Disparities in lung cancer stage, treatment and survival among American Indians and Alaskan Natives

Smith, Cardinale B.; Bonomi, Marcelo; Wisnivesky, Juan P.

doi:10.1016/j.lungcan.2010.08.015

Cited by 30 publications

(36 citation statements)

References 33 publications

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“…21–23 Another SEER-based study conducted between 1988 and 2006 indicated that AI/ANs with stage I through III nonsmall cell lung cancer had rates of surgical resection that were significantly lower than the rates among whites. 24 In addition, 5-year lung cancer-specific survival was 47% for AI/ANs versus 56% for whites ( P <.0001). Not surprisingly, we demonstrated that survival was lower among those patients with cancer who did not receive guideline-concordant therapy.…”

Section: Discussionmentioning

confidence: 92%

Guideline‐concordant cancer care and survival among American Indian/Alaskan Native patients

Javid

Varghese

Morris

et al. 2014

Cancer

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BACKGROUND American Indians/Alaskan Natives (AI/ANs) have the worst 5-year cancer survival of all racial/ethnic groups in the United States. Causes for this disparity are unknown. The authors of this report examined the receipt of cancer treatment among AI/AN patients compared with white patients. METHODS This was a retrospective cohort study of 338,204 patients who were diagnosed at age ≥65 years with breast, colon, lung, or prostate cancer between 1996 and 2005 in the Surveillance, Epidemiology, and End Results-Medicare database. Nationally accepted guidelines for surgical and adjuvant therapy and surveillance were selected as metrics of optimal, guideline-concordant care. Treatment analyses compared AI/ANs with matched whites. RESULTS Across cancer types, AI/ANs were less likely to receive optimal cancer treatment and were less likely to undergo surgery (P ≤ .025 for all cancers). Adjuvant therapy rates were significantly lower for AI/AN patients with breast cancer (P <.001) and colon cancer (P = .001). Rates of post-treatment surveillance also were lower among AI/ANs and were statistically significantly lower for AI/AN patients with breast cancer (P = .002) and prostate cancer (P <.001). Nonreceipt of optimal cancer treatment was associated with significantly worse survival across cancer types. Disease-specific survival for those who did not undergo surgery was significantly lower for patients with breast cancer (hazard ratio [HR], 0.62), colon cancer (HR, 0.74), prostate cancer (HR, 0.52), and lung cancer (HR, 0.36). Survival rates also were significantly lower for those patients who did not receive adjuvant therapy for breast cancer (HR, 0.56), colon cancer (HR, 0.59), or prostate cancer (HR, 0.81; all 95% confidence intervals were <1.0). CONCLUSIONS Fewer AI/AN patients than white patients received guideline-concordant cancer treatment across the 4 most common cancers. Efforts to explain these differences are critical to improving cancer care and survival for AI/AN patients.

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Section: Discussionmentioning

confidence: 92%

Guideline‐concordant cancer care and survival among American Indian/Alaskan Native patients

Javid

Varghese

Morris

et al. 2014

Cancer

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“…Although AI/AN have the lowest cancer incidence rates among racial/ethnic groups in the United States, they also have the highest mortality and lowest five-year survival rates after diagnosis. 1,60,61 As with other racial/ethnic minority groups, differences in quality of treatment, delay in receipt of treatment, and lack of treatment likely play a significant role in cancer survival disparities 2,3,7,8,62 and enhancing the patient-provider relationship and satisfaction with the treatment plan may play an important role in addressing these disparities. In our experience, traditional models of shared decision making may be inappropriate to Native communities.…”

Section: Discussionmentioning

confidence: 99%

Shared Decision-Making for Cancer Care Among Racial and Ethnic Minorities: A Systematic Review

et al. 2013

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To assess decision making for cancer treatment among racial/ethnic minority patients, we systematically reviewed and synthesized evidence from studies of “shared decision-making,” “cancer,” and “minority groups,” using PubMed, PsycInfo, CINAHL, and EMBASE. We identified significant themes that we compared across studies, refined, and organized into a conceptual model. Five major themes emerged: treatment decision-making, patient factors, family and important others, community, and provider factors. Thematic data overlapped categories, indicating that individuals’ preferences for medical decision-making cannot be authentically examined outside the context of family and community. The shared decision-making model should be expanded beyond the traditional patient–physician dyad to include other important stakeholders in the cancer treatment decision process, such as family or community leaders.

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“…However, our fully-adjusted HR estimates indicate that these disparities may be largely explained by differences in social and demographic factors between AI/ANs and NHWs. Though prior studies note differences in stage at presentation may account for some difference in cancer outcomes, this would not explain the differences observed in this analysis restricted to metastatic-stage cancer patients (13, 21). In our analysis, marital status and zip-code level median income were significantly different between AI/ANs and NHWs.…”

Section: Discussionmentioning

confidence: 57%

“…Though prior studies have evaluated cancer care in AI/ANs, these have been limited by inclusion of no or few stage IV cases, analysis restricted to a certain region of the country, and/or earlier years of Medicare enrollment, resulting in potentially less relevant results to an evaluation of the experience of AI/ANs with metastatic cancer nationwide (13, 21, 25, 26). Given the relatively small numbers of AI/AN cancer patients in the SEER-Medicare database, this analysis cannot make inferences about specific sub-groups of AI/ANs, such as individual cancer types.…”

Section: Discussionmentioning

confidence: 99%

“…As noted with other diseases, AI/ANs may experience delays in time to presentation for care or receipt of care (10, 11). This raises the concern that AI/ANs with metastatic cancer may be less likely than NHWs to receive chemotherapy, which is potentially life-prolonging, as has been demonstrated for earlier stage cancers (9, 12, 13). AI/ANs may also undergo less surgery and/or radiation for palliation of symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Cancer-Directed Therapy and Hospice Care for Metastatic Cancer in American Indians and Alaska Natives

Shiovitz

Bansal

Burnett‐Hartman

et al. 2015

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Little has been reported regarding patterns of oncologic care in American Indian/Alaska Natives (AI/ANs). Observed worse survival has been attributed to later-stage presentation. We aimed to evaluate racial differences in cancer-directed therapy and hospice care utilization in AI/ANs and non-Hispanic Whites (NHWs) with metastatic cancer. Methods The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was accessed for AI/AN and NHW metastatic-cancer cases diagnosed 2001–2007. Utilization of cancer-directed therapy (surgery, radiation, and/or chemotherapy) and/or hospice services were compared between AI/ANs and NHWs. Minimally-adjusted (age, sex, diagnosis year) and fully-adjusted (also Klabunde comorbidity score, sociodemographic factors) regression models were used to estimate odds (ORs) and hazard ratios (HRs) for receipt of care. Results AI/ANs were younger, more likely to reside in the West, be unmarried, have lower income, and live in a non-urban setting than NHWs. Fewer AI/ANs received any cancer-directed therapy (57% vs. 61% NHWs) within 3 months of diagnosis; sociodemographic factors accounted for much of this difference (fully-adjusted HR 0.94, 95% confidence interval(CI) 0.83–1.08). We noted differences in hospice utilization between AI/ANs (52%) and NHWs (61%). A significant difference in hospice utilization remained after adjustment for sociodemographics (OR 0.78, 95%CI: 0.61–0.99). Conclusion Observed absolute differences in care for AI/ANs and NHWs with metastatic cancer were largely accounted for by adjusting for socioeconomics, comorbidities, and demographic factors. A significant association between race and hospice utilization was noted. Impact Efforts to improve metastatic-cancer care should focus on socioeconomic barriers and investigate the observed disparity in receipt of hospice services.

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Disparities in lung cancer stage, treatment and survival among American Indians and Alaskan Natives

Cited by 30 publications

References 33 publications

Guideline‐concordant cancer care and survival among American Indian/Alaskan Native patients

Guideline‐concordant cancer care and survival among American Indian/Alaskan Native patients

Shared Decision-Making for Cancer Care Among Racial and Ethnic Minorities: A Systematic Review

Cancer-Directed Therapy and Hospice Care for Metastatic Cancer in American Indians and Alaska Natives

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