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]

Impact of rurality versus neighborhood deprivation on stage at diagnosis and survival: A regional analysis.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 158-158
Author(s):  
Laura Elizabeth Panattoni ◽  
Catherine R. Fedorenko ◽  
Qin Sun ◽  
Li Li ◽  
Karma L. Kreizenbeck ◽  
...  
Keyword(s):  
Cancer Care ◽  
Multinomial Logistic Regression ◽  
Regional Analysis ◽  
Survival Models ◽  
Area Deprivation ◽  
Cancer Type ◽  
Stage At Diagnosis ◽  
Rural Residents ◽  
Neighborhood Deprivation ◽  
The Impact

158 Background: Evidence that rural residents compared to urban residents are more likely to be diagnosed at later stages and have worse survival outcomes has prompted recent policy initiatives by ASCO to address the rural cancer care gap. However, rural residents are generally poorer, potentially confounding the cause of these disparities. This study examined the impact of rurality, travel time to oncologist (TTO), and neighborhood deprivation (ND) on stage of diagnosis and 3-year survival in a regional setting. Methods: Cancer registry records for patients in Western Washington were linked with claims from regional commercial insurers, Medicare, and Medicaid at time of diagnosis. The study included adult patients with solid tumors diagnosed between 2012-2014. Rurality was sourced from the Rural-Urban Commuting Area Codes (RUCAs): Metro, Metro with Commute, Micropolitan, Small Town/Rural. ND was measured by the census block Area Deprivation Index from 1 (least) to 10 (most) deprived; TTO from Google Maps (minutes). Multinomial logistic regression measured stage at diagnosis (local, regional, distant). Cox survival models were stratified by insurance type. We adjusted all models for age, gender, race, marital status, cancer type and grade, and hierarchical condition categories. Results: The table below lists the effect size of rurality, TTO, and ND on the outcomes where significant (p<0.05). Conclusions: In Washington State, neighborhood deprivation, not rurality, was largely associated with later stage at diagnosis and poorer survival. Regional stakeholders need to carefully examine the local sources of cancer care disparities to effectively target interventions.[Table: see text]

scholarly journals Australian Experiences of Out-of-Pocket Costs and Financial Burden Following a Cancer Diagnosis: A Systematic Review

2021 ◽  
Vol 18 (5) ◽  
pp. 2422
Author(s):  
Annie Bygrave ◽  
Kate Whittaker ◽  
Christine Paul ◽  
Elizabeth A. Fradgley ◽  
Megan Varlow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Patients ◽  
Low Income ◽  
Cancer Care ◽  
Financial Burden ◽  
Secondary Outcome ◽  
Cancer Type ◽  
Increased Risk ◽  
The Impact ◽  
Out Of Pocket Costs

(1) Background: This systematic review was conducted to identify cancer patient experiences, and the impact of out-of-pocket costs and financial burden in Australia. (2) Methods: A systematic review, following the Preferring Reporting Items for Systematic Reviews and Meta-Analyses, was conducted. Cumulative Index of Nursing and Allied Health Literature and PubMed were searched. The primary outcome was financial burden among cancer patients and their families in Australia. The secondary outcome was out-of-pocket costs associated with cancer care and treatment within the population sample, and the impact of financial burden. (3) Results: Nineteen studies were included, covering more than 70,000 Australians affected by cancer. Out-of-pocket costs varied by cancer type and ranged from an average of AUD 977 for breast cancer and lymphoedema patients to AUD 11,077 for prostate cancer patients. Younger aged patients (≤65 years), Aboriginal and Torres Strait Islander people, people in rural and/or remote areas, households with low income, those who were unemployed and people with private health insurance were at increased risk of experiencing out-of-pocket costs, financial burden or a combination of both. (4) Conclusions: Australians diagnosed with cancer frequently experience financial burden, and the health and financial consequences are significant. Focusing efforts on the costs of care and options about where to have care within the context of informed decisions about cancer care is necessary.

scholarly journals Assessment of Quality of Life of Cervical Cancer Patients Using ECOG-Performance Status Scale

2019 ◽  
pp. 1-8
Author(s):  
Shubham Lingappanoor ◽  
Geetha Rani Manupati ◽  
Vasthalya Meesala ◽  
Padma Yaragani ◽  
Brahmani Bachu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cervical Cancer ◽  
Socioeconomic Status ◽  
Cancer Patients ◽  
Group Performance ◽  
Performance Status ◽  
Tertiary Care ◽  
Care Hospital ◽  
The Impact

Background: Cervical cancer is becoming one of the emerging health burdens for womenhood and India accounts for one-third of the cervical cancer deaths globally. More than 80% of women with cervical cancer are diagnosed at an advanced stage. In this study, we aimed to assess the Quality of Life (QOL) of patients with cervical cancer after treatment and to examine the factors affecting their QOL. Materials and Methods: This is a retrospective observational study, included 218 cervical cancer patients. The study was conducted in a tertiary care hospital in Warangal of Telangana State. The impact of socioeconomic factors and clinical factors on the QOL of the patients were studied using Eastern Cooperative Oncology Group-Performance status (ECOG-PS) scale. The protocol was approved by KIEC-KMC, Warangal. The statistical analysis was performed by using Fischer's Exact test, a value of p<.05 was considered as significant. Results: Out of 218 patients 189 were alive and 29 were deceased. Patient of age group 21-40 years, patients from urban areas, from upper socioeconomic status (SES), patients with literacy, without any social habits had good QOL, where as patients in labour forces had poor QOL and are statistically significant. Patients with early stage at diagnosis and patients underwent surgical treatment along with chemoradiation therapy had good QOL yet, these results are statistically insignificant. Conclusion: The lack of access to preventive and definitive care by the health care sectors, poor socioeconomic status, educational status of the women and awareness regarding the disease and its treatment patterns resulted in poor follow up, low adherence to the treatment, which accentuated the cervical cancer burden. Hence, enhancing the above listed factors could be beneficial in improving QOL of cervical cancer patients.

scholarly journals Outcomes Related to Percutaneous Nephrostomies (PCN) in Malignancy-Associated Ureteric Obstruction: A Systematic Review of the Literature

2021 ◽  
Vol 10 (11) ◽  
pp. 2354
Author(s):  
Francesca J. New ◽  
Sally J. Deverill ◽  
Bhaskar K. Somani
Keyword(s):  
Quality Of Life ◽  
Advanced Cancer ◽  
Previous Treatment ◽  
Cochrane Library ◽  
Cancer Type ◽  
Ureteric Obstruction ◽  
Survival Times ◽  
Advanced Malignancies ◽  
The Impact

Background: Malignant ureteric obstruction occurs in a variety of cancers and has been typically associated with a poor prognosis. Percutaneous nephrostomy (PCN) can potentially help increase patient longevity by establishing urinary drainage and treating renal failure. Our aim was to look at the outcomes of PCN in patients with advanced cancer and the impact on the patients’ lifespan and quality of life. Materials and Methods: A literature review was carried out for articles from 2000 to 2020 on PCN in patients with advanced malignancies, using MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Library, clinicaltrials.gov, and Google Scholar. All English-language articles reporting on a minimum of 20 patients who underwent PCN for malignancy-associated ureteric obstruction were included. Results: A total of 21 articles (1674 patients) met the inclusion criteria with a mean of 60.2 years (range: 21–102 years). PCN was performed for ureteric obstruction secondary to urological malignancies (n = −633, 37.8%), gynaecological malignancies (n = 437, 26.1%), colorectal and GI malignancies (n = 216, 12.9%), and other specified malignancies (n = 205, 12.2%). The reported mean survival times varied from 2 to 8.5 months post PCN insertion, with an average survival time of 5.6 months, which depended on the cancer type, stage, and previous treatment. Conclusions: Patients with advanced malignancies who need PCN tend to have a survival rate under 12 months and spend a large proportion of this time in the hospital. Although the advent of newer chemotherapy and immunotherapy options has changed the landscape of managing advanced cancer, decisions on nephrostomy must be balanced with their survival and quality of life, which must be discussed with the patient.

Assessing the impact of chemotherapy-induced nausea and vomiting on patients’ quality of life: An Arabic version of the Functional Living Index-Emesis

2021 ◽  
pp. 107815522199844
Author(s):  
Abdullah M Alhammad ◽  
Nora Alkhudair ◽  
Rawan Alzaidi ◽  
Latifa S Almosabhi ◽  
Mohammad H Aljawadi
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Arabic Language ◽  
Nausea And Vomiting ◽  
Cancer Center ◽  
Arabic Version ◽  
Patient Reported ◽  
Arabic Speaking ◽  
The Impact

Introduction Chemotherapy-induced nausea and vomiting is a serious complication of cancer treatment that compromises patients’ quality of life and treatment adherence, which necessitates regular assessment. Therefore, there is a need to assess patient-reported nausea and vomiting using a validated scale among Arabic speaking cancer patient population. The objective of this study was to translate and validate the Functional Living Index-Emesis (FLIE) instrument in Arabic, a patient-reported outcome measure designed to assess the influence of chemotherapy-induced nausea and vomiting on patients’ quality of life. Methods Linguistic validation of an Arabic-language version was performed. The instrument was administered to cancer patients undergoing chemotherapy in a tertiary hospital's cancer center in Saudi Arabia. Results One-hundred cancer patients who received chemotherapy were enrolled. The participants’ mean age was 53.3 ± 14.9 years, and 50% were female. Half of the participants had a history of nausea and vomiting with previous chemotherapy. The Cronbach coefficient alpha for the FLIE was 0.9606 and 0.9736 for nausea and vomiting domains, respectively, which indicated an excellent reliability for the Arabic FLIE. The mean FLIE score was 110.9 ± 23.5, indicating no or minimal impact on daily life (NIDL). Conclusions The Arabic FLIE is a valid and reliable tool among the Arabic-speaking cancer population. Thus, the Arabic version of the FLIE will be a useful tool to assess the quality of life among Arabic speaking patients receiving chemotherapy. Additionally, the translated instrument will be a useful tool for future research studies to explore new antiemetic treatments among cancer patients.

scholarly journals The patients’ perspective on coordinated action for cancer and AMR

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
K Apostolidis
Keyword(s):  
Quality Of Life ◽  
Immune System ◽  
Cancer Patients ◽  
Cancer Treatments ◽  
Unique Challenge ◽  
Coordinated Action ◽  
The Impact ◽  
Patients Perspective

Abstract The speaker will present the perspective of the cancer patients, and the challenges they encounter across the spectrum of care and what measures they consider relevant in terms of prevention, diagnosis, treatment and, indeed, to raise awareness of the impact of AMR on rendering cancer treatments ineffective. She will elaborate on survivorship, and on the impact of AMR on the quality of life of patients, their carers, and families. Emphasis will be given on the implications of modern therapies, such as immunotherapy, representing a unique challenge in terms of better understanding the effect on overall health of patients, with the effect they have the immune system, further weakening the patient and leaving him/her exposed to infections potentially of higher risk than cancer itself.

scholarly journals Considerations for the Management of Women with Breast Cancer during the COVID-19 Pandemic

2020 ◽  
Vol 5 (03) ◽  
pp. 260-263
Author(s):  
Monica Irukulla ◽  
Palwai Vinitha Reddy
Keyword(s):  
Breast Cancer ◽  
Resource Allocation ◽  
Patient Care ◽  
Cancer Patients ◽  
Cancer Care ◽  
Clinical Care ◽  
Current Availability ◽  
The Individual

AbstractOutcomes in cancer patients are strongly influenced by timeliness and quality of multidisciplinary interventions. The COVID-19 pandemic has led to severe disruption in cancer care in many countries. This has necessitated several changes in clinical care and workflow, including resource allocation, team segregation and deferment of many elective procedures. Several international oncological societies have proposed guidelines for the care of patients afflicted with breast cancer during the pandemic with a view to optimize resource allocation and maximize risk versus benefit for the individual and society. Clinicians may utilize these recommendations to adapt patient care, based on the current availability of resources and severity of the COVID-19 pandemic in each region. This article discusses the guidelines for care of patients afflicted with breast cancer during the pandemic.

scholarly journals Incarceration and Cancer-Related Outcomes (ICRO) study protocol: using a mixed-methods approach to investigate the role of incarceration on cancer incidence, mortality and quality of care

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e048863
Author(s):  
Lisa Puglisi ◽  
Alexandra A Halberstam ◽  
Jenerius Aminawung ◽  
Colleen Gallagher ◽  
Lou Gonsalves ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Quality Of Care ◽  
Mixed Methods ◽  
Cancer Incidence ◽  
Cancer Care ◽  
Survival Models ◽  
Structural Racism ◽  
Interaction Terms ◽  
The Relationship

IntroductionIncarceration is associated with decreased cancer screening rates and a higher risk for hospitalisation and death from cancer after release from prison. However, there is a paucity of data on the relationship between incarceration and cancer outcomes and quality of care. In the Incarceration and Cancer-Related Outcomes Study, we aim to develop a nuanced understanding of how incarceration affects cancer incidence, mortality and treatment, and moderates the relationship between socioeconomic status, structural racism and cancer disparities.Methods and analysisWe will use a sequential explanatory mixed-methods study design. We will create the first comprehensive linkage of data from the Connecticut Department of Correction and the statewide Connecticut Tumour Registry. Using the linked dataset, we will examine differences in cancer incidence and stage at diagnosis between individuals currently incarcerated, formerly incarcerated and never incarcerated in Connecticut from 2005 to 2016. Among individuals with invasive cancer, we will assess relationships among incarceration, quality of cancer care and mortality, and will assess the degree to which incarceration status moderates relationships among race, socioeconomic status, quality of cancer care and cancer mortality. We will use multivariable logistic regression and Cox survival models with interaction terms as appropriate. These results will inform our conduct of in-depth interviews with individuals diagnosed with cancer during or shortly after incarceration regarding their experiences with cancer care in the correctional system and the immediate postrelease period. The results of this qualitative work will help contextualise the results of the data linkage.Ethics and disseminationThe Yale University Institutional Review Board (#2000022899) and the Connecticut Department of Public Health Human Investigations Committee approved this study. We will disseminate study findings through peer-reviewed publications and academic and community presentations. Access to the deidentified quantitative and qualitative datasets will be made available on review of the request.

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