Dong Wook Shin1, Jong Ho Cho2, Jae Myoung Noh3, Hyesook Han4, Kyungdo Han5, Sang Hyun Park5, So Young Kim6, Jong Heon Park7, Jong Hyock Park8, Ichiro Kawachi9. 1. Supportive Care Center, Department of Family Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea. 2. Department of Thoracic Surgery, Samsung Medical Center, Seoul, Republic of Korea. 3. Department of Radiation Oncology, Samsung Medical Center, Seoul, Republic of Korea. 4. Division of Hemato-Oncology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea. 5. Department of Medical Statistics, The Catholic University of Korea, Seoul, Republic of Korea. 6. Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea; College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea. 7. Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea. 8. College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea; Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea. Electronic address: jonghyock@gmail.com. 9. T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
Abstract
INTRODUCTION: Potential disparities in the diagnosis, treatment, and survival of patients with lung cancer with and without disabilities have rarely been investigated. METHODS: We conducted a retrospective cohort study with a data set linking the Korean National Health Service database, disability registration data, and Korean Central Cancer Registry data. A total of 13,591 people with disabilities in whom lung cancer had been diagnosed and 43,809 age- and sex-matched control subjects in whom lung cancer had been diagnosed were included. RESULTS: Unknown stage was more common in people with severe disabilities (13.1% versus 10.3%), especially those with a communication (14.2%) or mental/cognitive disability (15.7%). People with disabilities were less likely to undergo a surgical procedure (adjusted OR [aOR] = 0.82, 95% confidence interval [CI]: 0.77-0.86), chemotherapy (aOR = 0.80, 95% CI: 0.77-0.84), or radiotherapy (aOR = 0.92, 95% CI: 0.88-0.96). This higher likelihood was more evident for people with severe communication impairment (aORs of 0.46 for surgery and 0.64 for chemotherapy) and severe brain/mental impairment (aORs 0.39 for surgery, 0.47 for chemotherapy, and 0.49 for radiotherapy). Patients with disabilities had a slightly higher overall mortality than did people with no disability (adjusted hazard ratio = 1.08, 95% CI: 1.06-1.11), especially in the group with a severe disability (a hazard ratio = 1.20, 95% CI: 1.16-1.24). CONCLUSIONS: Patients with lung cancer and disabilities, especially severe ones, underwent less staging work-up and treatment even though their treatment outcomes were only slightly worse than those of people without a disability. Although some degree of disparity might be attributed to reasonable clinical judgement, unequal clinical care for people with communication and brain/mental disabilities suggests unjustifiable disability-related barriers that need to be addressed.
INTRODUCTION: Potential disparities in the diagnosis, treatment, and survival of patients with lung cancer with and without disabilities have rarely been investigated. METHODS: We conducted a retrospective cohort study with a data set linking the Korean National Health Service database, disability registration data, and Korean Central Cancer Registry data. A total of 13,591 people with disabilities in whom lung cancer had been diagnosed and 43,809 age- and sex-matched control subjects in whom lung cancer had been diagnosed were included. RESULTS: Unknown stage was more common in people with severe disabilities (13.1% versus 10.3%), especially those with a communication (14.2%) or mental/cognitive disability (15.7%). People with disabilities were less likely to undergo a surgical procedure (adjusted OR [aOR] = 0.82, 95% confidence interval [CI]: 0.77-0.86), chemotherapy (aOR = 0.80, 95% CI: 0.77-0.84), or radiotherapy (aOR = 0.92, 95% CI: 0.88-0.96). This higher likelihood was more evident for people with severe communication impairment (aORs of 0.46 for surgery and 0.64 for chemotherapy) and severe brain/mental impairment (aORs 0.39 for surgery, 0.47 for chemotherapy, and 0.49 for radiotherapy). Patients with disabilities had a slightly higher overall mortality than did people with no disability (adjusted hazard ratio = 1.08, 95% CI: 1.06-1.11), especially in the group with a severe disability (a hazard ratio = 1.20, 95% CI: 1.16-1.24). CONCLUSIONS:Patients with lung cancer and disabilities, especially severe ones, underwent less staging work-up and treatment even though their treatment outcomes were only slightly worse than those of people without a disability. Although some degree of disparity might be attributed to reasonable clinical judgement, unequal clinical care for people with communication and brain/mental disabilities suggests unjustifiable disability-related barriers that need to be addressed.
Authors: YoungJee Kim; Dong Wook Shin; Hyoung Woo Kim; Jin Hyung Jung; Kyungdo Han; In Young Cho; So Young Kim; Kui Son Choi; Jong Heon Park; Jong Hyock Park; Ichiro Kawachi Journal: Gastric Cancer Date: 2019-11-01 Impact factor: 7.370
Authors: Jin Young Choi; Kyoung Eun Yeob; Seung Hwa Hong; So Young Kim; Eun-Hwan Jeong; Dong Wook Shin; Jong Heon Park; Gil-Won Kang; Hak Soon Kim; Jong Hyock Park; Ichiro Kawachi Journal: Cancer Control Date: 2021 Jan-Dec Impact factor: 3.302