Is mortality after childhood cancer dependent on social or economic resources of parents? A population‐based study

Diagnostic and treatment protocols for childhood cancer are generally standardized, and therefore, survival ought to be fairly equal across social strata in societies with free public health care readily available. Nevertheless, our study explores whether there are disparities in mortality after childhood cancer in Norway depending on socioeconomic status of parents. Limited knowledge on differentials exists from earlier analyses. Discrete-time hazard regression models for all-cause mortality for the first 10 years after diagnosis were estimated for all Norwegian children (younger than 20 years), who were diagnosed with cancer during 1974-2007 (N = 6,280), using data from five national registers. Mortality was reduced by about 15% for children with highly educated mothers and children without siblings. These effects were most pronounced for cancers predicted to encompass intense, long-lasting treatments resulting in chronic health problems. Neither earnings nor the marital status of parents affected children's survival. This large, registry-based study suggests that time constraints and various noneconomic rewards of parents from their education appears to have an impact on childhood cancer survival. It may be that children with resourceful parents are healthier at the outset and/or are more likely to avoid later health problems. It may also be that children of well-informed and strongly involved parents are offered better treatment or are able to make better use of what is offered, for instance, by adhering more closely to recommendations for follow-up treatment. The possibility of such differentials in offered and actual treatment should be addressed in future research.     

Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer

BACKGROUND:

This study seeks to examine the relation between sociodemographic characteristics and the utilization of fertility preservation services in reproductive age women diagnosed with cancer.

METHODS:

A total of 1041 women diagnosed with cancer between the ages of 18 and 40 years responded to a retrospective survey on demographic information and reproductive health history. Five cancer types were included: leukemia, Hodgkin disease, non‐Hodgkin lymphoma, breast cancer, and gastrointestinal cancer. Nine hundred eighteen women reported treatment with potential to affect fertility (chemotherapy, pelvic radiation, pelvic surgery, or bone marrow transplant). Student t test, linear regression, and multivariate logistic regression were used where appropriate to determine the relation between sociodemographic characteristics and the odds of using fertility preservation services.

RESULTS:

Sixty‐one percent of women were counseled on the risk of cancer treatment to fertility by the oncology team. Overall, 4% of women pursued fertility preservation. In multivariate analysis, women who had not attained a bachelor's degree (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.5‐0.9) were less likely to be counseled. Trends also suggested possible disparities in access to fertility preservation with age older than 35 years (OR, 0.1; 95% CI, 0.0‐1.4) or previous children (OR, 0.3; 95% CI, 0.1‐1.1) at diagnosis. Disparities in access to fertility preservation based on ethnicity and sexual orientation were also observed.

CONCLUSIONS:

Sociodemographic health disparities likely affect access to fertility preservation services. Although awareness of fertility preservation has improved in the past decade, an unmet need remains for reproductive health counseling and fertility preservation in reproductive age women diagnosed with cancer. Cancer 2012. © 2012 American Cancer Society.     

Early referral to supportive care specialists for symptom burden in lung cancer patients: a comparison of non-Hispanic whites, Hispanics, and non-Hispanic blacks

BACKGROUND:

Effective management of symptoms in cancer patients requires early intervention. This study assessed whether the timing of referral to the Supportive Care Center (SCC) and symptom burden outcome varied by race or ethnicity in lung cancer patients who had been seen at a tertiary cancer center.

METHODS:

Non‐Hispanic white (n = 752), Hispanic (n = 111), and non‐Hispanic black (n = 117) patients with nonsmall cell lung cancer comprised this sample. Data on sociodemographic factors, stage of disease, comorbid conditions, and symptom severity (pain, depressed mood, fatigue) served as potential predictor variables.

RESULTS:

Whereas the mean time (15 months; median = 7 months) from initial presentation at the cancer center to referral to the SCC did not vary by race or ethnicity, we found that Hispanics and non‐Hispanic blacks had higher symptom burden when they first presented at the cancer center than non‐Hispanic whites. Severe pain, depressed mood, and fatigue were significant predictors for early referral (<7 months) of non‐Hispanic whites, but only severe fatigue (P <.05) was predictive of early referral for Hispanics and non‐Hispanic blacks. Furthermore, while the proportion of non‐Hispanic white patients reporting severe pain, depressed mood, and fatigue significantly decreased (P <.001) at first follow‐up visit after referral to the SCC; among Hispanics, improvement was only observed for depressed mood. No improvement in any of these symptoms was observed for non‐Hispanic blacks.

CONCLUSIONS:

Whereas the timing of referral to supportive services did not vary by race, disparities in symptom burden outcomes persisted. Additional studies are needed to validate our findings. Cancer 2012;. © 2011 American Cancer Society.     

Improving prognosis of glioblastoma in the 21st century: Who has benefited most?

BACKGROUND:

Glioblastoma multiforme (GBM) is the most frequent primary brain tumor in adults. Temozolomide was rapidly incorporated into first‐line treatment following the publication of the pivotal European Organization for Research and Treatment of Cancer–National Cancer Institute of Canada phase 3 trial in 2005. However, in the trial, enrollment was limited to younger patients with good performance status. Therefore, this study performed a population‐based survival analysis of patients with newly diagnosed GBM covering the period before and after the introduction of temozolomide.

METHODS:

Survival statistics and clinical and demographic variables were extracted from the Survival, Epidemiology and End Results Database for patients diagnosed with GBM from 2001 to 2007. Mean regional income for each patient was also collected. Survival was analyzed using the Kaplan‐Meier method and proportional hazard models.

RESULTS:

A total of 13,003 adult patients diagnosed with a GBM were identified. Prognostic variables included age <70 years, use of radiation, gross total resection, and residence in a high‐income district (P < .001). Between 2001 and 2007, the median survival time increased from 7 to 9 months for the entire population. The 1‐year survival increased from 29% to 39%. Prognosis of patients aged 70 or more years did not improve over this time. Over the study period, the absolute disparity in 1‐year survival between low‐ and high‐income districts increased from 6.6% to 10.1%.

CONCLUSIONS:

There has been a stepwise improvement in the overall survival of patients with GBM between 2001 and 2007. This improvement has been confined to patients <70 years of age and has been most prominent among patients living in high‐income districts. Cancer 2012. © 2011 American Cancer Society.     

Racial and Ethnic Differences in the Mental Health Needs and Access to Care of Older Adults in California

Little is known about the unmet mental health needs of minority older adults. Racial and ethnic differences in the prevalence rates of psychological distress and reported need and use of mental health services were examined in a population‐based sample of older adults using the 2005 California Health Interview Survey. The sample comprised 16,974 people aged 55 and older, with 13,974 non‐Hispanic whites, 719 African Americans, 1,215 Asians, and 1,066 Latinos. Respondents were compared in terms of prevalence of symptoms of mental distress and serious mental illness, reported need for help, and access to mental health services. African Americans, Asians, and Latinos were more likely to have mental distress than whites (21.2–24.2% vs 14.4%, P<.001) and a higher prevalence of serious mental illness (4.1–7.7% vs 2.5%, P<.001). After adjustment for age, sex, birthplace, marital status, education, limited English proficiency, chronic health conditions, and insurance status, older African‐American (adjusted odds ratio (aOR)=1.37, 95% confidence interval (CI)=1.04–1.81) and Asian (aOR=1.50, CI=1.13–2.00) adults still had greater odds of mental distress than whites. Furthermore, all three groups had worse access to mental health services than whites (African American aOR=0.64, 95% CI=0.43–0.96; Asian aOR=0.32, CI=0.16–0.63; Latino aOR=0.35, CI=0.17–0.70). Clinicians caring for older individuals should be aware of their high risk for mental health needs. Given that minorities' access to mental health services is worse than whites', even after adjusting for health insurance status, providing insurance alone will not eliminate this disparity. Innovative clinical and systemic strategies are needed to better identify individuals at risk and to provide needed services.     

Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors

Background This paper describes the ethnic and socioeconomic correlates of functioning in a cohort of long-term nonrecurring breast cancer survivors. Methods Participants (n = 804) in this study were women from the Health, Eating, Activity, and Lifestyle (HEAL) Study, a population-based, multicenter, multiethnic, prospective study of women newly diagnosed with in situ or Stages I to IIIA breast cancer. Measurements occurred at three timepoints following diagnosis. Outcomes included standardized measures of functioning (MOS SF-36). Results Overall, these long-term survivors reported values on two physical function subscales of the SF-36 slightly lower than population norms. Black women reported statistically significantly lower physical functioning (PF) scores (P = 0.01), compared with White and Hispanic women, but higher mental health (MH) scores (P < 0.01) compared with White and Hispanic women. In the final adjusted model, race was significantly related to PF, with Black participants and participants in the “Other” ethnic category reporting poorer functioning compared to the White referent group (P < 0.01, 0.05). Not working outside the home, being retired or disabled and being unemployed (on leave, looking for work) were associated with poorer PF compared to currently working (both P < 0.01). Conclusion These data indicate that race/ethnicity influences psychosocial functioning in breast cancer survivors and can be used to identify need for targeted interventions to improve functioning.     

Disparities in self-reported geriatric depressive symptoms due to sociodemographic differences: An extension of the bi-factor item response theory model for use in differential item functioning

This study evaluates the measurement noninvariance, or differential item functioning (DIF), in the Center for Epidemiological Studies-Depression (CES-D) items attributable to age, sex, and race/ethnicity among community-dwelling older adults. Participants (N = 2773) were from the New Haven site of the Established Populations for Epidemiologic Studies in the Elderly. Statistical analyses included exploratory factor analysis, bi-factor confirmatory factor analysis, and a bi-factor multiple indicator and multiple causes (MIMIC) model to address measurement noninvariance. Blacks, compared with whites, were more likely to endorse items loading on the interpersonal factor, which include “people dislike me” and “people are unfriendly.” Women were less likely to endorse the interpersonal items and the “I felt like a failure” item (odds ratio [OR] = 0.63, 95% confidence interval [CI]: 0.42, 0.94) than men. But women had a higher proportional odds than men for endorsing the “crying” item (OR = 1.86, 95% CI: 1.17, 2.96). Those 75 years and older (relative to those aged 65-74) were less likely to endorse the “I felt like a failure” item (OR = 0.65, 95% CI: 0.43, 0.97). However, measurement noninvariance found in both the “crying” and “failure” items were attributable to women and to those aged 75 and older were trivial after controlling for the underlying level of depressive symptomatology. Therefore, the interpersonal items showed measurement noninvariance attributable to sex and race. The bi-factor MIMIC model is useful for examining measurement noninvariance due to sociodemographics in a multidimensional depression instrument.     

Predictors of Having a Potential Live Donor: A Prospective Cohort Study of Kidney Transplant Candidates

The barriers to live donor transplantation are poorly understood. We performed a prospective cohort study of individuals undergoing renal transplant evaluation. Participants completed a questionnaire that assessed clinical characteristics as well as knowledge and beliefs about transplantation. A participant satisfied the primary outcome if anyone contacted the transplant center to be considered as a live donor for that participant. The final cohort comprised 203 transplant candidates, among whom 80 (39.4%) had a potential donor contact the center and 19 (9.4%) underwent live donor transplantation. In multivariable logistic regression, younger candidates (OR 1.65 per 10 fewer years, p < 0.01) and those with annual income ≥US$ 15 000 (OR 4.22, p = 0.03) were more likely to attract a potential live donor. Greater self‐efficacy, a measure of the participant's belief in his or her ability to attract a donor, was a predictor of having a potential live donor contact the center (OR 2.73 per point, p < 0.01), while knowledge was not (p = 0.56). The lack of association between knowledge and having a potential donor suggests that more intensive education of transplant candidates will not increase live donor transplantation. On the other hand, self‐efficacy may be an important target in designing interventions to help candidates find live donors.