Racial and Socioeconomic Treatment Disparities in Adolescents and Young Adults with Stage II–III Rectal Cancer

Lee, David Y.; Teng, Annabelle; Pedersen, Rose C.; Tavangari, Farees Ricky; Attaluri, Vikram; McLemore, Elisabeth C.; Stern, Stacey L.; Bilchik, Anton J.; Goldfarb, Melanie

doi:10.1245/s10434-016-5626-0

Cited by 32 publications

(33 citation statements)

References 27 publications

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“…These two factors may be associated with a reduced risk of surgery refusal because patients who were traveling a long distance 18,19 and the racial/socioeconomic barriers discussed previously. 12,17,18 Patients are often concerned with quality of life following rectal cancer surgery given the high rate of morbidity following surgery, including low anterior resection syndrome, sexual dysfunction, and permanent colostomy. In fact, in a survey, patients said they were willing to accept higher rates of tumor recurrence and decreased survival to avoid radical surgery.…”

Section: Discussionmentioning

confidence: 97%

“…There are several reasons why patients may refuse recommended rectal cancer surgery. These include avoidance of radical surgery and quality of life concerns, 14,20 personal values, 15,16 communication difficulties with providers, 18,19 and the racial/socioeconomic barriers discussed previously 12,17,18 . Patients are often concerned with quality of life following rectal cancer surgery given the high rate of morbidity following surgery, including low anterior resection syndrome, sexual dysfunction, and permanent colostomy.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Although there have been advances in the treatment of rectal cancer which have led to decreases in cancer mortality, there are still patients who are not receiving recommended treatment. [9][10][11] Studies have shown that between 30% and 80% who do not receive the recommended therapy are refusing surgery, although the exact number of patients is unknown 12,13 There are several reasons why patients might refuse surgery, which include avoidance of a radical operation, 14 personal values, or beliefs, 15,16 racial or socioeconomic barriers, 12,17,18 difficulties in physician communication, 18,19 or quality of life concerns. [14][15][16][17][18][19][20] Refusal of surgery is associated with worse oncologic outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of stage I‐III rectal cancer: Who is refusing surgery?

Fields

Yoo

et al. 2020

Journal of Surgical Oncology

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Background and Objectives Surgical resection is a cornerstone in the management of patients with rectal cancer. Patients may refuse surgical treatment for several reasons although the rate of refusal is currently unknown. Methods The National Cancer Database was utilized to identify patients with stage I‐III rectal cancer. Patients who refused surgical resection were compared to patients who underwent curative resection. Results A total of 509 (2.6%) patients with stage I and 2082 (3.5%) patients with stage II/III rectal cancer refused surgery. In multivariable analysis for stage I disease, older age, Black race, and Medicaid/no insurance were independent predictors of surgery refusal. Patients were less likely to refuse surgery if they had a higher income or lived further distances from the treatment facility. In multivariable analysis for stage II/III disease, older age, Black race, insurance other than private, and rural county were independent predictors of surgery refusal. Patients were less likely to refuse surgery if they had higher Charlson comorbidity scores, lived further distances from the treatment facility, or underwent chemoradiation. There was a significant decrease in survival for patients refusing surgery compared to patients undergoing recommended surgery. Conclusions A small proportion of patients refuse surgery for rectal cancer, and this treatment decision significantly affects survival.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of stage I‐III rectal cancer: Who is refusing surgery?

Fields

Yoo

et al. 2020

Journal of Surgical Oncology

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“…Insurance status, a key health‐related socioeconomic measure, also plays an important role in survival . Several cancers including germ cell tumors, thyroid cancer, lymphoma, and other solid tumors have worse outcomes for those with no insurance or public insurance compared to private insurance. The Patient Protection and Affordable Care Act (ACA)'s expansion of Medicaid and coverage to dependents under 26 years provided a recent means to protect this especially vulnerable age group .…”

Section: Introductionmentioning

confidence: 99%

A U.S. population‐based study of insurance disparities in cancer survival among adolescents and young adults

et al. 2019

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Background Adolescents and young adults (AYA), patients age 15‐39, may experience worse outcomes than pediatric and adult patients. The aim of this paper was to document survival disparities associated with insurance status across the AYA age continuum in the United States. Methods We utilized the Surveillance, Epidemiologic, and End Results database to identify 66 556 AYA patients between 2007 and 2014 with 10 International Classification of Childhood Cancer diagnoses and calculated the Cox proportional hazard ratios of death for those with public or no insurance status compared to private insurance. The odds ratios of having a late stage of diagnosis by insurance status were also calculated. Results Insurance status was a statistically significant predictor of death for lymphoid leukemia (age 15‐19, 30‐34, and 35‐39), acute myeloid leukemia (age 15‐19 and 25‐29), Hodgkin lymphoma (all ages), non‐Hodgkin lymphoma (age 20‐24, 25‐29, 30‐34, and 35‐39), astrocytomas (age 30‐34), other gliomas (age 25‐29, 30‐34, and 35‐39), hepatic carcinomas (age 25‐29), fibrosarcomas, peripheral nerve and other fibrous tumors (age 30‐34), malignant gonadal germ cell tumors (age 20‐24, 25‐29, 30‐34, and 35‐39), and other and unspecified carcinomas (age 20‐24, 25‐29, 30‐34, and 35‐39), independent of stage at diagnosis. This hazard increased with age for most cancer types. Insurance status strongly predicted the odds of a metastatic cancer diagnosis for lymphoma, fibrosarcomas (age 15‐19), germ cell tumors, and other carcinomas. Conclusions AYA in the US experience disparities in cancer survival based on insurance status, independent of late stage of presentation. Patients age 26‐39 may be especially vulnerable to health outcomes associated with poor socioeconomic status, treatment disparities, and poor access to care.

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“…In ersten Studien zeigen sich zudem Hinweise darauf, dass sozioökonomische Faktoren in derselben Weise wie onkologische Parameter (bspw. Histologie) das AYA-Überleben determinieren können (51)(52)(53). Häufig übernehmen gera-de die AYA-Eltern für junge Krebs-Patienten in der praktischen Bewältigung dieses ebenfalls existenziellen Unsicherheitserlebens nach Abschluss der Krebsbehandlung eine Schlüsselposition (54).…”

Section: Unterstützungsbedürfnisseunclassified

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Köhler¹

2017

Nervenheilkunde

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ZusammenfassungAdoleszente und junge Erwachsene (Adolescents and Young Adults, AYA) mit Krebs stellen mit einer Inzidenz von 15 000 Fällen pro Jahr in ihrer Peer Group eine Ausnahme dar. Mittlerweile liegen eine Reihe forschungsbasierter Befunde vor, welche die klinische Bedeutsamkeit des umschriebenen Altersintervalls zwischen dem 15. und 39. Lebensjahr im Vergleich zu Kindern und älteren Erwachsenen kennzeichnen. Darüber hinaus stehen das körperliche und seelische Erleben sowie die individuelle Bewältigung der existenziellen Abhängigkeiten durch den Krebs und die Krebsbehandlung in einem deutlichen Gegensatz zum Charakter der Lebenssituation eines gesund aufwachsenden jungen Erwachsenen. Eine Evidenz zur forschungsbasierten Entwicklung geprüfter Beurteilungsverfahren, Erhebung psychosozialer Beanspruchungen und Wirksamkeitsprüfung personalisierter Interventionsansätze ist bislang allerdings kaum gegeben. Die Anwendung entwicklungspsychologischer Konzepte und familienbasierter Ansätze kann ein professionelles Verständnis im Umgang mit den AYAKrebspatienten und deren existenziell bedrohlichen Herausforderungen fördern.

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Racial and Socioeconomic Treatment Disparities in Adolescents and Young Adults with Stage II–III Rectal Cancer

Abstract: There are racial and socioeconomic disparities in the treatment of stage II-III rectal cancer in AYAs, many of which impact OS. Interventions that can address and mitigate these differences may lead to improvements in OS for some patients.

Cited by 32 publications

References 27 publications

Treatment of stage I‐III rectal cancer: Who is refusing surgery?

Treatment of stage I‐III rectal cancer: Who is refusing surgery?

A U.S. population‐based study of insurance disparities in cancer survival among adolescents and young adults

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