Download or read book Racial Disparities in Breast Cancer Surgical Treatment and Radiation Therapy Use written by Tracey Koehlmoos and published by . This book was released on 2005 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: ABSTRACT: This study explores the relationship between race and surgical treatment and radiation therapy use for localized breast cancer patients in the state of Florida in 2001. The study will be useful in raising awareness of the relationship between Black race and appropriate breast cancer treatment within the Florida Cancer Data System. The Healthy People 2010 initiatives call to eliminate racial disparities and the high placement of breast cancer on the national research agenda make this study timely and insightful for health policymakers, clinicians and other health researchers.
Download or read book Racial Disparities in Early Stage Breast Cancer Treatment written by Prethibha A. George and published by . This book was released on 2012 with total page 121 pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: Appropriate treatment disparity and delay in receipt of treatment are possible reasons that contribute to shorter survival in African-American (AA) breast cancer patients compared to their White counterparts. Specific Aims: In early stage breast cancer: 1) determine if racial differences exist in treatment, 2) examine racial disparity of delays in diagnosis and treatment initiation and explore factors that predicted delay in the overall population and by race, 3) examine factors that influenced the choice between mastectomy and breast-conserving surgery (BCS) and whether these factors differed by race. Methods: Newly diagnosed invasive breast cancer patients during 2005-2010 were identified in seven eastern New Jersey counties through rapid case ascertainment. For each AA woman 18-85 years of age, a white woman was randomly selected (± 5 years of age and from same county). Two data collection methods took place: medical chart review (Aims 1 & 2) and semi-structured interviews (Aim 3). Multivariable binomial and linear regression models were conducted to explore associations between race and outcomes (receipt of standard treatment; diagnosis and treatment delay). Results: In Aim 1, AAs tended not to receive optimal treatment compared to whites (RR: 1.60; 95% CI: .94, 2.71). Aim 2 demonstrated that AA women experienced longer time to diagnosis and surgical treatment. The geometric mean (95% CI) for whites and AAs in time to diagnosis was 35 (31, 40) and 47 (41, 54); time to surgery was 28 (26, 30) and 33 (30, 35) respectively. Aim 3 demonstrated that health issues that interfered with physical/social activities influenced AAs to receive mastectomy compared to BCS (RR: 1.68; 95% CI: 1.01, 2.77). Conclusion: We observed racial differences in receipt of optimal treatment (after controlling clinical factors) and took longer time to diagnosis and treatment for early stage breast cancer among AAs compared to white women. These differences could contribute to the observed poor survival in AAs with breast cancer. Also AAs listed previous health issues as an influencing factor in the surgical treatment they received. The findings suggest that interventions are needed to eliminate barriers that contribute to the observed disparity and to help narrow the racial gap in survival rates.
Download or read book Disparities in the Treatment of Early Breast Cancer written by and published by . This book was released on 2008 with total page 109 pages. Available in PDF, EPUB and Kindle. Book excerpt: Context: Breast cancer is the most common cancer and the second leading cause of cancer death among US women. Compounding the impact of breast cancer are significant age and race differences that have been noted in the incidence and mortality of breast cancer. The elderly suffer disproportionately from the burden of breast cancer because they are a rapidly growing population in the US and they also have relatively higher mortality and morbidity from this disease. There is conclusive evidence of the efficacy of adjuvant systemic treatment in prolonging survival. However, very little is known about the frequency of use of this treatment in the elderly. On the other hand, racial differences in breast cancer reveal that although black women have lower incidence of breast cancer than whites, they sustain higher mortality rates. There is evidence that the reduced survival among blacks may be attributable more to differences in socioeconomic status and access to appropriate care, rather than to biological differences between the races. Therefore, it is apparent that the elderly and ethnic minority groups, especially black women, experience poorer outcomes from their breast cancers than their counterparts. Age and race disparities in treatment of early breast cancer may be one mechanism by which these women suffer poorer outcomes. Therefore, the overall goal of this dissertation was to examine age and race disparities in the treatment of early breast cancer as articulated in the three specific aims described below. Specific Aims: The aims of this dissertation were to: (1) determine the frequency of use of adjuvant systemic treatment for early breast cancer among women 65 years of age and older, (2) examine whether differences exist in receipt of standard treatment for early breast cancer between black and white women, and (3) examine whether differences exist in delays in initiation of treatment for early breast cancer between black and white women. Design, Setting, and Patients: Aim 1 utilized data from the population-based New Jersey Cancer Registry (NJSCR) to ascertain the frequency of use of adjuvant systemic treatment among 200 women (100 fatal cases and 100 non-fatal cases) who were greater than or equal to 65 years of age and diagnosed with early stage breast cancer during 1987-1998. Study subjects were stratified based on their estrogen receptor (ER) status into ER positive and ER negative cases. NJSCR data provided information on patient and tumor characteristics as well as information on treatment received and their providers. Cancer registry data are usually obtained from hospital tumor registrars, while adjuvant systemic treatment is frequently administered on an outpatient basis. Therefore, cancer registry data was supplemented with data obtained from patients' primary care physicians and oncologists. For Aims 2 and 3 of this dissertation, a retrospective cohort study was designed using a linked NJSCR and New Jersey Medicaid dataset for the years 1997 through 2001. Participants in these studies were women 20-64 years of age who were diagnosed with early-stage breast cancer (SEER Summary Stage 'localized' and 'regional spread to lymph nodes') between January 1997 and December 2001. Women who were neither white nor black, who were diagnosed with other cancers, and whose breast cancer was not the primary cancer were excluded. The linked database was used to obtain diagnostic, prognostic, and treatment information on 237 black and 485 white women. Descriptive analyses were done to characterize the study populations for all three aims. For Aim 1, the frequency of use of surgical therapy, hormonal therapy alone, chemotherapy alone, and hormonal therapy in combination with chemotherapy was calculated separately for subjects with ER positive and ER negative tumors. Multivariate logistic regression models were constructed to examine the predictors of adjuvant hormonal and chemotherapy use. For Aim 2, logistic regression models were constructed to compare receipt of standard treatment between blacks and whites. Racial differences in breast cancer specific and overall survival were evaluated using Cox proportional hazard models. For Aim 3, we compared blacks and whites with respect to delays in initiation of surgical treatment after confirmed diagnosis, of adjuvant radiation therapy after breast conserving surgery, and of adjuvant hormonal and chemotherapy after definitive surgery. Logistic regression models were constructed to examine the association between delays in initiation of surgical treatment (greater than or equal to 1 month vs.
Download or read book Disparities and Determinants of Health in Surgical Oncology An Issue of Surgical Oncology Clinics of North America E Book written by Oluwadamilola “Lola Fayanju and published by Elsevier Health Sciences. This book was released on 2021-11-18 with total page 145 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this issue of Surgical Oncology Clinics, guest editor Oluwadamilola "Lola" Fayanju brings considerable expertise to the topic of Disparities and Determinants of Health in Surgical Oncology. Provides in-depth, clinical reviews on the latest updates on Disparities and Determinants of Health in Surgical Oncology, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field; Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews.
Download or read book Factors Contributing to Disparities in Early Breast Cancer Treatment written by Sheenu Chandwani and published by . This book was released on 2012 with total page 123 pages. Available in PDF, EPUB and Kindle. Book excerpt: Specific Aims: This dissertation was conducted to examine the following specific aims among early breast cancer patients: 1) Racial differences in the use of pre-operative magnetic resonance imaging (MRI) and the role of pre-operative MRI on rates of re-operation and contralateral prophylactic mastectomy (CPM), and time to surgery; 2) Racial differences in elapsed time and sessions received during radiation therapy; and 3) Racial differences in chemotherapy dose modifications and role of neutropenia in this association. Design, setting and subjects: Subjects were selected from the Breast Cancer Treatment Disparity Study which is an ongoing cohort study of African American (AA) and white subjects residing in eastern New Jersey who were newly diagnosed with early breast cancer between 2005 and 2010. Data were collected through a detailed review of medical records obtained from multiple health care providers of these participants. Results: A significantly higher use of pre-operative MRI among whites versus AAs (58.3% vs. 39.7%, p0.01) was seen in the first study. Receipt of pre-operative MRI was associated with a non-significant lower rate of re-operation (RR= 0.76; 95% confidence interval [CI]: 0.54, 1.07), but a significantly higher rate of CPM (RR= 1.75; 95% CI: 1.04, 2.92) and a longer time to surgery (geometric mean= 40.5 days versus 27.6 days, p0.01). The second study revealed no differences between AA and white women in elapsed time and sessions received during standard radiation therapy following lumpectomy (median elapsed time= 48 days, % subjects with49 days elapsed time= 36%, and mean sessions= 33, for both racial groups). In the third study, a significantly lower relative dose intensity (RDI) was delivered to AA subjects than white subjects (94.4% versus 100.0%, p= 0.005) during chemotherapy and the risk of15% reduction in RDI was more than double (RR= 2.62; 95% CI: 1.40, 4.89) in AA women as compared to white women. White blood cell counts at initiation of chemotherapy and in subsequent cycles were similar between the races and were unable to account for differences in dose intensity between the two groups. Conclusion: The rapid rise in use of pre-operative MRI is a concern as no benefit of its use was observed in this study. We also conclude that once treatment is initiated AA women and white women were very similar in receipt of care delivered during radiation. However, this did not hold true for chemotherapy. AA women in comparison to white women were at more than two-fold risk of experiencing dose modifications during chemotherapy that was not explained by differences in their blood counts.
Download or read book Breast Cancer Quality of Care written by Brinda Venkatesh and published by . This book was released on 2018 with total page 81 pages. Available in PDF, EPUB and Kindle. Book excerpt: Despite significant advances that have been made in breast cancer diagnosis and treatment, a disproportionate burden of the disease continues to fall on women from minority groups. Studies suggest that differentials in the quality of breast cancer care in the treatment stage influence breast cancer disparities. Because treatment is defined by medical intervention, the health system plays a critical role in understanding breast cancer disparities and needs to be further examined. Moreover, studies examining such differentials have focused on aggregated racial data, which may be masking smaller ethnic groups that may be at higher risk. This dissertation attempts to clarify the health system contribution to breast cancer quality of care disparities and highlights the need to examine breast cancer quality of care disparities using disaggregated racial/ethnic data in order to help inform the design of more targeted quality improvement efforts. Paper #1 examines the relationship between designated specialty cancer centers and breast cancer quality of care. In cancer care delivery, there has been an emerging trend for cancer centers to obtain special designations from one or more of the following institutions: the National Cancer Institute (NCI), the National Comprehensive Cancer Network (NCCN), and the American College of Surgeon’ Commission on Cancer. These designations are markers for high quality cancer care, yet little is known about the actual effectiveness of the care they provide or the communities that they tend to serve. Paper #2 examines breast cancer quality of care differences between Asian women (aggregated and disaggregated) and non-Hispanic White women. Cancer disparities research often focus on examining communities in aggregate. Recently, more scholars are utilizing disaggregated ethnic data when assessing cancer disparities in order to acknowledge the diversity of these large communities. Little is known about breast cancer quality of care disparities among Asian American ethnic groups. Paper #3 examines the relative contribution of within hospital and between hospital effects on racial/ethnic disparities on the quality of breast cancer treatment. Existing literature posits that there are two mechanisms at the health systems level that contribute to disparities in the quality of care received by minority groups. Some studies suggest that disparities are due to minorities receiving differential treatment within the same institution as White patients, while others propose that minorities tend to receive care from lower quality health care settings. Studies to date have not examined the ways in which the health system may be contributing to breast cancer quality of care disparities. Data from the California Cancer Registry (CCR) was used for the analyses. The study population consisted of women ages 20 years or older and who have had a first invasive primary breast cancer diagnosis between 2011-2014. This dissertation contributes to the existing literature on breast cancer disparities by clarifying the mechanism of the health system contribution to breast cancer disparities and uncovering disparities in disaggregated ethnic groups. Findings from this dissertation will provide important information for the development of quality improvement efforts in cancer care delivery.
Download or read book Patterns of Care and Disparities in the Treatment of Early Breast Cancer written by and published by . This book was released on 2008 with total page 39 pages. Available in PDF, EPUB and Kindle. Book excerpt: Prior research evidence that has suggested that regional variation and socioeconomic barriers in breast cancer treatment remain substantial problems for patients across the nation. The purpose of our project was to characterize national patterns in the treatment of early invasive breast cancer in older women with incident disease. We specifically sought to characterize disparities in care and regional variation in treatment patterns. Methods. We sought to apply a novel resource, comprehensive national Medicare claims data, to study disparities in care and outcomes in women with breast cancer. We calculated national and state-by-state absolute and standardized utilization rates of radiotherapy (RT) and chemotherapy in patients with early invasive breast cancer treated with conservative surgery (CS); analyzed the modifying effect of race on RT utilization; and evaluated the utility of claims-based covariates in predicting breast cancer stage. Multivariate logistic regression was used to model these outcomes. Findings. Significant regional variation in utilization of breast cancer treatment existed in our cohort of older women diagnosed with invasive disease, even after standardization for patient and disease characteristics. In addition, significant racial disparities in care existed, with non-white women significantly less likely than white women to receive RT after CS, despite this treatment modality generally considered standard treatment. Conclusions. Our research adds to the existing literature by providing the first comprehensive national sample to address these study questions. Our future research will extend on our current findings by determining whether these variations in breast cancer treatment also affect outcomes, such as cancer recurrence, mortality, and costs of cancer care.
Download or read book Racial Disparities in Breast Cancer Treatment in Alabama written by Julie Lynn Worthington and published by . This book was released on 2006 with total page 92 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Unequal Treatment written by Institute of Medicine and published by National Academies Press. This book was released on 2009-02-06 with total page 781 pages. Available in PDF, EPUB and Kindle. Book excerpt: Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
Download or read book Ductal Carcinoma In Situ and Microinvasive Borderline Breast Cancer written by Lisa A. Newman and published by Springer. This book was released on 2015-02-04 with total page 171 pages. Available in PDF, EPUB and Kindle. Book excerpt: This volume reviews the evolution of information regarding the epidemiology of DCIS and its modes of detection, as well as treatment options as a function of both clinical trial data and ongoing investigational therapeutic prospects. Several of the challenging and clinically-relevant scenarios of DCIS that appear in daily practice is discussed, including the difficulties of distinguishing “true” DCIS from borderline patterns of other breast diseases and the therapeutic implications of differentiating these various diagnoses. Particular attention is paid to pathologic evaluation of DCIS, including histologic patterns and the importance of margin evaluation/margin control. The text also explores the data regarding DCIS in medical research in hereditary susceptibility for breast cancer and race/ethnicity-associated disparities in breast cancer. Written by experts in the field, Ductal Carcinoma In Situ and Microinvasive/Borderline Breast Cancer is a comprehensive, state-of-the art review of the field, and serves as a valuable resource for clinicians, surgeons and researchers with an interest in breast cancer.
Download or read book Breast Cancer Metastasis and Drug Resistance written by Aamir Ahmad and published by Springer Nature. This book was released on 2019-08-27 with total page 427 pages. Available in PDF, EPUB and Kindle. Book excerpt: Resistance to therapies, both targeted and systemic, and metastases to distant organs are the underlying causes of breast cancer-associated mortality. The second edition of Breast Cancer Metastasis and Drug Resistance brings together some of the leading experts to comprehensively understand breast cancer: the factors that make it lethal, and current research and clinical progress. This volume covers the following core topics: basic understanding of breast cancer (statistics, epidemiology, racial disparity and heterogeneity), metastasis and drug resistance (bone metastasis, trastuzumab resistance, tamoxifen resistance and novel therapeutic targets, including non-coding RNAs, inflammatory cytokines, cancer stem cells, ubiquitin ligases, tumor microenvironment and signaling pathways such as TRAIL, JAK-STAT and mTOR) and recent developments in the field (epigenetic regulation, microRNAs-mediated regulation, novel therapies and the clinically relevant 3D models). Experts also discuss the advances in laboratory research along with their translational and clinical implications with an overarching goal to improve the diagnosis and prognosis, particularly that of breast cancer patients with advanced disease.
Download or read book Adjuvant Therapy for Breast Cancer written by Monica Castiglione and published by Springer Science & Business Media. This book was released on 2009-07-11 with total page 483 pages. Available in PDF, EPUB and Kindle. Book excerpt: Adjuvant treatment is administered prior to or as follow up to surgical procedures for breast cancer. Proven success in using medical therapies allowing for breast conserving procedures or reducing risk of occurrence. Although there has been much progress towards a cure, including the introduction of new targeted therapies, metastasizing cancer remains highly incurable.
Download or read book Measuring the Quality of Health Care written by The National Roundtable on Health Care Quality and published by National Academies Press. This book was released on 1999-02-23 with total page 42 pages. Available in PDF, EPUB and Kindle. Book excerpt: The National Roundtable on Health Care Quality was established in 1995 by the Institute of Medicine. The Roundtable consists of experts formally appointed through procedures of the National Research Council (NRC) who represent both public and private-sector perspectives and appropriate areas of substantive expertise (not organizations). From the public sector, heads of appropriate Federal agencies serve. It offers a unique, nonadversarial environment to explore ongoing rapid changes in the medical marketplace and the implications of these changes for the quality of health and health care in this nation. The Roundtable has a liaison panel focused on quality of care in managed care organizations. The Roundtable convenes nationally prominent representatives of the private and public sector (regional, state and federal), academia, patients, and the health media to analyze unfolding issues concerning quality, to hold workshops and commission papers on significant topics, and when appropriate, to produce periodic statements for the nation on quality of care matters. By providing a structured opportunity for regular communication and interaction, the Roundtable fosters candid discussion among individuals who represent various sides of a given issue.
Download or read book The Breast Cancer Wars written by Barron H. Lerner and published by Oxford University Press. This book was released on 2001-05-31 with total page 408 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this riveting narrative, Barron H. Lerner offers a superb medical and cultural history of our century-long battle with breast cancer. Revisiting the past, Lerner argues, can illuminate and clarify the dilemmas confronted by women with--and at risk for--the disease. Writing with insight and compassion, Lerner tells a compelling story of influential surgeons, anxious patients and committed activists. There are colorful portraits of the leading figures, ranging from the acerbic Dr. William Halsted, who pioneered the disfiguring radical mastectomy at the turn of the century to George Crile, Jr., the Cleveland surgeon who shocked the medical establishment by "going public" with his doubts about mastectomy, to Rose Kushner, a brash journalist who relentlessly educated American women about breast cancer. Lerner offers a fascinating account of the breast cancer wars: the insistent efforts of physicians to vanquish the "enemy"; the fights waged by feminists and maverick doctors to combat a paternalistic legacy that discouraged decision-making by patients; and the struggles of statisticians and researchers to generate definitive data in the face of the great risks and uncertainties raised by the disease. As easy as it is to demonize male physicians, the persistence of the radical mastectomy and other invasive treatments has had as much to do with the complicated scientific understandings of breast cancer as with sexism. In Lerner's hands, the fight against breast cancer opens a window on American medical practice over the last century: the pursuit of dramatic cures with sophisticated technologies, the emergence of patients' rights, the ethical and legal challenges raised by informed consent, and the limited ability of scientific knowledge to provide quick solutions for serious illnesses. A searching and profound work on an emotionally charged issue, The Breast Cancer Wars tells a story that remains of vital importance to modern breast cancer patients, their families and the clinicians who strive to treat and prevent this dreaded disease.
Download or read book Understanding Racial and Ethnic Differences in Health in Late Life written by National Research Council and published by National Academies Press. This book was released on 2004-09-08 with total page 184 pages. Available in PDF, EPUB and Kindle. Book excerpt: As the population of older Americans grows, it is becoming more racially and ethnically diverse. Differences in health by racial and ethnic status could be increasingly consequential for health policy and programs. Such differences are not simply a matter of education or ability to pay for health care. For instance, Asian Americans and Hispanics appear to be in better health, on a number of indicators, than White Americans, despite, on average, lower socioeconomic status. The reasons are complex, including possible roles for such factors as selective migration, risk behaviors, exposure to various stressors, patient attitudes, and geographic variation in health care. This volume, produced by a multidisciplinary panel, considers such possible explanations for racial and ethnic health differentials within an integrated framework. It provides a concise summary of available research and lays out a research agenda to address the many uncertainties in current knowledge. It recommends, for instance, looking at health differentials across the life course and deciphering the links between factors presumably producing differentials and biopsychosocial mechanisms that lead to impaired health.
Download or read book Preoperative Neoadjuvant Chemotherapy written by Joseph Ragaz and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 172 pages. Available in PDF, EPUB and Kindle. Book excerpt: Despite recent advances in adjuvant therapies of cancer, the regi mens of postoperative adjuvant chemotherapy treatment which are presently available fail to cure the majority of cancer patients. Pre operative (neoadjuvant) chemotherapy represents a new approach in drug scheduling, based on sound theoretical, pharmacokinetic, and experimental principles. The preoperative timing of chemotherapy before definitive sur gery is not a minor change in the therapy of cancer. To be successful, large numbers of practitioners and their patients must participate. Substantial alterations of many aspects of the present management of cancer will have to follow. Therefore, before such therapy can be fully and routinely implemented, results of the novel treatment and its rationale have to be carefully evaluated. In preoperative treatment, other features will likely gain impor tance. For the first time, clinicians have a chance to follow the in vivo response of the tumor exposed to preoperative chemotherapy. The subsequent histological assessment of the tumor sample may likely become an important prognostic guide, permitting more re fined individual approaches to the planning of postoperative adju vant treatment. The value of such a treatment strategy can already be appreciated in the clinical setting, as seen from the therapy of osteosarcoma. Furthermore, preoperative chemotherapy might render previously inoperable tumors operable and hence resectable with a curative intention. The preoperative reduction of tumor bulk may also effectively decrease the need for more radical operations, permitting a more uniform adoption of conservative surgery.
Download or read book Communication in Cancer Care written by F. Stiefel and published by Springer Science & Business Media. This book was released on 2006-09-13 with total page 131 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book covers all the relevant aspects of communication in cancer care, such as communication in cancer prevention and genetic counseling, communication at different stages of disease and communication with the family and children. In addition, more general topics are discussed, such as the benefits and evidence of communication skills training and the challenges of interdisciplinary and cross-cultural communication.
