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(A) Lung cancer mortality among men, United States 2000–2010 and disparity ratio trend. (B) Lung cancer mortality among women, United States 2000–2010 and disparity ratio trend.
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Declining cancer incidence and mortality rates in the United States (U.S.) have continued through the first decade of the twenty-first century. Reductions in tobacco use, greater uptake of prevention measures, adoption of early detection methods, and improved treatments have resulted in improved outcomes for both men and women. However, Black Ameri...
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Citations
... 17,18 Other studies have also shown that socioeconomic factors can play a role in worse outcomes in patients with cancer. 19,20 It may be that integrated delivery systems mitigate traditional racial and socioeconomic health disparities for patients with cancer. 19 Asian and female patients were also found to have a lower risk of mortality than White and male patients in our study. ...
... were not associated with increased risk of mortality. African American and Asian/Pacific Islander patients were found to have a lower risk of mortality compared with White patients 95% CI, 11.61-40.20) in younger patients (age ,40 years) than in older ones (P ,.001 for interaction between ECOG PS and age). Similarly, ECOG PS 3 and 4 was more predictive of mortality (aHR, 27.66; 95% CI, 19.10-40.06) in patients with breast cancer compared with other types of cancer (P ,.001 for interaction between ECOG PS and cancer type) ...
Background: The ECOG performance status (PS) scale was developed to support national clinical trials, but the degree to which ECOG PS predicts clinical outcomes in patient subgroups outside of clinical trials is relatively unknown. This study examined associations between ECOG PS and adverse outcomes in a diverse community oncology population. Patients and Methods: In this retrospective cohort study, demographic and clinical characteristics, including the most recent ECOG PS between January 1, 2017, and December 31, 2019, were examined for patients receiving cancer treatment within Kaiser Permanente Northern California (KPNC). Proportional hazard models were used to evaluate the effect of ECOG PS on adverse outcomes. Results: A total of 21,730 patients were identified. Overall, most patients had an ECOG PS of 0 (42.5%) or 1 (42.5%). In multivariable analysis, an ECOG PS of 3 or 4 was associated with higher risk of 30-day emergency department visits (adjusted hazard ratio [aHR], 3.85; 95% CI, 3.47–4.26), 30-day hospitalizations (aHR, 4.70; 95% CI, 4.12–5.36), and 6-month mortality (aHR, 7.34; 95% CI, 6.64–8.11) compared with an ECOG PS of 0. Additionally, we found that upper gastrointestinal and stage IV cancers were associated with a higher risk of adverse outcomes compared with breast and stage I cancers, respectively. When adjusted for ECOG PS, African American race, Asian race, and female sex were associated with a lower risk of mortality than White race and male sex. An ECOG PS of 3 or 4 was more predictive of mortality in younger patients and those with breast cancer ( P <.001). Conclusions: ECOG PS and upper gastrointestinal and stage IV cancers were independently associated with increased risk of emergency department visits, hospitalizations, and mortality, whereas African American and Asian race and female sex were associated with decreased risk of mortality. An ECOG PS of 3 or 4 was more predictive of an increased risk of mortality in younger patients and patients with breast cancer. These findings can enhance the use of ECOG PS for clinical decision-making and defining eligibility for clinical trials.
... With that said, disparities in PBT utilization appear to be a reflection of the disparities in the health care system as a whole. 6 Several studies have made these revelations previously, but to our knowledge, none have isolated their analyses to centers with access to photons and protons alike. ...
... 25 Social inequities have always existed in health care, and several studies link ethnic minorities and lower income patients with poorer cancer outcomes. 6,26,27 Recent NCDB studies, using similar data to what we present here, also highlight racial and income inequities as it pertains to PBT utilization for breast, lung, and prostate cancer. [3][4][5] Notably, after mitigating the geographic bias as we have done in this study, nearly all of the previously reported socioeconomic discrepancies disappear for breast cancer and NSCLC, with the exception of race in breast cancer. ...
Purpose
To report demographic and clinical characteristics of patients who were more likely to receive proton beam therapy (PBT) than photon therapy from facilities with access to proton centers.
Materials and Methods
We utilized the national cancer database to identify the facilities with access to PBT between 2004 and 2015 and compared the relative usage of photons and PBT for demographic and clinical scenarios in breast, prostate, and nonsmall cell cancer.
Results
In total, 231 facilities with access to proton centers accounted for 168 323 breast, 39 975 lung, and 77 297 prostate cancer patients treated definitively. Proton beam therapy was used in 0.5%, 1.5%, and 8.9% of breast, lung, and prostate cases. Proton beam therapy was correlated with a farther distance traveled and longer start time from diagnosis for each site (P < .05).
For breast, demographic correlates of PBT were treatment in the west coast (odds ratio [OR] = 4.81), age <60 (OR = 1.25), white race (OR = 1.94), and metropolitan area (OR = 1.58). Left-sided cancers (OR = 1.28), N2 (OR = 1.71), non-ER+/PR+/Her2Neu− cancers (OR = 1.24), accelerated partial breast irradiation (OR = 1.98), and hypofractionation (OR = 2.35) were predictors of PBT.
For nonsmall cell cancer, demographic correlates of PBT were treatment in the south (OR = 2.6), metropolitan area (OR = 1.72), and Medicare insurance (OR = 1.64). Higher comorbid score (OR = 1.36), later year treated (OR = 3.16), and hypofractionation (not SBRT) (OR = 3.7) were predictors of PBT.
For prostate, correlates of PBT were treatment in the west coast (OR = 2.48), age <70 (OR = 1.19), white race (OR = 1.41), metropolitan area (OR = 1.25), higher income/education (OR = 1.25), and treatment at an academic center (OR = 33.94). Lower comorbidity score (OR = 1.42), later year treated (OR = 1.37), low-risk disease (OR = 1.45), definitive compared to postoperative (OR = 6.10), and conventional fractionation (OR = 1.64) were predictors of PBT.
Conclusion
Even for facilities with established referrals to proton centers, PBT utilization was low; socioeconomic status was potentially a factor. Proton beam therapy was more often used with left-sided breast and low-risk prostate cancers, without a clear clinical pattern in lung cancer.
... Disparities in US cancer incidence and outcomes have been well documented for a variety of communities, including populations defined by race/ethnicity, geography, age, and sexual orientation/gender identity, to name a few [6][7][8]. While strategies and frameworks for improving cancer equity have been published [9][10][11], the design and implementation of sustainable programs to mitigate cancer disparities at the institutional level is often nuanced and requires input from the communities at greatest risk for poor outcomes. ...
The Office of Cancer Health Equity at the Atrium Health Wake Forest Baptist Comprehensive Cancer Center used a community-engaged approach to develop an innovative Population Health Navigation Program designed to improve access to cancer care and reduce cancer disparities.
... For many cancer types, Black patients are diagnosed with more advanced or aggressive cancers than white patients [5][6][7] . Although cancer outcomes have drastically improved over the past several decades, Black patients continue to have higher rates of cancer-related death [8][9][10] . Mortality disparities are exacerbated within certain cancer types, including breast and endometrial cancers, in which Black patients exhibit 41% and 21% higher mortality, respectively, compared to white patients [11][12][13] . ...
... We sought to determine whether the increased incidence of WGD events in Black patients was linked with racial disparities in patient outcome. Consistent with previous observations, we found that Black cancer patients exhibited a significantly shorter overall survival time following diagnosis compared to white patients ( Fig. 3A) [8][9][10] . Similarly, WGD events were also associated with worse patient outcomes (Fig. 3B). ...
In the United States, Black individuals have higher rates of cancer mortality than any other racial or ethnic group. The sources of these significant racial disparities are not fully understood, and may include social, environmental, and genetic factors that influence cancer onset, diagnosis, and treatment. Here, we examined genomic data from several large-scale cancer patient cohorts to search for racial associations in chromosome copy number alterations. We found that tumors from Black patients were significantly more likely to exhibit whole-genome duplications (WGDs), a genomic event that enhances metastasis and aggressive disease, compared to tumors from white patients. Among patients with WGD-positive cancers, there was no significant difference in survival between Black and white patients, suggesting that the increased incidence of WGD events could contribute to the disparities in patient outcome. Genomic analysis identified several somatic alterations associated with WGD events that were consistent between Black and white populations, indicating that the increase in WGD events may be driven by environmental or epigenetic factors in Black patients. In total, these findings identify a class of genomic alterations that may influence racial disparities in cancer patient outcome. As cancers that have undergone WGD events exhibit unique genetic vulnerabilities, therapies that selectively target WGD-positive cancers may be particularly effective at treating aggressive malignancies in Black patients.
... Additionally, factors such as demographics (e.g., socioeconomics, social capital), access to care, and health literacy may affect the likelihood of mammography screening (American Cancer Society, 2020a;Ashing-Giwa, Padilla, Tejero, Kraemer, Wright, Coscarelli, et al., 2004;Lee, Ju, Vang, & Lundquist, 2010;O'Keefe, Meltzer, & Bethea, 2015). Besides, fear of cancer, fatalistic views on cancer, language, and cultural-based embarrassment contributed to a lower rate of breast cancer screening in Hispanic communities (Austin, Ahmad, McNally, & Stewart, 2002;Li & Malone, 2003). ...
Background Despite the death rates of breast cancer declining in the last two decades, new breast cancer cases have disproportionately affected some marginalized populations such as African American women. Since mammography screening disparities by sexual orientation and gender identity are inconsistent, it is important to understand the patterns of mammography screening to inform public health interventions.
... Improving access to health care is considered paramount to improving patient outcomes and achieving health equity (1)(2)(3)(4). Assessing the spatial distribution of health-care professionals is a well-established method for determining access to primary and specialty health-care services (5,6). Workforce reports on the spatial distribution of oncologists from the American Society of Clinical Oncology have shown striking geographic disparities in oncologist density across the United States, with rural areas particularly at risk of oncology workforce shortages (7). ...
... We also found that hospital referral regions with a higher-than-expected proportion of linchpin oncologists tracked with indicators of socioeconomic disadvantage and lower rates of radiation therapy receipt. A better understanding of how physician relationships are associated with overall survival is critical to guide efforts aimed at reducing the disparities in cancer mortality that have been observed across race, rurality, and socioeconomic status (3,(14)(15)(16)(17). ...
Background:
Patients with cancer frequently require multidisciplinary teams for optimal cancer outcomes. Network analysis can capture relationships among cancer specialists, and we developed a novel physician linchpin score to characterize "linchpin" physicians whose peers have fewer ties to other physicians of the same oncologic specialty. Our study examined whether being treated by a linchpin physician was associated with worse survival.
Methods:
In this cross-sectional study, we analyzed Surveillance, Epidemiology, and End Results (SEER)-Medicare data for patients diagnosed with stage I-III non-small cell lung or colorectal cancer in 2016-2017. We assembled patient-sharing networks and calculated linchpin scores for medical oncologists, radiation oncologists, and surgeons. Physicians were considered a linchpin if their linchpin score was within the top 15% for their specialty. We used Cox proportional hazards models to examine associations between being treated by a linchpin physician and survival with a two-year follow-up period.
Results:
The study cohort included 10,081 patients with non-small cell lung cancer and 9,036 patients with colorectal cancer. Patients with lung cancer treated by a linchpin radiation oncologist had a 17% (95% CI = 1.04-1.32) greater hazard of mortality and similar trends were observed for linchpin medical oncologists. Patients with colorectal cancer treated by a linchpin surgeon had a 22% (95% CI = 1.03-1.43) greater hazard of mortality.
Conclusions:
In an analysis of Medicare beneficiaries with non-metastatic lung or colorectal cancer, those treated by linchpin physicians often experienced worse survival. Efforts to improve outcomes can leverage network analysis to identify areas with less access to multidisciplinary specialists.
... Previous literature has explored the impact of demographic factors on cancer diagnosis and treatment. Factors like race, sex, age, and other socioeconomic disparities have been correlated with variations in cancer diagnosis, treatment, and mortality rates [10,11]. Thus, identifying the socioeconomic and demographic variables that influence the stage of NSCLC at diagnosis can offer valuable insights into which patient populations are at the highest risk for an advanced diagnosis of NSCLC. ...
Introduction
Lung cancer is a prevalent and potentially lethal cancer. The stage at initial presentation for diagnosis predicts mortality and helps to guide treatment options. Thus, it is critical to determine what factors impact the stage of cancer at diagnosis. This study sought to determine if certain socioeconomic and demographic factors are associated with receiving an early (Stage 0-I) or advanced (Stage IV) diagnosis of non-small cell lung cancer (NSCLC).
Methods
Using the National Cancer Database (NCDB), 1,149,539 patients were identified as having an NCDB Analytic Stage Group diagnosis of Stage 0-I (early) versus Stage IV (advanced) NSCLC between 2004 and 2018. Patients with early and delayed diagnoses were compared based on specific characteristics including sex, race, ethnicity, number of comorbid conditions, insurance status, median annual income, level of education, geographic location, and reporting facility. Using IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York, United States), the data underwent analysis using binary multivariate logistic regression, chi-square analyses, and one-way ANOVA.
Results
Factors associated with an advanced diagnosis of NSCLC include being male, Black, Native American, or Hispanic. Compared to patients with at least one comorbid condition, those without comorbid conditions are more likely to present with advanced disease. Patients with private insurance, Medicaid, Medicare, or other government insurance are all less likely to present with advanced-stage cancer than patients without insurance. Compared to patients in the lowest median household income quartile, those in the second and fourth quartiles are diagnosed earlier. Patients living in areas where a higher proportion of residents lack a high school diploma are more likely to present with advanced NSCLC. Additionally, living in the Midwest and Western United States and presenting to Community Cancer programs are associated with advanced disease at initial presentation.
Conclusions
Factors that were associated with the advanced presentation of NSCLC included being male, Black, Native American, or Hispanic, having a lack of comorbid conditions or insurance, earning a lower median annual income, and living in a zip code where a higher proportion of residents lack a high school diploma. Additionally, residing in the Midwest and Western United States and seeking care at Community Cancer programs were associated with advanced disease at initial presentation. Understanding that certain socioeconomic and demographic factors impact the stage at initial diagnosis of NSCLC can allow for targeted intervention strategies aimed at the most at-risk individuals, areas, and facilities.
... 5,6 Research efforts over the past decade have aimed at identifying the causes of these disparate survival outcomes and largely point to access-to-care as a major contributor to health disparities. [7][8][9][10][11][12] Socioeconomic status (SES) is strongly correlated with race in the US and is a critical factor driving racial inequalities in cancer outcomes, as it impacts the ability to access high-quality health care and the receipt of optimal disease treatment. 6,9,13,14 An increasing number of studies suggest that after adjusting for treatment, or in equal-access healthcare systems such as the Veterans Health Administration (VHA), race alone is not a predictor of outcomes, suggesting that efforts to equalize access-to-care and treatment might result in improved outcomes for Black patients with NSCLC. ...
... [7][8][9][10][11][12] Socioeconomic status (SES) is strongly correlated with race in the US and is a critical factor driving racial inequalities in cancer outcomes, as it impacts the ability to access high-quality health care and the receipt of optimal disease treatment. 6,9,13,14 An increasing number of studies suggest that after adjusting for treatment, or in equal-access healthcare systems such as the Veterans Health Administration (VHA), race alone is not a predictor of outcomes, suggesting that efforts to equalize access-to-care and treatment might result in improved outcomes for Black patients with NSCLC. 12,[15][16][17][18][19][20] Given that Black patients have historically represented a small percentage of the population included in immunotherapy clinical trials for NSCLC but represent the group of highest burden in terms of incidence and mortality, real-world utilization studies may be helpful in identifying barriers to equitable care to ensure equal treatment. ...
... though there were no significant differences in associated reasons for TID between the groups (Table 2). Overall, there were no significant differences between White and Black patients in the median number of doses received (White: 15 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], Black: 18 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]; P = .25). Black patients had a numerically longer DOT than White patients (White: 8.7 months [2.9-11.8], ...
Background:
Real-world evidence is limited regarding the relationship between race and use of durvalumab, an immunotherapy approved for use in adults with unresectable stage III non-small cell lung cancer (NSCLC) post-chemoradiotherapy (CRT). This study aimed to evaluate if durvalumab treatment patterns differed by race in patients with unresectable stage III NSCLC in a Veterans Health Administration (VHA) population.
Materials and methods:
This was a retrospective analysis of White and Black adults with unresectable stage III NSCLC treated with durvalumab presenting to any VHA facility in the US from January 1, 2017, to June 30, 2020. Data captured included baseline characteristics and durvalumab treatment patterns, including treatment initiation delay (TID), interruption (TI), and discontinuation (TD); defined as CRT completion to durvalumab initiation greater than 42 days, greater than 28 days between durvalumab infusions, and more than 28 days from the last durvalumab dose with no new durvalumab restarts, respectively. The number of doses, duration of therapy, and adverse events were also collected.
Results:
A total of 924 patients were included in this study (White = 726; Black = 198). Race was not a significant factor in a multivariate logistic regression model for TID (OR, 1.39; 95% CI, 0.81-2.37), TI (OR, 1.58; 95% CI, 0.90-2.76), or TD (OR, 0.84; 95% CI, 0.50-1.38). There were also no significant differences in median (interquartile range [IQR]) number of doses (White: 15 [7-24], Black: 18 [7-25]; P = .25) or median (IQR) duration of therapy (White: 8.7 months [2.9-11.8], Black: 9.8 months [3.6-12.0]; P = .08), although Black patients were less likely to experience an immune-related adverse event (28% vs. 36%, P = .03) and less likely to experience pneumonitis (7% vs. 14%, P < .01).
Conclusion:
Race was not found to be linked with TID, TI, or TD in this real-world study of patients with unresectable stage III NSCLC treated with durvalumab at the VHA.
... Although this may have been somewhat corrected in the sub-group analysis, the potential for confounding cannot be completely ruled out. Furthermore, studies have shown culture's influence on pain (18,19). To that end, while disaggregating the study population into five racial/ethnic groups may have aided in identifying the observed disparity, it may not have sufficiently accounted for cultural differences within and across the racial/ ethnic groups. ...
Background
Studies have suggested racial and ethnic-based disparities in the intensity of postoperative pain experienced by patients. The objective of this study was to compare the peak and average post-anesthesia care unit (PACU) pain intensity scores of children of non-Hispanic (NH) White race to those of children of other racial/ethnic groups.
Methods
Single-institution retrospective study of children (≤18 years) who had undergone cancer-related surgical procedures from June 2016 through April 2022. Multivariable logistic regression was used to assess the association between race/ethnicity and the peak and average PACU pain intensity scores.
Results
Of the 1,009 unique patients, 74 (7.3%) were Asian, 93 (9.2%) were NH-Black, 310 (30.7%) were Hispanic/Latino, 51 (5.1%) identified as “Other” race (NH-Other), and 481 (47.7%) were NH-White. The median age [interquartile range (IQR)] was 13.7 years (IQR, 8.2–16.6), and 517 (51.2%) were female.
In the multivariable analysis, the association between race/ethnicity and a peak PACU pain score greater than 3 was not significant ( p = 0.062 for overall effect of race). However, upon comparing the peak PACU pain scores of children of other racial/ethnic groups to NH-White children, NH-Black children were 50.1% less likely than NH-White children to have a peak PACU pain score greater than 3 (odds ratio [OR], 0.499, 95% confidence interval [CI], 0.304–0.818; p = 0.006). Patient race/ethnicity was not associated with an average PACU pain score greater than 3 ( p = 0.778).
In the sub-group analysis of children who had undergone orthopedic or open abdominal surgeries, the proportions of children with peak and average PACU pain scores which were greater than 3 were not significantly different across racial/ethnic groups ( p = 0.250 and p = 0.661, respectively).
Conclusions
In this retrospective study of children who had undergone cancer-related surgery, NH-Black children had significantly lesser odds than NH-White children of having a peak PACU pain score of moderate or severe intensity. However, in the sub-group analysis of children who had undergone orthopedic or open abdominal procedures, peak and average PACU pain scores were not significantly different across racial/ethnic groups.
... With this rise in incidence, the annual national costs for cancer-related medical services and treatments is projected to swell from $185 billion in 2015 to $246 billion by 2030 [2]. Social determinants of health (SDOH), which are non-medical factors such as socioeconomic status (SES), race, and ethnicity that influence health outcomes, are known to contribute to disparities in cancer incidence and mortality [3][4][5][6][7]. Identifying and understanding health disparities in cancer patients can inform initiatives designed to prevent excess cancer morbidity and mortality, decrease economic costs to society, and promote health equity. ...
Purpose
The social vulnerability index (SVI), developed by the Centers for Disease Control and Prevention, is a novel composite measure encompassing multiple variables that correspond to key social determinants of health. The objective of this review was to investigate innovative applications of the SVI to oncology research and to employ the framework of the cancer care continuum to elucidate further research opportunities.
Methods
A systematic search for relevant articles was performed in five databases from inception to 13 May 2022. Included studies applied the SVI to analyze outcomes in cancer patients. Study characteristics, patent populations, data sources, and outcomes were extracted from each article. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results
In total, 31 studies were included. Along the cancer care continuum, five applied the SVI to examine geographic disparities in potentially cancer-causing exposures; seven in cancer diagnosis; fourteen in cancer treatment; nine in treatment recovery; one in survivorship care; and two in end-of-life care. Fifteen examined disparities in mortality.
Conclusion
In highlighting place-based disparities in patient outcomes, the SVI represents a promising tool for future oncology research. As a reliable geocoded dataset, the SVI may inform the development and implementation of targeted interventions to prevent cancer morbidity and mortality at the neighborhood level.
