bims-cahedi Biomed News
on Cancer health disparities
Issue of 2023–04–09
seven papers selected by
Keshav K. Singh, University of Alabama at Birmingham
  1. Current Status and Future Direction to Address Disparities in Diversity, Equity, and Inclusion in Prostate Cancer Care.
  2. Cancer-Specific health equity metrics in the United States of America: A scoping review.
  3. Cancer Progress and Priorities: Gastric Cancer.
  4. The social vulnerability index as a risk stratification tool for health disparity research in cancer patients: a scoping review.
  5. Trends in health care spending on kidney cancer in the United States, 1996-2016.
  6. Addressing the Elephant in the Room: Structural Racism and Health Disparities in the Philippines.
  7. DNA methylation accelerated age as captured by epigenetic clocks influences breast cancer risk.
  1. Curr Oncol Rep. 2023 Apr 03.
    Current Status and Future Direction to Address Disparities in Diversity, Equity, and Inclusion in Prostate Cancer Care.
    Jerry Fu, Chen Fu, Robert S Wang, Daniel M Geynisman, Pooja Ghatalia, Shannon M Lynch, Sharon R Harrison, Erin K Tagai, Camille Ragin.
       PURPOSE OF REVIEW: Disparities in prostate cancer care and outcomes have been well recognized for decades. The purpose of this review is to methodically highlight known racial disparities in the care of prostate cancer patients, and in doing so, recognize potential strategies for overcoming these disparities moving forward.
    RECENT FINDINGS: Over the past few years, there has been a growing recognition and push towards addressing disparities in cancer care. This has led to improvements in care delivery trends and a narrowing of racial outcome disparities, but as we highlight in the following review, there is more to be addressed before we can fully close the gap in prostate cancer care delivery. While disparities in prostate cancer care are well recognized in the literature, they are not insurmountable, and progress has been made in identifying areas for improvement and potential strategies for closing the care gap.
    Keywords:  Care delivery; Disparities; Equity; Prostate cancer; Review
    DOI:  https://doi.org/10.1007/s11912-023-01399-0
  2. Cancer Med. 2023 Apr 05.
    Cancer-Specific health equity metrics in the United States of America: A scoping review.
    Angela Starkweather, Bevin Cohen, Tamryn F Gray, Lauri Linder, Noah Zanville.
      Health disparities in cancer care persist, and in some cases are growing, despite decades of research aimed at achieving equal outcomes for all Americans. There is growing consensus that reducing disparities will require a shift from aiming to provide care that is equal, to aiming to provide care that is equitable. The current landscape of metrics and interventions that move beyond equality (i.e., care provided equally to all patients) and towards equity (i.e., care provided variably and justly such that patients achieve equal outcomes) have not been characterized. Thus, the aim of this scoping literature review was to identify cancer-specific health equity metrics and interventions, and to explore current gaps in the field. Following PRISMA guidelines, PubMed, CINAHL, PsycInfo, and Scopus were searched for studies published in English between 2012 and 2022 that implemented a metric to identify or an intervention to address cancer care inequities in the United States. The search returned 36,724 unique articles, of which 40 articles (1%) included an intervention to advance health equity. Metrics included timeliness of screening and treatment, receipt of goal-concordant care, and survival. The vast majority of articles were cross-sectional or cohort studies that described health disparities using one or more outcome metrics. Gaps identified included research on receipt of guideline-concordant care, interventions addressing multiple levels of structural and social determinants of health, inclusion of children and families, and patient-reported outcomes or other sources of data that could help inform interventions to advance equity.
    Keywords:  cancer outcomes; health equity; quality indicators
    DOI:  https://doi.org/10.1002/cam4.5881
  3. Cancer Epidemiol Biomarkers Prev. 2023 04 03. 32(4): 473-486
    Cancer Progress and Priorities: Gastric Cancer.
    Priya Alagesan, Jessica C Goodwin, Katherine S Garman, Meira Epplein.
      Gastric cancer, the fifth leading cause of cancer worldwide, is estimated to be responsible for approximately 1.4% of all new cancers and 1.8% of all cancer-related deaths in the United States. Despite declining incidence rates and improved survival rates, however, gastric cancer continues to disproportionately affect racial and ethnic minorities and individuals of lower socioeconomic status at higher rates than the general population. To improve outcomes globally and address disparities within the United States, continued improvements are needed in risk factor modification and biomarker development and to improve access to existing preventative measures such as genetic testing and H. pylori eradication testing, in addition to expanding upon current clinical guidelines for premalignant disease to address gaps in endoscopic surveillance and early detection.
    DOI:  https://doi.org/10.1158/1055-9965.EPI-22-0994
  4. Cancer Causes Control. 2023 Apr 07.
    The social vulnerability index as a risk stratification tool for health disparity research in cancer patients: a scoping review.
    Tiffaney Tran, Morgan A Rousseau, David P Farris, Cici Bauer, Kelly C Nelson, Hung Q Doan.
       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.
    Keywords:  Cancer; Health disparity, minority and vulnerable populations; Health inequities; Healthcare disparities; Neighborhood characteristics; Residence characteristics; Social determinants of health; Social vulnerability; Socioeconomic factors
    DOI:  https://doi.org/10.1007/s10552-023-01683-1
  5. Cancer. 2023 Apr 02.
    Trends in health care spending on kidney cancer in the United States, 1996-2016.
    Kosuke Takemura, Newaz Shubidito Ahmed, Igor Stukalin, Mehul Gupta, Christopher Ma, Daniel Y C Heng.
       BACKGROUND: Paradigm shifts in kidney cancer management have led to higher health care spending. Here, total and per capita health care spending and primary drivers of change in health expenditures for kidney cancer in the United States between 1996 and 2016 are estimated.
    METHODS: Public databases developed by the Institute for Health Metrics and Evaluation for the Disease Expenditure Project were used. The prevalence of kidney cancer was estimated from the Global Burden of Disease Study. Changes in health care spending on kidney cancer were assessed by joinpoint regression and expressed as annual percent changes (APCs).
    RESULTS: In 2016, total health care spending on kidney cancer was $3.42 billion (95% CI, $2.91 billion to $3.89 billion) compared with $1.18 billion (95% CI, $1.07 billion to $1.31 billion) in 1996. Per capita spending had two inflection points in 2005 and 2008, close to the approval years of targeted therapies, which corresponded to APCs of +2.9% (95% CI, +2.3% to +3.6%; p < .001) per year, 1996-2005; +9.2% (95% CI, +3.4% to +15.2%; p = .004) per year, 2005-2008; and +3.1% (95% CI, +2.2% to +3.9%; p < .001) per year, 2008-2016. Inpatient care was the largest contributor to health expenditures, which accounted for $1.56 billion (95% CI, $1.19 billion to $1.95 billion) in 2016. Price and intensity of care was the primary driver of increased health expenditures, whereas service utilization was the primary driver of reduced health expenditures.
    CONCLUSIONS: Prevalence-adjusted health care spending on kidney cancer continues to rise in the United States, which is primarily attributable to inpatient care and driven by the price and intensity of care over time.
    Keywords:  costs and cost analysis; health expenditures; kidney neoplasms; molecular targeted therapy; renal cell carcinoma
    DOI:  https://doi.org/10.1002/cncr.34770
  6. Int Forum Nurs Healthc. 2022 Aug;5 14-16
    Addressing the Elephant in the Room: Structural Racism and Health Disparities in the Philippines.
    Lorraine S Evangelista, Reimund Serafica, Andrew T Reyes, Miguel Fudolig, Jennifer Kawi, Francisco Sy.
      
  7. Front Oncol. 2023 ;13 1150731
    DNA methylation accelerated age as captured by epigenetic clocks influences breast cancer risk.
    Celina I Valencia, Devin Saunders, Jennifer Daw, Adria Vasquez.
       Introduction: Breast cancer continues to be the leading form of cancer among women in the United States. Additionally, disparities across the breast cancer continuum continue to increase for women of historically marginalized populations. The mechanism driving these trends are unclear, however, accelerated biological age may provide key insights into better understanding these disease patterns. Accelerated age measured by DNA methylation using epigenetic clocks is to date the most robust method for estimating accelerated age. Here we synthesize the existing evidence on epigenetic clocks measurement of DNA methylation based accelerated age and breast cancer outcomes.
    Methods: Our database searches were conducted from January 2022 to April 2022 and yielded a total of 2,908 articles for consideration. We implemented methods derived from guidance of the PROSPERO Scoping Review Protocol to assess articles in the PubMed database on epigenetic clocks and breast cancer risk.
    Results: Five articles were deemed appropriate for inclusion in this review. Ten epigenetic clocks were used across the five articles demonstrating statistically significant results for breast cancer risk. DNA methylation accelerated age varied by sample type. The studies did not consider social factors or epidemiological risk factors. The studies lacked representation of ancestrally diverse populations.
    Discussion: DNA methylation based accelerated age as captured by epigenetic clocks has a statistically significant associative relationship with breast cancer risk, however, important social factors that contribute to patterns of methylation were not comprehensively considered in the available literature. More research is needed on DNA methylation based accelerated age across the lifespan including during menopausal transition and in diverse populations. This review demonstrates that DNA methylation accelerated age may provide key insights for tackling increasing rates of U.S. breast cancer incidence and overall disease disparities experienced by women from minoritized backgrounds.
    Keywords:  DNAm; accelerated age; breast cancer; epigenetic clocks; underrepresented populations
    DOI:  https://doi.org/10.3389/fonc.2023.1150731
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