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Regional disparities affect treatment and survival of patients with intrahepatic cholangiocarcinoma--a Texas Cancer Registry analysis.
- Source :
-
Journal of surgical oncology [J Surg Oncol] 2014 Sep; Vol. 110 (4), pp. 416-21. Date of Electronic Publication: 2014 May 30. - Publication Year :
- 2014
-
Abstract
- Background: Intrahepatic cholangiocarcinoma (ICC) is often diagnosed at advanced stage and few patients qualify for resection. Effects of barriers to access on outcomes are unknown. We hypothesized that income and rural residence account for delays in treatment and decreased survival.<br />Methods: Texas Cancer Registry was queried for ICC patients from 2000 to 2008. Median household income (MHI) and urban/rural status were analyzed. Regression analyses were performed for (1) time-to- treatment (TTT), and (2) overall survival (OS).<br />Results: Among 1,089 patients, 20.2% patients resided in rural areas and MHI ranged $24,497-$81,113/year. Primary treatment included surgery for 9.5%, radiation 5.4% and chemotherapy 21.0%. Median TTT was 29 (range 0-235) days. Patients from low-income areas were less likely to receive treatment (below median MHI, 29.7% vs. above median MHI, 37.5%%; P = 0.007). MHI was associated with TTT (per $10,000/year: hazard ratio (HR) = 1.05; 95% CI: 1.01-1.09). Adjusting for stage, MHI was associated with OS (per $10,000/year: HR = 0.97; 95%CI: 0.94-0.99). Rural residence was neither associated with TTT nor OS.<br />Conclusion: Overall treatment rates for ICC patients are low. Regional income, not urbanization was associated treatment and survival independent of stage. Further research is needed to determine how regional prosperity relates to care access.<br /> (© 2014 Wiley Periodicals, Inc.)
- Subjects :
- Adult
Aged
Bile Duct Neoplasms epidemiology
Bile Duct Neoplasms pathology
Bile Duct Neoplasms therapy
Bile Ducts, Intrahepatic pathology
Cholangiocarcinoma epidemiology
Cholangiocarcinoma pathology
Cholangiocarcinoma therapy
Female
Humans
Income
Male
Middle Aged
Neoplasm Staging
Prognosis
Registries
Regression Analysis
Texas
Bile Duct Neoplasms mortality
Cholangiocarcinoma mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1096-9098
- Volume :
- 110
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 24889699
- Full Text :
- https://doi.org/10.1002/jso.23664