Do Learning Disabilities Affect Testicular Cancer Survival: A National Cohort Study Between 2001 and 2015

Afshar, Mehran; Patel, Hiten; DeSantis, Maria; Tanner, J; O'Neill, T.; Evison, Felicity; James, Nicholas D.; Selby, Peter J.; Patel, Prashant

doi:10.1016/j.euo.2018.12.008

Cited by 10 publications

(7 citation statements)

References 19 publications

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“…Moreover, only one reviewer evaluated papers for risk of bias. Finally, the findings were very diverse hence it was not possible to conduct a meta-analysis, and approximately 15% of the studies had a high risk of bias Almost half (45%) of the eligible studies had a medium risk of bias, mostly due to possible misclassification bias for inclusion of PwD based on disability records (that have a tendency to miss mild cases) or missing data like details about cancer treatment goals, behavioral factors or date of diagnosis [ 36 , 37 , 42 , 43 , 49 , 54 , 56 , 64 , 65 ]. Approximately 15% of the studies had a high risk of bias due to factors such as having a very small sample size, a short follow-up, low data quality, a biased cohort or using a self-reporting survey [ 38 , 46 , 51 , 58 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

Do people with disabilities experience disparities in cancer care? A systematic review

Tosetti,

Kuper

2023

PLoS ONE

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Background Over 1.3 billion people, or 16% of the world’s population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. Methods A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of adult patients with disabilities and a sample without disabilities were included. Studies focused on cancer screening and not treatment were excluded, as well as editorials, commentaries, opinion papers, reviews, case reports, case series under 10 patients and conference abstracts. Studies were evaluated by one reviewer for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding. Results Thirty-one studies were included in the systematic review. Compared to people without disabilities, PwD had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that PwD received poorer quality cancer care, including lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care. Discussion Limitations of this work include the exclusion of qualitative research, no assessment of publication bias, selection performed by only one reviewer, results from high-income countries only, no meta-analysis and a high risk of bias in 15% of included studies. In spite of these limitations, our results show that PwD often experience severe disparities in cancer care with less guideline-consistent care and higher mortality than people without disabilities. These findings raise urgent questions about how to ensure equitable care for PwD; in order to prevent avoidable morbidity and mortality, cancer care programs need to be evaluated and urgently improved, with specific training of clinical staff, more disability inclusive research, better communication and shared decision-making with patients and elimination of physical, social and cultural barriers.

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Section: Discussionmentioning

confidence: 99%

Do people with disabilities experience disparities in cancer care? A systematic review

Tosetti,

Kuper

2023

PLoS ONE

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“…Over a third of the eligible studies focused on people with psychosocial disability (42%, n=13) defined as a previous diagnosis of psychiatric or mental health issues. (38,39,41,(44)(45)(46)(47)(48)(49)(50)(51)(52)(53) Nine studies (29%, n=9) focused on intellectual, learning disabilities, cognitive impairment or dementia (40,42,(54)(55)(56)(57)(58)(59)(60). Nine other studies (29%, n=9) considered all disability in general or grouped into subcategories (e.g.…”

Section: Types Of Disabilitiesmentioning

confidence: 99%

Do people with disabilities experience disparities in cancer care? A systematic review

Tosetti

Kuper

2023

Preprint

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Background: Over 1.3 billion people, or 16% of the world's population, live with some form of disability. Recent studies have reported that patients with disabilities might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. Methods: A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of patients with disabilities and a sample without disabilities were included. Studies were evaluated for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding. Results: Thirty-one studies were included in the systematic review. Compared to people without disabilities, people with disabilities had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that people with disabilities received poorer quality cancer care, including: lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care. Discussion: Limitations of this work include results from high-income countries only, exclusion of qualitative research, no meta-analysis and high risk of bias in 15% of included studies. In spite of these limitations, our results show that people with disabilities often experience severe disparities in cancer care: barriers at different levels must be eliminated to ensure that they receive equitable treatment.

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“…The World Health Organization defines overweight as a body mass index (BMI) greater than 25 and obesity as greater than 30. Obesity is further stratified into three classes by the Centers for Disease Control (CDC): class I (BMI 30-35), class II (BMI [35][36][37][38][39][40], and Class III (BMI >40). Notably, from 1999 to 2018, obesity rates in the USA have increased from 30.5 to 42.4% [40].…”

Section: Elevated Bmimentioning

confidence: 99%

“…As reported in several studies, cancer and preventive screenings are offered at lower rates to PWD, and access to gynecologic care is inadequate [ 34 – 37 ••]. A study in the UK identified that men with a learning disability were diagnosed with testicular cancer at lower rates and experienced worse outcomes [ 38 ]. In the USA, patients with reported disabilities are less likely to undergo PSA testing than those without disabilities [ 39 ].…”

Section: Introductionmentioning

confidence: 99%

Creating an Inclusive Urology Practice

Gonzalez

Anger

2023

Curr Bladder Dysfunct Rep

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Purpose of Review Patients seeking urologic care come from diverse backgrounds. Therefore, clinics should strive for inclusivity to make all patients feel comfortable seeing a urologist. This review aims to outline and analyze literature relevant to the care of LGTBQIA+ (lesbian, gay, transgender/transexual, queer/questioning, intersex, asexual/allies, nonbinary/genderqueer +), racial and ethnic minorities, those who have disabilities, and those with a high body mass index (BMI). Although this review article presents the care of diverse communities separately, there is an overlap of the various social axes influencing healthcare outcomes. Healthcare workers should be open-minded to learning about evolving community needs. Recent Findings Creating a safe space for LGTBQIA+ requires understanding terminology, awareness of community-specific challenges and health risks, and changing heteronormative behaviors built into medicine. Specific clinical care delivery structural processes and patient-physician-centered practices can make a clinic welcoming for patients from underrepresented backgrounds and with disabilities. BMI surgical requirements may pose barriers to care, and if implemented, there should be assistance to reach specified weight goals. Summary Creating an inclusive urology clinical practice takes time, but it can be achieved by building a collaborative team. Treating patients with consideration of their personal identities and social determinants of health will lead to better patient-center care and health outcomes.

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Do Learning Disabilities Affect Testicular Cancer Survival: A National Cohort Study Between 2001 and 2015

Cited by 10 publications

References 19 publications

Do people with disabilities experience disparities in cancer care? A systematic review

Do people with disabilities experience disparities in cancer care? A systematic review

Do people with disabilities experience disparities in cancer care? A systematic review

Creating an Inclusive Urology Practice

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