1
|
Forrester P, Antwi HA, Robert NJ, Winston T, O’Sullivan AK, Mullins CD. Health equity principles for oncology real world evidence studies. Oncologist 2024; 29:e1260-e1271. [PMID: 39014544 PMCID: PMC11449068 DOI: 10.1093/oncolo/oyae174] [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: 03/21/2024] [Accepted: 06/20/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Real-world research on cancer care in the community should address social determinants of health (SDOH) to advance health equity in cancer diagnosis, treatment, and survivorship. We sought patient and stakeholder perspectives to co-develop research principles to guide researchers when using patient record data to address health equity in their research protocols. MATERIALS AND METHODS Key informant interviews with 13 individuals elicited perspectives and insights related to health equity and SDOH when conducting research using data from community-based oncology care. Interviews included a brief overview of a prior scoping review and related questions in the interview guide. Key informants included experts in health equity and SDOH, and patient and community advisory board members. Rapid qualitative analysis was used to identify key themes, patterns, and insights from the interview data. Principles were developed based on the results of the analysis. RESULTS Three overarching categories for promoting health equity were (1) education; (2) community engagement; and (3) research design and implementation. Education principles highlight the necessity of training in relevant skills to address health equity. Community engagement principles highlight various actions that researchers can take to conduct research inclusive of community concerns regarding health equity. The research design and implementation category provides practical guidelines for researchers in planning, conducting, and disseminating community-based oncology research to address health equity. CONCLUSION Our principles guide oncology real-world research protocols to address SDOH in community settings and promote health equity. These principles should be tailored to specific cancer topics and communities.
Collapse
Affiliation(s)
- Patrice Forrester
- University of Maryland, School of Pharmacy, Baltimore, MD 21201, United States
| | - Henry Asante Antwi
- University of Maryland, School of Pharmacy, Baltimore, MD 21201, United States
| | | | - Terri Winston
- University of Maryland, School of Pharmacy, Baltimore, MD 21201, United States
| | | | - C Daniel Mullins
- University of Maryland, School of Pharmacy, Baltimore, MD 21201, United States
| |
Collapse
|
2
|
Nephew LD, Rawl SM, Carter A, Garcia N, Monahan PO, Holden J, Ghabril M, Montalvan-Sanchez E, Patidar K, Desai AP, Orman E, Chalasani N. Health literacy and cumulative social disadvantage are associated with survival and transplant in patients with hepatocellular carcinoma: a prospective study. BMJ Open Gastroenterol 2024; 11:e001537. [PMID: 39357929 PMCID: PMC11448155 DOI: 10.1136/bmjgast-2024-001537] [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: 07/31/2024] [Accepted: 09/06/2024] [Indexed: 10/04/2024] Open
Abstract
OBJECTIVE To investigate how individual social determinants of health (SDOH) and cumulative social disadvantage (CSD) affect survival and receipt of liver transplant (LT) in patients with hepatocellular carcinoma (HCC). METHODS We enrolled 139 adult patients from two Indianapolis hospital systems between June 2019 and April 2022. Structured questionnaires collected SDOH and social risk factor data. We compared SDOH and CSD by race, gender and disease aetiology, assigning one point per adverse SDOH. Multivariable competing risk survival analysis assessed associations between SDOH, CSD, survival and LT receipt. RESULTS Black patients experienced higher CSD than white patients in the cohort (5.4±2.5 vs 3.2±2.1, p<0.001). Black patients were significantly more likely to have household incomes CONCLUSIONS There are significant racial and aetiology-related differences in SDOH burden. Low health literacy and high CSD are linked to worse outcomes in HCC patients. Health literacy screening and targeted interventions for those with high CSD could improve LT access and survival rates.
Collapse
Affiliation(s)
- Lauren D. Nephew
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Susan M Rawl
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Allie Carter
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nicole Garcia
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Patrick O Monahan
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John Holden
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marwan Ghabril
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eleazar Montalvan-Sanchez
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Kavish Patidar
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Archita P Desai
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eric Orman
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
3
|
Johnson SM, Miller-Hammond K, McKenzie-Johnson T, Stewart J. Disparities in Health Outcomes in Surgical Oncology. J Surg Oncol 2024. [PMID: 39359121 DOI: 10.1002/jso.27891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 08/24/2024] [Indexed: 10/04/2024]
Abstract
Cancer health disparities refer to the unequal burden, treatment, and outcomes of cancer care experienced by specific populations. These disparities are systemic and often preventable, impacting diverse populations, including racial and ethnic minorities, medically underserved populations, populations in rural areas, individuals from the LGBT communities, disabled persons, extremes of age, and those living in persistent poverty. Addressing this topic is essential and timely to ensure equitable oncologic outcomes for all populations. Experts in surgical oncology and health disparities have collaborated to produce this seminar issue on Disparities in Surgical Oncology.
Collapse
Affiliation(s)
- Shaneeta M Johnson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | | | - Tamra McKenzie-Johnson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - John Stewart
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Biddell CB, Spees LP, Trogdon JG, Kent EE, Rosenstein DL, Angove RSM, Wheeler SB. Association of patient-reported financial barriers with healthcare utilization among Medicare beneficiaries with a history of cancer. J Cancer Surviv 2024; 18:1697-1708. [PMID: 37266819 PMCID: PMC10692305 DOI: 10.1007/s11764-023-01409-x] [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: 03/06/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE We examined characteristics associated with financial barriers to healthcare and the association of financial barriers with adverse healthcare events among US adult cancer survivors enrolled in Medicare. METHODS We used nationally representative Medicare Current Beneficiary Survey data (2011-2013, 2015-2017) to identify adults with a history of non-skin cancer. We defined financial barriers as cost-related trouble accessing and/or delayed care in the prior year. Using propensity-weighted multivariable logistic regression, we examined associations between financial barriers and adverse healthcare events (any ED visits, any inpatient hospitalizations). RESULTS Overall, 11.0% of adult Medicare beneficiaries with a history of cancer reported financial barriers in the prior year, with higher burden among beneficiaries < 65 years of age vs. ≥ 65 (32.5% vs. 8.2%, p < 0.0001) and with annual income < $25,000 vs. ≥ $25,000 (18.1% vs. 6.9%, p < 0.0001). In bivariate models, financial barriers were associated with a 7.8 percentage point (95% CI: 1.5-14.0) increase in the probability of ED visits. In propensity-weighted models, this association was not statistically significant. The association between financial barriers and hospitalizations was not significant in the overall population; however, financial barriers were associated with a decreased probability of hospitalization among Black/African American beneficiaries. CONCLUSIONS Despite Medicare coverage, beneficiaries with a history of cancer are at risk for experiencing financial barriers to healthcare. In the overall population, financial barriers were not associated with ED visits or hospitalizations. IMPLICATIONS FOR CANCER SURVIVORS Policies limiting Medicare patient out-of-pocket spending and care models addressing health-related social needs are needed to reduce financial barriers experienced.
Collapse
Affiliation(s)
- Caitlin B Biddell
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
| | - Lisa P Spees
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Justin G Trogdon
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Erin E Kent
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Donald L Rosenstein
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA
| | | | - Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| |
Collapse
|
5
|
Schroeder T, Ozieh MN, Thorgerson A, Williams JS, Walker RJ, Egede LE. Social Risk Factor Domains and Preventive Care Services in US Adults. JAMA Netw Open 2024; 7:e2437492. [PMID: 39365580 DOI: 10.1001/jamanetworkopen.2024.37492] [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: 10/05/2024] Open
Abstract
Importance Growing evidence suggests that social determinants of health are associated with low uptake of preventive care services. Objective To examine the independent associations of social risk factor domains with preventive care services among US adults. Design, Setting, and Participants This cross-sectional study used National Health Interview Survey data on 82 432 unweighted individuals (239 055 950 weighted) from 2016 to 2018. Subpopulations were created for each of the primary outcomes: routine mammography (women aged 40-74 years), Papanicolaou test (women aged 21-65 years), colonoscopy (adults aged 45-75 years), influenza vaccine (adults aged ≥18 years), and pneumococcal vaccine (adults aged ≥65 years). Statistical analysis was performed from July to December 2023. Exposures Six social risk domains (economic instability, lack of community, education deficit, food insecurity, social isolation, and lack of access to care) and a count of domains. Main Outcomes and Measures Logistic regression models were used to examine the independent association between each primary outcome (mammography, Papanicolaou test, colonoscopy, influenza vaccine, and pneumococcal vaccine) and social risk factor domains, while controlling for covariates (age, sex, race and ethnicity, health insurance, and comorbidities). Results A total of 82 432 unweighted US individuals (239 055 950 weighted individuals) were analyzed. A total of 54.3% were younger than 50 years, and 51.7% were female. All 5 screening outcomes were associated with educational deficit (mammography: odds ratio [OR], 0.73 [95% CI, 0.67-0.80]; Papanicolaou test: OR, 0.78 [95% CI, 0.72-0.85]; influenza vaccine: OR, 0.71 [95% CI, 0.67-0.74]; pneumococcal vaccine: OR, 0.68 [95% CI, 0.63-0.75]; colonoscopy: OR, 0.82 [95% CI, 0.77-0.87]) and a lack of access to care (mammography: OR, 0.32 [95% CI, 0.27-0.38]; Papanicolaou test: OR, 0.49 [95% CI, 0.44-0.54]; influenza vaccine: OR, 0.44 [95% CI, 0.41-0.47]; pneumococcal vaccine: OR, 0.30 [95% CI, 0.25-0.38]; colonoscopy: OR, 0.35 [95% CI, 0.30-0.41]). Fully adjusted models showed that every unit increase in social risk count was significantly associated with decreased odds of receiving a mammography (OR, 0.74 [95% CI, 0.71-0.77]), Papanicolaou test (OR, 0.84 [95% CI, 0.81-0.87]), influenza vaccine (OR, 0.81 [95% CI, 0.80-0.83]), pneumococcal vaccine (OR, 0.80 [95% CI, 0.77-0.83]), and colonoscopy (OR, 0.88 [95% CI, 0.86-0.90]). Conclusions and Relevance This cross-sectional study of US adults suggests that social risk factor domains were associated with decreased odds of receiving preventive services; this association was cumulative. There is a need to address social risk factors to optimize receipt of recommended preventive services.
Collapse
Affiliation(s)
- Tamara Schroeder
- Department of Surgery, University of California, Davis, Sacramento
| | - Mukoso N Ozieh
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Division of Nephrology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Abigail Thorgerson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Joni S Williams
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Rebekah J Walker
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Leonard E Egede
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| |
Collapse
|
6
|
Henry T, Hayes M, Eisele CD, Veldheer S, Allen SI, Hoglen B, Houser KR, Lengerich EJ, Rodriguez-Colon SM, Jenkins AC, Hobkirk AL. Barriers to Identifying and Addressing Health-Related Social Needs in Cancer Care: Patient and Patient Navigator Perspectives. J Cancer Policy 2024:100508. [PMID: 39357623 DOI: 10.1016/j.jcpo.2024.100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 07/31/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND The study aimed to gain insight into the experiences of patients with cancer and survivors regarding the integration of social needs assessment into their care, while also gathering perspectives from patient navigators on the barriers to obtaining and utilizing social needs information during cancer care, which taken together may influence cancer care policies. By comparing the perspectives of patients and navigators, the study sought to inform best practices for integrating, identifying, and addressing social needs to improve patient experiences and outcomes. METHODS We conducted qualitative interviews and self-report surveys involving patients with cancer, providers, and patient navigators or care coordinators, seeking their insights and firsthand experiences related to health-related social needs in cancer care. Interviews were transcribed, separated into memos of main themes based on deductive coding, and further analyzed for new emergent themes using inductive coding. RESULTS The present analysis focuses solely on the perspectives of 20 patient navigators and 21 patients. Qualitative analyses revealed two overarching themes: Theme 1: Personal and health system-related factors may create barriers for patients to disclose health-related social needs information during cancer care; and Theme 2: When social needs are identified, it is best practice to acknowledge and address social needs through referrals, resources, timely follow-up, and continued care coordination. Key barriers include individual beliefs and attitudes, concerns regarding privacy and sensitivity of questions, uncertainties about the outcomes of disclosing information, and patient-provider relationships and trust. CONCLUSION Drawing upon the perspectives of patients and patient navigators provided valuable insight into the challenges associated with acquiring information on social needs. Their viewpoints presented feasible solutions to overcome barriers through early acknowledgment of patient needs, timely resource provision, and maintaining consistent follow-up actions. Additionally, it enhanced understanding of the pivotal role patient navigators play in oncology, serving as crucial links between screening for health-related social needs and addressing individual patient requirements. POLICY SUMMARY The policies and policy improvements our paper seeks to impact include: inequalities in cancer care and health-related social needs of cancer.
Collapse
Affiliation(s)
- Tilicea Henry
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Michael Hayes
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA; Penn State Cancer Institute, 400 University Drive, Hershey, PA 17033, USA; Department of Medicine, Pennsylvania State University College of Medicine, 500 University Drive Hershey, PA, 17033, USA
| | - Caroline D Eisele
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Susan Veldheer
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, 500 University Drive Hershey, PA, 17033, USA; Department of Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 10733, USA
| | - Sophia I Allen
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA; Department of Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 10733, USA; Penn State Cancer Institute, 400 University Drive, Hershey, PA 17033, USA
| | - Brianna Hoglen
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Kenneth R Houser
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Eugene J Lengerich
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, 500 University Drive Hershey, PA, 17033, USA; Department of Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 10733, USA; Penn State Cancer Institute, 400 University Drive, Hershey, PA 17033, USA
| | | | - Amy C Jenkins
- Medical College of Georgia, 1120 15th Street, Augusta, GA 30912; Augusta University/University of Georgia Medical Partnership, 108 Spear Road, Athens, GA 30602
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA; Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University College of Medicine, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA; Department of Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 10733, USA; Penn State Cancer Institute, 400 University Drive, Hershey, PA 17033, USA.
| |
Collapse
|
7
|
Cammy R, Banks J, Vaughan-Briggs C, Garber G, Pantilat S, Worster B. A descriptive study of the connections between social risk and healthcare utilization with supportive oncology care. J Psychosoc Oncol 2024:1-15. [PMID: 39328018 DOI: 10.1080/07347332.2024.2404560] [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: 09/28/2024]
Abstract
OBJECTIVE This study utilized social risk data in the electronic heath record collected as part of routine clinical practice and examined relationships with supportive oncology care contacts and healthcare utilization. METHODS A total of 2,807 cancer patients were screened for four social determinants of health (SDOH) domains (financial resource strain, housing instability, food insecurity, and transportation need) and categorized to low or high risk SDOH groups. The number of patient contacts with supportive oncology was compared amongst the groups. The data were analyzed for demographic and outcome differences including emergency department visits, inpatient admissions, and appointment adherence. RESULTS Heightened social risk was associated with more total contacts with supportive oncology care. Patients with high SDOH risk had more contacts across all outcomes examined including emergency department visits (M = 13), inpatient admissions (M = 14), and missed appointments (M = 11). CONCLUSIONS Patients with both greater social risks and acute care utilization are associated with more psychosocial interventions in supportive oncology follow-up. These findings highlight the need for comprehensive action to respond to social risk factors identified in SDOH screening.
Collapse
Affiliation(s)
- Rebecca Cammy
- Division of Supportive Oncology, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA
| | - Joshua Banks
- Department of Population Health, Jefferson Health, Philadelphia, PA
| | - Celeste Vaughan-Briggs
- Division of Supportive Oncology, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA
| | - Gregory Garber
- Division of Supportive Oncology, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA
| | - Steven Pantilat
- Division of Palliative Medicine, University of California, San Francisco, CA
| | - Brooke Worster
- Division of Supportive Oncology, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA
| |
Collapse
|
8
|
Brazee RL, Alsbrook KE, Lindell KO, Seaman JB, Rosenzweig MQ. Perspectives on Death and Dying by the Bereaved Designated Personal Representatives of Women Diagnosed With Metastatic Breast Cancer. J Hosp Palliat Nurs 2024:00129191-990000000-00156. [PMID: 39356255 DOI: 10.1097/njh.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2024]
Abstract
Metastatic breast cancer (MBC) is a complex disease with variability in disease subtype, length of survival, treatment selection, symptom burden, and, ultimately, end-of-life (EOL) care. Influencing factors that contribute to the complexity of this disease are socioeconomic factors, provider differences, and patient and family preferences. Because of this variability, it is challenging for health care providers to know when treatments are no longer helpful but contribute to a poor quality of end-of-life care and a poor death experience for both patients and their families. Determining the unique point, based on their own values and goals, at which patients and their family members feel that MBC treatment becomes unhelpful and unwanted, is difficult to ascertain. Of the 25 individuals who participated in the Quality of Death and Dying survey, 16 individuals participated in an interview to provide a reflection of the patient's EOL experience and its congruence with their wishes. Four major categories emerged as primary priorities essential to high quality end-of-life care, that is, resilience, communication, support, and knowledge. Without tailored and precise care, patients with MBC will continue to receive prolonged, inappropriate, and costly treatment, resulting in a potentially unacceptable poor-quality EOL and death experience.
Collapse
|
9
|
Korn AR, Oh AY, Manian N, Tsakraklides S, Carter-Edwards L. Practitioner perspectives on equitable implementation of evidence-based interventions for cancer prevention and control. Transl Behav Med 2024:ibae048. [PMID: 39304521 DOI: 10.1093/tbm/ibae048] [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] [Indexed: 09/22/2024] Open
Abstract
Longstanding inequities in cancer prevention and control require novel approaches to improve evidence-based intervention implementation. Exploring and elevating the perspectives of cancer prevention and control practitioners working to advance health equity and equitably implement evidence-based interventions is an important yet underutilized step among researchers working in this space. The purpose of this study was to explore practitioners' perspectives of how health equity is defined and integrated into their work, challenges of advancing health equity for implementation in local settings, and associated strategies. We conducted virtual key informant interviews and focus groups with 16 US practitioners (e.g. clinicians, health administrators, public health professionals) in 2021-2022. Interviews and focus groups were audio recorded and transcribed. Data were coded using inductive content analysis and summarized into themes. Four major themes emerged: (i) how health equity is conceptualized as a process and outcome; (ii) need to shift equity mindsets; (iii) importance of community partnerships; (iv) organizational policies and strategies for fostering equity in implementation. Respondents noted the need for research and medical communities to learn about the importance and benefits of allowing communities to shape implementation to advance equity in the delivery of evidence-based interventions and outcomes. Additionally, respondents emphasized that institutional leaders should initiate changes regarding equitable implementation at the organizational- and system-levels. Respondents endorsed the need to address equity issues related to the implementation of cancer prevention and control programs, practices, and policies. Many findings can be applied beyond cancer prevention and control to support equitable implementation and outcomes more generally.
Collapse
Affiliation(s)
- Ariella R Korn
- Cancer Prevention Fellowship Program, Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
- Behavioral and Policy Sciences Department, RAND, 20 Park Plaza, Suite 910, Boston, MA 02116, USA
| | - April Y Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | | | | | - Lori Carter-Edwards
- Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S. Los Robles Ave., Pasadena, CA 91101, USA
| |
Collapse
|
10
|
Ivic-Pavlicic T, Sly JR, Tuminello S, Untalan M, Meah Y, Taioli E, Miller SJ. The association between food insecurity and colorectal cancer screening: 2018-2021 New York State Behavioral Risk Factor Surveillance System (BRFSS). Cancer Causes Control 2024:10.1007/s10552-024-01915-y. [PMID: 39277553 DOI: 10.1007/s10552-024-01915-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 08/28/2024] [Indexed: 09/17/2024]
Abstract
PURPOSE To assess the association between food insecurity and colorectal cancer screening uptake in screening eligible participants in New York State. METHODS We analyzed 28,154 adults who participated in New York State Behavioral Risk Factor Surveillance System (BRFSS) from 2018 to 2021, were age-eligible for colorectal cancer screening based on the USPSTF guidelines at the time of survey administration and answered a version of the administered survey that included the module on food insecurity. Participants were defined as food insecure if they self-reported being always, usually, or sometimes stressed about having enough money to buy nutritious meals in the past 12 months. We compared demographic, healthcare access, overall health status, food insecurity by colorectal cancer screening status. Multivariable analyses were performed to assess the association of food insecurity and colorectal cancer screening status after adjusting for relevant covariates. Weighted analyses were performed using survey procedures to obtain population estimates. RESULTS Food insecurity was statistically significantly associated a decreased likelihood of being up to date on colorectal cancer screening (ORadj 0.83, 95% CI [0.72, 0.94]) and being ever screened for colorectal cancer (ORadj 0.74, 95% CI [0.64, 0.87]) after adjusting for overall health status, healthcare coverage, interview year, age, race/ethnicity, sex, educational attainment, and income. Health status, health coverage, age, and Non-Hispanic Black race/ethnicity showed positive, statistically significant association with ever being screened and with being up to date for colorectal cancer screening. Lower income, lower educational attainment, and non-Hispanic Asian race/ethnicity were statistically significant inverse predictors of ever being screened and being up to date on screening. CONCLUSION This project assessed the association between food insecurity and colorectal cancer screening uptake using the BRFSS survey. Food insecurity may be an important predictor for colorectal cancer screening uptake in eligible adults in the United States. The results from the study can inform future interventions and policies designed to improve participation in routine colorectal cancer screening.
Collapse
Affiliation(s)
- Tara Ivic-Pavlicic
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jamilia R Sly
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephanie Tuminello
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew Untalan
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yasmin Meah
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah J Miller
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- , One Gustave L. Levy Place, Box 1133, 10029, New York, USA.
| |
Collapse
|
11
|
Nguyen L, Chung TH, Le YCL, Reygaerts H, Olguin X, Zamorano A. Hispanic individuals' cervical cancer screening disparities amidst the COVID-19 pandemic. Gynecol Oncol 2024; 190:243-249. [PMID: 39243700 DOI: 10.1016/j.ygyno.2024.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 08/21/2024] [Accepted: 08/29/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE To examine the impact of the COVID-19 pandemic on cervical cancer screening rates of Hispanic individuals compared to non-Hispanic White (NHW) individuals in the United States, whether a responsive surge in catch-up screenings occurred as society adapted to pandemic changes, and to investigate the sociodemographic characteristics between the study populations. METHODS Using cross-sectional data from the All of Us Research Program, which incorporates electronic health record data and survey data from a demographically, geographically, and medically diverse participant group, we assessed the annual cervical cancer screening rates during 2019-2021 by race/ethnicity among eligible individuals ages 21-64. RESULTS Among 116,052 unique individuals (78,829 NHW and 37,223 Hispanic), Hispanic individuals had lower annual cervical cancer screening rates than NHWI across the three years studied. They experienced a more significant decrease in screening from 2019 to 2020 (39.27 %) compared to NHWIs (21.15 %) and less of a rebound increase in the following year, 2021 (10.33 % vs 13.83 %). Hispanic individuals aged 50-64 experienced the sharpest decline in screening rates (-43.01 % from 2019 to 2020). Hispanic individuals also experienced greater adverse social conditions, including lack of insurance or employment, lower educational attainment, and lower household income. CONCLUSIONS Hispanic individuals experienced a more significant decrease in cervical cancer screening rates with the onset of the COVID-19 pandemic compared with NHW individuals and did not experience a robust rebound in cervical cancer screening rates in 2021. As a result, the disparity in cervical cancer screening rates between NHW and Hispanic individuals considerably worsened with the COVID-19 pandemic.
Collapse
Affiliation(s)
- Linh Nguyen
- The University of Texas Health Science Center at Houston, UT Physicians Center of Population Health Management & Quality, 1200 Binz Street, Suite 730, Houston, TX 77004, United States of America.
| | - Tong Han Chung
- The University of Texas Health Science Center at Houston, UT Physicians Center of Population Health Management & Quality, 1200 Binz Street, Suite 730, Houston, TX 77004, United States of America.
| | - Yen-Chi L Le
- The University of Texas Health Science Center at Houston, UT Physicians Center of Population Health Management & Quality, 1200 Binz Street, Suite 730, Houston, TX 77004, United States of America.
| | - Hannah Reygaerts
- UTHealth School of Public Health, 1200 Pressler Street, Houston, TX 77030, United States of America.
| | - Xochitl Olguin
- The University of Texas Health Science Center at Houston, Healthcare Transformation Initiatives Department, 1200 Binz Street, Suite 730, Houston, TX 77004, United States of America.
| | - Abigail Zamorano
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 3.119, Houston, TX 77030, United States of America.
| |
Collapse
|
12
|
Hao S, Quinn AW, Iasiello JA, Lea CS, Popowicz P, Fu Y, Irish W, Parikh AA, Snyder RA. Correlation of Patient-Reported Social Determinants of Health With Census Tract Measures of Socioeconomic Disadvantage in Patients With GI Cancers in Eastern North Carolina. JCO Oncol Pract 2024; 20:1280-1288. [PMID: 38759124 DOI: 10.1200/op.23.00703] [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: 10/29/2023] [Revised: 03/13/2024] [Accepted: 04/08/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE Investigating the impact of social determinants of health (SDOHs) on cancer care in large populations relies on census estimates. Routine clinic SDOH screening provides timely patient-level information which could inform best practices. This study evaluated the correlation between patient-reported SDOH needs and population-level census tract measures. METHODS This was a retrospective cross-sectional study of a cohort of adult patients with GI malignancy screened for SDOHs such as financial insecurity, transportation, and food insecurity during initial outpatient evaluation at East Carolina University (formerly Vidant) Health Medical Center in Greenville, NC (November 2020-July 2021). Primary outcomes included number and severity of identified SDOH needs and area deprivation index (ADI) and census tract measures for each patient. Spearman rank correlations were calculated among patient-level needs and between patient-level needs and similar census tract measures. RESULTS Of 112 patients screened, 58.9% self-identified as White (n = 66) and 41.1% as Black (n = 46). A total of 50.5% (n = 54) resided in a rural county. The collective median state ADI rank was 7 (IQR, 5-9). The median household income was $38,125 in US dollars (USD) (IQR, $31,436-$48,934 [USD]). Only 12.5% (n = 14) reported a moderate or severe financial need. Among reported needs, financial need moderately correlated with food insecurity (coefficient, 0.46; P < .001) and transportation (coefficient, 0.45; P < .001). Overall, census tract measures and reported needs poorly correlated. Lack of transportation correlated with percentage of households without a vehicle (coefficient, 0.18; P = .03) and limited access to healthy foods (coefficient, 0.18; P = .04). CONCLUSION Given the poor correlation between reported and census needs, population-level measures may not accurately predict patient-reported needs. These findings highlight the importance of SDOH screening in the clinical setting to reduce health disparities and identify opportunities to improve care delivery.
Collapse
Affiliation(s)
- Scarlett Hao
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Ashley W Quinn
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - John A Iasiello
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - C Suzanne Lea
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Patrycja Popowicz
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Yuanyuan Fu
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - William Irish
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Alexander A Parikh
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Division of Surgical Oncology, University of Texas Health San Antonio, San Antonio, TX
| | - Rebecca A Snyder
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
13
|
Peng X, Liu J. The relationship between household income and prognosis of patients with cervical adenocarcinoma in the United States: A retrospective cohort study based on the SEER database. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108516. [PMID: 38968853 DOI: 10.1016/j.ejso.2024.108516] [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: 04/10/2024] [Revised: 06/12/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE To investigate the association between household income and overall survival (OS) of patients with cervical adenocarcinoma. METHODS We conducted a retrospective cohort study involving participants selected from the Surveillance, Epidemiology, and End Results (SEER) database. Data were collected on various variables, including demographic variables such as median household income and clinicopathological characteristics for all participants. Cox regression analysis was utilized to examine the association between household income and OS. Subgroup analysis, sensitivity analysis, and E-value were used to further confirm the association. RESULTS A total of 2217 patients were included in the study. Compared with low-income (<$35,000-$54,999), middle-income (55,000-$69,999) or high-income (≥$70,000) was significantly associated with a higher 5-year OS (70.8 %, 58.7 % vs 50 %) in patients with cervical adenocarcinoma. The HR was 0.49, 95 % CI 0.41-0.58, p < 0.001 and 0.66 (0.55-0.78), p < 0.001 respectively, in the unadjusted model. After adjustment for potential confounders, the results were similar (adjusted HR 0.54 (0.45-0.65), p < 0.001) and 0.79 (0.66-0.94), p = 0.01), respectively. This significant association was also present in the various adjusted models. Subgroup and sensitivity analyses suggested that the relationship remained robust and reliable. The E-value analysis indicated robustness to unmeasured confounding. There was evidence of an interaction between age at diagnosis, race, primary site, tumor grade, T, N, M, or Scope Reg LN Sur, and household income on increasing the 5-year OS of cervical adenocarcinoma. CONCLUSIONS Our study found that middle or high household income was significantly associated with a better 5-year OS compared with low household income in patients with cervical adenocarcinoma.
Collapse
Affiliation(s)
- Xiaolian Peng
- Department/Division Name: Obstetrics and Gynecology, Xiegang Branch, Dongguan Municipal People's Hospital, Guang Dong Province, China.
| | - Jie Liu
- Department/Division Name: Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China. http://
| |
Collapse
|
14
|
Yang D, Orellana K, Lee J, Bram J, Sarkar S, Renjilian CB, Ganley TJ. The Child Opportunity Index and Outcomes After Pediatric Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2024; 12:23259671241248433. [PMID: 39351066 PMCID: PMC11440534 DOI: 10.1177/23259671241248433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 10/04/2024] Open
Abstract
Background Research at the intersection between social determinants of health (SDOH) and orthopaedics remains an area of active exploration, with recent literature demonstrating significant disparities in a wide array of orthopaedic outcomes in patients with different SDOH. Purpose/Hypothesis The purpose of this study was to use a validated composite measure of SDOH mapped to census tracts (Child Opportunity Index [COI]) to explore disparities in functional outcomes after anterior cruciate ligament (ACL) reconstruction. It was hypothesized that patients with a lower COI score would have delayed surgical care and worse functional outcomes after ACL reconstruction. Study Design Cohort study; Level of evidence, 3. Methods Demographic, surgical, and functional outcomes data were extracted for all patients aged ≤18 years who underwent primary ACL reconstruction at our institution between 2009 and 2019. Strength deficits were calculated, and COI quintile scores were obtained. One-way analysis of variance, the chi-square test, and the Fisher exact test were used to compare variables of interest between the lower 2 quintiles (low group) and the upper 2 quintiles (high group). Results Of the 1027 patients, 226 (22.0%) were in the low group, while 801 (78.0%) were in the high group. There was a significantly greater time from injury to surgery in the low group than in the high group (98.15 ± 102.65 vs 71.79 ± 101.88 days, respectively; P < .001). The low group had a significantly lower extension-flexion range of motion at 1- and 3-month follow-up (P = .03 and P = .02, respectively) but no difference at 6-month follow-up (P = .27). The low group attended fewer physical therapy visits than the high group (24.82 ± 10.55 vs 37.81 ± 18.07, respectively; P < .001). The low group had significant deficits in quadriceps strength at 3, 6, and 9 months at 180 deg/s (P = .03, P < .001, and P = .01, respectively) and at 6 months at 300 deg/s (P = .002). Conclusion In this study, we found that the COI was associated with disparities in key clinical outcomes including time to surgery, postoperative range of motion, and postoperative strength.
Collapse
Affiliation(s)
- Daniel Yang
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kevin Orellana
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julianna Lee
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joshua Bram
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sulagna Sarkar
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
15
|
Dako F, Holden N, Narayan A, Guerra C. Understanding Health-Related Social Risks. J Am Coll Radiol 2024; 21:1336-1344. [PMID: 38461918 DOI: 10.1016/j.jacr.2024.03.004] [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: 12/06/2023] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
Because of the established contribution of social factors to health outcomes, approaches that address upstream determinants of health have increasingly been recognized as cost-effective means to improve population health. Understanding and usage of precise terminology is important to facilitate collaboration across disciplines. Social determinants of health affect everyone, not just the socially and economically disadvantaged, whereas health-related social risks (HRSR) are specific adverse conditions at the individual or family level that are associated with poor health and related to the immediate challenges individuals face. Health-related social needs account for patient preference in addressing identified social risks. The use of validated screening tools is important to capture risk factors in a standardized fashion to support research and quality improvement. There is a paucity of studies that address HRSR in the context of radiology. This review provides an understanding of HRSR and outlines various ways in which radiologists can work to mitigate them.
Collapse
Affiliation(s)
- Farouk Dako
- Director, Center for Global and Population Health Research in Radiology, Senior Fellow, Leonard Davis Institute of Health Economics, and Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Natasha Holden
- College of Osteopathic Medicine of the Pacific Western University of Health Sciences, Pomona, California
| | - Anand Narayan
- Vice Chair, Health Equity, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Carmen Guerra
- Vice Chair of Diversity and Inclusion, Department of Medicine, and Associate Director of Diversity and Inclusion, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
16
|
Seven M, Adawudu EA, Moraitis AM, Evans BD, Sturgeon S, Wenzel J, Hammer MJ. Experiences in Recruitment for Hispanic, Non-Hispanic Black, and Other Non-White Cancer Survivors Through Community Outreach and Other Targeted Approaches. Semin Oncol Nurs 2024:151719. [PMID: 39217031 DOI: 10.1016/j.soncn.2024.151719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/13/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Recruitment of racial/ethnic underserved populations in oncology research is essential to address health disparities. This article presents strategies and lessons learned from community outreach and other approaches for recruiting non-Hispanic Black, Hispanic, and other non-White survivors of cancer into a pilot study that investigated biopsychosocial determinants of health behaviors. METHODS We critically examined the participant recruitment approaches to explore challenges and successful strategies and develop recommendations for future studies. Direct recruitment strategies included engaging with research staff members' personal community contacts/liaisons and participating in community outreach events (eg, farmers' markets, block parties, library events, cancer awareness events). Indirect recruitment strategies included posting and distribution of study flyers in community centers (eg, LIVESTRONG® at the YMCA, churches, libraries), online platforms (eg, FORCE, Survivor Journey website), and invitation letters sent to individuals identified as eligible through a single state cancer registry. RESULTS Between April 2022 and May 2023, among the 64 individuals recruited, 36 were non-Hispanic Black, 25 were Hispanic, and three were American Indian/Alaska Native people. The use of a state cancer registry (64.1%), snowballing/word of mouth (7.8%), and advertisement through an established cancer support organization (ie, FORCE) website (7.8%) were the most effective strategies in this study. CONCLUSION Recruitment of non-Hispanic Black, Hispanic, and other non-White people into biobehavioral studies through community-engaged research is challenging and requires long-term commitment and engagement with partners from target communities and affiliated organizations. IMPLICATION FOR NURSING PRACTICE Registries and community outreach events can build trust for successful enrollment. Using multiple strategies can provide the best opportunities to reach diverse populations and enroll them in cancer-related research studies.
Collapse
Affiliation(s)
- Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Emefa Awo Adawudu
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts
| | | | - Brenda D Evans
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Susan Sturgeon
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Jennifer Wenzel
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | | |
Collapse
|
17
|
Huang H, Wei T, Huang Y, Zhang A, Zhang H, Zhang Z, Xu Y, Pan H, Kong L, Li Y, Li F. Association between social determinants of health and survival among the US cancer survivors population. BMC Med 2024; 22:343. [PMID: 39183305 PMCID: PMC11346002 DOI: 10.1186/s12916-024-03563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Racial and ethnic disparities in mortality persist among US cancer survivors, with social determinants of health (SDoH) may have a significant impact on these disparities. METHODS A population-based cohort study of a nationally representative sample of adult cancer survivors, who participated in the US National Health and Nutrition Examination Survey from 1999 to 2018 was included. Sociodemographic characteristics and SDoH were self-reported using standardized questionnaires in each survey cycle. The SDoH was examined by race and estimated for associations with primary outcomes, which included all-cause and cancer-specific mortality. Multiple mediation analysis was performed to assess the contribution of each unfavorable SDoH to racial disparities to all-cause and cancer-specific mortality. RESULTS Among 5163 cancer survivors (2724 [57.7%] females and 3580 [69.3%] non-Hispanic White individuals), only 881 (24.9%) did not report an unfavorable SDoH. During the follow-up period of up to 249 months (median 81 months), 1964 deaths were recorded (cancer, 624; cardiovascular, 529; other causes, 811). Disparities in all-cause and cancer-specific mortality were observed between non-Hispanic Black and White cancer survivors. Unemployment, lower economic status, education less than high school, government or no private insurance, renting a home or other arrangements, and social isolation were significantly and independently associated with worse overall survival. Unemployment, lower economic status, and social isolation were significantly associated with cancer-specific mortality. Compared to patients without an unfavorable SDoH, the risk of all-cause mortality was gradually increased in those with a cumulative number of unfavorable SDoHs (1 unfavorable SDoH: hazard ratio [HR] = 1.54, 95% CI 1.25-1.89; 2 unfavorable SDoHs: HR = 1.81, 95% CI 1.46-2.24; 3 unfavorable SDoHs: HR = 2.42, 95% CI 1.97-2.97; 4 unfavorable SDoHs: HR = 3.22, 95% CI 2.48-4.19; 5 unfavorable SDoHs: HR = 3.99, 95% CI 2.99-5.33; 6 unfavorable SDoHs: HR = 6.34 95% CI 4.51-8.90). A similar trend existed for cancer-specific mortality. CONCLUSIONS In this cohort study of a nationally representative sample of US cancer survivors, a greater number of unfavorable SDoH was associated with increased risks of mortality from all causes and cancer. Unfavorable SDoH levels were critical risk factors for all-cause and cancer-specific mortality, as well as the underlying cause of racial all-cause mortality disparities among US cancer survivors.
Collapse
Affiliation(s)
- Hongbo Huang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Tingting Wei
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Ying Huang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Aijie Zhang
- Health Management Center of University-Town Hospital Affiliated to Chongqing Medical University, Chongqing, 401331, China
| | - Heng Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Ze Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yijing Xu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Haonan Pan
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Lingquan Kong
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yunhai Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Fan Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| |
Collapse
|
18
|
Seven M, Moraitis AM, Pearlman J, Reid AE, Sturgeon S, Wenzel J, Hammer MJ. The Interplay of Psycho-Social Determinants on Quality of Life and Health Behaviors Among Hispanic, Non-Hispanic Black Cancer Survivors. Semin Oncol Nurs 2024:151698. [PMID: 39129095 DOI: 10.1016/j.soncn.2024.151698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVES This study aimed to explore psycho-social factors (i.e., socio-demographics, health insurance, stress) associated with Quality of life (QOL) and the degree to which self-reported access to healthcare and health behaviors (i.e., fruit and vegetable consumption, physical activity) mediate the effects of psycho-social factors on QOL among Hispanic, non-Hispanic Black (NHB), and other non-White cancer survivors. METHODS The descriptive cross-sectional study enrolled a total of 74 Hispanic (n = 26), NHB (n = 42), and other non-White (n = 6) people affected by cancer. QOL, physical activity, diet, stress, and survivorship care data were collected prospectively between June 2022-September 2023. RESULTS The mean scores of QOL were moderate for global health (59.4 ± 21.4) and functional status (64.8 ± 22.2) and low for symptom experience (33.6 ± 19.4). Of the participants, 35.1% (n = 24) reported at least one challenge in accessing healthcare. The average daily consumption of fruits and vegetables was 2.44 ± 0.61 cup equivalents. Most participants had insufficient (37.8%) or minimal (47.3%) engagement in physical activity. Men and those with higher stress levels reported lower global health status. Higher stress level was associated with an increased likelihood of lower physical activity. Private insurance and some college education were associated with an increased likelihood of consuming more fruit and vegetables. Self-reported access to healthcare did not mediate the association between any of the variables and the global health score of QOL. CONCLUSIONS Hispanic, NHB and other non-White cancer survivors had moderate global health and functional status with lower symptom burden. Further research with a large sample is needed to explore the associations between health behaviors, access to care challenges, and other factors that may better explain determinants of QOL among non-White cancer survivors. IMPLICATIONS FOR NURSING PRACTICE Findings suggest that tailored interventions should consider the interplay of psychosocial determinants to optimize health behaviors and QOL.
Collapse
Affiliation(s)
- Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts.
| | | | - Jessica Pearlman
- Institute for Social Science Research, University of Massachusetts, Amherst, Massachusetts
| | - Allecia E Reid
- Psychological & Brain Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Susan Sturgeon
- School of Public Health & Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Jennifer Wenzel
- Johns Hopkins School of Nursing, and School of Medicine, Oncology, Baltimore, Maryland
| | | |
Collapse
|
19
|
Almouh M, Soukkarieh C, Kassouha M, Ibrahim S. Crosstalk between circular RNAs and the STAT3 signaling pathway in human cancer. BIOCHIMICA ET BIOPHYSICA ACTA. GENE REGULATORY MECHANISMS 2024; 1867:195051. [PMID: 39121909 DOI: 10.1016/j.bbagrm.2024.195051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024]
Abstract
Circular RNAs (circRNAs) are endogenous covalently closed single-stranded RNAs produced by reverse splicing of pre-mRNA. Emerging evidence suggests that circRNAs contribute to cancer progression by modulating the oncogenic STAT3 signaling pathway, which plays key roles in human malignancies. STAT3 signaling-related circRNAs expression appears to be extensively dysregulated in diverse cancer types, where they function either as tumor suppressors or oncogenes. However, the biological effects of STAT3 signaling-related circRNAs and their associations with cancer have not been systematically studied before. Given this, shedding light on the interaction between circRNAs and STAT3 signaling pathway in human malignancies may provide several novel insights into cancer therapy. In this review, we provide a comprehensive introduction to the molecular mechanisms by which circRNAs regulate STAT3 signaling in cancer progression, and the crosstalk between STAT3 signaling-related circRNAs and other signaling pathways. We also further discuss the role of the circRNA/STAT3 axis in cancer chemotherapy sensitivity.
Collapse
Affiliation(s)
- Mansour Almouh
- Department of Animal Production, Faculty of Veterinary Medicine, Hama University, Hama, Syria.
| | - Chadi Soukkarieh
- Department of Animal Biology, Faculty of Sciences, Damascus University, Damascus, Syria
| | - Morshed Kassouha
- Department of Microbiology, Faculty of Veterinary Medicine, Hama University, Hama, Syria
| | - Samer Ibrahim
- Department of Microbiology, Faculty of Veterinary Medicine, Hama University, Hama, Syria; Faculty of Dentistry, Arab Private University of science and Technology, Hama, Syria
| |
Collapse
|
20
|
Kennedy K, Jusue-Torres I, Buller ID, Rossi E, Mallisetty A, Rodgers K, Lee B, Menchaca M, Pasquinelli M, Nguyen RH, Weinberg F, Rubinstein I, Herman JG, Brock M, Feldman L, Aldrich MC, Hulbert A. Neighborhood-level deprivation and survival in lung cancer. BMC Cancer 2024; 24:959. [PMID: 39107707 PMCID: PMC11301857 DOI: 10.1186/s12885-024-12720-w] [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: 05/28/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Despite recent advances in lung cancer therapeutics and improving overall survival, disparities persist among socially disadvantaged populations. This study aims to determine the effects of neighborhood deprivation indices (NDI) on lung cancer mortality. This is a multicenter retrospective cohort study assessing the relationship between NDI and overall survival adjusted for age, disease stage, and DNA methylation among biopsy-proven lung cancer patients. State-specific NDI for each year of sample collection were computed at the U.S. census tract level and dichotomized into low- and high-deprivation. RESULTS A total of 173 non small lung cancer patients were included, with n = 85 (49%) and n = 88 (51%) in the low and high-deprivation groups, respectively. NDI was significantly higher among Black patients when compared with White patients (p = 0.003). There was a significant correlation between DNA methylation and stage for HOXA7, SOX17, ZFP42, HOXA9, CDO1 and TAC1. Only HOXA7 DNA methylation was positively correlated with NDI. The high-deprivation group had a statistically significant shorter survival than the low-deprivation group (p = 0.02). After adjusting for age, race, stage, and DNA methylation status, belonging to the high-deprivation group was associated with higher mortality with a hazard ratio of 1.81 (95%CI: 1.03-3.19). CONCLUSIONS Increased neighborhood-level deprivation may be associated with liquid biopsy DNA methylation, shorter survival, and increased mortality. Changes in health care policies that consider neighborhood-level indices of socioeconomic deprivation may enable a more equitable increase in lung cancer survival.
Collapse
Affiliation(s)
- Kathleen Kennedy
- Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
| | - Ignacio Jusue-Torres
- Department of Neurologic Surgery, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Ian D Buller
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Emily Rossi
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Apurva Mallisetty
- Department of Surgery, Cancer Center, University of Illinois College of Medicine in Chicago, 909 South Wolcott Ave COMRB Suite 5140, Chicago, IL, 60612, USA
| | - Kristen Rodgers
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Beverly Lee
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Martha Menchaca
- Department of Radiology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
| | - Mary Pasquinelli
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
| | - Ryan H Nguyen
- Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
| | - Frank Weinberg
- Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
| | - Israel Rubinstein
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
- Division of Research Services, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - James G Herman
- Lung Cancer Program, University of Pittsburgh Cancer Institute, The Hillman Cancer Center, Pittsburgh, PA, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Malcolm Brock
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Lawrence Feldman
- Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
- Division of Research Services, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Melinda C Aldrich
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alicia Hulbert
- Department of Surgery, Cancer Center, University of Illinois College of Medicine in Chicago, 909 South Wolcott Ave COMRB Suite 5140, Chicago, IL, 60612, USA.
- Division of Research Services, Jesse Brown VA Medical Center, Chicago, IL, USA.
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
| |
Collapse
|
21
|
Robinson-Oghogho JN, Alcaraz KI, Thorpe RJ. Associations between Structural Racism, Environmental Burden, and Cancer Rates: An Ecological Study of US Counties. Ethn Dis 2024; 34:145-154. [PMID: 39211816 PMCID: PMC11354823 DOI: 10.18865/ethndis-2023-68] [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: 09/04/2024] Open
Abstract
Objective In this study, we examined associations between county-level measures of structural racism and county-level cancer incidence and mortality rates between race groups while accounting for factors associated with cancer rates and county-level measures of environmental burden. Methods To explore this relationship, we conducted multiple linear regression analyses. Data for these analyses came from an index of county-level structural racism and publicly available data on 2015 to 2019 age-adjusted cancer rates from the US Cancer Statistics Data Visualization Tool, 2019 County Health Rankings and Roadmaps, the Environmental Protection Agency's 2006 to 2010 Environmental Quality Index, and 2015 to 2019 estimates from the US Census American Community Survey. Results County-level structural racism was associated with higher county cancer incidence rates among Black (adjusted incidence rate: 17.4, 95% confidence interval [95% CI]: 9.3, 25.5) and Asian/Pacific Islander populations (adjusted incidence rate: 9.3, 95% CI: 1.8, 16.9) and higher mortality rates for American Indian/Alaskan Native (adjusted mortality rate [AMR]: 17.4, 95% CI: 4.2, 30.6), Black (AMR: 11.9, 95% CI: 8.9, 14.8), and Asian/Pacific Islander (AMR: 4.7, 95% CI: 1.3, 8.1) populations than White populations. Conclusion Our findings highlight the detrimental impact of structural racism on cancer outcomes among minoritized populations. Strategies aiming to mitigate cancer disparities must embed processes to recognize and address systems, policies, laws, and norms that create and reproduce patterns of discrimination.
Collapse
Affiliation(s)
- Joelle N. Robinson-Oghogho
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Kassandra I. Alcaraz
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
- Department of Oncology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Roland J. Thorpe
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
22
|
Pollack CE, Garrison V, Johnson T, Blackford AL, Banks B, Howe W, Yabroff KR, Enewold L. Housing assistance among patients with cancer: SEER-Medicare US Department of Housing and Urban Development data linkage. J Natl Cancer Inst 2024; 116:1270-1279. [PMID: 38588578 PMCID: PMC11308178 DOI: 10.1093/jnci/djae082] [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: 09/29/2023] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Lack of stable, affordable housing is an important social determinant of health. Federal housing assistance may buffer against housing vulnerabilities among low-income households, but research examining the association of housing assistance and cancer care has been limited. We introduce a new linkage of Surveillance, Epidemiology, and End Results (SEER) program-Medicare and US Department of Housing and Urban Development (HUD) administrative data. METHODS Individuals enrolled in HUD public and assisted housing programs between 2006 and 2021 were linked with cancer diagnoses between 2006 and 2019 identified in the SEER-Medicare data from 16 states using Match*Pro (National Institutes of Health, Bethesda, MD) probabilistic linkage software. HUD administrative data include timing and type of housing assistance as well as verified household income. Medicare administrative data are available through 2020. RESULTS A total of 335 490 unique individuals who received housing assistance at any time point, including 156 794 who received housing assistance around the time of their diagnosis (at least 6 months before diagnosis until 6 months after diagnosis or death), were matched to SEER-Medicare data. A total of 63 251 individuals receiving housing assistance at the time of their diagnosis were aged 66 years and older and continuously enrolled in Medicare parts A and B fee for service; 12 035 had a diagnosis of lung cancer, 8866 of breast cancer, 7261 of colorectal cancer, and 4703 of prostate cancer. CONCLUSIONS This novel data linkage will be available through the National Cancer Institute and can be used to explore the ways in which housing assistance is associated with cancer diagnosis, care, and outcomes, including the role of housing assistance status in potentially reducing or contributing to inequities across racialized and ethnic groups.
Collapse
Affiliation(s)
- Craig Evan Pollack
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, and Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Veronica Garrison
- Office of Policy Development & Research, US Department of Housing and Urban Development, Washington, DC, USA
| | - Taylor Johnson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda L Blackford
- Division of Quantitative Sciences, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bob Banks
- Information Management Services Inc, Calverton, MD, USA
| | - William Howe
- Information Management Services Inc, Calverton, MD, USA
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Lindsey Enewold
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
23
|
Doose M, Mollica MA, Acevedo AM, Tesauro G, Gallicchio L, Reed C, Guida J, Maher ME, Srinivasan S, Tonorezos E. Advancing health equity in cancer survivorship research: National Institutes of Health 2017-2022 portfolio review. J Natl Cancer Inst 2024; 116:1238-1245. [PMID: 38544292 DOI: 10.1093/jnci/djae073] [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: 12/28/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Communities and researchers have called for a paradigm shift from describing health disparities to a health equity research agenda that addresses structural drivers. Therefore, we examined whether the cancer survivorship research portfolio has made this shift. METHODS We identified grants focused on populations experiencing health disparities from the National Institutes of Health (NIH) Cancer Survivorship Research Portfolio (N = 724), Fiscal Years 2017-2022. Grant characteristics were abstracted, drivers of health disparities were mapped onto the levels and domains of influence, and opportunities for future research were identified. RESULTS A total of 147 survivorship grants focused on health disparities were identified, of which 73.5% of grants focused on survivors from racial and ethnic minoritized groups, 25.9% living in rural areas, 24.5% socioeconomically disadvantaged, and 2.7% sexual and gender minority groups. Study designs were 51.0% observational; 82.3% of grants measured or intervened on at least 1 individual-level of influence compared to higher levels of influence (32.7% interpersonal, 41.5% institutional and community, and 12.2% societal). Behavioral and health care system domains of influence were commonly represented, especially at the individual level (47.6% and 36.1%, respectively). Less frequently represented was the physical and built environment (12.2%). CONCLUSIONS NIH-funded cancer survivorship research on health disparities is still focused on individual level of influence. However, the proportion of grants examining structural and social drivers as well as the mechanisms that drive disparities in health care and health outcomes among cancer survivors have increased over time. Gaps in funded research on specific populations, cancer types, and focus areas of survivorship science were identified and warrant priority.
Collapse
Affiliation(s)
- Michelle Doose
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michelle A Mollica
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Amanda M Acevedo
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Gina Tesauro
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Crystal Reed
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jennifer Guida
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Molly E Maher
- Office of Cancer Centers, Office of the Director, National Cancer Institute, Rockville, MD, USA
| | - Shobha Srinivasan
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Emily Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| |
Collapse
|
24
|
Matthews AK, Steffen AD, Akufo J, Burke L, Diaz H, Dodd D, Hughes A, Madrid S, Onyiapat E, Opuada H, Sejo J, Vilona B, Williams BJ, Donenberg G. Factors Associated with Uptake of Patient Portals at a Federally Qualified Health Care Center. Healthcare (Basel) 2024; 12:1505. [PMID: 39120208 PMCID: PMC11311389 DOI: 10.3390/healthcare12151505] [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: 05/24/2024] [Revised: 07/27/2024] [Accepted: 07/28/2024] [Indexed: 08/10/2024] Open
Abstract
Federally qualified health centers (FQHC) aim to improve cancer prevention by providing screening options and efforts to prevent harmful behavior. Patient portals are increasingly being used to deliver health promotion initiatives. However, little is known about patient portal activation rates in FQHC settings and the factors associated with activation. This study examined patient portal activation among FQHC patients and assessed correlations with demographic, clinical, and health service use variables. We analyzed electronic health record data from adults >18 years old with at least one appointment. Data were accessed from the electronic health records for patients seen between 1 September 2018 and 31 August 2022 (n = 40,852 patients). We used multivariate logistic regression models to examine the correlates of having an activated EPIC-supported MyChart patient portal account. One-third of patients had an activated MyChart portal account. Overall, 35% of patients with an activated account had read at least one portal message, 69% used the portal to schedule an appointment, and 90% viewed lab results. Demographic and clinical factors associated with activation included younger age, female sex, white race, English language, being partnered, privately insured, non-smoking, and diagnosed with a chronic disease. More frequent healthcare visits were also associated with an activated account. Whether or not a patient had an email address in the EHR yielded the strongest association with patient portal activation. Overall, 39% of patients did not have an email address; only 2% of those patients had activated their accounts, compared to 54% of those with an email address. Patient portal activation rates were modest and associated with demographic, clinical, and healthcare utilization factors. Patient portal usage to manage one's healthcare needs is increasing nationally. As such, FQHC clinics should enhance efforts to improve the uptake and usage of patient portals, including educational campaigns and eliminating email requirements for portal activation, to reinforce cancer prevention efforts.
Collapse
Affiliation(s)
- Alicia K. Matthews
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Alana D. Steffen
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Jennifer Akufo
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Larisa Burke
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Hilda Diaz
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Darcy Dodd
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Ashley Hughes
- Department of Biomedical and Health Information Science, The University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Samantha Madrid
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Enuma Onyiapat
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Hope Opuada
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | - Jessica Sejo
- College of Medicine, The University of Illinois Chicago, Chicago, IL 60612, USA; (J.S.); (G.D.)
| | - Brittany Vilona
- Department of Population Health Nursing, College of Nursing, The University of Illinois Chicago, Chicago, IL 60612, USA; (A.D.S.); (J.A.); (L.B.); (H.D.); (D.D.); (S.M.); (E.O.); (H.O.); (B.V.)
| | | | - Geri Donenberg
- College of Medicine, The University of Illinois Chicago, Chicago, IL 60612, USA; (J.S.); (G.D.)
| |
Collapse
|
25
|
Jones SC, Schlundt D, Williams N, Smalls M, Idrizi K, Alexander L, Anthony M, Selove R. Challenges in Disseminating Evidence-Based Health Promotion Programs in Faith Community Settings: What We Need to Include. Health Promot Pract 2024:15248399241259688. [PMID: 39066625 DOI: 10.1177/15248399241259688] [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: 07/28/2024]
Abstract
BACKGROUND Effective dissemination of information about evidence-based programs (EBPs) is essential for promoting health equity. Faith-based and other community organizations have difficulty locating EBPs for implementation in their settings. A research team engaged in a systematic search to identify a menu of EBPs that could be offered to African American FBOs as part of a community-engaged implementation study. Methods. A four-stage process was developed to search for EBPs meeting seven inclusion criteria for dissemination in faith-based organizations (FBOs). Criteria included relevance to identified health disparity topics, endorsement on a federal website, free access to downloadable program materials, facilitator guidance, no requirements for health care providers, and culturally relevant materials for African American communities. RESULTS Nineteen government websites were searched. Sixty-six potential EBPs were identified. Six EBPs met all inclusion criteria. DISCUSSION The search for EBPs that met seven criteria for implementation in African American FBOs demonstrated challenges that have been described in the literature. Researchers encountered a lack of standardized terminology for identifying EBPs on federal websites, frequent requirement for health care providers or clinics and/or fees for training and materials. FBOs are supportive and safe places to offer EBPs to promote health, and EBPs need to be designed and disseminated to meet the needs and preferences of FBOs. Including members of FBOs and others in the community in EBP development, design, and dissemination, such as searchable health promotion EBP registries, can increase the likelihood that effective programs intended to address health disparities are readily accessible to FBOs for implementation.
Collapse
Affiliation(s)
| | | | - Neely Williams
- Tennessee Community Engaged Alliance, Nashville, TN, USA
| | | | | | | | | | | |
Collapse
|
26
|
Ochoa-Dominguez CY, Banegas MP, Miller KA, Orellana Garcia C, Sabater-Minarim D, Chan RY. Healthcare Communication Experiences of Hispanic Caregivers of Childhood Cancer Survivors. Healthcare (Basel) 2024; 12:1307. [PMID: 38998842 PMCID: PMC11241517 DOI: 10.3390/healthcare12131307] [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: 06/01/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Interpersonal communication is a crucial component of the cancer experience that can contribute to managing cancer care and improving cancer survivors' and caregivers' quality of life. Cultural and contextual factors may impact Hispanic childhood cancer survivor (CCS) and parent caregiver relationships and communication. This study sought to describe the healthcare communication experiences of Hispanic parents with CCS, families, and medical providers. METHODS We conducted 15 semi-structured interviews with Hispanic caregivers from a safety-net hospital in Los Angeles County. Interviews were conducted in English and Spanish, audio-recorded and professionally transcribed, and analyzed using a thematic approach. RESULTS Caregivers shared the importance and impact of medical communication when exploring the "first big talk" of the diagnosis, uncertainty about treatment, navigating multiple providers, therapeutic communication (i.e., providing emotional reassurance), and current and lingering effects of cancer. All caregivers shared "good communication" experiences, while others shared various barriers to communication, including a lack of understanding of the cancer diagnosis and caregiver experience, psychological challenges impacting communication, cultural and language differences, physical factors that limit communication, and young age of child impacting communication with caregivers. CONCLUSIONS Our findings suggest that a strong interpersonal communication skill set for clinicians can contribute to managing cancer care and improving caregivers' psychological adjustment.
Collapse
Affiliation(s)
- Carol Y Ochoa-Dominguez
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92093, USA
- Center for Health Equity Education and Research, University of California San Diego, La Jolla, CA 92093, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92093, USA
- Center for Health Equity Education and Research, University of California San Diego, La Jolla, CA 92093, USA
| | - Kimberly A Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Carlos Orellana Garcia
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Daniel Sabater-Minarim
- Center for Health Equity Education and Research, University of California San Diego, La Jolla, CA 92093, USA
- Department of Biological Sciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Randall Y Chan
- Department of Pediatrics, Los Angeles General Medical Center, Los Angeles, CA 90033, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| |
Collapse
|
27
|
Nechuta S, Chen WY, Goerge A, Boopathy D, Sanderson M. The role of breast cancer-related arm lymphedema in physical functioning and physical activity participation among long-term African American breast cancer survivors. Support Care Cancer 2024; 32:446. [PMID: 38900224 PMCID: PMC11368064 DOI: 10.1007/s00520-024-08648-3] [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: 02/14/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Breast cancer-related arm lymphedema (BCRL) is a common chronic and debilitating condition that involves accumulation of lymphatic fluid in the arm or hand. Limited data are available on BCRL in African American women. Lack of physical activity (PA) and poor physical functioning (PF) are both associated with increased morbidity and mortality among breast cancer survivors. We examined the association of BCRL with PA and PF among African American breast cancer survivors. METHODS 323 African American women who previously participated in a case-only study in three states (TN, GA, SC) completed a survivorship-focused questionnaire (mean: 4.2 years post-diagnosis) in 2015-2016. Validated measures were used to determine BCRL, PF, and PA. Adjusted binary logistic regression models estimated ORs and 95% CIs for the association of BCRL and meeting PA guidelines (≥ 150 min/week), while multinomial logistic regression was used for PF and PA (minutes/week) categorized based on tertiles. RESULTS Approximately 32% reported BCRL since diagnosis; 25.4% reported BCRL in the last 12-months. About 26% and 50% reported that BCRL interfered with exercise and ability to do daily activities, respectively. The mean PF among those with BCRL was 51.0(SD:29.0) vs. 68.5(SD:30.1) among those without BCRL. BCRL was associated with lower PF (adjusted-OR for tertile 2: 2.12(95% CI:1.03-4.36) and adjusted-OR for tertile 1: 2.93(95% CI:1.44-5.96)). CONCLUSIONS BCRL was associated with lower PF among long-term African American breast cancer survivors. Continued monitoring by health care professionals and increased education and behavioral interventions to support PA and improved PF among survivors living with BCRL are warranted.
Collapse
Affiliation(s)
- Sarah Nechuta
- School of Interdisciplinary Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, USA.
| | - Wendy Y Chen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Deptartment of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Ally Goerge
- School of Interdisciplinary Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, USA
| | - Deepika Boopathy
- School of Interdisciplinary Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, USA
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Maureen Sanderson
- School of Medicine, Meharry Medical College, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, USA
| |
Collapse
|
28
|
Gaur P, Ganguly AP, Kuo M, Martin R, Alvarez KS, Bhavan KP, Kho KA. Childcare needs as a barrier to healthcare among women in a safety-net health system. BMC Public Health 2024; 24:1608. [PMID: 38886715 PMCID: PMC11181530 DOI: 10.1186/s12889-024-19125-1] [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: 09/21/2023] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Childcare needs are an understudied social determinant of health. The effect of childcare needs on access to healthcare must be understood to inform health system interventions and policy reform. This study sought to characterize childcare needs, access to childcare, and prior experience with navigating childcare needs in healthcare settings among women in a safety-net population. METHODS We conducted a cross-sectional study of patient-reported survey data collected in-person between April and October 2019. Surveys were administered in waiting rooms of ambulatory services in a large, urban safety-net health system in Dallas, Texas. Survey respondents were derived from a random convenience sample of women waiting for outpatient appointments. Participants were screened for having children under the age of 13 and/or childcare responsibilities for inclusion in the sample. Outcomes of interest included self-reported delayed or missed care, reasons for delayed or missed care, perceived difficulty in accessing childcare, prior methods for managing childcare during healthcare appointments, and prior experience with childcare centers. RESULTS Among the 336 respondents (96.7% response rate), 121 (36.0%) reported delaying or missing a mean 3.7 appointments/year. Among women with delayed or missed care, 54.5% reported childcare barriers as the primary reason for deferral of care, greater than transportation (33%) or insurance (25%) barriers. Respondents rated childcare access as more difficult than healthcare access. Delayed or missed care due to childcare was more common among White (68.8%) and Black (55.0%) women compared to Hispanic women (34.3%). Common methods of navigating childcare needs during scheduled appointments included bringing children to appointments (69.1%) and re-scheduling or missing the scheduled appointment (43.0%). 40.6% of patients reported leaving an appointment before completion due to childcare needs. CONCLUSIONS Childcare needs are a leading barrier to healthcare among women accessing care in safety-net settings. Unmet childcare needs result in deferral of care, which may impact health outcomes. Childcare access is perceived as more challenging than healthcare access itself. Health system and policy interventions are needed to address childcare as a social determinant of health.
Collapse
Affiliation(s)
- Priyanka Gaur
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Anisha P Ganguly
- Center of Innovation and Value at Parkland, Parkland Health, Dallas, TX, United States of America.
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
- Parkland Health Center for Innovation and Value at Parkland, 5200 Harry Hines Blvd, Dallas, TX, 75235, USA.
| | - Madyson Kuo
- Department of Obstetrics and Gynecology, Methodist Health System, Dallas, TX, United States of America
| | - Robert Martin
- Center of Innovation and Value at Parkland, Parkland Health, Dallas, TX, United States of America
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Kristin S Alvarez
- Center of Innovation and Value at Parkland, Parkland Health, Dallas, TX, United States of America
| | - Kavita P Bhavan
- Center of Innovation and Value at Parkland, Parkland Health, Dallas, TX, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Kimberly A Kho
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| |
Collapse
|
29
|
Fram J, Boss K, Villaflor V, Jayabalan P. Barriers to and enablers of physical activity participation in lung cancer survivors. PM R 2024. [PMID: 38874321 DOI: 10.1002/pmrj.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 03/21/2024] [Accepted: 04/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Although physical activity physical activity has been shown to have significant benefits for individuals living with cancer, engaging lung cancer survivors (LCS) in increasing routine physical activity participation has been particularly challenging. PURPOSE To describe enablers of, barriers to, and patterns of physical activity among LCS and to characterize interest in a physical activity program as a first step to improving physical activity engagement. METHODS The study consisted of a cross-sectional survey (n = 100) of adult LCS recruited from a thoracic oncology clinic assessing multiple domains of physical activity (engagement, perceived barriers, benefits, physical function, psychosocial factors, self-efficacy, and programmatic preferences). RESULTS Only 12% of LCS in our cohort (average age 67 years, 54% male, 81% with stage III or IV disease) met American College of Sports Medicine (ACSM) physical activity guidelines. Participants engaged in moderate-to-vigorous physical activity, with an average (SD) of 48.4 (91.8) minutes per week. The most commonly reported barriers to physical activity were fatigue (49%), dyspnea (39%), and difficulty with daily activities (34%). Regression analysis demonstrated a positive association between moderate-to-vigorous physical activity and higher income (r = 0.241, p = .016), physical function (r = 0.281, p = .005), and physical activity self-efficacy (r = 0.270, p = .007). Qualitative results demonstrated a strong interest in physical activity programming that is lung-cancer specific with a high level of support and guidance. CONCLUSION This study identified that LCS had low levels of physical activity with fatigue, dyspnea, socioeconomic, and functional limitations contributing. The majority of LCS are interested in an exercise program and believe that exercise engagement will produce functional benefits. The present study presents a framework to guide development of community-based interventions to increase LCS physical activity participation among LCS.
Collapse
Affiliation(s)
- Julia Fram
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Victoria Villaflor
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Prakash Jayabalan
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
30
|
Torres-Perez AC, Ramos-Lopez WA, Covarrubias-Gómez A, Sánchez-Roman S, Quiroz-Friedman P, Alcocer-Castillejos N, Milke-García MDP, Carrillo-Soto M, Morales-Alfaro A, Chávarri-Guerra Y, Soto-Perez-de-Celis E. Supportive care needs among older Mexican adults with metastatic cancer. J Geriatr Oncol 2024; 15:101796. [PMID: 38761773 DOI: 10.1016/j.jgo.2024.101796] [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: 03/21/2024] [Revised: 04/18/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Supportive care needs may vary according to age. The purpose of this research is to describe and compare supportive care needs between older adults with metastatic cancer (age ≥ 65 years) and their younger counterparts. MATERIALS AND METHODS We conducted a retrospective secondary analysis of a cohort of patients with newly diagnosed metastatic solid tumors. Supportive care needs were assessed at baseline and at a three-month follow-up. Patients were divided into two groups (aged ≥65/<65 years). Differences in clinical characteristics and supportive care needs were compared utilizing descriptive statistics. Multivariate logistic regression models were employed to identify patient characteristics associated with specific supportive care needs. RESULTS Between 2018 and 2022, 375 patients were enrolled. Median age was 66 years (interquartile range 19-94). At baseline, older adults had a higher number of supportive care needs (4.8 vs. 4.2, p = 0.01) and were at higher risk of malnutrition (75 vs. 65%, p = 0.05). Increasing age (odds ratio [OR] 1.02 (95% confidence interval [CI] 1.0-1.04, p = 0.03) and an estimated life expectancy <6 months (OR 3.0, 95%CI 1.5-6.1; p < 0.01) were associated with higher odds of malnutrition, while a higher educational level was associated with decreased odds (OR 0.68, 95%CI 0.5-0.8; p < 0.01). At three-month follow-up, older adults still had a higher number of supportive care needs (3.8 vs.2.6, p < 0.01) and were more likely to have fatigue (62 vs. 47%, p = 0.02). An estimated life expectancy of <6 months was associated with increased odds of fatigue (OR 3.0, 95%CI 1.5-6.3; p < 0.01). DISCUSSION Older adults reported significantly more supportive care needs, particularly risk of malnutrition and fatigue. This information can help in the creation of supportive care services tailored to the needs of older individuals.
Collapse
Affiliation(s)
- Ana Cristina Torres-Perez
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Wendy Alicia Ramos-Lopez
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Alfredo Covarrubias-Gómez
- Department of Palliative Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Sofía Sánchez-Roman
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Paulina Quiroz-Friedman
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Natasha Alcocer-Castillejos
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Del Pilar Milke-García
- Department of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Mónica Carrillo-Soto
- Department of Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Andrea Morales-Alfaro
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Yanin Chávarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| |
Collapse
|
31
|
Lara-Morales A, Soto-Ruiz N, Agudelo-Suárez AA, García-Vivar C. Social determinants of health in post-treatment cancer survivors: Scoping review. Eur J Oncol Nurs 2024; 70:102614. [PMID: 38795448 DOI: 10.1016/j.ejon.2024.102614] [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: 11/29/2023] [Revised: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE To identify, analyze and describe the available scientific evidence about the influence of social determinants of health on cancer survivors. METHODS A scoping review was outlined according to the steps described by the Joanna Brigs Institute Reviewer's Manual: selection of studies, data mapping, and results grouping, synthesis and report, was conducted. PubMed, CINAHL, Scopus and LILACS databases were searched from 2011 to 2023. RESULTS Out of a total of 1783 papers initially screened, only 19 studies met the inclusion criteria for the scoping review, focusing on the primary social determinants impacting the health of cancer survivors. These studies were categorized into six main themes: a) employment (challenges in work reintegration and work-place difficulties); b) variations among different ethnic groups; c) disparities based on sex; d) barriers and facilitators in accessing health and social security services; e) the role of support networks and social environments; and f) socioeconomic lever (influence of income and socioeconomic status). CONCLUSIONS Understanding the impact of social determinants on the post-treatment quality of life for cancer survivors is crucial. Comprehensive survivorship care should address not just medical needs but also holistic aspects like social support, education, overall well-being, and improvements in physical and social environments. This multifaceted approach ensures the well-rounded support needed for optimal survivorship outcomes.
Collapse
Affiliation(s)
- Alfredo Lara-Morales
- Department of Nursing and Obstetrics, Guanajuato University, C. Pedro Lascurain de Retana, Calzada de Guadalupe, 36700, Guanajuato, Gto, Mexico.
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/n, 31008, Pamplona, Navarra, Spain; IdiSNA, Navarra Institute for Health Research, Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| | - Andrés A Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Calle 64 Nº 52-59, 050010, Medellin, Antioquia, Colombia.
| | - Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/n, 31008, Pamplona, Navarra, Spain; IdiSNA, Navarra Institute for Health Research, Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| |
Collapse
|
32
|
Burus T, Thompson JR, McAfee CR, Williams LB, Knight JR, Huang B, Kanotra S, Wilhite NP, Russell E, Rogers M, Sorrell CL, Stroebel C, King R, Hull PC. A framework and process for community-engaged, mixed-methods cancer needs assessments. Cancer Causes Control 2024:10.1007/s10552-024-01892-2. [PMID: 38809305 DOI: 10.1007/s10552-024-01892-2] [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: 10/16/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Community health needs assessments are required for most state and local public health agencies and non-profit hospitals. Typically based on community health improvement planning models, these assessments encompass overall community health and multiple diseases to inform program planning. National Cancer Institute (NCI)-designated Cancer Centers and community-based cancer-focused programs share the goal of reducing cancer burden in the catchment areas they serve. However, to date, no published models exist to guide cancer-specific needs assessments for a determined geographic area that can inform both public health and research initiatives. The purpose of this article is to outline a cancer needs assessment (CNA) framework and community-engaged, mixed-methods process, along with a case study of how we applied it in Kentucky. METHODS We convened a steering committee of key organizational partners to provide input throughout the process. We developed a conceptual framework of multi-level determinants affecting cancer-related outcomes. We incorporated both quantitative and qualitative data gathered through a variety of means, including a novel application of group concept mapping to guide definition of priorities. RESULTS The resulting CNA has helped guide strategic planning and priorities for Kentucky's Cancer Action Plan, Markey Cancer Center, state agencies, and community-based organizations. CONCLUSION This framework and process can be used collaboratively by cancer center Community Outreach and Engagement offices, public health agencies, oncology programs, and community partners to plan impactful cancer control programs and research in their catchment areas. Universities can also use them to inform the planning of community engagement and health equity research efforts.
Collapse
Affiliation(s)
- Todd Burus
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
- University of Kentucky Markey Cancer Center, 760 Press Avenue, Suite 460, Lexington, KY, 40536, USA.
| | | | - Caree R McAfee
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Lovoria B Williams
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Jennifer Redmond Knight
- Kentucky Cancer Consortium, Lexington, KY, USA
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Bin Huang
- Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, KY, USA
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | | | | | - Elaine Russell
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Kentucky Cancer Consortium, Lexington, KY, USA
| | - Melinda Rogers
- Kentucky Cancer Program, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Connie L Sorrell
- Kentucky Cancer Program, Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | | | | | - Pamela C Hull
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
33
|
Bourgeois A, Horrill T, Mollison A, Stringer E, Lambert LK, Stajduhar K. Barriers to cancer treatment for people experiencing socioeconomic disadvantage in high-income countries: a scoping review. BMC Health Serv Res 2024; 24:670. [PMID: 38807237 PMCID: PMC11134650 DOI: 10.1186/s12913-024-11129-2] [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: 09/12/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Despite advances in cancer research and treatment, the burden of cancer is not evenly distributed. People experiencing socioeconomic disadvantage have higher rates of cancer, later stage at diagnoses, and are dying of cancers that are preventable and screen-detectable. However, less is known about barriers to accessing cancer treatment. METHODS We conducted a scoping review of studies examining barriers to accessing cancer treatment for populations experiencing socioeconomic disadvantage in high-income countries, searched across four biomedical databases. Studies published in English between 2008 and 2021 in high-income countries, as defined by the World Bank, and reporting on barriers to cancer treatment were included. RESULTS A total of 20 studies were identified. Most (n = 16) reported data from the United States, and the remaining included publications were from Canada (n = 1), Ireland (n = 1), United Kingdom (n = 1), and a scoping review (n = 1). The majority of studies (n = 9) focused on barriers to breast cancer treatment. The most common barriers included: inadequate insurance and financial constraints (n = 16); unstable housing (n = 5); geographical distribution of services and transportation challenges (n = 4); limited resources for social care needs (n = 7); communication challenges (n = 9); system disintegration (n = 5); implicit bias (n = 4); advanced diagnosis and comorbidities (n = 8); psychosocial dimensions and contexts (n = 6); and limited social support networks (n = 3). The compounding effect of multiple barriers exacerbated poor access to cancer treatment, with relevance across many social locations. CONCLUSION This review highlights barriers to cancer treatment across multiple levels, and underscores the importance of identifying patients at risk for socioeconomic disadvantage to improve access to treatment and cancer outcomes. Findings provide an understanding of barriers that can inform future, equity-oriented policy, practice, and service innovation.
Collapse
Affiliation(s)
- Amber Bourgeois
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada.
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada.
| | - Tara Horrill
- College of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Ashley Mollison
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada
| | - Eleah Stringer
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada
| | - Leah K Lambert
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall T201, Vancouver, BC, V6T 2B5, Canada
| | - Kelli Stajduhar
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada
| |
Collapse
|
34
|
Siegel RD, LeFebvre KB, Temin S, Evers A, Barbarotta L, Bowman RM, Chan A, Dougherty DW, Ganio M, Hunter B, Klein M, Miller TP, Mulvey TM, Ouzts A, Polovich M, Salazar-Abshire M, Stenstrup EZ, Sydenstricker CM, Tsai S, Olsen MM. Antineoplastic Therapy Administration Safety Standards for Adult and Pediatric Oncology: ASCO-ONS Standards. JCO Oncol Pract 2024:OP2400216. [PMID: 38776491 DOI: 10.1200/op.24.00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE To update the ASCO-Oncology Nursing Society (ONS) standards for antineoplastic therapy administration safety in adult and pediatric oncology and highlight current standards for antineoplastic therapy for adult and pediatric populations with various routes of administration and location. METHODS ASCO and ONS convened a multidisciplinary Expert Panel with representation of multiple organizations to conduct literature reviews and add to the standards as needed. The evidence base was combined with the opinion of the ASCO-ONS Expert Panel to develop antineoplastic safety standards and guidance. Public comments were solicited and considered in preparation of the final manuscript. RESULTS The standards presented here include clarification and expansion of existing standards to include home administration and other changes in processes of ordering, preparing, and administering antineoplastic therapy; the advent of immune effector cellular therapy; the importance of social determinants of health; fertility preservation; and pregnancy avoidance. In addition, the standards have added a fourth verification. STANDARDS Standards are provided for which health care organizations and those involved in all aspects of patient care can safely deliver antineoplastic therapy, increase the quality of care, and reduce medical errors.Additional information is available at www.asco.org/standards and www.ons.org/onf.
Collapse
Affiliation(s)
| | | | - Sarah Temin
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Amy Evers
- University of Pennsylvania Health System, Philadelphia, PA
| | - Lisa Barbarotta
- Smilow Cancer Hospital and Yale Cancer Center, New Haven, CT
| | - Ronda M Bowman
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Alexandre Chan
- University of California, Irvine, Chao Family Comprehensive Cancer Center, National Cancer Centre Singapore, Irvine, CA
| | | | - Michael Ganio
- ASHP (American Society of Health-System Pharmacists), Bethesda, MD
| | | | - Meredith Klein
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Tamara P Miller
- Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | | | | | | | - Maritza Salazar-Abshire
- Department of Nursing Education, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Susan Tsai
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | |
Collapse
|
35
|
Cruz S, Lu C, Ulloa M, Redding A, Hester J, Jacobs M. Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study. JMIR Mhealth Uhealth 2024; 12:e50826. [PMID: 38717816 PMCID: PMC11112471 DOI: 10.2196/50826] [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: 07/14/2023] [Revised: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low-socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. OBJECTIVE This study's aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. METHODS We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. RESULTS Through qualitative analysis, we identified 4 main themes. Participants' perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants' interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. CONCLUSIONS The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices.
Collapse
Affiliation(s)
- Stefany Cruz
- Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Claire Lu
- Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Mara Ulloa
- Department of Computer Science, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Alexander Redding
- Department of Computer Science and Engineering, Irwin & Joan Jacobs School of Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Josiah Hester
- Interactive Computing and Computer Science, College of Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Maia Jacobs
- Department of Computer Science, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| |
Collapse
|
36
|
Keruakous AR, Akpan I, Chahin M, Kirolos A, Keruakous M. Equity in oncology care: addressing disparities in cancer treatment in Georgia. Front Public Health 2024; 12:1381075. [PMID: 38756877 PMCID: PMC11098010 DOI: 10.3389/fpubh.2024.1381075] [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: 02/02/2024] [Accepted: 04/04/2024] [Indexed: 05/18/2024] Open
Abstract
This research delves into the disparities in access to oncology care among cancer patients in Georgia, with a specific focus on the distinct challenges faced by African American (AA) individuals compared to non-African American (Non-AA) counterparts. Leveraging data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) survey and supplementary online resources, the study meticulously examines socioeconomic factors, including income, education, and insurance coverage, which significantly influence the quality of cancer care received. The analysis reveals substantial income gaps between AA and Non-AA patients, underscoring the critical implications for healthcare access. Moreover, AA patients exhibit lower rates of full insurance coverage for cancer-related treatments, posing additional barriers to comprehensive care. By investigating the intersections of race, income, and education, the research aims to pinpoint the root causes of these disparities and proposes evidence-based solutions to address the identified challenges. The ultimate objective is to contribute valuable insights that inform targeted policy recommendations and community-based interventions, fostering a more equitable landscape for oncology care in Georgia. This study seeks to amplify awareness and advocate for tangible measures, striving toward healthcare equity for all cancer patients, irrespective of their racial or socioeconomic backgrounds.
Collapse
Affiliation(s)
- Amany R. Keruakous
- Hematology Oncology Department, Georgia Cancer Center, Wellstar MCG Health, Augusta, GA, United States
| | | | - Michael Chahin
- Hematology Oncology Department, Georgia Cancer Center, Wellstar MCG Health, Augusta, GA, United States
| | | | - Mai Keruakous
- Mercer County Community College, Trenton, NJ, United States
| |
Collapse
|
37
|
Dantas AAG, de Oliveira NPD, Costa GAB, Martins LFL, Dos Santos JEM, Migowski A, de Camargo Cancela M, de Souza DLB. Multilevel analysis of social determinants of advanced stage colorectal cancer diagnosis. Sci Rep 2024; 14:9667. [PMID: 38671078 PMCID: PMC11053035 DOI: 10.1038/s41598-024-60449-0] [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: 08/22/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
The advanced stage at diagnosis of colorectal cancer (CRC) may be related to individual factors, socioeconomic conditions, and healthcare service availability. The objective of the study was to analyze the prevalence of advanced stage CRC at the time of diagnosis and its association with individual, contextual, socioeconomic, and healthcare service indicators. An observational, cross-sectional study was conducted, analyzing cases of malignant neoplasms of the colon and rectum in individuals of both sexes, aged between 18 and 99 years, diagnosed between 2010 and 2019 in Brazil (n = 69,047). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A Multilevel Poisson Regression model with random intercept was used. The prevalence of advanced stage CRC at diagnosis was 65.6%. Advanced stage was associated with older age groups prevalence ratio (PR) 4.40 and younger age groups (PR 1.84), low Human Development Index (HDI) (PR 1.22), and low density of family health strategy teams (PR 1.10). The study highlights the unequal distribution of social determinants of health in the diagnosis CRC in Brazil, revealing the need to evaluate and redirect public policies aimed at improving early detection and prevention of CRC in the country.
Collapse
Affiliation(s)
| | | | - Guilherme Augusto Barcello Costa
- Graduate Program in Oncology, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Luís Felipe Leite Martins
- Surveillance and Situation Analysis Division, Prevention and Surveillance Coordination (CONPREV), National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Jonas Eduardo Monteiro Dos Santos
- Surveillance and Situation Analysis Division, Prevention and Surveillance Coordination (CONPREV), National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Arn Migowski
- Division of Clinical Research and Technological Development, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
- Professional Master's Program in Health Technology Assessment, Education and Research Coordination, National Institute of Cardiology (INC), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Marianna de Camargo Cancela
- Graduate Program in Oncology, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Dyego Leandro Bezerra de Souza
- Graduate Program in Public Health, Federal University of Rio Grande do Norte - UFRN, Natal, RN, Brazil.
- Methodology, Methods, Models and Results in Health and Social Sciences Research Group (M3O), Faculty of Health Sciences and Well-Being. Health and Social Care Research Center (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.
- Public Health Department, Graduate Program in Public Health, Federal University of Rio Grande do Norte, 1787 Senador Salgado Filho Ave., Lagoa Nova, Natal, RN, 59010-000, Brazil.
| |
Collapse
|
38
|
Miller JW, King JA, Trivers KF, Town M, Sabatino SA, Puckett M, Richardson LC. Vital Signs: Mammography Use and Association with Social Determinants of Health and Health-Related Social Needs Among Women - United States, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:351-357. [PMID: 38652735 PMCID: PMC11037433 DOI: 10.15585/mmwr.mm7315e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Introduction Approximately 40,000 U.S. women die from breast cancer each year. Mammography is recommended to screen for breast cancer and reduce breast cancer mortality. Adverse social determinants of heath (SDOH) and health-related social needs (HRSNs) (e.g., lack of transportation and social isolation) can be barriers to getting mammograms. Methods Data from the 2022 Behavioral Risk Factor Surveillance System were analyzed to estimate the prevalence of mammography use within the previous 2 years among women aged 40-74 years by jurisdiction, age group, and sociodemographic factors. The association between mammography use and measures of SDOH and HRSNs was assessed for jurisdictions that administered the Social Determinants and Health Equity module. Results Among women aged 50-74 years, state-level mammography use ranged from 64.0% to 85.5%. Having health insurance and a personal health care provider were associated with having had a mammogram within the previous 2 years. Among women aged 50-74 years, mammography prevalence was 83.2% for those with no adverse SDOH and HRSNs and 65.7% for those with three or more adverse SDOH and HRSNs. Life dissatisfaction, feeling socially isolated, experiencing lost or reduced hours of employment, receiving food stamps, lacking reliable transportation, and reporting cost as a barrier for access to care were all strongly associated with not having had a mammogram within the previous 2 years. Conclusions and Implications for Public Health Practice Identifying specific adverse SDOH and HRSNs that women experience and coordinating activities among health care providers, social services, community organizations, and public health programs to provide services that help address these needs might increase mammography use and ultimately decrease breast cancer deaths.
Collapse
|
39
|
Ameri P, Bertero E, Lombardi M, Porto I, Canepa M, Nohria A, Vergallo R, Lyon AR, López-Fernández T. Ischaemic heart disease in patients with cancer. Eur Heart J 2024; 45:1209-1223. [PMID: 38323638 DOI: 10.1093/eurheartj/ehae047] [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: 08/01/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
Cardiologists are encountering a growing number of cancer patients with ischaemic heart disease (IHD). Several factors account for the interrelationship between these two conditions, in addition to improving survival rates in the cancer population. Established cardiovascular (CV) risk factors, such as hypercholesterolaemia and obesity, predispose to both IHD and cancer, through specific mechanisms and via low-grade, systemic inflammation. This latter is also fuelled by clonal haematopoiesis of indeterminate potential. Furthermore, experimental work indicates that IHD and cancer can promote one another, and the CV or metabolic toxicity of anticancer therapies can lead to IHD. The connections between IHD and cancer are reinforced by social determinants of health, non-medical factors that modify health outcomes and comprise individual and societal domains, including economic stability, educational and healthcare access and quality, neighbourhood and built environment, and social and community context. Management of IHD in cancer patients is often challenging, due to atypical presentation, increased bleeding and ischaemic risk, and worse outcomes as compared to patients without cancer. The decision to proceed with coronary revascularization and the choice of antithrombotic therapy can be difficult, particularly in patients with chronic coronary syndromes, necessitating multidisciplinary discussion that considers both general guidelines and specific features on a case by case basis. Randomized controlled trial evidence in cancer patients is very limited and there is urgent need for more data to inform clinical practice. Therefore, coexistence of IHD and cancer raises important scientific and practical questions that call for collaborative efforts from the cardio-oncology, cardiology, and oncology communities.
Collapse
Affiliation(s)
- Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Edoardo Bertero
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Marco Lombardi
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Roma, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Anju Nohria
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rocco Vergallo
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | | | - Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
- Cardiology Department, Quirón Pozuelo University Hospital, Madrid, Spain
| |
Collapse
|
40
|
Graboyes EM, Lee SC, Lindau ST, Adams AS, Adjei BA, Brown M, Sadigh G, Incudine A, Carlos RC, Ramsey SD, Bangs R. Interventions addressing health-related social needs among patients with cancer. J Natl Cancer Inst 2024; 116:497-505. [PMID: 38175791 DOI: 10.1093/jnci/djad269] [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: 11/10/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
Health-related social needs are prevalent among cancer patients; associated with substantial negative health consequences; and drive pervasive inequities in cancer incidence, severity, treatment choices and decisions, and outcomes. To address the lack of clinical trial evidence to guide health-related social needs interventions among cancer patients, the National Cancer Institute Cancer Care Delivery Research Steering Committee convened experts to participate in a clinical trials planning meeting with the goal of designing studies to screen for and address health-related social needs among cancer patients. In this commentary, we discuss the rationale for, and challenges of, designing and testing health-related social needs interventions in alignment with the National Academy of Sciences, Engineering, and Medicine 5As framework. Evidence for food, housing, utilities, interpersonal safety, and transportation health-related social needs interventions is analyzed. Evidence regarding health-related social needs and delivery of health-related social needs interventions differs in maturity and applicability to cancer context, with transportation problems having the most maturity and interpersonal safety the least. We offer practical recommendations for health-related social needs interventions among cancer patients and the caregivers, families, and friends who support their health-related social needs. Cross-cutting (ie, health-related social needs agnostic) recommendations include leveraging navigation (eg, people, technology) to identify, refer, and deliver health-related social needs interventions; addressing health-related social needs through multilevel interventions; and recognizing that health-related social needs are states, not traits, that fluctuate over time. Health-related social needs-specific interventions are recommended, and pros and cons of addressing more than one health-related social needs concurrently are characterized. Considerations for collaborating with community partners are highlighted. The need for careful planning, strong partners, and funding is stressed. Finally, we outline a future research agenda to address evidence gaps.
Collapse
Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Simon C Lee
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- University of Kansas Cancer Center, University of Kansas, Kansas City, KS, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA
| | - Alyce S Adams
- Departments of Health Policy/Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Office of Cancer Health Equity and Community Engagement, Stanford Cancer Institute, Stanford Medicine, Stanford, CA, USA
| | - Brenda A Adjei
- Office of the Associate Director, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Mary Brown
- Adena Cancer Center, Hematology and Oncology, Chillicothe, OH, USA
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California-Irvine, Irvine, CA, USA
| | | | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Scott D Ramsey
- Department of Pharmacy, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - Rick Bangs
- SWOG Cancer Research Network, Portland, OR, USA
| |
Collapse
|
41
|
Jeong S, Choi YJ. Association between Socioecological Status, Nutrient Intake, and Cancer Screening Behaviors in Adults Aged 40 and Over: Insights from the Eighth Korea National Health and Nutrition Examination Survey (KNHANES, 2019). Nutrients 2024; 16:1048. [PMID: 38613081 PMCID: PMC11013844 DOI: 10.3390/nu16071048] [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: 03/09/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer screening is pivotal for early detection and improved survival rates. While socio-ecological factors are known to influence screening uptake, the role of lifestyle, dietary habits, and general health in shaping these decisions remains underexplored. Utilizing the 2019 Korea National Health and Nutrition Examination Survey (KNHANES), this study examined the myriad of factors impacting cancer screening utilization. Data from 274,872 adults aged 40 years or older were scrutinized, highlighting demographics, income, lifestyle behaviors, health-related variables, nutrient intake, and dietary quality. A combination of descriptive statistics and logistic regression helped us ascertain influential determinants. Higher educational attainment and income quartiles were positively correlated with cancer screening rates. Regular walkers, those engaged in moderate physical activity, and individuals with a previous cancer diagnosis were more likely to get screened. High-risk drinkers and smokers were less inclined towards screening. Dietary habits also influenced screening decisions. Notably, participants with healthier eating behaviors, indicated by factors such as regular breakfasts and fewer meals out, were more likely to undergo screening. Additionally, nutrient intake analysis revealed that those who had undergone screening consumed greater quantities of most nutrients, bar a few exceptions. For individuals aged 50-64, nutritional assessment indicators highlighted a higher mean adequacy ratio (MAR) and index of nutritional quality (INQ) value among those who participated in screening, suggesting better nutritional quality. This study elucidates the complex socio-ecological and nutritional landscape influencing cancer screening decisions. The results underscore the importance of a holistic approach, emphasizing lifestyle, dietary habits, and socio-economic considerations. It provides a roadmap for policymakers to craft more inclusive screening programs, ensuring equal access and promoting early detection.
Collapse
Affiliation(s)
- Seungpil Jeong
- Department of Medical Informatics, College of Medicine, Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Yean-Jung Choi
- Department of Food and Nutrition, Sahmyook University, Seoul 01795, Republic of Korea
| |
Collapse
|
42
|
Wethington SL, Rositch AF, Yu R, Bielman M, Topel K, Stone RL, Ferriss JS, Fader AN, Beavis AL. Integrating Social Needs Screening and Resource Referral Into Standard Ambulatory Oncology Care: A Quality Improvement Project. JCO Oncol Pract 2024; 20:566-571. [PMID: 38277618 DOI: 10.1200/op.23.00485] [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: 08/04/2023] [Revised: 10/20/2023] [Accepted: 11/22/2023] [Indexed: 01/28/2024] Open
Abstract
PURPOSE We previously implemented paper-based screening for health-related social resource needs (HRSN) in our gynecologic oncology clinic and found that 36% of patients who completed the screening reported HRSN. We identified two primary deficiencies with our process. First, only 52% of patients completed the screening. Second, 37% of patients with needs failed to indicate if they desired resource referral or not. Therefore, we conducted a quality improvement project to integrate screening and referral processes into the electronic medical record (EMR) and routine clinic workflow to achieve at least 90% screening compliance and 90% elicited referral preference. METHODS A multidisciplinary team consisting of physicians, a health outcomes researcher, a computer programmer, project assistants, and the staff of a partner community organization designed and implemented an intervention that screened for HRSN online via the EMR patient platform or in person during visits. The primary outcome was the percentage of eligible patients who completed the HRSN screening (ie, reach). Outcomes were reviewed weekly, and feedback was provided to stakeholders monthly. Iterative changes were incorporated into five successive Plan-Do-Study-Act (PDSA) cycles completed from January 2021 to March 2023. RESULTS Screening compliance increased from the baseline of 52% (paper-based) to 97% in PDSA 4. Completion via the online patient portal increased from 17% in prelaunch to 49% in PDSA 4. Of patients who reported needs, 100% had a documented referral preference. CONCLUSION Compared with paper-based screening, an EMR-integrated HRSN screening and referral system significantly improved reach to patients at a gynecologic oncology clinic. Implementation efforts to expand to other ambulatory clinic settings are in process.
Collapse
Affiliation(s)
- Stephanie L Wethington
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | | | - Ruoxi Yu
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Marie Bielman
- The Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Kristin Topel
- Hopkins Community Connection, Johns Hopkins University, Baltimore, MD
| | - Rebecca L Stone
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - James Stuart Ferriss
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Amanda N Fader
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Anna L Beavis
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| |
Collapse
|
43
|
Byrne M, Sia TY, Fong C, Khurram A, Waters M, Kemel YM, Zhou Q, Ranganathan M, Long Roche K, Chi DS, Saban S, Wu M, Varice N, Hamilton JG, Carrot-Zhang J, Abu-Rustum NR, Iasonos A, Ellenson LH, Mandelker D, Weigelt B, Brown CL, Aghajanian C, Stadler Z, Liu YL. Mainstreaming in parallel with ovarian cancer tumor testing to improve genetic testing uptake. Gynecol Oncol 2024; 183:126-132. [PMID: 38493020 DOI: 10.1016/j.ygyno.2024.03.005] [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: 01/25/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES Although genetic testing (GT) is universally recommended for patients with epithelial ovarian cancer (EOC), rates are low (34%). In 1/2019, we implemented mainstreaming-GT in parallel with tumor testing via MSK-IMPACT within oncology clinics. We sought to determine GT rates pre/post-mainstreaming and patient characteristics associated with GT. METHODS Patients with newly diagnosed EOC seen at our institution from 7/1/2015-3/31/2022 were included. Clinical data were abstracted including social determinants of health (SDOH) variables, race/ethnicity, marital status, insurance, language, comorbidities, employment, and Yost index, a measure of socioeconomic status. GT rates were calculated overall and pre-/post-mainstreaming (1/2019). Logistic regression models were fit to identify variables associated with GT. RESULTS Of 1742 patients with EOC, 1591 (91%) underwent GT. Rates of GT increased from 87% to 95% after mainstreaming (p < 0.001). Among 151 patients not undergoing GT, major reasons were lack of provider recommendation (n = 76, 50%) and logistical issues (n = 38, 25%) with few declining (n = 14, 9%) or having medical complications preventing GT (n = 7, 4.6%). High-grade serous histology, advanced stage (III/IV), and having a spouse/partner were associated with increased GT uptake (p < 0.01). Among SDOH variables, there were no differences by insurance, Yost score, language, comorbidities, employment, or race/ethnicity. In multivariable models, likelihood of GT increased with mainstreaming, even after adjustment for histology, stage, and marital status (OR 3.77; 95% CI: 2.56-5.66). CONCLUSIONS Mainstreaming increased the likelihood of GT in patients with EOC. We found lower testing rates in patients without partners/spouses, non-high-grade serous histology, and early-stage disease, representing potential areas for future interventions.
Collapse
Affiliation(s)
- Maureen Byrne
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Tiffany Y Sia
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Christopher Fong
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Aliya Khurram
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Michele Waters
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Yelena M Kemel
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Megha Ranganathan
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Sally Saban
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Michelle Wu
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Nancy Varice
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Jada G Hamilton
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States of America; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Jian Carrot-Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Lora H Ellenson
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Diana Mandelker
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Carol L Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Zsofia Stadler
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Ying L Liu
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America.
| |
Collapse
|
44
|
Lorentsen MK, Sanoff HK. Social Determinants of Health and the Link to Colorectal Cancer Outcomes. Curr Treat Options Oncol 2024; 25:453-464. [PMID: 38498252 DOI: 10.1007/s11864-024-01191-7] [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] [Accepted: 02/09/2024] [Indexed: 03/20/2024]
Abstract
OPINION STATEMENT: Colorectal cancer (CRC) remains the second most deadly cancer in the United States, behind only lung cancer. Despite improvements in incidence due to screening and mortality in part due to better treatments, there are some groups that have not seen these promising changes. American Indian/Alaska Native and non-Hispanic Black individuals, certain geographic regions, and lower socioeconomic groups have all been shown to have worse CRC outcomes. A significant body of evidence has linked these disparities in outcomes to social determinants of health (SDH). SDH are defined by the WHO as "the non-medical factors that influence health outcomes." These factors include but are not limited to income, education, social support, neighborhood of residence, and access to healthcare. Individuals who are negatively impacted by SDH have been shown to have a higher incidence of CRC. These individuals are also less likely to receive adequate CRC screening, are less likely to receive appropriate treatment, and have increased CRC mortality. Interventions that target different SDH domains have been shown to lead to increased rates of CRC screening and receipt of appropriate treatment while simultaneously improving CRC mortality. The aim of this review is to highlight the connection between SDH and CRC outcomes while also exploring interventions that target SDH and thereby improve CRC outcomes.
Collapse
Affiliation(s)
- Michael K Lorentsen
- University of North Carolina at Chapel Hill, 170 Manning Drive, CB 7305, Chapel Hill, NC, 27599, USA
- Division of Oncology, University of North Carolina at Chapel Hill, 170 Manning Drive, CB 7305, Chapel Hill, NC, 27599, USA
| | - Hanna K Sanoff
- Division of Oncology, University of North Carolina at Chapel Hill, 170 Manning Drive, CB 7305, Chapel Hill, NC, 27599, USA.
| |
Collapse
|
45
|
Wojcik KM, Kamil D, Zhang J, Wilson OWA, Smith L, Butera G, Isaacs C, Kurian A, Jayasekera J. A scoping review of web-based, interactive, personalized decision-making tools available to support breast cancer treatment and survivorship care. J Cancer Surviv 2024:10.1007/s11764-024-01567-6. [PMID: 38538922 PMCID: PMC11436482 DOI: 10.1007/s11764-024-01567-6] [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: 08/29/2023] [Accepted: 03/12/2024] [Indexed: 09/29/2024]
Abstract
PURPOSE We reviewed existing personalized, web-based, interactive decision-making tools available to guide breast cancer treatment and survivorship care decisions in clinical settings. METHODS The study was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched PubMed and related databases for interactive web-based decision-making tools developed to support breast cancer treatment and survivorship care from 2013 to 2023. Information on each tool's purpose, target population, data sources, individual and contextual characteristics, outcomes, validation, and usability testing were extracted. We completed a quality assessment for each tool using the International Patient Decision Aid Standard (IPDAS) instrument. RESULTS We found 54 tools providing personalized breast cancer outcomes (e.g., recurrence) and treatment recommendations (e.g., chemotherapy) based on individual clinical (e.g., stage), genomic (e.g., 21-gene-recurrence score), behavioral (e.g., smoking), and contextual (e.g., insurance) characteristics. Forty-five tools were validated, and nine had undergone usability testing. However, validation and usability testing included mostly White, educated, and/or insured individuals. The average quality assessment score of the tools was 16 (range: 6-46; potential maximum: 63). CONCLUSIONS There was wide variation in the characteristics, quality, validity, and usability of the tools. Future studies should consider diverse populations for tool development and testing. IMPLICATIONS FOR CANCER SURVIVORS There are tools available to support personalized breast cancer treatment and survivorship care decisions in clinical settings. It is important for both cancer survivors and physicians to carefully consider the quality, validity, and usability of these tools before using them to guide care decisions.
Collapse
Affiliation(s)
- Kaitlyn M Wojcik
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Dalya Kamil
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA
| | | | - Oliver W A Wilson
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Laney Smith
- Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Claudine Isaacs
- Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Allison Kurian
- Departments of Medicine and Epidemiology and Population Health at Stanford University School of Medicine, Stanford, CA, USA
| | - Jinani Jayasekera
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA.
| |
Collapse
|
46
|
Alaniz-Cantú EI, Goodwin K, Smith L, Acosta E, Chávez-Iñiguez A, Evans MJ, Gaitán M, Lei F, Yousefi-Nooraie R, Fiscella KA, Rivera MP, Cupertino AP, Cartujano-Barrera F. Understanding the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos: A qualitative study. Front Oncol 2024; 14:1365739. [PMID: 38571494 PMCID: PMC10987732 DOI: 10.3389/fonc.2024.1365739] [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: 01/04/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Rates of lung cancer screening among Latinos remain low. The purpose of the study was to understand the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos. Methods Participants (N=20) were recruited using community-based recruitment strategies. Eligibility criteria included: 1) self-identified as Hispanic/Latino, 2) spoke English and/or Spanish, and 3) met the USA Preventive Services Task Force eligibility criteria for lung cancer screening. Interviews were conducted in Spanish and English, audio recorded, and transcribed verbatim. Using the health belief model, a qualitative theoretical analysis was used to analyze the interviews. Results Participants' mean age was 58.3 years old (SD=5.8), half of the participants were female, 55% had completed high school or lower educational level, and 55% reported speaking more Spanish than English. All participants were currently smoking. Fourteen participants (70%) were unaware of lung cancer screening, and eighteen (90%) did not know they were eligible for lung cancer screening. Regarding lung cancer screening, participants reported multiple perceived benefits (e.g., smoking cessation, early detection of lung cancer, increased survivorship) and barriers (e.g., fear of outcomes, cost, lung cancer screening not being recommended by their clinician). Lastly, multiple cues to actions for lung cancer screening were identified (e.g., family as a cue to action for getting screened). Conclusions Most Latinos who were eligible for lung cancer screening were unaware of it and, when informed, they reported multiple perceived benefits, barriers, and cues to action. These factors provide concrete operational strategies to address lung cancer screening among Latinos.
Collapse
Affiliation(s)
- Edgar I. Alaniz-Cantú
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Kalese Goodwin
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - London Smith
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Eliany Acosta
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Arlette Chávez-Iñiguez
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Mary Jo Evans
- Imaging Population Health Programs, University of Rochester Medical Center, Rochester, NY, United States
| | - Marcela Gaitán
- National Alliance for Hispanic Health, Washington, DC, United States
| | - Fang Lei
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Kevin A. Fiscella
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - M. Patricia Rivera
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States
| | | |
Collapse
|
47
|
Matejcic M, Teer JK, Hoehn HJ, Diaz DB, Shankar K, Gong J, Nguyen NT, Lorona N, Coppola D, Fulmer C, Saglam O, Jiang K, Cress D, Muñoz-Antonia T, Flores I, Gordian E, Oliveras Torres JA, Felder SI, Sanchez JA, Fleming J, Siegel EM, Freedman JA, Dutil J, Stern MC, Fridley BL, Figueiredo JC, Schmit SL. Spectrum of somatic mutational features of colorectal tumors in ancestrally diverse populations. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.11.24303880. [PMID: 38558992 PMCID: PMC10980113 DOI: 10.1101/2024.03.11.24303880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Ancestrally diverse and admixed populations, including the Hispanic/Latino/a/x/e community, are underrepresented in cancer genetic and genomic studies. Leveraging the Latino Colorectal Cancer Consortium, we analyzed whole exome sequencing data on tumor/normal pairs from 718 individuals with colorectal cancer (128 Latino, 469 non-Latino) to map somatic mutational features by ethnicity and genetic ancestry. Global proportions of African, East Asian, European, and Native American ancestries were estimated using ADMIXTURE. Associations between global genetic ancestry and somatic mutational features across genes were examined using logistic regression. TP53 , APC , and KRAS were the most recurrently mutated genes. Compared to non-Latino individuals, tumors from Latino individuals had fewer KRAS (OR=0.64, 95%CI=0.41-0.97, p=0.037) and PIK3CA mutations (OR=0.55, 95%CI=0.31-0.98, p=0.043). Genetic ancestry was associated with presence of somatic mutations in 39 genes (FDR-adjusted LRT p<0.05). Among these genes, a 10% increase in African ancestry was associated with significantly higher odds of mutation in KNCN (OR=1.34, 95%CI=1.09-1.66, p=5.74×10 -3 ) and TMEM184B (OR=1.53, 95%CI=1.10-2.12, p=0.011). Among RMGs, we found evidence of association between genetic ancestry and mutation status in CDC27 (LRT p=0.0084) and between SMAD2 mutation status and AFR ancestry (OR=1.14, 95%CI=1.00-1.30, p=0.046). Ancestry was not associated with tumor mutational burden. Individuals with above-average Native American ancestry had a lower frequency of microsatellite instable (MSI-H) vs microsatellite stable tumors (OR=0.45, 95%CI=0.21-0.99, p=0.048). Our findings provide new knowledge about the relationship between ancestral haplotypes and somatic mutational profiles that may be useful in developing precision medicine approaches and provide additional insight into genomic contributions to cancer disparities. Significance Our data in ancestrally diverse populations adds essential information to characterize mutational features in the colorectal cancer genome. These results will help enhance equity in the development of precision medicine strategies.
Collapse
|
48
|
Anderson EC, DiPalazzo J, Lucas FL, Hall MJ, Antov A, Helbig P, Bourne J, Graham L, Gaitor L, Lu-Emerson C, Bradford LS, Inhorn R, Sinclair SJ, Brooks PL, Thomas CA, Rasmussen K, Han PKJ, Liu ET, Rueter J. Genome-matched treatments and patient outcomes in the Maine Cancer Genomics Initiative (MCGI). NPJ Precis Oncol 2024; 8:67. [PMID: 38461318 PMCID: PMC10924947 DOI: 10.1038/s41698-024-00547-4] [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: 06/11/2023] [Accepted: 02/16/2024] [Indexed: 03/11/2024] Open
Abstract
Genomic tumor testing (GTT) is an emerging technology aimed at identifying variants in tumors that can be targeted with genomically matched drugs. Due to limited resources, rural patients receiving care in community oncology settings may be less likely to benefit from GTT. We analyzed GTT results and observational clinical outcomes data from patients enrolled in the Maine Cancer Genomics Initiative (MCGI), which provided access to GTTs; clinician educational resources; and genomic tumor boards in community practices in a predominantly rural state. 1603 adult cancer patients completed enrollment; 1258 had at least one potentially actionable variant identified. 206 (16.4%) patients received a total of 240 genome matched treatments, of those treatments, 64% were FDA-approved in the tumor type, 27% FDA-approved in a different tumor type and 9% were given on a clinical trial. Using Inverse Probability of Treatment Weighting to adjust for baseline characteristics, a Cox proportional hazards model demonstrated that patients who received genome matched treatment were 31% less likely to die within 1 year compared to those who did not receive genome matched treatment (HR: 0.69; 95% CI: 0.52-0.90; p-value: 0.006). Overall, GTT through this initiative resulted in levels of genome matched treatment that were similar to other initiatives, however, clinical trials represented a smaller share of treatments than previously reported, and "off-label" treatments represented a greater share. Although this was an observational study, we found evidence for a potential 1-year survival benefit for patients who received genome matched treatments. These findings suggest that when disseminated and implemented with a supportive infrastructure, GTT may benefit cancer patients in rural community oncology settings, with further work remaining on providing genome-matched clinical trials.
Collapse
Affiliation(s)
- Eric C Anderson
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - John DiPalazzo
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
| | - F Lee Lucas
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
| | | | | | | | | | | | | | | | - Leslie S Bradford
- Maine Medical Partners Women's Health, Gynecologic Oncology, Scarborough, ME, USA
| | - Roger Inhorn
- PenBay Medical Center Oncology, Rockport, ME, USA
| | | | | | | | | | - Paul K J Han
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
- National Cancer Institute, Bethesda, MD, USA
| | - Edison T Liu
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | | |
Collapse
|
49
|
Peppercorn J. What's Going On?: A Call for Rededication to Addressing Disparities in Oncology Practice. JCO Oncol Pract 2024; 20:305-307. [PMID: 38394606 DOI: 10.1200/op.24.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
|
50
|
Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2024; 74:136-166. [PMID: 37962495 DOI: 10.3322/caac.21812] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.
Collapse
Affiliation(s)
| | | | | | | | | | - Priti Bandi
- American Cancer Society, Atlanta, Georgia, USA
| | | | | | | | | | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | |
Collapse
|