Cancers

Research

14 pages, 221 KiB

Open AccessArticle

Neighborhood Disadvantage, Built Environment, and Breast Cancer Outcomes: Disparities in Tumor Aggressiveness and Survival

by Jie Shen, Yufan Guan, Supraja Gururaj, Kai Zhang, Qian Song, Xin Liu, Harry D. Bear, Bernard F. Fuemmeler, Roger T. Anderson and Hua Zhao

Cancers 2025, 17(9), 1502; https://doi.org/10.3390/cancers17091502 - 29 Apr 2025

Abstract

Background: Breast cancer disparities persist globally, with growing evidence implicating neighborhood and built environmental factors in disease outcomes. Methods: This study investigates the associations between neighborhood disadvantage, environmental exposures, and breast tumor characteristics and survival among 3041 stage I–III breast cancer patients treated [...] Read more.

Background: Breast cancer disparities persist globally, with growing evidence implicating neighborhood and built environmental factors in disease outcomes. Methods: This study investigates the associations between neighborhood disadvantage, environmental exposures, and breast tumor characteristics and survival among 3041 stage I–III breast cancer patients treated at the University of Virginia Comprehensive Cancer Center (2014–2024). Neighborhood disadvantage was assessed via the Area Deprivation Index (ADI), while environmental exposures included PM2.5, green space (NDVI), and food indices (modified retail food environment index (mRFEI), retail food activity index (RFAI)). Multivariable regression and Cox models adjusted for demographic, socioeconomic, and clinical covariates were employed. Results: A higher ADI score was associated with aggressive tumor characteristics, including advanced stage (Odds Ratio (OR) = 1.06, 95% Confidence Interval (CI):1.01–1.11), poor differentiation (OR = 1.07, 1.01–1.15), ER-negative status (OR = 1.06, 1.01–1.12), and triple-negative breast cancer (TNBC) (OR = 1.08, 1.02–1.16), as well as younger diagnosis age (β = −0.22, −0.36 to −0.09). PM2.5 exposure was correlated with advanced tumor stage (OR = 1.24, 1.09–1.40 for stage III) but paradoxically predicted improved survival (Hazard Ratio (HR) = 0.71, 0.63–0.82). The food environment indices showed subtype-specific survival benefits: higher mRFEI and RFAI scores were linked to reduced mortality in ER-negative (HR = 0.45, 0.23–0.85 and HR = 0.61, 0.38–0.97) and TNBC (HR = 0.40, 0.18–0.90 and HR = 0.48, 0.26–0.87) patients. NDVI scores exhibited no significant associations. Conclusion: Our findings underscore the dual role of neighborhood disadvantage and the built environmental in breast cancer outcomes. While neighborhood disadvantage and PM2.5 exposure elevate tumor aggressiveness, survival disparities may be mediated by other factors. Improved food environments may enhance survival in aggressive subtypes, highlighting the need for integrated interventions addressing socioeconomic inequities, environmental risks, and nutritional support needs. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

18 pages, 243 KiB

Open AccessArticle

Disparities in Cervical and Breast Cancer Screening Among Sexual Minority Women in Japan: A Comparative Cross-Sectional Study

by Akemi Hara, Akihiko Ozaki, Michio Murakami, Hiroaki Saito, Mika Nashimoto, Daisuke Hori, Masaharu Tsubokura, Kenji Gonda, Masahiro Wada, Kazunoshin Tachibana, Tohru Ohtake and Takahiro Tabuchi

Cancers 2025, 17(9), 1411; https://doi.org/10.3390/cancers17091411 - 23 Apr 2025

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Abstract

Objectives: While health disparities affecting sexual minority women are well-documented globally, little is known about cancer screening behaviors among sexual minority women in Japan. Following our previous study on breast cancer screening, this study examined cervical cancer screening participation patterns and compared [...] Read more.

Objectives: While health disparities affecting sexual minority women are well-documented globally, little is known about cancer screening behaviors among sexual minority women in Japan. Following our previous study on breast cancer screening, this study examined cervical cancer screening participation patterns and compared screening behaviors between both cancer types among sexual minority women in Japan. Methods: We analyzed data from 13,730 individuals with female sex assigned at birth who participated in a nationwide online survey between September and November 2023. Multinomial logistic regression was used to examine factors associated with screening participation, comparing sexual minority women (n = 2685) and women who are not part of a sexual minority (n = 11,045). Among participants aged 40 and above (n = 8933), we compared participation patterns between cervical and breast cancer screenings. Results: Sexual minority women showed significantly lower cervical cancer screening rates compared to women who are not part of a sexual minority (38.7% vs. 45.6%, p < 0.001), with a wider disparity than observed in breast cancer screening (43.4% vs. 45.9%, p < 0.001). Among those aged 40 and above, sexual minority women were more likely to skip both screenings (35.0% vs. 27.2%) and less likely to participate in both (55.0% vs. 62.6%). Additionally, our analysis revealed that participants with a current mental disorder (i.e., those reporting ongoing mental health issues) were more likely to intend to undergo cervical cancer screening (aOR = 1.39, 95% CI = 1.15–1.67, p = 0.001). In contrast, among bisexual participants and those classified as having “other” mental health conditions—defined as a history of mental health issues without current symptoms—exhibited significantly lower odds of being screened (aOR = 0.31, 95% CI = 0.11–0.82, p = 0.02). Conclusions: Significant disparities exist in cancer screening participation among sexual minority women in Japan, with more pronounced differences in cervical cancer screening compared to breast cancer screening. These findings highlight the need for targeted interventions addressing the unique barriers to gynecological care among sexual minority women. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

26 pages, 1013 KiB

Open AccessArticle

Predictors for Emergency Admission Among Homeless Metastatic Cancer Patients and Association of Social Determinants of Health with Negative Health Outcomes

by Poolakkad S. Satheeshkumar, Stephen T. Sonis, Joel B. Epstein and Roberto Pili

Cancers 2025, 17(7), 1121; https://doi.org/10.3390/cancers17071121 - 27 Mar 2025

Viewed by 358

Abstract

Background/Objectives: Social determinants of health (SDOHs) are especially impactful with respect to emergency reliance among patients with cancer. Methods: To better predict the extent to which SDOHs affect emergency admissions in homeless patients with metastatic disease, we employed machine learning models, Lasso, ridge, [...] Read more.

Background/Objectives: Social determinants of health (SDOHs) are especially impactful with respect to emergency reliance among patients with cancer. Methods: To better predict the extent to which SDOHs affect emergency admissions in homeless patients with metastatic disease, we employed machine learning models, Lasso, ridge, random forest (RF), and elastic net (EN) regression. We also examined prostate cancer (PC), breast cancer (BC), lung (LC) cancer, and cancers of the lip, oral cavity, and pharynx (CLOP) for association between key SDOH variables—homelessness and living alone—and clinical outcomes. For this, we utilized generalized linear models to assess the association while controlling for patient and clinical characteristics. We used the United States National Inpatient Sample database for this study. Results: There were 2635 (weighted) metastatic cancer patients with homelessness. Transfer from another facility or not, elective admission or not, deficiency anemia, alcohol dependence, weekend admission or not, and blood loss anemia were the important predictors of emergency admission. C-statistics were associated with Lasso (train AUC-0.85; test AUC—0.86), ridge (85, 88), RF (0.96, 0.85), and EN (0.83, 0.80), respectively. In the adjusted analysis, PC homelessness was significantly associated with anxiety and depression (5.15, 95% CI: 3.17–8.35) and a longer LOS (1.96; 95% CI: 1.03–3.74). Findings were comparable in the BC, LC, and CLOP cohorts. Cancer patients with poor SDOHs presented with the worst clinical outcomes. Conclusions: Cancer patients with poor SDOH presented with worst clinical outcomes. The findings of this study highlight a vacuum in the cancer literature, and the recommendations stress the value of social support in achieving a better prognosis and Quality of life. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

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18 pages, 4284 KiB

Open AccessArticle

Biosocial Determinants of Health Among Patients with Chronic Liver Disease and Liver Cancer

by Tagari Samanta, Jun Hyoung Park and Benny Abraham Kaipparettu

Cancers 2025, 17(5), 844; https://doi.org/10.3390/cancers17050844 - 28 Feb 2025

Viewed by 591

Abstract

Background: Metabolic disorders and chronic liver disease (CLD) play crucial roles in the development and progression of liver cancer (LC). Since the ethnic minority population increasingly suffers from CLD and LC, it is vital to understand the biosocial factors contributing to CLD and [...] Read more.

Background: Metabolic disorders and chronic liver disease (CLD) play crucial roles in the development and progression of liver cancer (LC). Since the ethnic minority population increasingly suffers from CLD and LC, it is vital to understand the biosocial factors contributing to CLD and LC. The ’All of Us’ database, with significant participation from minority populations, provides a valuable tool for studies in different racial/ethnic groups. Using different databases, including the ‘All of Us’ and ‘The Cancer Genome Atlas’, this study aimed to understand the biosocial factors contributing to CLD and LC. Methods: Using ‘All of Us’ data, confounding factors like the lack of immunization, comorbidities, and socioeconomic status (SES) barriers were analyzed in a cohort of 33767 CLD [non-alcoholic fatty liver disease, alcoholic liver disease, and Hepatitis B and C] patients. Among the 556 LC patients in the ‘All of Us’ database, 92% had CLD. Since hypoxanthine is known to be increased in the urine of LC patients, purine metabolic pathway genes were analyzed using different databases and validated using publicly available RNASeq data. Results: We identified several confounding factors associated with CLD in Hispanic (HA) and African American (AA) populations compared to the non-Hispanic White (NHW) populations. HA and AA CLD patients suffer from high SES barriers. While most of the genes related to the purine metabolic pathway were upregulated in LC, xanthine dehydrogenase (XDH), which converts hypoxanthine to uric acid, showed a downregulation in the tumor compared to the normal tissues. The TCGA data among different racial/ethnic groups showed that only in Asian (AN) LC tumors the XDH expression was significantly lower compared to the NHW. The decreased XDH mRNA expression in AN LC compared to benign tissues was further validated using publicly available RNAseq datasets. Survival analysis confirmed poor overall survival among the AN LC patients with lower XDH expression in their tumors. Conclusions: Our study identified several confounding factors contributing to the minority CLD population. This study also identified decreased XDH expression as a critical metabolic alteration that has clinical significance in AN LC patients. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

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15 pages, 2635 KiB

Open AccessArticle

Impact of Small Area Level Deprivation on Colorectal Cancer Survival: Findings from the Regional Cancer Registry in Korea

by Seung Min Hong, Ahreum Kim, Changhoon Kim, Seunghye Jang, Dong Uk Kim, Dong Hoon Baek, Seung Hun Lee, Yu Hyeon Yi, Heeseung Park, Jonghyun Lee, Tae In Kim and Hyun Joo Lee

Cancers 2025, 17(4), 567; https://doi.org/10.3390/cancers17040567 - 7 Feb 2025

Viewed by 853

Abstract

Background/Objectives: Research on the relationship between small-area-level deprivation and cancer survival, particularly for colorectal cancer (CRC), is lacking. Therefore, we investigated the relationship among small area-level deprivation, individual-level factors, and CRC survival using data from the Busan Regional Cancer Registry. Methods: We analyzed [...] Read more.

Background/Objectives: Research on the relationship between small-area-level deprivation and cancer survival, particularly for colorectal cancer (CRC), is lacking. Therefore, we investigated the relationship among small area-level deprivation, individual-level factors, and CRC survival using data from the Busan Regional Cancer Registry. Methods: We analyzed 34,999 patients with CRC from the Busan Regional Cancer Registry from 2003 to 2020. The primary outcome was CRC mortality. The explanatory variables at the individual level included age, gender, cancer stage, and year of diagnosis, whereas the Deprivation Index (DI) was used at the regional level. We conducted a multilevel survival analysis with frailty to assess the impact of individual- and area-level factors on survival probabilities. Results: In the multilevel survival model, each unit increase in the DI at the area level was associated with a 6.6% decrease in survival probability. When applying Model 2 and deriving regional estimates using the empirical Bayesian estimation method, the graph of the DI (x-axis) against survival probability (y-axis) showed that the slope of the regional DI for the 3-year and 5-year survival probabilities increased compared with the 1-year rate across all stages of the disease. Additionally, the slopes were steeper for the distant stage than for the local or regional stages. Conclusions: Small-area level deprivation negatively affects CRC survival, especially in distant-stage patients and those with longer disease duration. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

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18 pages, 547 KiB

Open AccessArticle

Evaluating Real World Health System Resource Utilization and Costs for a Risk-Based Breast Cancer Screening Approach in the Canadian PERSPECTIVE Integration and Implementation Project

by Soo-Jin Seung, Nicole Mittmann, Zharmaine Ante, Ning Liu, Kristina M. Blackmore, Emilie S. Richard, Anisia Wong, Meghan J. Walker, Craig C. Earle, Jacques Simard and Anna M. Chiarelli

Cancers 2024, 16(18), 3189; https://doi.org/10.3390/cancers16183189 - 18 Sep 2024

Viewed by 1694

Abstract

Background: A prospective cohort study was undertaken within the PERSPECTIVE I&I project to evaluate healthcare resource utilization and costs associated with breast cancer risk assessment and screening and overall costs stratified by risk level, in Ontario, Canada. Methods: From July 2019 to December [...] Read more.

Background: A prospective cohort study was undertaken within the PERSPECTIVE I&I project to evaluate healthcare resource utilization and costs associated with breast cancer risk assessment and screening and overall costs stratified by risk level, in Ontario, Canada. Methods: From July 2019 to December 2022, 1997 females aged 50 to 70 years consented to risk assessment and received their breast cancer risk level and personalized screening action plan in Ontario. The mean costs for risk-stratified screening-related activities included risk assessment, screening and diagnostic costs. The GETCOST macro from the Institute of Clinical Evaluative Sciences (ICES) assessed the mean overall healthcare system costs. Results: For the 1997 participants, 83.3%, 14.4% and 2.3% were estimated to be average, higher than average, and high risk, respectively (median age (IQR): 60 [56–64] years). Stratification into the three risk levels was determined using the validated multifactorial CanRisk prediction tool that includes family history information, a polygenic risk score (PRS), breast density and established lifestyle/hormonal risk factors. The mean number of genetic counseling visits, mammograms and MRIs per individual increased with risk level. High-risk participants incurred the highest overall mean risk-stratified screening-related costs in 2022 CAD (±SD) at CAD 905 (±269) followed by CAD 580 (±192) and CAD 521 (±163) for higher-than-average and average-risk participants, respectively. Among the breast screening-related costs, the greatest cost burden across all risk groups was the risk assessment cost, followed by total diagnostic and screening costs. The mean overall healthcare cost per participant (±SD) was the highest for the average risk participants with CAD 6311 (±19,641), followed by higher than average risk with CAD 5391 (±8325) and high risk with CAD 5169 (±7676). Conclusion: Although high-risk participants incurred the highest risk-stratified screening-related costs, their costs for overall healthcare utilization costs were similar to other risk levels. Our study underscored the importance of integrating risk stratification as part of the screening pathway to support breast cancer detection at an earlier and more treatable stage, thereby reducing costs and the overall burden on the healthcare system. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

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11 pages, 579 KiB

Open AccessArticle

Disparities in Overall Survival Rates for Cancers across Income Levels in the Republic of Korea

by Su-Min Jeong, Kyu-Won Jung, Juwon Park, Hyeon Ji Lee, Dong Wook Shin and Mina Suh

Cancers 2024, 16(16), 2923; https://doi.org/10.3390/cancers16162923 - 22 Aug 2024

Cited by 1 | Viewed by 1380

Abstract

Background: The overall survival rates among cancer patients have been improving. However, the increase in survival is not uniform across socioeconomic status. Thus, we investigated income disparities in the 5-year survival rate (5YSR) in cancer patients and the temporal trends. Methods: This study [...] Read more.

Background: The overall survival rates among cancer patients have been improving. However, the increase in survival is not uniform across socioeconomic status. Thus, we investigated income disparities in the 5-year survival rate (5YSR) in cancer patients and the temporal trends. Methods: This study used a national cancer cohort from 2002 to 2018 that was established by linking the Korea Central Cancer Registry and the National Health Insurance Service (NHIS) claim database to calculate the cancer survival rate by income level in the Republic of Korea. Survival data were available from 2002 onward, and the analysis was based on the actuarial method. We compared the survival of the earliest available 5-year period of 2002–2006 and the latest available 5-year period of 2014–2018, observing until 31 December 2021. Income level was classified into six categories: Medical Aid beneficiaries and five NHIS subtypes according to insurance premium. The slope index of inequality (SII) and relative index of inequality were used to measure absolute and relative differences in 5YSR by income, respectively. Results: The 5YSR between the 2002–2006 and 2014–2018 periods for all cancers improved. A significant improvement in 5-year survival rates (5YSR) over the study period was observed in lung, liver, and stomach cancer. The SII of survival rates for lung (17.5, 95% confidence interval (CI) 7.0–28.1), liver (15.1, 95% CI 10.9–19.2), stomach (13.9, 95% CI 3.2–24.7), colorectal (11.4, 95% CI 0.9–22.0), and prostate (10.7, 95% CI 2.5–18.8) cancer was significantly higher, implying higher survival rates as income levels increased. The SII for lung, liver, and stomach cancer increased, while that of thyroid, breast, cervical, prostate, and colorectal cancer decreased over the study period. Conclusions: Although substantial improvement in the 5YSR was observed across cancer types and income levels from 2002 to 2018, this increase was not uniformly distributed across income levels. Our study revealed persistent income disparities in the survival of cancer patients, particularly for lung and liver cancer. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

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20 pages, 10479 KiB

Open AccessArticle

Discrepancies between the Spatial Distribution of Cancer Incidence and Mortality as an Indicator of Unmet Needs in Cancer Prevention and/or Treatment in Hungary

by Róza Ádány, Attila Juhász, Csilla Nagy, Bernadett Burkali, Péter Pikó, Martin McKee and Beatrix Oroszi

Cancers 2024, 16(16), 2917; https://doi.org/10.3390/cancers16162917 - 22 Aug 2024

Cited by 1 | Viewed by 1532 | Correction

Abstract

There is a rich body of literature on the distribution of cancer incidence and mortality in socioeconomically different world regions, but none of the studies has compared the spatial distribution of mortality and incidence to see if they are consistent with each other. [...] Read more.

There is a rich body of literature on the distribution of cancer incidence and mortality in socioeconomically different world regions, but none of the studies has compared the spatial distribution of mortality and incidence to see if they are consistent with each other. All malignant neoplasms combined and cervical, colorectal, breast, pancreatic, lung, and oral cancers separately were studied in the Hungarian population aged 25–64 years for 2007–2018 at the municipality level by sex. In each case, the spatial distribution of incidence and mortality were compared with each other and with the level of deprivation using disease mapping, spatial regression, risk analysis, and spatial scan statistics. A positive association between deprivation and mortality was found for each type of cancer, but there was no significant association for male colorectal cancer (relative risk (RR) 1.00; 95% credible interval (CI) 0.99–1.02), pancreatic cancer (RR: 1.01; 95%CI 0.98–1.04), and female colorectal cancer incidence (RR: 1.01; 95%CI 0.99–1.03), whereas a negative association for breast cancer (RR: 0.98; 95%CI 0.96–0.99) was found. Disease mapping analyses showed only partial overlap between areas of high incidence and mortality, often independent of deprivation. Our results highlight not only the diverse relationship between cancer burden and deprivation, but also the inconsistent relationship between cancer incidence and mortality, pointing to areas with populations that require special public health attention. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

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24 pages, 346 KiB

Open AccessArticle

Enablers and Inhibitors to Implementing Tobacco Cessation Interventions within Homeless-Serving Agencies: A Qualitative Analysis of Program Partners’ Experiences

by Isabel Martinez Leal, Ammar D. Siddiqi, Anastasia Rogova, Maggie Britton, Tzuan A. Chen, Teresa Williams, Kathleen Casey, Hector Sanchez and Lorraine R. Reitzel

Cancers 2024, 16(11), 2162; https://doi.org/10.3390/cancers16112162 - 6 Jun 2024

Viewed by 1793

Abstract

Despite the high tobacco use rates (~80%) and tobacco-related cancers being the second leading cause of death among people experiencing homelessness within the United States, these individuals rarely receive tobacco use treatment from homeless-serving agencies (HSAs). This qualitative study explored the enablers and [...] Read more.

Despite the high tobacco use rates (~80%) and tobacco-related cancers being the second leading cause of death among people experiencing homelessness within the United States, these individuals rarely receive tobacco use treatment from homeless-serving agencies (HSAs). This qualitative study explored the enablers and inhibitors of implementing an evidence-based tobacco-free workplace (TFW) program offering TFW policy adoption, specialized provider training to treat tobacco use, and nicotine replacement therapy (NRT) within HSAs. Pre- and post-implementation interviews with providers and managers (n = 13) pursued adapting interventions to specific HSAs and assessed the program success, respectively. The organizational readiness for change theory framed the data content analysis, yielding three categories: change commitment, change efficacy and contextual factors. Pre- to post-implementation, increasing challenges impacted the organizational capacity and providers’ attitudes, wherein previously enabling factors were reframed as inhibiting, resulting in limited implementation despite resource provision. These findings indicate that low-resourced HSAs require additional support and guidance to overcome infrastructure challenges and build the capacity needed to implement a TFW program. This study’s findings can guide future TFW program interventions, enable identification of agencies that are well-positioned to adopt such programs, and facilitate capacity-building efforts to ensure their successful participation. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

12 pages, 968 KiB

Open AccessArticle

Socioeconomic Deprivation and Invasive Breast Cancer Incidence by Stage at Diagnosis: A Possible Explanation to the Breast Cancer Social Paradox

by Giulio Borghi, Claire Delacôte, Solenne Delacour-Billon, Stéphanie Ayrault-Piault, Tienhan Sandrine Dabakuyo-Yonli, Patricia Delafosse, Anne-Sophie Woronoff, Brigitte Trétarre, Florence Molinié and Anne Cowppli-Bony

Cancers 2024, 16(9), 1701; https://doi.org/10.3390/cancers16091701 - 27 Apr 2024

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Abstract

In this study, we assessed the influence of area-based socioeconomic deprivation on the incidence of invasive breast cancer (BC) in France, according to stage at diagnosis. All women from six mainland French departments, aged 15+ years, and diagnosed with a primary invasive breast [...] Read more.

In this study, we assessed the influence of area-based socioeconomic deprivation on the incidence of invasive breast cancer (BC) in France, according to stage at diagnosis. All women from six mainland French departments, aged 15+ years, and diagnosed with a primary invasive breast carcinoma between 2008 and 2015 were included (n = 33,298). Area-based socioeconomic deprivation was determined using the French version of the European Deprivation Index. Age-standardized incidence rates (ASIR) by socioeconomic deprivation and stage at diagnosis were compared estimating incidence rate ratios (IRRs) adjusted for age at diagnosis and rurality of residence. Compared to the most affluent areas, significantly lower IRRs were found in the most deprived areas for all-stages (0.85, 95% CI 0.81–0.89), stage I (0.77, 95% CI 0.72–0.82), and stage II (0.84, 95% CI 0.78–0.90). On the contrary, for stages III–IV, significantly higher IRRs (1.18, 95% CI 1.08–1.29) were found in the most deprived areas. These findings provide a possible explanation to similar or higher mortality rates, despite overall lower incidence rates, observed in women living in more deprived areas when compared to their affluent counterparts. Socioeconomic inequalities in access to healthcare services, including screening, could be plausible explanations for this phenomenon, underlying the need for further research. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

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15 pages, 785 KiB

Open AccessArticle

Financial Toxicity in Swiss Cancer Patients Treated with Proton Therapy: An Observational Cross-Sectional Study on Self-Reported Outcome

by Barbara Bachtiary, Leonie Grawehr, Filippo Grillo Ruggieri, Ulrike Held and Damien C. Weber

Cancers 2023, 15(23), 5498; https://doi.org/10.3390/cancers15235498 - 21 Nov 2023

Cited by 1 | Viewed by 1628

Abstract

Background: Proton therapy is indicated for cancers that would be difficult to treat with conventional radiotherapy. Compulsory healthcare insurance covers the costs of this therapy in Switzerland, but this does not mean that proton therapy is cost-neutral for every cancer patient. Significant out-of-pocket [...] Read more.

Background: Proton therapy is indicated for cancers that would be difficult to treat with conventional radiotherapy. Compulsory healthcare insurance covers the costs of this therapy in Switzerland, but this does not mean that proton therapy is cost-neutral for every cancer patient. Significant out-of-pocket (OOP) costs may arise due to expenses associated with proton therapy, and patients may experience treatment-related financial distress—an effect known as “financial toxicity.” This study investigates the financial toxicity of patients undergoing proton therapy in a high-income country with a compulsory health insurance policy. Methods: Between September 2019 and November 2021, 146 Swiss cancer patients treated with proton therapy participated in this study, of whom 90 (62%) were adults and 56 (38%) were caregivers of child cancer patients. Financial toxicity was assessed using the FACIT Comprehensive Score for Financial Toxicity (COST). OOP costs during proton therapy were recorded weekly, and financial coping strategies were captured at the end of treatment. Findings: The median COST score, indicating financial toxicity, was 29.9 (IQR 21.0; 36.0) for all patients, 30.0 (IQR 21.3; 37.9) for adults, and 28.0 (IQR 20.5; 34.0) for children’s caregivers. Higher income (estimate 8.1, 95% CI 3.7 to 12.4, p ≤ 0.001) was significantly associated with higher COST scores, indicating less financial toxicity. Further distance from home to the treatment centre per 100 km (estimate −3.7, 95% CI −5.7 to −1.9, p ≤ 0.001) was significantly associated with lower COST scores, indicating increased financial toxicity. Married adult patients had substantially lower COST scores than single patients (estimate: −9.1, 95% CI −14.8 to −3.4, p ≤ 0.001). The median OOP cost was 2050 Swiss francs (CHF) and was spent mainly on travel, accommodation, and eating out. Sixty-three (43%) patients used their savings; 54 (37%) cut spending on leisure activities; 21 (14.4%) cut living expenses; 14 (9.6%) borrowed money; nine (6.2%) worked more; and four (2.7%) sold property. Patients with high COST scores used significantly fewer coping strategies such as saving on leisure activities (estimate −9.5, 95% CI −12.4 to −6.6, p ≤ 0.001), spending savings (estimate −3.9, 95% CI −6.3 to −1.4, p = 0.002), borrowing money (estimate −6.3, 95% CI −10.4 to −2.2, p = 0.003), and increasing workload (estimate −5.5, 95% CI −10.5 to −0.4, p = 0.035). Interpretation: A substantial number of cancer patients treated with proton therapy experience financial toxicity in Switzerland. Long travel distances to the proton therapy centre and low income negatively affect the financial well-being of these patients during proton therapy. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

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Review

Jump to: Research, Other

17 pages, 1242 KiB

Open AccessReview

Disparities in Cancer Screening Among the Foreign-Born Population in the United States: A Narrative Review

by Andrew Rosowicz and Daniel Brock Hewitt

Cancers 2025, 17(4), 576; https://doi.org/10.3390/cancers17040576 - 8 Feb 2025

Viewed by 828

Abstract

Background: The foreign-born population in the United States has reached a record high over the last three years. Significant disparities in cancer screening rates exist among this population, resulting in later-stage diagnoses and worse outcomes. This narrative review explores the sociodemographic factors, [...] Read more.

Background: The foreign-born population in the United States has reached a record high over the last three years. Significant disparities in cancer screening rates exist among this population, resulting in later-stage diagnoses and worse outcomes. This narrative review explores the sociodemographic factors, barriers, and interventions influencing cancer screening rates among foreign-born individuals in the U.S. Methods: A comprehensive review of studies was conducted to assess colorectal, cervical, and breast cancer screening disparities among immigrants. Factors examined include length of residence, race and ethnicity, income, education, citizenship, insurance, usual source of care, language, medical literacy, and cultural barriers. Furthermore, the effectiveness of educational interventions, patient navigators, and at-home testing in addressing these screening disparities was evaluated. Results: Immigrants have lower screening rates for colorectal, cervical, and breast cancer compared to U.S.-born individuals, with the largest disparities observed in colorectal cancer. Factors influencing these gaps include shorter duration of residence, Asian ethnicity, and lower income and education levels. Lack of health insurance and of a usual source of care are currently the most significant barriers to screening. Interventions such as education, patient navigation, and at-home testing have shown moderate success in improving screening rates, though data on their effectiveness remain limited. Conclusions: Addressing cancer screening disparities within the U.S. foreign-born population is essential, especially as the immigrant population continues to reach record numbers. Targeted interventions are needed to improve screening among immigrant groups with the lowest completion rates. Future research on these interventions should prioritize larger sample sizes, longitudinal studies, and the utility of new technologies such as artificial intelligence. Full article

(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)

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