Race and Health Disparities in Patient Refusal of Surgery for Early-Stage Pancreatic Cancer: An NCDB Cohort Study

Tohme, Samer; Kaltenmeier, Christof; Bou‐Samra, Patrick; Varley, Patrick; Tsung, Allan

doi:10.1245/s10434-018-6680-6

Cited by 67 publications

(76 citation statements)

References 22 publications

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“…Colon cancer is becoming an increasingly treatable malignancy, however oncologic surgical resection remains a critical part of treatment 4 . A proportion of patients are known to receive treatment that is not concordant with the prescribed standard of care, and prior work has shown that this disproportionally applies to vulnerable populations 9‐11 . In this study, we find that older age, Black race, lack of insurance, Medicaid, and Medicare insurance were significant predictors of refusing surgery for stage I‐III adenocarcinoma of the colon.…”

Section: Discussionmentioning

confidence: 51%

“…Older age was predictive of refusing surgery in our study, with patients aged 61 or greater having significantly higher odds of refusing operative intervention compared to those aged 50 or younger. Prior work has also demonstrated that elderly patients are more likely to refuse surgery for other malignancies compared to those who are younger despite being deemed appropriate surgical candidates 9‐12 . As to why elderly patients may be refusing surgery, Rothman et al 19 found that amongst elderly patients with advanced illness, 41% of patients who refused a surgical or medical procedure reported fear of side effects as a major driving reason.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, we find that Black race was a significant predictor of refusing surgery. Black race has been previously found to be predictive of refusing surgery in a range of other diseases, including esophageal, lung, prostate, gastric and breast cancers 9‐12,24 . There exists a body of literature regarding the experience of Black patients in the health care system, where a history of medical distrust and ineffective patient‐provider communication can have significantly negative impacts on patients' care 25,26 .…”

Section: Discussionmentioning

confidence: 99%

“…Prior work has shown that a proportion of patients diagnosed with a variety of cancers do not undergo recommended potentially curative operations 8 . While some of this has been posited to be due to inadequate healthcare access, other studies have shown that there are also patients who refuse surgery recommended by health care providers 9‐12 . While the reason behind such refusal is unclear, prior evidence has suggested that such refusal may be a result of racial and socioeconomic differences 9‐11 .…”

Section: Introductionmentioning

confidence: 99%

“…While some of this has been posited to be due to inadequate healthcare access, other studies have shown that there are also patients who refuse surgery recommended by health care providers 9‐12 . While the reason behind such refusal is unclear, prior evidence has suggested that such refusal may be a result of racial and socioeconomic differences 9‐11 . Colon cancer resection carries a lower risk profile than resections for other cancers, such as esophageal or pancreatic disease, however refusal of surgery in this population is understudied and the number of patients who refuse surgery is unknown 13‐15 …”

Section: Introductionmentioning

confidence: 99%

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Sociodemographic predictors of surgery refusal in patients with stage I‐III colon cancer

Fields

Yoo

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Over 104 000 cases of colon cancer are estimated to be diagnosed in 2020. Surgical resection is a critical part of colon cancer treatment and adequate resection impacts prognosis. However, some patients refuse potentially curative surgery. We aimed to identify the rate and predictors of surgery refusal among patients with colon cancer.Methods: The National Cancer Database (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) was queried for patients diagnosed with stage I-III colonic adenocarcinoma. Sociodemographic factors, clinical features, and treatment facility characteristics were collected. Patients who underwent surgery with curative intent were compared to those who refused surgery. Multivariable analysis was used to identify factors associated with surgery refusal. Adjusted survival analysis was performed on propensity-matched cohorts.Results: A total of 151 020 patients were included and 1071 (0.71%) refused surgery. In multivariable analysis older age, Black race, higher Charlson comorbidity score, Medicaid, Medicare, or lack of insurance were predictive of refusing surgery.After propensity matching, there was a significant difference in 5-year survival for patients who refused surgery vs those who underwent surgery (P < .001).Conclusions: There are racial and socioeconomic disparities in the refusal of surgery for colon cancer. Further studies are needed to better understand the drivers behind differences in refusing curative surgery for colon cancer. K E Y W O R D S colon cancer, disparities, race, refusal, treatment 1 | INTRODUCTION Despite decreasing mortality rates, colorectal cancer remains the third leading cause of cancer-related deaths amongst both men and women in the United States. 1 Colon cancer is more frequently diagnosed than rectal cancer, with over 104 000 new cases diagnosed annually. 2 Fortunately, the mortality rate associated with colon cancer has been steadily decreasing, which is thought to be the result of earlier diagnosis with routine screening and improved chemotherapy regimens. 3 Surgical resection remains the standard treatment for curative therapy. 4 Although well-defined evidence-based guidelines in the optimal treatment of colon cancer are available, a number of patients still do not receive stage-appropriate standard of care. 5-7

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Sociodemographic predictors of surgery refusal in patients with stage I‐III colon cancer

Fields

Yoo

et al. 2020

Journal of Surgical Oncology

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Disparities in Pancreatic Ductal Adenocarcinoma—The Significance of Hispanic Ethnicity, Subgroup Analysis, and Treatment Facility on Clinical Outcomes

et al. 2020

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Background Disparities exist among patients with pancreatic ductal adenocarcinoma (PDAC). Non‐White race is regarded as a negative predictor of expected treatment and overall survival. Data suggest that Academic Research Programs (ARP) provide better outcomes for minorities, but ethnic/minority outcomes are underreported. We hypothesize that outcomes among racially/ethnically diverse PDAC patients may be influenced by treatment facility. Methods The National Cancer Database was used to identify 170,327 patients diagnosed with PDAC between 2004 and 2015. Cox proportional‐hazard regression was used to compare survival between race/ethnic groups across facilities. Results In unadjusted models, compared to non‐Hispanic Whites (NHW), non‐Hispanic Blacks (NHB) had the worst overall survival (HR = 1.05, 95%CI: 1.03‐1.06, P < .001) and Hispanics had the best overall survival (HR = 0.92, 95%CI: 0.90‐0.94, P < .001). After controlling for socioeconomic and clinical covariates, NHB (HR = 0.95, 95%CI: 0.93‐0.96, P < .001) had better overall survival compared to NHW, and Hispanics continued to have the best comparative outcomes (HR = 0.84, 95%CI: 0.82‐0.86, P < .001). Among Hispanics, Dominicans and South/Central Americans lived the longest, at 10.25 and 9.82 months, respectively. The improved survival in Hispanics was most pronounced at ARP (HR = 0.80, 95%CI: 0.77‐0.84, P < .001) and Integrated Network Cancer Programs (HR = 0.78, 95%CI: 0.73‐0.84, P < .001). NHB had improved survival over NHW at Comprehensive Community Care Programs (HR = 0.96, 95%CI: 0.93‐0.98, P = .002) and ARP (HR = 0.96, 95%CI: 0.94‐0.98, P = .001), which was influenced by income, education, and surgical resection. Conclusion Survival was improved at ARP for all populations. Hispanics had the best comparative overall survival. NHB had improved overall survival at higher volume centers, but this was dependent upon income, education, and surgical resection.

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Incidence, factors, and disparities related to cancer among Black individuals in Canada: A scoping review

Cénat

Dromer

Darius

et al. 2022

Cancer

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Background In Canada, two of five individuals will be diagnosed with cancer in their lifetime and one in four will die from this disease. Given the disparities observed in health research among Black individuals, we conducted a scoping review to analyze the state of cancer research in Canadian Black communities regarding prevalence, incidence, screening, mortality, and related factors to observe advances and identify gaps and disparities. Methods A comprehensive search strategy was developed and executed in December 2021 across 10 databases (e.g., Embase). Of 3451 studies generated by the search, 19 were retained for extraction and included in this study. Results Studies were focused on a variety of cancer types among Black individuals including anal, breast, cervical, colorectal, gastric, lung, and prostate cancers. They included data on incidence, stage of cancer at diagnosis, type of care received, diagnostic interval length, and screening. A few studies also demonstrated racial disparities among Black individuals. This research reveals disparities in screening, incidence, and quality of care among Black individuals in Canada. Conclusions Given the gaps observed in cancer studies among Black individuals, federal and provincial governments and universities should consider creating special funds to generate research on this important health issue. Plain language summary Important gaps were observed on research on cancer among Black communities in Canada. Studies included in the scoping review highlights disparities in screening, incidence, and quality of care among Black individuals in Canada.

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Race and Health Disparities in Patient Refusal of Surgery for Early-Stage Pancreatic Cancer: An NCDB Cohort Study

Cited by 67 publications

References 22 publications

Sociodemographic predictors of surgery refusal in patients with stage I‐III colon cancer

Sociodemographic predictors of surgery refusal in patients with stage I‐III colon cancer

Disparities in Pancreatic Ductal Adenocarcinoma—The Significance of Hispanic Ethnicity, Subgroup Analysis, and Treatment Facility on Clinical Outcomes

Incidence, factors, and disparities related to cancer among Black individuals in Canada: A scoping review

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