Cancer-related Disparities: Weathering the Perfect Storm Through Comprehensive Cancer Control Approaches

Hayes, Nikki; Rollins, Rochelle; Weinberg, Armin D.; Brawley, Otis W.; Baquet, Claudia R.; Kaur, Judith S.; Palafox, Neal A.

doi:10.1007/s10552-005-0487-z

Cited by 16 publications

(5 citation statements)

References 11 publications

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“…Not only did we discover the unequal selection of standard treatments for HL based on insurance status, we found that this parameter remained significant despite adjustments for patient, facility, or sociodemographic factors. Undoubtedly, studies of disparities in cancer patients have found that equal treatment may yield similar outcomes, but there may be inherent biases for patients with an unfavorable insurance status that account for our observed differences in outcomes. Because of the aforementioned limitations of our retrospective study, the findings are hypothesis‐generating and certainly warrant further exploration.…”

Section: Discussionmentioning

confidence: 90%

Disparities in survival by insurance status in patients with Hodgkin lymphoma

Parikh

Grossbard

Green

et al. 2015

Cancer

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BACKGROUND:The association between insurance status and outcomes has not been well established for patients with Hodgkin lymphoma (HL). The purpose of this study was to examine the disparities in overall survival (OS) by insurance status in a large cohort of patients with HL. METHODS: The National Cancer Data Base (NCDB) was used to evaluate patients with stage I to IV HL from 1998 to 2011. The association between insurance status, covariables, and outcomes was assessed in a multivariate Cox proportional hazards model. Survival was estimated with the Kaplan-Meier method. RESULTS: Among the 76,681 patients within the NCDB, 45,777 patients with stage I to IV HL were eligible for this study (median follow-up, 6.0 years). The median age was 39 years (range, 18-90 years). The insurance status was as follows: 3247 (7.1%) were uninsured, 7962 (17.4%) had Medicaid, 30,334 (66.3%) had private insurance, 3746 (8.2%) had managed care, and 488 (1.1%) had Medicare. Patients with an unfavorable insurance status (Medicaid/uninsured) were at a more advanced stage, had higher comorbidity scores, had B symptoms, and were in a lower income/education quartile (all P <.01). These patients were less likely to receive radiotherapy and start chemotherapy promptly and were less commonly treated at academic/research centers (all P <.01). Patients with unfavorable insurance had a 5-year OS of 54% versus 87% for those favorably insured (P <.01). When adjustments were made for covariates, an unfavorable insurance status was associated with significantly decreased OS (hazard ratio, 1.60; 95% confidence interval, 1.34-1.91; P <.01). The unfavorable insurance status rate increased from 22.8% to 28.8% between 1998 and 2011. CONCLUSIONS: This study reveals that HL patients with Medicaid and uninsured patients have outcomes inferior to those of patients with more favorable insurance. Targeting this subset of patients with limited access to care may help to improve outcomes. Cancer 2015;121:3515-24.

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Section: Discussionmentioning

confidence: 90%

Disparities in survival by insurance status in patients with Hodgkin lymphoma

Parikh

Grossbard

Green

et al. 2015

Cancer

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“…While a number variables may influence disparities in treatment outcomes including patient-related, provider-related, healthcare system-related, and societal factors (34-37), prior studies investigating healthcare disparities in cancer patients indicate that equal treatment yields equal outcomes. (38-41) For lymphoma patients limited data exist regarding disparities in treatment utilization that are linked to treatment outcomes. A recent SEER analysis comparing survival trends among patients with DLCBL from 1973 to 2004 demonstrated improved median OS in the era of immunotherapy [2000-2004 median OS 47 months, (p=0.005)], however this benefit was not maintained across race with white patients having significantly better outcomes [47 months vs. 29 months (p=0.001)].…”

Section: Discussionmentioning

confidence: 99%

Disparities in the Early Adoption of Chemoimmunotherapy for Diffuse Large B-cell Lymphoma in the United States

Flowers

Fedewa

Chen

et al. 2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Since the 1970s, CHOP chemotherapy has been the standard treatment for patients with diffuse large B-cell lymphoma (DLBCL). In 2002, randomized trials changed this standard by demonstrating that adding rituximab immunotherapy to CHOP improved survival. However, how these results influenced chemo-immunotherapy adoption in clinical practice remains unclear. Methods Using the National Cancer Database to compare chemo-immunotherapy use with chemotherapy alone, we collected data on demographics, stage, health insurance, area-level socio-economic status (SES), facility characteristics, and type of treatment for DLBCL patients diagnosed in the United States 2001-2004. Multivariable log binomial models examined associations between race, insurance, and treatment allocation, adjusting for covariates. Results Among 38,002 patients with DLBCL, 27% received chemo-immunotherapy and 50% chemotherapy alone. Patients who had localized disease, were diagnosed in 2001, black, uninsured/Medicaid insured, or lower SES were less likely to receive any form of chemotherapy (all p<0.0001). Patients who were diagnosed 2001, black [relative risk (RR) 0.83, 95% Confidence Interval (CI) 0.78-0.89], >60 years (RR 0.94, 95% CI 0.90-0.98), or had localized disease (RR 0.89, 95% CI 0.86-0.92) were less likely to receive chemo-immunotherapy. Receiving treatment at high DLBCL volume teaching/research facilities was associated with the greatest likelihood of chemo-immunotherapy (RR 1.69, 95% CI 1.52-1.89). Conclusions Black DLBCL patients were less likely to receive chemotherapy or chemo-immunotherapy during this period. Impact This large national cohort study demonstrates disparities in the diffusion of chemo-immunotherapy for DLBCL. Improving DLBCL outcomes will require efforts to extend access to proven advances in therapy to all segments of the population.

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“…However, unlike sex, race was a significant predictor of survival in multivariate models along with IPI factors. Although several variables may influence disparities in treatment outcomes, including patient‐related, provider‐related, healthcare system‐related, and societal factors,62‐65 prior studies investigating racial disparities in cancer patients indicate that equal treatment yields equal outcomes 66‐69. Developing interventions to address the disparities in treatment outcomes will require a broader understanding of the context in which cancer treatments are selected for this population70 and identifying predictors for when particular patient populations receive therapy that does not correspond to the current standard of care.…”

Section: Discussionmentioning

confidence: 99%

Racial differences in the presentation and outcomes of diffuse large B‐cell lymphoma in the United States

Shenoy

Malik

Nooka

et al. 2010

Cancer

138

124

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BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is often cured with standard chemoimmunotherapy, but there is great heterogeneity in presentation and outcomes. METHODS: By using Surveillance, Epidemiology, and End Results (SEER) data from 13 registries across the United States, the authors examined differences in incidence and survival for DLBCL by race. International Classification of Diseases for Oncology, third edition histology codes 9678, 9679, 9680, and 9684 were used to identify cases. RESULTS: From 1992 to 2007, 38,522 cases of DLBCL were recorded in SEER. Sixty-five percent of black patients compared with 37% of white patients presented at age 60 years, 52% of blacks compared with 44% of whites presented with stage III/IV disease, and 31% of black versus 24% of white patients presented with B symptoms (all P < .001). Although survival improved by era of diagnosis for all races (log rank P < .001), 2-year relative survival rates were better for women than men (61% vs 58%, P < .001) and white than black patients (60% vs 50%, P < .001). Black race, male sex, age at diagnosis >60, advanced stage, and B symptoms at diagnosis were predictors of worse survival (P < .001). CONCLUSIONS: Black patients with DLBCL in the United States present at younger age, more advanced stage, and have inferior survival. Epidemiological studies that examine the biological variants of DLBCL in concert with race are needed to elucidate the etiology of these disparities.

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Cancer-related Disparities: Weathering the Perfect Storm Through Comprehensive Cancer Control Approaches

Cited by 16 publications

References 11 publications

Disparities in survival by insurance status in patients with Hodgkin lymphoma

Disparities in survival by insurance status in patients with Hodgkin lymphoma

Disparities in the Early Adoption of Chemoimmunotherapy for Diffuse Large B-cell Lymphoma in the United States

Racial differences in the presentation and outcomes of diffuse large B‐cell lymphoma in the United States

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