Effect of Patient Socioeconomic Status on Access to Early-Phase Cancer Trials

2013 ◽  
Vol 31 (2) ◽  
pp. 224-230 ◽  
Author(s):  
Aisyah Mohd Noor ◽  
Debashis Sarker ◽  
Suzanne Vizor ◽  
Blair McLennan ◽  
Sarah Hunter ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Early Phase ◽  
Cancer Type ◽  
Cancer Trial ◽  
Nonwhite Population ◽  
Incident Cancer ◽  
Cancer Trials ◽  
Incident Cases ◽  
First Time ◽  
Index Of Multiple Deprivation

Purpose Little is known about the influence of socioeconomic factors on patient access to cancer trials. Differences should be considered to ensure generalizability of trial results and equality of access. Methods Phase I trials unit referrals at our center over 5 years, from 2007 to 2012, were reviewed. Socioeconomic status was defined by the Index of Multiple Deprivation (IMD; 1, least deprived; 5, most deprived). Multivariate analysis was performed comparing incident cancer cases with referred patients and those ultimately enrolled onto a trial. Results Four hundred thirty patients were referred (median age, 62 years). Compared with 10,784 incident cases, referral was less likely for patients in the more-deprived quintiles compared with the least deprived (IMD 5: odds ratio [OR], 0.53; 95% CI, 0.38 to 0.74). Once reviewed in the unit, enrollment onto a trial was not affected (IMD 5: OR, 0.81; 95% CI, 0.40 to 1.63). Ethnicity analysis showed the nonwhite population was less likely to be recruited (OR, 0.48; 95% CI, 0.26 to 0.88). This relationship was lost with adjustment for age, sex, cancer type, and deprivation index. Conclusion We show for the first time to our knowledge that socioeconomic status affects early-phase cancer trial referrals. The least-deprived patients are almost twice as likely to be referred compared with the most deprived. This may be because more-deprived patients are less suitable for a trial—as a result of comorbidities, for example—or because of inequalities that could be addressed by patient or referrer education. Once reviewed at the unit, enrollment onto a trial is not affected by deprivation.

scholarly journals Proportion of children with cancer that have an indication for genetic counseling and testing based on the cancer type irrespective of other features

2021 ◽  
Author(s):  
Thi Minh Kha Nguyen ◽  
Astrid Behnert ◽  
Torsten Pietsch ◽  
Christian Vokuhl ◽  
Christian Peter Kratz
Keyword(s):  
Childhood Cancer ◽  
Rhabdoid Tumor ◽  
Juvenile Myelomonocytic Leukemia ◽  
Cancer Type ◽  
Nerve Sheath Tumor ◽  
Children With Cancer ◽  
Pediatric Pathology ◽  
Cancer Trial ◽  
Cancer Predisposition Syndrome ◽  
Cancer Types

Abstract In children with cancer, specific clinical features such as physical anomalies, occurrence of cancer in young relatives, specific cancer histologies, and unique mutation/methylation signatures may indicate the presence of an underlying cancer predisposition syndrome (CPS). The proportion of children with a cancer type suggesting a CPS among all children with cancer is unknown. To determine the proportion of children with cancer types suggesting an underlying CPS among children with cancer. We evaluated the number of children with cancer types strongly associated with CPS diagnosed in Germany between 2007 and 2016. Data were obtained from various sources including two national pediatric pathology reference laboratories for brain and solid tumors, respectively, various childhood cancer trial offices as well as the German Childhood Cancer Registry. Among 21,127 children diagnosed with cancer between 2007 and 2016, 2554 (12.1%) had a cancer type strongly associated with a CPS. The most common diagnoses were myelodysplastic syndrome and juvenile myelomonocytic leukemia, retinoblastoma, malignant peripheral nerve sheath tumor, infantile myofibromatosis, medulloblastomaSHH, rhabdoid tumor as well as atypical teratoid/rhabdoid tumor. Based on cancer type only, 12.1% of all children with cancer have an indication for a genetic evaluation. Pediatric oncology patients require access to genetic counselling and testing.

scholarly journals Bayesian adaptive design of early-phase clinical trials for precision medicine based on cancer biomarkers

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shinjo Yada
Keyword(s):  
Neural Network ◽  
Clinical Trials ◽  
Precision Medicine ◽  
Early Phase ◽  
Patient Specific ◽  
Specific Gene ◽  
Cancer Type ◽  
Background Characteristics ◽  
Number Of Patients ◽  
Early Phase Clinical Trials

Abstract Cancer tissue samples obtained via biopsy or surgery were examined for specific gene mutations by genetic testing to inform treatment. Precision medicine, which considers not only the cancer type and location, but also the genetic information, environment, and lifestyle of each patient, can be applied for disease prevention and treatment in individual patients. The number of patient-specific characteristics, including biomarkers, has been increasing with time; these characteristics are highly correlated with outcomes. The number of patients at the beginning of early-phase clinical trials is often limited. Moreover, it is challenging to estimate parameters of models that include baseline characteristics as covariates such as biomarkers. To overcome these issues and promote personalized medicine, we propose a dose-finding method that considers patient background characteristics, including biomarkers, using a model for phase I/II oncology trials. We built a Bayesian neural network with input variables of dose, biomarkers, and interactions between dose and biomarkers and output variables of efficacy outcomes for each patient. We trained the neural network to select the optimal dose based on all background characteristics of a patient. Simulation analysis showed that the probability of selecting the desirable dose was higher using the proposed method than that using the naïve method.

Lung Cancer in Brazil

2012 ◽  
pp. 426-431
Author(s):  
Gilberto Schwartsmann
Keyword(s):  
Lung Cancer ◽  
Cause Of Death ◽  
Public Health Problem ◽  
Lung Cancer Mortality ◽  
World Health ◽  
Cancer Type ◽  
Positive Effects ◽  
Incident Cancer ◽  
Health Organization ◽  
Tremendous Challenge

Overview: Cancer is now the second leading cause of death in Brazil (after cardiovascular diseases) and a public health problem, with around 500,000 new cases in 2012. Excluding nonmelanoma skin cancer, lung cancer is the second most incident cancer type in men, with 17,210 expected new cases. In women, it is the fifth most incident cancer, with 10,110 expected new cases. The estimated age-adjusted lung cancer mortality rate is about 13/100,000 for men and 5.4/100,000 for women. Lung cancer rates in men increased until the early 1990s and decreased thereafter, especially in the younger population. In contrast, a steady upward trend was observed for women. The positive effects in men were probably due to the successful anti-tobacco campaign conducted in Brazil over the last decades, which led to a decrease in the adult smoking population, from 32% in the early 1980s to 17% in the 2000s. Although the Brazilian National Cancer Institute is strongly committed to providing excellence in multimodality care to cancer patients, limitations in availability and adequate geographic distribution of specialists and well-equipped cancer centers are evident. Major disparities in patient access to proper staging and state-of-the-art treatment still exist. Considering that World Health Organization (WHO) officials estimate that cancer will become the number one cause of death in most developing countries, including Brazil, in the next decades, it is highly recommended for government authorities to implement firm actions to face this tremendous challenge.

Regulation of 25-hydroxyvitamin D3-1α-hydroxylase and production of 1α,25-dihydroxyvitamin D3 by human dendritic cells

Blood ◽  
2003 ◽  
Vol 102 (9) ◽  
pp. 3314-3316 ◽  
Author(s):  
Jana Fritsche ◽  
Krishna Mondal ◽  
Achim Ehrnsperger ◽  
Reinhard Andreesen ◽  
Marina Kreutz
Keyword(s):  
Dendritic Cells ◽  
Early Phase ◽  
Constitutive Expression ◽  
Terminal Differentiation ◽  
Dihydroxyvitamin D3 ◽  
Key Enzyme ◽  
Functional Consequences ◽  
Constitutive Production ◽  
Human Dendritic Cells ◽  
First Time

Abstract25-Hydroxyvitamin D3-1α-hydroxylase (25(OH)D3-1α-hydroxylase), the key enzyme of 1α,25-dihydroxyvitamin D3 (1,25(OH)2D3) production, is expressed in monocyte-derived macrophages (MACs). Here we show for the first time constitutive expression of 25(OH)D3-1α-hydroxylase in monocyte-derived dendritic cells (DCs), which was increased after stimulation with lipopolysaccharide (LPS). Accordingly, DCs showed low constitutive production of 1,25(OH)2D3, but activation by LPS increased 1,25(OH)2D3 synthesis. In addition, 25(OH)D3-1α-hydroxylase expression was found in blood DCs but not in CD34+-derived DCs. Next we analyzed the functional consequences of these results. Addition of 1,25(OH)2D3 at concentrations comparable with those produced by DCs inhibited the allostimulatory potential of DCs during the early phase of DC differentiation. However, terminal differentiation decreased the responsiveness of DCs to 1,25(OH)2D3. In conclusion, DCs are able to produce 1,25(OH)2D3 especially following stimulation with LPS. Terminal maturation renders DCs unresponsive to the effects of 1,25(OH)2D3, but those cells are able to suppress the differentiation of their own precursor cells in a paracrine way through the production of 1,25(OH)2D3.

scholarly journals Purpose and Benefits of Early Phase Cancer Trials: What Do Oncologists Say? What Do Patients Hear?

2008 ◽  
Vol 3 (3) ◽  
pp. 57-68 ◽  
Author(s):  
Nancy Kass ◽  
Holly Taylor ◽  
Linda Fogarty ◽  
Jeremy Sugarman ◽  
Steven N. Goodman ◽  
...  
Keyword(s):  
Early Phase ◽  
Cancer Trials

scholarly journals Geographic Disparities In Access To Cancer Clinical Trials In India

2020 ◽  
Author(s):  
Santam Chakraborty ◽  
Indranil Mallick ◽  
Hung N Luu ◽  
Tapesh Bhattacharyya ◽  
Arunsingh Moses ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Sample Size ◽  
The State ◽  
Cancer Site ◽  
Cancer Clinical Trials ◽  
Clinical Trial Registry ◽  
Geographic Disparities ◽  
Incident Cancer ◽  
Incident Cases

Abstract Introduction The current study was aimed at quantifying the disparity in geographic access to cancer clinical trials in India. Methods We collated data of cancer clinical trials from the clinical trial registry of India (CTRI) and data on state-wise cancer incidence from the Global Burden of Disease Study. The total sample size for each clinical trial was divided by the trial duration to get the sample size per year. This was then divided by the number of states in which accrual was planned to get the sample size per year per state (SSY). For interventional trials investigating a therapy, the SSY was divided by the number of incident cancers in the state to get the SSY per 1,000 incident cancer cases. The SSY data was then mapped to visualise the geographical disparity.Results We identified 181 ongoing studies, of whom 132 were interventional studies. There was a substantial inter-state disparity - with a median SSY of 1.55 per 1000 incident cancer cases (range 0.00 - 296.81 per 1,000 incident cases) for therapeutic interventional studies. Disparities were starker when cancer site-wise SSY was considered. Even in the state with the highest SSY, only 29.7 % of the newly diagnosed cancer cases have an available slot in a therapeutic cancer clinical trial. Disparities in access were also apparent between academic (range: 0.21 - 226.60) and industry-sponsored trials (range: 0.17 - 70.21).Conclusion There are significant geographic disparities in access to cancer clinical trials in India. Future investigations should evaluate the reasons and mitigation approaches for such disparities.

Are paediatric stabbings in London related to socioeconomic status?

Trauma ◽  
2018 ◽  
Vol 21 (4) ◽  
pp. 310-316 ◽  
Author(s):  
Christine Lam ◽  
Christopher Aylwin ◽  
Mansoor Khan
Keyword(s):  
Socioeconomic Status ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Interquartile Range ◽  
Negatively Associated ◽  
Multiple Deprivation ◽  
Deprivation Score ◽  
Major Trauma Centre ◽  
Increased Risk ◽  
Index Of Multiple Deprivation

Introduction Paediatric stabbings are on the increase across the United Kingdom, especially in large urban centres. Many London trauma centres are reporting a significant annual rise in the cases of penetrating trauma. Studies have shown victims with a lower socioeconomic status have an increased risk of paediatric penetrating trauma. This study aims to determine whether high depravity of an area increases the risk of paediatric stabbings in West London. We hypothesise that more deprived areas are likely to have a higher incidence of paediatric stabbings. Methods A retrospective review of data from the emergency department at a major trauma centre in West London was conducted using patient <18 years with a stabbing injury between March 2015 and July 2017. Gender, age, incident postcode and home postcode were collected. Socioeconomic status was measured using the 2015 English index of multiple deprivation. Incident postcode and home postcode were matched to an index of multiple deprivation decile, with 1 being the most deprived. Data were analysed using SPSS© Statistics 24. Results One hundred seventy-four cases were included; 97.7% of the cases were male and the mean age was 16 years. The location of the stabbings had a median index of multiple deprivation score of 3 (interquartile range = 3) with 61% of the cases occurring in areas with an index of multiple deprivation decile of 3 or less. Index of multiple deprivation decile from incident location and frequency of stabbing were strongly negatively associated (r = −0.85, p = 0.002). The victim’s home location had a median index of multiple deprivation score of 3 (interquartile range = 3) and 59.3% of victims living in areas with an index of multiple deprivation decile of less than 3. Again, they were strongly negatively associated (r = −0.85, p = 0.002). Conclusion The location of paediatric stabbings is associated with areas of high depravity and with victims from a more deprived background. To prevent paediatric stabbings, a multifactorial approach is required to increase the socioeconomic status of these areas.

Sex and funding trends in phase 3 oncology trials registered with clinicaltrials.gov.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 295-295
Author(s):  
Nicholas M. Moloci ◽  
Sarah Yee ◽  
David Tomczyk ◽  
Gordon Sun
Keyword(s):  
Gynecological Cancer ◽  
Gynecologic Cancer ◽  
Temporal Trends ◽  
Funding Source ◽  
Cancer Type ◽  
Private Industry ◽  
Phase 3 ◽  
Funding Sources ◽  
Primary Investigator ◽  
Cancer Trials

295 Background: Women have been historically underrepresented as authors of clinical research, which may obscure important scientific interpretations and perspectives. We examined whether primary investigator sex was associated with funding sources of registered phase 3 oncology trials. Methods: We searched ClinicalTrials.gov, identifying completed phase 3 oncology trials registered from 1/1/2005 to 12/31/2010. The first investigator sex and nationality, funding source, and cancer type were collected. Bivariate associations between first investigator and funding source were analyzed with chi-square tests. Temporal trends were analyzed using the Cochran Armitage test. Results: Of 1,365 trials, 882 listed an individual as first investigator and were eligible for analysis; 195 (22.1%) listed a woman as first investigator. From 2005 to 2010 the proportion of women as first investigator across all funding sources did not change significantly (p for trend >.05). The proportion of breast and gynecological cancer trials led by women was significantly higher than the proportion led by men (29.3% of all trials led by women vs. 17.8% of all trials led by men, p<.001). In contrast, the proportions of prostate cancer trials led by women and men were similar (7.7% vs. 6.8%, p>.05). The National Institutes of Health (NIH) funded 95 trials with 32.6% led by women. Private industry funded 305 trials with 19.3% led by women. Of 659 trials funded by other sources such as universities and community-based organizations, 22.6% were led by women. The proportion of women leading industry trials increased from 11.3% to 27.3% (p for trend=.02), while the proportion of women leading trials by the NIH or other sources remained stagnant (p for trend>.05). However, the odds of a woman leading a trial funded by the NIH were 1.84 (95% confidence interval: 1.16-2.92) times greater than the odds for a man (15.9% vs. 9.3%). Conclusions: Women may be underrepresented as lead investigators of oncologic clinical trials, though they do appear to lead a substantial number of breast and gynecologic cancer trials. Primary investigator sex was associated with both funding source and cancer type.

Do rural cancer patients receive lower quality cancer care? Assessing the impact of rurality on oncology practice performance measures.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 166-166
Author(s):  
Catherine R. Fedorenko ◽  
Laura Elizabeth Panattoni ◽  
Qin Sun ◽  
Li Li ◽  
Karma L. Kreizenbeck ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cancer Patients ◽  
Cancer Care ◽  
Performance Measure ◽  
Area Deprivation ◽  
Cancer Type ◽  
Quality Cancer Care ◽  
Practice Performance ◽  
The Impact

166 Background: Rural residents are diagnosed at later stages of cancer compared to urban residents, have poorer survival, and face distinct barriers to receiving quality cancer care. ASCO has developed policy initiatives to address rural cancer care; however, little is known about quality of cancer care among patients residing in rural areas. This study examined the impact of rurality on performance metrics, controlling for socioeconomic status and insurance type. Methods: We linked Washington state cancer registry records from 2015-2017 with claims records for two large commercial insurers, Medicare, and Medicaid. Using claims from this database, we generated eight nationally recognized quality measures. Rurality was measured by the Rural-Urban Commuting Area Codes (RUCAs) categorized into 4 levels (Metro, Metro with commute, Micropolitan, Small Town/Rural). Process and outcome measures were adjusted for age, sex, race, comorbidity score, stage, cancer type, marital status, the Area Deprivation Index, and treatment factors where appropriate. Results were stratified by payer type. Results: The table below lists the effect of a patient’s rurality on the quality metric where significant (p<0.05). Where rurality did not impact the performance measure, results are left blank. Conclusions: After controlling for socioeconomic status and payer type, quality of cancer care for rural cancer patients was not consistently poorer compared to urban patients. These results suggest that lower survival among rural patients may be due to factors beyond quality of care.[Table: see text]

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