 |
|
Unequal access: Hispanic children rarely get top-notch care for brain tumors
October 09, 2009Hispanic children diagnosed with brain tumors get high-quality treatment at hospitals that specialize in neurosurgery far less often than other children with the same condition, potentially compromising their immediate prognosis and long-term survival, according to research from Johns Hopkins published in October's Pediatrics.
More than a decade after the Institute of Medicine's landmark report Crossing the Quality Chasm, the Hopkins investigators say their findings detect persistent gaps in access to specialized care among certain patients, raising questions about how far across the chasm we have actually come.
"What was shocking to us was the finding that, despite the push over the last decade to equalize access to high-quality care, gaps are still there, particularly among Hispanics, and, if anything, they may be getting even worse," said lead investigator Raj Mukherjee, M.D., M.P.H., a postdoctoral fellow in the Department of Neurosurgery at Hopkins.
Research has shown that patients treated at specialty hospitals that admit a high volume of patients with similar conditions fare better in the long and short term, investigators say. For example, studies show that patients undergoing brain surgeries in hospitals that perform the fewest neurosurgeries have up to 16 times the mortality rate of patients treated in hospitals performing the highest number.
"Given that brain tumors are the most common solid tumors in children, lack of access to specialized care simply means that thousands of pediatric patients are getting less-than-optimal treatment, putting them at risk for relapse and a host of neurological complications," says pediatric neurosurgeon George Jallo, M.D., co-author on the study and director of Neurosurgery at Johns Hopkins Children's Center.
The Hopkins study, which looked at 4,421 children with brain tumors over the span of 18 years, found that access was worst among Hispanics, as well as among those of lower socio-economic status and those living in areas with higher immigrant population and with few neurosurgeons. Insurance did not play a role in where a patient was treated, the researchers found. The Hopkins team linked two databases-one detailing hospital and patient information and another one with demographic and environmental information-elucidating in a novel way the impact of such factors as ethnicity and proportion of foreign-born people in the county of residence.
Overall, only 37 percent of the patients in the study who should have been treated at a high-volume hospital had surgeries in such institutions. Hispanics consistently fared worse than the others: Even when adjusting for factors that may affect access to care, such as socioeconomic status and health insurance, Hispanic children still got specialized care at one-third the rate of other children, the Hopkins team found.
"If you're a Hispanic child diagnosed with a brain tumor, you're far less likely to get the best possible treatment, and this is concerning in and of itself, but there's another looming threat emerging from our findings," said senior investigator Alfredo Quiñones-Hinojosa, M.D., associate professor of Neurosurgery and Oncology at Hopkins. "Hispanics will make up 25 percent of this country's population by the year 2050, so unless we do something about this, it looks like in the next few decades, a quarter of our population may end up getting substandard care."
"Our findings are yet another reminder that we are at a unique crossroad in history as we try to restructure our healthcare system, and we have been given a chance to reduce, perhaps even eliminate, these inequalities once and for all," Quiñones adds.
Researchers say that pinpointing the exact factors that determine who gets care and where they get it requires carefully designed studies that examine individual patient decision-making, as well as systemic factors, such as insurance and possible institutional bias in patient selection.
Johns Hopkins Medical Institutions
Research has shown that patients treated at specialty hospitals that admit a high volume of patients with similar conditions fare better in the long and short term, investigators say. For example, studies show that patients undergoing brain surgeries in hospitals that perform the fewest neurosurgeries have up to 16 times the mortality rate of patients treated in hospitals performing the highest number.
"Given that brain tumors are the most common solid tumors in children, lack of access to specialized care simply means that thousands of pediatric patients are getting less-than-optimal treatment, putting them at risk for relapse and a host of neurological complications," says pediatric neurosurgeon George Jallo, M.D., co-author on the study and director of Neurosurgery at Johns Hopkins Children's Center.
The Hopkins study, which looked at 4,421 children with brain tumors over the span of 18 years, found that access was worst among Hispanics, as well as among those of lower socio-economic status and those living in areas with higher immigrant population and with few neurosurgeons. Insurance did not play a role in where a patient was treated, the researchers found. The Hopkins team linked two databases-one detailing hospital and patient information and another one with demographic and environmental information-elucidating in a novel way the impact of such factors as ethnicity and proportion of foreign-born people in the county of residence.
Overall, only 37 percent of the patients in the study who should have been treated at a high-volume hospital had surgeries in such institutions. Hispanics consistently fared worse than the others: Even when adjusting for factors that may affect access to care, such as socioeconomic status and health insurance, Hispanic children still got specialized care at one-third the rate of other children, the Hopkins team found.
"If you're a Hispanic child diagnosed with a brain tumor, you're far less likely to get the best possible treatment, and this is concerning in and of itself, but there's another looming threat emerging from our findings," said senior investigator Alfredo Quiñones-Hinojosa, M.D., associate professor of Neurosurgery and Oncology at Hopkins. "Hispanics will make up 25 percent of this country's population by the year 2050, so unless we do something about this, it looks like in the next few decades, a quarter of our population may end up getting substandard care."
"Our findings are yet another reminder that we are at a unique crossroad in history as we try to restructure our healthcare system, and we have been given a chance to reduce, perhaps even eliminate, these inequalities once and for all," Quiñones adds.
Researchers say that pinpointing the exact factors that determine who gets care and where they get it requires carefully designed studies that examine individual patient decision-making, as well as systemic factors, such as insurance and possible institutional bias in patient selection.
Johns Hopkins Medical Institutions
Brain Tumors Current Events and Brain Tumors News RSSBarrow study identifies new way to biopsy brain tumors in real time
A new miniature, hand-held microscope may allow more precise removal of brain tumors and an easier recognition of tumor locations during surgery.
Brain tumors in childhood leave a lasting mark on cognition, life status
Brain tumors in childhood cast a long shadow on survivors. The first study of the lasting impact of these tumors -- the most common solid malignancies in childhood -- shows that survivors have ongoing cognitive problems.
The Largest Congress Worldwide on Ion Therapy in Heidelberg
The largest congress worldwide on the topic of particle or ion therapy - radiation with heavy ions and protons - has taken place in the fall of 2009 in Heidelberg.
Exercise can aid recovery after brain radiation
Exercise is a key factor in improving both memory and mood after whole-brain radiation treatments in rodents, according to data presented by Duke University scientists at the Society for Neuroscience meeting.
Researchers report benefits of new standard treatment study for rare pediatric brain cancer
A team of researchers led by The University of Texas M. D. Anderson Cancer Center unveiled results today from the largest-ever collaborative study addressing the treatment of a rare pediatric brain tumor.
Survivors of childhood cancer less likely to marry
Childhood cancer survivors typically suffer from the long-term effects of cancer treatment on physical health, and results of a new study suggest that social implications also exist, which may affect their chance of an "I do" at the altar.
Stereotactic radiosurgery preferred method of treating cancer patients with brain metastases
Cancer patients who receive stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) for the treatment of metastatic brain tumors have more than twice the risk of developing learning and memory problems than those treated with SRS alone, according to researchers at The University of Texas M. D. Anderson Cancer Center.
New Approach for the Treatment of Malignant Brain Tumors
Initial chemotherapy alone after surgery is just as successful as initial radiation therapy for patients from whom a very malignant brain tumor (anaplastic glioma) was removed. With this treatment, the patients survive on average > 30 months without a recurrence.
Why don't brain tumors respond to medication?
Malignant brain tumors often fail to respond to promising new medication. Researchers in Heidelberg have discovered a mechanism and a tumor marker for the development of this resistance.
Small peptide found to stop lung cancer tumor growth in mice
In new animal research done by investigators at Wake Forest University School of Medicine, scientists have discovered a treatment effective in mice at blocking the growth and shrinking the size of lung cancer tumors, one of the leading causes of cancer death in the world.
More Brain Tumors Current Events and Brain Tumors News Articles
 |
Living with a Brain Tumor: Dr. Peter Black's Guide to Taking Control of Your Treatment by Peter Black (Author) Each year, 100,000 people in the United States are diagnosed with a brain tumor. With his new book, Dr. Peter Black fills a gap in the lay readership, providing an accessible medical resource for adult patients and their families. Dr. Black, who has operated on more than 3,000 patients with brain tumors, is uniquely qualified to discuss both clinical treatment of and research into brain tumors. This invaluable resource tells patients everything they need to know to understand and address their diagnosis, in a four-part structure: • “What is a Brain Tumor?" provides straightforward information about how brain tumors are diagnosed, the different types of tumors and how they develop, and where to go for treatment. • “Coping with Shock” addresses the emotional... |
 |
Curveball: When Life Throws You a Brain Tumor by Liz Holzemer (Author) Life seemed idyllic for thirty-two-year-old Liz Holzemer. Wife of Major League Baseball pitcher Mark Holzemer, Liz was enjoying a successful career as a journalist when an MRI revealed a baseball-size brain tumor she soon found out was called meningioma. Told with clarity and unwavering humor, this book is an inspirational and informative account of one woman’s battle for her life. It shows how she emerged from this frightening diagnosis and two brain surgeries retaining her remarkable spirit of survival and renewed sense of purpose and hope. With practical information about meningioma and brain surgery, Curveball is a manual for people who face life-altering challenges and is also proof that one need not fight such battles alone. |
 |
Guerilla Guide to Brain Tumors: Shameless Dirty Tricks to beat the system and STAY ALIVE! by Skip Goebel (Author) In an unprecedented format, the Guerilla Guide to Brain Tumors is written in a format that combines the layout of the For Dummies series with a drill-sargent's attitude. (the back page says it all) This is a book of War Nothing warm and fuzzy or socially acceptable here and nothing about "Dying with Dignity". Just what it takes to win. And win you will, complete with a trail of wreckage behind you. It's a book for the patient, NOT the caregiver. The Guerilla Guide to Brain Tumors is a book that will take you out of the "Grovel and Wretch" mode and into the "Command and Dominate" mode with the following factions of our society: The Medical EstablishmentThe Social Services EstablishmentChurch, Friends and FamilyAnd most importantly...Yourself No punches are pulled here. Prepare to be... |
 |
Damn The Statistics, I Have a Life to Live!: Coping with a Brain Tumor My Personal Story by Harry Wolf (Author) June 3, 2002 was the day that changed my life forever. A 43-year-old father of three, whom in oneday went from being a successful senior manager to a man with a braintumor. I have a glioblastoma multiformegrade IV brain tumor, the most deadly and aggressive type of brain tumor. This book covers how I have dealt with lifeafter being informed that I have a tumor that only 1-2% survive for 2years. I share the experiences, thoughts,and events from my first year as a survivor. When I was first diagnosed, I searched for a book that covered thedetails of what could be expected on both a medical and personal level. I could not find, so I wrote one. I maintained a detailed journal. I cover the first surgery, an awakecraniotomy, and the subsequent head infection that led to a second... |
 |
Brain Tumors: Leaving the Garden of Eden--A Survival Guide to Diagnosis, Learning the Basics, Getting Organized, and Finding Your Medical Team by Paul M. Zeltzer (Author) A guidebook for the 150,000+ people/ year and families affected by brain tumors. This book will help you learn the basics about diagnosis, getting organized and finding your medical team. Included are chapters on all major types of brain tumors & metastases, glossary, medications, using the Internet to search for information, and getting a second opinion. "Brain Tumors:Leaving the Garden of Eden" is all about improving your odds by gathering information, & assessing your situation: What you need to do; what you need to know; what you can do now! |
 |
Brain Tumors: An Encyclopedic Approach by Andrew H. Kaye MD MBBS FRACS (Editor), Edward R. Laws MD FACS (Editor) (Churchill Livingstone) Second author, Edward R. Laws, Jr. Extensive reference providing a systematic updating of the chapters from the previous edition, c1995, with a number of new contributors. Retains an encyclopedic approach and includes key points and key references where appropriate. Color and halftone illustrations. For neurosurgeons. |
 |
Tumors of the Brain and Spine (M.D. Anderson Cancer Care Series) by Franco DeMonte (Editor), Mark R. Gilbert (Editor), Anita Mahajan (Editor), Ian E. McCutcheon (Editor), R. Sawaya (Editor), W.K.A. Yung (Editor) Tumors of the Brain and Spine focuses primarily on the standard approaches to the treatment of benign, primary low-grade to high-grade, and metastatic tumors in the brain and spine used by surgeons and clinicians at The University of Texas M. D. Anderson Cancer Center. It is written mainly for the primary care oncologist, general neurologist, and general neurosurgeon. Chapters on treatment focus on neurosurgery, chemotherapy, and radiation therapy, both singly and in combination. Chapters on symptom management, the molecular genetics and neuropathology of intracranial tumors, the leptomeningeal dissemination of systemic cancer, the epidemiology of brain tumors, and innovative treatment strategies round out the volume. |
 |
100 Q&A About Brain Tumors (100 Questions & Answers) by Virginia Stark-Vance (Author) Consumer text provides authoritative, practical answers to questions regarding treatment options, post-treatment quality of life, and sources of support. Co-authored by a brain-tumor survivor, text explains what to expect after the diagnosis and the treatment of a brain tumor. Softcover. |
 |
Cure Brain Tumor Long Sleeve T-shirt Large White by Shop Zeus |
 |
Brain Tumors: Practical Guide to Diagnosis and Treatment (Neurological Disease and Therapy) by Joachim M. Baehring (Editor), Joseph M. Piepmeier (Editor) Emphasizing new and emerging therapies in each chapter, this reference provides essential information for clinicians to provide accurate diagnoses and select the most appropriate treatment regimens for patients with primary and metastatic brain tumors and neurological complications of cancer. Edited by a leading cast of authorities on the topic-including the Chief and Associate Editors of the Journal of Neuro-oncology-this easily-accessible guide reviews the epidemiology, identification, and management of brain tumors while exploring the latest advances in this increasingly diverse field. |
| © 2009 BrightSurf.com |