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10. 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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11. Investigating inequalities in cancer staging and survival for adults with intellectual or developmental disabilities and cancer: A population-based study in Manitoba, Canada

Author

Hansford, Rebecca, primary, Ouellette-Kuntz, Hélène, additional, Bourque, Michaela A., additional, Decker, Kathleen, additional, Derksen, Shelley, additional, Hallet, Julie, additional, Dawe, David E., additional, Cobigo, Virginie, additional, Shooshtari, Shahin, additional, Stirling, Morgan, additional, Kelly, Christine, additional, Brownell, Marni, additional, Turner, Donna, additional, and Mahar, Alyson L., additional

Published
2024
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29. Stage IV breast, colorectal, and lung cancer at diagnosis in adults living with intellectual or developmental disabilities: A population‐based cross‐sectional study.

Author

Mahar, Alyson L., Biggs, Kelly, Hansford, Rebecca L., Derksen, Shelley, Griffiths, Rebecca, Enns, Jennifer E., Dawe, David E., Hallet, Julie, Kristjanson, Mark, Decker, Kathleen, Cobigo, Virginie, Shooshtari, Shahin, Stirling, Morgan, Kelly, Christine, Brownell, Marni, Turner, Donna, and Ouellette‐Kuntz, Hélène

Subjects
*PEOPLE with developmental disabilities, *DEVELOPMENTAL disabilities, *LUNG cancer, *INTELLECTUAL disabilities, *CANCER diagnosis, *CANCER patients, *DELAYED diagnosis
Abstract

Background: Cancer is a leading cause of death among people living with intellectual or developmental disabilities (IDD). Although studies have documented lower cancer screening rates, there is limited epidemiological evidence quantifying potential diagnostic delays. This study explores the risk of metastatic cancer stage for people with IDD compared to those without IDD among breast (female), colorectal, and lung cancer patients in Canada. Methods: Separate population‐based cross‐sectional studies were conducted in Ontario and Manitoba by linking routinely collected data. Breast (female), colorectal, and lung cancer patients were included (Manitoba: 2004–2017; Ontario: 2007–2019). IDD status was identified using established administrative algorithms. Modified Poisson regression with robust error variance models estimated associations between IDD status and the likelihood of being diagnosed with metastatic cancer. Adjusted relative risks were pooled between provinces using random‐effects meta‐analyses. Potential effect modification was considered. Results: The final cohorts included 115,456, 89,815, and 101,811 breast (female), colorectal, and lung cancer patients, respectively. Breast (female) and colorectal cancer patients with IDD were 1.60 and 1.44 times more likely to have metastatic cancer (stage IV) at diagnosis compared to those without IDD (relative risk [RR], 1.60; 95% confidence interval [CI], 1.16–2.20; RR, 1.44; 95% CI, 1.24–1.67). This increased risk was not observed in lung cancer. Significant effect modification was not observed. Conclusions: People with IDD were more likely to have stage IV breast and colorectal cancer identified at diagnosis compared to those without IDD. Identifying factors and processes contributing to stage disparities such as lower screening rates and developing strategies to address diagnostic delays is critical. People with intellectual or developmental disabilities were more likely to be diagnosed with metastatic breast and colorectal cancer compared to those without. Action toward more timely cancer diagnoses is needed to avoid unnecessary morbidity and mortality. [ABSTRACT FROM AUTHOR]

Published
2024
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31. 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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42. The impact of unexpected intensive care unit admission after cancer surgery on long-term symptom burden among older adults: a population-based longitudinal analysis

Author

Tillmann, Bourke W., Hallet, Julie, Sutradhar, Rinku, Guttman, Matthew P., Coburn, Natalie, Chesney, Tyler R., Zuckerman, Jesse, Mahar, Alyson L., Chan, Wing C., Haas, Barbara, and University of Manitoba

Abstract

Background Older adults are at high-risk for a post-operative intensive care unit (ICU) admission, yet little is known about the impact of these admissions on quality of life. The objective of this study was to evaluate the impact of an unexpected post-operative ICU admission on the burden of cancer symptoms among older adults who underwent high-intensity cancer surgery and survived to hospital discharge. Methods We performed a population-based cohort study of older adults (age ≥ 70) who underwent high-intensity cancer surgery and survived to hospital discharge in Ontario, Canada (2007–2017). Using the Edmonton Symptom Assessment System (ESAS), a standardized tool that quantifies patient-reported physical, mental, and emotional symptoms, we described the burden of cancer symptoms during the year after surgery. Total symptom scores ≥ 40 indicated a moderate-to-severe symptom burden. Modified log-Poisson analysis was used to estimate the impact of an unexpected post-operative ICU admission (admission not related to routine monitoring) on the likelihood of experiencing a moderate-to-severe symptom burden during the year after surgery, accounting for potential confounders. We then used multivariable generalized linear mixed models to model symptom trajectories among patients with two or more ESAS assessments. A 10-point difference in total symptom scores was considered clinically significant. Results Among 16,560 patients (mean age 76.5 years; 43.4% female), 1,503 (9.1%) had an unexpected ICU admission. After accounting for baseline characteristics, patients with an unexcepted ICU admission were more likely to experience a moderate-to-severe symptom burden relative to those without an unexpected ICU admission (RR 1.64, 95% CI 1.31–2.05). Specifically, among patients with an unexcepted ICU admission the average probability of experiencing moderate-to-severe symptoms ranged from 6.9% (95 CI 5.8–8.3%) during the first month after surgery to 3.2% (95% CI 0.9–11.7%) at the end of the year. Among the 11,229 (67.8%) patients with multiple ESAS assessments, adjusted differences in total scores between patients with and without an unexpected ICU admission ranged from 2.0 to 5.7-points throughout the year (p

Published
2023

44. 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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