Racial Disparities in Time to Treatment Initiation and Outcomes for Early Stage Anal Squamous Cell Carcinoma

Goksu, Suleyman Yasin; Özer, Muhammet; Kazmi, Syed Mohammad Ali; Aguilera, Todd A.; Ahn, Chul; Hsiehchen, David; Sanjeevaiah, Aravind; Maxwell, Mary Claire; Beg, Muhammad S.; Sanford, Nina N.

doi:10.1097/coc.0000000000000744

Cited by 7 publications

(7 citation statements)

References 42 publications

(49 reference statements)

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“…Individuals from lower‐income strata and with Medicare and Medicaid insurance had higher utilization rates of palliative treatments in front‐line settings. Our previous work in early‐stage anal cancer also showed that socioeconomic disparities adversely affect treatment and outcomes in anal cancer 18 . Race did not have a significant role in the current cohort.…”

Section: Discussionsupporting

confidence: 41%

“…Our previous work in early‐stage anal cancer also showed that socioeconomic disparities adversely affect treatment and outcomes in anal cancer. 18 Race did not have a significant role in the current cohort. Consistently, Medicare and Medicaid patients had higher use of first‐line palliative therapies, which was also noted in the other studies conducted in similar populations in colorectal and pancreatic cancer patients.…”

Section: Discussionmentioning

confidence: 55%

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Trends in utilization of first‐line palliative treatments for anal squamous cell carcinoma

et al. 2022

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Background Anal squamous cell carcinoma patients often present with significant symptoms, including pain, bleeding, and obstructive symptoms. This requires palliation‐directed therapy as a first‐line treatment to alleviate symptoms. The proportion of patients receiving first‐line palliative treatments is unknown. We aimed to study the factors associated with the use of first‐line palliative treatments in stage II–IV anal squamous cell carcinoma patients. Methods We used the National Cancer Database to identify adult patients diagnosed with stage II–IV anal squamous cell carcinoma between 2004 and 2016. We performed univariable and multivariable logistic regression analysis to determine the clinical and sociodemographic variables associated with the utilization of palliative treatment in the first‐line setting, including palliative radiotherapy, chemotherapy, surgery, and pain management. Results Among 16,944 patients diagnosed with stage II–IV anal squamous cell carcinoma, only a small proportion of 492 (2.9%) required first‐line palliative treatments to control symptoms. The majority of these patients received palliative radiotherapy (32%), followed by palliative surgery (25%), palliative chemotherapy (19%), combination therapies (14%), and pain management (10%). On multivariable analysis, higher stage disease, lower income, Medicare and Medicaid insurance, and life expectancy <6 months were associated with higher odds of use of first‐line palliative therapy. Conclusions First‐line use of palliative treatments to control symptoms is needed in a small proportion of anal squamous cell cancer patients. It was utilized in all stages, but it was most frequently observed in patients with stage IV disease and patients with <6 months life expectancy. First‐line palliative therapy was also more frequent in lower‐income patients and patients with Medicare and Medicaid insurance which highlights the disparities in anal cancer management.

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Section: Discussionsupporting

confidence: 41%

Section: Discussionmentioning

confidence: 55%

Trends in utilization of first‐line palliative treatments for anal squamous cell carcinoma

et al. 2022

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“…Two published analyses of patients with anal cancer suggest that Black patients have longer delays to initiation of chemoradiation and also have inferior survival. 15,16 Similarly, Hispanic patients with anal squamous cell carcinoma have been found to have longer delays in start of chemoradiation than NHW patients. 18 NHB and Hispanic women with cervical cancer have longer treatment delays than NHW patients, with IMRT utilization correlated with longer delays.…”

Section: Discussionmentioning

confidence: 99%

“…Limited published data suggest that sociodemographic factors including race, ethnicity, and insurance coverage may contribute to delays in IIT of RT. [15][16][17][18][19][20] As IMRT utilization has significantly increased over the past decade, a contemporary examination of the burden of treatment delays and disparities in timely initiation of definitive IMRT is needed. 21 We hypothesize that delays in initiation of therapy associated with the use of advanced radiotherapy modalities disproportionately affect minoritized patients.…”

Section: Racial and Ethnic Health Disparities In Delay To Initiation ...mentioning

confidence: 99%

Racial and Ethnic Health Disparities in Delay to Initiation of Intensity-Modulated Radiotherapy

Hutten

Weil

Gaffney

et al. 2022

JCO Oncology Practice

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PURPOSE: Delays in initiation of radiotherapy may contribute to inferior oncologic outcomes that are more commonly observed in minoritized populations in the United States. We aimed to examine inequities associated with delayed initiation of intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: The National Cancer Database was queried to identify the 10 cancer sites most commonly treated with IMRT. Interval to initiation of treatment (IIT) was broken into quartiles for each disease site, with the 4th quartile classified as delayed. Multivariable logistic regression for delayed IIT was performed for each disease site using clinical and demographic covariates. Differences in magnitude of delay between subsets of patients stratified by race and insurance status were evaluated using two-sample t-tests. RESULTS: Among patients (n = 350,425) treated with IMRT between 2004 and 2017, non-Hispanic Black (NHB), Hispanic, and Asian patients were significantly more likely to have delayed IIT with IMRT for nearly all disease sites compared with non-Hispanic White (NHW) patients. NHB, Hispanic, and Asian patients had significantly longer median IIT than NHW patients (NHB 87 days, P < .01; Hispanic 76 days, P < .01; Asian 74 days, P < .01; and NHW 67 days). NHW, Hispanic, and Asian patients with private insurance had shorter median IIT than those with Medicare ( P < .01); however, NHB patients with private insurance had longer IIT than those with Medicare ( P < .01). CONCLUSION: Delays in initiation of IMRT in NHB, Hispanic, and Asian patients may contribute to the known differences in cancer outcomes and warrant further investigation, particularly to further clarify the role of different insurance policies in delays in advanced modality radiotherapy.

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“…[110][111][112][113] Other studies showed that Black patients had longer time to treatment initiation (more than 6 weeks vs 6 weeks or less) (OR 1.78, 95% CI 1.53-2.08), as did patients with Medicaid insurance (OR 1.17, 95% CI 0.93-1.49) or low socioeconomic status. 114,115 This disparity in treatment leads to lower survival. [115][116][117][118] In one large study, Black patients with anal HSIL were less likely to get treatment for precancer than White patients (adjusted OR 0.61, 95% CI 0.43-0.85).…”

Section: Anal Cancermentioning

confidence: 99%

Executive Summary of the Lower Anogenital Tract Cancer Evidence Review Conference

Chelmow

Cejtin

Conageski

et al. 2023

Obstetrics &Amp; Gynecology

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The Centers for Disease Control and Prevention sponsored a project conducted by the American College of Obstetricians and Gynecologists to develop educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. For this final module, focusing on the cancers of the lower anogenital tract (vulva, vagina, and anus), a panel of experts in evidence assessment from the Society for Academic Specialists in General Obstetrics and Gynecology, ASCCP, and the Society of Gynecologic Oncology reviewed relevant literature and current guidelines. Panel members conducted structured literature reviews, which were then reviewed by other panel members. Representatives from stakeholder professional and patient advocacy organizations met virtually in September 2022 to review and provide comment. This article is the executive summary of the review. It covers prevention, early diagnosis, and special considerations of lower anogenital tract cancer. Knowledge gaps are summarized to provide guidance for future research.

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Racial Disparities in Time to Treatment Initiation and Outcomes for Early Stage Anal Squamous Cell Carcinoma

Cited by 7 publications

References 42 publications

Trends in utilization of first‐line palliative treatments for anal squamous cell carcinoma

Trends in utilization of first‐line palliative treatments for anal squamous cell carcinoma

Racial and Ethnic Health Disparities in Delay to Initiation of Intensity-Modulated Radiotherapy

Executive Summary of the Lower Anogenital Tract Cancer Evidence Review Conference

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