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Crabtree-Ide C, Sevdalis N, Bellohusen P, Constine LS, Fleming F, Holub D, Rizvi I, Rodriguez J, Shayne M, Termer N, Tomaszewski K, Noyes K. Strategies for Improving Access to Cancer Services in Rural Communities: A Pre-implementation Study. FRONTIERS IN HEALTH SERVICES 2022; 2:818519. [PMID: 36925773 PMCID: PMC10012790 DOI: 10.3389/frhs.2022.818519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/28/2022] [Indexed: 12/18/2022]
Abstract
Background Implementation science is defined as the scientific study of methods and strategies that facilitate the uptake of evidence-based practice into regular use by practitioners. Failure of implementation is more common in resource-limited settings and may contribute to health disparities between rural and urban communities. In this pre-implementation study, we aimed to (1) evaluate barriers and facilitators for implementation of guideline-concordant healthcare services for cancer patients in rural communities in Upstate New York and (2) identify key strategies for successful implementation of cancer services and supportive programs in resource-poor settings. Methods The mixed methods study was guided by the Consolidated Framework for Implementation Research (CFIR). Using engagement approaches from Community-Based Participatory Research, we collected qualitative and quantitative data to assess barriers and facilitators to implementation of rural cancer survivorship services (three focus groups, n = 43, survey n = 120). Information was collected using both in-person and web-based approaches and assessed attitude and preferences for various models of cancer care organization and delivery in rural communities. Stakeholders included cancer survivors, their families and caregivers, local public services administrators, health providers, and allied health-care professionals from rural and remote communities in Upstate New York. Data was analyzed using grounded theory. Results Responders reported preferences for cross-region team-based cancer care delivery and emphasized the importance of connecting local providers with cancer care networks and multidisciplinary teams at large urban cancer centers. The main reported barriers to rural cancer program implementation included regional variation in infrastructure and services delivery practices, inadequate number of providers/specialists, lack of integration among oncology, primary care and supportive services within the regions, and misalignment between clinical guideline recommendations and current reimbursement policies. Conclusions Our findings revealed a unique combination of community, socio-economic, financial, and workforce barriers to implementation of guideline-concordant healthcare services for cancer patients in rural communities. One strategy to overcome these barriers is to improve provider cross-region collaboration and care coordination by means of teamwork and facilitation. Augmenting implementation framework with provider team-building strategies across and within regions could improve rural provider confidence and performance, minimize chances of implementation failure, and improve continuity of care for cancer patients living in rural areas.
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Affiliation(s)
- Christina Crabtree-Ide
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Nick Sevdalis
- Center for Implementation Science, King's College London, London, United Kingdom
| | - Patricia Bellohusen
- Judy DiMarzo Cancer Survivorship Program, University of Rochester, Rochester, NY, United States
| | - Louis S. Constine
- Department of Radiation Oncology, Wilmot Cancer Institute, Rochester, NY, United States
| | - Fergal Fleming
- Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY, United States
| | - David Holub
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Irfan Rizvi
- Mid-Atlantic Permanente Medical Group, McLean, VA, United States
| | - Jennifer Rodriguez
- Livingston County Public Health Department, Mt. Morris, NY, United States
| | - Michelle Shayne
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Nancy Termer
- Flatiron Healthcare Inc., New York, NY, United States
| | | | - Katia Noyes
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, United States
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Arega M, Linggonegoro DW, Dee EC, Torous J. Financial Worry and Psychological Distress Among Immigrants in the United States, 2013-2018. J Psychiatr Pract 2022; 28:117-129. [PMID: 35238823 DOI: 10.1097/pra.0000000000000612] [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: 11/26/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has highlighted links among economic stability, health outcomes, and migration. The facets of financial worry and their associated psychological burden have been understudied among the immigrant population. The goal of this study was to determine the specific facets of financial worry and associated psychological burden in immigrants. This cross-sectional study, which used data from the 2013 to 2018 National Health Interview Survey (NHIS), examined patient-reported measures of worry regarding financial strain. The NHIS is a household survey of noninstitutionalized, nonmilitary adults in the United States. Multivariable ordinal logistic regressions were used to define adjusted odds ratios (AORs) for financial worry and psychological distress, adjusting for various sociodemographic variables. Among 131,669 US-born and 26,155 non-US-born participants who responded to all 6 questions on the 6-item Kessler Psychological Distress Scale (K6), the overall prevalence of participants reporting any serious psychological distress (K6 score ≥13) was 3.0% and 2.25%, respectively. Despite these overall prevalence data, there were specific areas of financial worries that were higher in non-US-born participants than in US-born participants. Compared with US-born participants, non-US-born participants had higher rates of financial worries regarding retirement [75.78% vs. 69.08%, AOR=1.37, 95% confidence interval (CI) 1.29-1.45, P<0.001], medical costs due to illness (worry about not being able to pay medical costs of a serious illness or accident) (74.94% vs. 65.27%, AOR=1.37, 95% CI: 1.29-1.45, P<0.001), standard of living (74.25% vs. 65.29%, AOR=1.42, 95% CI: 1.34-1.51, P<0.001), and medical cost of health care (worry about not having enough to pay medical costs for normal health care) (66.52% vs. 52.67%, AOR=1.51, 95% CI: 1.43-1.60, P<0.001), among other costs. Notably, serious psychological distress in non-US-born individuals was associated with increased financial worry relative to US-born individuals with a similar level of psychological distress. Further research is needed to evaluate the role physicians can play in mitigating psychological distress in patients with increased financial worry.
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Jamieson A, Huvila J, Thompson EF, Leung S, Chiu D, Lum A, McConechy M, Grondin K, Aguirre-Hernandez R, Salvador S, Kean S, Samouelian V, Gougeon F, Azordegan N, Lytwyn A, Parra-Herran C, Offman S, Gotlieb W, Irving J, Kinloch M, Helpman L, Scott SA, Vicus D, Plante M, Huntsman DG, Gilks CB, Talhouk A, McAlpine JN. Variation in practice in endometrial cancer and potential for improved care and equity through molecular classification. Gynecol Oncol 2022; 165:201-214. [PMID: 35246332 DOI: 10.1016/j.ygyno.2022.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We measured the variation in practice across all aspects of endometrial cancer (EC) management and assessed the potential impact of implementation of molecular classification. METHODS Centers from across Canada provided representative tumor samples and clinical data, including preoperative workup, operative management, hereditary cancer program (HCP) referrals, adjuvant therapy, surveillance and outcomes, for all EC patients diagnosed in 2016. Tumors were classified into the four ProMisE molecular subtypes. RESULTS A total of 1336 fully evaluable EC patients were identified from 10 tertiary cancer centers (TC; n = 1022) and 19 community centers (CC; n = 314). Variation of surgical practice across TCs was profound (14-100%) for lymphadenectomy (LND) (mean 57% Gr1/2, 82% Gr3) and omental sampling (20% Gr1/2, 79% Gr3). Preoperative CT scans were inconsistently obtained (mean 32% Gr1/2, 51% Gr3) and use of adjuvant chemo or chemoRT in high risk EC ranged from 0-55% and 64-100%, respectively. Molecular subtyping was performed retrospectively and identified 6% POLEmut, 28% MMRd, 48% NSMP and 18% p53abn ECs, and was significantly associated with survival. Within patients retrospectively diagnosed with MMRd EC only 22% had been referred to HCP. Of patients with p53abn EC, LND and omental sampling was not performed in 21% and 23% respectively, and 41% received no chemotherapy. Comparison of management in 2016 with current 2020 ESGO/ESTRO/ESP guidelines identified at least 26 and 95 patients that would have been directed to less or more adjuvant therapy, respectively (10% of cohort). CONCLUSION Molecular classification has the potential to mitigate the profound variation in practice demonstrated in current EC care, enabling reproducible risk assessment, guiding treatment and reducing health care disparities.
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Affiliation(s)
- Amy Jamieson
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, Vancouver, Canada
| | - Jutta Huvila
- Department of Pathology, University of Turku, Turku University Hospital, Turku, Finland; Department of Molecular Oncology, University of British Columbia, Vancouver, Canada
| | - Emily F Thompson
- Department of Molecular Oncology, University of British Columbia, Vancouver, Canada
| | - Samuel Leung
- Department of Molecular Oncology, University of British Columbia, Vancouver, Canada
| | - Derek Chiu
- Department of Molecular Oncology, University of British Columbia, Vancouver, Canada
| | - Amy Lum
- Department of Molecular Oncology, University of British Columbia, Vancouver, Canada
| | | | | | | | - Shannon Salvador
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, McGill University, Montreal, Canada
| | - Sarah Kean
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of Manitoba, Winnipeg, Canada
| | - Vanessa Samouelian
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of Montreal, Montreal, Canada
| | - Francois Gougeon
- Department of Pathology, University of Montreal, Montreal, Canada
| | - Nazila Azordegan
- Department of Pathology, University of Manitoba, Winnipeg, Canada
| | - Alice Lytwyn
- Department of Pathology, McMaster University, Hamilton, Canada
| | | | - Saul Offman
- Department of Pathology, Dalhousie University, Halifax, Canada
| | - Walter Gotlieb
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, McGill University, Montreal, Canada
| | - Julie Irving
- Department of Pathology, University of British Columbia, Vancouver, Canada
| | - Mary Kinloch
- Department of Pathology, University of Saskatchewan, Saskatoon, Canada
| | - Limor Helpman
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, McMaster University, Hamilton, Canada
| | - Stephanie A Scott
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Dalhousie University, Halifax, Canada
| | - Danielle Vicus
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of Toronto, Toronto, Canada
| | - Marie Plante
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Laval University, Quebec City, Canada
| | - David G Huntsman
- Department of Molecular Oncology, University of British Columbia, Vancouver, Canada; Canexia Health, Inc., Vancouver, Canada; Department of Pathology, University of British Columbia, Vancouver, Canada
| | - C Blake Gilks
- Department of Pathology, University of British Columbia, Vancouver, Canada
| | - Aline Talhouk
- Department of Molecular Oncology, University of British Columbia, Vancouver, Canada
| | - Jessica N McAlpine
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, Vancouver, Canada.
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Cohen SA, Nash CC, Byrne EN, Mitchell LE, Greaney ML. Black/White Disparities in Obesity Widen with Increasing Rurality: Evidence from a National Survey. Health Equity 2022; 6:178-188. [PMID: 35402770 PMCID: PMC8985531 DOI: 10.1089/heq.2021.0149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Steven A. Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Caitlin C. Nash
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Erin N. Byrne
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lauren E. Mitchell
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
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Jensen JD, Shannon J, Iachan R, Deng Y, Kim SJ, Demark-Wahnefried W, Faseru B, Paskett ED, Hu J, Vanderpool RC, Lazovich D, Mendoza JA, Shete S, Robertson LB, Balkrishnan R, Briant KJ, Haaland B, Haggstrom DA, Fuemmeler BF. Examining Rural-Urban Differences in Fatalism and Information Overload: Data from 12 NCI-Designated Cancer Centers. Cancer Epidemiol Biomarkers Prev 2022; 31:393-403. [PMID: 35091459 DOI: 10.1158/1055-9965.epi-21-0355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/01/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rural populations experience a disproportionate cancer burden relative to urban populations. One possibility is that rural populations are more likely to hold counterproductive cancer beliefs such as fatalism and information overload that undermine prevention and screening behaviors. METHODS Between 2016 and 2020, 12 U.S. cancer centers surveyed adults in their service areas using online and in-person survey instruments. Participants (N = 10,362) were designated as rural (n = 3,821) or urban (n = 6,541). All participants were 18 and older (M = 56.97, SD = 16.55), predominately non-Hispanic White (81%), and female (57%). Participants completed three items measuring cancer fatalism ("It seems like everything causes cancer," "There's not much you can do to lower your chances of getting cancer," and "When I think about cancer, I automatically think about death") and one item measuring cancer information overload ("There are so many different recommendations about preventing cancer, it's hard to know which ones to follow"). RESULTS Compared with urban residents, rural residents were more likely to believe that (i) everything causes cancer (OR = 1.29; 95% CI, 1.17-1.43); (ii) prevention is not possible (OR = 1.34; 95% CI, 1.19-1.51); and (iii) there are too many different recommendations about cancer prevention (OR = 1.26; 95% CI, 1.13-1.41), and cancer is always fatal (OR = 1.21; 95% CI, 1.11-1.33). CONCLUSIONS Compared with their urban counterparts, rural populations exhibited higher levels of cancer fatalism and cancer information overload. IMPACT Future interventions targeting rural populations should account for higher levels of fatalism and information overload.
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Affiliation(s)
- Jakob D Jensen
- Department of Communication, University of Utah, Salt Lake City, Utah.
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jackilen Shannon
- Oregon Health and Science University - Portland State University, School of Public Health, Oregon Health and Science University, Portland, Oregon
| | | | | | - Sunny Jung Kim
- Department of Health Behavior and Policy, Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences and O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Babalola Faseru
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas
- University of Kansas Cancer Center, Kansas City, Kansas
| | - Electra D Paskett
- Department of Internal Medicine, College of Medicine, and OSU Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Jinxiang Hu
- University of Kansas Cancer Center, Kansas City, Kansas
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Robin C Vanderpool
- Department of Health, Behavior and Society and Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Jason A Mendoza
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Sanjay Shete
- Department of Biostatistics and Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Linda B Robertson
- School of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rajesh Balkrishnan
- Department of Public Health Sciences and UVA Cancer Center, University of Virginia, Charlottesville, Virginia
| | - Katherine J Briant
- Office of Community Outreach and Engagement, Fred Hutch/University of Washington Cancer Consortium, Seattle, Washington
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Population Sciences, University of Utah, Salt Lake City, Utah
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Kaur H, Fernández JR, Locher JL, Demark-Wahnefried W. Rural and Urban Differences in Vegetable and Fruit Consumption Among Older Cancer Survivors in the Deep South: An Exploratory Cross-Sectional Study. J Acad Nutr Diet 2022; 122:1717-1724.e4. [PMID: 35017097 PMCID: PMC9271124 DOI: 10.1016/j.jand.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/21/2021] [Accepted: 01/06/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Cancer survivors, especially those who are older, experience increased comorbidity and risk for secondary cancers. A varied dietary pattern, rich in vegetables and fruit (V&F) is recommended to improve health. However, V&F intake may differ by rural versus urban status. OBJECTIVE To assess differences in V&F consumption among older cancer survivors residing in urban- and rural-designated areas, and explore whether differences exist by sex, race, and cancer type. DESIGN This was a cross-sectional secondary analysis. PARTICIPANTS/SETTING Screening data from the Harvest for Health trial were obtained from October 2016 to November 2019 on 731 Medicare-eligible cancer survivors across Alabama. MAIN OUTCOME MEASURES V&F consumption was measured by 2-items from the Eating at America's Table NCI Dietary Screener. Rural and urban residence was coded at the zip-code level using the USDA's Rural-Urban Commuting Area (RUCA) coding schema using five different classifications (A-E). Sex, race and cancer-type were dichotomized as male/female, Non-Hispanic White (NHW)/Non-Hispanic Black (NHB) and gastro-intestinal/other cancers, respectively. STATISTICAL ANALYSES Kruskal Wallis rank sum and post-hoc tests were performed to detect differences in V&F consumption (α<0.05). RESULTS The study sample was largely female (66.2%), NHW (78.1%), of mean age 70 years and reported an average V&F intake of 1.47 cups/day. V&F consumption of cancer survivors living in isolated, small, rural towns was roughly half that consumed by survivors living elsewhere; thus, statistically significant rural-urban differences were found in models that accounted specifically for this subgroup, i.e., RUCA categorizations A and E.V&F consumption also was significantly lower in NHB (1.32 ± 0.98 cups/day) than NHW survivors (1.51 ± 1.10 cups/day) (p=0.0456); however, no statistically significant differences were detected by sex and cancer type. CONCLUSION Analyses that address the variability within "rural" designated areas are important in future studies. Moreover, a greater understanding is needed of factors that adversely affect V&F consumption of those most vulnerable, i.e., older NHB cancer survivors as well as those living in isolated, small, rural towns to best target future interventions.
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Affiliation(s)
- Harleen Kaur
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), 1675 University Boulevard, Webb Nutrition Sciences Bldg., Room 604A Birmingham, AL 35294-3360.
| | - José R Fernández
- Professor and Vice Chair for Education, Department of Nutrition Sciences, UAB, 1675 University Boulevard, Webb Nutrition Sciences Bldg., Room 522 Birmingham, AL 35294-3360
| | - Julie L Locher
- Professor Emerita, Department of Medicine, UAB, CH19-Room 218F; Birmingham, Alabama 35294-2041
| | - Wendy Demark-Wahnefried
- Associate Director for Cancer Prevention and Control for the O'Neal Comprehensive Cancer Center at UAB, Professor and Webb Endowed Chair of Nutrition Sciences, American Cancer Society Clinical Research Professor, Department of Nutrition Sciences, UAB, 1675 University Boulevard, Webb Nutrition Sciences Bldg., Room 650 Birmingham, AL 35294-3360
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Adamowicz JL, Christensen A, Howren MB, Seaman AT, Kendell ND, Wardyn S, Pagedar NA. Health-related quality of life in head and neck cancer survivors: Evaluating the rural disadvantage. J Rural Health 2022; 38:54-62. [PMID: 33720456 PMCID: PMC8477149 DOI: 10.1111/jrh.12571] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Head and neck cancer (HNC) survivors often experience distress and health-related quality of life (HRQOL) impairment. Research suggests that rural cancer patients may have poorer outcomes than urban patients. This study examined whether HNC patient emotional and HRQOL outcomes differ in those living in a rural versus urban location at 6 and 12 months postdiagnosis. METHODS A total of 261 HNC patients were included from a longitudinal study of HNC outcomes. The majority were diagnosed with advanced stage cancer (51.3%); the most common cancer site was oral cavity (41.0%). Rurality was measured using the US Department of Agriculture Rural Urban Commuting Area codes. Depression was measured using the Beck Depression Inventory (BDI), general HRQOL using the Short Form-36 (SF-36), and HNC-specific HRQOL using the Head and Neck Cancer Inventory (HNCI). Analyses were 2 (group) × 3 (assessment) repeated measures ANCOVAs, controlling for demographic and clinical characteristics. FINDINGS Approximately 45% of the sample lived in a rural location. Follow-up comparisons of significant overall models indicated that rural patients reported significantly more nonsomatic depression symptoms at 6-month follow-up. Rural patients were also more likely to report significantly poorer general mental HRQOL at 12-month follow-up, significantly poorer HNC-specific HRQOL related to eating at 6- and 12-month follow-up, and marginally worse aesthetics at 12-month follow-up. CONCLUSIONS These findings are consistent with suggestions that rural HNC patients may be at heightened risk for depression symptoms and decrements in HRQOL. Patients should be screened and regularly monitored for issues with depression and HNC-specific HRQOL throughout the survivorship period.
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Affiliation(s)
- Jenna L. Adamowicz
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa
- Department of Psychological & Brain Sciences, The University of Iowa, Iowa City, Iowa
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Alan Christensen
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa
- Department of Psychological & Brain Sciences, The University of Iowa, Iowa City, Iowa
- Department of Psychology, East Carolina University, Greenville, North Carolina
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - M. Bryant Howren
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa
- Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida
- Florida Blue Center for Rural Health Research & Policy, College of Medicine, Florida State University, Tallahassee, Florida
- Center for Access Delivery Research & Evaluation, VA Iowa City Healthcare System, Iowa City, Iowa
| | - Aaron T. Seaman
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
- Center for Access Delivery Research & Evaluation, VA Iowa City Healthcare System, Iowa City, Iowa
| | - Nicholas D. Kendell
- Department of Otolaryngology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Shylo Wardyn
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa
- Center for Access Delivery Research & Evaluation, VA Iowa City Healthcare System, Iowa City, Iowa
| | - Nitin A. Pagedar
- Department of Otolaryngology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
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Difference in medical service use among Korean gastric cancer survivors according to regional healthcare vulnerabilities: a cohort study. Support Care Cancer 2022; 30:9233-9241. [PMID: 36056274 PMCID: PMC9633440 DOI: 10.1007/s00520-022-07346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/24/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE This study investigated the relationship between medical service use and healthcare vulnerability, pre- and post-gastric cancer diagnosis. Differences between healthcare-vulnerable and healthcare-nonvulnerable regions identified inequities that require intervention. METHODS This cohort study was done using the National Health Insurance claims data of patients diagnosed with gastric cancer between 2004 and 2013. The Position Value for Relative Comparison Index was used to determine whether the patients lived in a healthcare-vulnerable region. Medical service use was classified into annual outpatient treatment, hospitalization days, and emergency treatment. We used a generalized linear model to which the Poisson distribution was applied and compared regional differences in medical service use. RESULTS A total of 1797 gastric cancer patients who had survived 5 years post-diagnosis were included in the study, of which 14.2% lived in healthcare-vulnerable regions. The patients in vulnerable regions surviving 5-7 years post-diagnosis had a higher number of outpatient visits than those in nonvulnerable regions. Furthermore, hospitalization days were lesser for patients in vulnerable regions who survived 6 years post-diagnosis than those in nonvulnerable regions; however, this number increased in the seventh year. CONCLUSIONS Our results suggest that gastric cancer survivors living in healthcare-vulnerable regions have a higher probability of increased medical service use 5 years post-diagnosis compared with patients in nonvulnerable regions, which may significantly increase healthcare disparities over time. Therefore, in the future, additional research is needed to elucidate the causes of the disparities in healthcare use and the results of the differences in health outcomes.
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Hirko KA, Dorn JM, Dearing JW, Alfano CM, Wigton A, Schmitz KH. Implementation of Physical Activity Programs for Rural Cancer Survivors: Challenges and Opportunities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412909. [PMID: 34948517 PMCID: PMC8702182 DOI: 10.3390/ijerph182412909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 12/03/2022]
Abstract
Physical activity after cancer diagnosis has been consistently associated with improvements in quality of life and prognosis. However, few cancer survivors meet physical activity recommendations, and adherence is even lower among those living in rural settings. The purpose of this quasi-experimental study was to evaluate the implementation of a clinic-based physical activity program for cancer survivors at a rural community oncology setting. We also examined changes in quality-of-life measures among 24 cancer survivors participating in the physical activity program and described challenges and opportunities to optimize future implementation efforts in rural settings. Significant pre- to post-program improvements in fatigue (5.5 to 6.8; p = 0.03), constipation (7.7 to 9.0; p = 0.02), pain (6.7 to 8.0; p = 0.007), and sleep quality (p = 0.008) were observed. Participants also reported improved nausea, stamina, depression, stress, and overall physical health after participation in the physical activity program, although the differences were not statistically significant (all p-values > 0.13). However, the reach of the physical activity program was limited, with only 0.59% of cancer survivors participating. Fidelity to the physical activity program was relatively high, with 72.7% of survivors participating in at least five classes. Our findings suggest that physical activity programs in oncological settings may need tailoring to effectively reach rural cancer survivors.
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Affiliation(s)
- Kelly A. Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
- Correspondence:
| | - Joan M. Dorn
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA;
| | - James W. Dearing
- Department of Communications, Michigan State University, East Lansing, MI 48824, USA;
| | | | | | - Kathryn H. Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA;
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Mama SK, Lopez-Olivo MA, Bhuiyan N, Leach HJ. Effectiveness of Physical Activity Interventions among Rural Cancer Survivors: A Systematic Review and Meta-Analysis. Cancer Epidemiol Biomarkers Prev 2021; 30:2143-2153. [PMID: 34620628 PMCID: PMC8643319 DOI: 10.1158/1055-9965.epi-21-0871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/06/2021] [Accepted: 10/04/2021] [Indexed: 12/24/2022] Open
Abstract
This review estimated the effectiveness of behavior change interventions to increase physical activity (PA) among rural adult cancer survivors. PubMed Medline, CINAHL, and PsychINFO were systematically searched through July 2020. Two independent investigators screened citations to identify studies to increase PA in adults residing in rural areas who had received any cancer diagnosis. Meta-analyses were conducted to assess proportion of participants achieving PA goal, paired mean difference (MD) in aerobic PA and strength training, and retention from baseline to post-intervention. Seven studies met inclusion criteria encompassing a total of 722 participants (591 in intervention and 131 controls). Overall quality of evidence was low to medium. The pooled proportion of participants achieving PA goals (150-225 min/wk) was 39% [95% confidence interval (CI), 18%-62%]. The mean time spent engaging in aerobic PA increased from baseline to post-intervention (range, 6-52 weeks) by 97.7 min/wk (95% CI, 75.0-120.4), and the MD in time spent on strength training was 12.2 min/wk (95% CI, -8.3-32.8). The pooled retention rate was 82% (95% CI, 69%-92%) at 6 to 78 weeks. Because of the modest intervention effects, low quality of evidence, and small number of studies, further rigorously designed behavior change interventions, including randomized controlled trials with long-term follow up, are needed to confirm efficacy for increasing PA in rural cancer survivors and to test innovative implementation strategies to enhance reach and effectiveness.
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Affiliation(s)
- Scherezade K Mama
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Maria A Lopez-Olivo
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nishat Bhuiyan
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Heather J Leach
- Department of Health and Exercise Science, College of Health and Human Science, Colorado State University, Fort Collins, Colorado
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Osazuwa-Peters N, Barnes JM, Okafor SI, Taylor DB, Hussaini AS, Adjei Boakye E, Simpson MC, Graboyes EM, Lee WT. Incidence and Risk of Suicide Among Patients With Head and Neck Cancer in Rural, Urban, and Metropolitan Areas. JAMA Otolaryngol Head Neck Surg 2021; 147:1045-1052. [PMID: 34297790 PMCID: PMC8304170 DOI: 10.1001/jamaoto.2021.1728] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 01/13/2023]
Abstract
Importance Patients with head and neck cancer (HNC) are known to be at increased risk of suicide compared with the general population, but there has been insufficient research on whether this risk differs based on patients' rural, urban, or metropolitan residence status. Objective To evaluate whether the risk of suicide among patients with HNC differs by rural vs urban or metropolitan residence status. Design, Setting, and Participants This cross-sectional study uses data from the Surveillance, Epidemiology, and End Results database on patients aged 18 to 74 years who received a diagnosis of HNC from January 1, 2000, to December 31, 2016. Statistical analysis was conducted from November 27, 2020, to June 3, 2021. Exposures Residence status, assessed using 2013 Rural Urban Continuum Codes. Main Outcomes and Measures Death due to suicide was assessed by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes (U03, X60-X84, and Y87.0) and the cause of death recode (50220). Standardized mortality ratios (SMRs) of suicide, assessing the suicide risk among patients with HNC compared with the general population, were calculated. Suicide risk by residence status was compared using Fine-Gray proportional hazards regression models. Results Data from 134 510 patients with HNC (101 142 men [75.2%]; mean [SE] age, 57.7 [10.3] years) were analyzed, and 405 suicides were identified. Metropolitan residents composed 86.6% of the sample, urban residents composed 11.7%, and rural residents composed 1.7%. The mortality rate of suicide was 59.2 per 100 000 person-years in metropolitan counties, 64.0 per 100 000 person-years in urban counties, and 126.7 per 100 000 person-years in rural counties. Compared with the general population, the risk of suicide was markedly higher among patients with HNC in metropolitan (SMR, 2.78; 95% CI, 2.49-3.09), urban (SMR, 2.84; 95% CI, 2.13-3.71), and rural (SMR, 5.47; 95% CI, 3.06-9.02) areas. In Fine-Gray competing-risk analyses that adjusted for other covariates, there was no meaningful difference in suicide risk among urban vs metropolitan residents. However, compared with rural residents, residents of urban (subdistribution hazard ratio, 0.52; 95% CI, 0.29-0.94) and metropolitan counties (subdistribution hazard ratio, 0.55; 95% CI, 0.32-0.94) had greatly lower risk of suicide. Conclusions and Relevance The findings of this cross-sectional study suggest that suicide risk is elevated in general among patients with HNC but is significantly higher for patients residing in rural areas. Effective suicide prevention strategies in the population of patients with HNC need to account for rural health owing to the high risk of suicide among residents with HNC in rural areas.
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Affiliation(s)
- Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Editorial Board Member, JAMA Otolaryngology–Head & Neck Surgery
| | - Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Somtochi I. Okafor
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Adnan S. Hussaini
- Department of Otolaryngology–Head and Neck Surgery, Georgetown University Medical Center, Washington, DC
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
- Simmons Cancer Institute, Springfield, Illinois
| | - Matthew C. Simpson
- Department of Otolaryngology–Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
- Advanced Health Data Research Institute, St Louis University, St Louis, Missouri
| | - Evan M. Graboyes
- Editorial Board Member, JAMA Otolaryngology–Head & Neck Surgery
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Walter T. Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
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Pal T, Hull PC, Koyama T, Lammers P, Martinez D, McArthy J, Schremp E, Tezak A, Washburn A, Whisenant JG, Friedman DL. Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery. BMC Cancer 2021; 21:1262. [PMID: 34814868 PMCID: PMC8609269 DOI: 10.1186/s12885-021-08949-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite lower cancer incidence rates, cancer mortality is higher among rural compared to urban dwellers. Patient, provider, and institutional level factors contribute to these disparities. The overarching objective of this study is to leverage the multidisciplinary, multispecialty oncology team from an academic cancer center in order to provide comprehensive cancer care at both the patient and provider levels in rural healthcare centers. Our specific aims are to: 1) evaluate the clinical effectiveness of a multi-level telehealth-based intervention consisting of provider access to molecular tumor board expertise along with patient access to a supportive care intervention to improve cancer care delivery; and 2) identify the facilitators and barriers to future larger scale dissemination and implementation of the multi-level intervention. METHODS Coordinated by a National Cancer Institute-designated comprehensive cancer center, this study will include providers and patients across several clinics in two large healthcare systems serving rural communities. Using a telehealth-based molecular tumor board, sequencing results are reviewed, predictive and prognostic markers are discussed, and treatment plans are formulated between expert oncologists and rural providers. Simultaneously, the rural patients will be randomized to receive an evidence-based 6-week self-management supportive care program, Cancer Thriving and Surviving, versus an education attention control. Primary outcomes will be provider uptake of the molecular tumor board recommendation and patient treatment adherence. A mixed methods approach guided by the Consolidated Framework for Implementation Research that combines qualitative key informant interviews and quantitative surveys will be collected from both the patient and provider in order to identify facilitators and barriers to implementing the multi-level intervention. DISCUSSION The proposed study will leverage information technology-enabled, team-based care delivery models in order to deliver comprehensive, coordinated, and high-quality cancer care to rural and/or underserved populations. Simultaneous attention to institutional, provider, and patient level barriers to quality care will afford the opportunity for us to broadly share oncology expertise and develop dissemination and implementation strategies that will enhance the cancer care delivered to patients residing within underserved rural communities. TRIAL REGISTRATION Clinicaltrials.gov , NCT04758338 . Registered 17 February 2021 - Retrospectively registered, http://www.clinicaltrials.gov/.
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Affiliation(s)
- Tuya Pal
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 536 Robinson Research Building, Nashville, TN, 37232, USA
| | - Pamela C Hull
- University of Kentucky Markey Cancer Center, 800 Rose Street, Lexington, KY, 40536, USA
- Department of Behavioral Science, University of Kentucky College of Medicine, Rural and Underserved Health Research Center, Healthy Kentucky Research Building, 760 Press Avenue, Lexington, KY, 40536, USA
| | - Tatsuki Koyama
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Suite 1100, Nashville, TN, 37203, USA
| | - Phillip Lammers
- Baptist Cancer Center, 80 Humphreys Center Suite 330, Memphis, TN, 38120, USA
| | - Denise Martinez
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Jacob McArthy
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Emma Schremp
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Ann Tezak
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 536 Robinson Research Building, Nashville, TN, 37232, USA
| | - Anne Washburn
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Jennifer G Whisenant
- Division of Hematology & Oncology, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Debra L Friedman
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA.
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA.
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Suk R, Hong YR, Wasserman RM, Swint JM, Azenui NB, Sonawane KB, Tsai AC, Deshmukh AA. Analysis of Suicide After Cancer Diagnosis by US County-Level Income and Rural vs Urban Designation, 2000-2016. JAMA Netw Open 2021; 4:e2129913. [PMID: 34665238 PMCID: PMC8527360 DOI: 10.1001/jamanetworkopen.2021.29913] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Studies suggest the risk of suicide among people with cancer diagnosis is higher compared with the general population. However, little is known about how suicide risk among people diagnosed with cancer might vary according to area-level income and rurality. OBJECTIVE To examine whether the risks and patterns of suicide mortality among people with a cancer diagnosis differ by US county-level median income and rural or urban status. DESIGN, SETTING, AND PARTICIPANTS A retrospective, population-based cohort study following up individuals who were diagnosed with cancer between January 1, 2000, and December 31, 2016, was conducted. The Surveillance, Epidemiology, and End Results Program 18 registries (SEER 18) database was used to obtain data on persons diagnosed with a first primary malignant tumor. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. Analyses were conducted from February 22 to October 14, 2020. EXPOSURES County-level median household income and urban or rural status. MAIN OUTCOMES AND MEASURES Standardized mortality ratios (SMRs) of suicide deaths and annual percentage changes (APCs) of SMRs. RESULTS The SEER 18 database included 5 362 782 persons with cancer diagnoses living in 635 counties. Most study participants were men (51.2%), White (72.2%), and older than 65 years (49.7%). Among them, 6357 persons died of suicide (SMR, 1.41; 95% CI, 1.38-1.44). People with cancer living in the lowest-income counties had a significantly higher risk (SMR, 1.94; 95% CI, 1.76-2.13) than those in the highest-income counties (SMR, 1.30; 95% CI, 1.26-1.34). Those living in rural counties also had significantly higher SMR than those in urban counties (SMR, 1.81; 95% CI, 1.70-1.92 vs SMR, 1.35; 95% CI, 1.32-1.39). For all county groups, the SMRs were the highest within the first year following cancer diagnosis. However, among people living in the lowest-income counties, the risk remained significantly high even after 10 or more years following cancer diagnosis (SMR, 1.83; 95% CI, 1.31-2.48). The comparative risk of suicide mortality within 1 year following cancer diagnosis significantly decreased over the years but then plateaued in the highest-income (2005-2015: APC, 2.03%; 95% CI, -0.97% to 5.13%), lowest-income (2010-2015: APC, 4.80%; 95% CI, -19.97% to 37.24%), and rural (2004-2015: APC, 1.83; 95% CI, -1.98% to 5.79%) counties. CONCLUSIONS AND RELEVANCE This cohort study showed disparities in suicide risks and their patterns among people diagnosed with cancer by county-level income and rural or urban status. The findings suggest that additional research and effort to provide psychological services addressing these disparities among people with cancer may be beneficial.
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Affiliation(s)
- Ryan Suk
- Center for Health Systems Research, Policy and Practice, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
- Center for Health Promotion and Preventive Research, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
- UF Health Cancer Center, Gainesville, Florida
| | - Rachel M. Wasserman
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Orlando, Florida
| | - J. Michael Swint
- Center for Health Systems Research, Policy and Practice, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston McGovern School of Medicine
| | | | - Kalyani B. Sonawane
- Center for Health Services Research, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
- Center for Healthcare Data, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
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Li Y, Theodoropoulos N, Fujiwara Y, Xie H, Wang Q. Self-assessment of health status among lesbian, gay, and bisexual cancer survivors in the United States. Cancer 2021; 127:4594-4601. [PMID: 34406650 DOI: 10.1002/cncr.33845] [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: 03/20/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Research is lacking for understanding the health disparities in cancer survivorship in the lesbian, gay, and bisexual (LGB) population in the United States. Self-reported health status is used as a predictor of health disparities. METHODS This secondary data analysis study used 2018 Behavioral Risk Factor Surveillance System data to analyze cancer survivorship characteristics by sexual orientation and sex through the use of logistic regressions. RESULTS Overall, 17,656,329 US cancer survivors were included in this study after weighting, with percentage estimates of 1.52% for gays/lesbians and 1.41% for bisexuals. LGB participants were younger and more ethnically diverse. Significantly, bisexuals had current smoking (32.3% vs 13.6%) and binge drinking rates (17.1% vs 9.1%) twice those of heterosexuals; 16.6% of bisexuals versus 4.1% of heterosexuals reported no health insurance coverage (P < .0001). After adjustments for socioeconomic, health-related behavioral risk, and health care access factors, bisexual females reported poorer general health (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.31-1.36) as well as mental health (OR, 2.43; 95% CI, 2.39-2.46) than their heterosexual peers (P < .0001). Bisexual males were 5.14 times more likely to be told that they had depressive disorders than their heterosexual counterparts (95% CI, 5.05-5.23), whereas bisexual females were 3.23 times more likely for the same outcome (95% CI, 3.18-3.28). All LGB groups reported significantly more inadequate sleep than their heterosexual counterparts (especially lesbians: OR, 2.14; 95% CI, 2.10-2.18). CONCLUSIONS This study indicates that LGB cancer survivors have worse survivorship than their heterosexual peers with heterogeneity in subgroups. Future studies should use larger sample sizes, further investigate disparities, and promote survivorship in LGB populations. LAY SUMMARY It has been observed that lesbian, gay, and bisexual (LGB) cancer survivors may face challenges in cancer survivorship that are not as prevalent in the heterosexual community. This cross-sectional study has found that LGB cancer survivors, especially bisexuals, have overall poorer physical and mental health, are more likely to be told that they have depressive disorders, and have worse sleep quality in comparison with their heterosexual counterparts. These results also differ by sex, and this can provide rationales for future studies and guide interventions to relocate resources to better promote equality.
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Affiliation(s)
- Yannan Li
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Yu Fujiwara
- Department of Internal Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hui Xie
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Qian Wang
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Rural residence is related to shorter survival in epithelial ovarian cancer patients. Gynecol Oncol 2021; 163:22-28. [PMID: 34400004 DOI: 10.1016/j.ygyno.2021.07.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Rural residence has been related to health disparities and greater mortality risk in cancer patients, including gynecologic cancer patients. Lower survival rates for rural cancer survivors have been attributed to limited access to specialized healthcare, including surgery. Here, we examined whether a rural/urban survival gap existed in ovarian cancer patients receiving surgery at tertiary-care facilities, and potential causes for this gap, including educational attainment. METHODS Rural and urban patients with high grade invasive ovarian cancer (n = 342) seeking treatment at two midwestern tertiary-care university hospitals were recruited pre-surgery and followed until death or censoring date. Rural/urban residence was categorized using the USDA Rural-Urban Continuum Codes. Stratified Cox proportional hazards regression analyses, with clinical site as strata, adjusting for clinical and demographic covariates, were used to examine the effect of rurality on survival. RESULTS Despite specialized surgical care, rural cancer survivors showed a higher likelihood of death compared to their urban counterparts, HR = 1.39 (95% CI: 1.04, 1.85) p = 0.026, adjusted for covariates. A rurality by education interaction was observed (p = 0.027), indicating significantly poorer survival in rural vs. urban patients among those with trade school/some college education, adjusted HR = 2.49 (95% CI: 1.44, 4.30), p = 0.001; there was no rurality survival disparity for the other 2 levels of education. CONCLUSIONS Differences in ovarian cancer survival are impacted by rurality, which is moderated by educational attainment even in patients receiving initial care in tertiary settings. Clinicians should be aware of rurality and education as potential risk factors for adverse outcomes and develop approaches to address these possible risks.
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Effect of instrumental support on distress among family caregivers: Findings from a nationally representative study. Palliat Support Care 2021; 18:519-527. [PMID: 32090725 DOI: 10.1017/s1478951520000036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE A priority focus on palliative and supportive care is helping the 43.5 million caregivers who care for individuals with serious illness. Lacking support may lead to caregiver distress and poorer care delivery to patients with serious illness. We examined the potential of instrumental support (assistance with material and task performance) to mitigate distress among caregivers. METHOD We analyzed data from the nationally representative Health Information National Trends Survey (HINTS V2, 2018). Informal/family caregivers were identified in HINTS V2 if they indicated they were caring for or making healthcare decisions for another adult with a health problem. We used the PROMIS® instrumental support four-item short-form T-scores and the Patient Health Questionnaire (PHQ-4) for distress. We examined multivariable linear regression models for associations between distress and instrumental support, adjusted for sampling weights, socio-demographics, and caregiving variables (care recipient health condition(s), years caregiving (≥2), relationship to care recipient, and caregiver burden). We examined interactions between burden and instrumental support on caregiver distress level. RESULTS Our analyses included 311 caregivers (64.8% female, 64.9% non-Hispanic White). The unweighted mean instrumental support T-score was 50.4 (SD = 10.6, range = 29.3-63.3); weighted mean was 51.2 (SE = 1.00). Lower instrumental support (p < 0.01), younger caregiver age (p < 0.04), higher caregiving duration (p = 0.008), and caregiver unemployment (p = 0.006) were significantly associated with higher caregiver distress. Mean instrumental support scores by distress levels were 52.3 (within normal limits), 49.4 (mild), 48.9 (moderate), and 39.7 (severe). The association between instrumental support and distress did not differ by caregiver burden level. CONCLUSIONS Poor instrumental support is associated with high distress among caregivers, suggesting the need for palliative and supportive care interventions to help caregivers leverage instrumental support.
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Bhuiyan N, Linden-Carmichael AN, Lanza ST, Schmitz KH, Mama SK. Age-varying associations between physical activity and psychological outcomes among rural cancer survivors. J Behav Med 2021; 44:484-491. [PMID: 33047213 PMCID: PMC8039059 DOI: 10.1007/s10865-020-00187-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
We examined the prevalence of psychological outcomes (i.e., symptoms of depression and anxiety) by age and age-varying associations between physical activity and psychological outcomes among rural cancer survivors. Participants (N = 219; ages 22-93) completed sociodemographic, psychological, and physical activity questionnaires. Time-varying effect models estimated the prevalence of psychological outcomes and assessed associations between physical activity and psychological outcomes as a flexible function of age. Depression and anxiety symptoms decreased with age among cancer survivors aged 22-40 years and were relatively stable across age among those > 40 years. Positive associations between vigorous physical activity and psychological outcomes in those aged 22-40 years were identified. In those > 70-80 years, there were negative associations between vigorous physical activity and psychological outcomes. Results suggest there is variation across age in the associations between physical activity and psychological outcomes among rural survivors. Future research should further explore these age-varying relationships to identify important intervention targets.
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Affiliation(s)
- Nishat Bhuiyan
- Department of Kinesiology, The Pennsylvania State University, 23B Recreation Building, University Park, PA, 16802, USA.
| | - Ashley N Linden-Carmichael
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Stephanie T Lanza
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, 23B Recreation Building, University Park, PA, 16802, USA
- Penn State Cancer Institute, Hershey, PA, USA
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D'Arcy J, Haines K, Paul E, Doherty Z, Goodwin A, Bailey M, Barrett J, Bellomo R, Bucknall T, Gabbe BJ, Higgins AM, Iwashyna TJ, Murray LJ, Myles PS, Ponsford J, Pilcher D, Udy AA, Walker C, Young M, Cooper DJJ, Hodgson CL. The impact of distance on post-ICU disability. Aust Crit Care 2021; 35:355-361. [PMID: 34321180 DOI: 10.1016/j.aucc.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Nonurban residential living is associated with adverse outcomes for a number of chronic health conditions. However, it is unclear what effect it has amongst survivors of critical illness. OBJECTIVES The purpose of this study is to determine whether patients living greater than 50 km from the treating intensive care unit (ICU) have disability outcomes at 6 months that differ from people living within 50 km. METHODS This was a multicentre, prospective cohort study conducted in five metropolitan ICUs. Participants were adults admitted to the ICU, who received >24 h of mechanical ventilation and survived to hospital discharge. In a secondary analysis of these data, the cohort was dichotomised based on residential distance from the treating ICU: <50 km and ≥50 km. The primary outcome was patient-reported disability using the 12-item World Health Organization's Disability Assessment Schedule (WHODAS 2.0). This was recorded at 6 months after ICU admission by telephone interview. Secondary outcomes included health status as measured by EQ-5D-5L return to work and psychological function as measured by the Hospital Anxiety and Depression Scale (HADS). Multivariable logistic regression was used to assess the association between distance from the ICU and moderate to severe disability, adjusted for potential confounders. Variables included in the multivariable model were deemed to be clinically relevant and had baseline imbalance between groups (p < 0.10). These included marital status and hours of mechanical ventilation. Sensitivity analysis was also conducted using distance in kilometres as a continuous variable. RESULTS A total of 262 patients were enrolled, and 169 (65%) lived within 50 km of the treating ICU and 93 (35%) lived ≥50 km from the treating ICU (interquartile range [IQR] 10-664 km). There was no difference in patient-reported disability at 6 months between patients living <50 km and those living ≥50 km (WHODAS total disability % [IQR] 10.4 [2.08-25] v 14.6 [2.08-20.8], P = 0.74). There was also no difference between groups for the six major life domains of the WHODAS. There was no difference in rates of anxiety or depression as measured by HADS score (HADS anxiety median [IQR] 4 [1-7] v 3 [1-7], P = 0.60) (HADS depression median [IQR] 3 [1-6] v 3 [1-6], P = 0.62); health status as measured by EQ-5D (mean [SD] 66.7 [20] v 69.8 [22.2], P = 0.24); or health-related unemployment (% (N) 39 [26] v 25 [29.1], P = 0.61). After adjusting for confounders, living ≥50 km from the treating ICU was not associated with increased disability (odds ratio 0.61, 95% confidence interval: 0.33-1.16; P = 0.13) CONCLUSIONS: Survivors of intensive care in Victoria, Australia, who live at least 50 km from the treating ICU did not have greater disability than people living less than 50 km at 6 months after discharge. Living 50 km or more from the treating ICU was not associated with disability, nor was it associated with anxiety or depression, health status, or unemployment due to health.
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Affiliation(s)
| | | | - Eldho Paul
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia
| | - Zakary Doherty
- School of Public Health & Preventative Medicine, Monash University, Australia
| | - Andrew Goodwin
- Faculty of Engineering & Information Technologies, The University of Sydney, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; Department of Medicine and Radiology, University of Melbourne, Melbourne, Australia
| | - Jonathan Barrett
- Monash Partners Academic Health Science Centre, Australia; Epworth Hospital, Melbourne, Australia
| | - Rinaldo Bellomo
- Austin Health, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia
| | - Tracey Bucknall
- The Alfred Hospital, Melbourne, Australia; Deakin University, Melbourne, Geelong, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, UK
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - Theodore J Iwashyna
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; University of Michigan, Michigan, USA
| | - Lynne J Murray
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - Paul S Myles
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - Jennie Ponsford
- Monash Partners Academic Health Science Centre, Australia; School of Psychological Sciences, Monash University, Melbourne, Australia
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | | | - Meredith Young
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - D J Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia.
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Berkman AM, Andersen CR, Puthenpura V, Livingston JA, Ahmed S, Cuglievan B, Hildebrandt MAT, Roth ME. Impact of Race, Ethnicity, and Socioeconomic Status over Time on the Long-term Survival of Adolescent and Young Adult Hodgkin Lymphoma Survivors. Cancer Epidemiol Biomarkers Prev 2021; 30:1717-1725. [PMID: 34244160 DOI: 10.1158/1055-9965.epi-21-0103] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/24/2021] [Accepted: 06/23/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Although there are growing numbers of adolescent and young adult (AYA) Hodgkin lymphoma (HL) survivors, long-term overall survival (OS) patterns and disparities in this population are underreported. The aim of the current study was to assess the impact of race/ethnicity, socioeconomic status (SES), rurality, diagnosis age, sex, and HL stage over time on long-term survival in AYA HL survivors. METHODS The authors used the Surveillance, Epidemiology, and End Results (SEER) registry to identify survivors of HL diagnosed as AYAs (ages 15-39 years) between the years 1980 and 2009 and who were alive 5 years after diagnosis. An accelerated failure time model was used to estimate survival over time and compare survival between groups. RESULTS There were 15,899 5-year survivors of AYA HL identified, with a median follow-up of 14.4 years and range up to 33.9 years from diagnosis. Non-Hispanic black survivors had inferior survival compared with non-Hispanic white survivors [survival time ratio (STR): 0.71, P = 0.002]. Male survivors, older age at diagnosis, those diagnosed at higher stages, and those living in areas of higher SES deprivation had unfavorable long-term survival. There was no evidence of racial or sex-based survival disparities changing over time. CONCLUSIONS Racial, SES, and sex-based disparities persist well into survivorship among AYA HL survivors. IMPACT Disparities in long-term survival among AYA HL survivors show no evidence of improving over time. Studies investigating specific factors associated with survival disparities are needed to identify opportunities for intervention.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Clark R Andersen
- Division of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vidya Puthenpura
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - J Andrew Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Branko Cuglievan
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle A T Hildebrandt
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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70
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Batra A, Kong S, Cheung WY. Associations of Socioeconomic Status and Rurality With New-Onset Cardiovascular Disease in Cancer Survivors: A Population-Based Analysis. JCO Oncol Pract 2021; 17:e1189-e1201. [PMID: 34242068 DOI: 10.1200/op.20.01053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Patients with cancer are predisposed to develop new-onset cardiovascular disease (CVD). We aimed to assess if rural residence and low socioeconomic status modify such a risk. METHODS Patients diagnosed with solid organ cancers without any baseline CVD and on a follow-up of at least 1 year in a large Canadian province from 2004 to 2017 were identified using the population-based registry. We performed logistic regression analyses to examine the associations of rural residence and low socioeconomic status with the development of CVD. RESULTS We identified 81,418 patients eligible for the analysis. The median age was 62 years, and 54.3% were women. At a median follow-up of 68 months, 29.4% were diagnosed with new CVD. The median time from cancer diagnosis to CVD diagnosis was 29 months. Rural patients (32.3% v 28.5%; P < .001) and those with low income (30.4% v 25.9%; P < .001) or low educational attainment (30.7% v 27.6%; P < .001) experienced higher rates of CVD. After adjusting for baseline factors and treatment, rural residence (odds ratio [OR], 1.07; 95% CI, 1.04 to 1.11; P < .001), low income (OR, 1.17; 95% CI, 1.12 to 1.21; P < .001), and low education (OR, 1.08; 95% CI, 1.04 to 1.11; P < .001) continued to be associated with higher odds of CVD. A multivariate Cox regression model showed that patients with low socioeconomic status were more likely to die, but patients residing rurally were not. CONCLUSION Despite universal health care, marginalized populations experience different CVD risk profiles that should be considered when operationalizing lifestyle modification strategies and cardiac surveillance programs for the growing number of cancer survivors.
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Affiliation(s)
- Atul Batra
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada.,University of Calgary, Calgary, AB, Canada
| | | | - Winson Y Cheung
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada.,University of Calgary, Calgary, AB, Canada
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71
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Segel JE, Schaefer EW, Zaorsky NG, Hollenbeak CS, Ramian H, Raman JD. Potential Winners and Losers: Understanding How the Oncology Care Model May Differentially Affect Hospitals. JCO Oncol Pract 2021; 17:e1150-e1161. [PMID: 34242060 DOI: 10.1200/op.21.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE With the introduction of the Oncology Care Model and plans for the transition to Oncology Care First, alternative payment models (APMs) are an increasingly important piece of the oncology care landscape. Evidence is mixed on the Oncology Care Model's impact on utilization and costs, but as policymakers consider expansion of similar models, it is critical to understand the characteristics of hospitals that may be differentially affected. METHODS We used 2007-2016 SEER-Medicare data to identify patients with breast and prostate cancer receiving chemotherapy, endocrine therapy (breast), or androgen deprivation therapy (prostate). For each hospital, we calculated 6-month expected mortality, emergency department (ED) visits, inpatient admissions, and costs, all commonly collected APM outcomes. After calculating observed-to-expected rates for each outcome by hospital, we estimated the association between observed-to-expected rates and characteristics of each hospital to understand hospital characteristics that might be associated with higher- or lower-than-expected rates of each outcome. RESULTS Hospitals with > 15% rural patients had significantly higher-than-expected mortality (0.31 points higher, P < .001) and ED visit rates (0.10 points higher, P = .029) as well as significantly lower costs (0.06 points lower, P = .004). Hospitals unaffiliated with a medical school also experienced significantly higher-than-expected mortality and ED visits. Hospitals eligible for disproportionate share hospital payment experienced significantly higher ED visits but lower costs. For-profit hospitals experienced higher-than-expected mortality. CONCLUSION Rural hospitals and those unaffiliated with a medical school may require special consideration as APMs expand in oncology care. Designated cancer centers and larger hospitals may be advantaged.
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Affiliation(s)
- Joel E Segel
- Department of Health Policy and Administration, Penn State University, University Park, PA.,Penn State Cancer Institute, Hershey, PA.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Eric W Schaefer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Nicholas G Zaorsky
- Penn State Cancer Institute, Hershey, PA.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA.,Department of Radiation Oncology, Penn State College of Medicine, Hershey, PA
| | - Christopher S Hollenbeak
- Department of Health Policy and Administration, Penn State University, University Park, PA.,Penn State Cancer Institute, Hershey, PA.,Department of Surgery, Penn State College of Medicine, Hershey, PA
| | - Haleh Ramian
- Department of Health Policy and Administration, Penn State University, University Park, PA
| | - Jay D Raman
- Division of Urology, Penn State College of Medicine, Hershey, PA
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Impact of lay navigation on utilization and Medicare spending for cancer survivors in the "Deep South". J Cancer Surviv 2021; 16:705-713. [PMID: 34152532 DOI: 10.1007/s11764-021-01064-0] [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: 01/14/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Though lay navigation programs have proven beneficial for individuals during cancer treatment, little is known about the effects of lay navigation on health care utilization and Medicare spending among older adults during cancer survivorship. METHODS This retrospective cohort study used administrative claims data to evaluate a lay navigation program implemented from 2012 to 2015 at 12 academic and community cancer centers in the Southeast. Medicare beneficiaries age ≥65 years navigated during survivorship were compared to propensity score-matched, non-navigated cancer survivors. Quarterly trends in Medicare spending were estimated using repeated measures mixed models. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated using repeated measures generalized linear models for quarterly emergency room (ER) visits and hospitalizations. RESULTS Medicare spending for navigated (n = 3255) versus non-navigated older cancer survivors (n = 3255) was initially higher but declined faster by $513 per patient per quarter (95% CI -$616, -$410). Per patient per quarter risk of ER visits decreased by 11% (RR 0.89, 95% CI 0.86, 0.92) and hospitalizations decreased by 16% (RR 0.84, 95% CI 0.81, 0.88) over time comparing navigated versus non-navigated patients. Similar results were seen for patients enrolled in navigation post-treatment (N = 1893). CONCLUSIONS In older cancer survivors receiving care in the Deep South, patients receiving lay navigation compared to those non-navigated had significant reductions in Medicare spending, hospitalizations, and ER visits. IMPLICATIONS FOR CANCER SURVIVORS Though much emphasis has been placed on lay navigation during initial cancer treatment, navigation is needed throughout survivorship due to the high costs and health care utilization that persist post-treatment.
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Ester M, McNeely ML, McDonough MH, Dreger J, Culos-Reed SN. Protocol: A cluster randomized controlled trial of a mobile application to support physical activity maintenance after an exercise oncology program. Contemp Clin Trials 2021; 107:106474. [PMID: 34098040 DOI: 10.1016/j.cct.2021.106474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES/PURPOSE Increasing physical activity (PA) among adults living with cancer is a public health priority, especially for those in remote/rural locations who have worse health outcomes and lower PA than urban populations. Mobile health technology may overcome barriers to PA participation and change PA behavior. However, few mobile health interventions have focused on sustaining PA long-term in remote/rural adults living with cancer. The present study will examine the effectiveness of a mobile health application to promote PA maintenance in remote/rural adults after completing an exercise oncology program. METHODS The 24-week prospective 2-arm pilot randomized controlled trial will be embedded within an exercise oncology program in in remote/rural Canada. Participants will be randomized by class cluster 1:1 to the intervention or EXCEL only control group. Both groups will participate in a supervised 12-week group-based exercise oncology program, followed by a 12-week PA maintenance period. The intervention group will use a mobile health application, Zamplo, to complete regular health check-ins and reflections via graphs for 24 weeks. Data will be collected at baseline, 4, 12, 24 weeks using surveys, activity tracking, and semi-structured interviews. Analyses will assess intervention effectiveness to promote PA maintenance and examine participant perspectives and use of Zamplo to support PA. SIGNIFICANCE The present study will generate new knowledge on the potential of an mHealth app to promote PA maintenance in remote/rural adults living with cancer. It will inform the integration of mobile health resources within online-delivered exercise oncology programs, leading to sustainable long-term health benefits for this population.
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Affiliation(s)
- Manuel Ester
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| | - Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada; Rehabilitation Medicine, Cross Cancer Institute, Edmonton, AB, Canada
| | | | - Julianna Dreger
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Department of Oncology, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Psychosocial Resources, Tom Baker Cancer Centre, Cancer Care, Alberta Health Services, Calgary, AB, Canada
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Kaphingst KA, Kohlmann W, Chambers RL, Goodman MS, Bradshaw R, Chan PA, Chavez-Yenter D, Colonna SV, Espinel WF, Everett JN, Gammon A, Goldberg ER, Gonzalez J, Hagerty KJ, Hess R, Kehoe K, Kessler C, Kimball KE, Loomis S, Martinez TR, Monahan R, Schiffman JD, Temares D, Tobik K, Wetter DW, Mann DM, Kawamoto K, Del Fiol G, Buys SS, Ginsburg O. Comparing models of delivery for cancer genetics services among patients receiving primary care who meet criteria for genetic evaluation in two healthcare systems: BRIDGE randomized controlled trial. BMC Health Serv Res 2021; 21:542. [PMID: 34078380 PMCID: PMC8170651 DOI: 10.1186/s12913-021-06489-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/06/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Advances in genetics and sequencing technologies are enabling the identification of more individuals with inherited cancer susceptibility who could benefit from tailored screening and prevention recommendations. While cancer family history information is used in primary care settings to identify unaffected patients who could benefit from a cancer genetics evaluation, this information is underutilized. System-level population health management strategies are needed to assist health care systems in identifying patients who may benefit from genetic services. In addition, because of the limited number of trained genetics specialists and increasing patient volume, the development of innovative and sustainable approaches to delivering cancer genetic services is essential. METHODS We are conducting a randomized controlled trial, entitled Broadening the Reach, Impact, and Delivery of Genetic Services (BRIDGE), to address these needs. The trial is comparing uptake of genetic counseling, uptake of genetic testing, and patient adherence to management recommendations for automated, patient-directed versus enhanced standard of care cancer genetics services delivery models. An algorithm-based system that utilizes structured cancer family history data available in the electronic health record (EHR) is used to identify unaffected patients who receive primary care at the study sites and meet current guidelines for cancer genetic testing. We are enrolling eligible patients at two healthcare systems (University of Utah Health and New York University Langone Health) through outreach to a randomly selected sample of 2780 eligible patients in the two sites, with 1:1 randomization to the genetic services delivery arms within sites. Study outcomes are assessed through genetics clinic records, EHR, and two follow-up questionnaires at 4 weeks and 12 months after last genetic counseling contactpre-test genetic counseling. DISCUSSION BRIDGE is being conducted in two healthcare systems with different clinical structures and patient populations. Innovative aspects of the trial include a randomized comparison of a chatbot-based genetic services delivery model to standard of care, as well as identification of at-risk individuals through a sustainable EHR-based system. The findings from the BRIDGE trial will advance the state of the science in identification of unaffected patients with inherited cancer susceptibility and delivery of genetic services to those patients. TRIAL REGISTRATION BRIDGE is registered as NCT03985852 . The trial was registered on June 6, 2019 at clinicaltrials.gov .
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Affiliation(s)
- Kimberly A Kaphingst
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT, 84112, USA.
| | - Wendy Kohlmann
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | | | - Melody S Goodman
- School of Global Public Health, New York University, 726 Broadway, New York, NY, 10012, USA
| | - Richard Bradshaw
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| | - Priscilla A Chan
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
| | - Daniel Chavez-Yenter
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT, 84112, USA
| | - Sarah V Colonna
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Veterans Administration Medical Center, 500 S. Foothill Boulevard, Salt Lake City, UT, 84149, USA
| | - Whitney F Espinel
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Jessica N Everett
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Amanda Gammon
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Eric R Goldberg
- Department of Medicine, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Javier Gonzalez
- Medical Center Information Technology, NYU Langone Health, 360 Park Avenue South, New York, NY, 10010, USA
| | - Kelsi J Hagerty
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Kelsey Kehoe
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Cecilia Kessler
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Kadyn E Kimball
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Shane Loomis
- NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
- Boost Services, Epic Systems Corporation, 1979 Milky Way, Verona, WI, 53593, USA
| | - Tiffany R Martinez
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Rachel Monahan
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Joshua D Schiffman
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Dani Temares
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
| | - Katie Tobik
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - David W Wetter
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Devin M Mann
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| | - Saundra S Buys
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Ophira Ginsburg
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
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Noyd DH, Neely NB, Schroeder KM, Lantos PM, Power S, Kreissman SG, Oeffinger KC. Integration of cancer registry and electronic health record data to construct a childhood cancer survivorship cohort, facilitate risk stratification for late effects, and assess appropriate follow-up care. Pediatr Blood Cancer 2021; 68:e29014. [PMID: 33742534 DOI: 10.1002/pbc.29014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/12/2021] [Accepted: 02/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND This retrospective study harnessed an institutional cancer registry to construct a childhood cancer survivorship cohort, integrate electronic health record (EHR) and geospatial data to stratify survivors based on late-effect risk, analyze follow-up care patterns, and determine factors associated with suboptimal follow-up care. PROCEDURE The survivorship cohort included patients ≤18 years of age reported to the institutional cancer registry between January 1, 1994 and November 30, 2012. International Classification of Diseases for Oncology, third revision (ICD-O-3) coding and treatment exposures facilitated risk stratification of survivors. The EHR was linked to the cancer registry based on medical record number (MRN) to extract clinic visits. RESULTS Five hundred and ninety pediatric hematology-oncology (PHO) and 275 pediatric neuro-oncology (PNO) survivors were included in the final analytic cohort. Two hundred and eight-two survivors (32.6%) were not seen in any oncology-related subspecialty clinic at Duke 5-7 years after initial diagnosis. Factors associated with follow-up included age (p = .008), diagnosis (p < .001), race/ethnicity (p = .010), late-effect risk strata (p = .001), distance to treatment center (p < .0001), and area deprivation index (ADI) (p = .011). Multivariable logistic modeling attenuated the association for high-risk (OR 1.72; 95% CI 0.805, 3.66) and intermediate-risk (OR 1.23, 95% CI 0.644, 2.36) survivors compared to survivors at low risk of late effects among the PHO cohort. PNO survivors at high risk for late effects were more likely to follow up (adjusted OR 3.66; 95% CI 1.76, 7.61). CONCLUSIONS Nearly a third of survivors received suboptimal follow-up care. This study provides a reproducible model to integrate cancer registry and EHR data to construct risk-stratified survivorship cohorts to assess follow-up care.
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Affiliation(s)
- David H Noyd
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Kristin M Schroeder
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Paul M Lantos
- Departments of Internal Medicine, Pediatrics, and Community/Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Steve Power
- Duke Cancer Institute, Durham, North Carolina, USA
| | - Susan G Kreissman
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Kevin C Oeffinger
- Duke Cancer Institute, Durham, North Carolina, USA.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Somayaji D, Melendez M, Kwon M, Lathan C. Access to Cancer Care Resources in a Federally Qualified Health Center: a Mixed Methods Study to Increase the Understanding of Met and Unmet Needs of Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:591-602. [PMID: 31828550 DOI: 10.1007/s13187-019-01669-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Assessing the met and unmet needs of cancer survivors is critical in optimizing access to cancer services especially in underserved populations. The purpose of this study is to expand our understanding of the priority needs for cancer survivorship within racial/ethnic and underserved populations that speak either English or Spanish and seek health care in a federally qualified health center (FQHC). A convergent mixed methods design integrating survey and focus group data was utilized for this study. A total of 17 participants were enrolled in the study. The meta-inferences were drawn by looking across the top ten matched survey and focus group met and unmet needs including psychological, informational, and health system as well as patient care and support. The preferred languages of participants were Spanish 53% (n = 9) and English 47% (n = 8), and the survival breakdown was 65% (n = 11) within 0-5 years with 17.5% (n = 3), 6-10 years and 17.5% (n = 3), and 17.5% (n = 3) > 11 years. The most frequently met needs included health care providers and hospital staff being attentive to their physical and emotional needs and feeling they were treated with respect. Unmet needs were often related to physical and daily living needs such as pain, fatigue, sadness, depression, and not being able to work. Providing a needs-based approach of cancer health services in a FQHC or similar community-based health center is critical to meet the needs of cancer survivors to improve health outcomes and quality of life.
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Affiliation(s)
- Darryl Somayaji
- School of Nursing, University at Buffalo, 3435 Main St, Wende Hall 201C, Buffalo, NY, 14214, USA.
| | | | - Misol Kwon
- School of Nursing, University at Buffalo, 3435 Main St, Wende Hall 201C, Buffalo, NY, 14214, USA
| | - Christopher Lathan
- Dana Farber/Harvard Cancer Center Medicine Department, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA
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Examination of a distress screening intervention for rural cancer survivors reveals low uptake of psychosocial referrals. J Cancer Surviv 2021; 16:582-589. [PMID: 33983534 PMCID: PMC8116196 DOI: 10.1007/s11764-021-01052-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/26/2021] [Indexed: 12/14/2022]
Abstract
Purpose To determine the impact of a telemedicine-delivered intervention aimed at identifying unmet needs and cancer-related distress (CRD) following the end of active treatment on supportive care referral patterns. Methods We used a quasi-experimental design to compare supportive care referral patterns between a group of rural cancer survivors receiving the intervention and a control group (N = 60). We evaluated the impact of the intervention on the number and type of referrals offered and whether or not the participant accepted the referral. CRD was measured using a modified version of the National Comprehensive Cancer Network Distress Thermometer and Problem List. Results Overall, 30% of participants received a referral for further post-treatment supportive care. Supporting the benefits of the intervention, the odds of being offered a referral were 13 times higher for those who received the intervention than those in the control group. However, even among the intervention group, only 28.6% of participants who were offered a referral for further psychosocial care accepted. Conclusions A nursing telemedicine visit was successful in identifying areas of high distress and increasing referrals. However, referral uptake was low, particularly for psychosocial support. Distance to care and stigma associated with seeking psychosocial care may be factors. Further study to improve referral uptake is warranted. Implications for Cancer Survivors Screening for CRD may be inadequate for cancer survivors unless patients can be successfully referred to further supportive care. Strategies to improve uptake of psychosocial referrals is of high importance for rural survivors, who are at higher risk of CRD. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01052-4.
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Howren MB, Christensen AJ, Adamowicz JL, Seaman A, Wardyn S, Pagedar NA. Problem alcohol use among rural head and neck cancer patients at diagnosis: Associations with health-related quality of life. Psychooncology 2021; 30:708-715. [PMID: 33345347 PMCID: PMC8463955 DOI: 10.1002/pon.5616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Problem alcohol use in persons with head and neck cancer (HNC) is associated with poor outcomes, including survival. Some evidence suggests that individuals living in rural areas may be at greater risk of problem alcohol use. The present exploratory cross-sectional study sought to examine problem alcohol use at diagnosis in a sample of HNC patients by rural versus urban status. METHODS Self-reported problem alcohol use as measured by the Short Michigan Alcoholism Screening Test (SMAST) was examined in rural and urban HNC patients at diagnosis (N = 454). Multivariable linear regression analysis was conducted to examine correlates of problem alcohol use. Subgroup analyses examined HNC-specific health-related quality of life (HRQOL) by problem drinking status at diagnosis and 3- and 12-month postdiagnosis in rural patients. RESULTS Multivariable linear regression analysis controlling for age, cancer site, cancer stage, depressive symptoms at diagnosis, and tobacco use at diagnosis indicated that rural residence was significantly associated with SMAST scores at diagnosis such that rural patients were more likely to report higher scores (ß = 0.095, sr2 = 0.010, p = 0.04). Covariate-adjusted subgroup analyses suggest that rural patients with self-reported problem alcohol use may exhibit deficits in HNC-specific HRQOL at diagnosis and 3- and 12-month postdiagnosis. CONCLUSIONS HNC patients should be screened for problem alcohol use at diagnosis and counseled regarding the deleterious effects of continued drinking during treatment and beyond. Because access to treatment and referral options may be lacking in rural areas, additional ways of connecting rural patients to specialty care should be explored.
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Affiliation(s)
- M. Bryant Howren
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Iowa City, Iowa City VA Health Care System; Iowa City, IA
- Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University; Tallahassee, FL
- Florida Blue Center for Rural Health Research & Policy, College of Medicine, Florida State University; Tallahassee, FL
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System; Iowa City, IA
| | - Alan J. Christensen
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Iowa City, Iowa City VA Health Care System; Iowa City, IA
- Department of Psychology, East Carolina University; Greenville, NC
| | - Jenna L. Adamowicz
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Iowa City, Iowa City VA Health Care System; Iowa City, IA
- Department of Psychological & Brain Sciences, The University of Iowa; Iowa City, IA
| | - Aaron Seaman
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Iowa City, Iowa City VA Health Care System; Iowa City, IA
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System; Iowa City, IA
- Department of Internal Medicine, The University of Iowa; Iowa City, IA
| | - Shylo Wardyn
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Iowa City, Iowa City VA Health Care System; Iowa City, IA
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System; Iowa City, IA
| | - Nitin A. Pagedar
- Department of Otolaryngology—Head and Neck Surgery, Carver College of Medicine, The University of Iowa; Iowa City, IA
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Xu H, Kadambi S, Mohile SG, Yang S, Kehoe LA, Wells M, Culakova E, Kamen C, Obrecht S, Mohamed M, Gilmore NJ, Magnuson A, Grossman VA, Hopkins JO, Geer J, Berenberg J, Mustian K, Cupertino A, Mohile N, Loh KP. Caregiving burden of informal caregivers of older adults with advanced cancer: The effects of rurality and education. J Geriatr Oncol 2021; 12:1015-1021. [PMID: 33858803 DOI: 10.1016/j.jgo.2021.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Rural-urban disparities in the experiences of caregivers of older adults with advanced cancer may exist. This study examined factors associated with caregiver mastery and burden and explored whether rural-urban disparities in caregiver outcomes differed by education. MATERIALS AND METHODS Longitudinal data (baseline, 4-6 weeks, and 3 months) on caregivers of older adults (≥ 70) with advanced cancer were obtained from a multicenter geriatric assessment (GA) trial (ClinicalTrials.gov: NCT02107443). Rurality was determined based on 2010 Rural-Urban Commuting Area codes. Caregivers' education was categorized as ≥ some college vs ≤ high school. Caregiver outcomes included Ryff Environmental Mastery (scored 7-35) and Caregiver Reaction Assessment (including self-esteem, disrupted schedules, financial problems, lack of social support, and health problems; each scored 1-5). Separate linear mixed models with interaction term of education and rurality were performed. RESULTS Of 414 caregivers, 64 (15.5%) were from rural areas and 263 (63.5%) completed ≥ some college. Rurality was significantly associated with more disrupted schedules (β = 0.21), financial problems (β = 0.17), and lack of social support (β = 0.11). A significant interaction between education and rurality was found, with rurality associated with lower mastery (β = -1.27) and more disrupted schedule (β = 0.25), financial problems (β = 0.33), and lack of social support (β = 0.32) among caregivers with education ≤ high school. CONCLUSION Our study identifies subgroups of caregivers who are vulnerable to caregiving burden, specifically those from rural areas and with lower education. Multifaceted interventions are needed to improve caregivers' competency and reduce caregiving burden.
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Affiliation(s)
- Huiwen Xu
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Sindhuja Kadambi
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Supriya G Mohile
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Shuhan Yang
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Lee A Kehoe
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Megan Wells
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Eva Culakova
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Charles Kamen
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Spencer Obrecht
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Mostafa Mohamed
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Nikesha J Gilmore
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Allison Magnuson
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | | | - Judith O Hopkins
- Southeast Clinical Oncology Research Consortium, Winston-Salem, NC, USA.
| | - Jodi Geer
- Metro Minnesota Community Oncology Research Program, St Louis Park, MN, USA.
| | | | - Karen Mustian
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Anapaula Cupertino
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Nimish Mohile
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Kah Poh Loh
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Jafari A, Shen SA, Qualliotine JR, Lehmann AE, Humphreys IM, Abuzeid WM, Bergmark RW, Gray ST. Socioeconomic Factors Affect Presentation Stage and Survival in Sinonasal Squamous Cell Carcinoma. Laryngoscope 2021; 131:2421-2428. [PMID: 33844294 DOI: 10.1002/lary.29568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/03/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Socioeconomic factors affect oncologic outcome in sinonasal squamous cell carcinoma (SNSCC). However, the relationship between these factors and stage at presentation (SAP)-a critical, early point in the care cycle-is not known. This study sought to determine the role of race/ethnicity, treatment facility type, insurance status/carrier, and other socioeconomic factors in SAP and survival among patients with advanced SNSCC. STUDY DESIGN Retrospective cohort study. METHODS Using the National Cancer Database, 6,155 patients with SNSCC were identified and divided into those with "early" (Stage I or II; 2,212 (35.9%)) versus "advanced" (Stage III or IV; 3,943 (64.1%)) disease. Associations between sociodemographic and socioeconomic factors on SAP and survival were analyzed using multivariable logistic regression and Cox proportional hazard models. RESULTS Black (odds ratio [OR]: 2.18, CI: 1.74-2.76), Asian and Pacific Islander (API) (OR: 2.37, CI: 1.43-4.14), and Medicaid or uninsured (OR: 2.04, CI: 1.66-2.53) patients were more likely to present with advanced disease. Among patients with advanced disease, API patients demonstrated the highest 10-year survival rate (30.2%), and Black patients had the lowest 2-, 5-, and 10-year survival rates (47.7%, 31.9% and 19.2%, respectively). Older age (HR:1.03, CI:1.03-1.04), Black race (HR:1.39, CI:1.21-1.59), Medicaid or uninsured status (HR:1.48, CI:1.27-1.71), and treatment at a community hospital (HR:1.25, CI:1.14-1.37) were associated with poorer overall survival among patients with advanced disease. CONCLUSIONS Factors including race/ethnicity, treatment facility type, insurance status/carrier, and other socioeconomic factors influence SAP and survival in SNSCC. An improved understanding of how these factors relate to outcomes may elucidate opportunities to address gaps in education and access to care in vulnerable populations. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Sarek A Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jesse R Qualliotine
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Regan W Bergmark
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Adams RD, Johnson WE. Faith as a Mechanism for Health Promotion among Rural African American Prostate Cancer Survivors: A Qualitative Examination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3134. [PMID: 33803629 PMCID: PMC8003072 DOI: 10.3390/ijerph18063134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 01/04/2023]
Abstract
Conceptualized using critical race theory as a theoretical underpinning, this study analyzed the lived experiences of older, rural, African American male prostate cancer (hereafter referenced as PrCA) survivors' faith and health promotion practices within Northeast Louisiana. Qualitative data from journaling, observations, and semi-structured interviews were obtained from ten older, African American male PrCA survivors residing in four rural parishes of Louisiana. The data analysis employed a two-stage approach known as Polkinghorne's analysis of narratives and narrative analysis using an art-based methodological approach. Framed as composite character counterstories, survivors' narratives revealed how survivors made sense of and gave meaning to their PrCA diagnosis, treatment, recovery, and survivorship. Specifically, their counterstories indicate that centering and honoring the unique and often taken-for-granted perspectives of older, rural, African American male PrCA survivors offered a deeper understanding of the multiple factors influencing their quality of life, as well as the sociostructural mechanisms impacting their survivorship care. Faith was examined as both a secular and sacred source of support that these men viewed as central to the acceptance of their diagnosis, treatment, recovery, and survivorship.
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Affiliation(s)
- Raymond D. Adams
- Department of Social Work, Psychology & Counseling, College of Education, Humanities, and Behavioral Sciences, Alabama A&M University, Normal, AL 35810 1, USA
| | - Waldo E. Johnson
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, IL 60637 2, USA
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Dunn J, Goodwin B, Aitken JF, March S, Crawford-Williams F, Ireland M, Ralph N, Zajdlewicz L, Rowe A, Chambers SK. Are National Cancer Control Indicators for patient experiences being met in regional and remote Australia? A cross-sectional study of cancer survivors who travelled for treatment. BMJ Open 2021; 11:e042507. [PMID: 33619187 PMCID: PMC7903096 DOI: 10.1136/bmjopen-2020-042507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the health services experience of patients with cancer from regional and remote Australia using the Australian National Cancer Control Indicators (NCCI) guidelines as an assessment framework. DESIGN Cross-sectional. SETTING Queensland non-for-profit cancer accommodation lodges. PARTICIPANTS Participants were patients with cancer who travelled for treatment from rural and remote Queensland to major urban centres (n=518; age mean=64.6, SD=11.18). OUTCOME MEASURES Assessments included NCCI patient indicators, quality of life (QoL), psychological distress and unmet supportive care needs. RESULTS The frequency at which NCCI indicators were met ranged from 37.5% for receiving an assessment and care plan to 97.3% for understanding explanations about diagnosis. Geographical considerations did not impact patient experience, whereas middle school educated participants were more likely than those with senior-level education or higher to receive an assessment and care plan (OR=1.90, 95% CI 1.23 to 2.91) and to report having their views on treatment taken into account (OR=2.22, 95% CI 1.49 to 3.33). Patients with breast or prostate cancer reported better communication and patient involvement and information and services provision (r=p<0.001) compared with those with skin and head and neck cancer. When compared with information and service provision, communication and patient involvement showed stronger positive associations with QoL (z=2.03, p=0.042), psychosocial (z=2.05, p=0.040) and patient care (z=2.00, p=0.046) outcomes. CONCLUSION The patient care experience varies across the NCCI indicators by sociodemographic and clinical factors that likely reflect healthcare system biases. Perceptions about communication and involvement appear most critical for optimal outcomes and should be a priority action area for cancer control.
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Affiliation(s)
- Jeff Dunn
- Cancer Council Queensland, Queensland, Brisbane, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Queensland, Australia
- Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Belinda Goodwin
- Cancer Council Queensland, Queensland, Brisbane, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Queensland, Brisbane, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Queensland, Australia
- School of Public Health, The University of Queensland, Springfield, Queensland, Australia
| | - Sonja March
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield, Queensland, Australia
| | - Fiona Crawford-Williams
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - Michael Ireland
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield, Queensland, Australia
| | - Nicholas Ralph
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Arlen Rowe
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield, Queensland, Australia
| | - Suzanne K Chambers
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Queensland, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
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83
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The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041384. [PMID: 33546168 PMCID: PMC7913122 DOI: 10.3390/ijerph18041384] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/15/2022]
Abstract
One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.
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84
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Binnal A, Rajesh G, Prakash Saxena PU, Banerjee S, Denny C, Tadakamadla SK. Health-related quality of life among oral and oropharyngeal cancer patients: An exploratory study. Oral Dis 2021; 28:585-599. [PMID: 33426716 DOI: 10.1111/odi.13772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To comprehensively explore the effect of several sociodemographic-, patient- and tumour-related factors on the health-related quality of life (HRQoL) of oral and oropharyngeal cancer patients. METHODOLOGY Patients diagnosed with oral and oropharyngeal cancers were included in the present cross-sectional study. Information pertaining to various sociodemographic-, patient- and tumour-related factors was recorded. HRQoL was assessed using standard 12-item Short Form Health Survey version 2 (SF12V2), and oral health-related quality of life (OHRQoL) was assessed by Oral Health Impact Profile-14 (OHIP). RESULTS A total of 108 patients participated in the present study. Results revealed that nodal metastasis, histological differentiation and pain were significant predictors of OHRQoL, while site, size, stage, histological differentiation and pain were significant predictors of HRQoL. Pain was the single most significant negative determinant of HRQoL that was associated with worst total OHIP (B = 2.01, β = 0.45, p < .0001), physical (B = -0.88, β = -0.21, p = .017) and mental (B = -1.00, β = -0.22, p = .016) component summary scores. CONCLUSIONS Number of sociodemographic-, patient- and tumour-related factors emerged as significant predictors of HRQoL and OHRQoL. Study results might help in formulating targeted treatment plan, optimising patient care and follow-up.
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Affiliation(s)
- Almas Binnal
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, India.,Manipal Academy of Higher Education, Manipal, KA, India
| | - Gururaghavendran Rajesh
- Manipal Academy of Higher Education, Manipal, KA, India.,Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, India
| | - P U Prakash Saxena
- Manipal Academy of Higher Education, Manipal, KA, India.,Department of Radiation Oncology, Kasturba Medical College, Mangalore, India
| | - Sourjya Banerjee
- Manipal Academy of Higher Education, Manipal, KA, India.,Department of Radiation Oncology, Kasturba Medical College, Mangalore, India
| | - Ceena Denny
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, India.,Manipal Academy of Higher Education, Manipal, KA, India
| | - Santosh Kumar Tadakamadla
- National Health and Medical Research Council Early Career Fellow, School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia
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Dewar EO, Ahn C, Eraj S, Mahal BA, Sanford NN. Psychological distress and cognition among long-term survivors of adolescent and young adult cancer in the USA. J Cancer Surviv 2021; 15:776-784. [PMID: 33415652 DOI: 10.1007/s11764-020-00969-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients diagnosed with cancer as adolescent and young adult (AYA) are at risk for a range of long-term psychosocial sequelae, which have been poorly studied. We sought to characterize the prevalence of cognitive dysfunction and psychological distress among long-term AYA cancer survivors. METHODS Using data from the National Health Interview Survey between 2010 and 2018, multivariable logistic regression analyses defined the association between AYA cancer diagnosis and cognitive dysfunction and psychological distress, as defined by the 6-item Kessler Psychological Distress Scale. Among AYA cancer survivors, the association between psychological distress and cognitive dysfunction was assessed via multivariable logistic regression. RESULTS Among 230,675 participants, 2646 (1.1%) were AYA cancer survivors diagnosed > 10 years prior to survey administration. Prior AYA cancer diagnosis was associated with greater odds of cognitive dysfunction (AOR 1.61, 95% CI 1.41-1.82; 27.8% vs. 16.4%) and psychological distress (AOR 1.60, 95% CI 1.41-1.83; 26.6 vs. 15.3%) as compared to individuals without a cancer history. Among survey participants reporting a cancer diagnosis, greater psychological distress was associated with greater odds of cognitive dysfunction (AOR 12.31, 95% CI 7.51-20.18 for severe psychological distress) and cognitive dysfunction was associated with having psychological distress (AOR 4.97, 95% CI 3.66-6.73). CONCLUSION Long-term survivors of AYA cancer have higher rates of cognitive dysfunction and psychological distress as compared to the general population. Additional services addressing psychosocial and neurocognitive issues should be integrated into standard AYA cancer survivorship care. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors should be aware of self-reported high rates of long-term cognitive dysfunction and psychologic distress and actively seek out formal evaluation and services such as mental health counseling.
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Affiliation(s)
- Elena O Dewar
- Department of Radiation Oncology, University of Texas Southwestern, 2280 Inwood Road, Dallas, TX, 75390-9303, USA.,The Hockaday School, Dallas, TX, USA
| | - Chul Ahn
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Salman Eraj
- Department of Radiation Oncology, University of Texas Southwestern, 2280 Inwood Road, Dallas, TX, 75390-9303, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, 2280 Inwood Road, Dallas, TX, 75390-9303, USA.
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Paredes AZ, Hyer JM, Tsilimigras DI, Pawlik TM. Hepatopancreatic Surgery in the Rural United States: Variation in Outcomes at Critical Access Hospitals. J Surg Res 2021; 261:123-129. [PMID: 33422902 DOI: 10.1016/j.jss.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/03/2020] [Accepted: 12/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sixty million Americans live in rural America, with roughly 17.5% of the rural population being 65 y or older. Outcomes and costs of Medicare beneficiaries undergoing hepatopancreatic surgery at critical access hospitals (CAHs) are not known. MATERIALS AND METHODS Medicare files were used to identify patients who underwent hepatopancreatic resection. Outcomes were compared (CAHs versus non-CAHs). RESULTS Patients undergoing hepatopancreatic surgery at non-CAHs versus CAHs had a similar comorbidity score (4 versus 5, P = 0.53). After adjusting for patient-level factors and procedure-specific volume, there was no difference in complication rate (adjusted odds ratio (aOR) 0.80, 95% confidence interval (CI) 0.52-1.24). The median cost of hospitalization was roughly $4000 less at CAHs than that at non-CAHs (P < 0.001). However, compared with patients undergoing surgery at non-CAHs, beneficiaries operated at CAHs had more than two times the odds of dying within 30 (aOR 2.45, 95% CI 1.42-4.2) and 90 d (aOR 2.28, 95% CI 1.4-3.71). CONCLUSIONS Only a small subset of Medicare beneficiaries underwent hepatic or pancreatic resection at a CAH. Despite similar complication rate, Medicare beneficiaries undergoing surgery at a CAH had more than two times the odds of dying within 30 and 90 d after surgery.
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Affiliation(s)
- Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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87
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Lee H, Singh GK. The Association Between Psychological Distress and Cancer Mortality in the United States: Results from the 1997–2014 NHIS-NDI Record Linkage Study. Ann Behav Med 2021; 55:621-640. [DOI: 10.1093/abm/kaaa111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Abstract
Background/Purpose
Psychological distress can influence cancer mortality through socioeconomic disadvantage, health-risk behaviors, or reduced access to care. These disadvantages can result in higher risks of cancer occurrence, a delayed cancer diagnosis, hamper adherence to treatment, and provoke inflammatory responses leading to cancer. Previous studies have linked psychological distress to cancer mortality. However, studies are lacking for the U.S. population.
Methods
This study examines the Kessler six-item psychological distress scale as a risk factor for U.S. cancer mortality using the pooled 1997–2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N = 513,012). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates.
Results
In Cox models with 18 years of mortality follow-up, the cancer mortality risk was 80% higher (hazard ratio [HR] = 1.80; 95% CI = 1.64, 1.97) controlling for age; 61% higher (HR = 1.61; 95% CI = 1.46, 1.76) in the SES-adjusted model, and 33% higher (HR = 1.33; 95% CI = 1.21, 1.46) in the fully-adjusted model among adults with serious psychological distress (SPD), compared with adults without psychological distress. Males, non-Hispanic Whites, and adults with incomes at or above 400% of the federal poverty level had greater cancer mortality risk associated with SPD. Using an 8 years of mortality follow-up, those with SPD had 108% increased adjusted risks of mortality from breast cancer.
Conclusion
Our study findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing cancer mortality.
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Affiliation(s)
- Hyunjung Lee
- Health Resources and Services Administration, Office of Health Equity, Rockville, MD and Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Gopal K Singh
- US Department of Health and Human Services, Health Resources and Services Administration, Office of Health Equity, Rockville, MD, USA
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88
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Kaneko M, Ohta R, Vingilis E, Mathews M, Freeman TR. Systematic scoping review of factors and measures of rurality: toward the development of a rurality index for health care research in Japan. BMC Health Serv Res 2021; 21:9. [PMID: 33397396 PMCID: PMC7780409 DOI: 10.1186/s12913-020-06003-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rural-urban health care disparities are an important topic in health services research. Hence, developing valid and reliable tools to measure rurality is needed to support high quality research. However, Japan, has no index to measure rurality for health care research. In this study, we conducted a systematic scoping review to identify the important factors and methodological approaches to consider in a rurality index to inform the development of a rurality index for Japan. METHODS For our review, we searched six bibliographic databases (MEDLINE, PubMed, CINAHIL, ERIC, Web of Science and the Grey Literature Report) and official websites of national governments such as Government and Legislative Libraries Online Publications Portal (GALLOP), from 1 January 1989 to 31 December 2018. We extracted relevant variables used in the development of rurality indices, the formulas used to calculate indices, and any measures for reliability and validity of these indices. RESULTS We identified 17 rurality indices from 7 countries. These indices were primarily developed to assess access to health care or to determine eligibility for incentives for health care providers. Frequently used factors in these indices included population size/density and travel distance/time to emergency care or referral centre. Many indices did not report reliability or validity measures. CONCLUSIONS While the concept of rurality and concerns about barriers to access to care for rural residents is shared by many countries, the operationalization of rurality is highly context-specific, with few universal measures or approaches to constructing a rurality index. The results will be helpful in the development of a rurality index in Japan and in other countries.
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Affiliation(s)
- Makoto Kaneko
- Primary Care Research Unit, Graduate School of Health Data Science, Yokohama City University, 22-2, Seto, Kanazawa-ku, Yokohama, Kanagawa, 236-0027, Japan.
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, London, Ontario, Canada.
| | - Ryuichi Ohta
- Department of Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-Cho, Unnan City, Shimane, Japan
| | - Evelyn Vingilis
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, London, Ontario, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, London, Ontario, Canada
| | - Thomas Robert Freeman
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, London, Ontario, Canada
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89
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Carnahan LR, Rauscher GH, Watson KS, Altfeld S, Zimmermann K, Ferrans CE, Molina Y. Comparing the roles of social context, networks, and perceived social functioning with health-related quality of life among self-reported rural female cancer survivors. Support Care Cancer 2021; 29:331-340. [PMID: 32361830 PMCID: PMC7606329 DOI: 10.1007/s00520-020-05497-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Rural women, compared to urban, experience worse survivorship outcomes, including poorer health-related quality of life (QOL). There is a need to characterize the role of multilevel social factors that contribute to QOL, including context, networks, and functioning. Our objectives were to (1) use latent class analysis to identify distinct classes of social context and social networks and (2) examine how multilevel social factors (context, networks, and functioning) are associated with health-related QOL. METHODS We recruited self-identified rural survivors to the Illinois Rural Cancer Assessment (2017-2018), via community-based sampling methods, and participants completed the survey online, by phone, or on paper. We used latent class analysis to generate multidimensional variables for contextual and network factors. We next modeled each social factor sas a predictor in separate, bivariable linear regressions for the QOL outcomes, followed by multivariable, adjusted regressions. RESULTS For our first objective, there were three classes each of county-level contexts (1, highly rural, socioeconomically disadvantaged, and mostly lacking in cancer-related services; 2, mostly rural, moderately disadvantaged, and underserved; 3, mostly metropolitan, less disadvantaged, and most-resourced) and social networks (1, no caregivers; 2, only spousal caregivers with whom they communicated daily; 3, multiple caregivers with varying daily communication). For our second objective, among all social factors, only functioning was associated with better mental health-related QOL. No factors were associated with physical health-related QOL. CONCLUSIONS Our findings suggest a rich diversity of social context and networks among rural female cancer survivors, and social functioning is particularly important for mental health-related QOL.
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Affiliation(s)
- Leslie R Carnahan
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA.
- Center for Research on Women and Gender, University of Illinois at Chicago, Rm 536A, 1640 W. Roosevelt Rd., MC 980, Chicago, IL, 60608, USA.
| | - Garth H Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA
| | - Karriem S Watson
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA
- University of Illinois Cancer Center, 914 S. Wood St., Chicago, IL, 60612, USA
| | - Susan Altfeld
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA
| | - Kristine Zimmermann
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA
- Center for Research on Women and Gender, University of Illinois at Chicago, Rm 536A, 1640 W. Roosevelt Rd., MC 980, Chicago, IL, 60608, USA
| | - Carol E Ferrans
- Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave., Chicago, IL, 60612, USA
| | - Yamilé Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA
- Center for Research on Women and Gender, University of Illinois at Chicago, Rm 536A, 1640 W. Roosevelt Rd., MC 980, Chicago, IL, 60608, USA
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90
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Nelson D, Law GR, McGonagle I, Turner P, Jackson C, Kane R. The Effect of Rural Residence on Cancer-Related Self-Efficacy With UK Cancer Survivors Following Treatment. J Rural Health 2020; 38:28-33. [PMID: 33289206 DOI: 10.1111/jrh.12549] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To examine rural and urban differences in cancer-related self-efficacy with UK cancer survivors following treatment. METHODS A cross-sectional postal survey with posttreatment cancer survivors in the East Midlands of England. The survey collected data on demographics and cancer-related self-efficacy using the Cancer Survivors Self-Efficacy Scale. Rural-urban residence was determined using Office for National Statistics classifications. Linear Regression models were developed using a Directed Acyclic Graph that determined confounding variables. When the model deviated from normal the outcome variable was transformed using the Box-Cox transformation. FINDINGS Of those surveyed, 227 responded, of whom 58% were female and 45% lived in a rural area. A linear regression model showed a significant increase in cancer-related self-efficacy in cancer survivors living in rural areas compared to urban residents (0.76, 95% CI: 0.25-1.27), although the residual plot deviated from a normal distribution. A model of the effect of rural living on a Box-Cox transformed outcome variable confirmed an increased cancer-related self-efficacy score in rural regions (9.06, 95% CI: 2.97-15.14). Rural living remained significant (7.98, 95% CI: 1.78-14.19) after adjustment for the respondents' income. Similarly adjusting for deprivation led to a significant increase in cancer-related self-efficacy in rural regions (8.64, 95% CI: 2.48-14.79). CONCLUSION This study has important implications when considering the impact of location of residence on cancer-related self-efficacy in cancer survivorship. The role of deprivation had some impact for sample respondents in both the urban and rural environment and merits further analysis.
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Affiliation(s)
- David Nelson
- College of Social Science, Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
| | - Graham R Law
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK
| | - Ian McGonagle
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK
| | - Paul Turner
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK
| | - Christine Jackson
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK
| | - Ros Kane
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK
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91
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Jones SMW, Henrikson NB, Panattoni L, Syrjala KL, Shankaran V. A theoretical model of financial burden after cancer diagnosis. Future Oncol 2020; 16:3095-3105. [PMID: 32976048 PMCID: PMC7787147 DOI: 10.2217/fon-2020-0547] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022] Open
Abstract
Current models of financial burden after cancer do not adequately define types of financial burden, moderators or causes. We propose a new theoretical model to address these gaps. This model delineates the components of financial burden as material and psychological as well as healthcare-specific (affording treatment) versus general (affording necessities). Psychological financial burden is further divided into worry about future costs and rumination about past and current financial burden. The model hypothesizes costs and employment changes as causes, and moderators include precancer socioeconomic status and post-diagnosis factors. The model outlines outcomes affected by financial burden, including depression and mortality. Theoretically derived measures of financial burden, interventions and policy changes to address the causes of financial burden in cancer are needed.
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Affiliation(s)
- Salene MW Jones
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, King County, Washington 98101, USA
| | - Laura Panattoni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Karen L Syrjala
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Veena Shankaran
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
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92
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Robinson A, Oksuz U, Slight R, Slight S, Husband A. Digital and Mobile Technologies to Promote Physical Health Behavior Change and Provide Psychological Support for Patients Undergoing Elective Surgery: Meta-Ethnography and Systematic Review. JMIR Mhealth Uhealth 2020; 8:e19237. [PMID: 33258787 PMCID: PMC7738263 DOI: 10.2196/19237] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Digital technology has influenced many aspects of modern living, including health care. In the context of elective surgeries, there is a strong association between preoperative physical and psychological preparedness, and improved postoperative outcomes. Health behavior changes made in the pre- and postoperative periods can be fundamental in determining the outcomes and success of elective surgeries. Understanding the potential unmet needs of patients undergoing elective surgery is central to motivating health behavior change. Integrating digital and mobile health technologies within the elective surgical pathway could be a strategy to remotely deliver this support to patients. OBJECTIVE This meta-ethnographic systematic review explores digital interventions supporting patients undergoing elective surgery with health behavior changes, specifically physical activity, weight loss, dietary intake, and psychological support. METHODS A literature search was conducted in October 2019 across 6 electronic databases (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020157813). Qualitative studies were included if they evaluated the use of digital technologies supporting behavior change in adult patients undergoing elective surgery during the pre- or postoperative period. Study quality was assessed using the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesize existing qualitative data, using the 7 phases of meta-ethnography by Noblit and Hare. Using this approach, along with reciprocal translation, enabled the development of 4 themes from the data. RESULTS A total of 18 studies were included covering bariatric (n=2, 11%), cancer (n=13, 72%), and orthopedic (n=3, 17%) surgeries. The 4 overarching themes appear to be key in understanding and determining the effectiveness of digital and mobile interventions to support surgical patients. To successfully motivate health behavior change, technologies should provide motivation and support, enable patient engagement, facilitate peer networking, and meet individualized patient needs. Self-regulatory features such as goal setting heightened patient motivation. The personalization of difficulty levels in virtual reality-based rehabilitation was positively received. Internet-based cognitive behavioral therapy reduced depression and distress in patients undergoing cancer surgery. Peer networking provided emotional support beyond that of patient-provider relationships, improving quality of life and care satisfaction. Patients expressed the desire for digital interventions to be individually tailored according to their physical and psychological needs, before and after surgery. CONCLUSIONS These findings have the potential to influence the future design of patient-centered digital and mobile health technologies and demonstrate a multipurpose role for digital technologies in the elective surgical pathway by motivating health behavior change and offering psychological support. Through the synthesis of patient suggestions, we highlight areas for digital technology optimization and emphasize the importance of content tailored to suit individual patients and surgical procedures. There is a significant rationale for involving patients in the cocreation of digital health technologies to enhance engagement, better support behavior change, and improve surgical outcomes.
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Affiliation(s)
- Anna Robinson
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Umay Oksuz
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert Slight
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sarah Slight
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew Husband
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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93
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Moss JL, Pinto CN, Mama SK, Rincon M, Kent EE, Yu M, Cronin KA. Rural-urban differences in health-related quality of life: patterns for cancer survivors compared to other older adults. Qual Life Res 2020; 30:1131-1143. [PMID: 33136241 DOI: 10.1007/s11136-020-02683-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Health-related quality of life (HRQOL) among older cancer survivors can be impaired by factors such as treatment, comorbidities, and social challenges. These HRQOL impairments may be especially pronounced in rural areas, where older adults have higher cancer burden and more comorbidities and risk factors for poor health. This study aimed to assess rural-urban differences in HRQOL for older cancer survivors and controls. METHODS Data came from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS), which links cancer incidence from 18 U.S. population-based cancer registries to survey data for Medicare Advantage Organization enrollees (1998-2014). HRQOL measures were 8 standardized subscales and 2 global summary measures. We matched (2:1) controls to breast, colorectal, lung, and prostate cancer survivors, creating an analytic dataset of 271,640 participants (ages 65+). HRQOL measures were analyzed with linear regression models including multiplicative interaction terms (rurality by cancer status), controlling for sociodemographics, cohort, and multimorbidities. RESULTS HRQOL scores were higher in urban than rural areas (e.g., global physical component summary score for breast cancer survivors: urban mean = 38.7, standard error [SE] = 0.08; rural mean = 37.9, SE = 0.32; p < 0.05), and were generally lower among cancer survivors compared to controls. Rural cancer survivors had particularly poor vitality (colorectal: p = 0.05), social functioning (lung: p = 0.05), role limitation-physical (prostate: p < 0.01), role limitation-emotional (prostate: p < 0.01), and global mental component summary (prostate: p = 0.02). CONCLUSION Supportive interventions are needed to increase physical, social, and emotional HRQOL among older cancer survivors in rural areas. These interventions could target cancer-related stigma (particularly for lung and prostate cancers) and/or access to screening, treatment, and ancillary healthcare resources.
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Affiliation(s)
- Jennifer L Moss
- National Cancer Institute, Bethesda, MD, USA. .,Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
| | - Casey N Pinto
- Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | | | | | - Erin E Kent
- University of North Carolina, Chapel Hill, NC, USA
| | - Mandi Yu
- National Cancer Institute, Bethesda, MD, USA
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94
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The reality of virtual care: Implications for cancer care beyond the pandemic. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2020; 8:100480. [PMID: 33129178 PMCID: PMC7578846 DOI: 10.1016/j.hjdsi.2020.100480] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 01/10/2023]
Abstract
There has been longstanding interest in virtual care in oncology, but outdated reimbursement structures and a paradoxical lack of agility within electronic systems limited widespread adoption. Through the example of the Province of Ontario, Canada and the Princess Margaret Cancer Centre, we describe how a collective sense of action from COVID-19, a system of distributed leadership and decision-making, and the use of a Service Design process to map the ambulatory encounter onto a digital workflow were critical enablers of a large-scale virtual transition. Rigorous evaluation of virtual care models will be essential to maintain integration of virtual care post-pandemic.
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95
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Harrison NJ, Gunn KM, Wilson CJ. Can targeting information on cancer-related psychosocial services by male gender and rurality improve attitude to service use in this difficult-to-engage population? Psychooncology 2020; 29:2075-2083. [PMID: 33010091 DOI: 10.1002/pon.5566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/09/2020] [Accepted: 09/26/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Rural men affected by cancer are difficult to engage in psychosocial support services. This exploratory study tested whether exposure to printed brochures describing services, distinguished by a focus on rural men affected by cancer, resulted in more positive help-seeking attitudes than exposure to material focused on rural location only or generic cancer support material. METHODS Targeted versions of a South Australian Cancer Council service brochure were developed to enhance cultural appropriateness, consistent with the Elaboration Likelihood Model. Rural men affected by cancer were recruited via supportive accommodation and randomized to receive one of the three brochures. The primary outcome was positive attitude to help-seeking at post-test (between 1 and 2 days). Negative attitudes to help-seeking, intention to seek help, perceived isolation, and service use were secondary outcomes; perceived information relevance at immediate post-test was also measured. RESULTS Analysis (N = 114) indicated no detectable group differences (rurality/male gender, n = 33; rurality, n = 41; control, n = 40) on primary or secondary outcome measures (p > 0.05). Participants' existing service use was high, due to the recruitment methods. Support service information was primarily sourced from other people (e.g., friends/family, 22.22%; medical professionals, 27.27%). CONCLUSIONS Existing service use rates suggest that ceiling effects obscured any potential benefit from demographic targeting of materials. Further research should consider building understanding about the acceptability of targeting techniques in this population, replication with materials designed with greater consumer input, and employ samples recruited outside a support service.
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Affiliation(s)
- Nathan J Harrison
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.,Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,National Centre for Education and Training on Addiction, Flinders University, Adelaide, South Australia, Australia
| | - Kate M Gunn
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,UniSA Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.,Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Carlene J Wilson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
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96
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Mama SK, Bhuiyan N, Foo W, Segel JE, Bluethmann SM, Winkels RM, Wiskemann J, Calo WA, Lengerich EJ, Schmitz KH. Rural-urban differences in meeting physical activity recommendations and health status in cancer survivors in central Pennsylvania. Support Care Cancer 2020; 28:5013-5022. [PMID: 32036469 PMCID: PMC7415488 DOI: 10.1007/s00520-020-05342-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/02/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This study explored rural-urban differences in meeting physical activity (PA) recommendations and health status in cancer survivors in central Pennsylvania and associations between PA and health status. METHODS Cancer survivors (N = 2463) were identified through a state cancer registry and mailed questionnaires assessing PA and health status. Rural-urban residence was based on county of residence at diagnosis. Participants self-reported frequency and duration of leisure-time PA and were classified as meeting: (1) aerobic recommendations (≥ 150 min/week), (2) muscle-strengthening recommendations (≥ 2 times/week), (3) both aerobic and muscle-strengthening recommendations, or (4) neither recommendation. Logistic regression models examined associations between rural-urban residence and meeting PA recommendations and associations between PA and health status, adjusting for age, cancer type, gender, and income. RESULTS Nearly 600 (N = 591, 24.0%) cancer survivors returned completed questionnaires (rural 9.5%, urban 90.5%). Half (50.0%) of rural cancer survivors reported no leisure-time PA compared to 35.2% of urban cancer survivors (p = 0.020), and urban cancer survivors were 2.6 times more likely to meet aerobic PA recommendations (95% CI 1.1-6.4). Odds of reporting good physical and mental health were 2.3 times higher among survivors who reported meeting aerobic recommendations compared to those who did not meet PA recommendations (95% CI 1.1-4.5), adjusting for rurality and covariates. CONCLUSIONS Results demonstrate persistent rural-urban differences in meeting PA recommendations in cancer survivors and its association with self-reported health. IMPLICATIONS FOR CANCER SURVIVORS Findings underscore the need for interventions to increase PA in rural cancer survivors in an effort to improve health status and reduce cancer health disparities.
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Affiliation(s)
- Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA.
- Penn State Cancer Institute, Hershey, PA, USA.
| | - Nishat Bhuiyan
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA
| | - Wayne Foo
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Joel E Segel
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - Shirley M Bluethmann
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Renate M Winkels
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Human Nutrition & Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Joachim Wiskemann
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - William A Calo
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Eugene J Lengerich
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Kathryn H Schmitz
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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97
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Mollica MA, Buckenmaier SS, Halpern MT, McNeel TS, Weaver SJ, Doose M, Kent EE. Perceptions of care coordination among older adult cancer survivors: A SEER-CAHPS study. J Geriatr Oncol 2020; 12:446-452. [PMID: 32943359 DOI: 10.1016/j.jgo.2020.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/14/2020] [Accepted: 09/01/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Care coordination reflects deliberate efforts to harmonize patient care. This study examined variables associated with patient-reported care coordination scores among Medicare beneficiaries with a history of cancer. METHODS We utilized Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) linked data, which includes cancer registry data, patient experience surveys, and Medicare claims. We identified Medicare beneficiaries with a CAHPS survey ≤10 years after cancer diagnosis who reported seeing a personal doctor within six months. Multivariable regression models examined associations between cancer survivor characteristics and patient-reported care coordination, with higher scores indicating better coordination. RESULTS Cancer site distribution of the 14,646 survey respondents was 33.7% prostate, 22.1% breast, 11.1% colorectal, 7.2% lung, and 25.9% other. Rural residence at diagnosis (versus urban, 1.1-point difference; p = 0.04) and reporting >4 visits with a personal doctor (versus 1-2 visits, 3.0-point difference; p < 0.001) were significantly associated with higher care coordination. Older age (p < 0.001) and seeing more specialists (p = 0.006) were associated with significantly lower care coordination. Patients with melanoma (women: 5.2-point difference, p < 0.001; men: 2.7 points, p = 0.01) or breast cancer (women: 2.4 points; p < 0.001) reported significantly lower care coordination scores than did men with prostate cancer (reference group). Time from diagnosis to survey, cancer stage, number of cancers, and comorbidities were not significantly associated with care coordination scores. DISCUSSION Cancer site, rural residence, and number of physician interactions are associated with patient-reported care coordination scores. Future research should address multilevel influences that lead to worse care coordination for older adult cancer survivors.
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Affiliation(s)
- Michelle A Mollica
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, USA.
| | - Susan S Buckenmaier
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, USA
| | - Michael T Halpern
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, USA
| | | | - Sallie J Weaver
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, USA
| | - Michelle Doose
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, USA
| | - Erin E Kent
- University of North Carolina at Chapel Hill, NC, USA
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98
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Ball J, Thompson J, Wulff-Burchfield E, Ellerbeck E, Kimminau K, Brooks JV, Petersen S, Rotich D, Kinney AY, Ellis SD. Precision community: a mixed methods study to identify determinants of adoption and implementation of targeted cancer therapy in community oncology. Implement Sci Commun 2020. [DOI: 10.1186/s43058-020-00064-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
Precision medicine has enormous potential to improve cancer outcomes. Over one third of the 1.5 million Americans diagnosed with cancer each year have genetic mutations that could be targeted with an FDA-approved drug to treat their disease more effectively. However, the current uptake of targeted cancer therapy in clinical practice is suboptimal. Tumor testing is not widely used, and treatments based on molecular and genomic profiling are often not prescribed when indicated. Challenges with the uptake of precision medicine may disproportionately impact cancer patients in rural communities and other underserved populations. The objective of this study is to identify the determinants of adoption and implementation of precision cancer therapy to design an implementation strategy for community oncology practices, including those in rural areas.
Methods
This study is an explanatory sequential mixed methods study to identify factors associated with the use of targeted cancer therapy. Levels of targeted therapy use will be ascertained by secondary analysis of medical records to identify concordance with 18 national guideline recommendations for use of precision medicine in the treatment of breast, colorectal, lung, and melanoma skin cancer. Concurrently, facilitators and barriers associated with the use of precision cancer therapy will be elicited from interviews with up to a total of 40 oncologists, administrators, pathology, and pharmacy staff across the participating sites. Qualitative analysis will be a template analysis based on the Theoretical Domains Framework. Quantitative data aggregated at the practice level will be used to rank oncology practices’ adherence to targeted cancer therapy guidelines. Determinants will be compared among high and low users to isolate factors likely to facilitate targeted therapy use. The study will be conducted in eight community oncology practices, with an estimated 4121 targeted therapy treatment decision-making opportunities over a 3-year period.
Discussion
Despite unprecedented investment in precision medicine, translation into practice is suboptimal. Our study will identify factors associated with the uptake of precision medicine in community settings. These findings will inform future interventions to increase equitable uptake of evidence-based targeted cancer treatment.
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99
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Maxwell-Smith C, Cohen PA, Platell C, Tan J, Saunders C, Nightingale S, Lynch C, Sardelic F, McCormick J, Hardcastle SJ. "To be there for my family" and "Keep my independence": Metropolitan and Non-Metropolitan Cancer Survivors' Health Behaviour Motives. Support Care Cancer 2020; 29:1969-1976. [PMID: 32827055 DOI: 10.1007/s00520-020-05690-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/14/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Cancer survivors are at risk of comorbidities and mortality, and those living outside of metropolitan areas are particularly susceptible given poorer socioeconomic, health and support resources. As engagement in health behaviours is affected by participants' autonomous motives, investigation of the motives of cancer survivors in metropolitan and non-metropolitan areas could elucidate the values and reasons for practising health behaviours, allowing programs to be tailored to these motives. METHODS Metropolitan (n = 103) and non-metropolitan (n = 80) Australian cancer survivors completed a survey item by describing their motives for physical activity and healthy diet change. Inductive thematic analysis of responses was performed to establish themes across health behaviour motives. RESULTS Analyses revealed four themes: to be able to, longevity, psychological health and appearance. Survivors primarily referred to being able to enjoy family, leisure activities, travel and staying independent, with these motives often linked to longevity. Motives were similar across locations; however, those in non-metropolitan locations reported continuation of work and pain relief more frequently. Female survivors more often reported weight loss. CONCLUSIONS A predominant motive for health behaviour change in cancer survivors across geographical location was the ability to enjoy family and engage in leisure and work activities. Programs aiming to promote health behaviours in cancer survivors might consider framing interventions accordingly by emphasizing benefits of longevity and maintaining independence.
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Affiliation(s)
- Chloé Maxwell-Smith
- School of Psychology, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia. .,Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia.
| | - Paul A Cohen
- St John of God Hospital, Subiaco, Western Australia, Australia.,Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Cameron Platell
- St John of God Hospital, Subiaco, Western Australia, Australia.,University of Western Australia Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Jason Tan
- Women Centre, West Leederville, Western Australia, Australia
| | - Christobel Saunders
- St John of God Hospital, Subiaco, Western Australia, Australia.,University of Western Australia Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | | | - Craig Lynch
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Frank Sardelic
- Tamara Private Hospital, Tamworth, New South Wales, Australia
| | | | - Sarah J Hardcastle
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia.,School of Health and Human Performance, Dublin City University, Dublin, Ireland
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100
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Ratcliff CG, Torres D, Tullos EA, Geng Y, Lu Q. A systematic review of behavioral interventions for rural breast cancer survivors. J Behav Med 2020; 44:467-483. [PMID: 32813192 DOI: 10.1007/s10865-020-00174-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
Rural breast cancer survivors (RBCS) are at greater risk for poorer health outcomes and face greater treatment barriers compared to their urban counterparts, necessitating behavioral interventions tailored for the unique needs of RBCS. A systematic review of studies examining behavioral interventions delivered to RBCS living in the United States from 2000 to 2020 was conducted following PRIMSA guidelines. Nineteen unique studies were included: eight randomized controlled trials, two matched-control studies, six pre-post intervention feasibility studies, and three post-intervention satisfaction studies. Thirteen interventions aimed to improve psychosocial support, three to improve weight management, and three to improve education. Results indicate interventions' feasibility and acceptability. Six out of eight intervention conditions reported favorable outcomes compared to control conditions, suggesting promise for efficacy. However, variability in intervention objective, duration, delivery, and follow-up timing, and small sample sizes prevent overarching conclusions. Research involving larger sample sizes, higher quality control groups, and longer follow-up data is needed.
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Affiliation(s)
- Chelsea G Ratcliff
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA. .,Baylor College of Medicine, Houston, TX, USA.
| | - Debbie Torres
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA
| | - Emily A Tullos
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qian Lu
- Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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