An Interaction of Race and Ethnicity With Socioeconomic Status in Rectal Cancer Outcomes

Kim, Joseph; Artinyan, Avo; Mailey, Brian; Christopher, Stefanie; Lee, Wendy; McKenzie, Shaun; Chen, Steven L.; Bhatia, Smita; Pigazzi, Alessio; García-Aguilar, Julio

doi:10.1097/sla.0b013e3182111102

Cited by 61 publications

(61 citation statements)

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“…In contrast to traditional 5-year survival estimates where predictions are made for diverse groups of patients based on stage alone, the CS calculator can give individualized future survival estimates that also accounts for patient related factors such as age and race which have also been shown to be independently associated with traditional survival estimates. 34, 35 …”

Section: Discussionmentioning

confidence: 99%

An Individualized Conditional Survival Calculator for Patients with Rectal Cancer

Bowles

You

et al. 2013

Diseases of the Colon &Amp; Rectum

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Background Conditional survival estimates account for time survived since diagnosis to provide prognostic information for long-term cancer survivors. For rectal cancer, stage-related treatment (e.g. neoadjuvant radiotherapy) affects pathologic stage and therefore stage-associated survival estimates. Objectives To estimate conditional survival for rectal cancer patients and to develop an interactive calculator to use for individualized patient counseling. Patients Patients with rectal adenocarcinoma were identified using the Surveillance Epidemiology and End Results registry (1988-2002, N=22,610). Design Cox regression models were developed to determine adjusted survival estimates (years 1-10) and used to calculate 5-year adjusted conditional survival. Models were built separately for no radiotherapy, preoperative radiotherapy, postoperative radiotherapy and stage IV patients. Covariates included age, gender, race, tumor grade, and type of surgery. An internet-based conditional survival calculator was developed. Results Radiotherapy was given to 42.6% of patients (14.1% pre-operative, 28.4% post-operative). Significant improvements in 5-year conditional survival were observed for all stages, except stage I due to initial high survival probability at diagnosis. Patients with advanced stage had the greatest improvements in conditional survival, with 5-year absolute increases of 33% (stage IIIC) and 54% (IV). Other factors associated with conditional survival included sequence of radiotherapy and surgery, age, race, and tumor grade. The internet-based conditional survival calculator can be accessed at www.mdanderson.org/rectalcalculator. Limitations Data source used does not include information on chemotherapy treatment, change in staging after neoadjuvant treatment, or patient comorbidities. Conclusion Conditional survival estimates improve over 5 years in rectal cancer patients, with the greatest improvements observed among advanced stage patients. The conditional survival calculator is an individualized decision support tool that informs patients, who must make non-treatment-related life decisions, and their clinicians planning follow-up and surveillance.

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Section: Discussionmentioning

confidence: 99%

An Individualized Conditional Survival Calculator for Patients with Rectal Cancer

Bowles

You

et al. 2013

Diseases of the Colon &Amp; Rectum

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“…3,5,9,11,13,14,16,18,22,23,32– 36 Thirteen of these studies found that Hispanic mortality outcomes were as good or better than that of white patients. 3,5, 9,14,16,18,22,23,32–36 In a study of invasive cervical cancer patients in Florida, median survival was significantly longer for Hispanics compared to non-Hispanic patients (52.8 months vs. 41.6 months, respectively). 5 There was conflicting evidence on differences in surgical graft survival rates between Hispanic and white patients.…”

Section: Methodsmentioning

confidence: 99%

Racial Disparities in Surgical Care and Outcomes in the United States: A Comprehensive Review of Patient, Provider, and Systemic Factors

Haider

Scott

Rehman

et al. 2013

Journal of the American College of Surgeons

464

262

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Summary It is well known that there are significant racial disparities in health care outcomes, including surgery. However, the mechanisms that lead to these disparities are still not fully understood. In this comprehensive review of the currently published surgical disparity literature in the United States, we assess racial disparities in outcomes after surgical procedures, focusing on patient, provider, and systemic factors. The PubMed, EMBASE, and Cochrane Library electronic databases were searched with the keywords: healthcare disparities AND surgery AND outcome AND US. Only primary research articles published between April 1990 and December 2011 were included in the study. Studies analyzing surgical patients of all ages and assessing the endpoints of mortality, morbidity, or the likelihood of receiving surgical therapy were included. A total of 88 articles met the inclusion criteria. This evidence-based review was compiled in a systematic manner, relying on retrospective, cross-sectional, case-control, and prospective studies in the absence of Class I studies. The review found that patient factors such as insurance status and socioeconomic status (SES) need to be further explored, as studies indicated only a premature understanding of the relationship between racial disparities and SES. Provider factors such as differences in surgery rates and treatment by low volume or low quality surgeons also appear to play a role in minority outcome disparities. Finally, systemic factors such as access to care, hospital volume, and hospital patient population have been shown to contribute to disparities, with research consistently demonstrating that equal access to care mitigates outcome disparities.

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“…Median household income and the percentage of patients with at least a high school degree were used as surrogate measures of socioeconomic status, similar to accepted methods used in other studies. [15][16][17][18] Quartiles of household income were based on a median of $41,019, and the cutoff for the lowest quartile was less than $28,575. Education quartiles were created based on a median of 79.8 % of eligible residents having at least a high school education.…”

Section: Socioeconomic Statusmentioning

confidence: 99%

Association of Race and Socioeconomic Status and Outcomes of Patients with Rectal Cancer

et al. 2013

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An Interaction of Race and Ethnicity With Socioeconomic Status in Rectal Cancer Outcomes

Cited by 61 publications

References 0 publications

An Individualized Conditional Survival Calculator for Patients with Rectal Cancer

An Individualized Conditional Survival Calculator for Patients with Rectal Cancer

Racial Disparities in Surgical Care and Outcomes in the United States: A Comprehensive Review of Patient, Provider, and Systemic Factors

Association of Race and Socioeconomic Status and Outcomes of Patients with Rectal Cancer

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