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Sakazaki A, Lui A, Wang M, Ngo K, Lugue MT, Aligireddy H, Nguyen M, Castro CL, Park K, Murakami S. Effects of Socioeconomic Status on Colorectal Cancer Incidence and Clinical Outcome Differences Among Asian American Populations: A Systematic Review. Cureus 2025; 17:e83806. [PMID: 40491647 PMCID: PMC12146441 DOI: 10.7759/cureus.83806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2025] [Indexed: 06/11/2025] Open
Abstract
Colorectal cancer (CRC) is a leading cause of cancer death among Asian Americans and Pacific Islanders (API) in the United States. Race, ethnicity, and socioeconomic status (SES) are known to impact outcomes of CRC, but the relationship is unclear in the context of the Asian American cohort and its diverse subgroups. This systematic review aims to gain insight into the relationship between CRC incidence and clinical outcomes in the Asian American community. A systematic literature search was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol using PubMed, Scopus, Excerpta Medica database (EMBASE), Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science databases, accessed on August 13, 2023. Of the 2225 studies identified, a total of 14 studies were included in the analysis. Four studies concluded that there was no association or variable response subgroup-specific to SES measurements in CRC incidence in the Asian American population. However, there was evidence that the incidence of CRC varies among Asian American subgroups, using varying measures of SES. Seven of the eight studies that measured mortality or survival as the primary outcome found decreased mortality and increased survival in the API population despite changes in SES. Out of the six studies that measured incidence, four studies found no association with SES. A study found that Chinese Americans had a significant decrease in the CRC incidence and mortality across all SES categories. Japanese Americans experienced a significant decrease in the lowest SES category, while Koreans and Filipinos experienced a significant increase in both the lowest and highest SES categories. Therefore, grouping various Asian American ethnicities as a single monolithic "Asian" category is misleading. Although the incidence of CRC was thought to be low and decreasing, this review identified various subgroup-specific trends among 24 different Asian American subsets. For example, there was a decrease in CRC rates in two ethnic groups and an increase in the other two ethnic groups. The potential causes of these varying CRC incidence rates are likely multifactorial and may include inadequate screening rates, lack of CRC education, and cultural barriers. Further studies are needed to understand these mechanisms. This review recommends a more detailed classification of the API ethnic population but not as a single monolithic entity as Asian. It also emphasizes preventative CRC screening within the API communities due to lower rates of CRC screening among them.
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Affiliation(s)
- Amy Sakazaki
- College of Osteopathic Medicine, Touro University California, Vallejo, USA
| | - Austin Lui
- College of Osteopathic Medicine, Touro University California, Vallejo, USA
| | - Melody Wang
- College of Osteopathic Medicine, Touro University California, Vallejo, USA
| | - Katherine Ngo
- College of Osteopathic Medicine, Touro University California, Vallejo, USA
| | | | - Himani Aligireddy
- College of Osteopathic Medicine, Touro University California, Vallejo, USA
| | - Maria Nguyen
- College of Osteopathic Medicine, Touro University California, Vallejo, USA
| | | | - Kenneth Park
- College of Osteopathic Medicine, Touro University California, Vallejo, USA
| | - Shin Murakami
- College of Osteopathic Medicine, Touro University California, Vallejo, USA
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Coughlin SS, Tsai MH, Cortes J, Bevel M, Vernon M. The Influence of Poverty and Rurality on Colorectal Cancer Survival by Race/Ethnicity: An Analysis of SEER Data with a Census Tract-Level Measure of Persistent Poverty. Curr Oncol 2025; 32:248. [PMID: 40422507 DOI: 10.3390/curroncol32050248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2025] [Revised: 04/15/2025] [Accepted: 04/21/2025] [Indexed: 05/28/2025] Open
Abstract
Purpose: Because of shared mechanisms such as decreased access to health care, rurality and poverty may act synergistically to decrease colorectal cancer (CRC) survival. Methods: We conducted a retrospective cohort analysis of SEER data (22 registries) with census tract-level measures of poverty/rurality for the period 2006-2015. Multivariable Cox proportional hazard regressions were applied to examine the independent and intersectional associations of persistent poverty and rurality on 5-year cause-specific CRC survival across five racial/ethnic groups. Results: Among 532,868 CRC patients, non-Hispanic Blacks (NHB) demonstrated lower 5-year survival probability (64.2% vs. 68.3% in non-Hispanic Whites [NHW], 66.5% in American Indian/Alaska Natives [AI/AN], 72.1% in Asian/Pacific Islanders, and 68.7% in Hispanic groups) (p-value < 0.001). In adjusted analysis, CRC patients living in rural areas with poverty were at a 1.2-1.6-fold increased risk of CRC death than those who did not live in these areas in five racial/ethnic groups. In particular, AI/AN patients living in rural areas with poverty were 66% more likely to die from CRC (95% CI, 1.32, 2.08). Conclusions: CRC patients who live in rural or poverty areas in SEER areas in the U.S. have a poorer survival compared with those who do not live in such areas regardless of race/ethnicity. Significantly greater risk of CRC death was observed in AI/ANs. Impact: Patient navigators, community education or screening, and other health care system interventions may be helpful to address these disparities by socioeconomic status, race, and geographic residence. Multi-level interventions aimed at institutional racism and medical mistrust may also be helpful.
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Affiliation(s)
- Steven S Coughlin
- Department of Biostatistics, Data Science and Epidemiology, Augusta University, Augusta, GA 30912, USA
| | - Meng-Han Tsai
- Georgia Prevention Institute, Augusta University, Augusta, GA 30912, USA
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Jorge Cortes
- Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Malcolm Bevel
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Marlo Vernon
- Georgia Prevention Institute, Augusta University, Augusta, GA 30912, USA
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
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Walle GT, Kitaw TA, Adane S. Incidence and determinants of mortality among patients with colorectal cancer in oncology centers of Amhara region, Ethiopia, 2024: multicenter retrospective follow up study. BMC Cancer 2025; 25:102. [PMID: 39827340 PMCID: PMC11742809 DOI: 10.1186/s12885-025-13462-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 01/06/2025] [Indexed: 01/22/2025] Open
Abstract
INTRODUCTION Colorectal cancer is a significant cause of mortality globally, with several factors impacting patient outcomes, including access to healthcare, early detection, and treatment. Despite this, the specific factors affecting incidence of death among colorectal cancer patients in the Amhara region have not been thoroughly investigated. Thus, this study seeks to assess incidence and determinants of mortality among colorectal cancer patients in Amhara Region oncology centers. RESULTS The mean age of the participants was 48.6 years (SD ± 15). Median survival time was 23.8 months. The overall incidence rate or incidence density of a colorectal cancer mortality rate was 2.9 per 100 person-months (95% CI: 2.5-3.4). Survival rates of colorectal cancer patients 1and 5 year was 69.78% and 16.1%, respectively. The result of the multivariable analysis showed that colorectal cancer patients who had presenting symptoms [AHR = 2.67 (95% CI: 1.95, 3.67)], Base line HGB level < 12.5 mg/dl [AHR = 1.63 (95% CI: 1.12, 2.37)], WHO or ECOG poor performance status [AHR = 2.99 (95% CI: 2.17, 4.12), late stage of cancer [AHR = 2.32 (95% CI: 1.42, 3.79)] and location of tumor on colorectal [AHR = 1.76 (95% CI: 1.20, 2.55)] were significantly associated with mortality of colorectal cancer. CONCLUSION AND RECOMMENDATION The study highlights significant findings on the survival and mortality of colorectal cancer patients. The overall mortality rate was 2.9 per 100 person-months. Multivariable analysis identified presenting symptoms, low baseline hemoglobin levels, poor performance status, late-stage cancer, and tumor location as significant predictors of mortality. Highlighting the need for early detection and targeted care strategies.
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Affiliation(s)
| | | | - Seteamlak Adane
- School of Public health, College of Health Science, Woldia University, Woldia, Ethiopia
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Dey P, Ray Chaudhuri S. Cancer-Associated Microbiota: From Mechanisms of Disease Causation to Microbiota-Centric Anti-Cancer Approaches. BIOLOGY 2022; 11:757. [PMID: 35625485 PMCID: PMC9138768 DOI: 10.3390/biology11050757] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Helicobacter pylori infection is the only well-established bacterial cause of cancer. However, due to the integral role of tissue-resident commensals in maintaining tissue-specific immunometabolic homeostasis, accumulated evidence suggests that an imbalance of tissue-resident microbiota that are otherwise considered as commensals, can also promote various types of cancers. Therefore, the present review discusses compelling evidence linking tissue-resident microbiota (especially gut bacteria) with cancer initiation and progression. Experimental evidence supporting the cancer-causing role of gut commensal through the modulation of host-specific processes (e.g., bile acid metabolism, hormonal effects) or by direct DNA damage and toxicity has been discussed. The opportunistic role of commensal through pathoadaptive mutation and overcoming colonization resistance is discussed, and how chronic inflammation triggered by microbiota could be an intermediate in cancer-causing infections has been discussed. Finally, we discuss microbiota-centric strategies, including fecal microbiota transplantation, proven to be beneficial in preventing and treating cancers. Collectively, this review provides a comprehensive understanding of the role of tissue-resident microbiota, their cancer-promoting potentials, and how beneficial bacteria can be used against cancers.
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Affiliation(s)
- Priyankar Dey
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India
| | - Saumya Ray Chaudhuri
- Council of Scientific and Industrial Research (CSIR), Institute of Microbial Technology, Chandigarh 160036, India;
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Pankratz VS, Kanda D, Edwardson N, English K, Adsul P, Li Y, Parasher G, Mishra SI. Colorectal Cancer Survival Trends in the United States From 1992 to 2018 Differ Among Persons From Five Racial and Ethnic Groups According to Stage at Diagnosis: A SEER-Based Study. Cancer Control 2022; 29:10732748221136440. [PMID: 36264283 PMCID: PMC9597478 DOI: 10.1177/10732748221136440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/27/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Survival following colorectal cancer (CRC) has improved in the US since 1975, but there is limited information on stage-specific survival trends among racial and ethnic subgroups. OBJECTIVES The purpose of this study was to estimate and compare trends in 1- and 5-year CRC cause-specific survival in the United States by both stage and race/ethnicity. METHODS We performed a retrospective cohort study of individuals diagnosed with CRC using the 1992-2018 Surveillance, Epidemiology and End Results (SEER) database. We estimated and compared time trends in 1- and 5-year survival for CRC stage by race/ethnicity. RESULTS Data from 399 220 individuals diagnosed with CRC were available. There were significant differences in stage-specific 1-year survival trends by race and ethnicity. Differences were most notable for distant stage CRC: survival probabilities increased most consistently for non-Hispanic American Indian/Alaska Native (AIAN) and Black (NHB) persons, but their trend lines were lower than those of Hispanic, and non-Hispanic Asian/Pacific Islander (API) and White (NHW) persons, whose initially greater gains appear to be slowing. Although the data do not support significant racial/ethnic differences in 5-year CRC survival trends by stage, AIAN and NHB persons have the lowest average survival probabilities for multiple CRC stages, and no racial/ethnic group has 5-year survival probabilities above 20% for distant-stage CRC. CONCLUSION Although there has been an overall improvement in adjusted CRC-specific survival probabilities since 1992, AIAN and NHB persons continue to experience worse prognosis than those of other races/ethnicities. This highlights the importance of reinvigorating efforts to understand the causes of mortality in CRC, including those which may differ according to an individual's race or ethnicity.
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Affiliation(s)
- Vernon S. Pankratz
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Deborah Kanda
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Nicholas Edwardson
- School of Public Administration, University of New Mexico, Albuquerque, NM, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc., Albuquerque, NM, USA
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Yiting Li
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Gulshan Parasher
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Shiraz I. Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Ferreira MDC, Sarti FM, Barros MBDA. Social inequalities in the incidence, mortality, and survival of neoplasms in women from a municipality in Southeastern Brazil. CAD SAUDE PUBLICA 2022; 38:e00107521. [DOI: 10.1590/0102-311x00107521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/28/2021] [Indexed: 12/24/2022] Open
Abstract
This study aims to analyze inequalities in the incidence, mortality, and survival of the main types of cancer in women according to the Social Vulnerability Index (SVI). The study was conducted in Campinas, São Paulo State, Brazil, from 2010 to 2014, and used data from the Population-based Cancer Registry and the Mortality Information System. Incidence and mortality rates standardized by age and 5-year survival estimates were calculated according to the social vulnerability strata (SVS), based on the São Paulo Social Vulnerability Index. Three SVS were delimited, with SVS1 being the lowest level of vulnerability and SVS3 being the highest. Rate ratios and the concentration index were calculated. The significance level was 5%. Women in SVS1 had a higher risk of breast cancer (0.46; 95%CI: 0.41; 0.51), colorectal cancer (0.56; 95%CI: 0.47; 0.68), and thyroid cancer (0.32; 95%CI: 0.26; 0.40), whereas women from SVS3 had a higher risk of cervical cancer (2.32; 95%CI: 1.63; 3.29). Women from SVS1 had higher mortality rates for breast (0.69; 95%CI: 0.53; 0.88) and colorectal cancer (0.69; 95%CI: 0.59; 0.80) and women from SVS3 had higher rates for cervical (2.35; 95%CI: 1.57; 3.52) and stomach cancer (1.43; 95%CI: 1.06; 1.91). Women of highest social vulnerability had lower survival rates for all types of cancer. The observed inequalities differed according to the location of the cancer and the analyzed indicator. Inequalities between incidence, mortality, and survival tend to revert and the latter is always unfavorable to the segment of highest vulnerability, indicating the existence of inequality in access to early diagnosis and timely treatment.
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Dhahri A, Kaplan J, Naqvi SMH, Brownstein NC, Ntiri SO, Imanirad I, Felder SI, Dineen SP, Sanchez J, Dessureault S, Carballido E, Powers BD. The impact of socioeconomic status on survival in stage III colon cancer patients: A retrospective cohort study using the SEER census-tract dataset. Cancer Med 2021; 10:5643-5652. [PMID: 34197047 PMCID: PMC8366079 DOI: 10.1002/cam4.4099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/20/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background The impact of socioeconomic status (SES) has been described for screening and accessing treatment for colon cancer. However, little is known about the “downstream” effect in patients who receive guideline‐concordant treatment. This study assessed the impact of SES on cancer‐specific survival (CSS) and overall survival (OS) for stage III colon cancer patients. Methods The SEER Census Tract‐Level SES Dataset from 2004 to 2015 was used to identify stage III colon adenocarcinoma patients who received curative‐intent surgery and adjuvant chemotherapy. The predictor variable was census tract SES. SES was analyzed as quintiles. The outcome variables were OR and CSS. Statistical analysis included chi square tests for association, Kaplan–Meier, Cox, Fine and Gray regression for survival analysis. Results In total, 27,222 patients met inclusion criteria. Lower SES was associated with younger age, Black or Hispanic race/ethnicity, Medicaid/uninsured, higher T stage, and lower grade tumors. CSS at the 25th percentile was 54 months for the lowest SES quintile and 80 for the highest. Median OS was 113 months for the lowest SES quintile and not reached for highest. The 5‐year CSS rate was 72.4% for the lowest SES quintile compared to 78.9% in the highest (p < 0.001). The 5‐year OS rate was 66.5% for the lowest SES quintile and 74.6% in the highest (p < 0.001). Conclusion This is the first study to evaluate CSS and OS in an incidence‐based cohort of stage III colon cancer patients using a granular, standardized measure of SES. Despite receipt of guideline‐based treatment, SES was associated with disparities in CSS and OS.
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Affiliation(s)
- Amina Dhahri
- Department of Internal Medicine, University of Maryland Capital Region Health, Largo, MD, USA
| | - Jori Kaplan
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Syeda M H Naqvi
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shana O Ntiri
- The University of Maryland Greenbaum Comprehensive Cancer Center, University of Maryland Greenbaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Iman Imanirad
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Seth I Felder
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Sean P Dineen
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Julian Sanchez
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Sophie Dessureault
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Estrella Carballido
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Benjamin D Powers
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.,Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
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Chen J, Zheng Y, Wang H, Zhang D, Zhao L, Yu D, Lin Z, Zhang T. Cause of death among patients with colorectal cancer: a population-based study in the United States. Aging (Albany NY) 2020; 12:22927-22948. [PMID: 33289707 PMCID: PMC7746372 DOI: 10.18632/aging.104022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/19/2020] [Indexed: 12/20/2022]
Abstract
CRC (Colorectal cancer) is one of the most common causes of death worldwide and in the US (United States). In this study, we aim to perform a population-based analysis on the cause of death among patients with CRC in the US. A total of 834,510 CRC patients diagnosed between 1975 and 2016 in the US were selected from the SEER (Surveillance, Epidemiology, and End Results) program. Causes of death among CRC patients were characterized and SMRs (standardized mortality ratios) of death from non-cancer causes were calculated. Among all CRC patients included in this study, a total of 531,507 deaths were recorded, of which 51.3% were due to CRC, 10.3% were due to other cancers, and 38.4% were due to non-cancer causes. Recently, there has been a relative decrease in index-cancer deaths and an increase in non-cancer causes among CRC patients. The mortality risk from non-cancer rises with accumulating age and longer follow-up time. Cardiovascular diseases are the most prevalent non-cancer causes, accounting for 20.3% of all deaths among CRC patients. Compared with the general population, the mortality rate of non-cancer deaths among CRC patients is doubled (SMR, 2.02; 95% confidence interval, 2.01-2.03).
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Affiliation(s)
- Jiayuan Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yongqiang Zheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Haihong Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Dejun Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lei Zhao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Dandan Yu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhenyu Lin
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Tao Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Social determinants of colorectal cancer risk, stage, and survival: a systematic review. Int J Colorectal Dis 2020; 35:985-995. [PMID: 32314192 DOI: 10.1007/s00384-020-03585-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Several social determinants of health have been examined in relation to colorectal cancer incidence, stage at diagnosis, and survival including income, education, neighborhood disadvantage, immigration status, social support, and social network. Colorectal cancer incidence rates are positively associated with income and other measures of socioeconomic status. In contrast, low socioeconomic status tends to be associated with poorer survival. METHODS The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from 1970 through April 1, 2019 were identified using the following MeSH search terms and Boolean algebra commands: colorectal cancer AND (incidence OR stage OR mortality) AND (social determinants OR neighborhood disadvantage OR racial discrimination OR immigration OR social support). RESULTS This review indicates that poverty, lack of education, immigration status, lack of social support, and social isolation play important roles in colorectal cancer stage at diagnosis and survival. CONCLUSIONS To address social determinants of colorectal cancer, effective interventions are needed that account for the social contexts in which patients live.
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Royston KJ, Adedokun B, Olopade OI. Race, the microbiome and colorectal cancer. World J Gastrointest Oncol 2019; 11:773-787. [PMID: 31662819 PMCID: PMC6815924 DOI: 10.4251/wjgo.v11.i10.773] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 02/05/2023] Open
Abstract
In the past decade, more cancer researchers have begun to understand the significance of cancer prevention, which has prompted a shift in the increasing body of scientific literature. An area of fascination and great potential is the human microbiome. Recent studies suggest that the gut microbiota has significant roles in an individual's ability to avoid cancer, with considerable focus on the gut microbiome and colorectal cancer. That in mind, racial disparities with regard to colorectal cancer treatment and prevention are generally understudied despite higher incidence and mortality rates among Non-Hispanic Blacks compared to other racial and ethnic groups in the United States. A comprehension of ethnic differences with relation to colorectal cancer, dietary habits and the microbiome is a meritorious area of investigation. This review highlights literature that identifies and bridges the gap in understanding the role of the human microbiome in racial disparities across colorectal cancer. Herein, we explore the differences in the gut microbiota, common short chain fatty acids produced in abundance by microbes, and their association with racial differences in cancer acquisition.
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Affiliation(s)
- Kendra J Royston
- Division of Hematology Oncology, University of Chicago, Chicago, IL 60637, United States
| | - Babatunde Adedokun
- Center for Clinical Cancer Genetics and Global Health Department of Medicine, University of Chicago, Chicago, IL 60637, United States
| | - Olufunmilayo I Olopade
- Division of Hematology Oncology, University of Chicago, Chicago, IL 60637, United States
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Ou JY, Warner EL, Nam GE, Martel L, Carbajal-Salisbury S, Fuentes V, Wetter DW, Kirchhoff AC, Kepka D. Colorectal cancer knowledge and screening adherence among low-income Hispanic employees. HEALTH EDUCATION RESEARCH 2019; 34:400-414. [PMID: 31329867 PMCID: PMC6646949 DOI: 10.1093/her/cyz013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/28/2019] [Indexed: 05/16/2023]
Abstract
Hispanics have the lowest colorectal cancer (CRC) screening rates of all racial/ethnic groups and comprise the largest proportion of low-income manual laborers in the nation. We partnered with businesses to implement a community health worker (CHW)-led intervention among Hispanic workers in service-related and manual labor occupations, which often pay low wages and do not provide health insurance. CHWs measured knowledge, screening adherence and perceptions of CRC risk before and after educational interventions via interview. CHWs provided fecal immunochemical tests (FITs) to participants aged ≥50 years. Chi-square tests and logistic regression identified pre-intervention predictors of CRC knowledge of all participants and adherence among eligible participants. Adherence among participants increased from 40% (n = 307) pre-intervention to 66% post-intervention. Knowledge about CRC was associated with age ≥50 years (OR = 8.90 [95% CI = 2.61-30.35]; ref = 18-30) and perceived personal risk for CRC (Likely, OR = 3.06 [95% CI = 1.40-6.67]; ref = Not likely). Insurance status was associated with screening adherence pre-intervention (OR = 3.00 [95% CI 1.10-8.12]; ref = No insurance). Improvement in adherence post-intervention was associated with income between $25 000 and ≥$55 000 (OR = 8.49 [95% CI 1.49-48.32]; ref = $5000-<$10 000). Community-based health programs can improve CRC screening adherence among Hispanic workers in service-related and manual labor positions, but lowest-income workers may need additional support.
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Affiliation(s)
- Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Division of Epidemiology, Department of Internal Medicine
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Gina E Nam
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Laura Martel
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Utah AIDS Education and Training Center, University of Utah, Salt Lake City, UT, USA
| | | | | | - David W Wetter
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Population Health Sciences
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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O’Connor JM, Sedghi T, Dhodapkar M, Kane MJ, Gross CP. Factors Associated With Cancer Disparities Among Low-, Medium-, and High-Income US Counties. JAMA Netw Open 2018; 1:e183146. [PMID: 30646225 PMCID: PMC6324449 DOI: 10.1001/jamanetworkopen.2018.3146] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There are concerns about the degree to which county income level might underlie the stark disparities in cancer death rates among US counties; at the same time, there is uncertainty about the factors that may mediate the disparities. OBJECTIVES To assess county-level cancer death rates and to identify possible mediators of the association between county-level median incomes and cancer death rates. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study using death records from the National Center for Health Statistics in 2014, with data collected and analyzed between October 1, 2016, and July 31, 2017. All US counties and county equivalents were included. EXPOSURES County-level median household income. MAIN OUTCOMES AND MEASURES County-level age-standardized cancer death rate. RESULTS In 3135 counties, median incomes ranged from $22 126 to $121 250 per year. Low-income counties (median income, $33 445) vs high-income counties (median income, $55 780) had higher proportions of residents who were non-Hispanic black, lived in rural areas, or reported poor or fair health. The mean (SD) cancer death rate was 185.9 (24.4) per 100 000 person-years in high-income counties, compared with 204.9 (26.3) and 229.7 (32.9) per 100 000 person-years in medium- and low-income counties, respectively. In mediation models, health risk behaviors (smoking, obesity, and physical inactivity); clinical care factors (unaffordable care and low-quality care); health environments (food insecurity); and health policies (state smoke-free laws and Medicaid payment rates) in aggregate accounted for more than 80% of the income-related disparity. The strongest possible mediators were food insecurity (explaining 19.1% [95% CI, 12.5%-26.5%] of the association between county incomes and cancer deaths), low-quality care (17.9%; 95% CI, 14.0%-21.8%), smoking (12.7%; 95% CI, 9.4%-15.6%), and physical inactivity (12.2%; 95% CI, 9.4%-15.6%). CONCLUSIONS AND RELEVANCE There are wide gaps in cancer death rates between low-, medium-, and high-income counties. Future studies are needed to assess whether targeting the possible mediators might ameliorate the substantial socioeconomic cancer disparities.
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Affiliation(s)
- Jeremy M. O’Connor
- Yale University School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program, New Haven, Connecticut
| | - Tannaz Sedghi
- Yale University School of Medicine, New Haven, Connecticut
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University School of Medicine, New Haven, Connecticut
| | | | - Michael J. Kane
- Yale University School of Public Health, New Haven, Connecticut
| | - Cary P. Gross
- Yale University School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program, New Haven, Connecticut
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University School of Medicine, New Haven, Connecticut
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13
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Kiviniemi MT, Klasko-Foster LB, Erwin DO, Jandorf L. Decision-making and socioeconomic disparities in colonoscopy screening in African Americans. Health Psychol 2018; 37:481-490. [PMID: 29595298 PMCID: PMC5920714 DOI: 10.1037/hea0000603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Socioeconomic status (SES) disparities in colorectal cancer screening are persistent. Lower education and income are both associated with lower screening rates. Both cognitive (e.g., perceived barriers) and affective (e.g., disgust, fear) decision-making constructs are known determinants of colorectal cancer screening behavior. This study tests the hypotheses that SES may be related to decision-making constructs and that this SES-decision-making construct relation may contribute to explaining the SES-screening behavior disparity. METHOD Surveys assessing perceived benefits and barriers to screening, self-efficacy, positive and negative affective associations with colonoscopy, fear of colonoscopy, colorectal cancer knowledge, past screening behavior, and demographics including education and income were completed by 2,015 African American participants ages 50 and older. Both univariable and multivariable relations of SES to decision-making constructs were examined, as were univariable and multivariable models of the indirect effect of SES on screening via decision-making constructs. RESULTS Socioeconomic status was related to both screening compliance and the decision-making constructs. Bootstrap modeling of the indirect effect showed that the total effect of the SES-screening behavior relation included an indirect effect via social cognitive decision-making constructs. CONCLUSION These findings suggest that cognitive and affective decision-making constructs account for at least some of the SES disparities in colorectal cancer screening behavior. As such, more research is needed to explore the intra individual-level influences of disparities in colorectal cancer screening. In addition, work is needed to develop effective intervention approaches to address the relation of SES to decision-making constructs. (PsycINFO Database Record
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Affiliation(s)
| | | | - Deborah O Erwin
- Office of Cancer Health Disparities Research, Roswell Park Cancer Institute
| | - Lina Jandorf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai
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Ansa BE, Coughlin SS, Alema-Mensah E, Smith SA. Evaluation of Colorectal Cancer Incidence Trends in the United States (2000-2014). J Clin Med 2018; 7:jcm7020022. [PMID: 29385768 PMCID: PMC5852438 DOI: 10.3390/jcm7020022] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 12/18/2022] Open
Abstract
Colorectal cancer (CRC) incidence rates have declined in recent years for people of all races/ethnicities; however, the extent to which the decrease varies annually by demographic and disease-related characteristics is largely unknown. This study examines trends and annual percent change (APC) in the incidence among persons diagnosed with CRC in the United States of America from 2000-2014. The data obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program were analyzed, and all persons (N = 577,708) with malignant CRC recorded in the SEER 18 database from 2000 to 2014 were characterized according to sex, race, age at diagnosis, disease site and stage. Incidence rates and APC were calculated for the entire study period. Overall, the incidence rate of CRC decreased from 54.5 in 2000 to 38.6 per 100,000 in 2014, with APC = -2.66 (p < 0.0001). Decline in rates was most profound between 2008 and 2011 from 46.0 to 40.7 per 100,000 (APC = -4.04; p < 0.0001). Rates were higher for males (vs. females; rate ratio (RR) = 1.33) and for blacks (vs. whites; RR = 1.23). Proximal colon cancers at the localized stage were the predominant cancers. An increase in rate was observed among people younger than 50 years (6.6 per 100,000, APC= 1.5). The annual rate of CRC has decreased over time. However, the development and implementation of interventions that further reduce the disparities among demographic and disease-related subgroups are warranted.
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Affiliation(s)
- Benjamin E Ansa
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA.
| | - Steven S Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA.
| | - Ernest Alema-Mensah
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA.
| | - Selina A Smith
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
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15
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Liang PS, Mayer JD, Wakefield J, Ko CW. Temporal Trends in Geographic and Sociodemographic Disparities in Colorectal Cancer Among Medicare Patients, 1973-2010. J Rural Health 2016; 33:361-370. [PMID: 27578387 DOI: 10.1111/jrh.12209] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/08/2016] [Accepted: 07/18/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Colorectal cancer (CRC) incidence and mortality in the United States have steadily declined since the 1980s, but racial and socioeconomic disparities remain. The influence of geographic factors is poorly understood and may be affected by evolving insurance coverage and screening test uptake. We characterized temporal trends in the association between geographic and sociodemographic factors and CRC outcomes. METHODS We used the 1973-2010 SEER-Medicare files to identify patients aged ≥65 years with and without CRC. Beneficiary residential ZIP codes were used to extract local-level data. We constructed multivariable logistic regression models for CRC incidence and mortality using geographic and sociodemographic variables in 4 time periods: (1) 1973-1997; (2) 1998-2001; (3) 2002-2006; and (4) 2007-2010. FINDINGS We analyzed 1,093,758 records, including 336,321 CRC cases. Compared to urban residence, small rural residence was strongly associated with increased CRC incidence (OR 1.50, 95% CI: 1.43-1.57) and mortality (OR 1.35, 95% CI: 1.26-1.45) in 1973-1997, but the associations diminished by 2007-2010 (OR 1.09, 95% CI: 1.04-1.15 for incidence; OR 1.10, 95% CI: 1.01-1.20 for mortality). The disparity between blacks and whites increased over time for both incidence (OR 1.09, 95% CI: 1.05-1.13 in 1973-1997 vs OR 1.32, 95% CI: 1.27-1.37 in 2007-2010) and mortality (OR 1.22, 95% CI: 1.16-1.28 in 1973-1997 vs OR 1.34, 95% CI: 1.26-1.42 in 2007-2010). High socioeconomic status was associated with greater incidence and mortality in 1973-1997, but it became protective after 1998. CONCLUSIONS Although disparities persist among Medicare beneficiaries, the relationship between geographic and sociodemographic factors and CRC incidence and mortality has evolved over time.
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Affiliation(s)
- Peter S Liang
- Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York.,VA New York Harbor Healthcare System, New York, New York
| | - Jonathan D Mayer
- Departments of Epidemiology and Medical Geography, University of Washington, Seattle, Washington
| | - Jon Wakefield
- Departments of Statistics and Biostatistics, University of Washington, Seattle, Washington
| | - Cynthia W Ko
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington
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Watt GP, Vatcheva KP, Griffith DM, Reininger BM, Beretta L, Fallon MB, McCormick JB, Fisher-Hoch SP. The Precarious Health of Young Mexican American Men in South Texas, Cameron County Hispanic Cohort, 2004-2015. Prev Chronic Dis 2016; 13:E113. [PMID: 27560721 PMCID: PMC5003530 DOI: 10.5888/pcd13.160020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction Hispanic men have higher rates of illness and death from various chronic conditions than do non-Hispanic men. We aimed to characterize the health of Mexican American men living on the US–Mexico border in South Texas and elucidate indications of chronic disease in young men. Methods We sampled all male participants from the Cameron County Hispanic Cohort, an ongoing population-based cohort of Mexican Americans in Brownsville, Texas. We calculated descriptive statistics and stratified the sample into 3 age groups to estimate the prevalence of sociodemographic, behavioral, and clinical factors by age group and evaluated differences between age groups. Results Obesity prevalence was approximately 50% across all age groups (P = .83). Diabetes prevalence was high overall (26.8%), and 16.9% (95% confidence interval [CI], 10.1%–23.8%) of men younger than 35 had diabetes. More than 70% of these young men had elevated liver enzymes, and mean values of aspartate aminotransferase were significantly higher in younger men (45.0 u/L; 95% CI, 39.5–50.6 u/L) than in both older age groups. Less than 20% of young men had any form of health insurance. Current smoking was higher in young men than in men in the other groups, and the rate was higher than the national prevalence of current smoking among Hispanic men. Conclusions We suggest a need for obesity and diabetes prevention programs and smoking cessation programs for men in this region. Opportunities exist to expand current intervention programs and tailor them to better reach this vulnerable population of young Hispanic men. Elevated liver enzymes in men younger than 35 suggest a substantial burden of liver abnormalities, a finding that warrants further study.
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Affiliation(s)
- Gordon P Watt
- University of Texas School of Public Health, Brownsville Regional Campus, 1 W University Blvd, Brownsville, TX 78520.
| | - Kristina P Vatcheva
- University of Texas School of Public Health, Brownsville Regional Campus, Brownsville, Texas
| | - Derek M Griffith
- Institute for Research on Men's Health, Vanderbilt University, Nashville, Tennessee
| | - Belinda M Reininger
- University of Texas School of Public Health, Brownsville Regional Campus, Brownsville, Texas
| | - Laura Beretta
- Department of Molecular and Cellular Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Michael B Fallon
- Division of Gastroenterology, Hepatology, and Nutrition, The University of Texas Health Science Center at Houston Medical School, Houston, Texas
| | - Joseph B McCormick
- University of Texas School of Public Health, Brownsville Regional Campus, Brownsville, Texas
| | - Susan P Fisher-Hoch
- University of Texas School of Public Health, Brownsville Regional Campus, Brownsville, Texas
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17
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Rust G, Zhang S, Yu Z, Caplan L, Jain S, Ayer T, McRoy L, Levine RS. Counties eliminating racial disparities in colorectal cancer mortality. Cancer 2016; 122:1735-48. [PMID: 26969874 DOI: 10.1002/cncr.29958] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/31/2015] [Accepted: 01/25/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although colorectal cancer (CRC) mortality rates are declining, racial-ethnic disparities in CRC mortality nationally are widening. Herein, the authors attempted to identify county-level variations in this pattern, and to characterize counties with improving disparity trends. METHODS The authors examined 20-year trends in US county-level black-white disparities in CRC age-adjusted mortality rates during the study period between 1989 and 2010. Using a mixed linear model, counties were grouped into mutually exclusive patterns of black-white racial disparity trends in age-adjusted CRC mortality across 20 three-year rolling average data points. County-level characteristics from census data and from the Area Health Resources File were normalized and entered into a principal component analysis. Multinomial logistic regression models were used to test the relation between these factors (clusters of related contextual variables) and the disparity trend pattern group for each county. RESULTS Counties were grouped into 4 disparity trend pattern groups: 1) persistent disparity (parallel black and white trend lines); 2) diverging (widening disparity); 3) sustained equality; and 4) converging (moving from disparate outcomes toward equality). The initial principal component analysis clustered the 82 independent variables into a smaller number of components, 6 of which explained 47% of the county-level variation in disparity trend patterns. CONCLUSIONS County-level variation in social determinants, health care workforce, and health systems all were found to contribute to variations in cancer mortality disparity trend patterns from 1990 through 2010. Counties sustaining equality over time or moving from disparities to equality in cancer mortality suggest that disparities are not inevitable, and provide hope that more communities can achieve optimal and equitable cancer outcomes for all. Cancer 2016;122:1735-48. © 2016 American Cancer Society.
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Affiliation(s)
- George Rust
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL.,Department of Community Health And Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Shun Zhang
- Statistics and Methodology Department, NORC at the University of Chicago, Chicago, Illinois
| | - Zhongyuan Yu
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey
| | - Lee Caplan
- Deparment of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Sanjay Jain
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Turgay Ayer
- Department of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Luceta McRoy
- School of Business and Management, Southern Adventist University, Collegedale, Tennessee
| | - Robert S Levine
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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18
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Faruque FS, Zhang X, Nichols EN, Bradley DL, Reeves-Darby R, Reeves-Darby V, Duhé RJ. The impact of preventive screening resource distribution on geographic and population-based disparities in colorectal cancer in Mississippi. BMC Res Notes 2015; 8:423. [PMID: 26351100 PMCID: PMC4562344 DOI: 10.1186/s13104-015-1352-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 08/17/2015] [Indexed: 12/22/2022] Open
Abstract
Background The state of Mississippi has the highest colorectal cancer (CRC) mortality rate in the USA. The geographic distribution of CRC screening resources and geographic- and population-based CRC characteristics in Mississippi are investigated to reveal the geographic disparity in CRC screening. Methods The primary practice sites of licensed gastroenterologists and the addresses of licensed medical facilities offering on-site colonoscopies were verified via telephone surveys, then these CRC screening resource data were geocoded and analyzed using Geographic Information Systems. Correlation analyses were performed to detect the strength of associations between CRC screening resources, CRC screening behavior and CRC outcome data. Results Age-adjusted colorectal cancer incidence rates, mortality rates, mortality-to-incidence ratios, and self-reported endoscopic screening rates from the years 2006 through 2010 were significantly different for Black and White Mississippians; Blacks fared worse than Whites in all categories throughout all nine Public Health Districts. CRC screening rates were negatively correlated with CRC incidence rates and CRC mortality rates. The availability of gastroenterologists varied tremendously throughout the state; regions with the poorest CRC outcomes tended to be underserved by gastroenterologists. Conclusions Significant population-based and geographic disparities in CRC screening behaviors and CRC outcomes exist in Mississippi. The effects of CRC screening resources are related to CRC screening behaviors and outcomes at a regional level, whereas at the county level, socioeconomic factors are more strongly associated with CRC outcomes. Thus, effective control of CRC in rural states with high poverty levels requires both adequate preventive CRC screening capacity and a strategy to address fundamental causes of health care disparities.
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Affiliation(s)
- Fazlay S Faruque
- GIS and Remote Sensing Program, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA.
| | - Xu Zhang
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA.
| | - Elizabeth N Nichols
- Murrah High School, Jackson, MS, 39216, USA. .,Vanderbilt University, Nashville, TN, 37240, USA.
| | - Denae L Bradley
- Murrah High School, Jackson, MS, 39216, USA. .,University of Mississippi, Oxford, MS, 38677, USA.
| | | | | | - Roy J Duhé
- Department of Radiation Oncology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216-4505, USA. .,Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA. .,UMMC Cancer Institute, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA.
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Nieder C, Angelo K, Dalhaug A, Pawinski A, Haukland E, Norum J. Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists. Oncol Lett 2015; 10:3043-3049. [PMID: 26722287 DOI: 10.3892/ol.2015.3656] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 08/05/2015] [Indexed: 12/12/2022] Open
Abstract
Oncologists commonly overestimate the survival time of patients receiving palliative therapy, which may result in the administration of treatments that are too aggressive for patients near the end of their lives. Previous studies have discussed the negative implications of palliative radiotherapy if administered during the last month of life. Models predicting a limited survival time may improve the ability of the oncologists to tailor the treatment according to the needs of each individual patient. In the present study, prognostic factors for survival time, and the use of palliative radiotherapy during the last month of life, were analyzed in 873 patients. Models predicting the likelihood of administering such therapy were examined, and the risk of receiving radiotherapy during the last month of life was observed to be lower in patients with non-metastatic cancer than in those with metastatic cancer (7 vs. 13%, respectively; P=0.12). On multivariate analysis, 11 factors that significantly influenced the survival time were identified. These findings emphasize the complexity of potential prediction models. The most important risk factor regarding the prediction of extremely short survival times was observed to be an Eastern Cooperative Oncology Group performance status (ECOG PS) of 4, followed by an ECOG PS of 3 (median survival times, 14 and 64 days, respectively). A limited number of patients who received palliative radiotherapy during their last month of life died unexpectedly. Disease-specific prediction models were developed; however, the small number of events available for analysis limited their immediate clinical impact. Furthermore, these prediction models identified a minority of patients who received radiotherapy during the last month of life. In conclusion, the majority of the palliative radiotherapy courses administered to patients with advanced cancer during their last month of life may be preventable if accurate decision models for the clinic are developed. However, due to the complexity associated with the prediction of survival times in patients receiving palliative radiotherapy, large databases are required to allow accurate models to be established. The present study also discusses the recommendations of the Department of Oncology and Palliative Medicine of Nordland Hospital (Bodø, Nordland, Norway) with regard to the use of palliative radiotherapy during the last month of life of patients with terminal cancer.
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Affiliation(s)
- Carsten Nieder
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Troms 9037, Norway ; Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Nordland 8092, Norway
| | - Kent Angelo
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Troms 9037, Norway
| | - Astrid Dalhaug
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Troms 9037, Norway ; Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Nordland 8092, Norway
| | - Adam Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Nordland 8092, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Nordland 8092, Norway
| | - Jan Norum
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Troms 9037, Norway ; Department of Radiology, University Hospital of North Norway, Tromsø, Troms 9038, Norway
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Mehrabani D, Shamsdin SA, Dehghan A, Safarpour A. Clinical significance of serum vascular endothelial growth factor and complement 3a levels in patients with colorectal cancer in southern Iran. Asian Pac J Cancer Prev 2015; 15:9713-7. [PMID: 25520093 DOI: 10.7314/apjcp.2014.15.22.9713] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colon cancer (CRC) is perhaps the second most common cause of cancer mortality. This study determined the clinical significance of serum vascular endothelial growth factor (VEGF) and serum complement 3a (C3a) levels in patients with CRC in Fars province, southern Iran. MATERIALS AND METHODS Between June 2010 and June 2012, 110 patients with CRC of both genders and different age groups were divided into 3 groups. Group A included patients who had just undergone surgery; Group B had undergone chemotherapy after surgery; and Group C had undergone chemotherapy and radiotherapy after surgery. Twenty one healthy subjects with normal colonoscopy were considered as a control group. ELISA was undertaken to determine VEGF and C3a levels before and after treatment measures. RESULTS The mean age of patients was 53.9±14.1 years. Considering VEGF level, a significant decrease was visible after treatment measures in groups A and B, but not Group C. For VEGF level, the difference was not statistically significant between two genders and various age groups before and after treatment. No significant difference was found for VEGF level between patients and normal group before any treatment. Regarding C3a levels in 101 subjects, they significantly decreased after treatment measures. Before and after treatment, the difference was statistically significant between two genders, but was not statistically significant among various age groups. CONCLUSIONS As VEGF and C3a levels were significantly lower in patients after treatment, these may be beneficial markers in assessment of CRC therapy especially in early stages.
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Affiliation(s)
- Davood Mehrabani
- Stem Cell and Transgenic Technology Research Center, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran E-mail :
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