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Siddique S, Wang R, Yasin F, Gaddy JJ, Zhang L, Gross CP, Ma X. USPSTF Colorectal Cancer Screening Recommendation and Uptake for Individuals Aged 45 to 49 Years. JAMA Netw Open 2024; 7:e2436358. [PMID: 39361285 PMCID: PMC11450516 DOI: 10.1001/jamanetworkopen.2024.36358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/29/2024] [Indexed: 10/05/2024] Open
Abstract
Importance In May 2021, the US Preventive Services Task Force (USPSTF) issued a grade B recommendation encouraging colorectal cancer (CRC) screening among average-risk individuals aged 45 to 49 years. The patterns of screening uptake and possible socioeconomic disparities in screening in this age group remain unknown. Objective To evaluate changes in CRC screening uptake among average-risk individuals aged 45 to 49 years after the USPSTF recommendation was issued in 2021. Design, Setting, and Participants This retrospective cohort study used deidentified claims data from commercially insured Blue Cross Blue Shield beneficiaries aged 45 to 49 years across the US between January 1, 2017, and December 31, 2022. Exposure Publication of the May 2021 USPSTF CRC screening recommendation for adults aged 45 to 49 years. Main Outcomes and Measures Absolute and relative changes in screening uptake were compared between a 20-month period preceding (May 1, 2018, to December 31, 2019) and a 20-month period following (May 1, 2021, to December, 31, 2022) the USPSTF recommendation. Interrupted time-series analysis and autoregressive integrated moving average models were used to evaluate changes in screening rates, adjusting for temporal autocorrelation and seasonality. Results In this cohort study of 10 221 114 distinct beneficiaries aged 45 to 49 years (mean [SD] age, 47.04 [1.41] years; 51.04% female), bimonthly mean (SD) numbers of average-risk beneficiaries were 3 213 935 (31 508) and 2 923 327 (105 716) in the prerecommendation and postrecommendation periods, respectively. Mean (SD) screening uptake increased from 0.50% (0.02%) to 1.51% (0.59%) between the 2 periods (P < .001), representing an absolute change of 1.01 percentage points (95% CI, 0.62-1.40 percentage points) but no significant relative change (202.51%; 95% CI, -30.59% to 436.87%). Compared with average-risk beneficiaries residing in areas with the lowest socioeconomic status (SES), those residing in areas with the highest SES experienced the largest absolute change in screening (1.25 [95% CI, 0.77-1.74] percentage points vs 0.75 [95% CI, 0.47-1.02] percentage points), but relative changes were not significant (214.01% [95% CI, -30.91% to 461.15%] vs 167.73% [95% CI, -16.30% to 352.62%]). After the recommendation was issued, the screening uptake rate also increased fastest among average-risk beneficiaries residing in the areas with highest SES (0.24 [95% CI, 0.23-0.25] percentage points every 2 months) and metropolitan areas (0.20 [95% CI, 0.19-0.21] percentage points every 2 months). Conclusions and Relevance This study found that among privately insured beneficiaries aged 45 to 49 years, CRC screening uptake increased after the USPSTF recommendation, with potential disparities based on SES and locality.
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Affiliation(s)
- Sunny Siddique
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Faiza Yasin
- Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jacquelyne J. Gaddy
- Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center, New Haven, Connecticut
| | - Lan Zhang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cary P. Gross
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center, New Haven, Connecticut
- General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center, New Haven, Connecticut
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Qiao Y, Guo F, Liu P. Enhancing colorectal cancer survivorship: Integrating social work to optimize Dietary and lifestyle interventions. Clin Nutr 2024; 43:108-109. [PMID: 39357084 DOI: 10.1016/j.clnu.2024.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 09/25/2024] [Indexed: 10/04/2024]
Affiliation(s)
- Yi Qiao
- Chengdu First People's Hospital, China
| | - Fulin Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, China
| | - Pan Liu
- Chengdu First People's Hospital, China.
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Mehta A, Jeon WJ, Nagaraj G. Association of US county-level social vulnerability index with breast, colorectal, and lung cancer screening, incidence, and mortality rates across US counties. Front Oncol 2024; 14:1422475. [PMID: 39169944 PMCID: PMC11335618 DOI: 10.3389/fonc.2024.1422475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/19/2024] [Indexed: 08/23/2024] Open
Abstract
Background Despite being the second leading cause of death in the United States, cancer disproportionately affects underserved communities due to multiple social factors like economic instability and limited healthcare access, leading to worse survival outcomes. This cross-sectional database study involves real-world data to explore the relationship between the Social Vulnerability Index (SVI), a measure of community resilience to disasters, and disparities in screening, incidence, and mortality rates of breast, colorectal, and lung cancer. The SVI encompasses four themes: socioeconomic status, household composition & disability, minority status & language, and housing type & transportation. Materials and methods Using county-level data, this study compared cancer metrics in U.S. counties and the impact of high and low SVI. Two-sided statistical analysis was performed to compare SVI tertiles and cancer screening, incidence, and mortality rates. The outcomes were analyzed with logistic regression to determine the odds ratio of SVI counties having cancer metrics at or above the median. Results Our study encompassed 3,132 United States counties. From publicly available SVI data, we demonstrated that high SVI scores correlate with low breast and colorectal cancer screening rates, along with high incidence and mortality rates for all three types of cancers. County level SVI has impact on incidence rates of cancers; breast cancer rates were lowest in high SVI counties, while colorectal and lung cancer rates were highest in the same counties. Age-adjusted mortality rates for all three cancers increased across SVI tertiles. After risk adjustment, a 10-point SVI increase correlated with lower screening and higher mortality rates. Conclusion In conclusion, our study establishes a significant correlation between SVI and cancer metrics, highlighting the potential to identify marginalized communities with health disparities for targeted healthcare initiatives. It underscores the need for further longitudinal studies on bridging the gap in overall cancer care in the United States.
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Affiliation(s)
- Akhil Mehta
- Houston Methodist Dr. Mary and Ron Neal Cancer Center, Houston Methodist Hospital, Houston, TX, United States
| | - Won Jin Jeon
- Division of Hematology and Medical Oncology, Loma Linda University Cancer Center, Loma Linda, CA, United States
| | - Gayathri Nagaraj
- Division of Hematology and Medical Oncology, Loma Linda University Cancer Center, Loma Linda, CA, United States
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Tsai MH, Coughlin SS. Investigating the role of county-level colorectal cancer screening rates on stage at diagnosis of colorectal cancer in rural Georgia. Cancer Causes Control 2024; 35:1123-1131. [PMID: 38587569 DOI: 10.1007/s10552-024-01874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND To examine the impact of county-level colorectal cancer (CRC) screening rates on stage at diagnosis of CRC and identify factors associated with stage at diagnosis across different levels of screening rates in rural Georgia. METHODS We performed a retrospective analysis utilizing data from 2004 to 2010 Surveillance, Epidemiology, and End Results Program. The 2013 United States Department of Agriculture rural-urban continuum codes were used to identify rural Georgia counties. The 2004-2010 National Cancer Institute small area estimates for screening behaviors were applied to link county-level CRC screening rates. Descriptive statistics and multinominal logistic regressions were performed. RESULTS Among 4,839 CRC patients, most patients diagnosed with localized CRC lived in low screening areas; however, many diagnosed with regionalized and distant CRC lived in high screening areas (p-value = 0.009). In multivariable analysis, rural patients living in high screening areas were 1.2-fold more likely to be diagnosed at a regionalized and distant stage of CRC (both p-value < 0.05). When examining the factors associated with stage at presentation, Black patients who lived in low screening areas were 36% more likely to be diagnosed with distant diseases compared to White patients (95% CI, 1.08-1.71). Among those living in high screening areas, patients with right-sided CRC were 38% more likely to have regionalized disease (95% CI, 1.09-1.74). CONCLUSION Patients living in high screening areas were more likely to have a later stage of CRC in rural Georgia. IMPACT Allocating CRC screening/treatment resources and improving CRC risk awareness should be prioritized for rural patients in Georgia.
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Affiliation(s)
- Meng-Han Tsai
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA, USA.
- Georgia Prevention Institute, Augusta University, 1120 15th Street, HS-1705, Augusta, GA, 30912, USA.
| | - Steven S Coughlin
- Department of Biostatistics, Data Science and Epidemiology, School of Public Health, Augusta University, Augusta, GA, USA
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Alvarez CS, Piazuelo MB, Fleitas-Kanonnikoff T, Ruhl J, Pérez-Fidalgo JA, Camargo MC. Incidence and Survival Outcomes of Gastrointestinal Stromal Tumors. JAMA Netw Open 2024; 7:e2428828. [PMID: 39158910 PMCID: PMC11333982 DOI: 10.1001/jamanetworkopen.2024.28828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/23/2024] [Indexed: 08/20/2024] Open
Abstract
Importance The incidence of gastrointestinal stromal tumors (GISTs) increased after the implementation of GIST-specific histology coding in 2001, but updated data on trends and survival are lacking. Objective To examine the evolving epidemiology of GISTs in major organ sites. Design, Setting, and Participants This descriptive, population-based cohort study used nationally representative data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program, including the SEER-22 and SEER-17 registries. Data were from evaluated patients aged 20 years or older with GISTs diagnosed between January 1, 2000, and December 31, 2019. Analyses were last updated on October 29, 2023. Main Outcomes and Measures Organ site-specific trends in age-standardized incidence rates and annual percent changes (APCs) in rates were estimated by race and ethnicity and, when possible, by sex, age, and primary indicator. Multivariable Cox proportional hazards regression models were used to examine racial and ethnic differences in overall and GIST-specific survival by site. Results The SEER-22 and SEER-17 datasets contained 23 001 and 12 109 case patients with GISTs, respectively. Patients in the SEER-22 registry had a mean (SD) age of 64 (13) years and 51.3% were men. With regard to race and ethnicity, 9.7% of patients were Asian or Pacific Islander, 12.3% were Hispanic, 19.6% were non-Hispanic Black, and 57.7% were non-Hispanic White. Overall incidence rates of GISTs in the SEER-22 cohort increased substantially over time for all organ sites but the colon (APCs: esophagus, 7.3% [95% CI, 4.4% to 10.2%]; gastric, 5.1% [95% CI, 4.2% to 6.1%]; small intestine, 2.7% [95% CI, 1.8% to 3.7%]; colon, -0.2% [95% CI, -1.3% to 0.9%]; and rectum, 1.9% [95% CI, 0.1% to 3.8%]). There were similar increasing trends by age groups (<50 vs ≥50 years), sex, race and ethnicity, and primary indicator for gastric and small intestine GISTs. Increases were mainly restricted to localized stage disease. Patients in the SEER-17 cohort had a mean (SD) age of 64 (14) years and 51.9% were men. With regard to race and ethnicity, 13.3% of patients were Asian or Pacific Islander, 11.6% were Hispanic, 17.8% were non-Hispanic Black, and 56.6% were non-Hispanic White. Non-Hispanic Black individuals had higher overall mortality for esophageal (adjusted hazard ratio [HR], 6.4 [95% CI, 2.0 to 20.3]) and gastric (adjusted HR, 1.4 [95% CI, 1.2 to 1.5]) GISTs compared with non-Hispanic White individuals. Asian or Pacific Islander individuals also had higher overall mortality for esophageal GISTs (adjusted HR, 5.6 [95% CI, 1.5 to 20.2]). Results were similar for GIST-specific survival. Conclusions and Relevance In this cohort study using SEER data, the incidence of GISTs in major organ sites increased in the last 2 decades among several population groups. These findings suggest that additional studies are warranted to identify risk factors, because histologic reclassification and higher availability of endoscopy and imaging do not fully explain these unfavorable incidence trends. Prevention efforts are needed to reduce the substantial survival disparities among racial and ethnic minoritized populations.
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Affiliation(s)
- Christian S. Alvarez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - M. Blanca Piazuelo
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Tania Fleitas-Kanonnikoff
- Department of Medical Oncology, Instituto de Investigación Sanitaria (INCLIVA) Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Jennifer Ruhl
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - J. Alejandro Pérez-Fidalgo
- Medical Oncology Department, University Hospital of Valencia, INCLIVA Biomedical Research Institute, Valencia, Spain
- Centro de Investigación Biomédica en Red Cáncer, Valencia, Spain
| | - M. Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Park YMM, Amick Iii BC, McElfish PA, Brown CC, Schootman M, Narcisse MR, Lee SS, Choi YJ, Han K. Income dynamics and risk of colorectal cancer in individuals with type 2 diabetes: a nationwide population-based cohort study. J Epidemiol 2024:JE20230310. [PMID: 38972733 DOI: 10.2188/jea.je20230310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Individuals with type 2 diabetes (T2D) have increased colorectal cancer (CRC) risk, but it is unknown whether income dynamics are associated with CRC risk in these individuals. We examined whether persistent low- or high-income and income changes are associated with CRC risk in non-elderly adults with T2D. METHODS Using nationally representative data from the Korean Health Insurance Service database, 1,909,492 adults aged 30 to 64 years with T2D and no history of cancer were included between 2009 and 2012 (median follow-up of 7.8 years). We determined income levels based on health insurance premiums and assessed annual income quartiles for the baseline year and the four preceding years. Hazard ratios(HRs) and 95% confidence intervals(CIs) were estimated after adjusting for sociodemographic factors, CRC risk factors, and diabetes duration and treatment. RESULTS Persistent low income (i.e., lowest income quartile) was associated with increased CRC risk (HRn=5years vs. n=0years 1.11, 95% CI 1.04-1.18; P for trend=0.004). Income declines (i.e., a decrease≥25% in income quantile) were also associated with increased CRC risk (HR≥2 vs. 0 declines 1.10, 95% CI 1.05-1.16; p for trend=0.001). In contrast, persistent high income (i.e., highest income quartile) was associated with decreased CRC risk (HRn=5years vs. n=0years 0.81, 95% CI 0.73-0.89; p for trend<0.0001), which was more pronounced for rectal cancer (HR 0.64, 95% CI 0.53-0.78) and distal colon cancer (HR 0.70, 95% CI 0.57-0.86). CONCLUSIONS Our findings underscore the need for increased public policy awareness of the association between income dynamics and CRC risk in adults with T2D.
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Affiliation(s)
- Yong-Moon Mark Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences
| | - Benjamin C Amick Iii
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences
| | - Pearl A McElfish
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences
| | - Clare C Brown
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences
| | - Mario Schootman
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences
| | - Marie-Rachelle Narcisse
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University
| | - Seong-Su Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Yoon Jin Choi
- Department of Gastroenterology, National Cancer Center
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University
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Sabbagh S, Herrán M, Hijazi A, Jabbal IS, Mohanna M, Dominguez B, Itani M, Sarna K, Liang H, Nahleh Z, Wexner SD, Nagarajan A. Biomarker Testing Disparities in Metastatic Colorectal Cancer. JAMA Netw Open 2024; 7:e2419142. [PMID: 38967928 PMCID: PMC11227072 DOI: 10.1001/jamanetworkopen.2024.19142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/24/2024] [Indexed: 07/06/2024] Open
Abstract
Importance Among patients with metastatic colorectal cancer (mCRC), data are limited on disparate biomarker testing and its association with clinical outcomes on a national scale. Objective To evaluate the socioeconomic and demographic inequities in microsatellite instability (MSI) and KRAS biomarker testing among patients with mCRC and to explore the association of testing with overall survival (OS). Design, Setting, and Participants This cohort study, conducted between November 2022 and March 2024, included patients who were diagnosed with mCRC between January 1, 2010, and December 31, 2017. The study obtained data from the National Cancer Database, a hospital-based cancer registry in the US. Patients with mCRC and available information on biomarker testing were included. Patients were classified based on whether they completed or did not complete MSI or KRAS tests. Exposure Demographic and socioeconomic factors, such as age, race, ethnicity, educational level in area of residence, median household income, insurance type, area of residence, facility type, and facility location were evaluated. Main Outcomes and Measures The main outcomes were MSI and KRAS testing between the date of diagnosis and the date of first-course therapy. Univariable and multivariable logistic regressions were used to identify the relevant factors in MSI and KRAS testing. The OS outcomes were also evaluated. Results Among the 41 061 patients included (22 362 males [54.5%]; mean [SD] age, 62.3 [10.1] years; 17.3% identified as Black individuals, 78.0% as White individuals, 4.7% as individuals of other race, with 6.5% Hispanic or 93.5% non-Hispanic ethnicity), 28.8% underwent KRAS testing and 43.7% received MSI testing. A significant proportion of patients had Medicare insurance (43.6%), received treatment at a comprehensive community cancer program (40.5%), and lived in an area with lower educational level (51.3%). Factors associated with a lower likelihood of MSI testing included age of 70 to 79 years (relative risk [RR], 0.70; 95% CI, 0.66-0.74; P < .001), treatment at a community cancer program (RR, 0.74; 95% CI, 0.70-0.79; P < .001), rural residency (RR, 0.80; 95% CI, 0.69-0.92; P < .001), lower educational level in area of residence (RR, 0.84; 95% CI, 0.79-0.89; P < .001), and treatment at East South Central facilities (RR, 0.67; 95% CI, 0.61-0.73; P < .001). Similar patterns were observed for KRAS testing. Survival analysis showed modest OS improvement in patients with MSI testing (hazard ratio, 0.93; 95% CI, 0.91-0.96; P < .001). The median (IQR) follow-up time for the survival analysis was 13.96 (3.71-29.34) months. Conclusions and Relevance This cohort study of patients with mCRC found that older age, community-setting treatment, lower educational level in area of residence, and treatment at East South Central facilities were associated with a reduced likelihood of MSI and KRAS testing. Highlighting the sociodemographic-based disparities in biomarker testing can inform the development of strategies that promote equity in cancer care and improve outcomes for underserved populations.
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Affiliation(s)
- Saad Sabbagh
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston
| | - María Herrán
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston
| | - Ali Hijazi
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston
| | - Iktej Singh Jabbal
- Department of Internal Medicine, Advent Health Sebring, Sebring, Florida
| | - Mohamed Mohanna
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston
| | - Barbara Dominguez
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston
| | - Mira Itani
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston
| | - Kaylee Sarna
- Department of Clinical Research, Cleveland Clinic Florida, Weston
| | - Hong Liang
- Department of Clinical Research, Cleveland Clinic Florida, Weston
| | - Zeina Nahleh
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston
| | - Steven D. Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston
| | - Arun Nagarajan
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston
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Riviere P, Morgan KM, Deshler LN, Demb J, Mehtsun WT, Martinez ME, Gupta S, Banegas M, Murphy JD, Rose BS. Racial disparities in colorectal cancer outcomes and access to care: a multi-cohort analysis. Front Public Health 2024; 12:1414361. [PMID: 38962767 PMCID: PMC11220245 DOI: 10.3389/fpubh.2024.1414361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Non-Hispanic Black (NHB) Americans have a higher incidence of colorectal cancer (CRC) and worse survival than non-Hispanic white (NHW) Americans, but the relative contributions of biological versus access to care remain poorly characterized. This study used two nationwide cohorts in different healthcare contexts to study health system effects on this disparity. Methods We used data from the Surveillance, Epidemiology, and End Results (SEER) registry as well as the United States Veterans Health Administration (VA) to identify adults diagnosed with colorectal cancer between 2010 and 2020 who identified as non-Hispanic Black (NHB) or non-Hispanic white (NHW). Stratified survival analyses were performed using a primary endpoint of overall survival, and sensitivity analyses were performed using cancer-specific survival. Results We identified 263,893 CRC patients in the SEER registry (36,662 (14%) NHB; 226,271 (86%) NHW) and 24,375 VA patients (4,860 (20%) NHB; 19,515 (80%) NHW). In the SEER registry, NHB patients had worse OS than NHW patients: median OS of 57 months (95% confidence interval (CI) 55-58) versus 72 months (95% CI 71-73) (hazard ratio (HR) 1.14, 95% CI 1.12-1.15, p = 0.001). In contrast, VA NHB median OS was 65 months (95% CI 62-69) versus NHW 69 months (95% CI 97-71) (HR 1.02, 95% CI 0.98-1.07, p = 0.375). There was significant interaction in the SEER registry between race and Medicare age eligibility (p < 0.001); NHB race had more effect in patients <65 years old (HR 1.44, 95% CI 1.39-1.49, p < 0.001) than in those ≥65 (HR 1.13, 95% CI 1.11-1.15, p < 0.001). In the VA, age stratification was not significant (p = 0.21). Discussion Racial disparities in CRC survival in the general US population are significantly attenuated in Medicare-aged patients. This pattern is not present in the VA, suggesting that access to care may be an important component of racial disparities in this disease.
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Affiliation(s)
- Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
- Center for Health Equity Education & Research (CHEER), University of California, San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego, La Jolla, CA, United States
| | - Kylie M. Morgan
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
- Center for Health Equity Education & Research (CHEER), University of California, San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego, La Jolla, CA, United States
| | - Leah N. Deshler
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
- Center for Health Equity Education & Research (CHEER), University of California, San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego, La Jolla, CA, United States
| | - Joshua Demb
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Winta T. Mehtsun
- Division of Surgical Oncology, Department of Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Maria Elena Martinez
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States
| | - Samir Gupta
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Matthew Banegas
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
- Center for Health Equity Education & Research (CHEER), University of California, San Diego, La Jolla, CA, United States
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
- Center for Health Equity Education & Research (CHEER), University of California, San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego, La Jolla, CA, United States
| | - Brent S. Rose
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
- Center for Health Equity Education & Research (CHEER), University of California, San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego, La Jolla, CA, United States
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Lo CH, Tun KM, Pan CW, Lee JK, Singh H, Samadder NJ. Association Between Social Vulnerability and Gastrointestinal Cancer Mortality in the United States Counties. GASTRO HEP ADVANCES 2024; 3:821-829. [PMID: 39280915 PMCID: PMC11401585 DOI: 10.1016/j.gastha.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/19/2024] [Indexed: 09/18/2024]
Abstract
Background and Aims Social determinants of health contribute to disparities in gastrointestinal (GI) cancer mortality between individuals in the US. Their effects on count-level mortality rates remain uncertain. We aimed to assess the association between county social vulnerability and GI cancer mortality. Methods In this ecological study (2016-2020), we obtained US county Social Vulnerability Index (SVI) from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and age-adjusted mortality rates (AAMRs) for GI cancers from Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiological Research). SVI ranges from 0 to 1, with higher indices indicating greater vulnerability. We presented AAMRs by quintiles of SVIs. We used Poisson regression through generalized estimating equation to calculate rate ratios (RRs) and 95% confidence intervals (CIs) for GI cancer mortality by quintiles of SVI. Results There were 799,968 deaths related to GI cancers from 2016 to 2020, resulting in an AAMR (95% CI) of 39.9 (41.4-51.2) deaths per 100,000 population. The largest concentration of counties with greater SVI and GI cancer mortality was clustered in the southern US. Counties with greater SVI had higher mortality related to all GI cancers (RRQ5 vs Q1, 1.19 [95% CI, 1.14-1.24]), gastric cancer (1.58 [1.48-1.69]), liver cancer (1.54 [1.36-1.73]), and colorectal cancer (RRQ5 vs Q1, 1.23 [95% CI, 1.15-1.31]). RRs for overall GI cancers were greater among individuals <45 years (1.24 [1.15-1.32]), men (1.22 [1.16-1.27]), Hispanic individuals (1.33 [1.18-1.50]), and rural counties (1.21 [1.14-1.27]) compared with their counterparts. Conclusion Socially disadvantaged counties face a disproportionately high burden of GI cancer mortality in the US. Targeted public health interventions should aim to address social inequities faced by underserved communities.
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Affiliation(s)
- Chun-Han Lo
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Kyaw Min Tun
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Chun-Wei Pan
- Cook County Health, John H. Stroger Hospital, Chicago, Illinois
| | - Jeffrey K Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Harminder Singh
- CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - N Jewel Samadder
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, Arizona
- Department of Clinical Genomics, Mayo Clinic, Phoenix, Arizona
- Center for Individualized Medicine, Mayo Clinic, Phoenix, Arizona
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Akbari P, Nemati S, Nahvijou A, Bolourinejad P, Forbes L, Zendehdel K. Survey of awareness and beliefs about cancer (ABC) in Tehran Province, Iran. BMC Cancer 2024; 24:579. [PMID: 38734656 PMCID: PMC11088007 DOI: 10.1186/s12885-024-12211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/01/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Knowledge, attitudes, and practices are essential measures for planning and evaluating cancer control programs. Little is known about these in Iran. METHODS We conducted a population-based interview survey of adults aged 30-70 using the Farsi version of the Awareness and Beliefs about Cancer questionnaire in the capital province of Tehran, Iran, 2019. We calculated weighted estimates of levels of cancer knowledge, attitudes, and practices to allow for different selection probabilities and nonresponse. We used multivariate logistic regression to understand demographic factors associated with bowel, cervix, and breast screening practices. RESULTS We interviewed 736 men and 744 women. The mean number of recalled cancer warning signs was less than one; 57.7% could not recall any cancer warning signs. Participants recognized 5.6 out of 11 early cancer warning signs and 8.8 of 13 cancer risk factors. Most (82.7%) did not know that HPV infection was a cancer risk factor. Approximately, half had negative attitudes towards cancer treatment, but over 80% had positive attitudes towards the effectiveness of screening for improving survival. Colorectal, breast, and cervical screening rates were 24%, 42%, and 49%, respectively. Higher socioeconomic status increased the odds of taking up screening for cancer. Women aged 60-70 were less likely to report taking up breast and cervical screening than younger women. DISCUSSION The Iranian population has poor awareness and negative attitudes about cancer, and participation in screening programs is low. Public awareness and early detection of cancer should be promoted in Iran.
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Affiliation(s)
- Paria Akbari
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Nemati
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Paria Bolourinejad
- Student Research Committee, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Lindsay Forbes
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
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11
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Seitz V, Calata J, Mei L, Davidson ERW. Racial Disparities in Sacral Neuromodulation for Idiopathic Fecal Incontinence. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00221. [PMID: 38710021 DOI: 10.1097/spv.0000000000001520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
IMPORTANCE Sacral neuromodulation (SNM) is an effective treatment for fecal incontinence (FI). Previous studies found that Black women undergo SNM for urinary incontinence less than White women, but there is less known about racial disparities for FI. OBJECTIVE This study assessed differences in Black and White patients' FI treatment; SNM counseling was the primary outcome. STUDY DESIGN This was a retrospective cohort study of adult non-Hispanic Black and White patients who received FI treatment at an academic institution from 2011 to 2021. Medical records were queried for treatments, testing, and treating specialties for a 2:1 age-matched cohort of White:Black patients. RESULTS Four hundred forty-seven women were included: 149 Black women and 298 age-matched White women. A total of 24.4% (109) of patients had documented SNM counseling, significantly fewer in Black patients (14.8% vs 29.2%, P < 0.001). A total of 5.1% (23) of patients received SNM, less frequent in Black patients (2.7% vs 6.4%, P = 0.003). Among patients with SNM counseling, there was no difference between cohorts. Black patients were less likely to be referred for physical therapy (59.7% vs 77.2%, P < 0.001), sphincter imaging (0.7% vs 5.7%, P = 0.011), and defecography (8.1% vs 17.1%, P = 0.009). Different specialties managed the 2 cohorts. Black patients were less likely to see urogynecology and colorectal surgery (21.5% vs 34.6%, P = 0.004; 9.4% vs 15.4%, P = 0.077). Patients seen by these surgeons were more likely to discuss SNM (48.6% vs 8.5%, P < 0.001). CONCLUSIONS There were differences between Black and White patients' FI treatment, including counseling about SNM. Multidisciplinary work is needed to provide equitable education for this life-altering condition.
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Kumar SS, Collings AT, Collins C, Colvin J, Sylla P, Slater BJ. Society of American Gastrointestinal and Endoscopic Surgeons guidelines development: health equity update to standard operating procedure. Surg Endosc 2024; 38:2315-2319. [PMID: 38575829 DOI: 10.1007/s00464-024-10809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION The SAGES Guidelines Committee creates evidence-based clinical practice guidelines. Due to existing health disparities, recommendations made in these guidelines may have different impacts on different populations. The updates to our standard operating procedure described herein will allow us to produce well-designed guidelines that take these disparities into account and potentially reduce health inequities. METHODS This paper outlines updates to the SAGES Guidelines Committee Standard Operating Procedure in order to incorporate issues of heath equity into our guideline development process with the goal of minimizing downstream health disparities. RESULTS SAGES has developed an evidence-based, standardized approach to consider issues of health equity throughout the guideline development process to allow physicians to better counsel patients and make research recommendations to better address disparities. CONCLUSION Societies that promote guidelines within their organization must make an intentional effort to prevent the widening of health disparities as a result of their recommendations. The updates to the Guidelines Committee Standard Operating Procedure will hopefully lead to increased attention to these disparities and provide specific recommendations to reduce them.
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Affiliation(s)
- Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Amelia T Collings
- Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Courtney Collins
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer Colvin
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Patricia Sylla
- System Chief, Division of Colon and Rectal Division, Mount Sinai Health System, New York, NY, USA
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
- Department of Surgery, University of Chicago, Chicago, IL, USA.
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Ore AS, Areán-Sanz R, Liu BS, Arndt KR, Hernandez Alvarez A, Ponce CJ, Bain PA, Messaris E. United States-Based Colorectal Cancer Surgical Trials Lack Representation and Adequate Reporting of Racially and Ethnically Diverse Participants: Systematic Review and Regression Analysis. Dis Colon Rectum 2024; 67:624-633. [PMID: 38276952 DOI: 10.1097/dcr.0000000000003217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND Despite the established National Institute of Health Revitalization Act, which aims to include ethnic and racial minority representation in surgical trials, racial and ethnic enrollment disparities persist. OBJECTIVE To assess the proportion of patients from minority races and ethnicities that are included in colorectal cancer surgical trials and reporting characteristics. DATA SOURCES Search was performed using MEDLINE (Ovid), Embase, Web of Science, and Cochrane Central. STUDY SELECTION Inclusion criteria included 1) trials performed in the United States between January 1, 2000, and May 30, 2022; 2) patients with colorectal cancer diagnosis; and 3) surgical intervention, technique, or postoperative outcome. Trials evaluating chemotherapy, radiotherapy, or other nonsurgical interventions were excluded. INTERVENTIONS Pooled proportion and regression analysis was performed to identify the proportion of patients by race and ethnicity included in surgical trials and the association of year of publication and funding source. MAIN OUTCOME MEASURES Proportion of trials reporting race and ethnicity and proportion of participants by race and ethnicity included in surgical trials. RESULTS We screened 10,673 unique publications, of which 80 were examined in full text. Fifteen studies met our inclusion criteria. Ten (66.7%) trials did not report race, 3 reported races as a proportion of White participants only, and 3 reported 3 or more races. There was no description of ethnicity in 11 (73.3%) trials, with 2 describing "non-Caucasian" as ethnicity and 2 describing only Hispanic ethnicity. Pooled proportion of White participants was 81.3%, of Black participants was 6.2%, of Asian participants was 3.6%, and of Hispanic participants was 3.5%. LIMITATIONS A small number of studies was identified that reported racial or ethnic characteristics of their participants. CONCLUSIONS Both race and ethnicity are severely underreported in colorectal cancer surgical trials. To improve outcomes and ensure the inclusion of vulnerable populations in innovative technologies and novel treatments, reporting must be closely monitored.
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Affiliation(s)
- Ana Sofia Ore
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rodrigo Areán-Sanz
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Betty S Liu
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kevin R Arndt
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Angelica Hernandez Alvarez
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Cristina J Ponce
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Korous KM, Brooks E, King-Mullins EM, Lucas T, Tuuhetaufa F, Rogers CR. Perceived Economic Strain, Subjective Social Status, and Colorectal Cancer Screening Utilization in U.S. Men-A Cross-Sectional Analysis. Behav Med 2024:1-10. [PMID: 38618978 DOI: 10.1080/08964289.2024.2335156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
Although socioeconomic status (SES) is fundamentally related to underutilization of colorectal cancer (CRC) screening, the role of perceived economic strain and subjective social status with CRC screening is understudied. The aim of this study was to investigate whether greater perceived economic strain or lower subjective social status would decrease the odds of CRC screening uptake and being up-to-date with guideline-recommended CRC screening. We also explored interactions with household income and educational attainment. Cross-sectional survey-based data from men aged 45-75 years living in the United States (N = 499) were collected in February 2022. Study outcomes were ever completing a stool- or exam-based CRC screening test and being up-to-date with CRC screening. Perceived economic strain and subjective social status were the predictors. We conducted logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CI). Greater perceptions of economic strain decreased odds of being up-to-date with CRC screening. Household income modified the association between perceived economic strain and completing a stool-based test; the association was stronger for men from lower-income households. In unadjusted models, higher subjective social status increased odds of completing an exam-based test and being up-to-date with CRC screening. Our findings suggest that experiencing economic strain may interfere with men's CRC screening decisions and may capture additional information about barriers to CRC screening utilization beyond those captured by income or education.
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Affiliation(s)
- Kevin M Korous
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ellen Brooks
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Todd Lucas
- College of Human Medicine, Division of Public Health, Michigan State University, Flint, MI, USA
| | - Fa Tuuhetaufa
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Charles R Rogers
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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15
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Rawl SM, Perkins SM, Tong Y, Katz ML, Carter-Bawa L, Imperiale TF, Schwartz PH, Fatima H, Krier C, Tharp K, Shedd-Steele R, Magnarella M, Malloy C, Haunert L, Gebregziabher N, Paskett ED, Champion V. Patient Navigation Plus Tailored Digital Video Disc Increases Colorectal Cancer Screening Among Low-Income and Minority Patients Who Did Not Attend a Scheduled Screening Colonoscopy: A Randomized Trial. Ann Behav Med 2024; 58:314-327. [PMID: 38470961 PMCID: PMC11008590 DOI: 10.1093/abm/kaae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Up to 50% of people scheduled for screening colonoscopy do not complete this test and no studies have focused on minority and low-income populations. Interventions are needed to improve colorectal cancer (CRC) screening knowledge, reduce barriers, and provide alternative screening options. Patient navigation (PN) and tailored interventions increase CRC screening uptake, however there is limited information comparing their effectiveness or the effect of combining them. PURPOSE Compare the effectiveness of two interventions to increase CRC screening among minority and low-income individuals who did not attend their screening colonoscopy appointment-a mailed tailored digital video disc (DVD) alone versus the mailed DVD plus telephone-based PN compared to usual care. METHODS Patients (n = 371) aged 45-75 years at average risk for CRC who did not attend a screening colonoscopy appointment were enrolled and were randomized to: (i) a mailed tailored DVD; (ii) the mailed DVD plus phone-based PN; or (iii) usual care. CRC screening outcomes were from electronic medical records at 12 months. Multivariable logistic regression analyses were used to study intervention effects. RESULTS Participants randomized to tailored DVD plus PN were four times more likely to complete CRC screening compared to usual care and almost two and a half times more likely than those who were sent the DVD alone. CONCLUSIONS Combining telephone-based PN with a mailed, tailored DVD increased CRC screening among low-income and minority patients who did not attend their screening colonoscopy appointments and has potential for wide dissemination.
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Affiliation(s)
- Susan M Rawl
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Susan M Perkins
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yan Tong
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mira L Katz
- Department of Health Behavior and Health Promotion, College of Public Heath, The Ohio State University (OSU), Columbus, OH, USA
- Cancer Control Program, Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH, USA
| | - Lisa Carter-Bawa
- Community Outreach and Engagement, Center for Discovery & Innovation, Cancer Prevention Precision Control Institute, Hackensack Meridian Health, Nutley, NJ, USA
| | - Thomas F Imperiale
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter H Schwartz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hala Fatima
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Connie Krier
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Kevin Tharp
- Indiana University Center for Survey Research, Bloomington, IN, USA
| | - Rivienne Shedd-Steele
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | | | - Caeli Malloy
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Laura Haunert
- School of Health and Human Sciences, Physician Assistant Program, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Netsanet Gebregziabher
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Electra D Paskett
- Cancer Control Program, Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Victoria Champion
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
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Ebner DW, Kisiel JB, Fendrick AM, Estes C, Li K, Vahdat V, Limburg PJ. Estimated Average-Risk Colorectal Cancer Screening-Eligible Population in the US. JAMA Netw Open 2024; 7:e245537. [PMID: 38551567 PMCID: PMC10980958 DOI: 10.1001/jamanetworkopen.2024.5537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/11/2024] [Indexed: 04/01/2024] Open
Abstract
This cross-sectional study estimates the number of average-risk colorectal cancer screening–eligible individuals in the US since the US Preventive Services Task Force updated its recommendations in 2021.
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Affiliation(s)
- Derek W. Ebner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - John B. Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - A. Mark Fendrick
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Chris Estes
- Exact Sciences Corporation, Madison, Wisconsin
| | - Kevin Li
- Exact Sciences Corporation, Madison, Wisconsin
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Somayaji D, Mohedat H, Li CS. Evaluating Social Determinants of Health Related to Cancer Survivorship and Quality of Care. Cancer Nurs 2024:00002820-990000000-00215. [PMID: 38416076 DOI: 10.1097/ncc.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Social determinants of health posit that negative outcomes are influenced by individuals living in underserved and underresourced neighborhoods. OBJECTIVE This study examines a cancer diagnosis, race/ethnicity, age, geographic location (residence), education, and social economic status factors at disease onset and treatment. METHODS A multivariable PO regression analysis was run for quality of care at testing or diagnosis, and quality of care at treatment and the quality of received care compared with another person. RESULTS Participants are representative of the Southern Community Cohort Study (SCCS) of adults diagnosed with breast (n = 263), prostate (n = 195), lung (n = 46), colorectal (n = 105), or other cancers (n = 526). This study includes cancer survivors who completed the SCCS Baseline and Cancer Navigation Surveys in urban (73.13%) and rural (26.87%) areas. White participants reported a higher quality of received care for testing or diagnosis and care for treatment compared with Black participants. Participants with high school or equivalent education (odds ratio, 1.662; 95% confidence interval, 1.172-2.356; P = .0044) or some college or junior college education (odds ratio, 1.970; 95% confidence interval, 1.348-2.879; P = .0005) were more likely to report a better level of quality of received care for treatment. CONCLUSIONS The SCCS represents individuals who are historically underrepresented in cancer research. The results of this study will have broad implications across diverse communities to reduce disparities and inform models of care. IMPLICATIONS FOR PRACTICE Nurses are positioned to evaluate the quality of population health and design and lead interventions that will benefit underserved and underresourced communities.
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Affiliation(s)
- Darryl Somayaji
- Author Affiliation: School of Nursing, University at Buffalo (Dr Somayaji and Mrs Mohedat), New York; and Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center (Dr Li), Rochester, New York
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Tsai M, Vernon M, Su S, Coughlin SS, Dong Y. Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia. Cancer Med 2024; 13:e6954. [PMID: 38348574 PMCID: PMC10904969 DOI: 10.1002/cam4.6954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The study's purpose was to examine 5-year colorectal cancer (CRC) survival rates between White and Black patients. We also determined whether regional socioeconomic status (SES) is associated with CRC survival between White and Black patients in the Clayton, West Central, East Central, Southeast, and Northeast Georgia public health districts. METHODS We performed a retrospective cohort analysis using data from the 1975 to 2016 Surveillance, Epidemiology, and End Results program. The 2015 United States Department of Agriculture Economic Research Services county typology codes were used to identify region-level SES with persistent poverty, low employment, and low education. Kaplan-Meier method and Cox proportional hazard regression were performed. RESULTS Among 10,876 CRC patients (31.1% Black patients), 5-year CRC survival rates were lower among Black patients compared to White patients (65.4% vs. 69.9%; p < 0.001). In multivariable analysis, White patients living in regions with persistent poverty had a 1.1-fold increased risk of CRC death (HR, 1.12; 95% CI, 1.00-1.25) compared to those living in non-persistent poverty regions. Among Black patients, those living in regions with low education were at a 1.2-fold increased risk of CRC death (HR, 1.19; 95% CI, 1.01-1.40) compared to those living in non-low education regions. DISCUSSION AND CONCLUSIONS Black patients demonstrated lower CRC survival rates in Georgia compared to their White counterparts. White patients living in regions with persistent poverty, and Black patients living in regions with low education had an increased risk of CRC death. Our findings provide important evidence to all relevant stakeholders in allocating health resources aimed at CRC early detection and prevention and timely referral for CRC treatment by considering the patient's regional SES in Georgia.
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Affiliation(s)
- Meng‐Han Tsai
- Cancer Prevention, Control & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Marlo Vernon
- Cancer Prevention, Control & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Shaoyong Su
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Steven S. Coughlin
- Department of Biostatistics, Data Science and EpidemiologyAugusta UniversityAugustaGeorgiaUSA
| | - Yanbin Dong
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
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Galadima H, Anson-Dwamena R, Johnson A, Bello G, Adunlin G, Blando J. Machine Learning as a Tool for Early Detection: A Focus on Late-Stage Colorectal Cancer across Socioeconomic Spectrums. Cancers (Basel) 2024; 16:540. [PMID: 38339293 PMCID: PMC10854986 DOI: 10.3390/cancers16030540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To assess the efficacy of various machine learning (ML) algorithms in predicting late-stage colorectal cancer (CRC) diagnoses against the backdrop of socio-economic and regional healthcare disparities. METHODS An innovative theoretical framework was developed to integrate individual- and census tract-level social determinants of health (SDOH) with sociodemographic factors. A comparative analysis of the ML models was conducted using key performance metrics such as AUC-ROC to evaluate their predictive accuracy. Spatio-temporal analysis was used to identify disparities in late-stage CRC diagnosis probabilities. RESULTS Gradient boosting emerged as the superior model, with the top predictors for late-stage CRC diagnosis being anatomic site, year of diagnosis, age, proximity to superfund sites, and primary payer. Spatio-temporal clusters highlighted geographic areas with a statistically significant high probability of late-stage diagnoses, emphasizing the need for targeted healthcare interventions. CONCLUSIONS This research underlines the potential of ML in enhancing the prognostic predictions in oncology, particularly in CRC. The gradient boosting model, with its robust performance, holds promise for deployment in healthcare systems to aid early detection and formulate localized cancer prevention strategies. The study's methodology demonstrates a significant step toward utilizing AI in public health to mitigate disparities and improve cancer care outcomes.
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Affiliation(s)
- Hadiza Galadima
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (R.A.-D.); (A.J.); (J.B.)
| | - Rexford Anson-Dwamena
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (R.A.-D.); (A.J.); (J.B.)
| | - Ashley Johnson
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (R.A.-D.); (A.J.); (J.B.)
| | - Ghalib Bello
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Georges Adunlin
- Department of Pharmaceutical, Social and Administrative Sciences, Samford University, Birmingham, AL 35229, USA;
| | - James Blando
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (R.A.-D.); (A.J.); (J.B.)
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Tsai M, Coughlin SS, Cortes J. County-level colorectal cancer screening rates on colorectal cancer survival in the state of Georgia: Does county-level rurality matter? Cancer Med 2024; 13:e6830. [PMID: 38164120 PMCID: PMC10807605 DOI: 10.1002/cam4.6830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/15/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE Investigating CRC screening rates and rurality at the county-level may explain disparities in CRC survival in Georgia. Although a few studies examined the relationship of CRC screening rates, rurality, and/or CRC outcomes, they either used an ecological study design or focused on the larger population. METHODS We conducted a retrospective analysis utilizing data from the 2004-2010 Surveillance, Epidemiology, and End Results Program. The 2013 United States Department of Agriculture rural-urban continuum codes and 2004-2010 National Cancer Institute small-area estimates for screening behaviors were used to identify county-level rurality and CRC screening rates. Kaplan-Meier method and Cox proportional hazard regression were performed. RESULTS Among 22,160 CRC patients, 5-year CRC survival rates were lower among CRC patients living in low screening areas in comparison with intermediate/high areas (69.1% vs. 71.6% /71.3%; p-value = 0.030). Patients living in rural high-screening areas also had lower survival rates compared to non-rural areas (68.2% vs. 71.8%; p-value = 0.009). Our multivariable analysis demonstrated that patients living in intermediate (HR, 0.91; 95% CI, 0.85-0.98) and high-screening (HR, 0.92; 95% CI, 0.85-0.99) areas were at 8%-9% reduced risk of CRC death. Further, non-rural CRC patients living in intermediate and high CRC screening areas were 9% (HR, 0.91; 95% CI, 0.83-0.99) and 10% (HR, 0.90; 95% CI, 0.82-0.99) less likely to die from CRC. CONCLUSIONS Lower 5-year survival rates were observed in low screening and rural high-screening areas. Living in intermediate/high CRC screening areas was negatively associated with the risk of CRC death. Particularly, non-rural patients living in intermediate/high-screening areas were 8%-9% less likely to die from CRC. Targeted CRC screening resources should be prioritized for low screening and rural communities.
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Affiliation(s)
- Meng‐Han Tsai
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Georgia Prevention InstituteAugusta UniversityAugustaGeorgiaUSA
| | - Steven S. Coughlin
- Department of Biostatistics, Data Science and EpidemiologyAugusta UniversityAugustaGeorgiaUSA
| | - Jorge Cortes
- Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
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Cross SH, Yabroff KR, Yeager KA, Curseen KA, Quest TE, Kamal A, Zarrabi AJ, Kavalieratos D. Social Deprivation and End-of-Life Care Use Among Adults With Cancer. JCO Oncol Pract 2024; 20:102-110. [PMID: 37983588 PMCID: PMC10827296 DOI: 10.1200/op.23.00420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/06/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Socioeconomic differences are partially responsible for racial inequities in cancer outcomes, yet the association of area-level socioeconomic disadvantage and race with end-of-life (EOL) cancer care quality is poorly understood. METHODS This retrospective study used electronic medical records from an academic health system to identify 33,635 adults with cancer who died between 2013 and 2019. Using multivariable logistic regression, we examined associations between decedent characteristics and EOL care, including emergency department (ED) visits, intensive care unit (ICU) stays, palliative care consultation (PCC), hospice order, and in-hospital deaths. Social deprivation index was used to measure socioeconomic disadvantages. RESULTS Racially minoritized decedents had higher odds of ICU stay than the least deprived White decedents (eg, other race Q3: aOR, 2.06 [99% CI, 1.26 to 0.3.39]). White and Black decedents from more deprived areas had lower odds of ED visit (White Q3: aOR, 0.382 [99% CI, 0.263 to 0.556]; Black Q3: aOR, 0.566 [99% CI, 0.373 to 0.858]) than least deprived White decedents. Compared with White decedents living in least deprived areas, racially minoritized decedents had higher odds of receiving PCC and hospice order, whereas White decedents in most deprived areas had lower odds of PCC (aOR, 0.727 [99% CI, 0.592 to 0.893]) and hospice order (aOR, 0.845 [99% CI, 0.724 to 0.986]). Greater deprivation was associated with greater odds of hospital death relative to least deprived White decedents, but only among minoritized decedents (eg, Black Q4: aOR, 2.16 [99% CI, 1.82 to 2.56]). CONCLUSION Area-level socioeconomic disadvantage is not uniformly associated with poorer EOL cancer care, with differences among decedents of different racial groups.
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Affiliation(s)
- Sarah H. Cross
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | | | | | - Kimberly A. Curseen
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | - Tammie E. Quest
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | | | - Ali John Zarrabi
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
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22
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Jeong SM, Jung KW, Park J, Kim N, Shin DW, Suh M. Disparities in Cancer Incidence across Income Levels in South Korea. Cancers (Basel) 2023; 15:5898. [PMID: 38136441 PMCID: PMC10741676 DOI: 10.3390/cancers15245898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Recent nationwide studies of disparities in cancer incidence by income are scarce in Korea. This study investigated such disparities in cancer incidence and the stage at cancer diagnosis across income groups in Korea. METHODS This study utilized data from a national cancer database, specifically focusing on cases recorded in the year 2018. Income levels were categorized into quintiles according to the insurance premium paid in addition to the Medicaid benefit. The slope index of inequality (SII) and relative index of inequality (RII) were used to measure absolute and relative differences in cancer incidence by income. A multivariable logistic regression was performed to estimate the risk of a distant stage at cancer diagnosis. RESULTS The total number of cases of incident cancer was 223,371 (men: 116,320, women: 107,051) with shares of the total of 29.5% (5Q), 20.4% (4Q), 16.0% (3Q), 13.5% (2Q), 15.6% (1Q), and 5% (Medicaid). The most common cancer type was thyroid cancer, followed by gastric and colorectal cancers. The age-standardized incidence rate for all cancers was lowest in the highest income group, but the SII was not statistically significant (SII: -35.7), and the RII was -0.07. Colorectal and cervical cancers had lower incidence rates for higher income groups, while thyroid and prostate cancers had higher incidence rates for higher income groups. The odds ratio for a distant stage at diagnosis for all cancers increased for lower income groups relative to 5Q. CONCLUSIONS Disparities in cancer incidence in a Korean population differed by cancer type, and lower income was a significant predictor of a distant stage at diagnosis for cancers overall. These results emphasize the need for further study of the underlying causes of disparities in cancer incidence and the stage at diagnosis, as well as the need for interventions to mitigate these disparities.
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Affiliation(s)
- Su-Min Jeong
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Kyu-Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
| | - Juwon Park
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
| | - Nayeon Kim
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
| | - Dong Wook Shin
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, School of Medicine, Sungkyunkwan University, Seoul 16419, Republic of Korea
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
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23
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Zhou MJ, Ladabaum U, Triadafilopoulos G, Clarke JO. Impact of race/ethnicity and socioeconomic status on incident and prevalent esophageal cancer in patients with Barrett's esophagus. Dis Esophagus 2023; 36:doad044. [PMID: 37431107 DOI: 10.1093/dote/doad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/02/2023] [Indexed: 07/12/2023]
Abstract
The impact of race/ethnicity (RE) or socioeconomic status (SES) on progression from Barrett's esophagus (BE) to esophageal cancer (EC) is not well established. We aimed to evaluate the association between demographic factors and SES on EC diagnosis in an ethnically diverse BE cohort. Patients aged 18-63 with incident BE diagnosed in October 2015-March 2020 were identified in the Optum Clinformatics DataMart Database. Patients were followed until the diagnosis of prevalent EC <1 year or incident EC ≥1 year from BE diagnosis, or until the end of their continuous enrollment period. Cox proportional hazards analysis was used to determine associations between demographics, SES factors, BE risk factors, and EC. Demographics of the 12,693 patients included mean age of BE diagnosis 53.0 (SD 8.5) years, 56.4% male, 78.3% White/10.0% Hispanic/6.4% Black/3.0% Asian. The median follow-up was 26.8 (IQR 19.0-42.0) months. In total, 75 patients (0.59%) were diagnosed with EC (46 [0.36%] prevalent EC; 29 [0.23%] incident EC), and 74 patients (0.58%) developed high-grade dysplasia (HGD) (46 [0.36%] prevalent HGD; 28 [0.22%] incident HGD). Adjusted HR (95% CI) for prevalent EC comparing household net worth ≥$150,000 vs. <$150,000 was 0.57 (0.33-0.98). Adjusted HRs (95% CI) for prevalent and incident EC comparing non-White vs. White patients were 0.93 (0.47-1.85) and 0.97 (0.21-3.47), respectively. In summary, a lower SES, captured by the household net worth, was associated with prevalent EC. There was no significant difference in prevalent or incident EC among White vs. non-White patients. EC progression in BE may be similar among racial/ethnic groups, but SES disparities may impact BE outcomes.
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Affiliation(s)
- Margaret J Zhou
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Lawler T, Walts ZL, Steinwandel M, Lipworth L, Murff HJ, Zheng W, Warren Andersen S. Type 2 Diabetes and Colorectal Cancer Risk. JAMA Netw Open 2023; 6:e2343333. [PMID: 37962884 PMCID: PMC10646729 DOI: 10.1001/jamanetworkopen.2023.43333] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/04/2023] [Indexed: 11/15/2023] Open
Abstract
Importance Type 2 diabetes and colorectal cancer (CRC) disproportionately burden indviduals of low socioeconomic status and African American race. Although diabetes is an emerging CRC risk factor, associations between diabetes and CRC in these populations are understudied. Objective To determine if diabetes is associated with CRC risk in a cohort representing understudied populations. Design, Setting, and Participants This cohort study uses data from the prospective Southern Community Cohort Study in the US, which recruited from 2002 to 2009 and completed 3 follow-up surveys by 2018. Of about 85 000 participants, 86% enrolled at community health centers, while 14% were enrolled via mail or telephone from the same 12 recruitment states. Participants with less than 2 years of follow-up, previous cancer diagnosis (excluding nonmelanoma skin cancer) at enrollment, missing enrollment diabetes status, diabetes diagnosis before age 30, and without diabetes at enrollment with no follow-up participation were excluded. Data were analyzed from January to September 2023. Exposures Physician-diagnosed diabetes and age at diabetes diagnosis were self-reported via survey at enrollment and 3 follow-ups. Main Outcomes and Measures Diabetes diagnosis was hypothesized to be positively associated with CRC risk before analysis. Incident CRC was assessed via state cancer registry and National Death Index linkage. Hazard ratios and 95% CIs were obtained via Cox proportional hazard models, using time-varying diabetes exposure. Results Among 54 597 participants, the median (IQR) enrollment age was 51 (46-58) years, 34 786 (64%) were female, 36 170 (66%) were African American, and 28 792 (53%) had income less than $15 000 per year. In total, 289 of 25 992 participants with diabetes developed CRC, vs 197 of 28 605 participants without diabetes. Diabetes was associated with increased CRC risk (hazard ratio [HR], 1.47; 95% CI, 1.21-1.79). Greater associations were observed among participants without colonoscopy screening (HR, 2.07; 95% CI, 1.16-3.67) and with smoking history (HR, 1.62; 95% CI, 1.14-2.31), potentially due to cancer screening differences. Greater associations were also observed for participants with recent diabetes diagnoses (diabetes duration <5 years compared with 5-10 years; HR, 2.55; 95% CI, 1.77-3.67), possibly due to recent screening. Conclusions and Relevance In this study where the majority of participants were African American with low socioeconomic status, diabetes was associated with elevated CRC risk, suggesting that diabetes prevention and control may reduce CRC disparities. The association was attenuated for those who completed colonoscopies, highlighting how adverse effects of diabetes-related metabolic dysregulation may be disrupted by preventative screening.
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Affiliation(s)
- Thomas Lawler
- University of Wisconsin Carbone Cancer Center, Madison
| | - Zoe L. Walts
- University of Wisconsin Carbone Cancer Center, Madison
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Mark Steinwandel
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Rockville, Maryland
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Harvey J. Murff
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Wei Zheng
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Rockville, Maryland
| | - Shaneda Warren Andersen
- University of Wisconsin Carbone Cancer Center, Madison
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Rockville, Maryland
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25
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Agunwamba AA, Zhu X, Sauver JS, Thompson G, Helmueller L, Finney Rutten LJ. Barriers and facilitators of colorectal cancer screening using the 5As framework: A systematic review of US studies. Prev Med Rep 2023; 35:102353. [PMID: 37576848 PMCID: PMC10415795 DOI: 10.1016/j.pmedr.2023.102353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/20/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023] Open
Abstract
Despite clear evidence that regular screening reduces colorectal cancer (CRC) mortality and the availability of multiple effective screening options, CRC screening continues to be underutilized in the US. A systematic literature search of four databases - Ovid, Medline, EBSCHOhost, and Web of Science - was conducted to identify US studies published after 2017 that reported on barriers and facilitators to CRC screening adherence. Articles were extracted to categorize relevant CRC screening barriers or facilitators that were assessed against CRC screening outcomes using the 5As dimensions: Access, Affordability, Acceptance, Awareness, Activation. Sixty-one studies were included. Fifty determinants of screening within the 5As framework and two additional dimensions including Sociodemographics and Health Status were identified. The Sociodemographics, Access, and Affordability dimensions had the greatest number of studies included. The most common factor in the Access dimension was contact with healthcare systems, within the Affordability dimension was insurance, within the Awareness dimension was knowledge CRC screening, within the Acceptance dimension was health beliefs, within the Activation dimension was prompts and reminders, within the Sociodemographics dimension was race/ethnicity, and among the Health Status dimension was chronic disease history. Among all studies, contact with healthcare systems, insurance, race/ethnicity, age, and education were the most common factors identified. CRC screening barriers and facilitators were identified across individual, clinical, and sociocontextual levels. Interventions that consider multilevel strategies will most effectively increase CRC screening adherence.
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Affiliation(s)
- Amenah A. Agunwamba
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Xuan Zhu
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jenny St. Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lila J. Finney Rutten
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Exact Sciences Corporation, Madison WI, USA
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26
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Ashad-Bishop KC, Baeker Bispo JA, Nahodyl L, Balise RR, Kobetz EK, Bailey ZD. Hyperlocal disparities in breast, cervical, and colorectal cancer screening: An ecological study of social vulnerability in Miami-Dade county. Prev Med Rep 2023; 35:102371. [PMID: 37654517 PMCID: PMC10465939 DOI: 10.1016/j.pmedr.2023.102371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/24/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023] Open
Abstract
Neighborhoods have been identified as important determinants of health-related outcomes, but limited research has assessed the influence of neighborhood context along the cancer continuum. This study used census tract-level data from the United States Census Bureau and Centers for Disease Control and Prevention to characterize Miami-Dade County census tracts (n = 492) into social vulnerability clusters and assess their associated breast, cervical, and colorectal cancer screening participation rates. We identified disparities by social vulnerability cluster in cancer screening participation rates. Further investigation of geographic disparities in social vulnerability and cancer screening participation could inform equity-focused cancer control efforts.
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Affiliation(s)
- Kilan C. Ashad-Bishop
- University of Miami, Miller School of Medicine, Miami, FL 33136, USA
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | | | - Lauren Nahodyl
- University of Miami, Miller School of Medicine, Miami, FL 33136, USA
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Raymond R. Balise
- University of Miami, Miller School of Medicine, Miami, FL 33136, USA
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Erin K. Kobetz
- University of Miami, Miller School of Medicine, Miami, FL 33136, USA
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Zinzi D. Bailey
- University of Miami, Miller School of Medicine, Miami, FL 33136, USA
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
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27
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Walts Z, Parlato L, Brent R, Cai Q, Steinwandel M, Zheng W, Warren Andersen S. Associations of Albumin and BMI with Colorectal Cancer Risk in the Southern Community Cohort Study: a Prospective Cohort Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01797-x. [PMID: 37733284 PMCID: PMC10954588 DOI: 10.1007/s40615-023-01797-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Obesity may increase colorectal cancer (CRC) risk through mechanisms of increased inflammation. Although BMI is the most used adiposity indicator, it may less accurately measure adiposity in Black populations. Herein, we investigate associations between BMI, low albumin as an inflammation biomarker, and CRC risk in a racially diverse cohort. METHODS Participant data arise from 71,141 participants of the Southern Community Cohort Study, including 724 incident CRC cases. Within the cohort, 69% are Black. Blood serum albumin concentrations, from samples taken at enrollment, were available for 235 cases and 567 controls. Controls matched by age, sex, and race were selected through incidence density sampling. Cox proportional hazards calculated BMI and CRC risk associations (hazard ratios [HRs]; 95% confidence intervals [CIs]. Conditional logistic regression calculated albumin and CRC risk associations (odds ratios [ORs]; 95%CIs). RESULTS Underweight, but not overweight or obese, compared to normal BMI was associated with increased CRC risk (HR:1.75, 95%CI:1.00-3.09). Each standard deviation increase of albumin was associated with decreased CRC risk, particularly for those who self-identified as non-Hispanic Black (OR: 0.56, 95%CI:0.34-0.91), or female (OR:0.54, 95%CI:0.30-0.98), but there was no evidence for interaction by these variables (p-interactions > 0.05). Moreover, albumin concentration was lower in Black than White participants. Mediation analysis suggested that the relation between albumin and CRC was not mediated by BMI. CONCLUSIONS Null associations of overweight/obesity with CRC risk demonstrates limited utility of BMI, especially among Black populations. Low albumin may indicate CRC risk. In Black individuals, albumin may better predict adiposity related risks than BMI.
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Affiliation(s)
- Zoe Walts
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut St, WARF Office Building, Suite 1007B, Madison, WI, 53726, USA
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Lisa Parlato
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut St, WARF Office Building, Suite 1007B, Madison, WI, 53726, USA
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Ronni Brent
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut St, WARF Office Building, Suite 1007B, Madison, WI, 53726, USA
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Mark Steinwandel
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Rockville, MD, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shaneda Warren Andersen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut St, WARF Office Building, Suite 1007B, Madison, WI, 53726, USA.
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA.
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28
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Korous KM, Ogbonnaya UC, De Vera MA, Brooks E, Moore JX, Rogers CR. Perceived economic pressure and colorectal cancer-related perceptions among U.S. males (aged 45-75). Cancer Causes Control 2023; 34:737-747. [PMID: 37243849 PMCID: PMC10961139 DOI: 10.1007/s10552-023-01713-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 05/04/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE To examine whether a greater perception of economic pressure would be associated with more-negative attitudes, greater perceived barriers, and lower subjective norms regarding colorectal cancer (CRC) and CRC screening among males aged 45-75 years. METHODS We recruited 492 self-identified males aged 45-75 years living in the United States. We operationalized perceived economic pressure as a latent factor with three subscales: can't make ends meet, unmet material needs, and financial cutbacks. Our dependent variables were attitudes toward CRC and CRC screening, perceived barriers to completing a CRC screening exam, and subjective norms regarding CRC screening (e.g., how others value CRC screening). We tested a hypothesized model using structural equation modeling with maximum-likelihood estimation, adjusting for covariates, and made post-hoc modifications to improve model fit. RESULTS Greater perceived economic pressure was associated with more-negative attitudes toward CRC and CRC screening (β = 0.47, 95% CI: 0.37,0.57) and with greater perceived barriers to CRC screening (β = 0.22, 95% CI: 0.11, 0.34), but was not significantly associated with subjective norms (β = 0.07, 95% CI: - 0.05, 0.19). Perceived economic pressure was an indirect pathway by which lower-income and younger age were associated with more-negative attitudes and greater perceived barriers. CONCLUSIONS Our study is one of the first to show that, among males, perceived economic pressure is associated with two social-cognitive mechanisms (i.e., negative attitudes, greater perceived barriers) that are known to influence CRC screening intent and, ultimately, CRC screening completion. Future research on this topic should employ longitudinal study designs.
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Affiliation(s)
- Kevin M Korous
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Uchenna C Ogbonnaya
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Ellen Brooks
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA
| | - Justin X Moore
- Medical College of Georgia, Georgia Cancer Center, Cancer Prevention, Control & Population Health, Augusta University, Augusta, GA, 30912, USA
| | - Charles R Rogers
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
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29
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Kane WJ, Fleming MA, Lynch KT, Friel CM, Williams MD, Hedrick TL, Yan G, Hoang SC. Associations of Race, Ethnicity, and Social Determinants of Health With Colorectal Cancer Screening. Dis Colon Rectum 2023; 66:1223-1233. [PMID: 35533321 PMCID: PMC9643677 DOI: 10.1097/dcr.0000000000002371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Racial and ethnic disparities in receipt of recommended colorectal cancer screening exist; however, the impact of social determinants of health on such disparities has not been recently studied in a national cohort. OBJECTIVE This study aimed to determine whether social determinants of health attenuate racial disparities in receipt of colorectal cancer screening. DESIGN This was a cross-sectional telephone survey of self-reported race and ethnicity and up-to-date colorectal cancer screening. Associations between race/ethnicity and colorectal cancer screening were tested before and after adjustment for demographics, behavioral factors, and social determinants of health. SETTING This was a nationally representative telephone survey of US residents in 2018. PATIENTS The patients included were US residents aged 50 to 75 years. MAIN OUTCOME MEASURES The primary outcome was up-to-date colorectal cancer screening status, according to 2008 US Preventive Services Task Force recommendations. RESULTS This study included 226,106 respondents aged 50 to 75 years. Before adjustment, all minority racial and ethnic groups demonstrated a significantly lower odds of screening than those of non-Hispanic white respondents. After adjustment for demographics, behavioral factors, and social determinants of health, compared to non-Hispanic white respondents, odds of screening were found to be increased among non-Hispanic black respondents (OR, 1.10; p = 0.02); lower but attenuated among Hispanic respondents (OR, 0.73; p < 0.001), non-Hispanic American Indian/Alaskan Native respondents (OR, 0.85; p = 0.048), and non-Hispanic respondents of other races (OR, 0.82; p = 0.01); and lower but not attenuated among non-Hispanic Asian respondents (OR, 0.68; p < 0.001). LIMITATIONS Recall bias, participant bias, and residual confounding. CONCLUSIONS Adjustment for social determinants of health reduced racial and ethnic disparities in colorectal cancer screening among all minority racial and ethnic groups except non-Hispanic Asian individuals; however, other unmeasured confounders likely exist. See Video Abstract at http://links.lww.com/DCR/B977 . ASOCIACIN DE RAZA, ETNICIDAD Y DETERMINANTES SOCIALES DE LA SALUD CON LA DETECCIN DEL CNCER COLORRECTAL ANTECEDENTES: Existen disparidades raciales y étnicas en la recepción de las pruebas recomendadas de detección de cáncer colorrectal; sin embargo, el impacto de los determinantes sociales de la salud en dichas disparidades no se ha estudiado recientemente en una cohorte nacional.OBJETIVO: El objetivo de este estudio fue determinar si los determinantes sociales de la salud atenúan las disparidades raciales en la recepción de pruebas de detección del cáncer colorrectal.DISEÑO: Encuesta telefónica transversal de raza y etnia autoinformada y detección actualizada de cáncer colorrectal. Las asociaciones entre la raza/etnicidad y la detección del cáncer colorrectal se probaron antes y después del ajuste por demografía, factores conductuales y determinantes sociales de la salud.ESCENARIO: Esta fue una encuesta telefónica representativa a nivel nacional de los residentes de EE. UU. en 2018.PACIENTES: Los pacientes eran residentes de EE. UU. de 50 a 75 años.PRINCIPALES MEDIDAS DE RESULTADO: Estado actualizado de detección de cáncer colorrectal, según las recomendaciones del Grupo de Trabajo de Servicios Preventivos de EE. UU. de 2008.RESULTADOS: Este estudio incluyó a 226.106 encuestados de 50 a 75 años. Antes del ajuste, todos los grupos étnicos y raciales minoritarios demostraron probabilidades significativamente más bajas de detección en comparación con los encuestados blancos no hispanos. Después del ajuste por demografía, factores conductuales y determinantes sociales de la salud, en comparación con los encuestados blancos no hispanos, las probabilidades de detección aumentaron entre los encuestados negros no hispanos (OR 1,10, p = 0,02); más bajo pero atenuado entre los encuestados hispanos (OR 0,73, p < 0,001), los encuestados indios americanos/nativos de Alaska no hispanos (OR 0,85, p = 0,048) y los encuestados no hispanos de otras razas (OR 0,82, p = 0,01); y menor pero no atenuado entre los encuestados asiáticos no hispanos (OR 0,68, p < 0,001).LIMITACIONES: Sesgo de recuerdo y sesgo de participante, así como confusión residual.CONCLUSIONES: El ajuste para los determinantes sociales de la salud redujo las disparidades raciales y étnicas en la detección del cáncer colorrectal entre todos los grupos étnicos y raciales minoritarios, excepto las personas asiáticas no hispanas; sin embargo, es probable que existan otros factores de confusión no medidos. Consulte Video Resumen en http://links.lww.com/DCR/B977 . (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
- William J Kane
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mark A Fleming
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Kevin T Lynch
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Charles M Friel
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Michael D Williams
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Traci L Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Guofen Yan
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sook C Hoang
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
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Smithson MG, McLeod MC, Al-Obaidi M, Harmon CA, Sawant A, Hardiman KM, Chu DI, Bhatia S, Williams GR, Hollis RH. Racial Differences in Aging-Related Deficits Among Older Adults With Colorectal Cancer. Dis Colon Rectum 2023; 66:1245-1253. [PMID: 37235857 PMCID: PMC10524491 DOI: 10.1097/dcr.0000000000002672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Despite the known influences of both race- and aging-related factors in colorectal cancer outcomes and mortality, limited literature is available on the intersection between race and aging-related impairments. OBJECTIVE To explore racial differences in frailty and geriatric deficit subdomains among patients with colorectal cancer. DESIGN Retrospective study using data from the Cancer and Aging Resilience Evaluation registry. SETTINGS A comprehensive cancer center in the Deep South. PATIENTS Older adults (aged ≥60 years) with colorectal cancer. MAIN OUTCOME MEASURES Measure of frailty and geriatric assessment subdomains of physical function, functional status, cognitive complaints, psychological function, and health-related quality of life. RESULTS Black patients lived in areas with a higher social vulnerability index compared to White patients (0.69 vs 0.49; p < 0.01) and had limited social support more often (54.5% vs 34.9%; p = 0.01). After adjustment for age, cancer stage, comorbidities, and social vulnerability index, Black patients were found to have a higher rate of frailty than White patients (adjusted OR 3.77; 95% CI, 1.76-8.18; p = 0.01). In addition, Black patients had more physical limitations (walking 1 block: adjusted OR 1.93; 95% CI, 1.02-3.69; p = 0.04), functional limitations (activities of daily living: adjusted OR 3.21; 95% CI, 1.42-7.24; p = 0.01), and deficits in health-related quality of life (poor global self-reported health: adjusted OR 2.45; 95% CI, 1.23-5.13; p = 0.01). Similar findings were shown after stratification by stage I to III vs IV. LIMITATIONS Retrospective study at a single institution. CONCLUSIONS Among older patients with colorectal cancer, Black patients were more likely to be frail than White patients, with deficits observed specifically in physical function, functional status, and health-related quality of life. Geriatric assessment may provide an important tool in addressing racial inequities in colorectal cancer. DIFERENCIAS RACIALES EN LOS DFICITS RELACIONADOS CON EL ENVEJECIMIENTO ENTRE ADULTOS MAYORES CON CNCER COLORRECTAL ANTECEDENTES: A pesar de las influencias conocidas de los factores relacionados con la raza y el envejecimiento en los resultados y la mortalidad del cáncer colorectal, hay muy poca literatura sobre la intersección entre los impedimentos relacionados con la raza y el envejecimiento.OBJETIVO: El objetivo era explorar las diferencias raciales en los subdominios de fragilidad y déficit geriátrico entre los pacientes con cáncer colorectal.DISEÑO: Estudio retrospectivo utilizando datos del registro Cancer and Aging Resilience Evaluation.AJUSTES: Un centro oncológico integral en el Sur Profundo.PACIENTES: Adultos mayores (≥60 años) con cáncer colorrectal de raza Negra o Blanca.PRINCIPALES MEDIDAS DE RESULTADO: Medida compuesta de fragilidad y subdominios de evaluación geriátrica de función física, estado funcional, quejas cognitivas, función psicológica y calidad de vida relacionada con la salud.RESULTADOS: De los 304 pacientes incluidos, el 21,7% (n = 66) eran negros y la edad media era de 69 años. Los pacientes negros vivían en áreas con un índice de vulnerabilidad social (SVI) más alto en comparación con los pacientes blancos (SVI 0,69 vs 0,49; p < 0,01) y con mayor frecuencia tenían apoyo social limitado (54,5% vs 34,9%; p = 0,01). Después de ajustar por edad, estadio del cáncer, comorbilidades y SVI, los pacientes de raza negra tenían una mayor tasa de fragilidad en comparación con los pacientes de raza blanca (ORa 3,77, IC del 95%: 1,76-8,18; p = 0,01). Además, los pacientes negros tenían más limitaciones físicas (caminar 1 cuadra: ORa 1,93, IC 95% 1,02-3,69; p = 0,04), limitaciones funcionales (actividades de la vida diaria: ORa 3,21, IC 95% 1,42-7,24; p = 0,01 ) y déficits en la calidad de vida relacionada con la salud (mala salud global autoinformada: ORa 2,45, IC 95% 1,23-5,13; p = 0,01). Las quejas cognitivas y las funciones psicológicas no difirieron según la raza (p > 0,05). Se mostraron hallazgos similares después de la estratificación por estadio I-III frente a IV.LIMITACIONES: Estudio retrospectivo en una sola institución.CONCLUSIONES: Entre los pacientes mayores con cáncer colorrectal, los pacientes negros tenían más probabilidades que los pacientes blancos de ser frágiles, observándose déficits específicamente en la función física, el estado funcional y la calidad de vida relacionada con la salud. La evaluación geriátrica puede proporcionar una herramienta importante para abordar las desigualdades raciales en el cáncer colorrectal.
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Affiliation(s)
- Mary G Smithson
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - M Chandler McLeod
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christian A Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Arundhati Sawant
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karin M Hardiman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Surgery, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Daniel I Chu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert H Hollis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
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邵 子, 吕 军. [Socioeconomic status and cecal adenocarcinoma mortality risk: an American population-based analysis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2023; 43:1417-1424. [PMID: 37712280 PMCID: PMC10505572 DOI: 10.12122/j.issn.1673-4254.2023.08.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To explore the relationship between socioeconomic status (SES) and disease mortality in patients with cecal adenocarcinoma in America through the Surveillance, Epidemiology, and End results (SEER) database. METHODS The SEER database was queried for patients with cecal adenocarcinoma in America diagnosed from 2011 to 2015. Factor analysis, cluster analysis, and univariate and multivariate Cox proportional hazard models were used for data analysis. Five social security factors were identified: factor 1, economic and educational disadvantage; factor 2, characteristics related to immigration (language isolation and foreign birth); factor 3, high relocation rate in the county; factor 4, high intra-state relocation rate; and factor 5, high domestic relocation rate. Five clusters defined by SES were identified. RESULTS The number of all-cause deaths among 17 185 patients was 5948, and the number of survivors was 11, 237. In the multivariate Cox regression analysis, with cluster 1 (low poverty rate and high education level) as the reference, the hazard ratio (HR) of cluster 3 (high intra-county mobility rate) was 1.13 (95% CI: 1.04-1.21, P < 0.05), and the risk was 13% higher than that of cluster 1. The HR of cluster 4 (low language isolation, foreign birth, housing overcrowding, and intra-country mobility rates) was 1.15 (95% CI: 1.07- 1.24, P < 0.001) with a 15% higher risk than cluster 1. The HR of cluster 5 (economic and educational disadvantages, immigration-related characteristics, and low intra-country mobility) was 1.11 (95% CI: 1.03-1.20, P < 0.01) with a 11% higher risk. The factors related to SES indicators were based on the mortality of patients with cecal adenocarcinoma, indicating that low economic and education levels are risk factors for cecal adenocarcinoma. CONCLUSION Low socioeconomic status is associated with an increased risk of death in patients with cecal adenocarcinoma in the United States and show different distribution patterns based on population. Improving health insurance policies and strengthening psychotherapy can provide guidance for improving prognosis f cecal adenocarcinoma patients.
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Affiliation(s)
- 子安 邵
- 南方医科大学第一临床医学院,广东 广州 510515First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - 军 吕
- 暨南大学附属第一医院临床研究部,广东 广州 510630Department of Clinical Research, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- 广东省中医药信息化重点实验室,广东 广州 510632Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou 510632, China
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Olaechea S, Sarver B, Liu A, Gilmore LA, Alvarez C, Iyengar P, Infante R. Race, Ethnicity, and Socioeconomic Factors as Determinants of Cachexia Incidence and Outcomes in a Retrospective Cohort of Patients With Gastrointestinal Tract Cancer. JCO Oncol Pract 2023; 19:493-500. [PMID: 37099735 PMCID: PMC10337717 DOI: 10.1200/op.22.00674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/08/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE Cachexia is a paraneoplastic syndrome of unintentional adipose and muscle tissue wasting with severe impacts to functionality and quality of life. Although health inequities across minority and socioeconomically disadvantaged groups are known, the role of these factors in cachexia progression is poorly characterized. This study aims to evaluate the relationship between these determinants and cachexia incidence and survival in patients with gastrointestinal tract cancer. METHODS Through retrospective chart review from a prospective tumor registry, we established a cohort of 882 patients with gastroesophageal or colorectal cancer diagnosed between 2006 and 2013. Patient race, ethnicity, private insurance coverage, and baseline characteristics were evaluated through multivariate, Kaplan-Meier, and Cox regression analyses to determine associations with cachexia incidence and survival outcomes. RESULTS When controlling for potentially confounding covariates (age, sex, alcohol and tobacco history, comorbidity score, tumor site, histology, and stage), Black (odds ratio [OR], 2.447; P < .0001) and Hispanic (OR, 3.039; P < .0001) patients are at an approximately 150% and 200%, respectively, greater risk of presenting with cachexia than non-Hispanic White patients. Absence of private insurance coverage was associated with elevated cachexia risk (OR, 1.439; P = .0427) compared to privately insured patients. Cox regression analyses with previously described covariates and treatment factors found Black race (hazard ratio [HR], 1.304; P = .0354) to predict survival detriments, while cachexia status did not reach significance (P = .6996). CONCLUSION Our findings suggest that race, ethnicity, and insurance play significant roles in cachexia progression and related outcomes that are not accounted for by conventional predictors of health. Disproportionate financial burdens, chronic stress, and limitations of transportation and health literacy represent targetable factors for mitigating these health inequities.
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Affiliation(s)
- Santiago Olaechea
- Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brandon Sarver
- McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | - Alison Liu
- Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX
| | - Linda Anne Gilmore
- Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christian Alvarez
- Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX
| | - Puneeth Iyengar
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rodney Infante
- Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX
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Purrington KS, Hastert TA, Madhav KC, Nair M, Snider N, Ruterbusch JJ, Schwartz AG, Stoffel EM, Peters ES, Rozek LS. The role of area-level socioeconomic disadvantage in racial disparities in cancer incidence in metropolitan Detroit. Cancer Med 2023. [PMID: 37184135 DOI: 10.1002/cam4.6065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/17/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Neighborhood deprivation is associated with both race and cancer incidence, but there is a need to better understand the effect of structural inequities on racial cancer disparities. The goal of this analysis was to evaluate the relationship between a comprehensive measure of neighborhood-level social disadvantage and cancer incidence within the racially diverse population of metropolitan Detroit. METHODS We estimated breast, colorectal, lung, and prostate cancer incidence rates using Metropolitan Detroit Cancer Surveillance System and US decennial census data. Neighborhood socioeconomic disadvantage was measured by the Area Deprivation Index (ADI) using Census Bureau's American Community Survey data at the Public Use Microdata Areas (PUMA) level. Associations between ADI at time of diagnosis and cancer incidence were estimated using Poisson mixed-effects models adjusting for age and sex. Attenuation of race-incidence associations by ADI was quantified using the "mediation" package in R. RESULTS ADI was inversely associated with incidence of breast cancer for both non-Hispanic White (NHW) and non-Hispanic Black (NHB) women (NHW: per-quartile RR = 0.92, 95% CI 0.88-0.96; NHB: per-quartile RR = 0.94, 95% CI 0.91-0.98) and with prostate cancer incidence only for NHW men (per-quartile RR = 0.94, 95% CI 0.90-0.97). ADI was positively associated with incidence of lung cancer for NHWs and NHBs (NHW: per-quartile RR = 1.12, 95% CI 1.04-1.21; NHB: per-quartile RR = 1.37, 95% CI 1.25-1.51) and incidence of colorectal cancer (CRC) only among NHBs (per-quartile RR = 1.11, 95% CI 1.02-1.21). ADI significantly attenuated the relationship between race and hormone receptor positive, HER2-negative breast cancer (proportion attenuated = 8.5%, 95% CI 4.1-16.6%) and CRC cancer (proportion attenuated = 7.3%, 95% CI 3.7 to 12.8%), and there was a significant interaction between race and ADI for lung (interaction RR = 1.22, p < 0.0001) and prostate cancer (interaction RR = 1.09, p = 0.00092). CONCLUSIONS Area-level socioeconomic disadvantage is associated with risk of common cancers in a racially diverse population and plays a role in racial differences in cancer incidence.
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Affiliation(s)
- Kristen S Purrington
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - K C Madhav
- Department of Internal Medicine, Yale School of Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Connecticut, New Haven, USA
| | - Mrudula Nair
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
| | - Natalie Snider
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
| | - Julie J Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Ann G Schwartz
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Elena M Stoffel
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Michigan, Ann Arbor, USA
| | - Edward S Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Laura S Rozek
- Department of Oncology, Georgetown University School of Medicine, District of Columbia, Washington, USA
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Champion VL, Paskett ED, Stump TE, Biederman EB, Vachon E, Katz ML, Rawl SM, Baltic RD, Kettler CD, Seiber EE, Xu WY, Monahan PO. Comparative Effectiveness of 2 Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening Among Women in the Rural US: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2311004. [PMID: 37115541 PMCID: PMC10148202 DOI: 10.1001/jamanetworkopen.2023.11004] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
Importance Women living in rural areas have lower rates of breast, cervical, and colorectal cancer screening compared with women living in urban settings. Objective To assess the comparative effectiveness of (1) a mailed, tailored digital video disc (DVD) intervention; (2) a DVD intervention plus telephonic patient navigation (DVD/PN); and (3) usual care with simultaneously increased adherence to any breast, cervical, and colorectal cancer screening that was not up to date at baseline and to assess cost-effectiveness. Design, Setting, and Participants This randomized clinical trial recruited and followed up women from rural Indiana and Ohio (community based) who were not up to date on any or all recommended cancer screenings. Participants were randomly assigned between November 28, 2016, and July 1, 2019, to 1 of 3 study groups (DVD, DVD/PN, or usual care). Statistical analyses were completed between August and December 2021 and between March and September 2022. Intervention The DVD interactively assessed and provided messages for health beliefs, including risk of developing the targeted cancers and barriers, benefits, and self-efficacy for obtaining the needed screenings. Patient navigators counseled women on barriers to obtaining screenings. The intervention simultaneously supported obtaining screening for all or any tests outside of guidelines at baseline. Main Outcomes and Measures Receipt of any or all needed cancer screenings from baseline through 12 months, including breast, cervical, and colorectal cancer, and cost-effectiveness of the intervention. Binary logistic regression was used to compare the randomized groups on being up to date for all and any screenings at 12 months. Results The sample included 963 women aged 50 to 74 years (mean [SD] age, 58.6 [6.3] years). The DVD group had nearly twice the odds of those in the usual care group of obtaining all needed screenings (odds ratio [OR], 1.84; 95% CI, 1.02-3.43; P = .048), and the odds were nearly 6 times greater for DVD/PN vs usual care (OR, 5.69; 95% CI, 3.24-10.5; P < .001). The DVD/PN intervention (but not DVD alone) was significantly more effective than usual care (OR, 4.01; 95% CI, 2.60-6.28; P < .001) for promoting at least 1 (ie, any) of the needed screenings at 12 months. Cost-effectiveness per woman who was up to date was $14 462 in the DVD group and $10 638 in the DVD/PN group. Conclusions and Relevance In this randomized clinical trial of rural women who were not up to date with at least 1 of the recommended cancer screenings (breast, cervical, or colorectal), an intervention designed to simultaneously increase adherence to any or all of the 3 cancer screening tests was more effective than usual care, available at relatively modest costs, and able to be remotely delivered, demonstrating great potential for implementing an evidence-based intervention in remote areas of the midwestern US. Trial Registration ClinicalTrials.gov Identifier: NCT02795104.
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Affiliation(s)
- Victoria L. Champion
- School of Nursing, Indiana University, Indianapolis
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - Electra D. Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus
| | - Timothy E. Stump
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
| | | | - Eric Vachon
- School of Nursing, Indiana University, Indianapolis
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
- Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana
| | - Mira L. Katz
- Comprehensive Cancer Center, The Ohio State University, Columbus
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus
| | - Susan M. Rawl
- School of Nursing, Indiana University, Indianapolis
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - Ryan D. Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus
| | - Carla D. Kettler
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
| | - Eric E. Seiber
- Division of Health Services Management and Policy, The Ohio State University, Columbus
| | - Wendy Y. Xu
- Division of Health Services Management and Policy, The Ohio State University, Columbus
| | - Patrick O. Monahan
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
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Kolb JM, Chen M, Tavakkoli A, Gallegos J, O’Hara J, Tarter W, Hochheimer CJ, Golubski B, Kopplin N, Hennessey L, Kalluri A, Devireddy S, Scott FI, Falk GW, Singal AG, Vajravelu RK, Wani S. Patient Knowledge, Risk Perception, and Barriers to Barrett's Esophagus Screening. Am J Gastroenterol 2023; 118:615-626. [PMID: 36219171 PMCID: PMC10624561 DOI: 10.14309/ajg.0000000000002054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/16/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Most patients with esophageal adenocarcinoma (EAC) do not have a previous diagnosis of Barrett's esophagus (BE), demonstrating a failure of current screening practices. An understanding of patient attitudes and barriers is essential to develop and implement interventions to improve BE screening adherence. METHODS We conducted a Web-based survey of patients aged >50 years with chronic gastroesophageal reflux disease at 3 academic medical centers and 1 affiliated safety net health systems. Survey domains included patient characteristics, endoscopy history, familiarity with screening practices, perceived BE/EAC risk, and barriers to screening. RESULTS We obtained a response rate of 22.6% (472/2,084) (74% men, mean age 67.9 years). Self-identified race and ethnicity of participants was 66.5% non-Hispanic White, 20.0% non-Hispanic Black, 13.4% other race, and 7.1% Hispanic. Screening for BE was recommended in only 13.2%, and only 5.3% reported previous screening. Respondents had notable gaps in knowledge about screening indications; only two-thirds correctly identified BE risk factors and only 19.5% believed BE screening was needed for gastroesophageal reflux disease. More than 1 in 5 respondents believed they would get BE (31.9%) or EAC (20.2%) but reported barriers to screening. Compared with White respondents, more Black respondents were concerned about getting BE/EAC and interested in screening but report higher barriers to screening. DISCUSSION Patients at risk for BE, particularly racial and ethnic minorities, are worried about developing EAC but rarely undergo screening and have poor understanding of screening recommendations.
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Affiliation(s)
- Jennifer M Kolb
- Division of Gastroenterology, Hepatology and Parenteral Nutrition, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA
| | - Mindy Chen
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna Tavakkoli
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jazmyne Gallegos
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jack O’Hara
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wyatt Tarter
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO
| | - Camille J Hochheimer
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO
| | - Bryan Golubski
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Noa Kopplin
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lilly Hennessey
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anita Kalluri
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shalika Devireddy
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Frank I. Scott
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gary W. Falk
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ravy K Vajravelu
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine and Center for Health Equity Research Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Barberan Parraga C, Singh R, Lin R, Tamariz L, Palacio A. Colorectal Cancer Screening Disparities Among Race: A Zip Code Level Analysis. Clin Colorectal Cancer 2023; 22:183-189. [PMID: 36842869 DOI: 10.1016/j.clcc.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) screening can prevent disease by early identification. Existing disparities in CRC screening have been associated with factors including race, socioeconomic status, insurance, and even geography. Our study takes a deeper look into how social determinants related to zip code tabulation areas affect CRC screenings. MATERIALS AND METHODS We conducted a retrospective cross-sectional study of CRC screenings by race at a zip code level, evaluating for impactful social determinant factors such as the social deprivation index (SDI). We used publicly available data from CDC 500 Cities Project (2016-2019), PLACES Project (2020), and the American Community Survey (2019). We conducted multivariate and confirmatory factor analyses among race, income, health insurance, check-up visits, and SDI. RESULTS Increasing the tertile of SDI was associated with a higher likelihood of being Black or Hispanic, as well as decreased median household income (P < .01). Lower rates of regular checkup visits were found in the third tertile of SDI (P < .01). The multivariate analysis showed that being Black, Hispanic, lower income, being uninsured, lack of regular check-ups, and increased SDI were related to decreased CRC screening. In the confirmatory factor analysis, we found that SDI and access to insurance were the variables most related to decreased CRC screening. CONCLUSION Our results reveal the top 2 factors that impact a locality's CRC screening rates are the social deprivation index and access to health care. This data may help implement interventions targeting social barriers to further promote CRC screenings within disadvantaged communities and decrease overall mortality via early screening.
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Affiliation(s)
- Carla Barberan Parraga
- Department of Medicine and Epidemiology Universidad Catolica Santiago de Guayaquil, Guayaquil, Ecuador.
| | - Roshni Singh
- Miller School of Medicine, University of Miami, Miami, FL
| | - Rachel Lin
- Miller School of Medicine, University of Miami, Miami, FL
| | | | - Ana Palacio
- Miami Veterans Affairs Medical Center, Miami, FL
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Gong Y, Zheng Y, Wu R, Liu M, Li H, Zeng Q. Detection rates of adenomas, advanced adenomas, and colorectal cancers among the opportunistic colonoscopy screening population: a single-center, retrospective study. Chin Med J (Engl) 2023; 136:159-166. [PMID: 36692899 PMCID: PMC10106243 DOI: 10.1097/cm9.0000000000002435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening is effective in reducing CRC incidence and mortality. The aim of this study was to retrospectively determine and compare the detection rate of adenomas, advanced adenomas (AAs) and CRCs, and the number needed to screen (NNS) of individuals in an average-risk Chinese population of different ages and genders. METHODS This was a retrospective study performed at the Institute of Health Management, Chinese People's Liberation Army General Hospital. Colonoscopy results were analyzed for 53,152 individuals finally enrolled from January 2013 to December 2019. The detection rate of adenomas, AAs, or CRCs was computed and the characteristics between men and women were compared using chi-squared test. RESULTS The average age was 48.8 years (standard deviation [SD], 8.5 years) for men and 50.0 years (SD, 9.0 years) for women, and the gender rate was 66.27% (35,226) vs . 33.73% (17,926). The detection rates of adenomas, AAs, serrated adenomas, and CRCs were 14.58% (7750), 3.09% (1641), 1.23% (653), and 0.59% (313), respectively. Men were statistically significantly associated with higher detection rates than women in adenomas (17.20% [6058/35,226], 95% confidence interval [CI] 16.74-17.53% vs . 9.44% [1692/17,926], 95% CI 8.94-9.79%, P < 0.001), AAs (3.72% [1309], 95% CI 3.47-3.87% vs . 1.85% [332], 95% CI 1.61-2.00%, P < 0.001), and serrated adenomas (1.56% [548], 95% CI 1.43-1.69% vs . 0.59% [105], 95% CI 0.47-0.70%, P < 0.001). The detection rate of AAs in individuals aged 45 to 49 years was 3.17% (270/8510, 95% CI 2.80-3.55%) in men and 1.69% (69/4091, 95% CI 1.12-1.86%) in women, and their NNS was 31.55 (95% CI 28.17-35.71) in men and 67.11 (95% CI 53.76-89.29) in women. The NNS for AAs in men aged 45 to 49 years was close to that in women aged 65 to 69 years (29.07 [95% CI 21.05-46.73]). CONCLUSIONS The detection rates of adenomas, AAs, and serrated adenomas are high in the asymptomatic population undergoing a physical examination and are associated with gender and age. Our findings will provide important references for effective population-based CRC screening strategies in the future.
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Affiliation(s)
- Yan Gong
- Department of Health Medicine, The Second Medical Center and National Clinical Research Center for Geriatric Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yansong Zheng
- Health Examination Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Rilige Wu
- Medical Big Data Research Center, Medical Innovation Research Division of Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Miao Liu
- Graduate School of Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hong Li
- Department of Health Medicine, The Second Medical Center and National Clinical Research Center for Geriatric Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Qiang Zeng
- Health Management Institute, The Second Medical Center and National Clinical Research Center for Geriatric Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Mohl JT, Ciemins EL, Miller-Wilson LA, Gillen A, Luo R, Colangelo F. Rates of Follow-up Colonoscopy After a Positive Stool-Based Screening Test Result for Colorectal Cancer Among Health Care Organizations in the US, 2017-2020. JAMA Netw Open 2023; 6:e2251384. [PMID: 36652246 PMCID: PMC9856942 DOI: 10.1001/jamanetworkopen.2022.51384] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
IMPORTANCE Noninvasive stool-based screening tests (SBTs) are effective alternatives to colonoscopy. However, a positive SBT result requires timely follow-up colonoscopy (FU-CY) to complete the colorectal cancer screening paradigm. OBJECTIVES To evaluate FU-CY rates after a positive SBT result and to assess the association of the early COVID-19 pandemic with FU-CY rates. DESIGN, SETTING, AND PARTICIPANTS This mixed-methods cohort study included retrospective analysis of deidentified administrative claims and electronic health records data between June 1, 2015, and June 30, 2021, from the Optum Labs Data Warehouse and qualitative, semistructured interviews with clinicians from 5 health care organizations (HCOs). The study population included data from average-risk primary care patients aged 50 to 75 years with a positive SBT result between January 1, 2017, and June 30, 2020, at 39 HCOs. MAIN OUTCOMES AND MEASURES The primary outcome was the FU-CY rate within 1 year of a positive SBT result according to patient age, sex, race, ethnicity, insurance type, Charlson Comorbidity Index (CCI), and prior SBT use. RESULTS This cohort study included 32 769 individuals (16 929 [51.7%] female; mean [SD] age, 63.1 [7.1] years; 2092 [6.4%] of Black and 28 832 [88.0%] of White race; and 825 [2.5%] of Hispanic ethnicity). The FU-CY rates were 43.3% within 90 days of the positive SBT result, 51.4% within 180 days, and 56.1% within 360 days (n = 32 769). In interviews, clinicians were uniformly surprised by the low FU-CY rates. Rates varied by race, ethnicity, insurance type, presence of comorbidities, and SBT used. In the Cox proportional hazards regression model, the strongest positive association was with multitarget stool DNA use (hazard ratio, 1.63 [95% CI, 1.57-1.68] relative to fecal immunochemical tests; P < .001), and the strongest negative association was with the presence of comorbidities (hazard ratio, 0.64 [95% CI, 0.59-0.71] for a CCI of >4 relative to 0; P < .001). The early COVID-19 pandemic was associated with lower FU-CY rates. CONCLUSIONS AND RELEVANCE This study found that FU-CY rates after a positive SBT result for colorectal cancer screening were low among an average-risk population, with the median HCO achieving a 53.4% FU-CY rate within 1 year. Socioeconomic factors and the COVID-19 pandemic were associated with lower FU-CY rates, presenting opportunities for targeted intervention by clinicians and health care systems.
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Affiliation(s)
- Jeff T. Mohl
- American Medical Group Association, Alexandria, Virginia
| | | | | | - Abbie Gillen
- American Medical Group Association, Alexandria, Virginia
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Allar BG, Mahmood R, Ortega G, Joseph T, Libaridian LN, Messaris E, Sheth K, Rayala HJ. Colorectal cancer screening in a safety-net health system: The intersectional impact of race, ethnicity, language, and mental health. Prev Med 2023; 166:107389. [PMID: 36529404 DOI: 10.1016/j.ypmed.2022.107389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/22/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Though rates of colorectal cancer (CRC) screening continue to improve with increased advocacy and awareness, there are numerous disparities that continue to be defined within different health systems and populations. We aimed to define associations between patients' socio-demographic characteristics and CRC screening in a well-resourced safety-net health system. A retrospective review was performed from 2018 to 2019 of patients between 50 and 75-years-old who had a primary care visit within the last two years. Numerous patient characteristics were extracted from the medical record, including self-reported race, self-reported ethnicity, insurance, preferred language, severe mental health diagnoses (SMHD), and substance use disorder (SUD). Multivariate logistic regression assessed characteristics associated with CRC screening. Of 22,145 included patients, 16,065 (72.5%) underwent CRC screening. <40% of the population was White or of North American/European ethnicity and 38% had limited English proficiency. Hispanic patients had the highest screening rate while White patients had the lowest among races (78.1% vs 68.5%, respectively). White patients had higher rates of SMHD and SUD (p < 0.001). In multivariable analysis, most other races (Black, Asian, and Hispanic), ethnicities, and languages had significantly higher odds of screening, ranging from 20% to 55% higher, when White, North American/European, English-speakers are used as reference. In a well-resourced safety-net health system, patients who were non-White, non-North American/European, and non-English-speaking, had higher odds of CRC screening. This data from a unique health system may better guide screening outreach and implementation strategies in historically under-resourced communities, leading to strategies for equitable colorectal cancer screening.
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Affiliation(s)
- Benjamin G Allar
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Rumel Mahmood
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States of America
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Taïsha Joseph
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lorky N Libaridian
- Department of Internal Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States of America
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Ketan Sheth
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States of America
| | - Heidi J Rayala
- Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America.
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Ebner D, Kisiel J, Barnieh L, Sharma R, Smith NJ, Estes C, Vahdat V, Ozbay AB, Limburg P, Fendrick AM. The cost-effectiveness of non-invasive stool-based colorectal cancer screening offerings from age 45 for a commercial and medicare population. J Med Econ 2023; 26:1219-1226. [PMID: 37752872 DOI: 10.1080/13696998.2023.2260681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
AIM The United States Preventive Services Taskforce (USPSTF) recently recommended lowering the age for average-risk colorectal cancer (CRC) screening from 50 to 45 years. While initiating screening at age 45 versus 50 provides a greater opportunity for CRC early detection and prevention, the full profile of benefits, risks, and cost-effectiveness of expanding the screen-eligible population requires further evaluation. MATERIALS AND METHODS The costs and clinical outcomes for screening at age 45 for triennial multi-target stool DNA [mt-sDNA], and other non-invasive stool-based modalities (annual fecal immunochemical test [FIT] and annual fecal-occult blood test [FOBT]), were estimated using the validated CRC-AIM microsimulation model over a lifetime horizon. Test sensitivity and specificity inputs were based on 2021 USPSTF modeling analyses; adherence rates were based on published real-world data and the costs of the screening test, follow-up colonoscopies, complications, and CRC care were included. Outcomes are reported from the perspective of a United States payer as clinical, life-years gained (LYG), and incremental cost-effectiveness ratio (ICER); stool-based and follow-up colonoscopy adherence ranges were explored in one-way, probabilistic and threshold analyses. RESULTS When compared to initiation of CRC screening at age 45 versus 50, all modalities reduced both the incidence of and mortality from CRC and increased LYG. Initiating CRC screening at age 45 was cost-effective with an ICER of $59,816 and $35,857 per quality-adjusted life year (QALY) for mt-sDNA versus FIT and FOBT, respectively. In the threshold analyses, at equivalent rates to stool-based screening, mt-sDNA was always cost-effective at a willingness-to-pay threshold of $100,000 per QALY versus FIT and FOBT. CONCLUSIONS Initiating average-risk CRC screening at age 45 instead of age 50 increases the estimated clinical benefit by reducing disease burden while remaining cost-effective. Among stool-based screening modalities, mt-sDNA provides the most clinical benefit in a Commercial and Medicare population.
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Affiliation(s)
- Derek Ebner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - John Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | - A Mark Fendrick
- Center for Value Based Insurance Design, University of Michigan, Ann Arbor, MI, USA
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Jiang Z, Hussain A, Grell J, Sly JR, Miller SJ. Systematic Review of Colorectal Cancer Screening-Related Apps. Telemed J E Health 2023; 29:87-92. [PMID: 35612435 PMCID: PMC10024053 DOI: 10.1089/tmj.2021.0337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 01/13/2023] Open
Abstract
Background: In the United States, colorectal cancer (CRC) is the second leading cause of cancer death in men and women combined. The United States Preventive Services Task Force recommends that average risk adults have regular CRC screening to detect and prevent CRC. Despite published CRC screening guidelines, national CRC screening rates remain suboptimal. With the exponential increase in technology use and device ownership, many mobile health applications (apps) have been developed to improve health outcomes. There is great potential for smartphone or tablet apps to help improve CRC screening uptake, with the ultimate goal of reducing CRC morbidity and mortality. To date, there are no systematic reviews that have examined the publicly available, free apps that are related to CRC screening, and therefore, the quality and the content of these apps remain unknown. Objectives: The purpose of this study was to systematically review smartphone and tablet apps that could be used to improve CRC screening uptake. Methods: Apps available on the Google Play and Apple App stores that were compatible with smartphones and tablets were reviewed. Of the 2,790 apps reviewed, 20 met inclusion criteria. Results: Of the 20 apps that met inclusion criteria, most were informational in nature. Approximately half of the apps focused on colonoscopies and did not discuss other CRC screening options. Furthermore, more than half of the apps did not include video/audio content and the majority of the apps did not provide navigation support (e.g., reminders, instructions, maps). Conclusions: There are multiple free, publicly available apps that may encourage CRC screening uptake. Despite their promise, there is a paucity of empirical evidence evaluating the efficacy and usability of these apps. Future research efforts can evaluate the content, usability, accessibility, and potential impact of these apps.
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Affiliation(s)
- Zhiye Jiang
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anum Hussain
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jewel Grell
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jamilia R. Sly
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sarah J. Miller
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Farzaneh CA, Pigazzi A, Duong WQ, Carmichael JC, Stamos MJ, Dekhordi-Vakil F, Dayyani F, Zell JA, Jafari MD. Analysis of delay in adjuvant chemotherapy in locally advanced rectal cancer. Tech Coloproctol 2023; 27:35-42. [PMID: 36042105 DOI: 10.1007/s10151-022-02676-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/27/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Adjuvant chemotherapy (AC) after neoadjuvant chemoradiation and surgical resection has been the standard of care for locally advanced rectal cancer. However, there are no evidence-based guidelines regarding the optimal timing of AC for rectal cancer. The objective of this study was to evaluate the effect of AC timing on overall survival for rectal cancer. METHODS The National Cancer Database (NCDB) from 2004 to 2016 was queried for primary clinical stage II or III rectal cancer patients who had undergone neoadjuvant chemoradiation followed by surgery and AC. Patients were grouped based on AC initiation: early ≤ 4 weeks, intermediate 4-8 weeks, and delayed ≥ 8 weeks. The primary outcome was overall survival. RESULTS We identified 8722 patients, of which 905 (10.4%) received early AC, 4621 (53.0%) intermediate AC, and 3196 (36.6%) delayed AC. Pathological lymph-node metastasis (ypN +) was positive in 73% of early AC, 74% intermediate AC, and 63% delayed AC (p < 0.05). The 5-year survival probability was 71.1% (95% CI 68-74%) for early AC, 73.2% (95% CI 72-75%) intermediate AC, and 65.8% (95% CI 64-68%) delayed AC (p < 0.001). Using Cox proportional hazard modeling, patients undergoing delayed AC had an associated decreased survival compared to patients receiving early AC (HR 1.18; 95% CI 1.028-1.353, p = 0.018) or intermediate AC (HR 1.28; 95% CI 1.179-1.395, p < 0.01). CONCLUSIONS Delay in AC administration may be associated with decreased 5-year survival. Compared to early or intermediate AC, patients in the delayed AC group were observed to have increased risk of death, despite having lower proportions with ypN + disease. Patients with higher socioeconomic and education status were more likely to receive early chemotherapy.
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Affiliation(s)
- C A Farzaneh
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA
| | - A Pigazzi
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell College of Medicine, 525 E 68th Street, Box #172, New York, NY, 10065, USA
| | - W Q Duong
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA
| | - J C Carmichael
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA
| | - M J Stamos
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA
| | - F Dekhordi-Vakil
- Department of Statistics, University of California, Irvine, Irvine, CA, USA
| | - F Dayyani
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Orange, CA, USA
| | - J A Zell
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Orange, CA, USA
| | - M D Jafari
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell College of Medicine, 525 E 68th Street, Box #172, New York, NY, 10065, USA.
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Giannakou K, Lamnisos D. Small-Area Geographic and Socioeconomic Inequalities in Colorectal Cancer in Cyprus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:341. [PMID: 36612661 PMCID: PMC9819875 DOI: 10.3390/ijerph20010341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Colorectal cancer (CRC) is one of the leading causes of death and morbidity worldwide. To date, the relationship between regional deprivation and CRC incidence or mortality has not been studied in the population of Cyprus. The objective of this study was to analyse the geographical variation of CRC incidence and mortality and its possible association with socioeconomic inequalities in Cyprus for the time period of 2000-2015. This is a small-area ecological study in Cyprus, with census tracts as units of spatial analysis. The incidence date, sex, age, postcode, primary site, death date in case of death, or last contact date of all alive CRC cases from 2000-2015 were obtained from the Cyprus Ministry of Health's Health Monitoring Unit. Indirect standardisation was used to calculate the sex and age Standardise Incidence Ratios (SIRs) and Standardised Mortality Ratios (SMRs) of CRC while the smoothed values of SIRs, SMRs, and Mortality to Incidence ratio (M/I ratio) were estimated using the univariate Bayesian Poisson log-linear spatial model. To evaluate the association of CRC incidence and mortality rate with socioeconomic deprivation, we included the national socioeconomic deprivation index as a covariate variable entering in the model either as a continuous variable or as a categorical variable representing quartiles of areas with increasing levels of socioeconomic deprivation. The results showed that there are geographical areas having 15% higher SIR and SMR, with most of those areas located on the east coast of the island. We found higher M/I ratio values in the rural, remote, and less dense areas of the island, while lower rates were observed in the metropolitan areas. We also discovered an inverted U-shape pattern in CRC incidence and mortality with higher rates in the areas classified in the second quartile (Q2-areas) of the socioeconomic deprivation index and lower rates in rural, remote, and less dense areas (Q4-areas). These findings provide useful information at local and national levels and inform decisions about resource allocation to geographically targeted prevention and control plans to increase CRC screening and management.
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Sharma RK, Patel S, Gallant JN, Esianor BI, Duffus S, Wang H, Weiss VL, Belcher RH. Racial, ethnic, and socioeconomic disparities in the presentation and management of pediatric thyroid cancer. Int J Pediatr Otorhinolaryngol 2022; 162:111331. [PMID: 36206698 PMCID: PMC10115562 DOI: 10.1016/j.ijporl.2022.111331] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/26/2022] [Accepted: 09/27/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Disparities across race and socioeconomic status (SES) in cancer treatment exist for many malignancies. Disadvantaged groups have repeatedly been shown to receive sub-optimal treatment. This study intends to analyze racial and SES disparities in the presentation and management of pediatric thyroid cancer. METHODS A retrospective national database study of children who underwent thyroidectomy for thyroid papillary, medullary, and follicular carcinoma between 2007 and 2016 was conducted using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. Multivariable logistic regression was conducted to identify predictors of 1) tumor stage/size at diagnosis and 2) treatment modalities. RESULTS 1942 children were analyzed. The average tumor size at presentation was 20 mm for White patients, 26 mm for Non-White patients, and 27 mm for Hispanic patients (p < 0.001). Stage of disease differed significantly by race/ethnicity (p < 0.001) with Non-White and Hispanic patients having more distant disease than White patients at presentation. On multivariable regression, Hispanic patients (OR 1.41, 95%CI 1.06-1.87, p = 0.017) were more likely to be diagnosed at later stages. Non-White (OR 2.03, 1.50-2.73, p < 0.001) and Hispanic patients (OR 1.57, 1.19-2.07, p = 0.002) had larger tumors at diagnosis than White patients after controlling for other SES factors. CONCLUSIONS SES disparities exist in pediatric thyroid cancer. Non-White and Hispanic patients are more likely to present with larger tumors and distant disease as compared to White patients. Understanding and intervening on these SES disparities is essential to improve outcomes.
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Affiliation(s)
- Rahul K Sharma
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Siddharth Patel
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Meharry Medical College, Nashville, TN, USA
| | - Jean-Nicolas Gallant
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brandon I Esianor
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara Duffus
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Huiying Wang
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vivian L Weiss
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan H Belcher
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Kim G, Qin J, Hall CB, In H. Association Between Socioeconomic and Insurance Status and Delayed Diagnosis of Gastrointestinal Cancers. J Surg Res 2022; 279:170-186. [PMID: 35779447 PMCID: PMC10132254 DOI: 10.1016/j.jss.2022.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/10/2022] [Accepted: 05/21/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Association between socioeconomic status (SES) and stage at diagnosis in gastrointestinal (GI) cancers is poorly described. Relationship between low SES and stage at diagnosis as well as the mediating role of insurance status (IS) was examined. METHODS The Surveillance, Epidemiology, and End Results database was queried for esophageal, gastric, liver, biliary, pancreatic, colon, and rectal cancers diagnosed in 2012-2016. Relationship between census-tract SES index quintiles and late diagnosis (distant disease at diagnosis) was examined. Uni and multivariable logistic regressions were performed. Mediation analyses were conducted to determine the degree to which IS (private/Medicare versus Medicaid/uninsured) mediates the relationship between SES and late diagnosis of cancer. RESULTS Analysis included 236,713 adult patients from 18 Surveillance, Epidemiology, and End Results areas. In univariable analysis, lowest SES quintile was significantly associated with late diagnosis for all cancers except gastric and biliary cancers. In multivariable analysis controlling for age, gender, marital status and race, this association remained significant for liver (odds ratio (OR) 1.41 [95% confidence interval (CI) 1.25-1.58]), pancreatic (OR 1.13 [95% CI 1.06-1.21]), and rectal (OR 1.31 [95% CI 1.20-1.42]) cancers. Further controlling for IS showed the largest effect size reduction for rectal cancer (OR 1.18 [95% CI 1.09-1.29]), with IS mediating 36.5% (P < 0.0001) of SES effect. CONCLUSIONS Low SES is an independent risk factor for late diagnosis in liver, pancreas, and rectal cancers. Insurance is not a critical mediator of difference by SES for most GI cancers, with the exception of rectal cancer. Further research is needed to understand factors beyond IS that can account for SES differences in late diagnosis for GI cancers. Insurance related differences for rectal cancer deserves further attention.
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Affiliation(s)
- Gina Kim
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Jiyue Qin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Haejin In
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
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Santos MO, Alves MDC, Lins Neto MADF, Moura FA. MUSCLE DEPLETED OBESITY IN INDIVIDUALS SCREENED FOR COLORECTAL CÂNCER. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:450-455. [PMID: 36515341 DOI: 10.1590/s0004-2803.202204000-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most incident cancer in the world and the second leading cause of cancer death. Significant decreases in incidence and mortality can be achieved by reducing risk factors and adhering to healthy lifestyle recommendations, as well as screening for the disease. OBJECTIVE To evaluate the clinical nutritional profile of individuals at medium risk screened for CRC residing in the city of Piranhas/Alagoas. METHODS Cross-sectional study conducted from September to October 2020, with individuals at medium risk for CRC, of both sexes and aged between 50 and 70 years old. Participants were screened for CRC with fecal immunochemical testing (FIT) and colonoscopy. Personal, socioeconomic, clinical, lifestyle and nutritional assessment data were collected. The latter was performed using anthropometric data (weight, height, arm circumference and triceps skinfold thickness), body composition (bioimpedance) and physical examination. Descriptive analysis of data frequencies and dichotomization according to the presence or absence of overweight was performed, followed by comparison of means and medians and frequencies by chi-square or Fisher's exact test. RESULTS In total, 82 people agreed to undergo the clinical nutritional assessment, most of them female (56.1%; n=46), adults (56.1%; n=46), with a mean age of 59.02 years (±6.30 SD). Pre-cancerous lesions were identified in 54.5% (n=42) of those screened, 52.4% (n=43) were smokers or former smokers, and 65.9% (n=54) did not practice scheduled physical activity. Nutritional assessment showed that 64.6% (n=53) were overweight according to body mass index. On the other hand, the muscle mass, % arm muscle circumference adequacy and body muscle mass (kg) markers showed that 32.9% (n=27) and 47.6% (n=39) of the subjects were muscle depleted, respectively. Above all, overweight participants had, in parallel, lower muscle mass (P<0.05), suggesting sarcopenic obesity in this population. CONCLUSION Obesity is one of the main risk factors for CRC; when concomitant with sarcopenia, it favors worse health outcomes. In this context, evidence shows the need to assess muscle composition in people with obesity, especially through other methods of assessing body composition. Our results add to the evidence on the importance of the population being guided about screening and adherence to healthy lifestyle recommendations, especially strategies aimed at weight control and the practice of physical activity.
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Affiliation(s)
- Monise Oliveira Santos
- Universidade Federal de Alagoas, Programa de Pós-graduação em Nutrição (PPGNUT), Maceió, AL, Brasil
| | - Marla de Cerqueira Alves
- Universidade Federal de Alagoas, Programa de Pós-graduação em Nutrição (PPGNUT), Maceió, AL, Brasil
| | | | - Fabiana Andréa Moura
- Universidade Federal de Alagoas, Programa de Pós-graduação em Nutrição (PPGNUT), Maceió, AL, Brasil.,Universidade Federal de Alagoas, Programa de Pós-graduação em Ciências Médicas (PPGCM), Maceió, AL, Brasil
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Korous KM, Farr DE, Brooks E, Tuuhetaufa F, Rogers CR. Economic Pressure and Intention to Complete Colorectal Cancer Screening: A Cross-Sectional Analysis Among U.S. Men. Am J Mens Health 2022; 16:15579883221125571. [PMID: 36121251 PMCID: PMC9490476 DOI: 10.1177/15579883221125571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Although men's lives can be saved by colorectal cancer (CRC) screening, its utilization remains below national averages among men from low-income households. However, income has not been consistently linked to men's CRC screening intent. This study tested the hypothesis that men who perceive more economic pressure would have lower CRC screening intent. Cross-sectional data were collected via an online survey in February 2022. Men (aged 45-75 years) living in the U.S. (N = 499) reported their CRC screening intent (outcome) and their perception of their economic circumstances (predictors). Adjusted binary and ordinal logistic analyses were conducted. All analyses were conducted in March 2022. Men who perceived greater difficulty paying bills or affording the type of clothing or medical care they needed (i.e., economic strain) were less likely to have CRC screening intent (OR = 0.67, 95% CI: 0.49, 0.93). This association was no longer significant when prior screening behavior was accounted for (OR = 0.75, 95% CI: 0.52, 1.10). Contrary to our hypothesis, men who reported more financial cutbacks were more likely to report wanting to be screened for CRC within the next year (OR = 1.06, 95% CI: 1.01, 1.11). This is one of the first studies to demonstrate that men's perceptions of their economic circumstances play a role in their intent to complete early-detection screening for CRC. Future research should consider men's perceptions of their economic situation in addition to their annual income when aiming to close the gap between intent and CRC screening uptake.
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Affiliation(s)
- Kevin M. Korous
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA,Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA,Kevin M. Korous, Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Deeonna E. Farr
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Ellen Brooks
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Fa Tuuhetaufa
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Charles R. Rogers
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA,Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Warren Andersen S, Zheng W, Steinwandel M, Murff HJ, Lipworth L, Blot WJ. Sociocultural Factors, Access to Healthcare, and Lifestyle: Multifactorial Indicators in Association with Colorectal Cancer Risk. Cancer Prev Res (Phila) 2022; 15:595-603. [PMID: 35609123 PMCID: PMC9444931 DOI: 10.1158/1940-6207.capr-22-0090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/24/2022] [Accepted: 05/19/2022] [Indexed: 12/29/2022]
Abstract
Black Americans of low socioeconomic status (SES) have higher colorectal cancer incidence than other groups in the United States. However, much of the research that identifies colorectal cancer risk factors is conducted in cohorts of high SES and non-Hispanic White participants. Adult participants of the Southern Community Cohort Study (N = 75,182) were followed for a median of 12.25 years where 742 incident colorectal cancers were identified. The majority of the cohort are non-Hispanic White or Black and have low household income. Cox models were used to estimate HRs for colorectal cancer incidence associated with sociocultural factors, access to and use of healthcare, and healthy lifestyle scores to represent healthy eating, alcohol intake, smoking, and physical activity. The association between Black race and colorectal cancer was consistent and not diminished by accounting for SES, access to healthcare, or healthy lifestyle [HR = 1.34; 95% confidence interval (CI),1.10-1.63]. Colorectal cancer screening was a strong, risk reduction factor for colorectal cancer (HR = 0.65; 95% CI, 0.55-0.78), and among colorectal cancer-screened, Black race was not associated with risk. Participants with high school education were at lower colorectal cancer risk (HR = 0.81; 95% CI, 0.67-0.98). Income and neighborhood-level SES were not strongly associated with colorectal cancer risk. Whereas individual health behaviors were not associated with risk, participants that reported adhering to ≥3 health behaviors had a 19% (95% CI, 1-34) decreased colorectal cancer risk compared with participants that reported ≤1 behaviors. The association was consistent in fully-adjusted models, although HRs were no longer significant. Colorectal cancer screening, education, and a lifestyle that includes healthy behaviors lowers colorectal cancer risk. Racial disparities in colorectal cancer risk may be diminished by colorectal cancer screening. PREVENTION RELEVANCE Colorectal cancer risk may be reduced through screening, higher educational attainment and performing more health behaviors. Importantly, our data show that colorectal cancer screening is an important colorectal cancer prevention strategy to eliminate the racial disparity in colorectal cancer risk. See related Spotlight, p. 561.
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Affiliation(s)
- Shaneda Warren Andersen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut St, WARF Office Building, Suite 1007B, Madison, WI 53726, USA,University of Wisconsin Carbone Cancer Center, Madison, WI, 53726, USA,Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 2525 West End Avenue, 8th floor, Suite 800, Nashville, TN 37203-1738, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 2525 West End Avenue, 8th floor, Suite 800, Nashville, TN 37203-1738, USA
| | - Mark Steinwandel
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, 1455 Research Blvd.; Suite 550, Rockville, MD 20850, USA
| | - Harvey J. Murff
- Department of Medicine, Vanderbilt University Medical Center, 6012 Medical Center East, 1215 21 Avenue South, Nashville TN, 37232, USA
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 2525 West End Avenue, 8th floor, Suite 800, Nashville, TN 37203-1738, USA
| | - William J. Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 2525 West End Avenue, 8th floor, Suite 800, Nashville, TN 37203-1738, USA,International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, 1455 Research Blvd.; Suite 550, Rockville, MD 20850, USA
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Bauer C, Zhang K, Xiao Q, Lu J, Hong YR, Suk R. County-Level Social Vulnerability and Breast, Cervical, and Colorectal Cancer Screening Rates in the US, 2018. JAMA Netw Open 2022; 5:e2233429. [PMID: 36166230 PMCID: PMC9516325 DOI: 10.1001/jamanetworkopen.2022.33429] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Area-level factors have been identified as important social determinants of health (SDoH) that impact many health-related outcomes. Less is known about how the social vulnerability index (SVI), as a scalable composite score, can multidimensionally explain the population-based cancer screening program uptake at a county level. OBJECTIVE To examine the geographic variation of US Preventive Services Task Force (USPSTF)-recommended breast, cervical, and colorectal cancer screening rates and the association between county-level SVI and the 3 screening rates. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study used county-level information from the Centers for Disease Control and Prevention's PLACES and SVI data sets from 2018 for 3141 US counties. Analyses were conducted from October 2021 to February 2022. EXPOSURES Social vulnerability index score categorized in quintiles. MAIN OUTCOMES AND MEASURES The main outcome was county-level rates of USPSTF guideline-concordant, up-to-date breast, cervical, and colorectal screenings. Odds ratios were calculated for each cancer screening by SVI quintile as unadjusted (only accounting for eligible population per county) or adjusted for urban-rural status, percentage of uninsured adults, and primary care physician rate per 100 000 residents. RESULTS Across 3141 counties, county-level cancer screening rates showed regional disparities ranging from 54.0% to 81.8% for breast cancer screening, from 69.9% to 89.7% for cervical cancer screening, and from 39.8% to 74.4% for colorectal cancer screening. The multivariable regression model showed that a higher SVI was significantly associated with lower odds of cancer screening, with the lowest odds in the highest SVI quintile. When comparing the highest quintile of SVI (SVI-Q5) with the lowest quintile of SVI (SVI-Q1), the unadjusted odds ratio was 0.86 (95% posterior credible interval [CrI], 0.84-0.87) for breast cancer screening, 0.80 (95% CrI, 0.79-0.81) for cervical cancer screening, and 0.72 (95% CrI, 0.71-0.73) for colorectal cancer screening. When fully adjusted, the odds ratio was 0.92 (95% CrI, 0.90-0.93) for breast cancer screening, 0.87 (95% CrI, 0.86-0.88) for cervical cancer screening, and 0.86 (95% CrI, 0.85-0.88) for colorectal cancer screening, showing slightly attenuated associations. CONCLUSIONS AND RELEVANCE In this cross-sectional study, regional disparities were found in cancer screening rates at a county level. Quantifying how SVI associates with each cancer screening rate could provide insight into the design and focus of future interventions targeting cancer prevention disparities.
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Affiliation(s)
- Cici Bauer
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Kehe Zhang
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Jiachen Lu
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
- UFHealth Cancer Center, Gainesville, Florida
| | - Ryan Suk
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston
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50
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Pettit N, Ceppa D, Monahan P. Low Rates of Lung and Colorectal Cancer Screening Uptake Among a Safety-net Emergency Department Population. West J Emerg Med 2022; 23:739-745. [PMID: 36205665 PMCID: PMC9541977 DOI: 10.5811/westjem.2022.5.55351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/24/2022] [Accepted: 05/22/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION A suspected diagnosis of cancer through an emergency department (ED) visit is associated with poor clinical outcomes. The purpose of this study was to explore the rate at which ED patients attend cancer screenings for lung, colorectal (CRC), and breast cancers based on national guidelines set forth by the United States Preventive Services Task Force (USPSTF). METHODS This was a prospective cohort study. Patients were randomly approached in the Eskenazi Hospital ED between August 2019-February 2020 and were surveyed to determine whether they would be eligible and had attended lung, CRC, and breast cancer screenings, as well as their awareness of lung cancer screening with low-dose computed tomography (LDCT). Patients who were English-speaking and ≥18 years old, and who were not critically ill or intoxicated or being seen for acute decompensated psychiatric illness were offered enrollment. Enrolled subjects were surveyed to determine eligibility for lung, colorectal, and breast cancer screenings based on guidelines set by the USPSTF. No cancer screenings were actually done during the ED visit. RESULTS A total of 500 patients were enrolled in this study. More participants were female (54.4%), and a majority were Black (53.0%). Most participants had both insurance (80.2%) and access to primary care (62.8%). Among the entire cohort, 63.0% identified as smokers, and 62.2% (140/225) of the 50- to 80-year-old participants qualified for lung cancer screening. No patients were screened for lung cancer in this cohort (0/225). Only 0.6% (3/500) were aware that LDCT was the preferred method for screening. Based on pack years, 35.5% (32/90) of the patients who were 40-49 years old and 6.7% (6/90) of those 30-39 years old would eventually qualify for screening. Regarding CRC screening, 43.6% (218/500) of the entire cohort was eligible. However, of those patients only 54% (118/218) had been screened. Comparatively, 77.7% (87/112) of the eligible females had been screened for breast cancer, but only 54.5% (61/112) had been screened in the prior two years. CONCLUSION Many ED patients are not screened for lung/colorectal/breast cancers even though many are eligible and have reported access to primary care. This study demonstrates an opportunity and a need to address cancer screening in the ED.
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Affiliation(s)
- Nicholas Pettit
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - DuyKhanh Ceppa
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Patrick Monahan
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
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