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3. Income differences in time to colon cancer diagnosis.

Author

Davis, Laura E., Strumpf, Erin C., Patel, Sunil V., and Mahar, Alyson L.

Subjects
*FECAL occult blood tests, *COLON cancer diagnosis, *COLON cancer, *DELAYED diagnosis, *INCOME
Abstract

Introduction: People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval. Methods: This was a retrospective cohort study of colon cancer patients diagnosed 2007–2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis. Results: A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low‐income neighborhoods was associated with longer 50th and 90th‐percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6–23) longer in patients living in the lowest income neighborhoods compared to the highest. Conclusion: These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Access to symptom screening and severe symptom risk among cancer patients with major mental illness

Author

Davis, Laura E., primary, Sutradhar, Rinku, additional, Bourque, Michaela A., additional, Eskander, Antoine, additional, Noel, Christopher W., additional, Isenberg‐Grzeda, Elie, additional, Vigod, Simone N., additional, Coburn, Natalie, additional, Deleemans, Julie, additional, Bolton, James M., additional, Chan, Wing C., additional, Hallet, Julie, additional, and Mahar, Alyson L., additional

Published
2023
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27. Low rates of specialized cancer consultation and cancer-directed therapy for noncurable pancreatic adenocarcinoma: a population-based analysis

Author

Mavros, Michail N., Coburn, Natalie G., Davis, Laura E., Mahar, Alyson L., Liu, Ying, Beyfuss, Kaitlyn, Myrehaug, Sten, Earle, Craig C., and Hallet, Julie

Subjects
Adenocarcinoma -- Care and treatment -- Analysis, Pancreatic cancer -- Care and treatment -- Analysis, Chemotherapy -- Analysis, Radiotherapy -- Analysis, Antineoplastic agents -- Analysis, Health care information services -- Analysis, Radiation (Physics) -- Analysis, Cancer treatment, Surgery, Cancer patients, Health, Society of Surgical Oncology
Abstract

BACKGROUND: Although advancements in systemic therapy have improved the outlook for pancreatic adenocarcinoma, it is not known if patients get access to these therapies. We aimed to examine the patterns and factors associated with access to specialized cancer consultations and subsequent receipt of cancer-directed therapy for patients with noncurative pancreatic adenocarcinoma. METHODS: We conducted a population-based analysis of noncurative pancreatic adenocarcinoma diagnosed over 2005-2016 in Ontario by linking administrative health care data sets. Our primary outcomes were specialized cancer consultation and receipt of cancer-directed therapy (chemotherapy or a combination of chemo- and radiation therapy [chemoradiation therapy]). We examined specialized cancer consultation with hepato-pancreatico-biliary surgery, medical and radiation oncology. We used multivariable logistic regression to identify factors associated with medical oncology consultation and cancer-directed therapy. RESULTS: Of 10881 patients, 64.9% had a consultation with specialists in medical oncology, 35.1% with hepatopancreatico-biliary surgery and 24.7% with radiation oncology. Sociodemographic characteristics were not associated with the likelihood of medical oncology consultation. Of these patients, 4144 received cancer-directed therapy, representing 38.1% of all patients and 58.6% of those who consulted with medical oncology. Of 6737 patients not receiving cancer directed therapy, 2988 (44.4%) had a consultation with medical oncology. Older age and lowest income quintile were independently associated with lower likelihood of cancer-directed therapy. If the first specialized cancer consultation was with medical or radiation oncology, the likelihood of cancer-directed therapy was significantly higher compared with surgery. INTERPRETATION: A considerable proportion of patients with noncurable pancreatic adenocarcinoma in Ontario did not have a specialized cancer consultation and most did not receive cancer-directed therapy. We identified disparities in specialized cancer consultation and receipt of systemic cancer-directed therapy that indicate potential gaps in assessment., Despite substantial improvements in cancer care, mortality from pancreatic adenocarcinoma is largely unchanged. (1,2) The only option for curative treatment is pancreatectomy. (3) However, 80% of patients who present with [...]

Published
2019
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28. Pain and Interventions in Stage IV Non-Small Cell Lung Cancer: A Province-Wide Analysis

Author

Tan, Vivian S., primary, Tjong, Michael C., additional, Chan, Wing C., additional, Yan, Michael, additional, Delibasic, Victoria, additional, Darling, Gail, additional, Davis, Laura E., additional, Doherty, Mark, additional, Hallet, Julie, additional, Kidane, Biniam, additional, Mahar, Alyson, additional, Mittmann, Nicole, additional, Parmar, Ambika, additional, Tan, Hendrick, additional, Wright, Frances C., additional, Coburn, Natalie G., additional, and Louie, Alexander V., additional

Published
2023
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29. Dyspnea in patients with stage IV non-small cell lung cancer: a population-based analysis of disease burden and patterns of care

Author

Yan, Michael, primary, Tjong, Michael, additional, Chan, Wing C., additional, Darling, Gail, additional, Delibasic, Victoria, additional, Davis, Laura E., additional, Doherty, Mark, additional, Hallet, Julie, additional, Kidane, Biniam, additional, Mahar, Alyson, additional, Mittmann, Nicole, additional, Parmar, Ambica, additional, Tan, Vivian, additional, Tan, Hendrick, additional, Wright, Frances C., additional, Coburn, Natalie G., additional, and Louie, Alexander V., additional

Published
2023
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32. 27: Province-Wide Analysis of Patient Reported Outcomes for Stage IV Non-Small Cell Lung Cancer

Author

Tjong, Michael C., primary, Doherty, Mark, additional, Tan, Hendrick, additional, Chan, Wing C., additional, Zhao, Haoyu, additional, Hallet, Julie, additional, Darling, Gail, additional, Kidane, Biniam, additional, Wright, Frances C., additional, Mahar, Alyson, additional, Davis, Laura E., additional, Delibasic, Victoria, additional, Parmar, Ambika, additional, Mittmann, Nicole, additional, Coburn, Natalie G., additional, and Louie, Alexander V., additional

Published
2021
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34. Province-Wide Analysis of Patient-Reported Outcomes for Stage IV Non-Small Cell Lung Cancer

Author

Tjong, Michael C., primary, Doherty, Mark, additional, Tan, Hendrick, additional, Chan, Wing C., additional, Zhao, Haoyu, additional, Hallet, Julie, additional, Darling, Gail, additional, Kidane, Biniam, additional, Wright, Frances C., additional, Mahar, Alyson, additional, Davis, Laura E., additional, Delibasic, Victoria, additional, Parmar, Ambika, additional, Mittmann, Nicole, additional, Coburn, Natalie G., additional, and Louie, Alexander V., additional

Published
2021
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35. Province-wide analysis of patient reported outcomes for stage IV non-small cell lung cancer.

Author

Tjong, Michael Chandra, primary, Doherty, Mark, additional, Tan, Hendrick, additional, Chan, Wing, additional, Zhao, Haoyu, additional, Hallet, Julie, additional, Darling, Gail Elizabeth, additional, Kidane, Biniam, additional, Wright, Frances Catriona, additional, Mahar, Alyson, additional, Davis, Laura E, additional, Delibasic, Victoria, additional, Parmar, Ambika, additional, Mittmann, Nicole, additional, Coburn, Natalie G., additional, and Louie, Alexander V, additional

Published
2021
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42. Severe symptoms persist for Up to one year after diagnosis of stage I-III lung cancer: An analysis of province-wide patient reported outcomes

Author

Hirpara, Dhruvin H., primary, Gupta, Vaibhav, additional, Davis, Laura E., additional, Zhao, Haoyu, additional, Hallet, Julie, additional, Mahar, Alyson L., additional, Sutradhar, Rinku, additional, Doherty, Mark, additional, Louie, Alexander V., additional, Kidane, Biniam, additional, Darling, Gail, additional, and Coburn, Natalie G., additional

Published
2020
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43. Textbook Outcome and Survival in Patients With Gastric Cancer

Author

Levy, Jordan, primary, Gupta, Vaibhav, additional, Amirazodi, Elmira, additional, Allen-Ayodabo, Catherine, additional, Jivraj, Naheed, additional, Jeong, Yunni, additional, Davis, Laura E., additional, Mahar, Alyson L., additional, De Mestral, Charles, additional, Saarela, Olli, additional, and Coburn, Natalie G., additional

Published
2020
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