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Objective: This study used real-world observational data to compare profiles of patients receiving different first-line treatment for hormone receptor positive (ER+), HER2 negative, metastatic breast cancer (MBC): CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) versus ET alone. Method: From a nationwide electronic health record-derived Flatiron Health de-identified database including 280 US cancer clinics, we identified patients with hormone receptor positive, HER2 negative, metastatic breast cancer receiving 1st -line therapy with ET alone or CDK4/6i plus ET between February 2015 and November 2021. Patient sociodemographic status, MBC treatment regimen and outcomes were the focus of this analysis. Patient characteristics were compared using t-tests and chi-square tests. Logistic regression analysis was performed to examine the association of patient characteristics with the likelihood of receiving 1st -line CDK4/6i plus ET vs. ET alone. Kaplan-Meier method and Cox proportional hazards were used to test the impact of 1st -line treatment regimen on real-world progression-free survival (PFS) and overall survival (OS). Baseline characteristics were balanced using inverse probability weighting (IPW). Results: The study population included 3,917 patients receiving CDK4/6i plus ET (n = 2170) and ET alone (n = 1747) for their MBC. Compared to patients receiving ET alone, those receiving CDK4/6i plus ET were younger (mean age 66.8 vs. 68.6, p < 0.001), more likely to present with de novo MBC (p < 0.001), had better performance status (50.2% vs. 40.5% patients with ECOG value 0, p = 0.001) and lower number of comorbidities (29.7% vs. 26.6% ≥ 1 comorbidity, p < 0.001). Logistic regression revealed increased odds of CDK4/6i plus ET in individuals aged 50–64 (OR: 3.42, 95% CI [2.41, 4.86]) and 65–74 (OR: 3.18, 95% CI [1.68, 6.02]) versus those aged 18–49 years of age. Black individuals had lower odds of CDK4/6i plus ET (OR: 0.76, 95% CI [0.58, 1.00]) compared to White individuals. Other characteristics associated with lower odds of CDK4/6i plus ET included patients with stage III disease (OR: 0.69, 95% CI [0.52, 0.92]), lower performance status (OR: 0.50, 95% CI [0.40, 0.62]), and Medicare insurance (OR: 0.73, 95% CI [0.30, 1.78]) compared to those with commercial and Medicaid insurance. After IPW adjustment, use of CDK4/6i plus ET as 1st -line treatment was associated with significantly longer median PFS compared to ET alone (27 vs. 17 months; hazard ratio [HR] = 0.61, p < 0.001). Median OS was 52 months in the CDK4/6i plus ET group and was 42 months with ET alone (HR = 0.74, p < 0.001). Conclusion: In this real-world database, disparities in receiving 1st -line CDK4/6 inhibitors were seen by age, diagnosis stage, baseline performance status, comorbidity, and insurance status. In adjusted analysis, the use of 1st -line CDK4/6i plus ET yielded better PFS and OS rates than ET alone. Further efforts are essential to enhance equitable use of and access to this crucial drug class. [ABSTRACT FROM AUTHOR]

Background: Heterogeneous Black populations encounter significant obstacles in accessing cancer care, yet research on lung cancer treatment disparities remains limited. This study investigates whether the disparity in receiving curative‐intent treatment (curative‐intent surgery and/or stereotactic body radiation therapy [SBRT]) for early‐stage non‐small cell lung cancer (NSCLC) between non‐Hispanic Whites (NHWs) and total Blacks extends to diverse Black populations, including US‐born, Afro‐Haitian, West Indian Black, and Hispanic Black individuals. Methods: This cross‐sectional study included all Florida cancer registry early‐stage NSCLC cases 2005–2017, linked to individual‐level discharge data containing comorbidity and specific treatment details (surgery and/or SBRT). Multivariable logistic regression assessed the association between race/ethnicity and the receipt of curative‐intent treatment, while accounting for sociodemographic factors (poverty, age, insurance, and smoking status) and clinical variables. Results: Among 55,655 early‐stage NSCLC patients, 71.1% received curative‐intent treatment: 72.1% NHW and 59.7% Black (non‐Hispanic and Hispanic) individuals. Black patients had 35% lower odds (ORadj, 0.65; 95% CI, 0.59–0.70) of receiving curative‐intent treatment compared to NHW patients. ORs varied from 0.57 (95% CI, 0.59–0.70) for Hispanic Black to 0.76 (95% CI, 0.56–1.02) for West Indian Black. Remarkably, Black‐White disparities persisted despite the availability of curative treatment options (SBRT) for both high Charlson Comorbidity Index (CCI) observed among US‐born Blacks and surgery for low CCI patients among all other Black subgroups. Conclusions: Pronounced disparities in accessing curative‐intent treatments for early‐stage NSCLC were evident across all Black subgroups, regardless of treatment availability and comorbidity profile. These findings underscore the need to address Black heterogeneity and prompt further research to rectify treatment disparities in early‐stage NSCLC. [ABSTRACT FROM AUTHOR]

Abstract Objective This study used real-world observational data to compare profiles of patients receiving different first-line treatment for hormone receptor positive (ER+), HER2 negative, metastatic breast cancer (MBC): CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) versus ET alone. Method From a nationwide electronic health record-derived Flatiron Health de-identified database including 280 US cancer clinics, we identified patients with hormone receptor positive, HER2 negative, metastatic breast cancer receiving 1st -line therapy with ET alone or CDK4/6i plus ET between February 2015 and November 2021. Patient sociodemographic status, MBC treatment regimen and outcomes were the focus of this analysis. Patient characteristics were compared using t-tests and chi-square tests. Logistic regression analysis was performed to examine the association of patient characteristics with the likelihood of receiving 1st -line CDK4/6i plus ET vs. ET alone. Kaplan-Meier method and Cox proportional hazards were used to test the impact of 1st -line treatment regimen on real-world progression-free survival (PFS) and overall survival (OS). Baseline characteristics were balanced using inverse probability weighting (IPW). Results The study population included 3,917 patients receiving CDK4/6i plus ET (n = 2170) and ET alone (n = 1747) for their MBC. Compared to patients receiving ET alone, those receiving CDK4/6i plus ET were younger (mean age 66.8 vs. 68.6, p

Objective: Anorexia nervosa (AN) and atypical AN are conceptualized as distinct illnesses, despite similar characteristics and sequelae. Whereas DSM‐5 differentiates youth with AN and atypical AN by the presence of clinical 'underweight' (i.e., 5th BMI percentile for age‐and‐sex (BMI%)), we hypothesized that using this weight cut‐off to discern diagnoses creates a skewed distribution for premorbid weight. Method: Participants included hospitalized youth with AN (n = 165, 43.1%) and atypical AN (n = 218, 56.9%). Frequency analyses and chi‐square tests assessed the distribution of premorbid BMI z‐scores (BMIz) for diagnosis. Non‐parametric Spearman correlations and Stepwise Linear regressions examined relationships between premorbid BMIz, admission BMIz, and weight loss in kg. Results: Premorbid BMIz distributions differed significantly for diagnosis (p <.001), with an underrepresentation of 'overweight/obesity' (i.e., BMI% ≥ 85th) in AN. Despite commensurate weight loss in AN and atypical AN, patients with premorbid 'overweight/obesity' were 8.31 times more likely to have atypical AN than patients with premorbid BMI% < 85th. Premorbid BMIz explained 57% and 39% of the variance in admission BMIz and weight loss, respectively. Discussion: Findings support a homogenous model of AN and atypical AN, with weight loss predicted by premorbid BMI in both illnesses. Accordingly, premorbid BMI and weight loss (versus presenting BMI) may better denote the presence of an AN‐like phenotype across the weight spectrum. Findings also suggest that differentiating diagnoses with BMI% < 5th requires that youth with higher BMIs lose disproportionately more weight for an AN diagnosis. This is problematic given unique treatment barriers experienced in atypical AN. Public significance: Anorexia nervosa (AN) and atypical AN are considered distinct conditions in youth, with differential diagnosis hinging upon a presenting weight status of 'underweight' (i.e., BMI percentile for age‐and‐sex (BMI%) < 5th). In our study, youth with premorbid 'overweight/obesity' (BMI% ≥ 85th) disproportionately remained above this threshold, despite similar weight loss. Coupled with prior evidence for commensurate characteristics and sequelae in both diagnoses, we propose that DSM‐5 differentiation of AN and atypical AN inadvertently reinforces weight stigma and may contribute to treatment disparities in atypical AN. [ABSTRACT FROM AUTHOR]

Abstract Background Undertreatment of ovarian cancer is common among older women. We aimed to evaluate the treatment modalities offered to older patients and their impact on overall survival (OS). Methods The study identified 5,055 patients with high-grade serous ovarian cancer and 3584 patients with advanced stage (IIIC + IV) disease from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010, to December 31, 2017. We performed comparisons of OS and ovarian cancer-specific survival (OCSS) across age groups using a Cox proportional hazards model. Results Very elderly patients (≥ 75 years old) received treatment with significantly less surgical complexity, such as no lymphadenectomy (59.7% vs. 48.6%; p

This study explored the economic, social, and spatial correlates of treatment prevalence, retention, and service utilization for substance use disorder (SUD) in South Sardinia. Data from 1,667 patients with an ICD-10 diagnosis of SUD were extracted from the medical records of individuals assisted by three public addiction services in 2019. We used a spatial autoregressive model, a parametric proportional hazard model, and Poisson regression to examine the associations of spatial factors and residents' socioeconomic status with the prevalence of treatment at the census block level, treatment retention, and SUD service utilization at the individual level. The prevalence was higher among residents of areas closer to competent treatment centers, with the worst building conservation status, a lower percentage of high school and university graduates, and a higher percentage of unemployed, divorced, separated, or widowed residents. Men who were older at the time of their first treatment access; primary users of cocaine, cannabis, and alcohol; had higher education level; and who lived far from competent treatment centers and closer to drug trafficking centers interrupted their treatment earlier. Primary heroin users experienced more SUD treatment encounters. Living in economically and socially disadvantaged areas and near treatment facilities was associated with a higher prevalence, whereas living near drug-dealing centers and far from competent treatment centers was associated with a decrease in treatment retention. [ABSTRACT FROM AUTHOR]

Background: Hispanics and American Indians (AI) have high kidney cancer incidence and mortality rates in Arizona. This study assessed: (1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability index (SVI) experience a longer time to surgery after clinical diagnosis, and (2) whether time to surgery, race and ethnicity, and SVI are associated with upstaging to pT3/pT4, disease‐free survival (DFS), and overall survival (OS). Methods: Arizona Cancer Registry (2009–2018) kidney and renal pelvis cases (n = 4592) were analyzed using logistic regression models to assess longer time to surgery and upstaging. Cox‐regression hazard models were used to test DFS and OS. Results: Hispanic and AI patients with T1 tumors had a longer time to surgery than non‐Hispanic White patients (median time of 56, 55, and 45 days, respectively). Living in neighborhoods with high (≥75) overall SVI increased odds of a longer time to surgery for cT1a (OR 1.54, 95% CI: 1.02–2.31) and cT2 (OR 2.32, 95% CI: 1.13–4.73). Race and ethnicity were not associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3/pT4 (OR 1.95, 95% CI: 0.99–3.84). A longer time to surgery was associated with PFS (HR 1.52, 95% CI: 1.17–1.99) and OS (HR 1.63, 95% CI: 1.26–2.11). Among patients with cT2 tumor, living in high SVI neighborhoods was associated with worse OS (HR 1.66, 95% CI: 1.07–2.57). Conclusions: High social vulnerability was associated with increased time to surgery and poor survival after surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Hispanics and American Indians (AI) have high kidney cancer incidence and mortality rates in Arizona. This study assessed: (1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability index (SVI) experience a longer time to surgery after clinical diagnosis, and (2) whether time to surgery, race and ethnicity, and SVI are associated with upstaging to pT3/pT4, disease‐free survival (DFS), and overall survival (OS). Methods Arizona Cancer Registry (2009–2018) kidney and renal pelvis cases (n = 4592) were analyzed using logistic regression models to assess longer time to surgery and upstaging. Cox‐regression hazard models were used to test DFS and OS. Results Hispanic and AI patients with T1 tumors had a longer time to surgery than non‐Hispanic White patients (median time of 56, 55, and 45 days, respectively). Living in neighborhoods with high (≥75) overall SVI increased odds of a longer time to surgery for cT1a (OR 1.54, 95% CI: 1.02–2.31) and cT2 (OR 2.32, 95% CI: 1.13–4.73). Race and ethnicity were not associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3/pT4 (OR 1.95, 95% CI: 0.99–3.84). A longer time to surgery was associated with PFS (HR 1.52, 95% CI: 1.17–1.99) and OS (HR 1.63, 95% CI: 1.26–2.11). Among patients with cT2 tumor, living in high SVI neighborhoods was associated with worse OS (HR 1.66, 95% CI: 1.07–2.57). Conclusions High social vulnerability was associated with increased time to surgery and poor survival after surgery.

Background Racial disparities in outcomes among patients in the United States are widely recognized, but disparities in treatment are less commonly understood. This study is intended to identify treatment disparities in delivery of surgery and time to surgery for diagnoses managed by general surgeons—appendicitis, cholecystitis, gallstone pancreatitis, abdominal wall hernias, intestinal obstructions, and viscus perforations.

Background: Survival outcomes in metastatic breast cancer (MBC) have improved due to novel agents such as CDK4/6 inhibitors (CDK4/6i). Nevertheless, Black patients and patients with lower socioeconomic status (SES) continue to bear a disproportionate mortality burden. Methods: We conducted a retrospective analysis of EHR-derived data from the Flatiron Health Database (FHD). A dataset was constructed to include Black/African-American (Black/AA) and White patients with hormone receptor (HR)-positive, HER2-negative MBC. Outcomes included CDK4/6i use (overall and first-line), and rates of leukopenia, dose reduction, and time on treatment for first-line CDK4/6i. Multivariable logistic regression was used to evaluate factors associated with use and outcomes. Results: A total of 6802 patients with MBC were included, of which 5187 (76.3%) received CDK4/6i. Of those, 3186 (61.4%) received CDK4/6i first-line. Overall, 86.7% of patients were categorized as White and 13.3% as Black/AA; 22.4% were > 75 years old; 12.6% were treated at an academic site; 3.3% had Medicaid insurance. In addition to advanced age and poorer performance status, lower use of CDK4/6i was associated with Black/AA vs White race (72.9% vs 76.8%; OR 0.83, 95% CI 0.70–0.99, p = 0.04) and Medicaid vs commercial insurance (69.6% vs 77.4%; OR: 0.68, 95% CI 0.49–0.95, p = 0.02). Odds of CDK4/6i use were twofold higher for patients treated at an academic center (p < 0.001). Rates of CDK4/6i-induced leukopenia and dose reductions did not differ significantly by race, insurance type, or treatment site. Time on CDK4/6i was significantly lower among Medicaid patients (395 days) than patients with commercial insurance (558 days) or Medicare (643 days) (p = 0.03). Conclusion: This analysis of real-world data suggests that Black race and lower SES are associated with decreased CDK4/6i use. However, among patients treated with CDK4/6i, subsequent toxicity outcomes are similar. Efforts to ensure access to these life-prolonging medications are warranted. [ABSTRACT FROM AUTHOR]

Abstract Background Lung cancer (LC) continues to be the leading cause of cancer deaths in the United States. Surgical treatment has proven to offer a favorable prognosis and a better 5‐year relative survival for patients with early or localized tumors. This novel study investigates the factors associated with the odds of receiving surgical treatment for localized malignant LC in Tennessee. Methods Population‐based data of 9679 localized malignant LC patients from the Tennessee Cancer Registry (2005–2015) were utilized to examine the factors associated with receiving surgical treatment for localized malignant LC. Bivariate and multivariate logistic regression analyses, cross‐tabulation, and Chi‐Square (χ2) tests were conducted to assess these factors. Results Patients with localized malignant LC who initiated treatment after 2.7 weeks were 46% less likely to receive surgery (adjusted odds ratio [AOR] = 0.54; 95% confidence interval [CI] = 0.50–0.59; p

Objective: The incidence and mortality rates of breast cancer in individuals with pre‐existing severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are higher than in the general population. Reduced screening is one factor but there is less information on possible barriers to subsequent treatment following diagnosis. Methods: We undertook a systematic review and meta‐analysis on access to guideline‐appropriate care following a diagnosis of breast cancer in people with SMI including the receipt of surgery, endocrine, chemo‐ or radiotherapy. We searched for full‐text articles indexed by PubMed, EMBASE, PsycInfo and CINAHL that compared breast cancer treatment in those with and without pre‐existing SMI. Study designs included population‐based cohort or case‐control studies. Results: There were 13 studies included in the review, of which 4 contributed adjusted outcomes to the meta‐analyses. People with SMI had a reduced likelihood of guideline‐appropriate care (RR = 0.83, 95% CI = 0.77–0.90). Meta‐analyses were not possible for the other outcomes but in adjusted results from a single study, people with SMI had longer wait‐times to receiving guideline‐appropriate care. The results for specific outcomes such as surgery, hormone, radio‐ or chemotherapy were mixed, possibly because results were largely unadjusted for age, comorbidities, or cancer stage. Conclusions: People with SMI receive less and/or delayed guideline‐appropriate care for breast cancer than the general population. The reasons for this disparity warrant further investigation, as does the extent to which differences in treatment access or quality contribute to excess breast cancer mortality in people with SMI. [ABSTRACT FROM AUTHOR]

Arterial hypertension represents the leading modifiable risk factor for all-cause death and early development of cardiovascular disease in women. Current clinical guidelines for the treatment of hypertension noted that women respond to antihypertensive drugs similarly to men and, therefore, treatment recommendations remain the same for both sexes. However, clinical evidence suggests the existence of sex- and gender-related differences (SGRD) in the prevalence, pathophysiology, pharmacodynamics (efficacy and safety) and pharmacokinetics of antihypertensive drugs. This review summarizes SGRD in the prevalence of hypertension, hypertension-mediated organ damage and blood pressure control, prescription patterns, and pharmacokinetics/ pharmacodynamics and doses of antihypertensive drugs. There is limited information on SGRD in antihypertensive drug efficacy because of the underrepresentation of women in randomized clinical trials and, more important, because few trials reported results stratified by sex or performed sex-specific analyses. However, there are SGRD in hypertension-mediated organ damage, drug pharmacokinetics and, particularly, in drug safety. Prospective trials specifically designed to better understand the basis for SGRD in the pathophysiology of hypertension and in the efficacy and safety of antihypertensive drugs are needed to achieve a more personalized treatment of hypertension and hypertension-mediated organ damage in women. [ABSTRACT FROM AUTHOR]

Background: Lung cancer (LC) continues to be the leading cause of cancer deaths in the United States. Surgical treatment has proven to offer a favorable prognosis and a better 5‐year relative survival for patients with early or localized tumors. This novel study investigates the factors associated with the odds of receiving surgical treatment for localized malignant LC in Tennessee. Methods: Population‐based data of 9679 localized malignant LC patients from the Tennessee Cancer Registry (2005–2015) were utilized to examine the factors associated with receiving surgical treatment for localized malignant LC. Bivariate and multivariate logistic regression analyses, cross‐tabulation, and Chi‐Square (χ2) tests were conducted to assess these factors. Results: Patients with localized malignant LC who initiated treatment after 2.7 weeks were 46% less likely to receive surgery (adjusted odds ratio [AOR] = 0.54; 95% confidence interval [CI] = 0.50–0.59; p < 0.0001). Females had a greater likelihood (AOR = 1.14; CI = 1.03–1.24) of receiving surgical treatment compared to men. Blacks had lower odds (AOR = 0.76; CI = 0.65–0.98) of receiving surgical treatment compared to Whites. All marital groups had higher odds of receiving surgical treatment compared to those who were single/never married. Patients living in Appalachian county had lower odds of receiving surgical treatment (AOR = 0.65; CI = 0.59–0.71) compared with those in the non‐Appalachian county. Patients with private (AOR = 2.09; CI = 1.55–2.820) or public (AOR = 1.42; CI = 1.06–1.91) insurance coverage were more likely to receive surgical treatment compared to self‐pay/uninsured patients. Overall, the likelihood of patients receiving surgical treatment for localized malignant LC decreases with age. Conclusion: Disparities exist in the receipt of surgical treatment among patients with localized malignant LC in Tennessee. Health policies should target reducing these disparities to improve the survival of these patients. [ABSTRACT FROM AUTHOR]

Background: People with mild cognitive impairment (MCI) receive fewer guideline-concordant treatments for cardiovascular disease (CVD) than people with normal cognition (NC). Objective: To understand physician perspectives on why patients with MCI receive fewer CVD treatments than patients with NC. Methods: As part of a mixed-methods study assessing how patient MCI influences physicians' decision making for acute myocardial infarction (AMI) and stroke treatments, we conducted a qualitative study using interviews of physicians. Topics included participants' reactions to data that physicians recommend fewer CVD treatments to patients with MCI and reasons why participants think fewer CVD treatments may be recommended to this patient population. Results: Participants included 22 physicians (8 cardiologists, 7 neurologists, and 7 primary care physicians). Most found undertreatment of CVD in patients with MCI unreasonable, while some participants thought it could be considered reasonable. Participants postulated that other physicians might hold beliefs that could be reasons for undertreating CVD in patients with MCI. These beliefs fell into four main categories: 1) patients with MCI have worse prognoses than NC, 2) patients with MCI are at higher risk of treatment complications, 3) patients' cognitive impairment might hinder their ability to consent or adhere to treatment, and 4) patients with MCI benefit less from treatments than NC. Conclusion: These findings suggest that most physicians do not think it is reasonable to recommend less CVD treatment to patients with MCI than to patients with NC. Improving physician understanding of MCI might help diminish disparities in CVD treatment among patients with MCI. [ABSTRACT FROM AUTHOR]

Background: Despite its association with lower survival rates among patients in various disease states, financial toxicity is often overlooked in healthcare. The aims of our study are to elucidate the effect of financial toxicity on the care of glioma patients., Methods: We retrospectively evaluated clinical information of 130 patients with newly diagnosed glioblastoma from a single institution between 2014 and 2021. The Area Deprivation Index characterized patients' socioeconomic status. Insurance claims were analyzed to assess the financial burden on patients following their neurosurgical procedure. This burden was then compared with socioeconomic factors using adjusted multivariable regression models., Results: 55 (42%) patients had out-of-pocket costs with 24 (18%) unable to pay off their procedure. High socioeconomic disadvantage (3.01; p = 0.02); other race (0.166; p = 0.039); and public insurance (0.114; p < 0.0001) were significantly associated with an increased risk of accumulating out-of-pocket costs. Age (0.097; p = 0.026); African American race (29.87; p = 0.029); marriage status (0.114; p = 0.017); and high socioeconomic disadvantage (5.96; p = 0.031) were significantly associated with risk of payments being sent to collections. Those with private insurance accrued higher gross out-of-pocket costs (1093 vs 506, [p<0.001]). Those with public insurance had a lower hazard of death (0.397; p = 0.003)., Conclusions: Our results suggest there is a strong association between financial toxicity, socioeconomic status, and the standard of care following GBM resection. They also shed light on the financial toxicities associated with the care of these patients., (Copyright © 2024. Published by Elsevier Inc.)

IntroductionRural populations in large countries often receive delayed or less effective diagnosis and treatment for lung cancer. Differences are related to population-based factors such as lower pro capita income or increased risk factors or to differences in access to facilities. Switzerland is a small, rich country with peculiar geographic and urban characteristics.We explored the relationship between lung cancer diagnostic–surgical pathway and urban–rural residency in our region.MethodsWe retrospectively analyzed the medical records of 280 consecutive patients treated for primary non-small cell lung cancer at our institution (2017–2021). This is a regional tertiary center for diagnosis and treatment, and data were extracted from a prospectively collected clinical database. We included anatomical lung resection. Collected variables included patients and surgical characteristics, risk factors, comorbidities, histology and staging, symptoms (vs. incidental diagnosis), general practitioner (GP) involvement, health insurance, and suspected test-treatment interval. The exposure was rurality, defined by the 2009 rural–urban residency classification from the Department of Land.ResultsA total of 150 patients (54%) lived in rural areas. Rural patients had a higher rate of smoking history (93% vs. 82%; p = 0.007). Symptomatic vs. incidental diagnosis did not differ as well as previous cancer rate, insurance, and pathological staging. In rural patients, there was a greater burden of comorbidities (mean Charlson Comorbidity Index Age-Adjusted 5.3 in rural population vs. 4.8 in urban population, p = 0.05), and GP was more involved in the diagnostic pathway (51% vs. 39%, p = 0.04). The interval between the first suspected test and treatment was significantly shorter (56 vs. 66.5 days, p = 0.03). Multiple linear regression with backward elimination was run. These variables statistically predicted the time from the first suspected test and surgical treatment [F(3, 270), p

Aims: People with severe mental illness (SMI) have a greater risk of dying from colorectal cancer (CRC), even though the incidence is lower or similar to that of the general population This pattern is unlikely to be solely explained by lifestyle factors, while the role of differences in cancer healthcare access or treatment is uncertain Methods: We undertook a systematic review and meta-analysis on access to guideline-appropriate care following CRC diagnosis in people with SMI including the receipt of surgery, chemo- or radiotherapy. We searched for full-text articles indexed by PubMed, EMBASE, PsychInfo and CINAHL that compared CRC treatment in those with and without pre-existing SMI (schizophrenia, schizoaffective, bipolar and major affective disorders). Designs included cohort or population-based case–control designs. Results: There were ten studies (sample size = 3501–591 561). People with SMI had a reduced likelihood of surgery (RR = 0.90, 95% CI 0.92–0.97; p = 0.005; k = 4). Meta-analyses were not possible for the other outcomes but in results from individual studies, people with SMI were less likely to receive radiotherapy, chemotherapy or sphincter-sparing procedures. The disparity in care was greatest for those who had been psychiatric inpatients. Conclusions: People with SMI, including both psychotic and affective disorders, receive less CRC care than the general population. This might contribute to higher case-fatality rates for an illness where the incidence is no higher than that of the general population. The reasons for this require further investigation, as does the extent to which differences in treatment access or quality contribute to excess CRC mortality in people with SMI. [ABSTRACT FROM AUTHOR]

The authors comment on the study "Using a cascade of care framework to identify gaps in access to medications for alcohol use disorder in British Columbia (BC), Canada" by M. E. Socias and colleagues, which uses administrative health records for 2015-19 from BC to describe the alcohol use disorder (AUD) care cascade. Topics discussed include percentage of specialty substance use disorder treatment programs that offered oral naltrexone for AUD, and benefits of telemedicine.

Purpose: Proper breast cancer screening and treatment should be considered in the elderly population; however, some tend to be less proactive. Our study aimed to investigate the impact of old age on treatment and prognosis in triple-negative breast cancer (TNBC)., Method: The study included patients with primary TNBC stage I-III diagnosed from 2002 to 2019 in single institution and retrospectively analyzed. We defined young (< 40 years), middle and old (> 70 years) groups. Clinicopathological factors, treatment, and prognosis were analyzed according to age group of TNBC patients., Result: TNBC patients aged 70 and above were 3.3 times more likely (P = .019) to have lymph node metastasis at the time of diagnosis compared to younger patients, but were found to be 0.24 times less likely to receive chemotherapy. (P = .003) Old TNBC patients have an expected likelihood 2.2 times higher of undergoing mastectomy rather than breast-conserving surgery. (P = .042) The 5-year prognosis is poorer in young and old group. (61%, 86%, and 65% in young, middle, and old groups). (P < .001). In subanalysis, old group of stages I and II received fewer chemotherapy compared to youngers (P < .05), but not in stage III. In Cox regression analysis, age and stage had significant impact on prognosis (hazard ratio 2-3), but treatment factors did not. However, in stratified analysis of adjuvant therapy and stage, prognosis of Old TNBC patients in stage II was improved when they underwent neo or adjuvant chemotherapy., Conclusion: TNBC presents challenges in older patients, who receive less aggressive treatment and have poorer outcomes. The primary cause of poor prognosis in old TNBC patients is the high disease stage at diagnosis, underscoring the need for promotion and education on early screening. Additionally, it is suggested that a more proactive approach to adjuvant chemotherapy is necessary for stage II old TNBC patients., Competing Interests: Disclosure The authors have no competing financial interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The increasing relevance of substance use disorder (SUD) within the Asian American, Native Hawaiian, and Pacific Islander (AA&NH/PI) communities, particularly amidst rising anti-Asian hate incidents and the disproportionate health and economic challenges faced by the NH/PI community during the COVID-19 pandemic, underscores the urgency of understanding substance use patterns, treatment disparities, and outcomes. Following PRISMA guidelines, 37 out of 231 studies met the search criteria. Study characteristics, study datasets, substance use rates, SUD rates, treatment disparities, treatment quality, completion rates, and analyses disaggregated by the most specific AA&NH/PI ethnic group reported were examined. Despite increased treatment admissions over the past two decades, AA&NH/PI remain underrepresented in treatment facilities and underutilize SUD care services. Treatment quality and completion rates are also lower among AA&NH/PI. Analyses that did not disaggregate AA and NHPI as distinct groups from each other or that presented aggregate data only within AA or NHPI as a whole were common, but available disaggregated analyses reveal variations in substance use and treatment disparities among ethnic groups. There is also a lack of research in exploring within-group disparities, including specific case of older adults and substance use. To address disparities in access to substance use treatment and improve outcomes for AA&NH/PI populations, targeted interventions and strategic data collection methods that capture diverse ethnic groups and languages are crucial. Acknowledging data bias and expanding data collection to encompass multiple languages are essential for fostering a more inclusive approach to addressing SUD among AA&NH/PI populations. • Underrepresentation of AA&NH/PI in substance use treatment facilities persists. • Treatment quality and completion rates are lower among AA&NH/PI. • Limited culturally competent treatment options are available for AA&NH/PI. [ABSTRACT FROM AUTHOR]

Cancer incidence, comorbidity, and polypharmacy increase with age, but the interplay between these factors on receipt of systemic therapy (ST) in advanced cancer has rarely been studied. A retrospective cohort study was conducted including patients aged ≥18 years diagnosed from 2004 to 2015 with multiple myeloma (MM) (all stages), lung cancer (stage IV), and stage III-IV non-Hodgkin's lymphoma (NHL), breast, colorectal (CRC), prostate, or ovarian cancer in Manitoba, Canada. Clinical and administrative health data were used to determine demographic and cancer characteristics, treatment history, comorbidity (Charlson Comorbidity Index [CCI] and Resource Utilization Band [RUB]), and polypharmacy (≥6 medications). Multivariable logistic regression was used to evaluate variable associations with receipt of ST and interaction with age. In total, 17,228 patients were diagnosed with advanced cancer. Ages were distributed as follows: 7% <50 years, 16% 50–59 years, 26% 60–69, 26% 70–79, 24% ≥80 years. ST was administered to 50% of patients. Increased age, polypharmacy, and comorbidity each independently decreased the likelihood of receiving ST. Significant interaction effects were found between age at diagnosis with stage of cancer and cancer type. Differences in probability of ST by cancer stage converged as age increased. In multivariable analysis, adjusting for covariates, patients with MM had the highest odds and lung cancer the lowest odds to receive ST. The impact of comorbidity and polypharmacy did not differ meaningfully with increasing age. Increased age, polypharmacy, and comorbidity were each independently associated with decreased receipt of ST in people with advanced cancers. The impact of comorbidity and polypharmacy did not differ meaningfully with increasing age, while age meaningfully interacted with stage and cancer type. [ABSTRACT FROM AUTHOR]

Background  Racial disparities in outcomes among patients in the United States are widely recognized, but disparities in treatment are less commonly understood. This study is intended to identify treatment disparities in delivery of surgery and time to surgery for diagnoses managed by general surgeons-appendicitis, cholecystitis, gallstone pancreatitis, abdominal wall hernias, intestinal obstructions, and viscus perforations. Methods  The National Inpatient Sample (NIS) was used to estimate and analyze disparities in delivery of surgery, type of surgery received, and timing of surgery. Age-adjusted means were compared by race/ethnicity and trends in treatment disparities were evaluated from 1993 to 2017. Linear modeling was used to measure trends in treatment and outcome disparities over time. Mediation analysis was performed to estimate contributions of all available factors to treatment differences. Relationships between treatment disparities and disparities in mortality and length of stay were similarly evaluated. Results  Black patients were less likely to receive surgery for appendicitis, cholecystitis, pancreatitis, and hernias, and more likely to receive surgery for obstructions and perforations. Black patients experienced longer wait times prior to surgery, by 0.15 to 1.9 days, depending on the diagnosis. Mediation analysis demonstrated that these disparities are not attributable to the patient factors available in the NIS, and provided some insight into potential contributors to the observed disparities, such as hospital factors and socioeconomic factors. Conclusion  Treatment disparities are present even with common indications for surgery, such as appendicitis, cholecystitis, and gallstone pancreatitis. Black patients are less likely to receive surgery with these diagnoses and must wait longer for surgery if it is performed. Surgeons should plan institution-level interventions to measure, explain, and potentially correct treatment disparities., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

Introduction: Curative intent for localized pancreatic cancer (pancreatic ductal adenocarcinoma [PDAC]) requires surgery, but despite improved perioperative outcomes, surgery remains underutilized. This study analyzed the Texas Cancer Registry (TCR) to identify resectable PDAC patients who underwent curative-intent surgery in Texas between 2004 and 2018. We then evaluated demographic and clinical factors associated with failure to operate and survival (OS)., Methods: We identified patients with localized PDAC or regional lymph node spread between 2004 and 2018 in the TCR. Resection rates were determined and multivariable regression and cox proportional hazards were used to identify factors associated with failure to OS., Results: Of 4274 patients, 22% underwent resection, 57% were not offered surgery, 6% had comorbidities precluding surgery, and 3% refused. Resection rates decreased from 31% in 2004 to 22% in 2018. Increasing age was associated with failure to operate (odds ratio [OR] 2.55; 95% confidence interval [CI] 1.80-3.61; p < 0.0001) while treatment at a Commission on Cancer (CoC) center correlated with reduced failure to operate (OR 0.63; 95% CI 0.50-0.78; p < 0.0001). Resection correlated with survival (HR 0.34; 95% CI 0.31-0.38; p < 0.0001) as did treatment at a National Cancer Institute (NCI)-designated center (hazard ratio 0.79; 95% CI 0.70-0.89; p < 0.0001)., Conclusions: Surgery is underutilized for the treatment of resectable PDAC in Texas with decreasing utilization, annually. Evaluation at CoC was associated with improved resection rates and NCI was associated with increased survival. Expanding access to multidisciplinary care including trained hepato-pancreatico-biliary surgeons may improve outcomes for PDAC patients., (© 2023 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC.)

Background: Disparities in cancer outcomes for minoritized people and groups experiencing disadvantages with Stage IV cancer is largely unknown., Methods: Patients with Stage IV pancreatic, colorectal, lung, breast, and prostate cancer were identified from 2004 to 2015 in the National Cancer Database. Cox proportional hazard models were used to quantify how demographics and treatments received were associated with overall survival., Results: 903,151 patients were included. Patients who were younger, non-Hispanic White, had private insurance, higher income, or received care at an academic center were more likely to receive surgery, chemotherapy, and/or radiation therapy (p < 0.001). Black patients, those with Medicare, Medicaid, no insurance, and lower income had lower survival rates across all five cancer types (p < 0.001). On multivariable analysis, receipt of surgery, radiation, and chemotherapy attenuated but did not eliminate this worse survival (p < 0.001)., Conclusions: Survival for patients with Stage IV cancer differs by socioeconomic and self-reported racial classifications., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Health care disparities based on race/ethnicity and sex can be found in a variety of settings. Our aim is to determine if there are disparities in treatment provided to Indiana Medicaid enrollees who have medically documented opioid use., Study Data and Methods: We used Medicaid reimbursement claims data to extract patients who were diagnosed with opioid use disorder (OUD) or had other medical event related to opioid use between January 2018 and March 2019. We used a two-proportion Z -test to verify the difference in the proportion of treatment provided between population subgroups. The study was approved by the Purdue University Institutional Review Board (2019-118)., Study Results: Over the study period, there were 52,994 Indiana Medicaid enrollees diagnosed with OUD or documentation of another opioid related event. Only 5.41% of them received at least one type of treatment service (detoxification, psychosocial, medication assisted treatment, or comprehensive)., Discussion: Although Medicaid began covering treatment services for enrollees with an OUD in Indiana at the start of 2018, very few received evidence-based services. Men and White enrollees with an OUD were in general more likely to receive services compared to women and non-White enrollees., Competing Interests: No competing financial interests exist., (© Carolina Vivas-Valencia et al., 2023; Published by Mary Ann Liebert, Inc.)

Introduction: Rural populations in large countries often receive delayed or less effective diagnosis and treatment for lung cancer. Differences are related to population-based factors such as lower pro capita income or increased risk factors or to differences in access to facilities. Switzerland is a small, rich country with peculiar geographic and urban characteristics.We explored the relationship between lung cancer diagnostic-surgical pathway and urban-rural residency in our region., Methods: We retrospectively analyzed the medical records of 280 consecutive patients treated for primary non-small cell lung cancer at our institution (2017-2021). This is a regional tertiary center for diagnosis and treatment, and data were extracted from a prospectively collected clinical database. We included anatomical lung resection. Collected variables included patients and surgical characteristics, risk factors, comorbidities, histology and staging, symptoms (vs. incidental diagnosis), general practitioner (GP) involvement, health insurance, and suspected test-treatment interval. The exposure was rurality, defined by the 2009 rural-urban residency classification from the Department of Land., Results: A total of 150 patients (54%) lived in rural areas. Rural patients had a higher rate of smoking history (93% vs. 82%; p  = 0.007). Symptomatic vs. incidental diagnosis did not differ as well as previous cancer rate, insurance, and pathological staging. In rural patients, there was a greater burden of comorbidities (mean Charlson Comorbidity Index Age-Adjusted 5.3 in rural population vs. 4.8 in urban population, p  = 0.05), and GP was more involved in the diagnostic pathway (51% vs. 39%, p  = 0.04). The interval between the first suspected test and treatment was significantly shorter (56 vs. 66.5 days, p  = 0.03). Multiple linear regression with backward elimination was run. These variables statistically predicted the time from the first suspected test and surgical treatment [ F (3, 270), p  < .05, R 2  = 0.24]: rurality ( p  = 0.04), GP involvement ( p  = 0.04), and presence of lung cancer-related symptoms ( p  = 0.02)., Conclusions: In our territory with inhomogeneous population distribution and geographic barriers, residency has an impact on the lung cancer pathway. It seems paradoxical that rural patients had a shorter route. The more constant involvement of GP might explain this finding, having suggested more tests for high-risk patients in the absence of symptoms or follow-ups. This did not change the staging of surgical patients, but it might be essential for the organization of an effective lung cancer screening program., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Minerva, Tessitore, Cafarotti and Patella.)