bims-cahedi Biomed News
on Cancer health disparities
Issue of 2023–04–30
ten papers selected by
Keshav K. Singh, University of Alabama at Birmingham
  1. Cancer disparities in Appalachian Kentucky.
  2. Disparities in ovarian cancer survival: does place matter?
  3. Rural-urban disparities in mortality and geriatric assessment among older adults with cancer: The cancer & aging resilience evaluation (CARE) registry.
  4. Income level and treatment selection in prostate cancer: analysis of a North Carolina population-based cohort.
  5. Disparities in prostate cancer diagnosis and management: recognizing that disparities exist at all junctures along the prostate cancer journey.
  6. Racial Disparity in Outcomes Among Prostate Cancer Patients in the Post-Affordable Care Act Period.
  7. Molecular and Sociodemographic Colorectal Cancer Disparities in Latinos Living in Puerto Rico.
  8. The Cost of Metastatic Prostate Cancer in the United States.
  9. The importance of aging in cancer research.
  10. The influence of socio-demographic factors on the stage at which women's breast cancer is diagnosed and treatment prescribed in the Gaza Strip, occupied Palestinian territory.
  1. J Rural Health. 2023 Apr 24.
    Cancer disparities in Appalachian Kentucky.
    Lauren Hudson, Todd Burus, Lee Park, Bin Huang, Pamela C Hull, Nathan L Vanderford.
       PURPOSE: Cancer is the second leading cause of death in the United States, and the disease burden is elevated in Appalachian Kentucky, due in part to health behaviors and inequities in social determinants of health. This study's goal was to evaluate Appalachian Kentucky's cancer burden compared to non-Appalachian Kentucky, and Kentucky compared to the United States (excluding Kentucky).
    METHODS: The following data were analyzed: annual all-cause and all-site cancer mortality rates from 1968 to 2018; 5-year all-site and site-specific cancer incidence and mortality rates from 2014 to 2018; aggregated screening and risk factor data from 2016 to 2018 for the United States (excluding Kentucky), Kentucky, non-Appalachian Kentucky, and Appalachian Kentucky; and human papilloma virus vaccination prevalence by sex from 2018 for the United States and Kentucky.
    FINDINGS: Since 1968, the United States has experienced a large decrease in all-cause and cancer mortality, but the reduction in Kentucky has been smaller and slower, driven by even smaller and slower reductions within Appalachian Kentucky. Appalachian Kentucky has higher overall cancer incidence and mortality rates and higher rates for several site-specific cancers compared to non-Appalachian Kentucky. Contributing factors include screening rate disparities and increased rates of obesity and smoking.
    CONCLUSIONS: Appalachian Kentucky has experienced persistent cancer disparities, including elevated all-cause and cancer mortality rates for 50+ years, widening the gap between this region and the rest of the country. In addition to addressing social determinants of health, increased efforts aimed at improving health behaviors and increased access to health care resources could help reduce this disparity.
    Keywords:  Appalachian Kentucky; cancer disparity; cancer incidence; cancer mortality; health behaviors
    DOI:  https://doi.org/10.1111/jrh.12763
  2. Am J Obstet Gynecol. 2023 Apr 26. pii: S0002-9378(23)00263-6. [Epub ahead of print]
    Disparities in ovarian cancer survival: does place matter?
    Scarlett L Gomez, Valerie Mcguire, Lindsay J Collin, Lauren Dempsey, Pushkar Inamdar, Katherine Lawson-Michod, Edward S Peters, Lawrence Kushi, Salma Shariff-Marco, Lauren Peres, Paul Terry, Elisa Bandera, Joellen M Schildkraut, Jennifer A Doherty, Andrew Lawson.
      Social inequities in cancer survival are persistent. Ovarian cancer is the fifth leading cause of cancer-associated mortality among women, with persistent survival disparities seen across race and ethnicity, and by socioeconomic status, even after accounting for histology, stage, treatment differences, and other clinical factors. Neighborhood and environmental context can play an important role in ovarian cancer survival, and, to the extent that minority racial and ethnic groups, and populations of lower socioeconomic status are more likely to be segregated into neighborhoods with lower quality social, built, and physical environment neighborhoods, contextual factors may be a critical component to ovarian cancer survival disparities. However, research on the impact of different domains of structural, environmental, and neighborhood context in ovarian cancer survival, and in disparities in ovarian cancer survival is limited. This review focuses on the following contextual domains: structural and institutional factors, healthcare access and geographic medical accessibility, environmental exposures within the physical environment, social environment, built environment, and rurality and the research to date and offers recommendations for future research studies in disparities in ovarian cancer survival. Recommendations for future research studies to address disparities in ovarian cancer survival are proposed.
    Keywords:  ovarian cancer; race and ethnicity; social inequities; survival disparities
    DOI:  https://doi.org/10.1016/j.ajog.2023.04.026
  3. J Geriatr Oncol. 2023 Apr 21. pii: S1879-4068(23)00102-9. [Epub ahead of print]14(4): 101505
    Rural-urban disparities in mortality and geriatric assessment among older adults with cancer: The cancer & aging resilience evaluation (CARE) registry.
    Mackenzie E Fowler, Kelly M Kenzik, Mustafa Al-Obaidi, Christian Harmon, Smith Giri, Sankalp Arora, Coryn Stephenson, Moh''d Khushman, Darryl Outlaw, Smita Bhatia, Grant R Williams.
       INTRODUCTION: Rural-urban disparities persist in cancer mortality, despite improvement in cancer screening and treatment. Although older adults represent the majority of cancer cases and are over-represented in rural areas, few studies have explored rural-urban disparities in mortality and age-related impairments among older adults with cancer.
    MATERIALS AND METHODS: We included 962 newly-diagnosed older adults (≥60 years) with cancer who underwent geriatric assessment (GA) at their first pre-chemotherapy visit to an academic medical center in the Southeastern United States. We used Rural-Urban Commuting Area (RUCA) codes to classify residence at time of diagnosis into urban and rural areas. We used one-year survival and pre-treatment frailty as outcomes. We used Cox proportional hazards regression to evaluate the association between residence and one-year mortality, and logistic regression to evaluate the association between residence and pre-treatment frailty. All tests were two-sided.
    RESULTS: Median age at GA was 68.0 (interquartile rage [IQR]: 64.0, 74.0) years; most had colorectal cancer (24.3%) with advanced stage (III/IV 73.2%) disease. Overall, 11.4% resided in rural and 88.6% in urban areas. Rural areas had a higher proportion of White and less educated participants. After adjustment for age, sex, race, education, employment status, and cancer type/stage, rural residence was associated with higher hazard of one-year mortality (hazard ratio [HR] = 1.78, 95% confidence interval [CI] = 1.23, 2.57) compared to urban residence. Frailty was an effect modifier of this association (HROverall = 1.83, 95% CI = 1.27, 2.57; HRFrail = 2.05, 95% CI = 1.23, 3.41; HRNot Frail = 1.55, 95% CI = 0.90, 2.68).
    DISCUSSION: Among older adults with newly diagnosed cancer, rural residence was associated with reduced one-year survival, particularly among frail older adults. The rural-urban disparities observed in the current study may be due to frailty in conjunction with disparities in social determinants of health across rural and urban areas. Future studies should focus on understanding and intervening on underlying causes of these disparities.
    Keywords:  Geriatric assessment; Geriatric oncology; Health status disparities; Neoplasms; Rural health
    DOI:  https://doi.org/10.1016/j.jgo.2023.101505
  4. JNCI Cancer Spectr. 2023 Apr 27. pii: pkad032. [Epub ahead of print]
    Income level and treatment selection in prostate cancer: analysis of a North Carolina population-based cohort.
    Crosby Rock, Ying Cao, Aaron J Katz, Deborah Usinger, Sarah Walden, Ronald C Chen, Xinglei Shen.
       BACKGROUND/PURPOSE: Disparities in treatment selection based on socioeconomic status (SES) for prostate cancer exist. However, the association between patient-level income with treatment selection priorities and treatment received has not been studied.
    METHODS: A population-based cohort of 1382 individuals with newly diagnosed prostate cancer was enrolled throughout North Carolina prior to treatment. Patients self-reported household income and were asked about the importance of 12 factors contributing to their treatment decision-making process. Diagnosis details and primary treatment received were abstracted from medical records and cancer registry data.
    RESULTS: Patients with lower income were diagnosed with more advanced disease (p < .01). "Cure" was deemed to be "very important" by > 90% of patients at all income levels. However, patients with lower vs higher household income were more likely to rate factors beyond cure as "very important" such as "cost" (p < .01), "effect on daily activities" (p = .01), "duration of treatment" (p < .01), "recovery time" (p < .01), and "burden on family and friends" (p < .01). On multivariable analysis, high vs low income was associated with increased utilization of radical prostatectomy (odds ratio [OR] 2.01, 95% CI 1.33-3.04, p<.01) and decreased use of radiotherapy (OR 0.48, 95% CI 031-0.75, p<.01).
    CONCLUSIONS: New insights from this study on the association between income and treatment decision-making priorities provide potential avenues for future interventions to reduce disparities in cancer care.
    DOI:  https://doi.org/10.1093/jncics/pkad032
  5. Prostate Cancer Prostatic Dis. 2023 Apr 28.
    Disparities in prostate cancer diagnosis and management: recognizing that disparities exist at all junctures along the prostate cancer journey.
    Soroush Rais-Bahrami, Yao Zhu.
      
    DOI:  https://doi.org/10.1038/s41391-023-00665-3
  6. Urol Pract. 2023 Mar;10(2): 123-129
    Racial Disparity in Outcomes Among Prostate Cancer Patients in the Post-Affordable Care Act Period.
    Sumedha Chhatre, S Bruce Malkowicz, Joseph J Gallo, Ravishankar Jayadevappa.
       INTRODUCTION: Our objective was to assess whether Medicaid expansion is associated with reduced racial disparity in quality of care measured as 30-day mortality, 90-day mortality, and 30-day readmission in prostate cancer patients receiving surgery.
    METHODS: We used the National Cancer Database to extract a cohort of African American and White men diagnosed with prostate cancer between 2004 and 2015 and surgically treated. We used 2004-2009 data to observe preexisting racial disparity in outcomes. We used 2010-2015 data to assess racial disparity in outcomes and the interaction of race and Medicaid expansion status.
    RESULTS: Between 2004 and 2009, 179,762 men met our criteria. In this period, African American patients reported higher hazard of 30- and 90-day mortality and higher odds of 30-day readmission compared to White patients. Between 2010 and 2015, 174,985 men met our criteria. Of these 84% were White and 16% were African American. Main effects models showed that compared to White men, African American men had higher odds of 30-day mortality (OR=1.96, 95% CI = 1.46, 2.67), 90-day mortality (OR=1.40, 95% CI = 1.11, 1.77), and 30-day readmission (OR=1.28, 95% CI = 1.19, 1.38).The interactions between race and Medicaid expansion were not significant (P = .1306, .9499, and .5080, respectively).
    CONCLUSIONS: Improved access to care via Medicaid expansion may not translate into reduced racial disparity in quality-of-care outcomes in prostate cancer patients treated surgically. System-level factors such as availability of and referrals to care, and complex socioeconomic structure may also play a role in improving quality of care and reducing disparities.
    Keywords:  healthcare disparities; prostatic neoplasms; quality of health care
    DOI:  https://doi.org/10.1097/UPJ.0000000000000372
  7. Genes (Basel). 2023 Apr 11. pii: 894. [Epub ahead of print]14(4):
    Molecular and Sociodemographic Colorectal Cancer Disparities in Latinos Living in Puerto Rico.
    Julyann Perez-Mayoral, Maria Gonzalez-Pons, Hilmaris Centeno-Girona, Ingrid M Montes-Rodríguez, Marievelisse Soto-Salgado, Belisa Suárez, Natalia Rodríguez, Giancarlo Colón, Javier Sevilla, Daphne Jorge, Xavier Llor, Rosa M Xicola, Doris H Toro, Luis Tous-López, Marla Torres-Torres, José S Reyes, Nicolas López-Acevedo, Ajay Goel, Segundo Rodríguez-Quilichini, Marcia Cruz-Correa.
       BACKGROUND: The incidence of sporadic colorectal cancer (CRC) among individuals <50 years (early-onset CRC) has been increasing in the United States (U.S.) and Puerto Rico. CRC is currently the leading cause of cancer death among Hispanic men and women living in Puerto Rico (PRH). The objective of this study was to characterize the molecular markers and clinicopathologic features of colorectal tumors from PRH to better understand the molecular pathways leading to CRC in this Hispanic subpopulation.
    METHODS: Microsatellite instability (MSI), CpG island methylator phenotype (CIMP), and KRAS and BRAF mutation status were analyzed. Sociodemographic and clinicopathological characteristics were evaluated using Chi-squared and Fisher's exact tests.
    RESULTS: Of the 718 tumors analyzed, 34.2% (n = 245) were early-onset CRC, and 51.7% were males. Among the tumors with molecular data available (n = 192), 3.2% had MSI, 9.7% had BRAF, and 31.9% had KRAS mutations. The most common KRAS mutations observed were G12D (26.6%) and G13D (20.0%); G12C was present in 4.4% of tumors. A higher percentage of Amerindian admixture was significantly associated with early-onset CRC.
    CONCLUSIONS: The differences observed in the prevalence of the molecular markers among PRH tumors compared to other racial/ethnic groups suggest a distinct molecular carcinogenic pathway among Hispanics. Additional studies are warranted.
    Keywords:  Hispanics; colorectal cancer; early-onset colorectal cancer; molecular markers
    DOI:  https://doi.org/10.3390/genes14040894
  8. Urol Pract. 2023 Jan;10(1): 41-47
    The Cost of Metastatic Prostate Cancer in the United States.
    T Anders Olsen, Christopher P Filson, Thomas B Richards, Donatus U Ekwueme, David H Howard.
       INTRODUCTION: We sought to estimate per patient and annual aggregate health care costs related to metastatic prostate cancer.
    METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified fee-for-service Medicare beneficiaries ages 66 and older diagnosed with metastatic prostate cancer or claims with diagnosis codes for metastatic disease (indicating tumor progression following diagnosis) between 2007 and 2017. We measured annual health care costs and compared costs between cases and a sample of beneficiaries without prostate cancer.
    RESULTS: We estimate that per-patient annual costs attributable to metastatic prostate cancer are $31,427 (95% CI: $31,219-$31,635; 2019 dollars). Annual attributable costs rose over time, from $28,311 (95% CI: $28,047-$28,575) in 2007-2013 to $37,055 (95% CI: $36,716-$37,394) in 2014-2017. In aggregate, health costs attributable to metastatic prostate cancer are $5.2 to $8.2 billion per year.
    CONCLUSIONS: The per patient annual health care costs attributable to metastatic prostate cancer are substantial and have increased over time, corresponding to the approval of new oral therapies used in treating metastatic prostate cancer.
    Keywords:  Medicare; antineoplastic agents; health care costs; prostatic neoplasms
    DOI:  https://doi.org/10.1097/UPJ.0000000000000363
  9. Nat Aging. 2022 May;2(5): 365-366
    The importance of aging in cancer research.
      
    DOI:  https://doi.org/10.1038/s43587-022-00231-x
  10. Ecancermedicalscience. 2023 ;17 1522
    The influence of socio-demographic factors on the stage at which women's breast cancer is diagnosed and treatment prescribed in the Gaza Strip, occupied Palestinian territory.
    Walaa Ammar-Shehada, Piet Bracke.
       Background: One of every three women diagnosed with breast cancer (BC) in Gaza does not live for more than 5 years. They are faced by unreliable treatment plans. Radiotherapy is not available locally and there are chronic shortages in the chemotherapy medications. This paper aims to provide understanding of how socio-demographic factors affect the stage at which the cancer is diagnosed and what treatment is prescribed.
    Methods: Data were collected through a cross-sectional survey targeting women living in Gaza who had been diagnosed with BC at least once. The survey was self-administered and distributed to 350 women between 1 March 2021 and 30 May 2021. Multinomial logistic regression (SPSS, version 28.0) was used to explore the association between stage of the cancer at diagnosis and socio-demographic characteristics. The relationship between the stage at diagnosis and prescribed treatment was explored using a cluster analysis and crosstabulations.
    Findings: Socio-demographic inequalities were reflected in stage at diagnosis and varied by age, education, employment, marital status, and refugee status. Breast cancer was less likely to be detected at an advanced stage among educated respondents (women with primary education OR = 0.093, p = 0.008 and women with preparatory education OR = 0.172, p = 0.005), employed women (OR = 0.056, p = 0.022). It was more likely to be detected at an early stage (OR = 3.954, p = 0.011) in women aged 41-50. In widowed and separated/divorced women, it was less likely to be detected at an early stage (OR = 0.217, p = 0.029) and (OR = 0.294, p = 0.028) respectively, than among married women. Among refugee women, it was less likely to be detected at early stage than among non-refugee women (OR = 0.251, p = 0.007). Among the total respondents, only 30% of the full prescribed treatment was available locally.
    Conclusion: Our research showed various levels of inequalities at the stage of diagnosis by age, marital status, education, employment and refugee status. Most of the survivors needed treatment that was unavailable locally.
    Keywords:  Gaza; Palestine; breast cancer; health inequities; refugees; social determinants of health
    DOI:  https://doi.org/10.3332/ecancer.2023.1522
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