Patients' Perceptions of Quality of Care for Colorectal Cancer by Race, Ethnicity, and Language

2005 ◽  
Vol 23 (27) ◽  
pp. 6576-6586 ◽  
Author(s):  
John Z. Ayanian ◽  
Alan M. Zaslavsky ◽  
Edward Guadagnoli ◽  
Charles S. Fuchs ◽  
Kathleen J. Yost ◽  
...  
Keyword(s):  
Access To Care ◽  
Health Information ◽  
Cancer Care ◽  
Psychosocial Care ◽  
Coordination Of Care ◽  
Treatment Information ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Information Difference ◽  
White Patients

Purpose To identify opportunities for improving care, we evaluated patients' perceptions of the quality of their cancer care by race, ethnicity, and language. Patients and Methods We surveyed a population-based cohort of 1,067 patients with colorectal cancer in northern California approximately 9 months after diagnosis. Adjusting for clinical and demographic factors, mean problem scores were analyzed on a 100-point scale for six domains of care. Results Mean problem scores were highest for health information (47.8), followed by treatment information (32.3), psychosocial care (31.7), coordination of care (21.3), confidence in providers (13.1), and access to cancer care (12.7). In adjusted comparisons with white patients, African American patients reported more problems with coordination of care (difference, 9.8; P < .001), psychosocial care (difference, 7.2; P = .03), access to care (difference, 6.6; P = .03), and health information (difference, 12.5; P < .001). Asian/Pacific Islander patients reported more problems than did white patients with coordination of care (difference, 13.2; P < .001), access to care (difference, 15.5; P < .001), and health information (difference, 12.6; P = .004). Hispanic patients tended to report more problems with coordination of care (difference, 4.4; P = .06), access to care (difference, 5.8; P = .08), and treatment information (difference, 7.0; P = .06). Non–English-speaking white patients reported more problems than other white patients with coordination of care (difference, 21.9; P < .001), psychosocial care (difference, 16.1; P = .009), access to care (difference, 19.8; P = .003), and treatment information (difference, 17.8; P = .002). Non–English-speaking Hispanic patients reported more problems than other Hispanic patients with confidence in providers (difference, 16.9; P = .01). Conclusion Efforts to improve patients' experiences with cancer care should address disparities by race, ethnicity, and language, particularly in coordination of care, access to care, and the provision of relevant information.

scholarly journals Contemporary Reevaluation of Race and Ethnicity With Outcomes in Heart Failure

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Samuel T. Savitz ◽  
Thomas Leong ◽  
Sue Hee Sung ◽  
Keane Lee ◽  
Jamal S. Rana ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Pacific Islander ◽  
Left Ventricular Ejection ◽  
Asian Pacific Islander ◽  
Black Patients ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Asian Pacific ◽  
White Patients

Background Variation in outcomes by race/ethnicity in adults with heart failure (HF) has been previously observed. Identifying factors contributing to these variations could help target interventions. We evaluated the association of race/ethnicity with HF outcomes and potentially contributing factors within a contemporary HF cohort. Methods and Results We identified members of Kaiser Permanente Northern California, a large integrated healthcare delivery system, who were diagnosed with HF between 2012 and 2016 and had at least 1 year of prior continuous membership and left ventricular ejection fraction data. We used Cox regression with time‐dependent covariates to evaluate the association of self‐identified race/ethnicity with HF or all‐cause hospitalization and all‐cause death, with backward selection for potential explanatory variables. Among 34 621 patients with HF, compared with White patients, Black patients had a higher rate of HF hospitalization (adjusted hazard ratio [HR], 1.28; 95% CI, 1.18–1.38) but a lower rate of death (adjusted HR, 0.78; 95% CI, 0.72–0.85). In contrast, Asian/Pacific Islander patients had similar rates of HF hospitalization, but lower rates of all‐cause hospitalization (adjusted HR, 0.89; 95% CI, 0.85–0.93) and death (adjusted HR, 0.75; 95% CI, 0.69–0.80). Hispanic patients also had a lower rate of death (adjusted HR, 0.85; 95% CI, 0.80–0.91). Sensitivity analyses showed that effect sizes for Black patients were larger among patients with reduced ejection fraction. Conclusions In a contemporary and diverse population with HF, Black patients experienced a higher rate of HF hospitalization and a lower rate of death compared with White patients. In contrast, selected outcomes for Asian/Pacific Islander and Hispanic patients were more favorable compared with White patients. The observed differences were not explained by measured potentially modifiable factors, including pharmacological treatment. Future research is needed to identify explanatory mechanisms underlying ongoing racial/ethnic variation to target potential interventions.

scholarly journals Medicaid Expansion and Racial/Ethnic Differences in Readmission After Acute Ischemic Stroke

2021 ◽  
Vol 58 ◽  
pp. 004695802110624
Author(s):  
Blake T. McGee ◽  
Seiyoun Kim ◽  
Dawn M. Aycock ◽  
Matthew J. Hayat ◽  
Karen B. Seagraves ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Low Income ◽  
Medicaid Expansion ◽  
Percentage Points ◽  
Predicted Probability ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
White Patients

To examine whether rates of 30-day readmission after acute ischemic stroke changed differentially between Medicaid expansion and non-expansion states, and whether race/ethnicity moderated this change, we conducted a difference-in-differences analysis using 6 state inpatient databases (AR, FL, GA, MD, NM, and WA) from the Healthcare Cost and Utilization Project. Analysis included all patients aged 19-64 hospitalized in 2012–2015 with a principal diagnosis of ischemic stroke and a primary payer of Medicaid, self-pay, or no charge, who resided in the state where admitted and were discharged alive (N=28 330). No association was detected between Medicaid expansion and readmission overall, but there was evidence of moderation by race/ethnicity. The predicted probability of all-cause readmission among non-Hispanic White patients rose an estimated 2.6 percentage points (or 39%) in expansion states but not in non-expansion states, whereas it increased by 1.5 percentage points (or 23%) for non-White and Hispanic patients in non-expansion states. Therefore, Medicaid expansion was associated with a rise in readmission probability that was 4.0 percentage points higher for non-Hispanic Whites compared to other racial/ethnic groups, after adjustment for covariates. Similar trends were observed when unplanned and potentially preventable readmissions were isolated. Among low-income stroke survivors, we found evidence that 2 years of Medicaid expansion promoted rehospitalization, but only for White patients. Future studies should verify these findings over a longer follow-up period.

Cancer treatment among the elderly in the United States: Examining the interplay of race/ethnicity and comorbidities.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18547-e18547
Author(s):  
Tung Pham ◽  
Avonne Connor ◽  
Gita Suneja ◽  
Anne Rositch
Keyword(s):  
Cancer Treatment ◽  
Minority Groups ◽  
Immune Therapy ◽  
The United States ◽  
Cancer Type ◽  
Curative Intent ◽  
Comorbidity Burden ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
White Patients

e18547 Background: As the life expectancy of Americans continues to increase, so does the number of individuals who are diagnosed with cancer and other comorbidities. Management of these patients can become increasingly complicated as physicians administer multiple combinations of interventions and drug therapies. To further complicate this issue, the average number of comorbidities among racial/ethnic minority patients is higher than non-Hispanic (NH) white patients, and this disparity could adversely affect receipt of curative cancer treatment among these minority groups. Therefore, we explored the association between race/ethnicity, comorbidities, and curative cancer treatment among elderly Americans diagnosed with the four most common cancer types. Methods: SEER-Medicare linked data was used to identify 727,136 individuals over 65 years old diagnosed with breast, colorectal, lung, or prostate cancer from 1992-2011. Comorbidity burden was measured using the Charlson Comorbidity Index (CCI) and analyzed as tertiles (T1: lowest CCI score to T3: highest CCI score). Treatment with curative intent was defined as receipt of any cancer-type-specific surgery, chemotherapy, radiation, hormone, or immune therapy within 6 months of cancer diagnosis. Modified Poisson regression models were used to assess the joint association between comorbidities and race/ethnicity on cancer treatment. Results: For all cancers, the percentage of patients receiving treatment declined rapidly with increasing age, CCI scores, number of comorbidities, and advanced cancer stage. In addition, variability in receipt of treatment by race/ethnicity was observed: 76% for NH-White patients, 75% for Hispanic patients, and 68% for NH-Black patients. Taking into account age, genders (for colorectal, lung cancer), year of diagnosis, stage at diagnosis, and socioeconomic status, we found that treatment proportions among NH-Black and Hispanic patients with low CCI score (T1) were 2%-15% lower than NH-White patients with the same CCI score (all p < 0.001). Although treatment proportions decreased with increasing CCI among NH White patients (ranging from 2.5-11.3%; p < 0.01), there was little difference in treatment by CCI among NH Black and Hispanic patients (ranging from 0.5%-2%; p > 0.05). Conclusions: Our findings suggested that racial disparities may exist in cancer treatment among patients with low comorbidities. This finding was unexpected as these patients are less likely than highly comorbid patients to experience drug interactions and other complications due to concurrent disease management therapies.

scholarly journals Racial, Ethnic, and Socioeconomic Factors Result in Disparities in Outcome Among Children with Acute Lymphoblastic Leukemia Not Fully Attenuated By Disease Prognosticators: A Children's Oncology Group (COG) Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 211-211
Author(s):  
Sumit Gupta ◽  
David T. Teachey ◽  
Meenakshi Devidas ◽  
Yunfeng Dai ◽  
Richard Aplenc ◽  
...  
Keyword(s):  
Lymphoblastic Leukemia ◽  
Advisory Committees ◽  
Black Patients ◽  
Increased Risk ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Subsequent Addition ◽  
Hispanic White ◽  
White Patients

Abstract Introduction: Health disparities are major issue for racial, ethnic, and socioeconomically disadvantaged groups. Though outcomes in childhood acute lymphoblastic leukemia (ALL) have steadily improved, identifying persistent disparities is critical. Prior studies evaluating ALL outcomes by race or ethnicity have noted narrowing disparities or that residual disparities are secondary to differences in leukemia biology or socioeconomic status (SES). We aimed to identify persistent inequities by race/ethnicity and SES in childhood ALL in the largest cohort ever assembled for this purpose. Methods: We identified a cohort of newly-diagnosed patients with ALL, age 0-30.99 years who were enrolled on COG trials between 2004-2019. Race/ethnicity was categorized as non-Hispanic white vs. Hispanic vs. non-Hispanic Black vs. non-Hispanic Asian vs. Non-Hispanic other. SES was proxied by insurance status: United States (US) Medicaid (public health insurance for low-income individuals) vs. US other (predominantly private insurance) vs. non-US patients (mainly jurisdictions with universal health insurance). Event-free and overall survival (EFS, OS) were compared across race/ethnicity and SES. The relative contribution of disease prognosticators (age, sex, white blood cell count, lineage, central nervous system status, cytogenetics, end Induction minimal residual disease) was examined with Cox proportional hazard multivariable models of different combinations of the three constructs of interest (race/ethnicity, SES, disease prognosticators) and examining hazard ratio (HR) attenuation between models. Results: The study cohort included 24,979 children, adolescents, and young adults with ALL. Non-Hispanic White patients were 13,872 (65.6%) of the cohort, followed by 4,354 (20.6%) Hispanic patients and 1,517 (7.2%) non-Hispanic Black patients. Those insured with US Medicaid were 6,944 (27.8%). Five-year EFS (Table 1) was 87.4%±0.3% among non-Hispanic White patients vs. 82.8%±0.6% [HR 1.37, 95 th confidence interval (95CI) 1.26-1.49; p&lt;0.0001] among Hispanic patients and 81.9%±1.2% (HR 1.45, 95CI 1.28-1.56; p&lt;0.0001) among non-Hispanic Black patients. Outcomes for non-Hispanic Asian patients were similar to those of non-Hispanic White patients. US patients on Medicaid had inferior 5-year EFS as compared to other US patients (83.2%±0.5% vs. 86.3%±0.3%, HR 1.21, 95CI 1.12-1.30; p&lt;0.0001) while non-US patients had the best outcomes (5-year EFS 89.0%±0.7%, HR 0.78, 95CI 0.71-0.88; p&lt;0.0001). There was substantial imbalance in traditional disease prognosticators (e.g. T-cell lineage) across both race/ethnicity and SES, and of race/ethnicity by SES. For example, T-lineage ALL accounted for 17.6%, 9.4%, and 6.6% of Non-Hispanic Black, Non-Hispanic White, and Hispanic patients respectively (p&lt;0.0001). Table 2 shows the multivariable models and illustrates different patterns of HR adjustment among specific racial/ethnic and SES groups. Inferior EFS among Hispanic patients was substantially attenuated by the addition of disease prognosticators (HR decreased from 1.37 to 1.17) and further (but not fully) attenuated by the subsequent addition of SES (HR 1.11). In contrast, the increased risk among non-Hispanic Black children was minimally attenuated by both the addition of disease prognosticators and subsequent addition of SES (HR 1.45 to 1.38 to 1.32). Similarly, while the superior EFS of non-US insured patients was substantially attenuated by the addition of race/ethnicity and disease prognosticators (HR 0.79 to 0.94), increased risk among US Medicaid patients was minimally attenuated by the addition of race/ethnicity or disease prognosticators (HR 1.21 to 1.16). OS disparities followed similar patterns but were consistently worse than in EFS, particularly among patients grouped as non-Hispanic other. Conclusions: Substantial disparities in survival outcomes persist by race/ethnicity and SES in the modern era. Our findings suggest that reasons for these disparities vary between specific disadvantaged groups. Additional work is required to identify specific drivers of survival disparities that may be mitigated by targeted interventions. Figure 1 Figure 1. Disclosures Gupta: Jazz Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees. Teachey: NeoImmune Tech: Research Funding; Sobi: Consultancy; BEAM Therapeutics: Consultancy, Research Funding; Janssen: Consultancy. Zweidler-McKay: ImmunoGen: Current Employment. Loh: MediSix therapeutics: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Racial and Ethnic Differences in Clonal Hematopoiesis, Tumor Markers, and Clinical Outcomes of Patients with Multiple Myeloma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 402-402
Author(s):  
Nancy Gillis ◽  
Lauren C Peres ◽  
Christelle M Colin-Leitzinger ◽  
Mingxiang Teng ◽  
Raghunandan Reddy Alugubelli ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Research Funding ◽  
Multivariable Analysis ◽  
Age At Diagnosis ◽  
Advisory Committees ◽  
Black Patients ◽  
Significant Difference ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
White Patients

Abstract Background: Multiple myeloma (MM) is twice as common in Blacks compared to Non-Hispanic (NH) Whites and Hispanics. While treatment and mortality differences have been reported for Black patients with MM compared to NH White patients, there is limited data on Hispanic populations. Furthermore, the factors driving observed differences in MM presentation and treatment responses by race and ethnicity are largely unknown. We investigated demographic, clinical, and molecular features, including tumor mutations and clonal hematopoiesis (CH), in a diverse population of patients with MM to elucidate mechanisms driving clinical disparities. Methods: Patients diagnosed with MM who consented to our institutional biorepository protocol were eligible for inclusion. Demographic and clinical data were obtained from cancer registry and abstracted from electronic medical records. MM tumor cells were purified from bone marrow aspirates by CD138 affinity chromatography. DNA was isolated from tumor cells and whole blood for each patient, and whole exome sequencing (WES) data was generated. Tumor somatic mutations were characterized using paired tumor-normal (blood) WES. CH was classified based on blood-derived somatic mutations, using paired tumors and reference populations as germline comparators. Outcomes included overall survival (OS; date of diagnosis to death/last contact) and progression-free survival (PFS; 1 st-line treatment start to 1 st disease progression/death). Results: A diverse group of MM patients (n=496) were included: NH White (80%), NH Black (10%) and Hispanic (9%). NH Black and Hispanic MM patients had a younger median age at diagnosis (57 and 53 yrs, respectively) compared to NH Whites (63 yrs, p = 0.0001; Fig A). There was no statistical difference in treatment categories received by race/ethnicity. NH Black patients had a longer time to hematopoietic cell transplant (HCT; 376 days) than NH White or Hispanic patients (248 and 270 days, respectively, p = 0.011). There was an improvement in OS for NH Black (HR 0.49, 95% CI 0.30-0.81) and Hispanic (HR 0.66, 95% CI 0.37-1.18) patients compared to NH White patients, but the association was not statistically significant in Hispanics. In univariable analysis, OS was also associated with age at diagnosis, International Staging System (ISS), treatment with HCT, and treatment regimen category. In multivariable analysis, after adjusting for age, ISS, HCT, and treatment category there was no longer a statistically significant association between OS and race/ethnicity. Although a worse PFS was present among Hispanic patients (adjusted HR 1.45, 95% CI 0.99-2.13), there was no statistically significant difference in PFS by race/ethnicity. The most mutated genes in MM tumors were KRAS (24%), NRAS (17%), TP53 (11%), DIS3 (9%), and BRAF (9%) (Fig B). Genes with significantly higher tumor mutation rates in Black compared to NH White patients were SP140 (12% v 4%, p = 0.026), AUTS2 (8% v 2%, p = 0.04), and SETD2 (6% v 1%, p = 0.037). IRF4 was most commonly mutated in Hispanics (11% v 3% in NH White and 0% in Black, p = 0.019). We identified CH using WES in 60 (12%) patients. The most CH mutations were in ASXL1, DNMT3A, and TET2. There was no difference in the prevalence of CH by race/ethnicity (p=0.8). There was a statistically significant difference in OS by race/ethnicity and CH status (Fig C). For NH Black patients, CH (HR 4.36, 95% CI 1.36-14.0) and age at diagnosis (HR 1.08, 95% CI 1.03-1.14) were associated with inferior OS (Fig C). After adjusting for age in multivariable analysis, the positive association with CH status among Black patients was no longer statistically significant (HR 2.72, 95% CI 0.48-15.4). A positive, but not statistically significant, association for PFS in NH White patients with CH was also noted (adjusted HR 1.38, 95% CI 0.95-2.0). Conclusions: This is the first study to examine differences in tumor mutation profiles, CH, and treatment among different racial and ethnic groups of patients diagnosed with MM. Our data suggest that age at diagnosis, tumor mutations, and CH may all contribute to clinical disparities observed in patients with MM. Efforts to expand our cohort and incorporate additional molecular biomarkers, epidemiologic characteristics, and clinical parameters are ongoing with the ultimate goal of elucidating targetable biological mechanisms to personalize management and optimize outcomes for diverse patients diagnosed with MM. Figure 1 Figure 1. Disclosures Hampton: M2Gen: Current Employment. Blue: WebMD: Consultancy; Janssen Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees. Siqueira Silva: AbbVie Inc.: Research Funding; Karyopharm Therapeutics Inc.: Research Funding. Baz: GlaxoSmithKline: Consultancy, Honoraria; BMS, sanofi, Karyopharm, Janssen, AbbVie: Consultancy, Research Funding; Oncopeptides: Consultancy; Merck: Research Funding. Nishihori: Novartis: Research Funding; Karyopharm: Research Funding. Shain: Janssen oncology: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Karyopharm Therapeutics Inc.: Honoraria, Research Funding; Sanofi Genzyme: Consultancy, Speakers Bureau; Novartis Pharmaceuticals Corporation: Consultancy; GlaxoSmithLine, LLC: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Adaptive Biotechnologies Corporation: Consultancy, Speakers Bureau; AbbVie: Membership on an entity's Board of Directors or advisory committees, Research Funding.

scholarly journals Race, ethnicity, and cognition in persons newly diagnosed with multiple sclerosis

Neurology ◽  
2020 ◽  
Vol 94 (14) ◽  
pp. e1548-e1556 ◽  
Author(s):  
Lilyana Amezcua ◽  
Jessica B. Smith ◽  
Edlin G. Gonzales ◽  
Samantha Haraszti ◽  
Annette Langer-Gould
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Educational Attainment ◽  
Rank Order ◽  
Newly Diagnosed ◽  
Entire Cohort ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Incident Cases ◽  
White Patients

ObjectiveTo determine whether black or Hispanic patients with newly diagnosed multiple sclerosis (MS) are more likely to have cognitive impairment than white patients when compared to controls matched on age, sex, and race/ethnicity. Whether black or Hispanic patients have a more aggressive MS disease course than white patients remains unclear. No prior studies have examined differences in early cognitive impairment. The oral Symbol Digit Modalities Test (SDMT) is sensitive to early cognitive impairment in MS but normative data in nonwhite patients are limited.MethodsWe studied 1,174 adults who enrolled in the MS Sunshine Study. SDMT and verbal fluency were measured in 554 incident cases of MS or clinically isolated syndrome (CIS) and 620 matched controls. Multivariable regression was used to examine correlates of abnormal SDMT in the entire cohort.ResultsThe strongest independent predictors of lower oral SDMT scores in rank order were having MS/CIS, lower educational attainment, and being black or Hispanic. Black and Hispanic patients and controls had lower SDMT scores than white participants even after controlling for age, sex, and education. However, no interaction between race/ethnicity and MS case status on SDMT scores was detected. Easy-to-use reference scores stratified by age and educational attainment for black and Hispanic patients are provided.ConclusionPersons with newly diagnosed MS/CIS are more likely to have subtly impaired cognitive function than controls regardless of race/ethnicity. Lower absolute SDMT scores among black and Hispanic patients compared to white patients highlight underlying US population differences rather than differences in MS disease severity.

Relationship of Race/Ethnicity and Survival After Single Umbilical Cord Blood Transplantation

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 224-224 ◽  
Author(s):  
Karen K. Ballen ◽  
John P. Klein ◽  
Tanya L. Pedersen ◽  
Joanne Kurtzberg ◽  
Hillard M. Lazarus ◽  
...  
Keyword(s):  
Stem Cell ◽  
Early Stage ◽  
Performance Status ◽  
Cord Blood Transplantation ◽  
Early Stage Disease ◽  
Cell Dose ◽  
Black Patients ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
White Patients

Abstract Abstract 224 Umbilical cord blood transplantation (UCBT) is an alternative stem cell source for patients with leukemia in need of an allogeneic transplant without a suitable marrow or peripheral blood stem cell donor. Extensive resources have been mobilized to increase the number of UCB donations from patients of diverse ethnic and racial backgrounds, in an effort to provide an adequate stem cell source for patients of ethnic minorities who may have a difficult time finding a compatible unrelated marrow or peripheral blood stem cell donor. We analyzed the association of race/ethnicity and outcomes of 907 patients receiving unrelated single unit UCBT from 1995 to 2006 for AML, ALL, CML, and MDS and who were reported to the CIBMTR. Race/ethnicity was reported by the transplant centers and included 612 Whites, 145 Blacks and 128 Hispanics. Patients received a variety of conditioning and graft versus host disease (GVHD) prophylaxis regimens. Most patients (72%) received ablative conditioning. Median ages at transplant were 8 years (<1-78), 8 years (<1-57), and 6 years (<1-56) for Whites, Blacks and Hispanics, respectively. Overall, 63% White, 30% Black and 33% Hispanic patients received UCB units from donors of the same race. Black patients were more likely to receive UCB units with a lower cell dose and inferior HLA match. A total nucleated cell (NC) count infused of ≥ 2.5 × 107/kg was given to 69% of White patients, 62% Blacks, and 77% Hispanics. A 6/6 matched unit was transplanted into 16% of White patients and 9% of Hispanic patients but only 4% of Black patients. Blacks received a ≤ 4/6 matched cord in 68% of cases, compared to 46% for Whites and 47% for Hispanics. Probability of overall survival (OS) at 2 years was 44% (95%CI 40–48%) for Whites, 34% (26-42%) for Blacks and 46% (37-55%) for Hispanics (P=0.117). Two-year leukemia-free survival (LFS) was 42% (38-46%), 34% (26-42%) and 43% (34-52%) (P=0.337) and cumulative incidence of 1-year treatment-related mortality (TRM) was 29% (26-33%), 38% (31-46%) and 27% (19-35%) for the three racial groups, respectively (P=0.107). Cumulative incidence of acute GVHD Grades II-IV and chronic GVHD, rates of engraftment, and relapse were similar across the racial/ethnic groups. Degree of HLA had no significant effect on OS. Causes of death were also similar among the three groups. In multivariate analysis, Blacks, as compared to Whites, had inferior OS (RR=1.3, P=0.02) while OS of Hispanics was similar to that of Whites (RR=1.03, P=0.81). The elevated risk of death among Blacks, compared with Whites, did not differ by cell dose (≥ 2.5 × 107 NC/kg, RR for OS=1.26, P=0.13; < 2.5 × 107 NC/kg, RR for OS=1.32, P=0.17). Young age at UCBT, early-stage disease, receipt of UCB with higher cell dose, and performance status ≥ 80% at UCBT were independent predictors of improved survival. Overall, the risks of LFS, TRM and relapse among Blacks and Hispanics were comparable to those among Whites. In conclusion, 1) Single unit unrelated UCBT for leukemia is associated with approximately 40% survival at 2 years; 2) As anticipated, higher cell dose, younger age, good performance status and early-stage disease were associated with improved survival across all groups; 3) Hispanic patients had similar survival to White patients; and 4) White patients have higher survival than Black patients, a difference that persists even after adjustment for cell dose and HLA, suggesting other factors may be important. Further investigation of other reasons for racial differences in the success of UCBT will benefit from increased numbers of patients for analysis. Disclosures: No relevant conflicts of interest to declare.

Racial disparities in pancreatic resection and survival among elderly patients: A SEER database analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16784-e16784
Author(s):  
Seojin Park ◽  
Dexter Waters ◽  
Karen Walsh ◽  
Nathan Handley ◽  
Harish Lavu
Keyword(s):  
Pancreatic Cancer ◽  
Elderly Patients ◽  
Racial Disparities ◽  
Tumor Size ◽  
Pancreatic Resection ◽  
Resection Rate ◽  
Term Survival ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
White Patients

e16784 Background: For localized pancreatic cancer treatment, surgical resection is the only potentially curative option. Currently, little is known about whether racial disparities exist in elderly patients’ access to resection and outcomes after resection. This study aims to understand the relationship between race/ethnicity and both resection rate and survival after surgery in elderly patients. Methods: The analysis included patients aged ≥65 years diagnosed with locoregional resectable (stage I and II according to the 6th AJCC TNM staging system) pancreatic cancer between 2007 and 2016 in the Surveillance, Epidemiology, and End Results database. Patients without complete surgical or survival data were excluded from the analysis. Multiple logistic regression was used to assess the association between race/ethnicity and receipt of resection. The effect of resection on 6-month and 5-year overall survival (OS) was evaluated using multivariate Cox proportional hazards regression, controlling for other clinical and demographic factors, such as sex, age, martial status, residence region, tumor location, tumor size, and year of diagnosis. Results: Of 12,829 patients, 4,310 (46.0%) received resection and 5,062 (54.0%) did not. Median follow-up among resected patients was 16 months (1-60 months), and 6-month and 5-year OS was 62.83% and 4.54%, respectively. The majority of the patients were white (73.1%), followed by Hispanic (9.3%), black (9.1%), and other (American Indian, Asian/Pacific Islander) (8.6%). Black (OR 0.69; 95%CI 0.60-0.80) and Hispanic patients (OR 0.78; 95%CI 0.68-0.90) were less likely to receive resection compared to white patients. While Hispanic patients had worse 6-month OS compared to white patients (HR 1.43; 95%CI 1.19-1.72), 5-year OS was not significantly different across the racial/ethnic groups. Other factors significantly worsened 5-year OS were being age 75 years or older, living in South region, and having tumor size greater than 50mm. Conclusions: Our findings support that racial disparities exist in resection rate in elderly populations. However, no racial difference was seen in the long-term survival after pancreatic resection. This may suggest that improving the access to resection for minorities with pancreatic cancer may improve their health outcomes. [Table: see text]

Telemedicine in Cancer Care

2018 ◽  
pp. 540-545 ◽  
Author(s):  
S. Joseph Sirintrapun ◽  
Ana Maria Lopez
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Cancer Care ◽  
Symptom Management ◽  
Lifestyle Modification ◽  
Clinical Settings ◽  
Home Based ◽  
Home Based Care ◽  
Care Costs ◽  
Improve Access

Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. Telemedicine has been tested in multiple clinical settings, demonstrating at least equivalency to in-person care and high levels of patient and health professional satisfaction. Teleoncology has been demonstrated to improve access to care and decrease health care costs. Teleconsultations may take place in a synchronous, asynchronous, or blended format. Examples of successful teleoncology applications include cancer telegenetics, bundling of cancer-related teleapplications, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and approaches to increase access to cancer clinical trials. Telepathology is critical to cancer care and may be accomplished synchronously and asynchronously for both cytology and tissue diagnoses. Mobile applications support symptom management, lifestyle modification, and medication adherence as a tool for home-based care. Telemedicine can support the oncologist with access to interactive tele-education. Teleoncology practice should maintain in-person professional standards, including documentation integrated into the patient’s electronic health record. Telemedicine training is essential to facilitate rapport, maximize engagement, and conduct an accurate virtual exam. With the appropriate attachments, the only limitation to the virtual exam is palpation. The national telehealth resource centers can provide interested clinicians with the latest information on telemedicine reimbursement, parity, and practice. To experience the gains of teleoncology, appropriate training, education, as well as paying close attention to gaps, such as those inherent in the digital divide, are essential.

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