Safety‐net versus private hospital setting for brain metastasis patients treated with radiosurgery alone: Disparities in follow‐up care and outcomes

Diao, Kevin; Sun, Yanqing; Yoo, Stella K.; Yu, Cheng; Ye, Jason C.; Trakul, Nicholas; Jennelle, R.; Kim, Paul E.; Zada, Gabriel; Gruen, J. Peter; Chang, Eric L.

doi:10.1002/cncr.30984

Cited by 14 publications

(8 citation statements)

References 28 publications

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“…However, the high rates of toxicities with head and neck cancer treatment coupled with the potential for early detection of local recurrence make evidence‐based follow‐up critically important. One study of patients treated with stereotactic radiosurgery for brain metastases showed that patients treated at a safety‐net hospital had fewer neuroimaging studies and were at higher risk for complications . Another study showed that compared to white breast‐cancer survivors, African American breast cancer survivors were more likely to report barriers to follow‐up care .…”

Section: Discussionmentioning

confidence: 99%

“…The National Comprehensive Cancer Network (NCCN) follow‐up guidelines on head and neck cancer include, but are not limited to, a history and physical within 3 months of treatment conclusion and repeat baseline imaging of the primary site within 6 months . Previously reported barriers to adequate follow‐up in other primary cancers include African American race, Spanish language preference, and safety‐net hospital treatment …”

Section: Introductionmentioning

confidence: 99%

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Disparities in adherence to head and neck cancer follow‐up guidelines

Perlow¹,

Ramey

Cassidy³

et al. 2018

The Laryngoscope

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Objectives In this study, we aim to determine the frequency of adherence to National Comprehensive Cancer Network follow‐up guidelines in a population of head and neck cancer patients who received curative treatment. We will also assess the impact of race, ethnicity, socioeconomic status, and treatment setting on utilization of follow‐up care. Methods This study included patients with biopsy‐proven, nonmetastatic oropharyngeal or laryngeal cancer treated with radiotherapy between January 1, 2014, and June 30, 2016, at a safety‐net hospital or adjacent private academic hospital. Components of follow‐up care analyzed included an appointment with a surgeon or radiation oncologist within 3 months and posttreatment imaging of the primary site within 6 months. Univariable and multivariable analyses were conducted using a logistic regression model to estimate odds ratios and corresponding 95% confidence intervals. Results Two hundred and thirty‐four patients were included in this study. Of those, 88.8% received posttreatment imaging of the primary site within 6 months; 88.5% attended a follow‐up appointment with a radiation oncologist within 3 months; and 71.1% of patients attended a follow‐up appointment with a surgeon within 3 months. On multivariable analysis, private academic hospital treatment versus safety‐net hospital treatment was associated with increased utilization of both surgical and radiation oncology follow‐up. Non‐Hispanic black (NHB) patients, Hispanic patients, and those with a low socioeconomic status were also less likely to receive follow‐up. Conclusion Safety‐net hospital treatment, socioeconomic status, Hispanic ethnicity, and NHB race were associated with decreased follow‐up service utilization. Quality improvement initiatives are needed to reduce these disparities. Level of Evidence 2b Laryngoscope, 129:2303–2308, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Disparities in adherence to head and neck cancer follow‐up guidelines

Perlow¹,

Ramey

Cassidy³

et al. 2018

The Laryngoscope

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“…HACs were identified using CMS-defined ICD-9 codes as outlined in Lopez Ramos et al 8 Inpatient costs were estimated by multiplying reported inpatient charges by all-payer hospital-specific cost-to-charge ratios provided by the CMS. 13 …”

Section: Methodsmentioning

confidence: 99%

The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: a 10-year nationwide analysis

Tang

Perla

Lim

et al. 2020

Neuro-Oncology Advances

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Background Outcome disparities have been documented at safety-net hospitals (SNHs), which disproportionately serve vulnerable patient populations. Using a nationwide retrospective cohort, we assessed inpatient outcomes following brain tumor craniotomy at SNHs in the United States. Methods We identified all craniotomy procedures in the National Inpatient Sample from 2002-2011 for brain tumors: glioma, metastasis, meningioma, and vestibular schwannoma. Safety-net burden was calculated as the number of Medicaid plus uninsured admissions divided by total admissions. Hospitals in the top quartile of burden were defined as SNHs. The association between SNH status and in-hospital mortality, discharge disposition, complications, hospital-acquired conditions (HACs), length of stay (LOS), and costs were assessed. Multivariate regression adjusted for patient, hospital, and severity characteristics. Results 304,719 admissions were analyzed. The most common subtype was glioma (43.8%). Of 1,206 unique hospitals, 242 were SNHs. SNH admissions were more likely to be non-white (P<0.001), low-income (P<0.001), and have higher severity scores (P=0.034). Mortality rates were higher at SNHs for metastasis admissions (odds ratio [OR]=1.48, P=0.025), and SNHs had higher complication rates for meningioma (OR=1.34, P=0.003) and all tumor types combined (OR=1.17, P=0.034). However, there were no differences at SNHs for discharge disposition or HACs. LOS and hospital costs were elevated at SNHs for all subtypes, culminating in a 10% and 9% increase in LOS and costs for the overall population, respectively (all P<0.001). Conclusions SNHs demonstrated poorer inpatient outcomes for brain tumor craniotomy. Further analyses of the differences observed and potential interventions to ameliorate interhospital disparities are warranted.

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“…One study found that patients with glioblastoma treated at an SNH or those who did not have insurance had higher mortality rates than patients treated at a PH. 5,7 According to a recent study at our center, SNH patients with brain metastases treated with stereotactic radiosurgery alone had less follow-up care and a higher rate of poor neurological outcomes than PH patients, 14 highlighting the importance of considering patient access to follow-up care when deciding on optimal treatment strategies.…”

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confidence: 99%

Comparative preoperative characteristics and postoperative outcomes at a private versus a safety-net hospital following endoscopic endonasal transsphenoidal resection of pituitary adenomas

J¹,

Pangal²,

Rutkowski³

et al. 2021

Journal of Neurosurgery

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OBJECTIVESociodemographic disparities in health outcomes are well documented, but the effects of such disparities on preoperative presentation of pituitary adenomas (PA) and surgical outcomes following resection are not completely understood. In this study the authors sought to compare the preoperative clinical characteristics and postoperative outcomes in patients undergoing PA resection at a private hospital (PH) versus a safety-net hospital (SNH).METHODSThe authors conducted a retrospective review over a 36-month period of patients with PAs who underwent endoscopic endonasal transsphenoidal surgery performed by the same attending neurosurgeon at either a PH or an SNH at a single academic medical institution.RESULTSA total of 92 PH patients and 69 SNH patients were included. SNH patients were more likely to be uninsured or have Medicaid (88.4% vs 10.9%, p < 0.0001). A larger percentage of SNH patients were Hispanic (98.7% vs 32.6% p < 0.0001), while PH patients were more likely to be non-Hispanic white (39.1% vs 4.3%, p < 0.0001). SNH patients had a larger mean PA diameter (26.2 vs 22.4 mm, p = 0.0347) and a higher rate of bilateral cavernous sinus invasion (13% vs 4.3%, p = 0.0451). SNH patients were more likely to present with headache (68.1% vs 45.7%, p = 0.0048), vision loss (63.8% vs 35.9%, p < 0.0005), panhypopituitarism (18.8% vs 4.3%, p = 0.0031), and pituitary apoplexy (18.8% vs 7.6%, p = 0.0334). Compared to PH patients, SNH patients were as likely to undergo gross-total resection (73.9% vs 76.1%, p = 0.7499) and had similar rates of postoperative improvement in headache (80% vs 89%, p = 0.14) and vision (82% vs 84%, p = 0.74), but had higher rates of postoperative panhypopituitarism (23% vs 10%, p = 0.04) driven by preoperative endocrinopathies. Although there were no differences in tumor recurrence or progression, loss to follow-up was seen in 7.6% of PH versus 18.6% (p = 0.04) of SNH patients.CONCLUSIONSPatients presenting to the SNH were more often uninsured or on Medicaid and presented with larger, more advanced pituitary tumors. SNH patients were more likely to present with headaches, vision loss, and apoplexy, likely translating to greater improvements in headache and vision observed after surgery. These findings highlight the association between medically underserved populations and more advanced disease states at presentation, and underscore the likely role of academic tertiary multidisciplinary care teams and endoscopic PA resection in somewhat mitigating sociodemographic factors known to portend poorer outcomes, though longer-term follow-up is needed to confirm these findings.

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Safety‐net versus private hospital setting for brain metastasis patients treated with radiosurgery alone: Disparities in follow‐up care and outcomes

Cited by 14 publications

References 28 publications

Disparities in adherence to head and neck cancer follow‐up guidelines

Disparities in adherence to head and neck cancer follow‐up guidelines

The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: a 10-year nationwide analysis

Comparative preoperative characteristics and postoperative outcomes at a private versus a safety-net hospital following endoscopic endonasal transsphenoidal resection of pituitary adenomas

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