Supportive care for patients with gastrointestinal cancer

Ahmed, Nisar; Ahmedzai, Sam H.; Vora, Vandana; Hillam, S; Paz, Silvia

doi:10.1002/14651858.cd003445

Cited by 13 publications

(17 citation statements)

References 7 publications

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“…Survival benefits are large for many with advanced, but non-metastasized, stage III disease and smaller, but still significant for some with stage II disease [1-3]. There are probably even small survival benefits of chemotherapy for people with metastasized, stage IV colon cancer, in addition to its clear palliative benefits [4]. Yet nearly half of all such people in the United States do not receive chemotherapy with the intention to either cure or comfort [5].…”

Section: Introductionmentioning

confidence: 99%

Lack of access to chemotherapy for colon cancer: multiplicative disadvantage of being extremely poor, inadequately insured and African American

Gorey

Haji-Jama

Bartfay

et al. 2014

BMC Health Serv Res

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BackgroundDespite evidence of chemotherapy’s ability to cure or comfort those with colon cancer, nearly half of such Americans do not receive it. African Americans (AA) seem particularly disadvantaged. An ethnicity by poverty by health insurance interaction was hypothesized such that the multiplicative disadvantage of being extremely poor and inadequately insured is worse for AAs than for non-Hispanic white Americans (NHWA).MethodsCalifornia registry data were analyzed for 459 AAs and 3,001 NHWAs diagnosed with stage II to IV colon cancer between 1996 and 2000 and followed until 2011. Socioeconomic data from the 2000 census categorized neighborhoods: extremely poor (≥ 30% of households poor), middle (5-29% poor) and low poverty (< 5% poor). Participants were randomly selected from these poverty strata. Primary health insurers were Medicaid, Medicare, private or none. Chemotherapy rates were age and stage-adjusted and comparisons used standardized rate ratios (RR). Logistic and Cox regressions, respectively, modeled chemotherapy receipt and long term survival.ResultsA significant 3-way ethnicity by poverty by health insurance interaction effect on chemotherapy receipt was observed. Among those who did not live in extremely poor neighborhoods and were adequately insured privately or by Medicare, chemotherapy rates did not differ significantly between AAs (37.7%) and NHWAs (39.5%). Among those who lived in extremely poor neighborhoods and were inadequately insured by Medicaid or uninsured, AAs (14.6%) were nearly 60% less likely to receive chemotherapy than were NHWAs (25.5%, RR = 0.41). When the 3-way interaction effect as well as the main effects of poverty, health insurance and chemotherapy was accounted for, survival rates of AAs and NHWAs were the same.ConclusionsThe multiplicative barrier to colon cancer care that results from being extremely poor and inadequately insured is worse for AAs than it is for NHWAs. AAs are more prevalently poor, inadequately insured, and have fewer assets so they are probably less able to absorb the indirect and direct, but uncovered, costs of colon cancer care. Policy makers ought to be cognizant of these factors as they implement the Affordable Care Act and consider future health care reforms.

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Section: Introductionmentioning

confidence: 99%

Lack of access to chemotherapy for colon cancer: multiplicative disadvantage of being extremely poor, inadequately insured and African American

Gorey

Haji-Jama

Bartfay

et al. 2014

BMC Health Serv Res

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“…Supportive care includes treatment to optimise cancer patients' physical comfort and functional ability, as well as non-tumour specific treatment such as social, informational, economic, psychological and spiritual support [1,16]. When needs for supportive care are not met, patients' quality of life and satisfaction with care may be affected [5].…”

Section: Introductionmentioning

confidence: 99%

Unmet supportive care needs in colorectal cancer: differences by age

Jorgensen

Young

Harrison

et al. 2011

Support Care Cancer

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“…Model 2 assumed zero costs for active symptom control in consideration that it is a component of chemotherapy administration [11]. The type of active symptom control provided in the phase III trial, the MVP clinical trials [12,13], and the vinorelbine clinical trials [14,15] was not reported consistently.…”

Section: Modelmentioning

confidence: 99%