Disparities in Survivorship and Patient Outcomes最新文献

{"title":"Abstract IA27: Disparities in breast cancer survivorship and outcomes","authors":"L. Kushi, I. Ergas, Janise M. Roh, S. Gomez, M. Kwan, C. Thomsen, S. Yao, C. Ambrosone","doi":"10.1158/1538-7755.DISP17-IA27","DOIUrl":"https://doi.org/10.1158/1538-7755.DISP17-IA27","url":null,"abstract":"In the U.S., women of European ancestry have historically had the highest incidence of breast cancer compared to other major race/ethnicity groups. In recent years, the incidence rate for black women has approached that of white women, while rates for Asian and Hispanic women are about 25% lower than for white or black women. However, once diagnosed with breast cancer, black women have poorer survival rates than white women. The most recent “Annual Report to the Nation on the Status of Cancer” using nationwide cancer-registry data from 2006-2013 (Jemal et al., JNCI, 2017) reported a higher age- and stage-adjusted relative mortality risk after breast cancer of 1.71 (95% confidence interval (CI), 1.66-1.76) for non-Hispanic blacks compared to non-Hispanic whites. Hispanic women also experienced a slightly increased relative mortality risk of 1.14 (95% CI, 1.10-1.18) compared to white women, while Asians experienced a lower relative mortality risk of 0.84 (95% CI, 0.80-0.88). The reasons for such disparities in outcomes after breast cancer are complex. One suggested contributing factor is differences in access to care, as blacks and Hispanics tend to be of lower socioeconomic status than whites or Asians. It is possible to minimize the effects of access to health care by examining outcomes after breast cancer diagnosis in an integrated health care setting such as Kaiser Permanente Northern California (KPNC), in which all patients have health insurance coverage with access to the same health care providers. We are currently conducting the Pathways Study, a prospective cohort study of 4,505 women diagnosed with breast cancer with enrollment from 2006-2013. This diverse cohort includes 557 Hispanics, 578 Asians, and 358 blacks. Preliminary analyses in the larger population of 11,176 women who were diagnosed with invasive breast cancer in KPNC and eligible for the Pathways Study found that, despite the uniform health care access, racial disparities in mortality after breast cancer were qualitatively similar to those observed nationally. With 1,738 total deaths as of September 20, 2016, and adjusted for age and stage at diagnosis, compared to white women, black women had an increased relative mortality risk of 1.59 (95% CI, 1.24-2.03). For Hispanic women, the relative risk was 0.92 (95% CI, 0.72-1.19), and for Asians it was 0.70 (95% CI, 0.51-0.97). Among the subset of women enrolled in the Pathways Study (n=538 total deaths), comparable relative risks were 1.74 (95% CI, 1.35-2.24) for black women, 0.99 (95% CI, 0.75-1.29) for Hispanic women, and 0.73 (95% CI, 0.52-1.02) for Asians. Similar black-white differences were also seen for breast cancer-specific mortality and recurrence in the Pathways Study cohort in which recurrences are being documented. These observations indicate that health care access is unlikely to explain racial/ethnic disparities in breast cancer outcomes. As the Pathways Study, we will be able to explore aspects of health care utiliz","PeriodicalId":192928,"journal":{"name":"Disparities in Survivorship and Patient Outcomes","volume":"1880 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129982093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract IA26: Developing effective community and health system partnerships to advance health equity and health disparities research","authors":"Nadine J. Barrett, Kearston L Ingraham, K. Williams, P. Lin, H. Eisenson, M. Chirinos, D. Harvey, S. Patierno","doi":"10.1158/1538-7755.DISP17-IA26","DOIUrl":"https://doi.org/10.1158/1538-7755.DISP17-IA26","url":null,"abstract":"Establishing sustainable and impactful partnerships to advance health equity and health disparities research requires a multipronged approach to assessing and aligning community and organizational priorities toward common goals and objectives. Partnerships to advance health equity and to ensure ongoing and meaningful health disparities research should ideally provide a win-win for community stakeholders and the health system. This often requires a cultural shift regarding how and to what extent academic/medical institutions value and fully engage diverse stakeholders as experts in the research process and delivery of care. At the Duke Cancer Institute, through the Office of Health Equity and Disparities, our intentional stakeholder engagement has led to robust partnerships with diverse community organizations and leaders capitalizing on each other9s strengths and expertise. Through this process the DCI, together with the community, has built a sustainable platform to advance health equity through research, capacity building, and open communication. Citation Format: Nadine Barrett, Kearston Ingraham, Kevin Williams, Pao-Hwa Lin, Howard Eisenson, Maritza Chirinos, Demetrius Harvey, Steven Patierno. Developing effective community and health system partnerships to advance health equity and health disparities research [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA26.","PeriodicalId":192928,"journal":{"name":"Disparities in Survivorship and Patient Outcomes","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126817157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract IA25: Disparities in survivors of pediatric, adolescent, and young adult cancers","authors":"S. Bhatia","doi":"10.1158/1538-7755.DISP17-IA25","DOIUrl":"https://doi.org/10.1158/1538-7755.DISP17-IA25","url":null,"abstract":"Outcome disparities in pediatric, adolescent, and young adult cancer are multifaceted. While disparities are commonly described along racial/ethnic lines, the underlying causes of these differences in outcome are often rooted in socioeconomic status, host genetics, disease biology, health literacy lifestyle factors, health behaviors, and comorbidities. Nonetheless, by the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the U.S. population. This temporal shift in the racial/ethnic composition of the U.S. population demands a close examination of the observed disparities in both the quality and quantity of survival in pediatric, adolescent, and young adult cancer. In this talk we describe the differences in overall and event-free survival by race/ethnicity as well as by age (children vs. adolescent and young adult) across a variety of cancer types. We examine the causes of the difference in these outcomes. We describe the burden of morbidity carried by cancer survivors across racial/ethnic and socioeconomic lines and present the current evidence for the causes of observed differences in morbidity. We speculate that any racial/ethnic differences in outcome are likely to be multifactorial, and draw on extant literature to illustrate the various contributors (socioeconomic characteristics, health behaviors, disease biology, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, we outline challenges in conducting race/ethnicity-specific survivorship research, demonstrating that there are limited absolute numbers who are diagnosed and survive histologically distinct cancers in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Citation Format: Smita Bhatia. Disparities in survivors of pediatric, adolescent, and young adult cancers [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA25.","PeriodicalId":192928,"journal":{"name":"Disparities in Survivorship and Patient Outcomes","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132568234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}