Cancer Causes & Control最新文献

Purpose:  Older Black women and women living in areas of low socioeconomic status (SES) diagnosed with cervical cancer (CC) have worse overall survival (OS). The objective was to investigate associations between OS and race/ethnicity and sociodemographic factors in younger (21-64 years) and older women (≥ 65 years) diagnosed with CC using Surveillance, Epidemiology, and End Results Program data.

Methods:  This retrospective, population-based cohort study included 39,000 women ≥ 21 years diagnosed with CC diagnosed between 2006 and 2020. Age-group stratified Cox proportional hazards models adjusted for age, diagnosis year, and histology examined sociodemographic (rurality, SES, and persistent poverty) differences in OS.

Results:  In the sample, 82.8% were < 65 years. Compared to younger women, older women were more likely to be non-Latinx (NL) Black (16.0 vs 12.9%) and diagnosed with late-stage CC (67.9 vs 47.5%). Adjusted models suggested younger NL Black women had worse OS than their NL White counterparts (HR 1.45 [95% CI 1.37-1.54]), this association was not found among older NL Black women (HR 1.06 [95% CI 0.96-1.16]). Similarly, younger women in lowest SES areas had worse OS compared to women in highest SES areas (HR 1.82 [95% CI 1.69-1.96]), this association was attenuated in older women (HR 1.27 [95% CI 1.15-1.42]). Finally, younger women living in persistent poverty had worse OS compared to those who did not (HR 1.40 [95% CI 1.32-1.48]), this association was not found in older women (HR 1.10 [95% CI 0.99-1.21]).

Conclusion: Sociodemographic disparities were found in CC OS for women < 65 that were attenuated or nonexistent in women ≥ 65 years.

Purpose: Rare cancers are defined as those for which there are less than 15 cases per 100,000 in the population annually. While much progress in detection and treatment has been made over the past decade for many rare cancers, less progress has been made in understanding survivorship needs. The objective of this study was to characterize the National Institutes of Health (NIH) cancer survivorship grant portfolio focused on rare cancers and to identify gaps specific to this area of science.

Methods: Newly awarded grants focused on rare cancers in the NIH cancer survivorship research portfolio from Fiscal Year (FY) 2017 to FY2023 were identified. Grant characteristics were abstracted and described. In addition, the number of grants for each rare cancer type was mapped to current Surveillance, Epidemiology, and End Results program incidence and relative survival rates.

Results: A total of 93 survivorship grants focused on one or multiple rare cancer types were funded from FY2017 to FY2023. Approximately 85% of these grants investigated one of four cancer types: leukemia, head & neck, ovarian and brain. Few grants focused on other rare cancer types, such as multiple myeloma (n = 5), testicular cancer (n = 3), rectal cancer (n = 1), thyroid cancer (n = 1), and cervical cancer (n = 0). About half of the grants (50.5%) were observational studies; 34.4% focused explicitly on pediatric cancer survivors.

Conclusions: Survivorship research for many rare cancer types is limited. This paucity of research is a barrier to the identification of survivorship needs and the development of interventions to address these needs.

Purpose: Although sociodemographic factors such as socioeconomic status (SES), travel time to health care, cohabitation status, and region of residence are observed to influence incidence and survival for several types of cancers, it is unclear whether similar effects have been observed in patients with glioma. This study investigates whether these factors affect survival for glioma patients.

Methods: In this retrospective study, the Swedish National Quality Registry for Brain Tumors was used to identify 1,276 patients with glioma WHO grade I-IV for whom data were deposited between 2009 and 2013. The RISK North database, which links data from the National Cancer Quality Register with citizen demographic data from the Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA), the Total Population Registry (TPR), and the Geography Database (GD), was utilized to assess survival in patients with glioma in relation to education level, cohabitation status, travel time to regional hospitals, and region of residence.

Results: In the multivariable analysis, longer survival was observed among WHO grade III-IV glioma patients with higher education level (middle school (ref) HR: 1, high school HR: 0.81 CI [0.67-0.98], p = 0.033; university/college HR: 0.81 CI [0.66-1.00], p = 0.048). Survival was not associated with travel time, cohabitation status, or region of residence in the multivariable survival analysis.

Conclusion: Low education level was associated with reduced survival for patients with glioma WHO grade III and IV in multivariable survival analyses, but no differences in survival were found in relation to travel time, cohabitation status, or region of residence.

Purpose: The prevalence of obesity, a crucial risk factor for breast cancer, is markedly higher among Hispanic women. The interaction between ethnic enclaves and neighborhood socioeconomic status (SES) as a determinant of this disparity warrants further research. We aimed to identify neighborhood profiles based on ethnic enclaves and socioeconomic status to evaluate the association with obesity among Hispanic women in the metropolitan Chicago region.

Methods: We used a convenience sample of 24,884 Hispanic women over age 40 who obtained breast imaging from the largest healthcare organization in Chicago between 2010 and 2017. We conducted LPA to characterize neighborhood composition based on tract indicators of ethnic enclaves, disadvantage, and affluence. Multivariate linear and multinomial logistic regression models were used to evaluate the association of neighborhood profiles with BMI.

Results: The LPA model identified four latent profiles, labeled based on their most significant characteristic as "middling," "disadvantage" "ethnic enclaves," and "affluent". Close to 50% of women in the disadvantage profile were obese and obese class II. Women in the disadvantage profile had the highest relative risk of being obese II (OR: 2.74 CI 95% 2.23, 3.36), compared to women in the middling profile. Women in the ethnic enclave and affluent profile were positively and negatively associated with obesity, respectively.

Discussion: Using LPA to group individuals according to their combined traits provides empirical evidence to strengthen our understanding of how neighborhoods influence obesity in Hispanic women. The study findings suggest that ethnic enclaves, that are also disadvantage, are associated with obesity in Hispanic women.

Purpose: Studies of healthcare encounters leading to cancer diagnosis have increased over recent years. While some studies examine healthcare utilization before the cancer registry date of diagnosis, relevant pre-diagnosis interactions are not always immediately prior to this date due to date abstraction guidelines. We evaluated agreement of a registry date with a claims-based index and examined Emergency Department (ED) involvement in cancer diagnosis as an example of possible pre-diagnostic healthcare misclassification that could arise from improper date choice.

Methods: We implemented an algorithm to define a claims-based index as the date of the earliest International Classification of Diseases code for the cancer in Medicare and estimated agreement with the date of diagnosis from a North Carolina registry for patients diagnosed aged 66 or older with 16 cancer types from 2008 to 2017 (n = 92,056). We then classified whether each cancer was initially diagnosed through care originating in the ED using each date.

Results: The index date was identical to the cancer registry date for 47% of patients and preceded the registry date for 28%, with extent of agreement varying by cancer- and patient-specific characteristics. Agreement in ED-involved diagnosis classification using each date varied by cancer site, with sensitivity of classifications using the registry date relative to the index having a minimum of 86% for prostate and kidney cancer.

Conclusion: Studies assessing healthcare utilization proximal to cancer diagnosis should carefully consider the relevant assessment window and be aware that the use of cancer registry versus claims-based dates may impact variable classification.

Purpose: Oncological treatments, such as radiotherapy, which requires consistent electricity, the presence of specialized clinical teams, and daily patient access to treatment facilities, are frequently disrupted by extreme weather events, posing several health hazards to patients. This study explores the association between declared wildfire disasters during radiotherapy and overall survival among patients with non-small cell lung cancer (NSCLC).

Methods: The study population consisted of 202,935 adults with inoperable Stage III NSCLC, who initiated radiotherapy from 2004 through 2019. Exposure was defined as a wildfire disaster declaration in the county of the treatment facility within 12 weeks of initiating radiotherapy. Overall survival was defined as the interval (months) between age at diagnosis and age at death, date of last contact, or study end. Cox proportional hazards was used to estimate crude and adjusted hazard ratios and 95% confidence intervals with inverse probability weighting.

Results: Patients exposed to a wildfire disaster declaration during radiation treatment had worse overall survival (HR, 1.03; 95% CI 1.00-1.06; p = 0.02), compared to unexposed patients in adjusted models.

Conclusion: Exposure to a wildfire disaster during radiotherapy is associated with worse overall survival among patients with stage III non-operable NSCLC. This finding underscores the critical need for developing adaptation strategies within the healthcare sector, especially in oncology.

Purpose: To examine incidence trends and patterns for early- and late-onset liver cancer.

Methods: Liver and intrahepatic bile duct (IBD) cancers diagnosed between 2000 and 2019 were acquired from 22 SEER registries. Variables included early-onset (20-49) vs. late-onset (50+), anatomic subsite, histologic type (hepatocellular carcinoma [HCC] and IBD cholangiocarcinoma [ICC]), sex, and race/ethnicity. Age-standardized incidence rates were calculated using SEER*Stat. Jointpoint regression analysis was employed to estimate the annual percent change (APC) and the average APC (AAPC) with pairwise comparisons for trend by sex and by race/ethnicity stratified by age and subsite.

Results: Liver cancer incidence decreased among early-onset (AAPC [95% CI] - 2.39 [- 2.74, - 2.07]) but increased among late-onset patients (2.85 [2.71, 3.01]), primarily driven by HCC (3.60 [3.50, 3.71]). IBD incidence increased for both ages with ICC incidence annually increasing 7.92% (6.84, 9.26) for early-onset and 6.32% (5.46, 8.86) for late-onset patients. Early-onset liver cancer displayed comparable trends across racial/ethnic groups; however, late-onset liver cancer showed more variation, particularly among American Indian/Alaska Native/Asian Pacific Islander (AI/AN/API) populations, which experienced a significant decrease in incidence, thereby narrowing the gap with other racial/ethnic groups. For IBD, an identical pattern of early-onset IBD among non-Hispanic Blacks (NHBs) compared to Hispanics was showed with coincidence test p = 0.1522, and a parallel pattern was observed among late-onset patients for both sexes (p = 0.5087).

Conclusion: Late-onset HCC continues to rise, except for NHB and AI/AN/API, where incidence rates have started to decrease over the past 4-5 years. Early and late-onset ICC incidence continues to increase across all racial/ethnic groups.

Purpose: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides access to timely breast and cervical cancer screening and diagnostic services to women who have low incomes and are uninsured or underinsured. Documenting the number of women eligible and the proportion of eligible women who receive NBCCEDP-funded services is important for identifying opportunities to increase screening and diagnostic services among those who would not otherwise have access.

Methods: Using the Census Bureau's Small Area Health Insurance Estimates data, we estimated the number of women who met the NBCCEDP eligibility criteria based on age, income, and insurance status. We used these estimates along with the number of women served by the NBCCEDP to calculate the percent of women served by race/ethnicity and state. We calculated the percent of eligible women who are up to date with screening using the 2019 National Health Interview Survey.

Results: The NBCCEDP served 15.0% of women ages 40-64 eligible for breast cancer services in 2018-2019 and 5.6% of women ages 21-64 eligible for cervical cancer services in 2018-2020. The NBCCEDP served 13.5% of women ages 40-64 eligible for breast cancer services in 2020-2021 and 5.9% of women ages 21-64 eligible for cervical cancer services in 2019-2021. The percent of women ages 40-64 who received breast cancer services declined by 1.5 percentage points between 2018-2019 and 2020-2021. The percent of women ages 21-64 who received cervical cancer services increased by 0.3 percentage points between 2018-2020 and 2019-2021. The percent of eligible women served varied among states. The state interquartile ranges of the percent of women served were 12.3-27.7% for breast cancer services in 2018-2019 and 3.9-14.7% for cervical cancer services in 2018-2020. Among women eligible for the NBCCEDP, 61.4% are not up to date with breast cancer screening and 40.6% are not up to date with cervical cancer screening.

Conclusion: There is wide variation between states in the share of eligible women served for breast and cervical cancer screening services. We found that both the number and the percentage of eligible women who received NBCCEDP breast cancer services declined during a period that overlapped with the COVID-19 pandemic. A large proportion of eligible women did not receive breast or cervical cancer screening.

Purpose: Respondent-driven sampling (RDS) is a sampling method that relies on social networks to recruit hard-to-reach populations, and reduces the bias from non-random selection. This study aimed to assess the efficacy of RDS in collecting health assessment data from underrepresented populations not captured by traditional sampling techniques.

Methods: An RDS study was conducted in Hawai'i between 2017 and 2018 of Native Hawaiians, Chuukese, and Marshallese participants. 1006 cases consisting of 352 seeds and 654 recruits were analyzed in conjunction with data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), filtered to include Native Hawaiian/Other Pacific Islander participants (n = 1564). Missing network size data was imputed by RDSAnalyst and determined by the sample median network size. Weighted samples were compared for differences.

Results: Chi-square testing revealed significant differences between the RDS and BRFSS weighted samples across sex, age, education, income, and colon/cervical cancer screening variables. Only BMI group and smoking status exhibited no significant differences. RDS methods recruited participants efficiently within one year.

Conclusion: The findings indicate that RDS offers an effective sampling methodology when trying to reach hidden populations and provides more insight into the social networks of underserved communities as the transfer/utilization of health information may be linked to social connectedness.

Purpose: Oral cavity (OC) and oropharyngeal (OP) cancer rates have increased annually rising in the U.S. and Texas. Dental providers could play a key role in lowering OC/OP cancer rates through prevention and screening, but Texas faces a significant shortage of dental health professionals, affecting access to dental care, including OC/OP cancer prevention and early detection. This study aims to explore the link between OC/OP cancer rates and these dental shortage areas in Texas.

Methods: We analyzed OC/OP cancer incidence in Texas using SEER-Medicare data for patients aged 65 and over from 2012 to 2017. Rates per 100,000 were stratified by age, gender, and dental health provider shortage area (DHPSA) status (yes/no). Zero-Inflated Poisson Regression models were used to adjust for patient characteristics in studying cancer incidence, Late-stage diagnoses were assessed using logistic regression.

Results: The incidence rate was 27.3 per 100,000 people in Texas. DHPSA counties had lower incidence rates (24.3 per 100,000) compared to non-DHPSA counties (29.8 per 100,000; p = 0.0423). Among patients with OC/OP diagnoses, those living in a DHPSA county had lower odds of advanced stage diagnoses (aOR: 0.79; CI: 0.64-0.96) than those in non-DHPSA counties.

Conclusion: The findings highlight the complex link between dental providers and OC/OP cancer diagnoses, noting differences in indicators of need based on DHPSA location. Limited local dental services may lead to underreported cancer cases. Further research on dental service usage could improve OC/OP outcomes by prioritizing interventions from dental professionals.