Publications by authors named "Anna Jo Bodurtha Smith"
Article Synopsis
- Disparities exist in the participation of racial and ethnic minority populations in gynecologic cancer clinical trials, particularly affecting groups with high endometrial cancer rates, which is influenced by geographic access to these trials.
- The study aimed to analyze the geographic distribution of gynecological cancer trials across the US and identify any existing disparities relevant to various state characteristics.
- An analysis of 1,561 invasive gynecological cancer trials revealed that ovarian cancer trials were the most prevalent, highlighting a disparity in trial availability relative to state demographics and social vulnerability factors.
In the United Sates, over 115,000 individuals are diagnosed with a gynecologic cancer annually with access to a gynecologic oncologist and evidence-based treatment remaining a persistent challenge. Coverage decisions by private and public insurance, including Medicaid and Medicare, play key roles in access to care, impacting oncologic outcomes. The expansion of Medicaid insurance under the Affordable Care Act improved early diagnosis, treatment, and survival in gynecologic cancers, but disparities remain for individuals in non-Medicaid expansion states.
View Article and Find Full Text PDFBackground: Racial disparities in clinical trial participation for uterine cancer have been reported.
Objective: We sought to examine disparities of endometrial cancer patient participation in clinical drug trials in a contemporary, real-world population in the United States.
Study Design: We conducted a retrospective cohort study of patients with advanced or recurrent patients with endometrial cancer diagnosed from 2013 to 2021 using a real-world electronic health record-derived database representing approximately 800 academic and community practice sites across the United States.
Objective: To examine patient barriers and facilitators to PARP inhibitor (PARP-I) maintenance therapy in ovarian cancer. PARP-I improves survival in ovarian cancer, but these multi-year therapies cost around $100,000 annually and are under-prescribed.
Methods: We recruited patients with ovarian cancer treated with PARP-I maintenance therapy at an academic health system for a semi-structured interview.
Transportation is an underrecognized, but modifiable barrier to accessing cancer care, especially for clinical trials. Clinicians, insurers, and health systems can screen patients for transportation needs and link them to transportation. Direct transportation services (i.
View Article and Find Full Text PDFArticle Synopsis
- PARP inhibitors (PARP-I) are effective in improving survival for ovarian cancer patients, particularly those with BRCA mutations or related genetic issues, but insurance companies often require prior authorization for their use.
- A study conducted at the University of Pennsylvania found that 64% of ovarian cancer patients prescribed PARP-I faced prior authorization, with patients in the frontline setting having a slightly higher rate (67%).
- The process of obtaining approval delays treatment, averaging an additional 10 days for those requiring prior authorization, which is particularly concerning for patients with beneficial genetic mutations like BRCA.
Introduction: Telemedicine rapidly increased with the COVID-19 pandemic and could reduce cancer care disparities. Our objective was to evaluate sociodemographic (race, insurance), patient, health system, and cancer factors associated with telemedicine use in gynecologic cancers.
Methods: We conducted a retrospective cohort study of patients with endometrial cancer and epithelial ovarian cancer with at least one visit from March 2020 to October 2021, using a real-world electronic health record-derived database, representing approximately 800 sites in US academic (14%) and community practices (86%).
Delays in starting potentially curative treatment for locally-advanced cervical cancer (LACC) decrease survival. Reasons for these delays are poorly understood. We conducted a retrospective chart review examining disparities in time from diagnosis of LACC to first clinic visit and to initiation of treatment based on insurance status within a single health system.
View Article and Find Full Text PDFBackground: The dependent coverage mandate in the 2010 Affordable Care Act (ACA) allows young adults to stay on a parent's private insurance through age 26. While this mandate is associated with gains in insurance and early-stage cancer diagnosis, its long-term impact on survival is unknown.
Objective: To compare insurance coverage, stage at diagnosis, and overall survival in patients with gynecologic cancer before and after the ACA's dependent coverage mandate.
Background: Significant disparities exist in clinical trial participation in non-gynecologic cancers, but little is known about disparities in ovarian cancer trial participation. Our objective was to examine patient, sociodemographic (race/ethnicity, insurance), cancer, and health system factors associated with clinical trial participation in ovarian cancer.
Methods: We conducted a retrospective cohort study of patients with epithelial ovarian cancer diagnosed from 2011 to 2021, using a real-world electronic health record derived database, representing around 800 sites of care in US academic and community practices.
While prior authorization aims to reduce unnecessary care, it may limit or delay medically necessary care. Delays in cancer care can impact survival and are more common in historically-marginalized populations. Our objective was to examine to what extent disparities occurred in prior authorizations for gynecologic oncology.
View Article and Find Full Text PDFBackground: Prior authorization was designed to minimize unnecessary care and reduce spending but has been associated with delays in necessary care. Our objective was to estimate the occurrence of prior authorization, and impact on cancer care, in gynecologic oncology.
Methods: We performed a retrospective cross-sectional study of patients seen in University of Pennsylvania gynecologic oncology practices (January-March 2021).
Objectives: The aim of the study are to compare trends in diagnosis and treatment of adenocarcinoma of the cervix (AC) to squamous cell carcinoma of the cervix (SCC) and to examine associations between stage at diagnosis and guideline-concordant treatment with race, age, and insurance type for AC and SCC.
Materials And Methods: We performed a retrospective cohort study of cervical AC ( n = 18,811) and SCC ( n = 68,421) from the 2004-2017 National Cancer Database. We used generalized linear models to evaluate trends in frequency of histologies and to evaluate associations between race, age, and insurance status with stage of diagnosis and receipt of National Comprehensive Cancer Network guideline-concordant treatment for AC and SCC.
Article Synopsis
- The study investigates the impact of the Affordable Care Act's Medicaid expansion in 2014 on the 1-year survival rates of ovarian cancer patients, comparing those in states that expanded Medicaid to those that did not.
- Results show a 2.2% increase in survival for patients in Medicaid expansion states, primarily benefiting White patients.
- The findings suggest that the increased survival rates are linked to earlier stage diagnoses due to better access to insurance, indicating that further Medicaid expansion could enhance outcomes and address disparities in cancer care.
Objective: To identify patient, clinical and hospital factors associated with long-term survival (≥10 years) in women with serous ovarian cancer.
Methods: This National Cancer Database cohort study included women with stage II-IV serous ovarian cancer. Multivariate logistic regression models were used to examine the association of long-term survival with patient (race, insurance, location, household income, education, distance traveled), clinical (age, comorbidities, stage, grade, primary treatment) and hospital factors (region, institution, hospital volume ≥20).
Objectives: To examine overall survival (OS) and cancer-specific survival (CSS) for different racial groups of women with surgically staged endometrial cancer by histologic subtype.
Methods: This is a retrospective cohort study of women with stage I-III endometrioid, serous, clear cell, and carcinosarcoma who underwent hysterectomy as primary surgical staging in the 2000-2016 SEER-Medicare database. OS and CSS outcomes were stratified by race (defined as White, Black, Other), stage, and histology.
Background And Objectives: This study aims to characterize the utilization of minimally invasive myomectomy in the United States and to identify the patient and hospital factors associated with surgical approach to myomectomy.
Methods: This is a cross-sectional study using the National Inpatient Sample database. We extracted women aged 18-50 years who underwent open and minimally invasive (laparoscopic and robotic) myomectomy (MIM) from January 1, 2010-December 31, 2014.
With 102,000 new cases of gynecologic cancer, 30,000 associated deaths annually, and increasing rates of endometrial cancer, gynecologic cancer is a growing problem. Although gynecologic cancer care has advanced significantly in the past decade owing to new therapeutics and specialized training in radical surgery, even insured women face major barriers to accessing and affording quality gynecologic cancer care. This commentary reviews current literature on insurance-mediated disparities in gynecologic cancer and provides education to clinicians on barriers to care.
View Article and Find Full Text PDFObjective: To compare recurrence rate, progression-free survival (PFS), and overall survival for early-stage cervical cancer after minimally invasive (MIS) vs abdominal radical hysterectomy.
Data Sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Library databases.
Methods Of Study Selection: We identified studies from 1990 to 2020 that included women with stage I or higher cervical cancer treated with primary radical hysterectomy and compared recurrence and/or PFS and overall survival with MIS vs abdominal radical hysterectomy.
Objective: To estimate how implementation of the 2010 Affordable Care Act (ACA) might be associated with stage at diagnosis and time to treatment for women with ovarian cancer.
Methods: We conducted a retrospective cohort study using difference-in-differences analysis comparing stage at diagnosis and time to treatment before and after implementation of the ACA among women with ovarian cancer aged 21-64 years (exposure group) compared with women aged 65 years or older (control group). Using 2004-2015 data from the National Cancer Database, outcomes were analyzed overall and by insurance type and race, adjusting for urban-rural, income and education level, comorbidities, distance traveled for care, region, and care at an academic center.
Gynecologic cancer in HIV-positive women: a systematic review and meta-analysis.
Am J Obstet Gynecol
September 2019
Background: While there is a significant body of literature on cervical cancer in HIV-positive women, little is known about other gynecologic cancers in this population.
Objective: The objective of this systematic review and meta-analysis is to describe the incidence, presentation, treatment, and outcomes for HIV-positive women with non-acquired immunodeficiency syndrome-defining gynecologic cancers.
Study Design: We searched MEDLINE, EMBASE, ClinicalTrials.