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Gillis A, Zmijewski P, Mcleod MC, Lindeman B, Fazendin J, Chen H, Bhatia S. Racial implications of time to surgery in disparities in thyroid cancer survival. Am J Surg 2024:S0002-9610(24)00063-1. [PMID: 38519403 DOI: 10.1016/j.amjsurg.2024.02.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION The influence of time to surgery on racial/ethnic disparities in papillary thyroid carcinoma (PTC) survival remains unstudied. MATERIALS AND METHODS The National Cancer Database (2004-2017) was queried for patients with localized PTC. Survival data was compared by time to surgery, patient demographics, and multivariable Cox regression was performed. RESULTS Of 126,708 patients included, 5% were Black, 10% Hispanic. Of all patients, 85% had no comorbidities. Non-Hispanic White (NHW) patients had a shorter median time to surgery than Black and Hispanic patients (36 vs. 43 vs. 42 days, respectively p < 0.001). In multivariable analysis, longer time to surgery (>90 days vs < 30 days) and Black race vs NHW, were associated with worse survival (HR: 1.56, (95%CI, 1.43-1.70), p < 0.001 and HR: 1.21, (1.08-1.36), p = 0.001), respectively. CONCLUSION Delaying surgery for thyroid cancer is associated with worse survival. However, independent of time to surgery and other confounders, there remains a disparity as black patients have poorer outcomes.
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Affiliation(s)
- Andrea Gillis
- University of Alabama At Birmingham, Department of General Surgery, USA.
| | - Polina Zmijewski
- University of Alabama At Birmingham, Department of General Surgery, USA
| | - M Chandler Mcleod
- University of Alabama At Birmingham, Department of General Surgery, USA
| | - Brenessa Lindeman
- University of Alabama At Birmingham, Department of General Surgery, USA
| | - Jessica Fazendin
- University of Alabama At Birmingham, Department of General Surgery, USA
| | - Herbert Chen
- University of Alabama At Birmingham, Department of General Surgery, USA
| | - S Bhatia
- University of Alabama At Birmingham, Department of General Pediatrics, USA
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Resnicow K, Patel MR, Mcleod MC, Katz SJ, Jagsi R. Physician attitudes about cost consciousness for breast cancer treatment: differences by cancer sub-specialty. Breast Cancer Res Treat 2019; 173:31-36. [PMID: 30259283 PMCID: PMC8968296 DOI: 10.1007/s10549-018-4976-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 06/12/2018] [Accepted: 09/20/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE High costs of cancer care place considerable burden on patients and society. Despite increasing recognition that providers should play a role in reducing care costs, how physicians across cancer specialties differ in their cost-consciousness has not been reported. We examined cost-consciousness regarding breast cancer care among medical oncologists, surgeons, and radiation oncologists. METHODS We identified 514 cancer surgeons, 504 medical oncologists, and 251 radiation oncologists by patient report through the iCanCare study. iCanCare identified newly diagnosed women with breast cancer through the Surveillance, Epidemiology, and End Results (SEER) registries of Georgia and Los Angeles. We queried providers on three dimensions of cost-consciousness: (1) perceived importance of cost saving for society, patients, practice, and payers; (2) awareness of patient out-of-pocket expenses; and (3) discussion of financial burden. RESULTS We received responses from 376 surgeons (73%), 304 medical oncologists (60%), and 169 radiation oncologists (67%). Overall levels of cost-consciousness were moderate, with scores ranging from 2.5 to 3.0 out of 5. After adjusting for covariates, surgeons had the lowest scores on all three cost-consciousness measures; medical oncologists had the highest scores. Pairwise contrasts showed surgeons had significantly lower scores than medical oncologists for all three measures and significantly lower scores than radiation oncologists for two of the three cost-consciousness variables: importance of cost saving and discussion of financial burden. CONCLUSIONS How cost-consciousness impacts medical decision-making across specialty and how policy, structural, and behavioral interventions might sensitize providers regarding cost-related matters merit further examination.
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Affiliation(s)
- Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 109 Observatory, Ann Arbor, MI, 48109, USA.
| | - Minal R Patel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 109 Observatory, Ann Arbor, MI, 48109, USA
| | - M Chandler Mcleod
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Steven J Katz
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Health Management, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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Katz SJ, Ward KC, Hamilton AS, Mcleod MC, Wallner LP, Morrow M, Jagsi R, Hawley ST, Kurian AW. Gaps in Receipt of Clinically Indicated Genetic Counseling After Diagnosis of Breast Cancer. J Clin Oncol 2018; 36:1218-1224. [PMID: 29528794 PMCID: PMC5908222 DOI: 10.1200/jco.2017.76.2369] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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] [Indexed: 01/07/2023] Open
Abstract
Purpose Little is known about the extent to which genetic counseling is integrated into community practices for patients newly diagnosed with breast cancer. We examined the receipt of clinically indicated genetic counseling in these patients. Patients and Methods We surveyed 5,080 patients between the ages of 20 and 79 years, diagnosed from July 2013 to August 2015 with early-stage breast cancer and reported to the SEER registries of Georgia and Los Angeles County. Surveys were linked to SEER clinical data and genetic test results. The study sample (N = 1,711) comprised patients with indications for formal genetic risk evaluation. Results Overall, 47.4% did not get tested, 40.7% tested negative, 7.4% had a variant of uncertain significance only, and 4.5% had a pathogenic mutation. Three quarters (74.6%) received some form of genetic counseling (43.5%, formal counseling and 31.1%, physician-directed discussion). Virtually all tested patients (96.1%) reported some form of genetic discussion (62.2%, formal counseling and 33.9%, physician-directed discussion). However, only one half (50.6%) of those not tested received any discussion about genetics. Younger women were more likely to report some type of counseling, controlling for other factors: odds ratio, 4.5 (95% CI, 2.6 to 8.0); 1.9 (95% CI, 1.1 to 3.3); and 1.5 (95% CI, 1.0 to 2.3) for women younger than 50 years of age, 50 to 59 years of age, and 60 to 69 years of age versus those 70 years of age and older. Patients' assessments of the amount of information they received about whether to get tested were similarly high whether they were counseled by a genetics expert or by a physician only (80.8% v 79.4% stated information was just right, P = .59). Conclusion Less than one half (43.5%) of patients with clinical indications received formal genetic counseling. There is a large gap between mandates for timely pretest formal genetic counseling in higher-risk patients and the reality of practice today.
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Affiliation(s)
- Steven J. Katz
- Steven J. Katz, M. Chandler Mcleod, Lauren P. Wallner, Reshma Jagsi, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; Allison W. Kurian, Stanford University, Stanford, CA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kevin C. Ward
- Steven J. Katz, M. Chandler Mcleod, Lauren P. Wallner, Reshma Jagsi, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; Allison W. Kurian, Stanford University, Stanford, CA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ann S. Hamilton
- Steven J. Katz, M. Chandler Mcleod, Lauren P. Wallner, Reshma Jagsi, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; Allison W. Kurian, Stanford University, Stanford, CA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Chandler Mcleod
- Steven J. Katz, M. Chandler Mcleod, Lauren P. Wallner, Reshma Jagsi, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; Allison W. Kurian, Stanford University, Stanford, CA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lauren P. Wallner
- Steven J. Katz, M. Chandler Mcleod, Lauren P. Wallner, Reshma Jagsi, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; Allison W. Kurian, Stanford University, Stanford, CA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica Morrow
- Steven J. Katz, M. Chandler Mcleod, Lauren P. Wallner, Reshma Jagsi, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; Allison W. Kurian, Stanford University, Stanford, CA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Reshma Jagsi
- Steven J. Katz, M. Chandler Mcleod, Lauren P. Wallner, Reshma Jagsi, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; Allison W. Kurian, Stanford University, Stanford, CA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sarah T. Hawley
- Steven J. Katz, M. Chandler Mcleod, Lauren P. Wallner, Reshma Jagsi, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; Allison W. Kurian, Stanford University, Stanford, CA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Allison W. Kurian
- Steven J. Katz, M. Chandler Mcleod, Lauren P. Wallner, Reshma Jagsi, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; Allison W. Kurian, Stanford University, Stanford, CA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
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