Impact of prognostic factor distributions on mortality disparities for socioeconomically disadvantaged cancer patients

Lu, Yan; Gehr, Aaron W.; Narra, Kalyani; Lingam, Anuradha; Ghabach, Bassam; Meadows, Rachel; Ojha, Rohit P.

doi:10.1016/j.annepidem.2021.09.014

Cited by 4 publications

(5 citation statements)

References 45 publications

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“…Although some prior studies have shown thyroid to be the fifth most common primary site leading to MBD, 10 another analysis of SEER data reported a similar finding to the current study 5 . Socioeconomic disparities have long been implicated in incidence and mortality associated with colon cancer 64–67 . The current analysis highlights lowest SES as being an independent predictor of poor prognosis.…”

Section: Discussionsupporting

confidence: 77%

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Socioeconomic and insurance‐related disparities in disease‐specific survival among patients with metastatic bone disease

Jawad

Pollock

Zeitlinger

et al. 2022

Journal of Surgical Oncology

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Background: Approximately 5% of cancer patients in the United States presented with metastatic bone disease (MBD) at diagnosis. Current study explores the disparities in survival for patients with MBD. Methods: Patients with the diagnosis of MBD at presentation for the five most common primary anatomical sites were extracted from Surveillance, Epidemiology, and End Results Census tract-level dataset (2010-2016). Kaplan-Meier and Cox Proportional Hazard models were used to evaluate survival, and prognostic factors for each cohort. Prognostic significance of socioeconomic status (SES) and insurance status were ascertained.Results: The five most common anatomical-sites with MBD at presentation included "lung" (n = 59 739), "prostate" (n = 19 732), "breast" (n = 16 244), "renal and urothelium" (n = 7718) and "colon" (n= 3068). Lower SES was an independent risk factor for worse disease-specific survival (DSS) for patients with MBD originating from lung, prostate, breast and colon. Lack of insurance was an independent risk factor for worse DSS for MBD patients with primary tumors in lung and breast.Conclusions: MBD patients from the five most common primary sites demonstrated SES and insurance-related disparities in disease-specific survival. This is the first and largest study to explore SES and insurance-related disparities among patients specifically afflicted with MBD. Our findings highlight vulnerability of patients with MBD across multiple primary sites to financial toxicity.

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Section: Discussionsupporting

confidence: 77%

“…5 Socioeconomic disparities have long been implicated in incidence and mortality associated with colon cancer. [64][65][66][67] The current analysis highlights lowest SES as being an independent predictor of poor prognosis. Insurance status, however, was not a predictor of DSS in colon primaries presenting with MBD.…”

Section: Discussionmentioning

confidence: 65%

Socioeconomic and insurance‐related disparities in disease‐specific survival among patients with metastatic bone disease

Jawad

Pollock

Zeitlinger

et al. 2022

Journal of Surgical Oncology

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“…For example, our population has higher prevalence of adverse prognostic characteristics and adverse social determinants of health that may override potential benefit of implementing a DST. 20 This phenomenon may not occur in populations outside of safety-net health systems. In addition, DSTs have been developed by commercial vendors, payers, and health systems using different criteria for treatment recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…The John Peter Smith (JPS) Oncology and Infusion Center is a Comprehensive Community Cancer Program in an urban safety-net health system and the primary source of care for socioeconomically marginalized populations in Tarrant County, Texas. 19 , 20 We used data from the institutional cancer registry to identify our study population. This registry includes patient characteristics, cancer staging and tumor characteristics, first course treatment, and outcomes observed during follow-up for all patients age 18 years and older who were treated at JPS Oncology and Infusion Center since January 1, 2008.…”

Section: Methodsmentioning

confidence: 99%

Survival After Implementation of a Decision Support Tool to Facilitate Evidence-Based Cancer Treatment

Ojha

Narra

et al. 2023

JCO Clinical Cancer Informatics

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PURPOSE Decision support tools (DSTs) to facilitate evidence-based cancer treatment are increasingly common in care delivery organizations. Implementation of these tools may improve process outcomes, but little is known about effects on patient outcomes such as survival. We aimed to evaluate the effect of implementing a DST for cancer treatment on overall survival (OS) among patients with breast, colorectal, and lung cancer. METHODS We used institutional cancer registry data to identify adults treated for first primary breast, colorectal, or lung cancer between December 2013 and December 2017. Our intervention of interest was implementation of a commercial DST for cancer treatment, and outcome of interest was OS. We emulated a single-arm trial with historical comparison and used a flexible parametric model to estimate standardized 3-year restricted mean survival time (RMST) difference and mortality risk ratio (RR) with 95% confidence limits (CLs). RESULTS Our study population comprised 1,059 patients with cancer (323 breast, 318 colorectal, and 418 lung). Depending on cancer type, median age was 55-60 years, 45%-67% were racial/ethnic minorities, and 49%-69% were uninsured. DST implementation had little effect on survival at 3 years. The largest effect was observed among patients with lung cancer (RMST difference, 1.7 months; 95% CL, –0.26 to 3.7; mortality RR, 0.95; 95% CL, 0.88 to 1.0). Adherence with tool-based treatment recommendations was >70% before and >90% across cancers. CONCLUSION Our results suggest that implementation of a DST for cancer treatment has nominal effect on OS, which may be partially attributable to high adherence with evidence-based treatment recommendations before tool implementation in our setting. Our results raise awareness that improved process outcomes may not translate to improved patient outcomes in some care delivery settings.

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“…The estimated risks of cardiotoxicity related to anthracyclines and trastuzumab reported in prior studies may not apply to socioeconomically marginalized breast cancer patients (i.e., lack of generalizability [ 13 – 15 ]). Socioeconomically marginalized breast cancer patients have a high prevalence of risk factors for cardiac dysfunction such as obesity and tobacco use [ 16 ], which may exacerbate cardiotoxicity risk [ 2 , 17 , 18 ]. Estimates of cardiotoxicity risk in this population could inform decisions related to addressing unmet needs for cardiotoxicity prevention, detection, and management.…”

Section: Introductionmentioning

confidence: 99%

Cardiotoxicity among socioeconomically marginalized breast cancer patients

Gehr

Anikpo

et al. 2022

Breast Cancer Res Treat

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Purpose Evidence of cardiotoxicity risk related to anthracycline or trastuzumab exposure is largely derived from breast cancer cohorts that under-represent socioeconomically marginalized women, who may be at increased risk of cardiotoxicity because of high prevalence of cardiovascular disease risk factors. Therefore, we aimed to estimate cardiotoxicity risk among socioeconomically marginalized breast cancer patients treated with anthracyclines or trastuzumab and describe clinical consequences of cardiotoxicity. Methods We linked electronic health records with institutional registry data from a Comprehensive Community Cancer Program within a safety-net health system. Eligible patients were adult females, diagnosed with first primary invasive breast cancer between 2013 and 2017, and initiated anthracyclines or trastuzumab as part of first-line therapy. We estimated cumulative incidence (risk) of cardiotoxicity with corresponding 95% confidence limits (CL) using the Aalen-Johansen estimator with death as competing risk. Results Our study population comprised 169 women with breast cancer (103 initiated anthracyclines and 66 initiated trastuzumab). Cumulative incidence of cardiotoxicity was 21% (95% CL: 12%, 32%) at one year and 25% (95% CL: 15%, 35%) at three years among women who initiated trastuzumab, whereas cumulative incidence was 3.9% (95% CL: 1.3%, 8.9%) at one year and 5.9% (95% CL: 2.4%, 12%) at three years among women who initiated anthracyclines. More than half of patients with cardiotoxicity experienced interruption of cancer treatment. Conclusion Our findings suggest high risk of cardiotoxicity among socioeconomically marginalized breast cancer patients after initiation of anthracyclines or trastuzumab. Strategies are needed for optimizing cancer treatment effectiveness while minimizing cardiotoxicity in this population.

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Impact of prognostic factor distributions on mortality disparities for socioeconomically disadvantaged cancer patients

Cited by 4 publications

References 45 publications

Socioeconomic and insurance‐related disparities in disease‐specific survival among patients with metastatic bone disease

Socioeconomic and insurance‐related disparities in disease‐specific survival among patients with metastatic bone disease

Survival After Implementation of a Decision Support Tool to Facilitate Evidence-Based Cancer Treatment

Cardiotoxicity among socioeconomically marginalized breast cancer patients

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