Factors Associated with Head and Neck Cancer Postoperative Radiotherapy Delays: A Systematic Review and Meta‐analysis

Otolaryngology, Год журнала: 2024, Номер unknown

Опубликована: Июнь 6, 2024

Abstract Objective Initiating postoperative radiotherapy (PORT) within 6 weeks of surgery for head and neck squamous cell carcinoma (HNSCC) is included in the National Comprehensive Cancer Network Clincal Practice Guidelines a Commission on quality metric. Factors associated with delays starting PORT have not been systematically described nor synthesized. Data Sources PubMed, Scopus, CINAHL. Review Methods We studies describing demographic characteristics, clinical factors, or social determinants health delay (>6 weeks) patients HNSCC treated United States after 2003. Meta‐analysis odds ratios (ORs) was performed nonoverlapping datasets. Results Of 716 unique abstracts reviewed, 21 were systematic review 15 meta‐analysis. Study sample size ranged from 19 to 60,776 patients. In meta‐analysis, factors black race (OR, 1.46, 95% confidence interval [CI]: 1.28‐1.67), Hispanic ethnicity 1.37, CI, 1.17‐1.60), Medicaid no insurance 2.01, 1.90‐2.13), lower income 1.38, 1.20‐1.59), admission >7 days 2.92, 2.31‐3.67), 30‐day hospital readmission 1.29‐1.47). Conclusion Patients at greatest risk initiating guideline‐adherent include those who are minoritized communities, socioeconomic status, experience challenges. These findings provide foundational evidence needed deliver targeted interventions enhance equity care delivery.

Язык: Английский

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A health equity framework to support the next generation of cancer population simulation models

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 255 - 264

Опубликована: Ноя. 1, 2023

Abstract Over the past 2 decades, population simulation modeling has evolved as an effective public health tool for surveillance of cancer trends and estimation impact screening treatment strategies on incidence mortality, including documentation persistent inequities. The goal this research was to provide a framework support next generation models identify leverage points in control continuum accelerate achievement equity care minoritized populations. In our framework, systemic racism is conceptualized root cause inequity upstream influence acting subsequent downstream events, which ultimately exert physiological effects mortality competing comorbidities. To date, most investigating racial have used individual-level race variables. Individual-level proxy exposure racism, not biological construct. However, single-level variables are suboptimal proxies multilevel systems, policies, practices that perpetuate inequity. We recommend future designed capture relationships between outcomes replace or extend with measures structural, interpersonal, internalized racism. Models should investigate actionable levers, such changes care, education, economic structures policies increase reductions health-care–based interpersonal This integrated approach could novel approaches, make explicit different highlight data gaps interactions model components mirroring how factors act real world, inform we collect equity, generate results policy.

Язык: Английский

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Opportunities, challenges, and future directions for simulation modeling the effects of structural racism on cancer mortality in the United States: a scoping review

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 231 - 245

Опубликована: Июль 14, 2023

Abstract Purpose Structural racism could contribute to racial and ethnic disparities in cancer mortality via its broad effects on housing, economic opportunities, health care. However, there has been limited focus incorporating structural into simulation models designed identify practice policy strategies support equity. We reviewed studies evaluating highlight challenges, future directions capture this concept modeling research. Methods used the Preferred Reporting Items for Systematic Reviews Meta-Analyses-Scoping Review Extension guidelines. Articles published between 2018 2023 were searched including terms related race, ethnicity, cancer-specific all-cause mortality, racism. included of United States. Results A total 8345 articles identified, 183 included. Studies different measures, data sources, methods. For example, 20 studies, residential segregation, one component racism, was measured by indices dissimilarity, concentration at extremes, redlining, or isolation. Data sources registries, claims, institutional linked area-level metrics from US census historical mortgage data. Segregation associated with worse survival. Nine location specific, segregation measures developed Black, Hispanic, White residents. Conclusions range are available provide a set recommendations best practices modelers consider when models.

Язык: Английский

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A scoping review of web-based, interactive, personalized decision-making tools available to support breast cancer treatment and survivorship care

Journal of Cancer Survivorship, Год журнала: 2024, Номер unknown

Опубликована: Март 28, 2024

Abstract Purpose We reviewed existing personalized, web-based, interactive decision-making tools available to guide breast cancer treatment and survivorship care decisions in clinical settings. Methods The study was conducted using the Preferred Reporting Items for Systematic reviews Meta-Analyses extension Scoping Reviews (PRISMA-ScR). searched PubMed related databases web-based developed support from 2013 2023. Information on each tool’s purpose, target population, data sources, individual contextual characteristics, outcomes, validation, usability testing were extracted. completed a quality assessment tool International Patient Decision Aid Standard (IPDAS) instrument. Results found 54 providing personalized outcomes (e.g., recurrence) recommendations chemotherapy) based stage), genomic 21-gene-recurrence score), behavioral smoking), insurance) characteristics. Forty-five validated, nine had undergone testing. However, validation included mostly White, educated, and/or insured individuals. average score of 16 (range: 6–46; potential maximum: 63). Conclusions There wide variation quality, validity, tools. Future studies should consider diverse populations development Implications survivors are It is important both physicians carefully these before them decisions.

Язык: Английский

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Data gaps and opportunities for modeling cancer health equity

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 246 - 254

Опубликована: Ноя. 1, 2023

Abstract Population models of cancer reflect the overall US population by drawing on numerous existing data resources for parameter inputs and calibration targets. Models require that are appropriately representative, collected in a harmonized manner, have minimal missing or inaccurate values, adequate sample sizes. Data resource priorities modeling to support health equity include increasing availability 1) arise from uninsured underinsured individuals those traditionally not included health-care delivery studies, 2) relevant exposures groups historically intentionally excluded across full control continuum, 3) disaggregate categories (race, ethnicity, socioeconomic status, gender, sexual orientation, etc.) their intersections conceal important variation outcomes, 4) identify specific populations interest clinical databases whose outcomes been understudied, 5) enhance records through expanded elements linkage with other types (eg, patient surveys, provider and/or facility level information, neighborhood data), 6) decrease misclassified underrecognized populations, 7) capture potential measures effects systemic racism corresponding intervenable targets change.

Язык: Английский

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Gerotherapeutics: Aging Mechanism-based Pharmaceutical and Behavioral Interventions to Reduce Cancer Racial and Ethnic Disparities

JNCI Journal of the National Cancer Institute, Год журнала: 2024, Номер unknown

Опубликована: Авг. 27, 2024

Abstract The central premise of this article is that a portion the established relationships between social determinants health and racial ethnic disparities in cancer morbidity mortality mediated through differences rates biological aging processes. We further posit using knowledge about could enable discovery testing new mechanism-based pharmaceutical behavioral interventions (“gerotherapeutics”) to differentially improve survivors from minority populations reduce disparities. These hypotheses are based on evidence lifelong adverse contribute (“social aging”), with individuals minoritized groups experiencing accelerated (ie, steeper slope or trajectory over time relative chronological age) more often than nonminoritized groups. Acceleration can increase risk, age onset, aggressiveness, stage many adult cancers. There also documented negative feedback loops whereby cellular damage caused by its therapies act as drivers additional aging. Together, these dynamic intersectional forces outcomes vs populations. highlight key targetable mechanisms potential applications reducing discuss methodological considerations for preclinical clinical impact gerotherapeutics Ultimately, promise will require broad societal policy changes address structural causes ensure equitable access all control paradigms.

Язык: Английский

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Using simulation modeling to guide policy to reduce disparities and achieve equity in cancer outcomes: state of the science and a road map for the future

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 159 - 166

Опубликована: Ноя. 1, 2023

Язык: Английский

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Population simulation modeling of disparities in US breast cancer mortality

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 178 - 187

Опубликована: Авг. 14, 2023

Abstract Background Populations of African American or Black women have persistently higher breast cancer mortality than the overall US population, despite having slightly lower age-adjusted incidence. Methods Three Cancer Intervention and Surveillance Modeling Network simulation teams modeled disparities between female populations population. Model inputs used racial group–specific data from clinical trials, national registries, nationally representative surveys, observational studies. Analyses began with in population sequentially replaced parameters for to quantify percentage morality attributable differences demographics, incidence, access screening treatment, variation tumor biology response therapy. Results were similar across 3 models. In 2019, incidence competing accounted a net ‒1% disparities, while subtype stage distributions mean 20% (range models = 13%-24%), 3% 3%-4%) disparities. Treatment majority disparities: 17% 16%-19%) treatment initiation 61% 57%-63%) real-world effectiveness. Conclusion Our model results suggest that changes policies target improvements could increase equity. The findings also highlight efforts must extend beyond targeting equity include high-quality completion. This research will facilitate future modeling test effects different specific policy on

Язык: Английский

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A Scoping Review of Personalized, Interactive, Web-Based Clinical Decision Tools Available for Breast Cancer Prevention and Screening in the United States

MDM Policy & Practice, Год журнала: 2024, Номер 9(1)

Опубликована: Янв. 1, 2024

Introduction. Personalized web-based clinical decision tools for breast cancer prevention and screening could address knowledge gaps, enhance patient autonomy in shared decision-making, promote equitable care. The purpose of this review was to present evidence on the availability, usability, feasibility, acceptability, quality, uptake support their integration into Methods. We used Preferred Reporting Items Systematic reviews Meta-Analyses extension Scoping Reviews Checklist conduct review. searched 6 databases identify literature development, validation, acceptability testing, practice settings. Quality assessment each tool conducted using International Patient Decision Aid Standard instrument, with quality scores ranging from 0 63 (lowest-highest). Results. identified 10 9 screening. included individual (e.g., age), genomic risk factors), health behavior alcohol use) characteristics. Fourteen race/ethnicity, but no incorporated contextual factors insurance, access) associated cancer. All were internally or externally validated. Six had undergone usability testing samples including White (median, 71%; range, 9%–96%), insured (99%; 97%–100%) women, college education higher (60%; 27%–100%). developed tested academic Seven (37%) showed potential practice. an average score 21 (range, 9–39). Conclusions. There is limited diverse nonacademic settings potentially improve access these tools. Highlights 19 personalized, interactive, Web-based Breast outcomes personalized based characteristics age, medical history), BRCA1/2), race ethnicity, behaviors smoking). did not include insurance status, facilities) that contribute outcomes. Validation, feasibility mostly among and/or patients some (or higher)

Язык: Английский

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Commentary: Some water in the data desert: the Cancer Intervention and Surveillance Modeling Network’s capacity to guide mitigation of cancer health disparities

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 167 - 172

Опубликована: Сен. 14, 2023

Despite significant progress in cancer research and treatment, a persistent knowledge gap exists understanding addressing care disparities, particularly among populations that are marginalized. This deficit has led to "data divide," where certain groups lack adequate representation cancer-related data, hindering their access personalized data-driven care. divide disproportionately affects marginalized minoritized communities such as the U.S. Black population. We explore concept of deserts," wherein entire populations, often based on race, ethnicity, gender, disability, or geography, comprehensive high-quality health data. Several factors contribute data deserts, including underrepresentation clinical trials, poor quality, limited digital technologies, rural lower-socioeconomic communities.The consequences divides deserts far-reaching, impeding equitable precision medicine perpetuating disparities. To bridge this divide, we highlight role Cancer Intervention Surveillance Modeling Network (CISNET), which employs population simulation modeling quantify emphasize importance collecting quality from various sources improve model accuracy. CISNET's collaborative approach, utilizing multiple independent models, offers consistent results identifies gaps knowledge. It demonstrates impact systemic racism incidence mortality, paving way for evidence-based policies interventions eliminate suggest potential use voting districts/precincts unit aggregation future CISNET modeling, enabling targeted informed policy decisions.

Язык: Английский

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