University Hospitals Seidman Cancer Center Team Finds Neighborhood-Level Disparities in Patients Receiving Complex Cancer Surgery

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CLEVELAND -- A recently published study published in the Annals of Surgery found disparities in the number of surgeries performed for patients with complex gastrointestinal (GI) cancers. 

Studying data from the Ohio Cancer Incidence Surveillance System, the researchers found that low-surgery clusters were mostly in urban cores and the Appalachian region, whereas high-surgery clusters were found in suburbs.  In addition, low-surgery clusters differed from high-surgery clusters with higher rates of poverty (23 percent vs. 12 percent), fewer married households (40 percent vs. 50 percent), and more tobacco use (25 percent vs. 19 percent; all P<0.01).

The study looked at data for 33,091 individuals who were diagnosed with one of five invasive, non-metastatic, complex GI cancers (esophagus, stomach, pancreas, bile ducts, liver) from 2009 to 2018.

Principal Investigator Richard Hoehn, MD, a surgical oncologist at University Hospitals Seidman Cancer Center (UHSCC) and a member of Case Comprehensive Cancer Center’s (Case CCC) Population and Cancer Prevention Program, said, “This improved understanding of neighborhood-level variation in receipt of potentially curative surgery can guide future outreach and community-based interventions to reduce treatment disparities. Similar methods can be used to target other treatment phases and other cancers.”

Lead author of the study was Weichuan Dong, PhD, of Population Cancer Analytics Shared Resources, Case CCC and co-led by Johnie Rose, MD, PhD, and Siran Koroukian, PhD, both members of Case CCC’s Population and Cancer Prevention Program. The team also included Matthew Kucmanic, MA, MPH, Case CCC and University of Iowa; Jordan Winter, MD, surgical oncologist at UHSCC, the Jerome A. and Joy Weinberger Family Master Clinician in Surgical Oncology and co-leader of Case CCC’s Developmental Therapeutics Program; Peter J. Pronovost, MD, PhD, FCCM, University Hospitals Chief Quality and Clinical Transformation Officer, Veale Distinguished Chair in Leadership and Clinical Transformation; and Uriel Kim, PhD, Case CCC and Northwestern University.

To preserve patient privacy, researchers combined US census tracts into the smallest geographic areas that included a minimum number of surgery cases (n=11) using the Max-p-regions method and renamed these new areas “MaxTracts.” Age-adjusted surgery rates were calculated for 1,006 MaxTracts in Ohio, and the Hot Spot analysis identified geographic clusters of high and low surgery rates. US Census and CDC PLACES were used to compare neighborhood characteristics between the high- and low-surgery clusters.

The study, “Understanding Disparities in Receipt of Complex Gastrointestinal Cancer Surgery at a Small Geographic Scale,” was published Feb. 21, 2023, and funded by an American Cancer Society IRG grant.

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