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Racial Disparities in the Time to Treatment in Patients Undergoing Therapy for Stage I Non-small Cell Lung Cancer
Başlık:
Racial Disparities in the Time to Treatment in Patients Undergoing Therapy for Stage I Non-small Cell Lung Cancer
Yazar:
Algan, Ozer, author.
ISBN:
9780438021518
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (76 pages)
Genel Not:
Source: Masters Abstracts International, Volume: 57-06M(E).
Advisors: Janis E. Campbell Committee members: Ann F. Chou; Amanda Janitz; Elizabeth Syzek.
Özet:
Purpose: The purpose of our project was two fold. The first goal was to evaluate potential disparities in the time to treatment by race using a large national database. If disparities in the time to treatment were identified, then the second goal was to evaluate the impact of the time-to-treatment on overall survival.
Methods: We performed a quantitative cohort study, using data from the National Cancer Database for cases diagnosed with Stage I non-small cell lung cancer to evaluate time to start of therapy for four different treatment times: time from diagnosis to start of any treatment, time to surgery, time to start of radiation therapy and time to start of chemotherapy. A directed acyclic graph (DAG) analysis was performed to identify potential mediators of the effect of race on the outcome of interest and adjust for them during data analysis. The DAG model included age, race, income, insurance status, education, Charlson Deyo score, tumor stage, facility type, and the treatment variables for surgery, radiation therapy and chemotherapy as important covariates. The time to treatment was also added to the survival analysis. Cox Proportional Hazards modeling was used to evaluate both the time to start of treatment and well as overall survival. Analysis was performed on SAS version 9.4. All p-values are two-sided with a significance level cut-off of 0.05.
Results: Our analysis demonstrates that for cases with Stage I NSCLC, there were disparities in the time-to-start of treatment when evaluated by race. White cases had the shortest interval to treatment for all treatment modalities evaluated. In general, Asian cases had time to treatments that were closest to white cases, while Hawaiian/Polynesian cases tended to have the longest time to the initiation of therapy. Other covariates associated with the start of treatment included age, socioeconomic factors such as insurance status, education and income, as well as the Charlson-Deyo comorbidities (CDCC) score. Analysis of the impact of time-to-treat on survival revealed two different groups of outcomes. For cases that undergo definitive surgery, a delay in surgery resulted in worse survival outcomes. However, this effect was mainly seen in White cases. Similar findings were also noted for the start of any treatment, 80% of whom also underwent surgical resection. For these two time points, race was also associated with overall survival. In general Asian cases had the best survival outcomes while Hawaiian/Polynesian cases had the worst survival outcomes. The results for the time-to-treatment analysis for cases undergoing radiation therapy and chemotherapy also revealed similar results to each other. However, in this case, starting treatment in the first tertile was associated with worst overall survival times when compared to starting treatment at later times. Potential explanations for these results will be discussed.
Conclusion: Our analysis demonstrates the presence of disparities in the time-to-start of treatment by race for all time points evaluated. White cases had shorter time-to-treatment while AI/AN and Hawaiian/Polynesian cases had the longest time to treatment. Further studies should be performed to better estimate the impact of these disparities in the time to start of therapy on survival outcomes and determine the best interventions to help improve upon these disparities.
Notlar:
School code: 0361
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(691863.1) | 691863-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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