Disparities in access to care and outcomes in patients with adrenocortical carcinoma. J Surg Res 2017 Jun 01;213:138-146
Date
06/12/2017Pubmed ID
28601306DOI
10.1016/j.jss.2017.02.046Scopus ID
2-s2.0-85015682098 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
BACKGROUND: Surgical resection remains the mainstay of treatment for patients with adrenocortical carcinoma (ACC). The aim of the present study is to examine disparities in access to surgical resection and identify factors associated with overall survival following surgical resection.
METHODS: The National Cancer Database was queried for patients with ACC (2004-2013). Patient characteristics and disease details were abstracted. Logistic regression analysis was performed to examine the factors associated with surgical resection, and a multivariate Cox proportional hazards model was used to identify predictors of survival in the surgical cohort.
RESULTS: Surgical resection was performed in 2007/2946 (68%) ACC patients. On multivariate logistic regression analysis controlling for clinicodemographic factors, surgery was less likely to be performed in patients ≥56 y, males, African-Americans, patients with government insurance, or those treated at community cancer centers (P < 0.05). On a multivariate Cox proportional hazards model adjusting for clinicodemographic and treatment variables, older age (≥56 y) and presence of comorbidities were associated with worse overall survival.
CONCLUSIONS: These findings suggest that there are demographic and socioeconomic disparities in access to surgical resection for ACC. However, after adjusting for patient and clinical characteristics, only patient age and presence of comorbidities were predictors of worse survival in patients undergoing surgery for ACC. More data are needed to determine the factors driving these disparities.
Author List
Hammad AY, Yen TWF, Carr AA, Evans DB, Wang TSAuthors
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinTracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdrenal Cortex Neoplasms
Adrenalectomy
Adrenocortical Carcinoma
Adult
Aged
Aged, 80 and over
Databases, Factual
Female
Follow-Up Studies
Health Services Accessibility
Healthcare Disparities
Humans
Logistic Models
Male
Middle Aged
Prognosis
Retrospective Studies
Survival Analysis
United States
Young Adult
