The role of socioeconomic disparity in colorectal cancer stage at presentation

Patel, Abhishek; Gantz, Owen; Zagadailov, Pavel; Merchant, Aziz M.

doi:10.1007/s13304-019-00632-5

Cited by 25 publications

(24 citation statements)

References 26 publications

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“…We found that socioeconomic factors, including residing in regions of high median income and type of medical insurance, correlated with receipt of proton RT, confirming the findings of others . Higher socioeconomic status has been associated with earlier stage cancer at presentation, increased receipt of standard‐of‐care cancer treatment, more timely initiation of therapy, and better cancer outcomes . Interestingly, although HNSCC patients treated with protons had higher socioeconomic status, they experienced longer delays prior to receiving either definitive or adjuvant RT, suggesting that these delays may be influenced by not only socioeconomic but also treatment‐specific factors.…”

Section: Discussionsupporting

confidence: 86%

“…27 Higher socioeconomic status has been associated with earlier stage cancer at presentation, increased receipt of standard-of-care cancer treatment, more timely initiation of therapy, and better cancer outcomes. [28][29][30] Interestingly, although HNSCC patients treated with protons had higher socioeconomic status, they experienced longer delays prior to receiving either definitive or adjuvant RT, suggesting that these delays may be influenced by not only socioeconomic but also treatmentspecific factors. Proton RT requires a specialized center with a large capital investment; hence, there are only 31 proton centers currently open in the United States.…”

Section: Discussionmentioning

confidence: 99%

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Proton radiotherapy and treatment delay in head and neck squamous cell carcinoma

Jin¹,

Harris²,

Sabolch

et al. 2019

The Laryngoscope

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Objective: For patients with head and neck squamous cell carcinoma (HNSCC), delays in the initiation of radiotherapy (RT) have been closely associated with worse outcomes. We sought to investigate whether RT modality (proton vs. photon) is associated with differences in the time to initiation of RT. Methods: The National Cancer Database was queried for patients diagnosed with nonmetastatic HNSCC between 2004 and 2015 who received either proton or photon RT as part of their initial treatment. Wilcoxon rank-sum and chi-square tests were used to compare continuous and categorical variables, respectively. Multivariable logistic regression was used to determine the association between use of proton RT and delayed RT initiation. Results: A total of 175,088 patients with HNSCC receiving either photon or proton RT were identified. Patients receiving proton RT were more likely to be white, reside in higher income areas, and have private insurance. Proton RT was associated with delayed RT initiation compared to photon RT (median 59 days vs. 45, P < 0.001). Receipt of proton therapy was independently associated with RT initiation beyond 6 weeks after diagnosis (adjusted OR [aOR, definitive RT] = 1.69; 95% confidence interval [CI] 1.26-2.30) or surgery (aOR [adjuvant RT] = 4.08; 95% CI 2.64-6.62). In the context of adjuvant proton RT, increases in treatment delay were associated with worse overall survival (weeks, adjusted hazard ratio = 1.099, 95% CI 1.011-1.194). Conclusion: Use of proton therapy is associated with delayed RT in both the definitive and adjuvant settings for patients with HNSCC and could be associated with poorer outcomes.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Proton radiotherapy and treatment delay in head and neck squamous cell carcinoma

Jin¹,

Harris²,

Sabolch

et al. 2019

The Laryngoscope

View full text Add to dashboard Cite

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“…One such populationbased study conducted using the SEER database between primary, site, state/county, and insurance status on cancer staging at diagnosis. This study found sociodemographic risk factors associated with a higher stage at diagnosis include low income, race/ethnicity, age, and gender (43). A smaller scale study, conducted at an urban-safety net hospital found that Black patients are nearly four times as likely to have stage III-IV CRC at diagnosis compared to Whites (P=0.055), thereby increasing the risk for cancer recurrence and mortality and further substantiating these findings in diverse care settings (44).…”

Section: Outcome Disparitiessupporting

confidence: 54%

A narrative review of sociodemographic risk and disparities in screening, diagnosis, treatment, and outcomes of the most common extrathoracic malignancies in the United States

Singh¹,

Sridhar²

2021

J Thorac Dis

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been identified as high risk based on race, ethnicity, gender, socioeconomic status (SES), education status, immigrant status, primary language, place of work, access to care, and residential segregation, and distance from healthcare facilities, among other sociodemographic factors. As we look to address these disparities in patients with lung cancer, it is helpful to understand how sociodemographic risk has

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“…Our hypothesis was that these findings would be most pronounced in patients with malignancy, as African-American patients have previously been shown to have lower access to care and significant delays in treatment initiation [25]. Previous studies of racial disparities in colorectal cancer have shown African-American patients to present at a more advanced stage and have decreased overall survival [26,27]. Although we did not observe a difference in the 30-day mortality rates, overall survival is likely not to be different within this short time.…”

Section: Discussionmentioning

confidence: 98%

Racial disparities after stoma construction in colorectal surgery

et al. 2020

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Aim Racial disparities are under‐recognized among patients undergoing colorectal surgery. The purpose of this study was to determine the complication rates and surgical outcomes stratified by race and ethnicity among patients undergoing colorectal surgery with intestinal stoma creation. Method The ACS NSQIP database from 2013 to 2016 was used. Colon, rectum and small bowel cases requiring intestinal stoma creation were selected. Both African‐American and other groups of minority patients were compared with Caucasian patients using a complex multivariable analysis model. Primary outcomes of interest were complication rates, mortality and extended hospital length of stay. Results The study included 38 088 admissions. After multivariable analysis, African‐American patients still had a prolonged length of hospital stay and higher complication rates. Other minorities also had a prolonged length of hospital stay and higher complication rates. Conclusions Both African‐American and other groups of minority patients requiring an ostomy suffer significantly higher postoperative complication rates and a prolonged hospital length of stay, even after comorbidity adjustment. Access to care, socioeconomic status and comorbid disease management are all important factors for minority patients who undergo colorectal surgery requiring intestinal stoma construction.

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The role of socioeconomic disparity in colorectal cancer stage at presentation

Cited by 25 publications

References 26 publications

Proton radiotherapy and treatment delay in head and neck squamous cell carcinoma

Proton radiotherapy and treatment delay in head and neck squamous cell carcinoma

A narrative review of sociodemographic risk and disparities in screening, diagnosis, treatment, and outcomes of the most common extrathoracic malignancies in the United States

Racial disparities after stoma construction in colorectal surgery

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