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Search Results (245)

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Keywords = socioeconomic status and cancer

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14 pages, 2544 KiB  
Article
Colorectal Cancer Risk in Korean Patients with Inflammatory Bowel Disease: A Nationwide Big Data Study of Subtype and Socioeconomic Disparities
by Kyeong Min Han, Ho Suk Kang, Joo-Hee Kim, Hyo Geun Choi, Dae Myoung Yoo, Nan Young Kim, Ha Young Park and Mi Jung Kwon
J. Clin. Med. 2025, 14(15), 5503; https://doi.org/10.3390/jcm14155503 - 5 Aug 2025
Viewed by 20
Abstract
Background/Objectives: The two major subtypes of inflammatory bowel disease (IBD)—Crohn’s disease (CD) and ulcerative colitis (UC)—are known to increase the likelihood of developing colorectal cancer (CRC). While this relationship has been well studied in Western populations, evidence from East Asia remains limited [...] Read more.
Background/Objectives: The two major subtypes of inflammatory bowel disease (IBD)—Crohn’s disease (CD) and ulcerative colitis (UC)—are known to increase the likelihood of developing colorectal cancer (CRC). While this relationship has been well studied in Western populations, evidence from East Asia remains limited and inconsistent. Using nationwide cohort data, this study explored the potential connection between IBD and CRC in a large Korean population. Methods: We conducted a retrospective cohort study using data from the Korean National Health Insurance Service–National Sample Cohort from 2005 to 2019. A total of 9920 CRC patients were matched 1:4 with 39,680 controls using propensity scores based on age, sex, income, and region. Overlap weighting and multivariable logistic regression were used to evaluate the association between IBD and CRC. Subgroup analyses were conducted to assess effect modification by demographic and clinical factors. Results: IBD markedly increased the likelihood of developing CRC (adjusted odds ratio (aOR) = 1.38; 95% confidence interval (CI): 1.20–1.58; p < 0.001), with the association primarily driven by UC (aOR = 1.52; 95% CI: 1.27–1.83). CD appeared unrelated to heightened CRC risk overall, though a significant association was observed among low-income CD patients (aOR = 1.58; 95% CI: 1.15–2.16). The UC–CRC association persisted across all subgroups, including patients without comorbidities. Conclusions: Our findings support an independent association between IBD—particularly UC—and increased CRC risk in Korea. These results underscore the need for personalized CRC surveillance strategies that account for disease subtype, comorbidity burden, and socioeconomic status, especially in vulnerable subpopulations. Full article
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13 pages, 674 KiB  
Article
Barriers to Post-Mastectomy Breast Reconstruction: A Comprehensive Retrospective Study
by Kella L. Vangsness, Ronald M. Cornely, Andre-Philippe Sam, Naikhoba C. O. Munabi, Michael Chu, Mouchammed Agko, Jeff Chang and Antoine L. Carre
Cancers 2025, 17(12), 2002; https://doi.org/10.3390/cancers17122002 - 16 Jun 2025
Viewed by 474
Abstract
Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health [...] Read more.
Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care. Materials and Methods: The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013–2021 and 2000–2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson’s chi-square analysis was performed. Results: We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40–49 age group received significantly less MO (38.1%) compared to the 70–74 age group (94.8%, (p = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, p = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, p = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (p = <0.001). Conclusions: Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care. Full article
(This article belongs to the Special Issue Socio-Demographic Factors and Cancer Research)
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27 pages, 3066 KiB  
Review
Beyond Barriers: Achieving True Equity in Cancer Care
by Zaphrirah S. Chin, Arshia Ghodrati, Milind Foulger, Lusine Demirkhanyan and Christopher S. Gondi
Curr. Oncol. 2025, 32(6), 349; https://doi.org/10.3390/curroncol32060349 - 12 Jun 2025
Viewed by 1991
Abstract
Healthcare disparities in cancer care remain pervasive, driven by intersecting socioeconomic, racial, and insurance-related inequities. These disparities manifest in various forms such as limited access to medical resources, underrepresentation in clinical trials, and worse cancer outcomes for marginalized groups, including low-income individuals, racial [...] Read more.
Healthcare disparities in cancer care remain pervasive, driven by intersecting socioeconomic, racial, and insurance-related inequities. These disparities manifest in various forms such as limited access to medical resources, underrepresentation in clinical trials, and worse cancer outcomes for marginalized groups, including low-income individuals, racial minorities, and those with inadequate insurance coverage, who face significant barriers in accessing comprehensive cancer care. This manuscript explores the multifaceted nature of these disparities, examining the roles of socioeconomic status, race, ethnicity, and insurance status in influencing cancer care access and outcomes. Historical and contemporary data highlight that minority racial status correlates with reduced clinical trial participation and increased cancer-related mortality. Barriers such as insurance coverage, health literacy, and language further hinder access to cancer treatments. Addressing these disparities requires a systemic approach that includes regulatory reforms, policy changes, educational initiatives, and innovative trial and treatment designs. This manuscript emphasizes the need for comprehensive interventions targeting biomedicine, socio-demographics, and social characteristics to mitigate these inequities. By understanding the underlying causes and implementing targeted strategies, we can work towards a more equitable healthcare system. This involves improving access to high-quality care, increasing participation in research, and addressing social determinants of health. This manuscript concludes with policy recommendations and future directions to achieve health equity in cancer care, ensuring optimal outcomes for all patients. Full article
(This article belongs to the Section Oncology Nursing)
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20 pages, 4772 KiB  
Article
Socioeconomic Disparities in Breast Cancer Survival: Examining Potential Mediator Role of Oncotype DX(ODX) Test and Stage at Diagnosis Among HR+/HER2- Breast Cancer Women
by Pratibha Shrestha, Qingzhao Yu, Edward S. Peters, Edward Trapido, Mei-Chin Hsieh, Tekeda Ferguson, Quyen D. Chu and Xiao-Cheng Wu
Cancers 2025, 17(11), 1802; https://doi.org/10.3390/cancers17111802 - 28 May 2025
Viewed by 805
Abstract
Background: Women with a lower socioeconomic status (SES) have an increased risk of dying from breast cancer (BC) than those with a higher SES. The association of SES with BC survival may be partially mediated by factors such as Oncotype DX (ODX) testing [...] Read more.
Background: Women with a lower socioeconomic status (SES) have an increased risk of dying from breast cancer (BC) than those with a higher SES. The association of SES with BC survival may be partially mediated by factors such as Oncotype DX (ODX) testing and stage at diagnosis. This study aims to examine SES disparities in survival among HR+/HER2- BC women and to quantify the mediating effects of the ODX test and stage. Methods: We used data from the Louisiana Tumor Registry to identify women aged 20–90 years diagnosed with stage I–II in 2011–2014 and stage I–III in 2015–2017 HR+/HER2- BC who underwent BC surgery. The follow-up cutoff date was 31 December 2020. Cox proportional hazard regression and generalized mediation analysis were both performed. Results: Of 8931 BC women, 41.4% underwent ODX testing. After adjusting for sociodemographic, tumor characteristic, and treatment variables, low SES women had a higher hazard of overall death (HR = 1.16, 95% CI: 1.02–1.32) and BC-specific death (HR = 1.37; 95% CI: 1.01–1.87) compared to high SES women. The ODX test and stage explained 9.0% and 11.2% SES differences in the hazard of overall death and 4.4% and 13.3% in BC-specific death, respectively. Conclusions: Low SES is associated with higher hazard rates of overall and cause-specific death among women with breast cancer, even after adjustment. Differences in Oncotype DX (ODX) testing and stage at diagnosis explained part of these disparities. Targeted interventions are needed to improve access to genomic testing and early detection to reduce SES-related disparities in breast cancer outcomes. Full article
(This article belongs to the Section Cancer Epidemiology and Prevention)
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10 pages, 256 KiB  
Review
Cancer Risk Associated with Residential Proximity to Municipal Waste Incinerators: A Review of Epidemiological and Exposure Assessment Studies
by Jose L. Domingo
Green Health 2025, 1(1), 4; https://doi.org/10.3390/greenhealth1010004 - 26 May 2025
Viewed by 905
Abstract
Municipal Solid Waste Incinerators (MSWIs) are facilities designed to burn municipal solid waste to reduce its volume and mass and generate energy. A significant concern related to MSWIs is the emission of toxic and carcinogenic pollutants, including polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), heavy [...] Read more.
Municipal Solid Waste Incinerators (MSWIs) are facilities designed to burn municipal solid waste to reduce its volume and mass and generate energy. A significant concern related to MSWIs is the emission of toxic and carcinogenic pollutants, including polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), heavy metals, and particulate matter. This review synthesizes global epidemiological and exposure assessment studies investigating cancer risks associated with residential proximity to MSWIs. Findings reveal a complex relationship: older incinerators with high emissions correlate with elevated risks of non-Hodgkin lymphoma (NHL), soft-tissue sarcoma (STS), and liver cancer in some studies, particularly in Europe. However, results remain inconsistent due to methodological limitations such as exposure misclassification, latency periods, and confounding factors like socioeconomic status. Modern facilities equipped with advanced pollution control technologies demonstrate reduced risks, often within regulatory thresholds. Key challenges include accurately quantifying historical exposures and disentangling MSWI-specific risks from other environmental or lifestyle factors. While advancements in dispersion modeling and biomonitoring have improved risk assessments, geographical and temporal variations in findings underscore the need for continued research. The review concludes that while historical evidence suggests potential cancer risks near older MSWIs, stricter emissions regulations and technological improvements have mitigated health impacts, although vigilance through long-term monitoring remains essential to safeguard public health. Full article
15 pages, 1218 KiB  
Systematic Review
Racial and Socioeconomic Disparity in Breast Cancer Mortality: A Systematic Review and Meta-Analysis
by Helena Fiats Ribeiro, Fernando Castilho Pelloso, Beatriz Sousa da Fonseca, Camila Wohlenberg Camparoto, Maria Dalva de Barros Carvalho, Vlaudimir Dias Marques, Mariá Romanio Bitencourt, Kely Paviani Stevanato, Pedro Beraldo Borba, Deise Helena Pelloso Borghesan, Paulo Acácio Egger, Ana Carolina Jacinto Alarcão, Roberto Kenji Nakamura Cuman, Isabella Morais Tavares Huber, Márcia Edilaine Lopes Consolaro, Constanza Pujals, Carlos Laranjeira, Raíssa Bocchi Pedroso and Sandra Marisa Pelloso
Cancers 2025, 17(10), 1641; https://doi.org/10.3390/cancers17101641 - 13 May 2025
Viewed by 856
Abstract
Background/Objectives: Breast cancer is one of the leading causes of female mortality worldwide, but significant racial and socioeconomic disparities persist in disease outcomes. This review aimed to analyze racial and socioeconomic inequalities in mortality and survival from breast cancer, identifying the impact [...] Read more.
Background/Objectives: Breast cancer is one of the leading causes of female mortality worldwide, but significant racial and socioeconomic disparities persist in disease outcomes. This review aimed to analyze racial and socioeconomic inequalities in mortality and survival from breast cancer, identifying the impact of social risk factors on access to diagnosis and treatment. Methods: A systematic literature review and meta-analysis was performed following PRISMA guidelines. Eighteen studies published between 2014 and 2024 were included, with 11 contributing to the meta-analysis. Random-effect models were used to assess correlations between socioeconomic status, race, and clinical outcomes, including heterogeneity and publication bias analyses. Results: The strongest associations were observed between income, race, and breast cancer survival, with survival significantly worse among Black women and low-income populations (p < 0.001). Income also showed a strong positive correlation with clinical outcomes. In contrast, the overall effect on mortality was not statistically significant (p = 0.290), likely due to high heterogeneity across studies (I2 = 100%). These findings suggest that structural disparities in access to healthcare and early detection substantially affect survival rates. Conclusions: Racial and socioeconomic disparities in breast cancer outcomes remain critical public health challenges. Targeted policies to expand early diagnosis and ensure equitable access to effective treatment are essential to reduce these disparities and improve survival in underserved populations. Full article
(This article belongs to the Special Issue Socio-Demographic Factors and Cancer Research)
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9 pages, 362 KiB  
Article
Breast Cancer Treatment Disparities in a Rural Setting: Conserving Surgery Versus Mastectomy
by Benjamin C. Kensing, Lutfi A. Barghuthi, Marvin Heck, Carly R. Wadle, Rebecca J. Swindall, Alan D. Cook and Hishaam N. Ismael
J. Clin. Med. 2025, 14(9), 3264; https://doi.org/10.3390/jcm14093264 - 7 May 2025
Viewed by 688
Abstract
Background/Objectives: Randomized controlled trials demonstrate comparable survival among early-stage breast cancer patients undergoing breast-conserving therapy or patient preference mastectomy. Many factors affect the choice of treatment like the availability of radiation centers, socioeconomic status, and insurance status. This study aimed to identify the [...] Read more.
Background/Objectives: Randomized controlled trials demonstrate comparable survival among early-stage breast cancer patients undergoing breast-conserving therapy or patient preference mastectomy. Many factors affect the choice of treatment like the availability of radiation centers, socioeconomic status, and insurance status. This study aimed to identify the determinants of surgical breast cancer treatments in a rural community. Methods: Retrospective data were obtained from the medical records of breast cancer patients between 2015 and 2022 at a single rural healthcare system. Demographics, barriers to care, support services offered, pre-treatment services, and the type and stage of cancer were analyzed to identify trends among patients who received breast-conserving therapy and mastectomy. Results: Among the 162 patients who underwent a mastectomy, 16.1% chose this procedure based on patient preference. The patient preference mastectomy group was younger with a median age of 58 years compared to 65 years in the breast conservation group. Additionally, they were 2.7 times more likely to choose a mastectomy when reporting no financial support. When receiving lymphedema management or psychosocial services, they were also more likely to be in the patient preference mastectomy group, 58.3% versus 5.2% and 100% versus 83.5%, respectively. Genetic screening, however, was more common among the breast conservation therapy group (61.9% vs. 26.9%). Conclusions: Our findings indicate an increase in the utilization of breast conservation therapy in a rural healthcare system. These patients were generally older, had financial support, and received genetic screening. Having a multidisciplinary approach to treating breast cancer contributes to our ability to pursue breast-conserving therapy measures in rural communities. Full article
(This article belongs to the Section Oncology)
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13 pages, 681 KiB  
Review
Navigating Pathways in Prostate Cancer Survivorship: A Comprehensive Review of Challenges, Interventions, and Long-Term Outcomes
by Anthony Galvez, Dhruv Puri, Elizabeth Tran, Kassandra Zaila Ardines and Yahir Santiago-Lastra
Uro 2025, 5(2), 10; https://doi.org/10.3390/uro5020010 - 7 May 2025
Viewed by 1057
Abstract
Advances in screening, early detection, and therapeutic innovations have significantly improved survival rates, transforming prostate cancer into a chronic condition for many men. However, these strides have also revealed persistent challenges in survivorship, including treatment-related side effects, disparities in care, and inequities in [...] Read more.
Advances in screening, early detection, and therapeutic innovations have significantly improved survival rates, transforming prostate cancer into a chronic condition for many men. However, these strides have also revealed persistent challenges in survivorship, including treatment-related side effects, disparities in care, and inequities in outcomes. This review explores the complex landscape of prostate cancer survivorship, with a focus on demographic disparities, barriers to care, symptom burden, and treatment patterns. Our findings highlight how factors such as race, socioeconomic status, and insurance type heavily influence patient outcomes. For instance, Black and Latiné patients often face delays in treatment initiation and are less likely to receive definitive therapies than White patients, leading to poorer survival outcomes. Furthermore, those with Medicaid or no insurance are more likely to receive systemic therapy only or no treatment at all, exacerbating existing inequities. Addressing gaps in diagnosis, treatment access, and survivorship care is essential to developing targeted interventions and policies that promote equitable, patient-centered care for prostate cancer survivors. Full article
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14 pages, 221 KiB  
Article
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
Cited by 1 | Viewed by 793 | Correction
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)
14 pages, 927 KiB  
Article
Socioeconomic Status and Vascular Access Patency in Hemodialysis: Analysis of Korean National Health Insurance Service Data from 2008 to 2019
by Jeong-Ik Park, Daehwan Kim, Hyangkyoung Kim, Seung Boo Yang, Sang Jun Park and Young-joo Kwon
J. Clin. Med. 2025, 14(9), 3074; https://doi.org/10.3390/jcm14093074 - 29 Apr 2025
Viewed by 511
Abstract
Background: Socioeconomic status (SES) disparities impact health outcomes, but their effect on vascular access (VA) in hemodialysis patients in Korea remains underexplored. Methods: This study evaluated the association between SES and VA outcomes using National Health Insurance Service data from 2008 [...] Read more.
Background: Socioeconomic status (SES) disparities impact health outcomes, but their effect on vascular access (VA) in hemodialysis patients in Korea remains underexplored. Methods: This study evaluated the association between SES and VA outcomes using National Health Insurance Service data from 2008 to 2019. Incident hemodialysis patients were categorized by insurance status into the health insurance group (HG) and medical aid group (MG). The primary endpoint was VA patency, and the secondary endpoint was all-cause mortality, adjusted for demographics, comorbidities, and lifestyle factors. Results: Among 86,036 patients, the MG (12.1%) was younger at VA creation (60.4 ± 13.5 vs. 63.1 ± 13.6 years, p < 0.001) and had higher rates of comorbidities (all p < 0.05 except cancer). Mortality rates per 100 person-years were higher in the MG (11.66 vs. 9.24 for AVF; 17.94 vs. 16.92 for AVG), as was the total procedure frequency (2.10 vs. 1.87, p < 0.001), despite similar percutaneous angioplasty counts (1.20 vs. 1.24, p = 0.314). Conclusions: Lower SES patients exhibited poorer VA patency and higher mortality rates despite equitable healthcare access and cost coverage in Korea. These findings suggest that non-medical factors, such as adherence to treatment and timely intervention, play a critical role in mitigating these disparities. Full article
(This article belongs to the Section Nephrology & Urology)
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14 pages, 548 KiB  
Article
The Influence of Poverty and Rurality on Colorectal Cancer Survival by Race/Ethnicity: An Analysis of SEER Data with a Census Tract-Level Measure of Persistent Poverty
by Steven S. Coughlin, Meng-Han Tsai, Jorge Cortes, Malcolm Bevel and Marlo Vernon
Curr. Oncol. 2025, 32(5), 248; https://doi.org/10.3390/curroncol32050248 - 23 Apr 2025
Viewed by 639
Abstract
Purpose: Because of shared mechanisms such as decreased access to health care, rurality and poverty may act synergistically to decrease colorectal cancer (CRC) survival. Methods: We conducted a retrospective cohort analysis of SEER data (22 registries) with census tract-level measures of poverty/rurality for [...] Read more.
Purpose: Because of shared mechanisms such as decreased access to health care, rurality and poverty may act synergistically to decrease colorectal cancer (CRC) survival. Methods: We conducted a retrospective cohort analysis of SEER data (22 registries) with census tract-level measures of poverty/rurality for the period 2006–2015. Multivariable Cox proportional hazard regressions were applied to examine the independent and intersectional associations of persistent poverty and rurality on 5-year cause-specific CRC survival across five racial/ethnic groups. Results: Among 532,868 CRC patients, non-Hispanic Blacks (NHB) demonstrated lower 5-year survival probability (64.2% vs. 68.3% in non-Hispanic Whites [NHW], 66.5% in American Indian/Alaska Natives [AI/AN], 72.1% in Asian/Pacific Islanders, and 68.7% in Hispanic groups) (p-value < 0.001). In adjusted analysis, CRC patients living in rural areas with poverty were at a 1.2–1.6-fold increased risk of CRC death than those who did not live in these areas in five racial/ethnic groups. In particular, AI/AN patients living in rural areas with poverty were 66% more likely to die from CRC (95% CI, 1.32, 2.08). Conclusions: CRC patients who live in rural or poverty areas in SEER areas in the U.S. have a poorer survival compared with those who do not live in such areas regardless of race/ethnicity. Significantly greater risk of CRC death was observed in AI/ANs. Impact: Patient navigators, community education or screening, and other health care system interventions may be helpful to address these disparities by socioeconomic status, race, and geographic residence. Multi-level interventions aimed at institutional racism and medical mistrust may also be helpful. Full article
(This article belongs to the Section Gastrointestinal Oncology)
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13 pages, 620 KiB  
Article
Outcomes for Medicaid Patients with Colorectal Cancer Are Improved in Affluent Neighborhoods, but Disparities Persist
by Kaelyn C. Cummins, Mohamad El Moheb, Chengli Shen, Susan J. Kim, Russell Witt, Samantha M. Ruff and Allan Tsung
Cancers 2025, 17(9), 1399; https://doi.org/10.3390/cancers17091399 - 22 Apr 2025
Viewed by 395
Abstract
Background: Socioeconomic status (SES) significantly influences outcomes in colorectal cancer (CRC) patients, with those from low-SES backgrounds facing worse prognoses. However, living in an affluent neighborhood may mitigate some of these disparities through environmental advantages. This study investigates whether Medicaid-insured CRC patients, as [...] Read more.
Background: Socioeconomic status (SES) significantly influences outcomes in colorectal cancer (CRC) patients, with those from low-SES backgrounds facing worse prognoses. However, living in an affluent neighborhood may mitigate some of these disparities through environmental advantages. This study investigates whether Medicaid-insured CRC patients, as a proxy for low individual SES, experience better outcomes when residing in high-SES neighborhoods. Methods: Using the National Cancer Database, we examined Medicaid CRC patients, stratifying them by neighborhood SES indicators: median household income and education level. Patients in the highest and lowest quartiles of income and education were compared. Medicaid patients from the highest-SES neighborhoods were compared to the general population. Multivariable regression models analyzed 30- and 90-day postoperative mortality, overall survival (OS), and time from diagnosis to treatment initiation and surgery. Results: CRC patients in high-income neighborhoods began treatment earlier (coefficient −1.847, p = 0.015) and exhibited improved OS (HR 0.810, p < 0.001) compared to those in low-income neighborhoods, irrespective of education level. Similarly, patients in high-education neighborhoods started treatment sooner (coefficient −3.926, p < 0.001) and had better OS (HR 0.897, p < 0.001). No differences were observed in time to surgery or postoperative mortality. Despite these advantages, Medicaid patients in high-income (HR 1.130, p < 0.001) and high-education (HR 1.209, p = 0.002) areas still had worse OS compared to non-Medicaid patients. Conclusions: Higher neighborhood SES is associated with a significant survival benefit for Medicaid CRC patients, but these patients still lag behind their non-Medicaid counterparts. Understanding the mechanisms by which neighborhood SES influences cancer outcomes could inform targeted interventions to close the survival gap. Full article
(This article belongs to the Special Issue Impact of Social Determinants on Cancer Care)
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12 pages, 219 KiB  
Review
The Optimal Age for Oophorectomy in Women with Benign Conditions: A Narrative Review
by Aikaterini-Gavriela Giannakaki, Maria-Nektaria Giannakaki, Konstantinos Nikolettos, Christina Pagkaki and Panagiotis Tsikouras
J. Pers. Med. 2025, 15(4), 158; https://doi.org/10.3390/jpm15040158 - 19 Apr 2025
Viewed by 1006
Abstract
Objective: Oophorectomy is a common procedure for benign uterine conditions, historically recommended for women aged 40–45 and older due to the belief that ovarian preservation had no significant benefits. This review evaluates the literature on the optimal age for oophorectomy in women with [...] Read more.
Objective: Oophorectomy is a common procedure for benign uterine conditions, historically recommended for women aged 40–45 and older due to the belief that ovarian preservation had no significant benefits. This review evaluates the literature on the optimal age for oophorectomy in women with benign conditions to assess its risks and benefits and guide clinical decision-making. Methods: A narrative review was conducted using a literature search of articles published between January 2000 and February 2025, focusing on the age-related outcomes of ovarian conservation versus removal. Results: Oophorectomy remains a complex decision in gynecological surgeries, especially among perimenopausal and postmenopausal women. Evidence supports ovarian conservation in average-risk women, highlighting reduced risks of cardiovascular disease, osteoporosis, and all-cause mortality. Conversely, oophorectomy is favored in high-risk populations, such as BRCA mutation carriers, due to significantly lower risks of ovarian and breast cancers. Despite declining rates, unnecessary oophorectomies persist, influenced by age, socioeconomic status, comorbidities, and surgical approaches. The development of a risk stratification tool offers promise for improving individualized decision-making. Conclusions: The decision to perform oophorectomy for benign conditions should be personalized, balancing patient-specific factors to optimize outcomes and long-term health benefits. Full article
(This article belongs to the Section Sex, Gender and Hormone Based Medicine)
12 pages, 259 KiB  
Article
High Frequency of Depression in Advanced Cancer with Concomitant Comorbidities: A Registry Study
by Peter Strang and Torbjörn Schultz
Cancers 2025, 17(7), 1214; https://doi.org/10.3390/cancers17071214 - 3 Apr 2025
Viewed by 1148
Abstract
Background/objectives: Depression is a common complication of cancer and is associated with distress and reduced participation in medical care. The prevalence is still uncertain in advanced cancer due to methodological problems. Our aim was to study depression in the last year of life [...] Read more.
Background/objectives: Depression is a common complication of cancer and is associated with distress and reduced participation in medical care. The prevalence is still uncertain in advanced cancer due to methodological problems. Our aim was to study depression in the last year of life and related variables. Methods: We used an administrative database and analyzed clinically verified diagnoses of depression during the last year of life for 27,343 persons (nursing home residents excluded) and related the data to age, sex, socioeconomic status on an area level (Mosaic system), and frailty risk as calculated by the Hospital Frailty Risk Score (HFRS). T-tests, chi-2 tests, and binary logistic regression models were used. Results: During the last year of life, a clinical diagnosis of depression was found in 1168/27,343 (4.3%) cases and more frequently seen in women (4.8% vs. 3.8%, p = 0.001), in the elderly aged 80 years or more, p = 0.03, and especially in persons with a frailty risk according to the HFRS, with rates of 3.3%, 5.3% and 7.8% in the low-risk, intermediate and high-risk groups, respectively (p < 0.001), whereas no differences were found based on socioeconomic status. In a multiple logistic regression model, being female (aOR 1.30, 95% CI 1.16–1.46) or having an intermediate (1.66, 1.46–1.88) or high frailty risk (2.57, 2.10–3.14) retained the predictive value (p < 0.001, respectively). Conclusions: Depression is more common in women and, above all, in people with multimorbidity. Depression affects the amount of health care needed, including the need for psychiatric care. Therefore, it should be included in clinical decision-making, especially as depression is associated with poorer prognosis in cancer. Full article
(This article belongs to the Special Issue Updates on Depression among Cancer Patients)
16 pages, 2792 KiB  
Article
Psychological Distress and Quality of Life in Patients with Colon Cancer: Predictors, Moderating Effects, and Longitudinal Impact
by Lavinia Alina Rat, Timea Claudia Ghitea and Adrian Marius Maghiar
Healthcare 2025, 13(7), 753; https://doi.org/10.3390/healthcare13070753 - 27 Mar 2025
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Abstract
Background/Objectives: Psychological distress, including anxiety and depression, significantly impacts quality of life (QoL) in colorectal cancer patients. This study explores the relationship between psychological distress and QoL, identifies risk factors (e.g., advanced disease stage, socioeconomic status, and social support levels), and evaluates [...] Read more.
Background/Objectives: Psychological distress, including anxiety and depression, significantly impacts quality of life (QoL) in colorectal cancer patients. This study explores the relationship between psychological distress and QoL, identifies risk factors (e.g., advanced disease stage, socioeconomic status, and social support levels), and evaluates the influence of emotional and social functioning on patient well-being. Additionally, this study examines workplace reintegration challenges faced by cancer survivors. Methods: A longitudinal study was conducted with 50 patients diagnosed with colorectal cancer undergoing chemotherapy. QoL was assessed using the EORTC QLQ-C30 and EQ-5D scales, while anxiety and depression were measured using the Hospital Anxiety and De-pression Scale (HADS). Assessments were conducted at baseline and at the end of a six-month treatment period. Data were analyzed using correlation and multivariate regression analyses to explore associations between psychological distress and QoL, adjusting for disease stage, social support, and demographic factors. Results: Emotional functioning showed a statistically significant improvement by the sixth chemotherapy cycle (p < 0.05), while physical and role functions remained stable. However, psychological health, as assessed through HADS, showed no significant improvement, highlighting the need for targeted psychological support. Negative correlations were observed between QoL scores and anxiety and depression levels, with stronger associations detected in the later stages of treatment. Patients with advanced disease stages and poor social support were identified as high-risk groups for psychological distress. Effect sizes (Cohen’s d) and confidence intervals were calculated to assess the practical significance of findings. Conclusions: This study highlights the critical impact of psychological distress on the QoL of colorectal cancer patients, emphasizing the importance of integrating systematic psychological assessments and tailored interventions in oncology care. Future research should incorporate larger sample sizes, extended follow-up periods, and an exploration of mediating factors to enhance understanding and improve patient-centered interventions. Full article
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