Elliott K Yee1,2, Natalie G Coburn2,3,4,5, Victoria Zuk2, Laura E Davis6, Alyson L Mahar7, Ying Liu4, Vaibhav Gupta2,4, Gail Darling4,8,9, Julie Hallet10,11,12,13. 1. Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 2. Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. 3. Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 4. Department of Surgery, University of Toronto, Toronto, ON, Canada. 5. ICES, Toronto, ON, Canada. 6. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. 7. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 8. Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada. 9. Toronto General Hospital Research Institute, Toronto General Hospital, Toronto, ON, Canada. 10. Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. Julie.hallet@sunnybrook.ca. 11. Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Julie.hallet@sunnybrook.ca. 12. Department of Surgery, University of Toronto, Toronto, ON, Canada. Julie.hallet@sunnybrook.ca. 13. ICES, Toronto, ON, Canada. Julie.hallet@sunnybrook.ca.
Abstract
BACKGROUND: Among patients not undergoing curative-intent therapy for esophagogastric cancer, access to care may vary. We examined the geographic distribution of care delivery and survival and their relationship with distance to cancer centres for non-curative esophagogastric cancer, hypothesising that patients living further from cancer centres have worse outcomes. METHODS: We conducted a population-based analysis of adults with non-curative esophagogastric cancer from 2005 to 2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival. Using geographic information system analysis, we mapped locations of cancer centres and outcomes across census divisions. Bivariate choropleth maps identified regional outcome discordances. Multivariable regression models assessed the relationship between distance from patient residence to the nearest cancer centre and outcomes, adjusting for demographic, clinical, and socioeconomic factors. RESULTS: Of 10,228 patients surviving a median 5.1 months (IQR: 2.0-12.0), 68.5% had medical oncology consultation and 32.2% received chemotherapy. Certain distances (reference ≤ 10 km) were associated with lower consultation [relative risk 0.79 (95% CI 0.63-0.97) for ≥ 101 km], chemotherapy receipt [relative risk 0.67 (95% CI 0.53-0.85) for ≥ 101 km], and overall survival [hazard ratio 1.07 (95% CI 1.02-1.13) for 11-50 km, hazard ratio 1.13 (95% CI 1.04-1.23) for 51-100 km]. CONCLUSION: A third of patients did not see medical oncology and most did not receive chemotherapy. Outcomes exhibited high geographic variability. Location of residence influenced outcomes, with inferior outcomes at certain distances > 10 km from cancer centres. These findings are important for designing interventions to reduce access disparities for non-curative esophagogastric cancer care.
BACKGROUND: Among patients not undergoing curative-intent therapy for esophagogastric cancer, access to care may vary. We examined the geographic distribution of care delivery and survival and their relationship with distance to cancer centres for non-curative esophagogastric cancer, hypothesising that patients living further from cancer centres have worse outcomes. METHODS: We conducted a population-based analysis of adults with non-curative esophagogastric cancer from 2005 to 2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival. Using geographic information system analysis, we mapped locations of cancer centres and outcomes across census divisions. Bivariate choropleth maps identified regional outcome discordances. Multivariable regression models assessed the relationship between distance from patient residence to the nearest cancer centre and outcomes, adjusting for demographic, clinical, and socioeconomic factors. RESULTS: Of 10,228 patients surviving a median 5.1 months (IQR: 2.0-12.0), 68.5% had medical oncology consultation and 32.2% received chemotherapy. Certain distances (reference ≤ 10 km) were associated with lower consultation [relative risk 0.79 (95% CI 0.63-0.97) for ≥ 101 km], chemotherapy receipt [relative risk 0.67 (95% CI 0.53-0.85) for ≥ 101 km], and overall survival [hazard ratio 1.07 (95% CI 1.02-1.13) for 11-50 km, hazard ratio 1.13 (95% CI 1.04-1.23) for 51-100 km]. CONCLUSION: A third of patients did not see medical oncology and most did not receive chemotherapy. Outcomes exhibited high geographic variability. Location of residence influenced outcomes, with inferior outcomes at certain distances > 10 km from cancer centres. These findings are important for designing interventions to reduce access disparities for non-curative esophagogastric cancer care.
Authors: K Muro; E Van Cutsem; Y Narita; G Pentheroudakis; E Baba; J Li; M-H Ryu; W I Wan Zamaniah; W-P Yong; K-H Yeh; K Kato; Z Lu; B C Cho; I M Nor; M Ng; L-T Chen; T E Nakajima; K Shitara; H Kawakami; T Tsushima; T Yoshino; F Lordick; E Martinelli; E C Smyth; D Arnold; H Minami; J Tabernero; J-Y Douillard Journal: Ann Oncol Date: 2019-01-01 Impact factor: 32.976
Authors: Christina Sinding; Rachel Warren; Donna Fitzpatrick-Lewis; Jonathan Sussman Journal: Support Care Cancer Date: 2014-08-14 Impact factor: 3.603
Authors: Jaffer A Ajani; Thomas A D'Amico; Khaldoun Almhanna; David J Bentrem; Stephen Besh; Joseph Chao; Prajnan Das; Crystal Denlinger; Paul Fanta; Charles S Fuchs; Hans Gerdes; Robert E Glasgow; James A Hayman; Steven Hochwald; Wayne L Hofstetter; David H Ilson; Dawn Jaroszewski; Kory Jasperson; Rajesh N Keswani; Lawrence R Kleinberg; W Michael Korn; Stephen Leong; A Craig Lockhart; Mary F Mulcahy; Mark B Orringer; James A Posey; George A Poultsides; Aaron R Sasson; Walter J Scott; Vivian E Strong; Thomas K Varghese; Mary Kay Washington; Christopher G Willett; Cameron D Wright; Debra Zelman; Nicole McMillian; Hema Sundar Journal: J Natl Compr Canc Netw Date: 2015-02 Impact factor: 11.908
Authors: Eric Van Cutsem; Vladimir M Moiseyenko; Sergei Tjulandin; Alejandro Majlis; Manuel Constenla; Corrado Boni; Adriano Rodrigues; Miguel Fodor; Yee Chao; Edouard Voznyi; Marie-Laure Risse; Jaffer A Ajani Journal: J Clin Oncol Date: 2006-11-01 Impact factor: 44.544
Authors: Julie Hallet; Laura E Davis; Alyson L Mahar; Ying Liu; Victoria Zuk; Vaibhav Gupta; Craig C Earle; Natalie G Coburn Journal: Gastric Cancer Date: 2019-10-18 Impact factor: 7.370
Authors: Christina Fitzmaurice; Tomi F Akinyemiju; Faris Hasan Al Lami; Tahiya Alam; Reza Alizadeh-Navaei; Christine Allen; Ubai Alsharif; Nelson Alvis-Guzman; Erfan Amini; Benjamin O Anderson; Olatunde Aremu; Al Artaman; Solomon Weldegebreal Asgedom; Reza Assadi; Tesfay Mehari Atey; Leticia Avila-Burgos; Ashish Awasthi; Huda Omer Ba Saleem; Aleksandra Barac; James R Bennett; Isabela M Bensenor; Nickhill Bhakta; Hermann Brenner; Lucero Cahuana-Hurtado; Carlos A Castañeda-Orjuela; Ferrán Catalá-López; Jee-Young Jasmine Choi; Devasahayam Jesudas Christopher; Sheng-Chia Chung; Maria Paula Curado; Lalit Dandona; Rakhi Dandona; José das Neves; Subhojit Dey; Samath D Dharmaratne; David Teye Doku; Tim R Driscoll; Manisha Dubey; Hedyeh Ebrahimi; Dumessa Edessa; Ziad El-Khatib; Aman Yesuf Endries; Florian Fischer; Lisa M Force; Kyle J Foreman; Solomon Weldemariam Gebrehiwot; Sameer Vali Gopalani; Giuseppe Grosso; Rahul Gupta; Bishal Gyawali; Randah Ribhi Hamadeh; Samer Hamidi; James Harvey; Hamid Yimam Hassen; Roderick J Hay; Simon I Hay; Behzad Heibati; Molla Kahssay Hiluf; Nobuyuki Horita; H Dean Hosgood; Olayinka S Ilesanmi; Kaire Innos; Farhad Islami; Mihajlo B Jakovljevic; Sarah Charlotte Johnson; Jost B Jonas; Amir Kasaeian; Tesfaye Dessale Kassa; Yousef Saleh Khader; Ejaz Ahmad Khan; Gulfaraz Khan; Young-Ho Khang; Mohammad Hossein Khosravi; Jagdish Khubchandani; Jacek A Kopec; G Anil Kumar; Michael Kutz; Deepesh Pravinkumar Lad; Alessandra Lafranconi; Qing Lan; Yirga Legesse; James Leigh; Shai Linn; Raimundas Lunevicius; Azeem Majeed; Reza Malekzadeh; Deborah Carvalho Malta; Lorenzo G Mantovani; Brian J McMahon; Toni Meier; Yohannes Adama Melaku; Mulugeta Melku; Peter Memiah; Walter Mendoza; Tuomo J Meretoja; Haftay Berhane Mezgebe; Ted R Miller; Shafiu Mohammed; Ali H Mokdad; Mahmood Moosazadeh; Paula Moraga; Seyyed Meysam Mousavi; Vinay Nangia; Cuong Tat Nguyen; Vuong Minh Nong; Felix Akpojene Ogbo; Andrew Toyin Olagunju; Mahesh Pa; Eun-Kee Park; Tejas Patel; David M Pereira; Farhad Pishgar; Maarten J Postma; Farshad Pourmalek; Mostafa Qorbani; Anwar Rafay; Salman Rawaf; David Laith Rawaf; Gholamreza Roshandel; Saeid Safiri; Hamideh Salimzadeh; Juan Ramon Sanabria; Milena M Santric Milicevic; Benn Sartorius; Maheswar Satpathy; Sadaf G Sepanlou; Katya Anne Shackelford; Masood Ali Shaikh; Mahdi Sharif-Alhoseini; Jun She; Min-Jeong Shin; Ivy Shiue; Mark G Shrime; Abiy Hiruye Sinke; Mekonnen Sisay; Amber Sligar; Muawiyyah Babale Sufiyan; Bryan L Sykes; Rafael Tabarés-Seisdedos; Gizachew Assefa Tessema; Roman Topor-Madry; Tung Thanh Tran; Bach Xuan Tran; Kingsley Nnanna Ukwaja; Vasiliy Victorovich Vlassov; Stein Emil Vollset; Elisabete Weiderpass; Hywel C Williams; Nigus Bililign Yimer; Naohiro Yonemoto; Mustafa Z Younis; Christopher J L Murray; Mohsen Naghavi Journal: JAMA Oncol Date: 2018-11-01 Impact factor: 31.777