The impact of driving time, distance, and socioeconomic factors on outcomes of patients with locally advanced rectal cancer

Gotfrit, Joanna; Thangarasa, Tharshika; Dudani, Shaan; Goodwin, Rachel; Tang, Patricia A.; Monzon, Jose Gerard; Dennis, Kristopher; Cheung, Winson Y.; Marginean, Horia; Vickers, Michael M.

doi:10.1016/j.puhip.2020.100012

Cited by 3 publications

(6 citation statements)

References 44 publications

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“…A rural address, for example, has been associated with compromised health care access and reduced LARC survival. 20 Urban areas, in contrast, are typically home to the high-volume centers that reportedly yield the highest rates of survival for LARC. 55 In this study, Hispanic and non-Hispanic Black patients were found to live disproportionately in metropolitan areas but were more likely to be treated in low-volume centers, an anomaly that is perhaps due to transportation difficulties related to limited economic resources and/or lack of public transit to high-volume centers in residentially segregated areas.…”

Section: Discussionmentioning

confidence: 99%

“…11,16 Large-scale studies of LARC 17,18 have also established the role of pathologic factors-tumor stage, lymph node status, and circumferential resection margin-in determining overall LARC survival, suggesting a potential role for these variables in any investigation of disparate outcomes. More recently, retrospective studies of LARC 19,20 have demonstrated the contribution to racial disparities of social determinants of health (SDOH), including educational level, income, marital status, geographic location, and access to treatment. Indeed, racial and ethnic minority individuals have been significantly underrepresented in clinical trials, and 43% of US cancer studies omit altogether the classification of outcome data by racial groups.…”

Section: Introductionmentioning

confidence: 99%

“…[23][24][25][26][27][28] Historically, if studies examining LARC have incorporated SDOH, it has been to a limited extent. 19,20,24,[29][30][31][32][33][34][35] As an illustration, a recent study of patients with colorectal cancer undergoing surgery 36 demonstrated decreased 1-and 5-year survival for Asian, Hispanic, non-Hispanic Black, and Pacific Islander patient populations compared with White patients. This disparity persisted after adjustment for multiple demographic variables, including insurance status and marital status, with Hispanic patients exhibiting the worst survival decrement.…”

Section: Introductionmentioning

confidence: 99%

“…Five main domains of SDOH are associated with racial or ethnic disparities and poor cancer outcomes: economic stability, educational attainment, health and health care access (eg, insurance status, health literacy), neighborhood and built environment (eg, neighborhood socioeconomic status, urban vs rural environment), and social and community context (eg, social support, perceived discrimination) . Historically, if studies examining LARC have incorporated SDOH, it has been to a limited extent . As an illustration, a recent study of patients with colorectal cancer undergoing surgery demonstrated decreased 1- and 5-year survival for Asian, Hispanic, non-Hispanic Black, and Pacific Islander patient populations compared with White patients.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Racial and Ethnic Disparities in Locally Advanced Rectal Cancer Outcomes

Shulman,

Deng,

Handorf

et al. 2024

JAMA Netw Open

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ImportanceHispanic and non-Hispanic Black patients receiving neoadjuvant therapy and surgery for locally advanced rectal cancer (LARC) achieve less favorable clinical outcomes than non-Hispanic White patients, but the source of this disparity is incompletely understood.ObjectiveTo assess whether racial and ethnic disparities in treatment outcomes among patients with LARC could be accounted for by social determinants of health and demographic, clinical, and pathologic factors known to be associated with treatment response.Design, Setting, and ParticipantsThe National Cancer Database was interrogated to identify patients with T3 to T4 or N1 to N2 LARC treated with neoadjuvant therapy and surgery. Patients were diagnosed between January 1, 2004, and December 31, 2017. Data were culled from the National Cancer Database from July 1, 2022, through December 31, 2023.ExposureNeoadjuvant therapy for rectal cancer followed by surgical resection.Main Outcomes and MeasuresThe primary outcome was the rate of pathologic complete response (pCR) following neoadjuvant therapy. Secondary outcomes were rate of tumor downstaging and achievement of pN0 status.ResultsA total of 34 500 patient records were reviewed; 21 679 of the patients (62.8%) were men and 12 821 (37.2%) were women. The mean (SD) age at diagnosis was 59.7 (12.0) years. In terms of race and ethnicity, 2217 patients (6.4%) were Hispanic, 2843 (8.2%) were non-Hispanic Black, and 29 440 (85.3%) were non-Hispanic White. Hispanic patients achieved tumor downstaging (48.9% vs 51.8%; P = .01) and pN0 status (66.8% vs 68.8%; P = .02) less often than non-Hispanic White patients. Non-Hispanic Black race, but not Hispanic ethnicity, was associated with less tumor downstaging (odds ratio [OR], 0.86 [95% CI, 0.78-0.94]), less frequent pN0 status (OR, 0.91 [95% CI, 0.83-0.99]), and less frequent pCR (OR, 0.81 [95% CI, 0.72-0.92]). Other factors associated with reduced rate of pCR included rural location (OR, 0.80 [95% CI, 0.69-0.93]), lack of or inadequate insurance (OR for Medicaid, 0.86 [95% CI, 0.76-0.98]; OR for no insurance, 0.65 [95% CI, 0.54-0.78]), and treatment in a low-volume center (OR for first quartile, 0.73 [95% CI, 0.62-0.87]; OR for second quartile, 0.79 [95% CI, 0.70-0.90]; OR for third quartile, 0.86 [95% CI, 0.78-0.94]). Clinical and pathologic variables associated with a decreased pCR included higher tumor grade (OR, 0.58 [95% CI, 0.49-0.70]), advanced tumor stage (OR for T3, 0.56 [95% CI, 0.42-0.76]; OR for T4, 0.30 [95% CI, 0.22-0.42]), and lymph node–positive disease (OR for N1, 0.83 [95% CI, 0.77-0.89]; OR for N2, 0.73 [95% CI, 0.65-0.82]).Conclusions and RelevanceThe findings of this cohort study suggest that disparate treatment outcomes for Hispanic and non-Hispanic Black patients are likely multifactorial in origin. Future investigation into additional social determinants of health and biological variables is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Racial and Ethnic Disparities in Locally Advanced Rectal Cancer Outcomes

Shulman,

Deng,

Handorf

et al. 2024

JAMA Netw Open

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“…Es gibt jedoch auch internationale Untersuchungen, die darauf hinweisen, dass höhere Fahrtzeiten zu Krebszentren mit einer geringeren Überlebenswahrscheinlichkeit im Zusammenhang stehen [25][26][27][28]. So zeigten Gotfrit et al (2021) beispielsweise, dass eine Fahrtzeit von über einer Stunde zum nächsten Krebszentrum mit einem schlechteren Gesamt-sowie krankheitsfreien Überleben der Betroffenen verbunden war [28]. Dabei konnten die Autor*innen hier nicht ausschließen, dass bestimmte Risikofaktoren bei eher ländlich lebenden Patient*innen ggf.…”

Section: Zielsetzung Und Fragestellungunclassified

Spezialisierte Behandlung von Darmkrebs in zertifizierten Krebszentren: Müssen Patient*innen wirklich weitere Wege auf sich nehmen?

et al. 2023

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Zusammenfassung Einleitung Der deutschen Krankenhauslandschaft mangelt es an einer gezielten Versorgungssteuerung, was u. a. an der unzureichenden Nutzung von durch die Deutsche Krebsgesellschaft (DKG) zertifizierten Krebszentren zu erkennen ist. So werden allzu viele Patient*innen außerhalb von Krebszentren und damit schlechter behandelt. Um dem zu begegnen, könnte die Behandlung in Anlehnung an Dänemark auf spezialisierte Krankenhäuser begrenzt werden und die vorliegende Studie ermittelt die Auswirkungen auf die Fahrzeiten von Patient*innen am Beispiel des kolorektalen Karzinoms. Methoden Die Analysen für das Jahr 2018 basieren auf Daten der strukturierten Qualitätsberichte (sQB) und von bei der AOK versicherten Patient*innen, bei denen eine Resektion des Kolons oder Rektums erfolgt ist. Darüber hinaus wurden Angaben der DKG bezüglich einer vorhandenen Zertifizierung eines Darmkrebszentrums genutzt. Die Fahrzeit wurde definiert als Zeit, die Patient*innen mit einem durchschnittlichen PKW bei durchschnittlichem Verkehr vom Mittelpunkt der Postleitzhal (PLZ) ihres Wohnorts zu den Koordinaten des Krankenhauses benötigen. Die Koordinaten der Krankenhäuser und die Mittelpunkte der PLZ wurden über eine Abfrage der Google API ermittelt. Die Berechnung der Fahrtzeiten wiederum erfolgte unter Zuhilfenahme eines lokalen Open Routing Machine Servers. Für die statistischen Analysen und kartographischen Darstellungen wurden die Statistikprogramme R und Stata verwendet. Ergebnisse In 2018 wurde fast die Hälfte aller Patient*innen mit Kolonkarzinom im nächstgelegenen Krankenhaus behandelt, wobei davon ca. 40% in einem zertifizierten Darmkrebszentrum behandelt wurden. Insgesamt fanden nur ca. 47% aller Behandlungen in einem zertifizierten Darmkrebszentrum statt. Die Fahrtzeit zum gewählten Behandlungsort lag insgesamt bei durchschnittlich 20 Minuten. Sie war etwas geringer (18 Minuten), wenn kein zertifiziertes Zentrum gewählt wurde, und etwas länger (21 Minuten) für diejenigen, deren Behandlung in einem zertifizierten Darmkrebszentrum stattfand. Die Modellierungen von Umverteilungen aller Patient*innen nur zu zertifizierten Zentren ergab eine maximale Fahrtzeit von 29 Minuten. Schlussfolgerung Bei einer Steuerung der Behandlung hin zu spezialisierten Krankenhäusern wäre eine wohnortnahe Behandlung weiterhin gewährleistet. Unabhängig von einer Zertifizierung lassen sich besonders in Ballungsgebieten Parallelstrukturen erkennen, die auf ein Umstrukturierungspotential hinweisen.

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Neoadjuvant Radiotherapy Facility Type Affects Anastomotic Complications After Esophagectomy

Morse

Mouw

Moreno

et al. 2023

Journal of Gastrointestinal Surgery

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The impact of driving time, distance, and socioeconomic factors on outcomes of patients with locally advanced rectal cancer

Cited by 3 publications

References 44 publications

Factors Associated With Racial and Ethnic Disparities in Locally Advanced Rectal Cancer Outcomes

Factors Associated With Racial and Ethnic Disparities in Locally Advanced Rectal Cancer Outcomes

Spezialisierte Behandlung von Darmkrebs in zertifizierten Krebszentren: Müssen Patient*innen wirklich weitere Wege auf sich nehmen?

Neoadjuvant Radiotherapy Facility Type Affects Anastomotic Complications After Esophagectomy

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