Health News - Targeting ovarian cancer - Dr. Robert Bristow finds disparities in access to the top-quality care that boosts survival

Health News - Targeting ovarian cancer

 Dr. Robert Bristow finds disparities in access to the top-quality care that boosts survival

abstract: Access to anti-cancer drugs: Many evidence-based treatments are off-label and unfunded by the PBS - Australia

Access to anti-cancer drugs: Many evidence-based treatments are off-label and unfunded by the PBS

 ABSTRACT

Background:  The off-label use of a drug refers to a use outside the terms of its approval by the Therapeutic Goods Administration's (TGA). It is also possible to prescribe unlicensed drugs under the Therapeutic Goods Administration's (TGA) Special Access Scheme. A high rate of off-label prescribing has previously been reported in cancer. Our study aimed to document the disparity between clincial evidence-based guidelines for anti-cancer therapy, product approval, and funding status of these agents within an academic tertiary/quaternary cancer centre.

Method:  All chemotherapy protocols approved for use in our specialist oncology centre were assessed to determine if the drugs were off-label or unlicensed for that indication based upon review of their current product information. The Pharmaceutical Benefits Scheme (PBS) funding status for each protocol was subsequently assessed.

Results:  A total of 448 protocols, containing 82 different drugs, across 15 tumour groups were identified. Overall, 189 (42.2%) of protocols were off-label and 3 (0.7%) were unlicensed. This resulted in all 192 protocols being unfunded by the PBS. Of the 189 off-label protocols, 132 (69.9%) were based on established evidence-based treatment guidelines and a further 39 (20.6%) were based upon phase II or III clinical trial data.

Discussion:  Over 90% of off-label protocols are supported by established treatment guidelines or published peer-reviewed research even though the medications are not approved for that particular use by the TGA. However, these off-label protocols are unfunded by the PBS: this results in a marked inequality of access to appropriate medications for cancer patients across Australia.

Disparities in the allocation of treatment in advanced ovarian cancer: are there certain patient characteristics associated with nonstandard therapy?

Editorial: Slow Progress in Cancer Care Disparities: HIPAA, PPACA, and CHEWBACCA… But We're Still not There! - the Oncologist

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Several factors (Table 1) appear to contribute to these differences in cancer outcomes, and these must become part of our medical consciousness as deficits that require urgent attention and/or resolution.

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Table 1.

Factors associated with disparities of cancer care

What is very clear is that this problem is not unique to the United States

Cancer claims more in rural areas (references ovarian cancer survivour) - Sunshine Coast Health |- media

abstract: Racial disparities in ovarian cancer surgical care: A population-based analysis

Conclusions Among women undergoing initial surgery for ovarian cancer, African-American patients are significantly less likely to be operated on by a high-volume surgeon and to undergo important ovarian cancer-specific surgical procedures compared to White patients.

AACR Hosts Cancer Disparities Conference in Miami, Fla. abstract online Sept

This year, the American Association for Cancer Research will host its third conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved at the Loews Miami Beach Hotel in Miami, Fla.

Findings presented at this year’s meeting will include:

• proven communication methods for reaching minority populations;
• strategies to increase enrollment in clinical trials;
• prognosis in lung cancer affected by race;
• breast cancer trends in Arab and Israeli Jewish women;
• the importance of social support and physical activity in survivors; and,
• socioeconomics and access to health care.
To help you plan your coverage of the conference, the program schedule is available online at
http://www.aacr.org/disparities2010

abstracts will be available on Sept. 22, 2010

Racial differences in stage at diagnosis and survival from epithelial ovarian cancer: A fundamental cause of disease approach

Social Science & Medicine

abstract:

Associations between race, socioeconomic status (SES) and health outcomes have been well established. One of the ways in which race and SES affect health is by influencing one’s access to resources, which confers ability to avoid or mitigate adverse outcomes. The fundamental cause of disease approach argues that when a new screening tool is introduced, individuals with greater resources tend to have better access to the innovation, thus benefiting from early detection and leading to better survival.  

Conversely, when there is no established screening tool, racial and SES differences in early detection may be less pronounced.

Most ovarian cancer is diagnosed at advanced stages, because of the lack of an effective screening tool and few early symptoms. However, once detected, racial differences may still be observed in mortality and survival outcomes. We examined the racial differences in diagnosis and survival among ovarian cancer cases diagnosed during 1994–1998, in Cook County, Illinois (N = 351). There were no racial differences in the stage at diagnosis: 51.7% of white and 52.9% of black women were diagnosed at later stages (III and IV). Only age was associated with the stage at diagnosis. Tumor characteristics also did not differ between white and black women. Compared to white women, black women were less likely to be married, less educated, more frequently used genital powder, had tubal ligation, and resided in higher poverty census tracts. As of December 31, 2005, 44.3% of white and 54.5% of black women had died of ovarian cancer. Controlling for known confounding variables, the hazard ratio for ovarian cancer death between black and white women was 2.2. The findings show that fundamental cause perspective provides a potential framework to explore subtleties in racial disparities, with which broader social causes may be accounted for in explaining post diagnosis racial differences.

Cancer, Culture, and Health Disparities: Time to Chart a New Course?

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