Racial disparities in survival among patients with advanced renal cell carcinoma in the targeted therapy era

Rose, Tracy L.; Deal, Allison M.; Krishnan, Bhavani; Nielsen, Matthew E.; Smith, Angela M.; Kim, William Y.; Milowsky, Matthew I.

doi:10.1002/cncr.30146

Cited by 35 publications

(32 citation statements)

References 20 publications

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“…A recent study also showed that blacks and Hispanics were less likely and Asians more likely than whites to receive EGFR testing (8). Racial disparities in cancer treatment have been well documented (15)(16)(17)(18); with respect to targeted therapy treatments in particular, it has been found that black patients are less likely than white patients to receive HER2-targeted therapies for breast cancer (19), and black patients with renal cancer show worse survival than whites even after the advent of targeted therapy based on VEGF inhibition (20,21). Despite these studies on disparities in cancer treatment, little is known about whether such discrepancies are stable, growing, or shrinking over time within the context of the rapidly evolving and relatively new field of precision cancer treatment.…”

Section: Introductionmentioning

confidence: 99%

Disparities and Trends in Genetic Testing and Erlotinib Treatment among Metastatic Non–Small Cell Lung Cancer Patients

Palazzo

Sheehan

Tramontano

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Despite reports of socioeconomic disparities in rates of genetic testing and targeted therapy treatment for metastatic non-small cell lung cancer (NSCLC), little is known about whether such disparities are changing over time.Methods: We performed a retrospective analysis to identify disparities and trends in genetic testing and treatment with erlotinib. Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified 9,900 patients with stage IV NSCLC diagnosed in 2007 to 2011 at age 65 or older. We performed logistic regression analyses to identify patient factors associated with odds of receiving a genetic test and erlotinib treatment, and to assess trends in these differences with respect to diagnosis year.Results: Patients were more likely to receive genetic testing if they were under age 75 at diagnosis [odds ratio (OR), 1.55] independent of comorbidity level, and this age-based gap showed a decrease over time (OR, 0.93). For untested patients, erlotinib treatment was associated with race (OR, 0.58, black vs. white; OR, 2.45, Asian vs. white), and was more likely among female patients (OR, 1.45); for tested patients, erlotinib treatment was less likely among low-income patients (OR, 0.32). Most of these associations persisted or increased in magnitude.Conclusions: Race and sex are associated with rates of erlotinib treatment for patients who did not receive genetic testing, and low-income status is associated with treatment rates for those who did receive testing. The racial disparity remained stable over time, while the income-based disparity grew larger.Impact: Attention to reducing disparities is needed as precision cancer treatments continue to be developed.

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Section: Introductionmentioning

confidence: 99%

Disparities and Trends in Genetic Testing and Erlotinib Treatment among Metastatic Non–Small Cell Lung Cancer Patients

Palazzo

Sheehan

Tramontano

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Unfortunately, not all patients have equal access to recommended follow‐up clinical care, neuroimaging, and salvage treatment. Disparities in access to cancer care among different racial and socioeconomic groups are well recognized in the medical literature . The effect of disparities in access to care on patient outcomes is unknown when a strategy of treating brain metastases with SRS alone is used.…”

Section: Introductionmentioning

confidence: 99%

“…Disparities in access to cancer care among different racial and socioeconomic groups are well recognized in the medical literature. [6][7][8][9][10][11][12][13] The effect of disparities in access to care on patient outcomes is unknown when a strategy of treating brain metastases with SRS alone is used. We compared clinical outcomes between safety-net hospital (SNH) and private hospital (PH) patients treated with SRS alone to test the hypothesis that, because of worse neurologic outcomes, SRS alone with observation may not always be suitable for patients originating from an SNH environment who may have barriers to appropriate follow-up care.…”

Section: Introductionmentioning

confidence: 99%

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

Diao

Sun

Yoo

et al. 2017

Cancer

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BACKGROUND: Stereotactic radiosurgery (SRS) alone is an increasingly accepted treatment for brain metastases, but it requires adherence to frequently scheduled follow-up neuroimaging because of the risk of distant brain metastasis. The effect of disparities in access to follow-up care on outcomes after SRS alone is unknown. METHODS: This retrospective study included 153 brain metastasis patients treated consecutively with SRS alone from 2010 through 2016 at an academic medical center and a safety-net hospital (SNH) located in Los Angeles, California. Outcomes included neurologic symptoms, hospitalization, steroid use and dependency, salvage SRS, salvage whole-brain radiotherapy, salvage neurosurgery, and overall survival. RESULTS: Ninety-three of the 153 patients were private hospital (PH) patients, and 60 were SNH patients. The median follow-up time was 7.7 months. SNH patients received fewer follow-up neuroimaging studies (1.5 vs 3; P 5.008). In a multivariate analysis, the SNH setting was a significant risk factor for salvage neurosurgery (hazard ratio [HR], 13.65; P <.001), neurologic symptoms (HR, 3.74; P 5.002), and hospitalization due to brain metastases (HR, 6.25; P <.001). More clinical visits were protective against hospitalizations due to brain metastases (HR, 0.75; P 5.002), whereas more neuroimaging studies were protective against death (HR, 0.65; P <.001). CONCLUSIONS: SNH patients with brain metastases treated with SRS alone had fewer follow-up neuroimaging studies and were at higher risk for neurologic symptoms, hospitalization for brain metastases, and salvage neurosurgery in comparison with PH patients. Clinicians should consider the practice setting and patient access to follow-up care when they are deciding on the optimal strategy for the treatment of brain metastases. Cancer 2018;124:167-75. V C 2017 American Cancer Society.KEYWORDS: brain metastases, follow-up care, health disparities, neuroimaging, neurologic outcomes, safety-net hospital, stereotactic radiosurgery. INTRODUCTIONThe standard of care for the treatment of brain metastases has historically been whole-brain radiotherapy (WBRT) with surgery or stereotactic radiosurgery (SRS) as an adjuvant treatment. 1 Recently, SRS alone has become an increasingly accepted treatment option because of the improved neurocognitive preservation demonstrated in 2 randomized controlled trials in comparison with treatment with SRS and WBRT. 2,3 SRS delivers a single, high dose of focal radiation to the tumor while sparing adjacent normal brain tissue and is administered in a single session. Multiple randomized controlled trials have shown no improvement in overall survival (OS) with the addition of WBRT to SRS. 4,5 The success of SRS alone, however, depends on close clinical observation with neuroimaging because of the increased risk of distant brain metastasis failure associated with the omission of WBRT. [3][4][5] Unfortunately, not all patients have equal access to recommended follow-up clinical care, neuroimaging, and salvage treatment. Disparitie...

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“…We appreciate the thoughtful comments by Grant et al on vitamin D status as a possible etiology for the observed racial disparity in survival between African American and white patients with advanced renal cell carcinoma in our analysis . Although the National Cancer Database is a powerful tool for performing disparity and outcomes research, it has limitations and specifically does not include information on serum 25‐hydroxyvitamin D levels, so we were unable to include 25‐hydroxyvitamin D as a covariate in our analysis.…”

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confidence: 99%

Reply to vitamin D status may explain racial disparities in survival among patients with advanced renal cell carcinoma in the targeted therapy era

Rose

Milowsky

2016

Cancer

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Racial disparities in survival among patients with advanced renal cell carcinoma in the targeted therapy era

Cited by 35 publications

References 20 publications

Disparities and Trends in Genetic Testing and Erlotinib Treatment among Metastatic Non–Small Cell Lung Cancer Patients

Disparities and Trends in Genetic Testing and Erlotinib Treatment among Metastatic Non–Small Cell Lung Cancer Patients

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

Reply to vitamin D status may explain racial disparities in survival among patients with advanced renal cell carcinoma in the targeted therapy era

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