Nancy L. Richter

An international comparison of cancer survival: Toronto, Ontario, and Detroit, Michigan, metropolitan areas

OBJECTIVES This study examined whether socioeconomic status has a differential effect on the survival of adults diagnosed with cancer in Canada and the United States. METHODS The Ontario Cancer Registry and the National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) program provided a total of 58,202 and 76,055 population-based primary malignant cancer cases for Toronto, Ontario, and Detroit, Mich, respectively. Socioeconomic data for each persons residence at time of diagnosis were taken from population censuses. RESULTS In the US cohort, there was a significant association between socioeconomic status and survival for 12 of the 15 most common cancer sites; in the Canadian cohort, there was no such association for 12 of the 15 sites. Among residents of low-income areas, persons in Toronto experienced a survival advantage for 13 of 15 cancer sites at 1- and 5-year follow-up. No such between-country differentials were observed in the middle- or high-income groups. CONCLUSIONS The consistent pattern of a survival advantage in Canada observed across various cancer sites and follow-up periods suggests that Canadas more equitable access to preventive and therapeutic health care services is responsible for the difference.

An international comparison of cancer survival: metropolitan Toronto, Ontario, and Honolulu, Hawaii.

OBJECTIVES Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii. METHODS Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 1986-1990, followed until 1996). Socioeconomic data for each persons residence at the time of diagnosis were taken from population censuses. RESULTS Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in Toronto experienced 5-year survival advantages for breast and prostate cancer. In support of the health insurance hypothesis, between-country differences were smaller than those observed with other state samples and the Canadian advantage was larger among younger women. CONCLUSIONS Hawaii seems to provide better cancer care than many other states, but patients in Toronto still enjoy a significant survival advantage. Although Hawaiis employer-mandated health insurance coverage seems an effective step toward providing equitable health care, even better care could be expected with a universally accessible, single-payer system.

Group work with female survivors of childhood sexual abuse : Evidence of poorer outcomes among those with eating disorders

OBJECTIVE This study explored levels of depression and self-esteem after childhood sexual abuse (CSA) group treatment for survivors with and without histories of eating disorders (ED). METHODS Fifty adult female survivors completed a 15-week CSA group treatment program and were assessed at intake, pre-group treatment, discharge, and six months follow-up using the Beck Depression Inventory, the Generalized Contentment Scale and the Index of Self-Esteem. They were also asked to report on their CSA histories and comorbid psychiatric issues including histories of ED. RESULTS Survivors with reported histories of anorexia nervosa or bulimia nervosa were significantly more depressed (minimum p<.05) and tended to have significantly less self-esteem (minimum p<.10) at discharge and six-month follow-up than those without ED. The size of these effects suggested their potential clinical significance as well. Seven to nine of every ten clients with histories of ED were more depressed and had lower self-esteem than the typical client without ED at discharge and at six-month follow-up. CONCLUSION The findings suggest that CSA treatment programs should assess survivors for ED as they might benefit from a more specialized focus on their emotional responses to the abuse.

The effectiveness of feminist social work methods: An integrative review

ABSTRACT This integrative review of the effectiveness of feminist social work methods compared 35 independent studies of feminist interventions with 44 independent studies of social work practice that were based on other theoretical orientations. Feminist interventions were observed to be more effective than those based on other practice models. And among feminist social work interventions, radical methods seemed to be more effective than liberal methods. These findings are consistent with a theory by target system interaction that was suggested by a previous meta-analysis (Gorey, Thyer, & Pawluck, 1998). While personal theoretical orientations such as cognitive-behavioral modes of practice seem more supportive of individual client change, systemic-structural models, including feminist ones, seem to be more effective in supporting mutual client-worker strategies to change larger system targets. This studys review-generated finding of feminist, specifically radical feminist, social works differential effectiveness is essentially a screened hypothesis. Its validity remains to be tested with well controlled primary research.

Palliative chemotherapy among people living in poverty with metastasised colon cancer: facilitation by primary care and health insurance

Background Many Americans with metastasised colon cancer do not receive indicated palliative chemotherapy. We examined the effects of health insurance and physician supplies on such chemotherapy in California. Methods We analysed registry data for 1199 people with metastasised colon cancer diagnosed between 1996 and 2000 and followed for 1 year. We obtained data on health insurance, census tract-based socioeconomic status and county-level physician supplies. Poor neighbourhoods were oversampled and the criterion was receipt of chemotherapy. Effects were described with rate ratios (RR) and tested with logistic regression models. Results Palliative chemotherapy was received by less than half of the participants (45%). Facilitating effects of primary care (RR=1.23) and health insurance (RR=1.14) as well as an impeding effect of specialised care (RR=0.86) were observed. Primary care physician (PCP) supply took precedence. Adjusting for poverty, PCP supply was the only significant and strong predictor of chemotherapy (OR=1.62, 95% CI 1.02 to 2.56). The threshold for this primary care advantage was realised in communities with 8.5 or more PCPs per 10 000 inhabitants. Only 10% of participants lived in such well-supplied communities. Conclusions This studys observations of facilitating effects of primary care and health insurance on palliative chemotherapy for metastasised colon cancer clearly suggested a way to maximise Affordable Care Act (ACA) protections. Strengthening Americas system of primary care will probably be the best way to ensure that the ACAs full benefits are realised. Such would go a long way towards facilitating access to palliative care.