus 30-59 days versus < 30 days postdiagnosis, adjusting for sociodemographic/clinical factors. RESULTS Among 694,876 patients, Japanese [AOR 1.08 (95% CI 1.01-1.15), p < 0.05], Filipino [AOR 1.17 (95% CI 1.09-1.25), p < 0.001], Korean [AOR 1.09 (95% CI 1.01-1.18), p < 0.05], Laotian [AOR 1.51 (95% CI 1.17-1.95), p < 0.01], Kampuchean [AOR 1.33 (95% CI 1.04-1.70), p < 0.01], Thai [AOR 1.60 (95% CI 1.22-2.10), p = 0.001], and Pacific Islander [AOR 1.41 (95% CI 1.20-1.67), p < 0.001] patients were more likely to present with more advanced colon cancer compared with white patients. Chinese [AOR 1.27 (95% CI 1.17-1.38), p < 0.001], Japanese [AOR 1.23 (95% CI 1.10-1.37], p < 0.001], Filipino [AOR 1.36 (95% CI 1.22-1.52), p < 0.001], Korean [AOR 1.16 (95% CI 1.02-1.32), p < 0.05], and Vietnamese [AOR 1.55 (95% CI 1.36-1.77), p < 0.001] patients were more likely to experience greater time to surgery than white patients. Disparities persisted when comparing among AANHPI subgroups. CONCLUSIONS Our findings reveal key disparities in stage at presentation and time to surgery by race/ethnicity among AANHPI subgroups. Heterogeneity upon disaggregation underscores the importance of examining and addressing access barriers and clinical disparities.
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Affiliation(s)
- Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Miranda B Lam
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Kaiser Permanente Northwest, Portland, OR, USA
| | - Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Nasari A, Nasari AS, Marzouk S, Dee EC, Jahanbeen F. Cancer Care in Afghanistan: Perspectives on Health Services Under the Taliban Regime. JCO Glob Oncol 2023; 9:e2300358. [PMID: 37972331 PMCID: PMC10846784 DOI: 10.1200/go.23.00358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023] Open
Abstract
Cancer landscape in Afghanistan continues to suffer under Taliban—global support is essential.
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Affiliation(s)
- Alaha Nasari
- Alaha Nasari, BA, Harvard University, Cambridge, MA; Amina Surosh Nasari, MD, CUNY School of Medicine, New York, NY; Sammer Marzouk, MA, Harvard University, Cambridge, MA; Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Faramarz Jahanbeen, MD, MBA, MPH, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Amina Surosh Nasari
- Alaha Nasari, BA, Harvard University, Cambridge, MA; Amina Surosh Nasari, MD, CUNY School of Medicine, New York, NY; Sammer Marzouk, MA, Harvard University, Cambridge, MA; Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Faramarz Jahanbeen, MD, MBA, MPH, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sammer Marzouk
- Alaha Nasari, BA, Harvard University, Cambridge, MA; Amina Surosh Nasari, MD, CUNY School of Medicine, New York, NY; Sammer Marzouk, MA, Harvard University, Cambridge, MA; Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Faramarz Jahanbeen, MD, MBA, MPH, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Edward Christopher Dee
- Alaha Nasari, BA, Harvard University, Cambridge, MA; Amina Surosh Nasari, MD, CUNY School of Medicine, New York, NY; Sammer Marzouk, MA, Harvard University, Cambridge, MA; Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Faramarz Jahanbeen, MD, MBA, MPH, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Faramarz Jahanbeen
- Alaha Nasari, BA, Harvard University, Cambridge, MA; Amina Surosh Nasari, MD, CUNY School of Medicine, New York, NY; Sammer Marzouk, MA, Harvard University, Cambridge, MA; Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Faramarz Jahanbeen, MD, MBA, MPH, Harvard T.H. Chan School of Public Health, Boston, MA
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Patel TA, Jain B, Eala MAB, Manlongat KD, Vapiwala N, Celi LA, Dee EC. Disparities in Receipt of Mental Health Services and Mental Distress Among Patients with Chronic Obstructive Pulmonary Disease. J Gen Intern Med 2023; 38:2849-2851. [PMID: 37349638 PMCID: PMC10506969 DOI: 10.1007/s11606-023-08273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Leo Anthony Celi
- Harvard Medical School, Boston, MA, USA.
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Ravella R, Dee EC, Corti C, Celi LA, Iyengar P. Broadening the scope of artificial intelligence in oncology. Lancet Reg Health Am 2023; 25:100573. [PMID: 37644992 PMCID: PMC10460984 DOI: 10.1016/j.lana.2023.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Revathi Ravella
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Chiara Corti
- Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Puneeth Iyengar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Jain B, Bajaj SS, Patel TA, Vapiwala N, Lam MB, Mahal BA, Muralidhar V, Amen TB, Nguyen PL, Sanford NN, Dee EC. ASO Visual Abstract: Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups. Ann Surg Oncol 2023; 30:5509-5510. [PMID: 37330450 DOI: 10.1245/s10434-023-13699-7] [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] [Indexed: 06/19/2023]
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Patel TA, Jain B, Dee EC, Gomez SL, Vapiwala N, Chino F, Fayanju OM. Delays in Time to Surgery Among Asian and Pacific Islander Women with Breast Cancer. Ann Surg Oncol 2023; 30:5337-5340. [PMID: 37365415 PMCID: PMC10869161 DOI: 10.1245/s10434-023-13806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Rena Rowan Breast Center, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
- Penn Center for Cancer Care Innovation (PC3I), Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, PA, USA.
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Cho HL, Perni S, D'Amico AV, Yamoah K, Dee EC. The imperative for clinical trial diversity: Perspectives in the context of prostate-specific membrane antigen-targeted imaging. Prostate Cancer Prostatic Dis 2023; 26:511-515. [PMID: 36872319 DOI: 10.1038/s41391-023-00657-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Affiliation(s)
| | - Subha Perni
- Departments of Radiation Oncology and Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Kosj Yamoah
- Department of Radiation Oncology, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Jain B, Bajaj SS, Patel TA, Vapiwala N, Lam MB, Mahal BA, Muralidhar V, Amen TB, Nguyen PL, Sanford NN, Dee EC. ASO Author Reflections: Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders. Ann Surg Oncol 2023; 30:5506-5508. [PMID: 37120487 DOI: 10.1245/s10434-023-13560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Miranda B Lam
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brandon A Mahal
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Kaiser Permanente Northwest, Portland, OR, USA
| | - Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Dee EC. The acknowledgment of death. Lancet 2023; 402:609-610. [PMID: 37597883 DOI: 10.1016/s0140-6736(23)01228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/12/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Lee YHA, Chan JSK, Leung CH, Hui JMH, Dee EC, Ng K, Liu K, Liu T, Tse G, Ng CF. Association between serum uric acid and prostate cancer mortality in androgen deprivation therapy: A population-based cohort study. Cancer Med 2023; 12:17056-17060. [PMID: 37455552 PMCID: PMC10501275 DOI: 10.1002/cam4.6344] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/10/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE This population-based study examined the association between baseline uric acid (UA) and prostate cancer (PCa)-related mortality amongst PCa patients receiving androgen deprivation therapy (ADT). METHODS Adults with PCa who received ADT in Hong Kong between December 1999 and March 2021 were identified. Patients with missing baseline UA were excluded. Patients were followed up until September 2021. The outcome was PCa-related mortality. RESULTS Altogether, 4126 patients (median follow-up 3.1[interquartile range 1.4-6.0] years) were included. A J-shaped association was observed between baseline UA level and PCa-related mortality risk, with a direct association in those with mean(0.401 mmol/L) or above-mean baseline UA levels (hazard ratio (HR) per standard deviation-increase 1.35 [95% confidence interval 1.21,1.51], p < 0.001), and an inverse association in those with below-mean baseline UA levels (HR 0.78[0.67,0.92], p = 0.003). The former remained significant on competing risk regression, but not the latter. CONCLUSIONS A J-shaped relationship between baseline UA level and PCa-related mortality risk was identified. This study was mainly limited by potential unmeasured and residual confounders. Further validation studies are warranted.
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Affiliation(s)
- Yan Hiu Athena Lee
- Cardio‐oncology Research UnitCardiovascular Analytics Group, PowerHealth LimitedHong KongChina
- SH Ho Urology Centre, Department of Surgery, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Jeffrey Shi Kai Chan
- Cardio‐oncology Research UnitCardiovascular Analytics Group, PowerHealth LimitedHong KongChina
| | - Chi Ho Leung
- SH Ho Urology Centre, Department of Surgery, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Jeremy Man Ho Hui
- Cardio‐oncology Research UnitCardiovascular Analytics Group, PowerHealth LimitedHong KongChina
| | - Edward Christopher Dee
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Kenrick Ng
- Department of Medical OncologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Kang Liu
- SH Ho Urology Centre, Department of Surgery, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Gary Tse
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
- Kent and Medway Medical SchoolCanterburyKentUK
- School of Nursing and Health StudiesHong Kong Metropolitan UniversityHong KongChina
| | - Chi Fai Ng
- SH Ho Urology Centre, Department of Surgery, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
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Hougen HY, Swami N, Dee EC, Alshalalfa M, Meiyappan K, Florez N, Penedo FJ, Nguyen PL, Punnen S, Mahal BA. Disparities in Diagnosis, Treatment Access, and Time to Treatment Among Hispanic Men With Metastatic Prostate Cancer. JCO Oncol Pract 2023; 19:645-653. [PMID: 37262399 PMCID: PMC10424902 DOI: 10.1200/op.23.00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE Reporting racial/ethnic disparities in aggregate obscures within-group heterogeneity. We sought to identify disparities in diagnosis and treatment in Hispanic subpopulations with metastatic prostate cancer (mPCa). METHODS We disaggregated men with prostate adenocarcinoma from the National Cancer Database from 2004 to 2017 by racial subgroup and Hispanic background. We assessed (1) presenting with mPCa, (2) receiving any treatment, and (3) receiving delayed treatment beyond 90 days. Logistic regression and adjusted odds ratios (aOR) were reported. RESULTS Hispanic men had greater odds of presenting with mPCa (aOR, 1.54; 95% CI, 1.50 to 1.58; P < .001) compared with non-Hispanic White (NHW) men. All Hispanic racial subgroups were more likely to present with mPCa, with the highest risk in Hispanic Black (HB) men (aOR, 1.68; 95% CI, 1.46 to 1.93; P < .01). Men from all Hispanic backgrounds had higher odds of presenting with mPCa, especially Mexican men (aOR, 1.99; 95% CI, 1.86 to 2.12; P < .01). Hispanic men were less likely to receive any treatment (aOR, 0.60; 95% CI, 0.53 to 0.67; P < .001), and this effect was particularly strong for Hispanic White patients (aOR, 0.58; 95% CI, 0.52 to 0.66; P < .001) and Dominican men (aOR, 0.52; 95% CI, 0.28 to 0.98; P = .044). Hispanic men were more likely to experience treatment delays compared with NHW men (aOR, 1.38; 95% CI, 1.26 to 1.52; P < .001) and in particular HB (aOR, 1.83; 95% CI, 1.22 to 2.75; P = .002) and South/Central American men (aOR, 1.48; 95% CI, 1.07 to 2.04; P = .018). CONCLUSION Differences exist in stage at presentation, treatment receipt, and delays in treatment on disaggregation by racial subgroup and Hispanic heritage. We need to study the potential mechanisms of the observed variations to help develop targeted interventions.
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Affiliation(s)
- Helen Y. Hougen
- Desai Sethi Urology Institute, University of Miami, Miami, FL
| | - Nishwant Swami
- University of Massachusetts Chan Medical School, Worcester, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | | | - Narjust Florez
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Frank J. Penedo
- Departments of Psychology and Medicine, University of Miami Miller School of Medicine and College of Arts and Sciences, Miami, FL
| | - Paul L. Nguyen
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami, Miami, FL
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Brandon A. Mahal
- Sylvester Comprehensive Cancer Center, Miami, FL
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL
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Ornos ED, Cando LF, Catral CD, Quebral EP, Tantengco OA, Arevalo MVP, Dee EC. Molecular basis of sex differences in cancer: Perspective from Asia. iScience 2023; 26:107101. [PMID: 37404373 PMCID: PMC10316661 DOI: 10.1016/j.isci.2023.107101] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Cancer is a leading cause of mortality and morbidity globally. Sex differences in cancer are evident in death rates and treatment responses in several cancers. Asian patients have unique cancer epidemiology influenced by their genetic ancestry and sociocultural factors in the region. In this review, we show molecular associations that potentially mediate sex disparities observed in cancer in Asian populations. Differences in sex characteristics are evident at the cytogenetic, genetic, and epigenetic levels mediating processes that include cell cycle, oncogenesis, and metastasis. Larger clinical and in vitro studies that explore mechanisms can confirm the associations of these molecular markers. In-depth studies of these markers can reveal their importance as diagnostics, prognostics, and therapeutic efficacy markers. Sex differences should be considered in designing novel cancer therapeutics in this era of precision medicine.
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Affiliation(s)
- Eric David Ornos
- Department of Medical Microbiology, College of Public Health, University of the Philippines Manila, Manila 1000, Philippines
- College of Medicine, University of the Philippines Manila, Manila, 1000, Philippines
| | - Leslie Faye Cando
- College of Medicine, University of the Philippines Manila, Manila, 1000, Philippines
| | | | - Elgin Paul Quebral
- College of Medicine, University of the Philippines Manila, Manila, 1000, Philippines
- Virology Laboratory, Department of Medical Microbiology, College of Public Health, University of the Philippines Manila, Manila 1000, Philippines
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
| | - Ourlad Alzeus Tantengco
- College of Medicine, University of the Philippines Manila, Manila, 1000, Philippines
- Department of Physiology, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
- Department of Biology, College of Science, De La Salle University, Manila 0922, Philippines
| | | | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10028, USA
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Abstract
Sex disparities in cancer exist along the cancer spectrum, ranging from genomic predisposition and behavioral risk factors to access to screening, diagnostics, treatment, and survivorship care. A growing body of research is studying the biological underpinnings of these differences, from cancer risk to tumor biology to treatment response. It is well known, however, that the social determinants of health play a large role across the cancer disease continuum, which encompasses risk, prevention, diagnosis, treatment, survivorship, rehabilitation, and palliative care. Less literature focuses on the gendered disparities that are epidemiologic in nature, especially in Southeast Asia (SEA), a diverse region that is home to nearly 670 million people, where most are lower middle income countries, and where socioeconomic and cultural factors increase cancer risk for women. In this review, we highlight the social drivers of gendered disparities, namely the geographic, environmental, sociocultural, economic, and political forces that contribute to the increased mortality and poorer health outcomes in the region.
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Affiliation(s)
| | | | | | - Eric David B. Ornos
- College of Medicine, University of the Philippines, 1000 Manila, Philippines
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Michelle Ann B. Eala
- College of Medicine, University of the Philippines, 1000 Manila, Philippines
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Patel TA, Dee EC, Jain B, Vapiwala N, Santos PMG, Fayanju OM. Disparities in Breast-Conserving Therapy Versus Mastectomy Among Asian American and Pacific Islander Women. Ann Surg Oncol 2023; 30:3894-3897. [PMID: 37014557 PMCID: PMC10431949 DOI: 10.1245/s10434-023-13315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/20/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Patricia Mae G Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Chan JSK, Lau DHH, King E, Roever L, Liu T, Shum YKL, Ng K, Dee EC, Ciobanu A, Bazoukis G, Mahmoudi E, Satti DI, Jeevaratnam K, Baranchuk A, Tse G. Virtual medical research mentoring. Clin Teach 2023:e13598. [PMID: 37354017 DOI: 10.1111/tct.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 06/05/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Medical research is important for professional advancement, and mentoring is a key means by which students and early-career doctors can engage in research. Contrasting international research collaborations, research mentoring programmes are often geographically limited. As the COVID-19 pandemic has led to increased use of online technology for classes and conferences, a virtual, international approach to medical research mentoring may be valuable. APPROACH We hereby describe our experience at the Cardiovascular Analytics Group, a virtual international medical research mentoring group established in 2015. We make use of virtual platforms in multi-level mentoring with peer mentoring and emphasise active participation, early leadership, an open culture, accessible research support and a distributed research workflow. EVALUATION With 63 active members from 14 different countries, the Group has been successful in training medical students and early-career medical graduates in academic medicine. Our members have led over 100 peer-reviewed publications of original research and reviews since 2015, winning 13 research prizes during this time. IMPLICATIONS Our accessible-distributed model of virtual international medical research collaboration and multi-level mentoring is viable and efficient and caters to the needs of contemporary healthcare. Others should consider building similar models to improve medical research mentoring globally.
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Affiliation(s)
| | | | - Emma King
- Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
| | - Leonardo Roever
- Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
- Departamento de Pesquisa Clinica, Universidade Federal de Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Tong Liu
- Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | | | - Kenrick Ng
- Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Edward Christopher Dee
- Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, Manhattan, New York, USA
| | - Ana Ciobanu
- Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine and Cardiology, Theodor Burghele Clinical Hospital, Bucharest, Romania
| | - George Bazoukis
- Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
- Medical School, University of Nicosia, Nicosia, Cyprus
| | - Elham Mahmoudi
- Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
- Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Danish Iltaf Satti
- Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Kamalan Jeevaratnam
- Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Adrian Baranchuk
- Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
- Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Kent and Medway Medical School, Canterbury, UK
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong
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Ranganathan S, Tomar V, Chino F, Jain B, Patel TA, Dee EC, Mathew A. A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India. Support Care Cancer 2023; 31:420. [PMID: 37354234 DOI: 10.1007/s00520-023-07886-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
In India, approximately 1.4 million new cases of cancer are recorded annually, with 26.7 million people living with cancer in 2021. Providing care for family members with cancer impacts caregivers' health and financial resources. Effects on caregivers' health and financial resources, understood as family and caregiver "financial toxicity" of cancer, are important to explore in the Indian context, where family members often serve as caregivers, in light of cultural attitudes towards family. This is reinforced by other structural issues such as grave disparities in socioeconomic status, barriers in access to care, and limited access to supportive care services for many patients. Effects on family caregivers' financial resources are particularly prevalent in India given the increased dependency on out-of-pocket financing for healthcare, disparate access to insurance coverage, and limitations in public expenditure on healthcare. In this paper, we explore family and caregiver financial toxicity of cancer in the Indian context, highlighting the multiple psychosocial aspects through which these factors may play out. We suggest steps forward, including future directions in (1) health services research, (2) community-level interventions, and (3) policy changes. We underscore that multidisciplinary and multi-sectoral efforts are needed to study and address family and caregiver financial toxicity in India.
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Affiliation(s)
| | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiation Oncology and Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Aju Mathew
- Department of Oncology, MOSC Medical College, Ernakulam, Kerala, 682311, India
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Dee EC, Ho FDV, Yee K, Lin VK. Survivorship Care for People With Cancer in the Indo-Pacific: The Imperative to Harness Political Determinants, International Exchange, and Technological Innovation. JCO Glob Oncol 2023; 9:e2300052. [PMID: 37290023 PMCID: PMC10497291 DOI: 10.1200/go.23.00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 06/10/2023] Open
Affiliation(s)
- Edward Christopher Dee
- Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Frances Dominique V. Ho, BSc, College of Medicine, University of the Philippines, Manila, Philippines; Kaisin Yee, BSc, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore; and Vivian K. Lin, DrPH, MPH, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Frances Dominique V. Ho
- Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Frances Dominique V. Ho, BSc, College of Medicine, University of the Philippines, Manila, Philippines; Kaisin Yee, BSc, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore; and Vivian K. Lin, DrPH, MPH, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Kaisin Yee
- Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Frances Dominique V. Ho, BSc, College of Medicine, University of the Philippines, Manila, Philippines; Kaisin Yee, BSc, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore; and Vivian K. Lin, DrPH, MPH, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Vivian K. Lin
- Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Frances Dominique V. Ho, BSc, College of Medicine, University of the Philippines, Manila, Philippines; Kaisin Yee, BSc, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore; and Vivian K. Lin, DrPH, MPH, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
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46
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Dee EC. Family and Caregiver Financial Toxicity Associated With Cancer-A Global, Inequitable, and Urgent Consideration. JAMA Netw Open 2023; 6:e2319317. [PMID: 37347488 DOI: 10.1001/jamanetworkopen.2023.19317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Chung CT, Lakhani I, Chou OHI, Lee TTL, Dee EC, Ng K, Wong WT, Liu T, Lee S, Zhang Q, Cheung BMY, Tse G, Zhou J. Sodium-glucose cotransporter 2 inhibitors versus dipeptidyl peptidase 4 inhibitors on new-onset overall cancer in Type 2 diabetes mellitus: A population-based study. Cancer Med 2023; 12:12299-12315. [PMID: 37148547 PMCID: PMC10278500 DOI: 10.1002/cam4.5927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/07/2023] [Accepted: 03/30/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Cancer is currently the second leading cause of death globally. There is much uncertainty regarding the comparative risks of new-onset overall cancer and pre-specified cancer for Type 2 diabetes mellitus (T2DM) patients on sodium-glucose cotransporter 2 inhibitors (SGLT2I) versus DPP4I. METHODS This population-based cohort study patients included patients who were diagnosed with T2DM and administered either SGLT2 or DPP4 inhibitors between 1 January 2015 and 31 December 2020 in public hospitals of Hong Kong. RESULTS This study included 60,112 T2DM patients (mean baseline age: 62.1 ± 12.4 years, male: 56.36%), of which 18,167 patients were SGLT2I users and 41,945 patients were dipeptidyl peptidase 4 inhibitor (DPP4I) users. Multivariable Cox regression found that SGLT2I use was associated with lower risks of all-cause mortality (HR: 0.92; 95% CI: 0.84-0.99; p= 0.04), cancer-related mortality (HR: 0.58; 95% CI: 0.42-0.80; p ≤ 0.001) and new diagnoses of any cancer (HR: 0.70; 95% CI: 0.59-0.84; p ≤ 0.001). SGLT2I use was associated with a lower risk of new-onset breast cancer (HR: 0.51; 95% CI: 0.32-0.80; p ≤ 0.001), but not of other malignancies. Subgroup analysis on the type of SGLT2I, dapagliflozin (HR: 0.78; 95% CI: 0.64-0.95; p = 0.01) and ertugliflozin (HR: 0.65; 95% CI: 0.43-0.98; p = 0.04) use was associated with lower risks of new cancer diagnosis. Dapagliflozin use was also linked to lower risks of breast cancer (HR: 0.48; 95% CI: 0.27-0.83; p = 0.001). CONCLUSION Sodium-glucose cotransporter 2 inhibitor use was associated with lower risks of all-cause mortality, cancer-related mortality and new-onset overall cancer compared to DPP4I use after propensity score matching and multivariable adjustment.
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Affiliation(s)
- Cheuk To Chung
- Diabetes Research UnitCardiovascular Analytics Group, China‐UK CollaborationHong KongChina
| | - Ishan Lakhani
- Diabetes Research UnitCardiovascular Analytics Group, China‐UK CollaborationHong KongChina
| | - Oscar Hou In Chou
- Diabetes Research UnitCardiovascular Analytics Group, China‐UK CollaborationHong KongChina
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, LKS Faculty of MedicineThe University of Hong KongHong KongChina
| | - Teddy Tai Loy Lee
- Diabetes Research UnitCardiovascular Analytics Group, China‐UK CollaborationHong KongChina
| | - Edward Christopher Dee
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Kenrick Ng
- Department of Medical OncologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Wing Tak Wong
- School of Life SciencesChinese University of Hong KongHong KongChina
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Sharen Lee
- Diabetes Research UnitCardiovascular Analytics Group, China‐UK CollaborationHong KongChina
| | - Qingpeng Zhang
- School of Data ScienceCity University of Hong KongHong KongChina
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, LKS Faculty of MedicineThe University of Hong KongHong KongChina
| | - Gary Tse
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
- Kent and Medway Medical SchoolUniversity of Kent and Canterbury Christ Church UniversityCanterburyUK
- School of Nursing and Health StudiesHong Kong Metropolitan UniversityHong KongChina
| | - Jiandong Zhou
- Diabetes Research UnitCardiovascular Analytics Group, China‐UK CollaborationHong KongChina
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
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Asdourian MS, Jacoby TV, Shah N, Otto T, Thompson LL, Dee EC, Reynolds KL, Semenov YR, Chen ST. Noncutaneous immune-related adverse events predict overall and progression-free survival in patients with cutaneous toxicities after immune checkpoint inhibitor therapy. J Am Acad Dermatol 2023; 88:1368-1370. [PMID: 36736625 PMCID: PMC10758294 DOI: 10.1016/j.jaad.2022.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/24/2022] [Accepted: 12/12/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Maria S Asdourian
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ted V Jacoby
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii
| | - Nishi Shah
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Tracey Otto
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Leah L Thompson
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kerry L Reynolds
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Yevgeniy R Semenov
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven T Chen
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
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Chan JSK, Satti DI, Lee YHA, Hui JMH, Dee EC, Ng K, Liu K, Tse G, Ng CF. Temporal trends in cardiovascular burden among patients with prostate cancer receiving androgen deprivation therapy: a population-based cohort study. Br J Cancer 2023; 128:2253-2260. [PMID: 37076564 PMCID: PMC10241887 DOI: 10.1038/s41416-023-02271-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Although androgen deprivation therapy (ADT) is associated with cardiovascular risks, the extent and temporal trends of cardiovascular burden amongst patients with prostate cancer receiving ADT are unclear. METHODS This retrospective cohort study analyzed adults with PCa receiving ADT between 1993-2021 in Hong Kong, with follow-up until 31/9/2021 for the primary outcome of major adverse cardiovascular events (MACE; composite of cardiovascular mortality, myocardial infarction, stroke, and heart failure), and the secondary outcome of mortality. Patients were stratified into four groups by the year of ADT initiation for comparisons. RESULTS Altogether, 13,537 patients were included (mean age 75.5 ± 8.5 years old; mean follow-up 4.7 ± 4.3 years). More recent recipients of ADT had more cardiovascular risk factors and used more cardiovascular or antidiabetic medications. More recent recipients of ADT had higher risk of MACE (most recent (2015-2021) vs least recent (1993-2000) group: hazard ratio 1.33 [1.11, 1.59], P = 0.002; Ptrend < 0.001), but lower risk of mortality (hazard ratio 0.76 [0.70, 0.83], P < 0.001; Ptrend < 0.001). The 5-year risk of MACE and mortality for the most recent group were 22.5% [20.9%, 24.2%] and 52.9% [51.3%, 54.6%], respectively. CONCLUSIONS Cardiovascular risk factors were increasingly prevalent amongst patients with prostate cancer receiving ADT, with increasing risk of MACE despite decreasing mortality.
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Affiliation(s)
- Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong-United Kingdom-China collaboration, Hong Kong, China
| | - Danish Iltaf Satti
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong-United Kingdom-China collaboration, Hong Kong, China
| | - Yan Hiu Athena Lee
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong-United Kingdom-China collaboration, Hong Kong, China
- Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremy Man Ho Hui
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong-United Kingdom-China collaboration, Hong Kong, China
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kenrick Ng
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kang Liu
- Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Gary Tse
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong-United Kingdom-China collaboration, Hong Kong, China.
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, 300211, Tianjin, China.
- Kent and Medway Medical School, Canterbury, Kent, CT2 7NT, UK.
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
| | - Chi Fai Ng
- Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
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Legaspi KEY, Dychiao RGK, Dee EC, Kho-Dychiao RM, Ho FDV. Pediatric asthma in the Philippines: risk factors, barriers, and steps forward across the child's life stages. Lancet Reg Health West Pac 2023; 35:100806. [PMID: 37424689 PMCID: PMC10326682 DOI: 10.1016/j.lanwpc.2023.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 07/11/2023]
Affiliation(s)
| | | | | | - Roslyn Marie Kho-Dychiao
- Department of Pediatrics, Section of Pediatric Pulmonology, Philippine General Hospital, 1000 Manila, Philippines
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