Abstract:
BACKGROUND:Metastatic colorectal cancer (CRC) outcomes continue to improve, but they vary significantly by race and ethnicity. We hypothesize that these disparities arise from unequal access to care. MATERIALS AND METHODS:The Harris Health System (HHS) is an integrated health delivery network that provides medical care to the underserved, predominantly minority population of Harris County, Texas. As the largest HHS facility and an affiliate of Baylor College of Medicine's Dan L. Duncan Comprehensive Cancer Center, Ben Taub Hospital (BTH) delivers cancer care through multidisciplinary subspecialty that prioritize access to care, adherence to evidence-based clinical pathways, integration of supportive services, and mitigation of financial toxicity. We performed a retrospective analysis of minority patients diagnosed with and treated for metastatic CRC at BTH between January 2010 and December 2012. Kaplan-Meier survival curves were compared with survival curves from randomized control trials reported during that time period. RESULTS:We identified 103 patients; 40% were black, 49% were Hispanic, and 12% were Asian or Middle Eastern. Thirty-five percent reported a language other than English as their preferred language. Seventy-four percent of patients with documented coverage status were uninsured. Eighty-four percent of patients received standard chemotherapy with a clinician-reported response rate of 63%. Overall survival for BTH patients undergoing chemotherapy was superior to that of subjects enrolled in the CRYSTAL (Cetuximab Combined with Irinotecan in First-Line Therapy for Metastatic Colorectal Cancer) trial (median, 24.0 vs. 19.9 months; P = .014). CONCLUSION:HHS provides a health delivery infrastructure through which minority patients with socioeconomic challenges experience clinical outcomes comparable with highly selected patients enrolled in randomized control trials. Efforts to resolve CRC disparities should focus on improving access of at-risk populations to high-quality comprehensive cancer care.
journal_name
Clin Colorectal Cancerjournal_title
Clinical colorectal cancerauthors
Lau-Min K,Prakash P,Jo E,Thrift AP,Hilsenbeck S,Musher BLdoi
10.1016/j.clcc.2019.09.002subject
Has Abstractpub_date
2020-06-01 00:00:00pages
e49-e57issue
2eissn
1533-0028issn
1938-0674pii
S1533-0028(19)30446-3journal_volume
19pub_type
杂志文章abstract::The standard in rectal cancer has been to add adjuvant radiation therapy to surgery in patients with stage II and III disease. Total mesorectal excision has led to lower local recurrence rates, and, if properly performed, may make adjuvant radiation unnecessary for certain stage II and III patients, such as T3 N0 pati...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,评审
doi:10.3816/CCC.2003.n.002
更新日期:2003-02-01 00:00:00
abstract::Hepatic colorectal metastases present a challenging problem in patients with recurrent colorectal cancer. Twenty percent of patients with recurrence will have liver metastases as a component of their disease, and only 10% of these patients will have isolated liver metastases that are resectable. Although systemic chem...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,评审
doi:10.3816/CCC.2003.n.010
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:In this study, the maximum tolerated dose and toxicity profile of FOLFIRI (infusional fluorouracil [5-FU]/leucovorin/irinotecan) plus gefitinib (an oral inhibitor of the epidermal growth factor receptor) were evaluated as first-line therapy in patients with metastatic colorectal cancer. PATIENTS AND METHODS...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.3816/CCC.2006.n.037
更新日期:2006-09-01 00:00:00
abstract::Combination protocols of 5-fluorouracil/leucovorin (5-FU/LV) plus irinotecan or oxaliplatin have demonstrated high activity in metastatic colorectal cancer. Capecitabine, an oral 5-FU prodrug, may replace infusional 5-FU/LV in combination protocols with irinotecan or oxaliplatin. We therefore initiated a phase II stud...
journal_title:Clinical colorectal cancer
pub_type: 临床试验,杂志文章
doi:10.3816/ccc.2004.n.009
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:5-Fluorouracil (5-FU) chemotherapy is associated with severe and unpredictable toxicity in a significant proportion of patients. 5,10-Methylenetetrahydrofolate and 5-fluorodeoxyuridine monophosphate bind to thymidylate synthase and together inhibit its function, resulting in cytotoxicity. We hypothesized tha...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2016.06.001
更新日期:2016-12-01 00:00:00
abstract::In the past 10 years, overall survival and disease-free survival of patients with colorectal cancer (CRC) has improved substantially because of a combination of factors: (1) more accurate staging as a result of advances in imaging technology; (2) refinements in surgical technique; (3) 'curative' metastasectomy for pat...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.3816/CCC.2009.n.013
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:Anal squamous cell carcinoma (ASCC) is a rare, human papilloma virus-associated cancer. The purpose was to investigate the population-based incidence rates, age and gender distribution, and survival of ASCC. MATERIALS AND METHODS:All primary ASCC in 1987 to 2016 were identified in the Cancer Registry of Nor...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2018.10.001
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Panitumumab, a fully human monoclonal antibody targeting the epidermal growth factor receptor (EGFR), is used as monotherapy for chemorefractory metastatic colorectal cancer (mCRC) in patients with wild-type (WT) KRAS tumors. Although skin toxicities are the most common adverse events associated with EGFR in...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.clcc.2011.06.004
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Systemic chemotherapy increases the possibility of resection in patients with initially unresectable colorectal cancer (CRC), especially patients with hepatic metastasis. However, the predictive factors and prognosis of conversion to resection after chemotherapy in patients with various organ metastases rema...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2017.10.002
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:The prognostic value of tumor sidedness in metastatic colorectal cancer (CRC) has been established, but its impact on nonmetastatic disease remains unclear. Our study aimed to explore the prognostic effect of tumor sidedness by subgroup survival analyses, according to histology and tumor grade in stage I-IV ...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2018.10.005
更新日期:2019-03-01 00:00:00
abstract::Colorectal cancer (CRC), one of the most common malignancies worldwide, is often diagnosed at an advanced stage, and resistance to chemotherapeutic and existing targeted therapy is a major obstacle to its successful treatment. New targets that offer alternative clinical options are therefore urgently needed. Recently,...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,评审
doi:10.1016/j.clcc.2016.06.006
更新日期:2017-03-01 00:00:00
abstract::The multiplicity of chemotherapy regimens currently available to treat colorectal cancer in the first-line setting precludes the identification of a single standard regimen for front-line therapy. The previous standard, 5-fluorouracil (5-FU), formerly the only agent with any significant activity against colorectal can...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,评审
doi:10.3816/ccc.2004.s.002
更新日期:2004-06-01 00:00:00
abstract:BACKGROUND:The Irinotecan Cetuximab Evaluation and Cetuximab Response Evaluation (ICECREAM) study assessed the efficacy of cetuximab monotherapy compared with cetuximab combined with chemotherapy for quadruple wild-type (KRAS, NRAS, BRAF, or P13KCA exon 20) metastatic colorectal cancer. PATIENTS AND METHODS:Patients w...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.clcc.2018.06.002
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:With improved survival and longer duration of treatment, clinicians managing metastatic colorectal cancer (mCRC) increasingly consider intermittent (IC) or maintenance chemotherapy (MC), but the effect of these treatment modifications on real-world outcomes is unclear. PATIENTS AND METHODS:Using a populatio...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2017.10.011
更新日期:2018-03-01 00:00:00
abstract:PURPOSE:American Society of Clinical Oncology (ASCO) guidelines define high-risk prognostic features (HRFs) in stage II colon cancer and recommend limiting adjuvant chemotherapy to patients with HRFs. We evaluated the extent to which HRFs influenced decisions on adjuvant chemotherapy before and after publication of the...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:As more patients are screened for colorectal cancer a small but significant number of interval cancers develop after colonoscopy for colorectal cancer screening. MATERIALS AND METHODS:We reviewed records of 75,314 adult patients who underwent colonoscopy for screening or diagnostic purposes between 1998 and...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2014.11.001
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Quinacrine plus a fluoropyrimidine has in vivo efficacy against metastatic colorectal cancer (mCRC). This phase 1b trial evaluated the combination of quinacrine plus capecitabine in patients with treatment-refractory mCRC. PATIENTS AND METHODS:Using a modified Simon accelerated titration design, adults with...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2020.08.003
更新日期:2020-08-19 00:00:00
abstract::The discovery of the key role of the epidermal growth factor receptor (EGFR) and its downstream signaling effectors in the pathophysiology of colorectal cancer (CRC) has ushered in the clinical use of targeted therapies in the treatment of metastatic CRC (mCRC). The anti-EGFR monoclonal antibodies cetuximab and panitu...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,评审
doi:10.1016/j.clcc.2015.05.006
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Individually, oxaliplatin and irinotecan have substantial activity in metastatic colorectal cancer (CRC) in combination with 5-fluorouracil/leucovorin. A combination regimen using all 4 agents could potentially increase response rates in CRC. PATIENTS AND METHODS:A multicenter phase II trial of oxaliplatin ...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,多中心研究
doi:10.3816/CCC.2007.n.017
更新日期:2007-05-01 00:00:00
abstract::Primary squamous cell colorectal carcinomas are uncommon, and their characteristics are not well known. They seem to occur most commonly in the fifth decade of life with a slight predominance for men. The most commonly reported anatomic locations are the rectum and the proximal colon. Clinical features and common diag...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.3816/CCC.2001.n.006
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:The safety of bevacizumab in older mCRC patients is poorly understood. The purpose of this analysis was to determine the prevalence, incidence, and risk factors for treatment-related AEs in older bevacizumab recipients. PATIENTS AND METHODS:Patients age ≥65 were identified from SEER-Medicare and categorized...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2012.11.004
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Metastatic colorectal cancer (mCRC) is increasingly treated using targeted therapies. Their real-life evaluation is insufficient, especially in elderly and frail patients. The aim was to describe use, safety, and effectiveness of targeted therapies in first-line mCRC treatment according to age. PATIENTS AND...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2018.11.005
更新日期:2019-03-01 00:00:00
abstract:PURPOSE:Our purpose is to perform a comprehensive literature review of the use of levoleucovorin in gastrointestinal malignancies and to assess whether levoleucovorin is a reasonable alternative to racemic leucovorin. DESIGN:This is an extensive literature review of levoleucovorin use in patients with gastrointestinal...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,评审
doi:10.3816/CCC.2009.n.034
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:As of 2006, bevacizumab was available for the treatment of metastatic colorectal cancer (mCRC) in British Columbia (BC). This study compares survival between referred patients diagnosed with mCRC in 2003/2004 (pre-bevacizumab era) and 2006 (bevacizumab era). PATIENTS AND METHODS:The BC cancer agency (BCCA) ...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2011.03.004
更新日期:2011-06-01 00:00:00
abstract::Significant advances have been made with respect to our understanding of the critical role of agents targeting angiogenic pathways in the treatment of metastatic colorectal cancer (mCRC). The approval of 3 agents that target angiogenic signaling, bevacizumab, ziv-aflibercept, and regorafenib, provides strong evidence ...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,评审
doi:10.1016/j.clcc.2014.02.001
更新日期:2014-09-01 00:00:00
abstract::Modern chemotherapy combinations for metastatic colorectal cancer (mCRC) comprise infusional 5-fluorouracil (5-FU), leucovorin, and irinotecan or oxaliplatin. The fluoropyrimidine derivative capecitabine is at least as effective as 5-FU plus leucovorin bolus regimens. It displays a favorable toxicity profile and offer...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,评审
doi:10.3816/CCC.2008.n.015
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:Anterior resection syndrome (ARS) is common after sphincter-saving surgery for rectal cancer. It includes changes in the frequency and urgency of bowel movements and fecal incontinence. The therapeutic efficacy of biofeedback on ARS is unclear. We sought to evaluate the effectiveness of biofeedback therapy i...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2015.11.002
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:The efficacy and safety of the FOLFIRI (leucovorin, 5-fluorouracil, irinotecan, and oxaliplatin) regimen combined with aflibercept has not been studied in the first-line management of patients with metastatic colorectal cancer (mCRC). PATIENTS AND METHODS:In the context of a prospective single-arm trial (NC...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,多中心研究
doi:10.1016/j.clcc.2018.06.003
更新日期:2018-12-01 00:00:00
abstract:INTRODUCTION:The aim of this study was to evaluate the efficacy and safety of maintenance therapy with axitinib versus placebo following induction therapy in patients with metastatic colorectal cancer (mCRC). PATIENTS AND METHODS:In this double-blinded, phase II trial, patients with mCRC who had not progressed after 6...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.clcc.2018.02.004
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:New treatment modalities and a growing understanding of the complex genetic tumor landscape have improved the outcome of colorectal cancer (CRC) patients. Nonetheless, more individualized treatment regimens, taking individual tumor characteristics into account, have been recently postulated and prognostic bi...
journal_title:Clinical colorectal cancer
pub_type: 杂志文章
doi:10.1016/j.clcc.2018.02.008
更新日期:2018-06-01 00:00:00