251
|
Alvarado Ortiz M, Suárez Ramos T, Torres Cintrón CR, Zavala Zegarra D, Tortolero Luna G, Ortiz-Ortiz KJ, Castaneda-Avila MA. Racial/ethnic disparities for leukemias in Puerto Rico and the United States of America, 2015-2019. PLoS One 2023; 18:e0285547. [PMID: 37196029 DOI: 10.1371/journal.pone.0285547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Leukemia is a cancer of the early-forming cells. Over the past decade, leukemia racial/ethnic disparities have been documented in the United States of America (USA). Although the Puerto Rican population in the USA represents the second-largest Hispanic population in the nation, most of the existing studies do not include Puerto Rico. We compared the incidence and mortality rates for leukemia and its subtypes in Puerto Rico and four racial/ethnic groups in the USA. METHODS We used data from the Puerto Rico Central Cancer Registry and the Surveillance, Epidemiology, and End Results Program (2015-2019). The racial/ethnic groups studied were non-Hispanic whites (NHW), non-Hispanic blacks (NHB), Hispanics (USH), and Asian/Pacific Islanders (NHAPI) living in the USA and the Puerto Rico population. We calculated the incidence and mortality rates. The relative risk of developing or dying due to leukemia was also calculated. RESULTS Compared with Puerto Rico, NHW [standardized incidence rate (SIR) = 1.47; 95%CI = 1.40-1.53; standardized mortality rates (SMR) = 1.55; 95%CI = 1.45-1.65)] and NHB (SIR = 1.09; 95%CI = 1.04-1.15; SMR = 1.27; 95%CI = 1.19-1.35) had higher incidence and mortality rates; but lower than the NHAPI (SIR = 0.78; 95%CI = 0.74-0.82; SMR = 0.83; 95%CI = 0.77-0.89); and similar to USH. However, we found differences among leukemia subtypes. For example, NHAPI and USH had lower risk of developing chronic leukemias than Puerto Rico. We found a lower risk to develop acute lymphocytic leukemia in NHB than in Puerto Rico. CONCLUSIONS Our study provides a better understanding of leukemia's racial/ethnic disparities and fills a knowledge gap by examining the incidence and mortality rates in Puerto Rico. Future studies are needed to better understand the factors influencing the differences found in the incidence and mortality of leukemia among different racial/ethnic groups.
Collapse
Affiliation(s)
- Mariela Alvarado Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Social Science, Graduated School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Tonatiuh Suárez Ramos
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Carlos R Torres Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Diego Zavala Zegarra
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Guillermo Tortolero Luna
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Division of Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Division of Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Maira A Castaneda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| |
Collapse
|
252
|
Rahimi S, Ononogbu O, Mohan A, Moussa D, Abughosh S, Trivedi M. Identifying the predictors of adherence to oral endocrine therapy in racial/ethnic minority patients with low socioeconomic status. RESEARCH SQUARE 2022:rs.3.rs-2379786. [PMID: 36597529 PMCID: PMC9810231 DOI: 10.21203/rs.3.rs-2379786/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Adherence to oral endocrine therapy (OET) is crucial in ensuring its maximum benefit in prevention and treatment of hormone receptor-positive (HR+) breast cancer (BC) in patients. Medication use behavior is suboptimal especially in racial/ethnic minorities of lower socioeconomic status (SES). We aimed to assess the OET adherence and its predictors in racial/ethnic minority patients of lower SES. Aim We aimed to assess the OET adherence and determine the predictors of OET nonadherence in racial/ethnic minority patients of lower SES. Method A retrospective study was conducted at the Harris Health System in Houston, Texas. Since the study period included the COVID-19 pandemic, data was collected during the 6 months prior and 6 months after the start of the pandemic. The adherence was assessed using the prescription refill data using the proportion of days covered. Multivariable logistic regression model was used to identify predictors of nonadherence. Eighteen years or older patients on appropriate doses of OET for prevention or treatment of BC were included. Result In 258 patients, the adherence was significantly lower during the pandemic (44%) compared to before the pandemic (57%). The predictors of OET nonadherence before the pandemic were Black/African American, obesity/extreme obesity, prevention setting, tamoxifen therapy, and 4 or more years on OET. During the pandemic, prevention setting and those not using home delivery were more likely to be nonadherent. Conclusion Racial/ethnic minority patients of lower SES, especially African Americans and those using OET for prevention of BC, require individualized interventions to improve adherence.
Collapse
|
253
|
Disparities in erythropoiesis-stimulating agent use after changes in medicare reimbursement and implementation of a risk evaluation and mitigation strategy. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00969-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
254
|
Nguyen ALT, Blizzard CL, Yee KC, Palmer AJ, de Graaff B. Survival of primary liver cancer for people from culturally and linguistically diverse backgrounds in Australia. Cancer Epidemiol 2022; 81:102252. [PMID: 36116274 DOI: 10.1016/j.canep.2022.102252] [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: 04/20/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Survival for Primary Liver Cancer (PLC) has been investigated in Australia, but limited work has been conducted on the burden for people with different socioeconomic status, region of residence, causes of PLC, and culturally and linguistically diverse (CALD) backgrounds. This study aimed to cover this gap in the literature by investigating PLC survival with the aforementioned factors. METHODS This study linked four administrative datasets: Victorian Cancer Registry, Admitted Episodes Dataset, Emergency Minimum Dataset, and Death Index. The cohort was all cases with a PLC notification within the Victorian Cancer Registry between 01/01/2008 and 01/01/2016. The Kaplan-Meier method was used to estimate survival probabilities and the log-rank test was used to compare the difference in survival between subgroups. The Cox proportional hazard model was used to explore factors associated with PLC survival. RESULTS The 1-, 3- and 5-year survival rates were 50.0%, 28.1% and 20.6%, respectively, with a median survival of 12.0 months (95% confidence interval (CI): 11.0 - 12.9 months). Higher survival was associated with younger age, hepatocellular carcinoma, and higher socio-economic status. People born in Asian, African, and American regions had higher survival than those born in Australia and New Zealand. Cases with viral hepatitis as an identified aetiology had higher survival than those whose PLC was related to alcohol consumption (hazard ratio=1.52, 95% CI: 1.19 - 1.96), diabetes and fatty liver disease (hazard ratio=1.35, 95% CI: 1.08 - 1.68). CONCLUSION Survival outcomes for people diagnosed with PLC were still poor and affected by many factors. Asian and African cases had better survival than Australian and New Zealand patients as PLC in Asian and African cases was mostly caused by viral hepatitis. Metropolitan areas were associated with a higher survival than rural areas, not only due to accessibility to surveillance and healthcare services but also because the majority of overseas-born patients reside in metropolitan areas.
Collapse
Affiliation(s)
- Anh Le Tuan Nguyen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia.
| | | | - Kwang Chien Yee
- School of Medicine, University of Tasmania, Hobart, TAS 7000, Australia; Royal Hobart Hospital, Hobart, TAS 7000, Australia..
| | - Andrew John Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia.
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia.
| |
Collapse
|
255
|
Moore KJ, Barragan F, Williams LA. Survival disparities for childhood cancers exist when defined by race/ethnicity and sex. Cancer Epidemiol 2022; 81:102262. [PMID: 36126471 DOI: 10.1016/j.canep.2022.102262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are documented racial/ethnic and sex differences in pediatric cancer survival; however, it is unknown whether pediatric cancer survival disparities exist when race/ethnicity and sex are considered jointly. METHODS Using SEER data (2000-2017), we estimated survival differences by race/ethnicity within sexes and by sex within race/ethnicity (White, Black, Hispanic, and Asian/Pacific Islander [API]) for 17 cancers in children aged (0-19 years). Kaplan-Meier curves (Log-Rank p-values) were assessed. Cox regression was used to estimate hazards ratios (HRs) and 95 % confidence intervals (95 % CIs) between race/ethnicity/sex and cancer. RESULTS We included 51,759 cases (53.6 % male, 51.9 % White). There were statistically significant differences in 18-year survival by race/ethnicity-sex for 12/17 cancers. Within sexes, minorities had an increased risk of death compared to Whites for various cancers including acute lymphoblastic leukemia (ALL) (females: HispanicHR: 1.78, 95 % CI: 1.52, 2.10; BlackHR: 1.70, 95 % CI: 1.29, 2.24; APIHR: 1.42, 95 % CI: 1.07-1.89; males ALL: HispanicHR: 1.58, 95 % CI: 1.39,1.79; BlackHR: 1.57, 95 % CI: 1.26,1,95; API-HR: 1.39, 95 % CI: 1.11, 1.75) and astrocytoma (females: HispanicHR: 1.49, 95 % CI: 1.19, 1.85; BlackHR: 1.67, 95 % CI: 1.29, 2.17; API-HR: 1.51, 95 % CI: 1.05, 2.15; males: HispanicHR:1.27, 95 % CI: 1.04, 1.56; BlackHR: 1.69, 95 % CI: 1.32, 2.17; API-HR: 1.92, 95 % CI: 1.43, 2.58). Sex differences in survival within racial/ethnic groups were observed for White (ALL, osteosarcoma), Hispanic (medulloblastoma), and API (Primitive Neuro-Ectodermal Tumor [PNET]) children. CONCLUSIONS There are disparities in survival by both race/ethnicity and sex highlighting the societal and biologic influences these features have on survival in children with cancer.
Collapse
Affiliation(s)
- Kristin J Moore
- Program in Health Disparities Research, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Freddy Barragan
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States; Macalester College, St. Paul, MN, United States
| | - Lindsay A Williams
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States; Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States; Brain Tumor Program, University of Minnesota, Minneapolis, MN, United States.
| |
Collapse
|
256
|
So WK, Chan DN, Law BM, Rana T, Wong CL. Achieving equitable access to cancer screening services to reduce the cancer burden in the Asia-Pacific region: Experience from Hong Kong. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 29:100587. [PMID: 36605882 PMCID: PMC9808425 DOI: 10.1016/j.lanwpc.2022.100587] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The global burden of cancer can be reduced through early detection by providing people with unrestricted access to cancer screening services. However, health disparities exist within and across countries and regions. This viewpoint article uses the Integrative Multicomponent Programme for Promoting South Asians' Cancer Screening Uptake (IMPACT) project as an example of sharing strategies, such as evidence-based multimedia interventions, community health worker-led interventions, strengthening relationships and building networks, that are being adopted to improve ethnic minorities' access to cancer screening services in Hong Kong. We find that the IMPACT project effectively increased South Asians' cancer screening uptake (e.g. the cervical cancer screening uptake rate saw a 42% increase over 5 years). Future directions for scaling up the IMPACT project have been suggested to contribute to achieving Goal 3 in the United Nations Sustainable Development Goals by 2030, that is, ensuring healthy lives and promoting the well-being of all people at all ages.
Collapse
|
257
|
Cousins MM, Van Til M, Steppe E, Ng S, Ellimoottil C, Sun Y, Schipper M, Evans JR. Age, race, insurance type, and digital divide index are associated with video visit completion for patients seen for oncologic care in a large hospital system during the COVID-19 pandemic. PLoS One 2022; 17:e0277617. [PMID: 36395112 PMCID: PMC9671352 DOI: 10.1371/journal.pone.0277617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic drove rapid adoption of telehealth across oncologic specialties. This revealed barriers to telehealth access and telehealth-related disparities. We explored disparities in telehealth access in patients with cancer accessing oncologic care. MATERIALS/METHODS Data for all unique patient visits at a large academic medical center were acquired pre- and intra-pandemic (7/1/2019-12/31/2020), including visit type (in-person, video, audio only), age, race, ethnicity, rural/urban (per zip code by Federal Office of Rural Health Policy), distance from medical facility, insurance, and Digital Divide Index (DDI; incorporates technology/internet access, age, disability, and educational attainment metrics by geographic area). Pandemic phases were identified based on visit dynamics. Multivariable logistic regression models were used to examine associations of these variables with successful video visit completion. RESULTS Data were available for 2,398,633 visits for 516,428 patients across all specialties. Among these, there were 253,880 visits from 62,172 patients seen in any oncology clinic. Dramatic increases in telehealth usage were seen during the pandemic (after 3/16/2020). In multivariable analyses, patient age [OR: 0.964, (95% CI 0.961, 0.966) P<0.0001], rural zip code [OR: 0.814 (95% CI 0.733, 0.904) P = 0.0001], Medicaid enrollment [OR: 0.464 (95% CI 0.410, 0.525) P<0.0001], Medicare enrollment [OR: 0.822 (95% CI 0.761, 0.888) P = 0.0053], higher DDI [OR: 0.903 (95% CI 0.877, 0.930) P<0.0001], distance from the facility [OR: 1.028 (95% CI 1.021, 1.035) P<0.0001], black race [OR: 0.663 (95% CI 0.584, 0.753) P<0.0001], and Asian race [OR: 1.229 (95% CI 1.022, 1.479) P<0.0001] were associated with video visit completion early in the pandemic. Factors related to video visit completion later in the pandemic and within sub-specialties of oncology were also explored. CONCLUSIONS Patients from older age groups, those with minority backgrounds, and individuals from areas with less access to technology (high DDI) as well as those with Medicare or Medicaid insurance were less likely to use video visits. With greater experience through the pandemic, disparities were not mitigated. Further efforts are required to optimize telehealth to benefit all patients and avoid increasing disparities in care delivery.
Collapse
Affiliation(s)
- Matthew M. Cousins
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail: ,
| | - Monica Van Til
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Emma Steppe
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sophia Ng
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Chandy Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Urology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yilun Sun
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Joseph R. Evans
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
| |
Collapse
|
258
|
Hantel A, Kohlschmidt J, Eisfeld AK, Stock W, Jacobson S, Mandrekar S, Larson RA, Stone RM, Lathan CS, DeAngelo DJ, Byrd JC, Abel GA. Inequities in Alliance Acute Leukemia Clinical Trial and Biobank Participation: Defining Targets for Intervention. J Clin Oncol 2022; 40:3709-3718. [PMID: 35696629 PMCID: PMC9649272 DOI: 10.1200/jco.22.00307] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Representativeness in acute leukemia clinical research is essential for achieving health equity. The National Cancer Institute's mandate for Comprehensive Cancer Centers (CCCs) to define and assume responsibility for cancer control and treatment across a geographic catchment area provides an enforceable mechanism to target and potentially remediate participatory inequities. METHODS We examined enrollee characteristics across 15 Cancer and Leukemia Group B/Alliance cooperative group adult acute leukemia clinical trials (N = 3,734) from 1998 to 2013, including participation in optional companion biobanks. We determined enrollment odds by race-ethnicity for all participants adjusted for national incidence, and for those enrolled at CCCs adjusted for catchment area incidence. We modeled biobank participation by sociodemographics using logistic regression. RESULTS Non-Hispanic (NH)-White patients were more likely to be enrolled than NH-Black, NH-Asian, or Hispanic patients (odds ratio [OR], 0.75, 0.48, and 0.44, respectively; all P < .001), but less likely than NH-Native American patients (OR, 1.91; P < .001), adjusted for national incidence. Enrollment odds were lower for NH-Black, NH-Asian, and Hispanic patients at CCCs adjusted for catchment area incidence (OR, 0.57, 0.26, and 0.32, respectively; P < .001); differences were driven by overenrollment of NH-White patients from outside self-defined catchment areas (18.1% v 12.3%; χ2 P = .01) and by CCCs with less absolute enrollee diversity (rank sum P = .03). Among all enrollees, NH-White race-ethnicity and lower neighborhood deprivation correlated with biobank participation (OR, 1.81 and 1.45, respectively; P = .01 and .03). For CCC enrollees, the correlation of race-ethnicity with biobank participation was attenuated by a measure accounting for their site's degree of enrollment disparity but not neighborhood deprivation. CONCLUSION Acute leukemia clinical research disparities are substantial and driven by structural trial enrollment barriers at CCCs. Real-time CCC access and enrollment monitoring is needed to better align research participation with local populations.
Collapse
Affiliation(s)
| | - Jessica Kohlschmidt
- Alliance Statistics and Data Management Center, The Ohio State University, Columbus, OH
| | | | - Wendy Stock
- The University of Chicago, Comprehensive Cancer Center, Chicago, IL
| | - Sawyer Jacobson
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Sumithra Mandrekar
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | | | | | | | | | - John C. Byrd
- University of Cincinnati, Cancer Center-UC Medical Center, Cincinnati, OH
| | | |
Collapse
|
259
|
Zhu L, Rahman A, Yeh MC, Ma GX. Racial/Ethnic Disparities of Cancer, Metabolic Syndrome, and Lifestyle Behaviors in People under 50: A Cross-Sectional Study of Data from the National Health and Nutrition Examination Survey. EPIDEMIOLOGIA 2022; 3:493-501. [PMID: 36416800 PMCID: PMC9680314 DOI: 10.3390/epidemiologia3040037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Recent epidemiological studies have suggested a trend of increasing prevalence of metabolic syndrome (MetS) and certain types of cancer among adults under age 50. How MetS is associated with cancer in adults under the age of 50, however, remains unclear. Furthermore, it remains unknown whether associations between MetS and cancer vary by racial/ethnic group and whether modifiable lifestyle factors influence MetS-cancer relationships. METHODS We used data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) to define a case-control sample to examine potential racial/ethnic disparities associated with MetS and cancer of any type. We used a chi-square test and binary logistic regression to examine the MetS and cancer association. RESULTS From a total sample of 10,220 cases, we identified 9960 no-cancer cases and 260 cancer cases. Binary logistic regression results showed that MetS was significantly associated with a cancer risk among non-Hispanic whites (odds ratio = 1.48, 95% confidence interval = 1.00-2.19); however, it was not associated with a risk among non-Hispanic Blacks, Hispanic/Latinos, or Asian Americans. We also found several significant predictors of cancer, including age, gender, tobacco use, and sleep duration, with their roles varying by racial/ethnic subgroup. CONCLUSION The findings of this study indicate that racial/ethnic differences are involved in the association between MetS and cancer, and highlight the potential mediating effects of lifestyle and behavioral factors. Future research should leverage the existing longitudinal data or data from cohort or case-control studies to better examine the causal link between MetS and cancer among racial/ethnic minorities.
Collapse
Affiliation(s)
- Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Areebah Rahman
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, New York, NY 10065, USA
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| |
Collapse
|
260
|
Arora K, Tran TN, Kemel Y, Mehine M, Liu YL, Nandakumar S, Smith SA, Brannon AR, Ostrovnaya I, Stopsack KH, Razavi P, Safonov A, Rizvi HA, Hellmann MD, Vijai J, Reynolds TC, Fagin JA, Carrot-Zhang J, Offit K, Solit DB, Ladanyi M, Schultz N, Zehir A, Brown CL, Stadler ZK, Chakravarty D, Bandlamudi C, Berger MF. Genetic Ancestry Correlates with Somatic Differences in a Real-World Clinical Cancer Sequencing Cohort. Cancer Discov 2022; 12:2552-2565. [PMID: 36048199 PMCID: PMC9633436 DOI: 10.1158/2159-8290.cd-22-0312] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/12/2022] [Accepted: 08/29/2022] [Indexed: 01/12/2023]
Abstract
Accurate ancestry inference is critical for identifying genetic contributors of cancer disparities among populations. Although methods to infer genetic ancestry have historically relied upon genome-wide markers, the adaptation to targeted clinical sequencing panels presents an opportunity to incorporate ancestry inference into routine diagnostic workflows. We show that global ancestral contributions and admixture of continental populations can be quantitatively inferred using markers captured by the MSK-IMPACT clinical panel. In a pan-cancer cohort of 45,157 patients, we observed differences by ancestry in the frequency of somatic alterations, recapitulating known associations and revealing novel associations. Despite the comparable overall prevalence of driver alterations by ancestry group, the proportion of patients with clinically actionable alterations was lower for African (30%) compared with European (33%) ancestry. Although this result is largely explained by population-specific cancer subtype differences, it reveals an inequity in the degree to which different populations are served by existing precision oncology interventions. SIGNIFICANCE We performed a comprehensive analysis of ancestral associations with somatic mutations in a real-world pan-cancer cohort, including >5,000 non-European individuals. Using an FDA-authorized tumor sequencing panel and an FDA-recognized oncology knowledge base, we detected differences in the prevalence of clinically actionable alterations, potentially contributing to health care disparities affecting underrepresented populations. This article is highlighted in the In This Issue feature, p. 2483.
Collapse
Affiliation(s)
- Kanika Arora
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thinh Ngoc. Tran
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yelena Kemel
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Robert and Kate Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miika Mehine
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ying L. Liu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Subhiksha Nandakumar
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shaleigh A Smith
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A. Rose Brannon
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Konrad H. Stopsack
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pedram Razavi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anton Safonov
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hira A. Rizvi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew D. Hellmann
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph Vijai
- Robert and Kate Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas C. Reynolds
- Office of Health Equity, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James A. Fagin
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jian Carrot-Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kenneth Offit
- Robert and Kate Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David B. Solit
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Ladanyi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nikolaus Schultz
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Zehir
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carol L. Brown
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Office of Health Equity, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zsofia K. Stadler
- Robert and Kate Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debyani Chakravarty
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chaitanya Bandlamudi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael F. Berger
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
261
|
Liu YL, Maio A, Kemel Y, Salo-Mullen EE, Sheehan M, Tejada PR, Trottier M, Arnold AG, Fleischut MH, Latham A, Carlo MI, Murciano-Goroff YR, Walsh MF, Mandelker D, Mehta N, Bandlamudi C, Arora K, Zehir A, Berger MF, Solit DB, Aghajanian C, Diaz LA, Robson ME, Brown CL, Offit K, Hamilton JG, Stadler ZK. Disparities in cancer genetics care by race/ethnicity among pan-cancer patients with pathogenic germline variants. Cancer 2022; 128:3870-3879. [PMID: 36041233 PMCID: PMC10335605 DOI: 10.1002/cncr.34434] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Germline risk assessment is increasing as part of cancer care; however, disparities in subsequent genetic counseling are unknown. METHODS Pan-cancer patients were prospectively consented to tumor-normal sequencing via custom next generation sequencing panel (Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets) inclusive of germline analysis of ≥76 genes from January 2015 through December 2019 (97.5% research nonbillable) with protocol for genetics referral. Rates of pathogenic/likely pathogenic germline variants (PVs) and downstream counseling were compared across ancestry groups (mutually exclusive groups based on self-reported race/ethnicity and Ashkenazi Jewish [AJ] heritage) using nonparametric tests and multivariable logistic regression models. RESULTS Among 15,775 patients (59.6%, non-Hispanic [NH]-White; 15.7%, AJ; 20.5%, non-White [6.9%, Asian; 6.8%, Black/African American (AA); 6.7%, Hispanic; 0.1%, Other], and 4.2%, unknown), 2663 (17%) had a PV. Non-White patients had a lower PV rate (n = 433, 13.4%) compared to NH-Whites (n = 1451, 15.4%) and AJ patients (n = 683, 27.6%), p < .01, with differences in mostly moderate and low/recessive/uncertain penetrance variants. Among 2239 patients with new PV, 1652 (73.8%) completed recommended genetic counseling. Non-White patients had lower rates of genetic counseling (67.7%) than NH-White (73.7%) and AJ patients (78.8%), p < .01, with lower rates occurring in Black/AA (63%) compared to NH-White patients, even after adjustment for confounders (odds ratio, 0.60; 95% confidence interval, 0.37-0.97; p = .036). Non-White, particularly Black/AA and Asian, probands had a trend toward lower rates and numbers of at-risk family members being seen for counseling/genetic testing. CONCLUSIONS Despite minimizing barriers to genetic testing, non-White patients were less likely to receive recommended cancer genetics follow-up, with potential implications for oncologic care, cancer risk reduction, and at-risk family members. LAY SUMMARY Genetic testing is becoming an important part of cancer care, and we wanted to see if genetics care was different between individuals of different backgrounds. We studied 15,775 diverse patients with cancer who had genetic testing using a test called MSK-IMPACT that was covered by research funding. Clinically important genetic findings were high in all groups. However, Black patients were less likely to get recommended counseling compared to White patients. Even after removing many roadblocks, non-White and especially Black patients were less likely to get recommended genetics care, which may affect their cancer treatments and families.
Collapse
Affiliation(s)
- Ying L Liu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Anna Maio
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yelena Kemel
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erin E Salo-Mullen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Margaret Sheehan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Prince Ray Tejada
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Magan Trottier
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Angela G Arnold
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Alicia Latham
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Maria I Carlo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Yonina R Murciano-Goroff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Michael F Walsh
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Diana Mandelker
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nikita Mehta
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chaitanya Bandlamudi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kanika Arora
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ahmet Zehir
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- AstraZeneca, New York, New York, USA
| | - Michael F Berger
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - David B Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Carol Aghajanian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Luis A Diaz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Mark E Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Carol L Brown
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jada G Hamilton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Zsofia K Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
262
|
Cheng ML, Lee JK, Kumar R, Klein H, Raskina K, Schrock AB, Michael KS, Mazor T, Cerami E, Oxnard GR, Liu D, Beltran H, Sholl LM, Nishino M, Jänne PA. Response to MEK Inhibitor Therapy in MAP2K1 ( MEK1) K57N Non-Small-Cell Lung Cancer and Genomic Landscape of MAP2K1 Mutations in Non-Small-Cell Lung Cancer. JCO Precis Oncol 2022; 6:e2200382. [PMID: 36455195 DOI: 10.1200/po.22.00382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Michael L Cheng
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA.,Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.,Present address: Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | | | - Rachit Kumar
- Harold Alfond Center for Cancer Care, MaineHealth, Augusta, MA
| | - Harry Klein
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Kesi S Michael
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA.,Present address: Foundation Medicine, Cambridge, MA
| | - Tali Mazor
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Ethan Cerami
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | | | - David Liu
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Himisha Beltran
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Pasi A Jänne
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA.,Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.,Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
263
|
Kazzi B, Chino F, Kazzi B, Jain B, Tian S, Paguio JA, Yao JS, Muralidhar V, Mahal BA, Nguyen PL, Sanford NN, Dee EC. Shared burden: the association between cancer diagnosis, financial toxicity, and healthcare cost-related coping mechanisms by family members of non-elderly patients in the USA. Support Care Cancer 2022; 30:8905-8917. [PMID: 35877007 DOI: 10.1007/s00520-022-07234-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/14/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE There has been little research on the healthcare cost-related coping mechanisms of families of patients with cancer. Therefore, we assessed the association between a cancer diagnosis and the healthcare cost-related coping mechanisms of participant family members through their decision to forego or delay seeking medical care, one of the manifestations of financial toxicity. METHODS Using data from the National Health Interview Survey (NHIS) between 2000 and 2018, sample weight-adjusted prevalence was calculated and multivariable logistic regressions defined adjusted odds ratios (aORs) for participant family members who needed but did not get medical care or who delayed seeking medical care due to cost in the past 12 months, adjusting for relevant sociodemographic covariates, including participant history of cancer (yes vs. no) and participant age (18-45 vs. 46-64 years old). The analysis of family members foregoing or delaying medical care was repeated using a cancer diagnosis * age interaction term. RESULTS Participants with cancer were more likely than those without a history of cancer to report family members delaying (19.63% vs. 16.31%, P < 0.001) or foregoing (14.53% vs. 12.35%, P = 0.001) medical care. Participants with cancer in the 18 to 45 years old age range were more likely to report family members delaying (pinteraction = 0.028) or foregoing (pinteraction < 0.001) medical care. Other factors associated with cost-related coping mechanisms undertaken by the participants' family members included female sex, non-married status, poorer health status, lack of health insurance coverage, and lower household income. CONCLUSION A cancer diagnosis may be associated with familial healthcare cost-related coping mechanisms, one of the manifestations of financial toxicity. This is seen through delayed/omitted medical care of family members of people with a history of cancer, an association that may be stronger among young adult cancer survivors. These findings underscore the need to further explore how financial toxicity associated with a cancer diagnosis can affect patients' family members and to design interventions to mitigate healthcare cost-related coping mechanisms.
Collapse
Affiliation(s)
- Bahaa Kazzi
- Department of Biology, Emory University, Atlanta, GA, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 02446, USA
| | - Brigitte Kazzi
- Department of Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bhav Jain
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sibo Tian
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph A Paguio
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - J Seth Yao
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, 2280 Inwood Road, Dallas, TX, 75235, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 02446, USA.
| |
Collapse
|
264
|
McGuinness S, Hughes L, Moss‐Morris R, Hunter M, Norton S, Moon Z. Adherence to adjuvant endocrine therapy among White British and ethnic minority breast cancer survivors in the United Kingdom. Eur J Cancer Care (Engl) 2022; 31:e13722. [PMID: 36255032 PMCID: PMC9787781 DOI: 10.1111/ecc.13722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Around half of women do not take adjuvant endocrine therapy (AET) as prescribed. Research suggests that adherence rates vary across ethnic groups. This study compared AET adherences rates in White British women and women from minority ethnic groups in the United Kingdom. METHODS This is an observational study with 2001 breast cancer survivors recruited from outpatient clinics. Eligible women were diagnosed with primary breast cancer and prescribed AET within the last 3 years. Adherence was measured using the Medication Adherence Rating Scale. Eligible women were asked to complete a questionnaire pack that collected sociodemographic data such as age, relationship status and ethnicity. Independent samples t tests and χ2 tests were used to compare White British women and women from minority ethnic groups on self-reported adherence to AET. RESULTS Of White British women, 27.8% were classed as non-adherent, compared to 44.4% of women from minority ethnic groups. A logistic regression controlling for relevant demographics indicated that women from minority ethnic groups had a significantly higher risk of non-adherence than women who were White British (odds ratio = 1.50, p = 0.03) CONCLUSION: Rates of non-adherence to AET are higher in women from minority ethnic groups, which may contribute towards racial disparities in breast cancer outcomes. Research with larger and more diverse samples is needed to explore this further and to investigate the psychosocial factors driving differences in adherence.
Collapse
Affiliation(s)
- Serena McGuinness
- Faculty of Nursing Midwifery and Palliative CareKing's College LondonLondonUK
| | - Lyndsay Hughes
- Psychology Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College London, Guy's HospitalLondonUK
| | - Rona Moss‐Morris
- Psychology Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College London, Guy's HospitalLondonUK
| | - Myra Hunter
- Psychology Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College London, Guy's HospitalLondonUK
| | - Sam Norton
- Psychology Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College London, Guy's HospitalLondonUK,Centre for Rheumatic DiseasesKing's College London, Weston Education CentreLondonUK
| | - Zoe Moon
- Centre for Behavioural Medicine, School of PharmacyUniversity College LondonLondonUK
| |
Collapse
|
265
|
Kunitomo Y, Bade B, Gunderson CG, Akgün KM, Brackett A, Tanoue L, Bastian LA. Evidence of Racial Disparities in the Lung Cancer Screening Process: a Systematic Review and Meta-Analysis. J Gen Intern Med 2022; 37:3731-3738. [PMID: 35838866 PMCID: PMC9585128 DOI: 10.1007/s11606-022-07613-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Annual lung cancer screening (LCS) with low-dose chest computed tomography for high-risk individuals reduces lung cancer mortality, with greater reduction observed in Black participants in clinical trials. While racial disparities in lung cancer mortality exist, less is known about disparities in LCS participation. We conducted a systematic review to explore LCS participation in Black compared with White patients in the USA. METHODS A systematic review was conducted through a search of published studies in MEDLINE, PubMed, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied-Health Literature Database, from database inception through October 2020. We included studies that examined rates of LCS participation and compared rates by race. Studies were pooled using random-effects meta-analysis. RESULTS We screened 18,300 titles/abstracts; 229 studies were selected for full-text review, of which nine studies met inclusion criteria. Studies were categorized into 2 groups: studies that reported the screening rate among an LCS-eligible patient population, and studies that reported the screening rate among a patient population referred for LCS. Median LCS participation rates were 14.4% (range 1.7 to 62.6%) for eligible patient studies and 68.5% (range 62.6 to 88.8%) for referred patient studies. The meta-analyses showed screening rates were lower in the Black compared to White population among the LCS-eligible patient studies ([OR]=0.43, [95% CI: 0.25, 0.74]). However, screening rates were the same between Black and White patients in the referred patient studies (OR=0.94, [95% CI: 0.74, 1.19]). DISCUSSION Black LCS-eligible patients are being screened at a lower rate than White patients but have similar rates of participation once referred. Differences in referrals by providers may contribute to the racial disparity in LCS participation. More studies are needed to identify barriers to LCS referral and develop interventions to increase provider awareness of the importance of LCS in Black patients. Trial Registry PROSPERO; No.: CRD42020214213; URL: http://www.crd.york.ac.uk/PROSPERO.
Collapse
Affiliation(s)
- Yukiko Kunitomo
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Brett Bade
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Craig G Gunderson
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M Akgün
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven, CT, USA
| | - Lynn Tanoue
- Yale University School of Medicine, New Haven, CT, USA
| | - Lori A Bastian
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.
- Yale University School of Medicine, New Haven, CT, USA.
| |
Collapse
|
266
|
Ghosh J, Schultz BM, Chan J, Wultsch C, Singh R, Shureiqi I, Chow S, Doymaz A, Varriano S, Driscoll M, Muse J, Kleiman FE, Krampis K, Issa JPJ, Sapienza C. Epigenome-Wide Study Identifies Epigenetic Outliers in Normal Mucosa of Patients with Colorectal Cancer. Cancer Prev Res (Phila) 2022; 15:755-766. [PMID: 36219239 PMCID: PMC9623234 DOI: 10.1158/1940-6207.capr-22-0258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/13/2022] [Accepted: 08/23/2022] [Indexed: 01/31/2023]
Abstract
Nongenetic predisposition to colorectal cancer continues to be difficult to measure precisely, hampering efforts in targeted prevention and screening. Epigenetic changes in the normal mucosa of patients with colorectal cancer can serve as a tool in predicting colorectal cancer outcomes. We identified epigenetic changes affecting the normal mucosa of patients with colorectal cancer. DNA methylation profiling on normal colon mucosa from 77 patients with colorectal cancer and 68 controls identified a distinct subgroup of normally-appearing mucosa with markedly disrupted DNA methylation at a large number of CpGs, termed as "Outlier Methylation Phenotype" (OMP) and are present in 15 of 77 patients with cancer versus 0 of 68 controls (P < 0.001). Similar findings were also seen in publicly available datasets. Comparison of normal colon mucosa transcription profiles of patients with OMP cancer with those of patients with non-OMP cancer indicates genes whose promoters are hypermethylated in the OMP patients are also transcriptionally downregulated, and that many of the genes most affected are involved in interactions between epithelial cells, the mucus layer, and the microbiome. Analysis of 16S rRNA profiles suggests that normal colon mucosa of OMPs are enriched in bacterial genera associated with colorectal cancer risk, advanced tumor stage, chronic intestinal inflammation, malignant transformation, nosocomial infections, and KRAS mutations. In conclusion, our study identifies an epigenetically distinct OMP group in the normal mucosa of patients with colorectal cancer that is characterized by a disrupted methylome, altered gene expression, and microbial dysbiosis. Prospective studies are needed to determine whether OMP could serve as a biomarker for an elevated epigenetic risk for colorectal cancer development. PREVENTION RELEVANCE Our study identifies an epigenetically distinct OMP group in the normal mucosa of patients with colorectal cancer that is characterized by a disrupted methylome, altered gene expression, and microbial dysbiosis. Identification of OMPs in healthy controls and patients with colorectal cancer will lead to prevention and better prognosis, respectively.
Collapse
Affiliation(s)
- Jayashri Ghosh
- Fels Cancer Institute for Personalized Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Bryant M. Schultz
- Fels Cancer Institute for Personalized Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Joe Chan
- Fels Cancer Institute for Personalized Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Claudia Wultsch
- Bioinformatics and Computational Genomics Laboratory, Hunter College, City University of New York, New York, New York.,Sackler Institute for Comparative Genomics, American Museum of Natural History, New York, New York
| | - Rajveer Singh
- Bioinformatics and Computational Genomics Laboratory, Hunter College, City University of New York, New York, New York
| | - Imad Shureiqi
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Stephanie Chow
- Nutrition Department, School of Urban Public Health at Hunter College, New York, New York
| | - Ahmet Doymaz
- Department of Chemistry, Hunter College, City University of New York, New York, New York
| | - Sophia Varriano
- The Graduate Center, City University of New York, New York, New York
| | | | - Jennifer Muse
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Frida E. Kleiman
- Department of Chemistry, Hunter College, City University of New York, New York, New York
| | - Konstantinos Krampis
- Bioinformatics and Computational Genomics Laboratory, Hunter College, City University of New York, New York, New York.,Department of Biological Sciences, Hunter College, City University of New York, New York, New York.,Institute of Computational Biomedicine, Weill Cornell Medical College, New York, New York
| | | | - Carmen Sapienza
- Fels Cancer Institute for Personalized Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Corresponding Author: Carmen Sapienza, Fels Cancer Institute for Personalized Medicine, Lewis Katz School of Medicine, Temple University, 3307 N. Broad Street, Room 300, Philadelphia, PA 19140. Phone: 215-707-7373; E-mail:
| |
Collapse
|
267
|
Zvolensky MJ, Kauffman BY, Smit T, Matoska CT, Mayorga NA, Gallagher M, Garey L. Anxiety sensitivity and its association with perceived barriers for quitting, smoking inflexibility, and severity of quit problems among Black smokers. J Ethn Subst Abuse 2022:1-18. [PMID: 36190317 PMCID: PMC10067536 DOI: 10.1080/15332640.2022.2129538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Black individuals who smoke in the United States experience health disparities related to tobacco use (e.g., greater nicotine dependence, less success in quitting smoking) and interoceptive distress (e.g., somatic symptoms, anxiety). Individual difference factors that amplify interoceptive distress and contribute to poorer smoking behaviors and outcomes warrant further attention and investigation. Thus, the present study sought to explore the association between anxiety sensitivity and clinically-relevant smoking variables of perceived barriers for quitting, smoking inflexibility, and problems experienced during past quit attempts. Participants in the current study included 98 Black adult smokers (71.4% male; Mage = 44.08 years, SD = 11.44 years). Results indicated greater levels of anxiety sensitivity were associated with greater levels of perceived barriers for quitting smoking (b = 0.10, SE = 0.08, p = 0.01), smoking inflexibility (b = 0.02, SE <.001, p <.001), and problems experienced during past smoking quit attempts (b = 0.17, SE = 0.07, p = 0.02). Clinical implications and future directions are further discussed as it relates to anxiety sensitivity and efforts to reduce or quit smoking for this health disparities population.
Collapse
Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| | | | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | | | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Matthew Gallagher
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| |
Collapse
|
268
|
Rodriguez GM, Wood EH, Xiao L, Duron Y, O'Brien D, Koontz Z, Rosas LG, Patel MI. Community health workers and precision medicine: A randomized controlled trial. Contemp Clin Trials 2022; 121:106906. [PMID: 36084898 PMCID: PMC10091902 DOI: 10.1016/j.cct.2022.106906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Precision cancer care has reduced cancer-related mortality. However, minorities remain less likely to receive precision medicine than White populations with cancer due to language and system-level barriers. Precision medicine knowledge increases involvement in treatment decisions and receipt of such treatment. Few interventions exist that seek to improve precision medicine knowledge among low-income and racial and ethnic minorities with cancer. METHODS We designed a randomized controlled trial to evaluate the effectiveness of a community health worker (CHW)-delivered intervention on patients' knowledge of precision medicine in partnership with a community oncology clinic in Monterey County, California. Eligibility includes adults with newly diagnosed, progression or recurrence of cancer, low-income, or racial and ethnic minorities, or uninsured, insured by Medicaid or by a local agricultural employer. We will randomize 110 patients with cancer to the intervention or usual cancer care. The intervention group will be assigned to a CHW who will deliver culturally tailored and personalized education on precision medicine and advance care planning, screen for social determinants of health barriers and connect patients to community resources. The primary outcome is precision medicine knowledge measured by a 6-item survey adapted from Davies at baseline, 3-, 6- and 12-months post-enrollment. Exploratory outcomes include patient satisfaction with decision, activation, health care utilization, and receipt of evidence-based precision medicine care. CONCLUSION This trial will assess whether the CHW-led intervention can increase knowledge of precision medicine as well as several exploratory outcomes including receipt of evidence-based cancer care among low-income and racial and ethnic minority adults with cancer. CLINICALTRIALS gov Registration # NCT04843332.
Collapse
Affiliation(s)
- Gladys M Rodriguez
- Division of Oncology, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Emily H Wood
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Ysabel Duron
- Latino Cancer Institute, San Jose, CA, United States of America
| | - Dale O'Brien
- Cancer Patients Alliance, Pacific Grove, CA, United States of America
| | - Zachary Koontz
- Pacific Cancer Care, Monterey, CA, United States of America
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Manali I Patel
- Division of Oncology, Stanford University School of Medicine, Stanford, CA, United States of America; Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States of America.
| |
Collapse
|
269
|
Ugai T, Sasamoto N, Lee HY, Ando M, Song M, Tamimi RM, Kawachi I, Campbell PT, Giovannucci EL, Weiderpass E, Rebbeck TR, Ogino S. Is early-onset cancer an emerging global epidemic? Current evidence and future implications. Nat Rev Clin Oncol 2022; 19:656-673. [PMID: 36068272 PMCID: PMC9509459 DOI: 10.1038/s41571-022-00672-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 02/07/2023]
Abstract
Over the past several decades, the incidence of early-onset cancers, often defined as cancers diagnosed in adults <50 years of age, in the breast, colorectum, endometrium, oesophagus, extrahepatic bile duct, gallbladder, head and neck, kidney, liver, bone marrow, pancreas, prostate, stomach and thyroid has increased in multiple countries. Increased use of screening programmes has contributed to this phenomenon to a certain extent, although a genuine increase in the incidence of early-onset forms of several cancer types also seems to have emerged. Evidence suggests an aetiological role of risk factor exposures in early life and young adulthood. Since the mid-20th century, substantial multigenerational changes in the exposome have occurred (including changes in diet, lifestyle, obesity, environment and the microbiome, all of which might interact with genomic and/or genetic susceptibilities). However, the effects of individual exposures remain largely unknown. To study early-life exposures and their implications for multiple cancer types will require prospective cohort studies with dedicated biobanking and data collection technologies. Raising awareness among both the public and health-care professionals will also be critical. In this Review, we describe changes in the incidence of early-onset cancers globally and suggest measures that are likely to reduce the burden of cancers and other chronic non-communicable diseases.
Collapse
Affiliation(s)
- Tomotaka Ugai
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Hwa-Young Lee
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute of Convergence Science, Convergence Science Academy, Yonsei University, Seoul, Republic of Korea
| | - Mariko Ando
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter T Campbell
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Timothy R Rebbeck
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
- Zhu Family Center for Global Cancer Prevention, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shuji Ogino
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber Harvard Cancer Center, Boston, MA, USA.
| |
Collapse
|
270
|
Basta DW, Vong M, Beshimova A, Nakamura BN, Rusu I, Kattah MG, Shao L. A20 Restricts NOS2 Expression and Intestinal Tumorigenesis in a Mouse Model of Colitis-Associated Cancer. GASTRO HEP ADVANCES 2022; 2:96-107. [PMID: 36636264 PMCID: PMC9833806 DOI: 10.1016/j.gastha.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIMS Colon cancer can occur sporadically or in the setting of chronic inflammation, such as in patients with inflammatory bowel disease. We previously showed that A20, a critical negative regulator of tumor necrosis factor signal transduction, could regulate sporadic colon cancer development. In this report, we investigate whether A20 also acts as a tumor suppressor in a model of colitis-associated cancer. METHODS Colitis and colitis-associated tumors were induced in wild-type and A20 intestinal epithelial cell-specific knockout (A20dIEC) mice using dextran sodium sulfate and azoxymethane. Clinicopathologic markers of inflammation were assessed in conjunction with colonic tumor burden. Gene expression analyses and immunohistochemistry were performed on colonic tissue and intestinal enteroids. Nitric oxide (NO) production and activity were assessed in whole colonic lysates and mouse embryonic fibroblasts. RESULTS A20dIEC mice develop larger tumors after treatment with dextran sodium sulfate and azoxymethane than wild-type mice. In addition to elevated markers of inflammation, A20dIEC mice have significantly enhanced expression of inducible nitric oxide synthase (iNOS), a well-known driver of neoplasia. Enhanced iNOS expression is associated with the formation of reactive nitrogen species and DNA damage. Loss of A20 also enhances NO-dependent cell death directly. CONCLUSION Mechanistically, we propose that A20 normally restricts tumor necrosis factor-induced nuclear factor kappa B-dependent production of iNOS in intestinal epithelial cells, thereby protecting against colitis-associated tumorigenesis. We also propose that A20 plays a direct role in regulating NO-dependent cell death.
Collapse
Affiliation(s)
- David W Basta
- Division of Gastroenterology and Liver Disease, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Mandy Vong
- Division of Gastroenterology and Liver Disease, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Adolat Beshimova
- Division of Gastroenterology and Liver Disease, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Brooke N Nakamura
- Division of Gastroenterology and Liver Disease, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Iulia Rusu
- Division of Gastroenterology and Liver Disease, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Michael G Kattah
- Division of Gastroenterology and Liver Disease, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Ling Shao
- Division of Gastroenterology and Liver Disease, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California
| |
Collapse
|
271
|
Kueh MTW, Rahim FF, Rashid A. Development and validation of the health belief model questionnaire to promote smoking cessation for nasopharyngeal cancer prevention: a cross-sectional study. BMJ Open 2022; 12:e057552. [PMID: 36104123 PMCID: PMC9476129 DOI: 10.1136/bmjopen-2021-057552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Lifestyle-induced nasopharyngeal carcinoma is a serious but preventable risk factor. This study serves to develop and validate a questionnaire that aims to predict the health behavioural intention on smoking cessation in Sarawak, Malaysia using the Health Belief Model (HBM). DESIGN A cross-sectional study. SETTING Urban and suburban areas in Sarawak, Malaysia. PARTICIPANTS The preliminary items of the instrument were developed after extensive literature review. The instrument was translated into the Malay language using the forward-backwards method before commencing with the content validity by a panel of 10 experts. Face validity was done both quantitatively and qualitatively by 10 smokers. The construct validity of the instrument was evaluated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). A total of 100 smokers participated in phase 1 for EFA, while 171 smokers participated in phase 2 for CFA. Internal consistency was measured using Cronbach's alpha coefficients to evaluate the reliability. RESULTS In the exploratory stage, the factor loading of each item remained within the acceptable threshold. The final revised CFA yielded appropriate fit of the seven-factor model with the following model fit indices: χ2=641.705; df=500; p<0.001; comparative fit index=0.953; Tucker-Lewis Index=0.948; root mean square error of approximation=0.041. Satisfactory convergent validity and divergent validity were shown, with the exception of one pairwise construct. The internal reliability of these scales was above the desirable threshold, with Cronbach's alpha coefficients ranging from 0.705 to 0.864 and 0.838 to 0.889 in phases 1 and 2, respectively. CONCLUSIONS The study substantiated the instrument to be valid and reliable for predicting smokers' health behavioural intention to reduce cancer risk. The instrument is made up of 34 items, categorised into two sections, six HBM constructs and health behavioural intention. The instrument can be utilised for other smoking cessation-related cancers in different at-risk populations.
Collapse
Affiliation(s)
- Martin Tze Wah Kueh
- Department of Public Health Medicine, RCSI & UCD Malaysia Campus, Georgetown, Malaysia
| | - Fairuz Fadzilah Rahim
- Department of Public Health Medicine, RCSI & UCD Malaysia Campus, Georgetown, Malaysia
| | - Abdul Rashid
- Department of Public Health Medicine, RCSI & UCD Malaysia Campus, Georgetown, Malaysia
| |
Collapse
|
272
|
Nadauld L, Goldman DP. Considerations in the implementation of multicancer early detection tests. Future Oncol 2022; 18:3119-3124. [PMID: 36062430 DOI: 10.2217/fon-2022-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Dana P Goldman
- University of Southern California, Los Angeles, CA 90089, USA
| |
Collapse
|
273
|
Doose M, Verhoeven D, Sanchez JI, Livinski AA, Mollica M, Chollette V, Weaver SJ. Team-Based Care for Cancer Survivors With Comorbidities: A Systematic Review. J Healthc Qual 2022; 44:255-268. [PMID: 36036776 PMCID: PMC9429049 DOI: 10.1097/jhq.0000000000000354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Coordination of quality care for the growing population of cancer survivors with comorbidities remains poorly understood, especially among health disparity populations who are more likely to have comorbidities at the time of cancer diagnosis. This systematic review synthesized the literature from 2000 to 2022 on team-based care for cancer survivors with comorbidities and assessed team-based care conceptualization, teamwork processes, and outcomes. Six databases were searched for original articles on adults with cancer and comorbidity, which defined care team composition and comparison group, and assessed clinical or teamwork processes or outcomes. We identified 1,821 articles of which 13 met the inclusion criteria. Most studies occurred during active cancer treatment and nine focused on depression management. Four studies focused on Hispanic or Black cancer survivors and one recruited rural residents. The conceptualization of team-based care varied across articles. Teamwork processes were not explicitly measured, but teamwork concepts such as communication and mental models were mentioned. Despite team-based care being a cornerstone of quality cancer care, studies that simultaneously assessed care delivery and outcomes for cancer and comorbidities were largely absent. Improving care coordination will be key to addressing disparities and promoting health equity for cancer survivors with comorbidities.
Collapse
Affiliation(s)
- Michelle Doose
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Dana Verhoeven
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Janeth I. Sanchez
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Alicia A. Livinski
- National Institutes of Health Library, Office of Research Services, OD, National Institutes of Health, Bethesda, MD, USA
| | - Michelle Mollica
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Veronica Chollette
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Sallie J. Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| |
Collapse
|
274
|
Ganatra S, Dani SS, Kumar A, Khan SU, Wadhera R, Neilan TG, Thavendiranathan P, Barac A, Hermann J, Leja M, Deswal A, Fradley M, Liu JE, Sadler D, Asnani A, Baldassarre LA, Gupta D, Yang E, Guha A, Brown SA, Stevens J, Hayek SS, Porter C, Kalra A, Baron SJ, Ky B, Virani SS, Kazi D, Nasir K, Nohria A. Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States. JACC CardioOncol 2022; 4:326-337. [PMID: 36213357 PMCID: PMC9537091 DOI: 10.1016/j.jaccao.2022.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Racial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD). Objectives The aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD. Methods The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC's Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD. Results The AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences. Conclusions Comorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology.
Collapse
Affiliation(s)
- Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Sourbha S. Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Ashish Kumar
- Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Safi U. Khan
- Department of Cardiovascular Medicine, Houston Methodist, Houston, Texas, USA
| | - Rishi Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tomas G. Neilan
- Cardiovascular Imaging Research Center and Cardio-Oncology Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Division of Cardiology and Joint Division of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ana Barac
- Cardio-Oncology Program, Department of Cardiology, MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, District of Columbia, USA
| | - Joerg Hermann
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Monika Leja
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anita Deswal
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Fradley
- Cardio-Oncology Translational Center of Excellence, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer E. Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Diego Sadler
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston, Florida, USA
| | - Aarti Asnani
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Lauren A. Baldassarre
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Yale New Haven Hospital, Yale University, New Haven, Connecticut, USA
| | - Dipti Gupta
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Eric Yang
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Avirup Guha
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer Stevens
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Salim S. Hayek
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles Porter
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Suzanne J. Baron
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Bonnie Ky
- Cardio-Oncology Translational Center of Excellence, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Salim S. Virani
- Health Policy and Quality Program, Michael E. DeBakey VA Medical Center, Health Services Research and Development Center of Excellence and Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Dhruv Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Khurram Nasir
- Department of Cardiovascular Medicine, Houston Methodist, Houston, Texas, USA
| | - Anju Nohria
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| |
Collapse
|
275
|
Chandhok NS, Sekeres MA. Just and Equitable Enrollment to Pivotal Clinical Trials in Hematologic Malignancies. J Clin Oncol 2022; 40:3677-3680. [PMID: 36037412 DOI: 10.1200/jco.22.01547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Namrata S Chandhok
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Mikkael A Sekeres
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| |
Collapse
|
276
|
Birnbaum HJ, Dittmann AG, Stephens NM, Reinhart EC, Carey RM, Markus HR. Personal harm from the Covid-19 pandemic predicts advocacy for equality. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2022; 104:104400. [PMID: 36032507 PMCID: PMC9395294 DOI: 10.1016/j.jesp.2022.104400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
The Covid-19 pandemic has laid bare the vast amount of economic inequality in the U.S. Yet, has it influenced Americans' attitudes and behaviors toward equality? With a three-wave longitudinal survey, the current research provides evidence that experiencing personal harm (e.g., contracting Covid-19, losing jobs, or psychological distress) from the pandemic predicts an increase in people's attitudinal and behavioral advocacy for equality. Specifically, we find that experiencing greater personal harm in the early stages of the pandemic (i.e., May 2020) is associated with increased advocacy for equality one year later (i.e., May 2021; e.g., contacting a public official to express support for reducing inequality). Furthermore, we find that this increase in advocacy for equality is explained, in part, by people's greater endorsement of the external factors (e.g., bad luck, discrimination, etc.) that contribute to inequality. Our work provides evidence that the extent to which people experience harm from the Covid-19 pandemic predicts both their increased understanding of external sources of inequality, as well as their efforts to combat this inequality (e.g., by advocating for policies that combat structural contributors to inequality).
Collapse
Affiliation(s)
- Hannah J Birnbaum
- Organizational Behavior Area, Olin Business School, Washington University in St. Louis, USA
| | - Andrea G Dittmann
- Organization and Management, Goizueta Business School, Emory University, USA
| | - Nicole M Stephens
- Management and Organizations, Kellogg School of Management, Northwestern University, USA
| | | | | | | |
Collapse
|
277
|
Impact of Medicaid Expansion on Incidence and Mortality from Gastric and Esophageal Cancer. Dig Dis Sci 2022; 68:1178-1186. [PMID: 35972583 DOI: 10.1007/s10620-022-07659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/02/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Individuals in Medicaid expanded states have increased access to treatment for medical conditions and other health care resources. Esophageal and gastric cancer are associated with several modifiable risk factors (e.g. smoking, drinking, Helicobacter pylori infection). The impact of Medicaid expansion on these cancers incidence and mortality remains uninvestigated. METHODS We evaluated the association between Medicaid expansion and gastric and esophageal cancer incidence and mortality in adults aged 25-64. We employed an observational design using a difference-in-differences method with state level data, from 2010 to 2017. Annual, age-adjusted gastric and esophageal cancer incidence and mortality rates, from the CDC Wonder Database, were analyzed. Rates were adjusted for by several socio-demographic factors. RESULTS Expansion and non-expansion states were similar in percent Hispanic ethnicity and female gender. The non-expansion states had significantly higher proportion of Black race, diabetics, obese persons, smokers, and those living below the federal poverty line. Adjusted analyses demonstrate that expansion states had significantly fewer new cases of gastric cancer: - 1.6 (95% CI 0.2-3.5; P = 0.08) per 1,000,000 persons per year. No significant association was seen between Medicaid expansion and gastric cancer mortality (0.46 [95% CI - 0.08 to 0.17; P = 0.46]) and esophageal cancer incidence (0.8 [95% CI - 0.08 to 0.24; P = 0.33]) and mortality (1.0 [95% CI - 0.06 to 0.26; P = 0.21]) in multivariable analyses. CONCLUSION States that adopted Medicaid expansion saw a decrease in gastric cancer incidence when compared to states that did not expand Medicaid. Though several factors may influence gastric cancer incidence, this association is important to consider during health policy negotiations.
Collapse
|
278
|
Walker PC. INAUGURAL ADDRESS OF THE INCOMING PRESIDENT. Am J Health Syst Pharm 2022. [PMID: 35972771 DOI: 10.1093/ajhp/zxac205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Paul C Walker
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| |
Collapse
|
279
|
Zhong P, Yang B, Pan F, Hu F. Temporal trends in Black-White disparities in cancer surgery and cancer-specific survival in the United States between 2007 and 2015. Cancer Med 2022; 12:3509-3519. [PMID: 35968573 PMCID: PMC9939184 DOI: 10.1002/cam4.5141] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/16/2022] [Accepted: 08/02/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The American Society of Clinical Oncology (ASCO) has strived to address racial/ethnic disparities in cancer care since 2009. Surgery plays a pivotal role in cancer care; however, it is unclear whether and how racial/ethnic disparities in cancer surgery have changed over time. METHODS This cohort study included 1,113,256 White and Black cancer patients across 9 years (2007-2015) using patient data extracted from the Surveillance, Epidemiology, and End Results (SEER)-18 registries. Patient data were included from 2007 to adjust insurance status and by 2015 to obtain at least a 3-year survival follow-up (until 2018). The primary outcome was a surgical intervention. The secondary outcomes were the use of (neo)adjuvant chemotherapy and cancer-specific survival (CSS). Adjusted associations of the race (Black/White) with the outcomes were measured in each cancer type and year. RESULTS The gap between surgery rates for Black and White patients narrowed overall, from an adjusted odds ratio (aOR) of 0.621 (0.592-0.652) in 2007 to 0.734 (0.702-0.768) in 2015. However, the racial gap persisted in the surgery rates for lung, breast, prostate, esophageal, and ovarian cancers. In surgically treated patients with lymph node metastasis, Black patients with colorectal cancer (CRC) were less likely to receive (neo)adjuvant chemotherapy than White patients. Black patients undergoing surgery were more likely to have a worse CSS rate than White patients undergoing surgery. In breast cancer patients, the overall trend was narrow, but continuously present, with an adjusted hazard ratio (aHR) of 1.224 (1.278-1.173) in 2007 and 1.042 (1.132-0.96) in 2015. CONCLUSIONS Overall, progress has been made toward narrowing the Black-White gap in cancer surgical opportunity and survival. Future efforts should be directed toward those specific cancers for which the Black-White gap continues. Additionally, it is worth addressing the Black-White gap regarding the use of (neo)adjuvant chemotherapy for CRC treatment.
Collapse
Affiliation(s)
- Peijie Zhong
- Clinical Medical CollegeSouthwest Medical UniversityLuzhouChina
- Department of Gastroenterology and HepatologyHuaihe Hospital of Henan UniversityKaifengChina
| | - Bo Yang
- Department of Interventional MedicineThe Affiliated hospital of Southwest Medical UniversityLuzhouChina
| | - Feng Pan
- Department of Interventional MedicineThe Affiliated hospital of Southwest Medical UniversityLuzhouChina
| | - Fang Hu
- Department of Interventional MedicineThe Affiliated hospital of Southwest Medical UniversityLuzhouChina
- College of nursingSouthwest Medical UniversityLuzhouChina
| |
Collapse
|
280
|
Carrasco-Aguilar A, Galán JJ, Carrasco RA. Obamacare: A bibliometric perspective. Front Public Health 2022; 10:979064. [PMID: 36033824 PMCID: PMC9416003 DOI: 10.3389/fpubh.2022.979064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023] Open
Abstract
Obamacare is the colloquial name given to the Affordable Care Act (ACA) signed into law by President Obama in the USA, which ultimately aims to provide universal access to health care services for US citizens. The aim of this paper is to provide an overview of the political-legal, economic, social, management (or administrative), and medical (or health) repercussions of this law, using a bibliometric methodology as a basis. In addition, the main contributors to research on ACA issues have been identified in terms of authors, organizations, journals, and countries. The downward trend in scientific production on this law has been noted, and it has been concluded that a balance has not yet been reached between the coexistence of private and public health care that guarantees broad social coverage without economic or other types of barriers. The law requires political consensus to be implemented in a definitive and global manner for the whole of the United States.
Collapse
|
281
|
Liu B, Ornstein KA, Frydman JL, Kelley AS, Benn EKT, Siu AL. Use of hospitals in the New York City Metropolitan Region, by race: how separate? How equal in resources and quality? BMC Health Serv Res 2022; 22:1021. [PMID: 35948923 PMCID: PMC9365444 DOI: 10.1186/s12913-022-08414-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/27/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Although racial and ethnic minorities disproportionately use some hospitals, hospital-based racial and ethnic composition relative to geographic region and its association with quality indicators has not been systematically analyzed. METHODS We used four race and ethnicity categories: non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and Asian/Pacific Islander/Alaskan Native/American Indian (API/AIAN), as well as a combined non-NHW category, from the 2010 (latest year publicly available) Medicare Institutional Provider & Beneficiary Summary public use file for 84 hospitals in the New York City region. We assessed the relative distribution of race and ethnicity across hospitals grouped at different geographic levels (region, county, hospital referral region [HRR], or hospital service areas [HSA]) using the dissimilarity index. Hospital characteristics included quality star ratings, essential professional services and diagnostic/treatment equipment, bed size, total expenses, and patients with dual Medicare and Medicaid enrollment. We assessed Spearman's rank correlation between hospital-based racial and ethnic composition and quality/structural measures. RESULTS Dissimilarity Index decreases from region (range 30.3-40.1%) to county (range 13.7-23.5%), HRR (range 10.5-27.5%), and HSA (range 12.0-16.9%) levels. Hospitals with larger non-NHW patients tended to have lower hospital ratings and higher proportions of dually-enrolled patients. They were also more likely to be safety net hospitals and non-federal governmental hospitals. CONCLUSIONS In the NYC metropolitan region, there is considerable hospital-based racial and ethnic segregation of Medicare patients among non-NHW populations, extending previous research limited to NHB. Availability of data on racial and ethnic composition of hospitals should be made publicly available for researchers and consumers.
Collapse
Affiliation(s)
- Bian Liu
- grid.59734.3c0000 0001 0670 2351Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Katherine A. Ornstein
- grid.59734.3c0000 0001 0670 2351Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1640, New York, NY 10029 USA
| | - Julia L. Frydman
- grid.59734.3c0000 0001 0670 2351Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1640, New York, NY 10029 USA
| | - Amy S. Kelley
- grid.59734.3c0000 0001 0670 2351Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1640, New York, NY 10029 USA ,grid.274295.f0000 0004 0420 1184Geriatric Research, Education, and Clinical Center, James J Peters Veterans Affairs Medical Center, Bronx, NY USA
| | - Emma K. T. Benn
- grid.59734.3c0000 0001 0670 2351Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Albert L. Siu
- grid.59734.3c0000 0001 0670 2351Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1640, New York, NY 10029 USA ,grid.274295.f0000 0004 0420 1184Geriatric Research, Education, and Clinical Center, James J Peters Veterans Affairs Medical Center, Bronx, NY USA
| |
Collapse
|
282
|
Mori JO, White J, Elhussin I, Duduyemi BM, Karanam B, Yates C, Wang H. Molecular and pathological subtypes related to prostate cancer disparities and disease outcomes in African American and European American patients. Front Oncol 2022; 12:928357. [PMID: 36033462 PMCID: PMC9399459 DOI: 10.3389/fonc.2022.928357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Prostate cancer (PCa) disproportionately affects African American (AA) men, yet present biomarkers do not address the observed racial disparity. The objective of this study was to identify biomarkers with potential benefits to AA PCa patients. Differentially expressed genes (DEG) analysis coupled with gene set enrichment analysis (GSEA) and leading-edge genes analysis showed that the keratin family of genes, including KRT8, KRT15, KRT19, KRT34, and KRT80, constituted the single most prominent family of genes enriched in AA compared to European American (EA) PCa cell lines. In PCa patients (TCGA and MSKCC patient cohorts), KRT8, KRT15, and KRT19 expression were relatively higher in AA than in EA patients. The differences in the expression of KRT15 and KRT19, but not KRT8, were enhanced by Gleason score and ERG fusion status; in low Gleason (Gleason ≤ 6 [TCGA cohort] and Gleason ≤ 7 [MSKCC cohort]), the expression of KRT15 and KRT19 was significantly (p ≤ 0.05) higher in AA than in EA patients. Survival analysis revealed that high expression of KRT15 and KRT19 was associated with increased risk of biochemical recurrence in low Gleason category patients in the TCGA patient cohort. Interestingly, KRT15 and KRT19 expression were also associated with an increased risk of death in the metastatic prostate adenocarcinoma cohort, suggesting the potential to predict the risks of disease recurrence and death in the low Gleason category and advanced disease conditions respectively. Gene set enrichment analysis revealed known oncogenic gene signatures, including KRAS and ERBB2, to be enriched in patients expressing high KRT15 and KRT19. Furthermore, high KRT15 and KRT19 were linked to the basal and LumA PCa subtypes, which are associated with poor postoperative androgen deprivation therapy (ADT) response compared to the LumB subtype. Taken together, the present study identifies genes with high expression in AA than in EA PCa. The identified genes are linked to oncogenic gene signatures, including KRAS and ERBB2, and to basal and LumA PCa subtypes that are associated with poor postoperative ADT response. This study, therefore, reveals biomarkers with the potential to address biomarker bias in PCa risk stratification and/or prognosis.
Collapse
Affiliation(s)
- Joakin O. Mori
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, United States
- Department of Integrative Biosciences, Tuskegee University, Tuskegee, AL, United States
| | - Jason White
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, United States
| | - Isra Elhussin
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, United States
- Department of Integrative Biosciences, Tuskegee University, Tuskegee, AL, United States
| | - Babatunde M. Duduyemi
- College of Medicine and Allied Health Sciences, University of Sierra Leone Teaching Hospital, Freetown, Sierra Leone
| | - Balasubramanyam Karanam
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, United States
| | - Clayton Yates
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, United States
| | - Honghe Wang
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL, United States
- *Correspondence: Honghe Wang,
| |
Collapse
|
283
|
Role of Polygenic Risk Score in Cancer Precision Medicine of Non-European Populations: A Systematic Review. Curr Oncol 2022; 29:5517-5530. [PMID: 36005174 PMCID: PMC9406904 DOI: 10.3390/curroncol29080436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
The development of new screening methods and diagnostic tests for traits, common diseases, and cancer is linked to the advent of precision genomic medicine, in which health care is individually adjusted based on a person’s lifestyle, environmental influences, and genetic variants. Based on genome-wide association study (GWAS) analysis, rapid and continuing progress in the discovery of relevant single nucleotide polymorphisms (SNPs) for traits or complex diseases has increased interest in the potential application of genetic risk models for routine health practice. The polygenic risk score (PRS) estimates an individual’s genetic risk of a trait or disease, calculated by employing a weighted sum of allele counts combined with non-genetic variables. However, 98.38% of PRS records held in public databases relate to the European population. Therefore, PRSs for multiethnic populations are urgently needed. We performed a systematic review to discuss the role of polygenic risk scores in advancing precision medicine for different cancer types in multiethnic non-European populations.
Collapse
|
284
|
Beaber EF, Kamineni A, Burnett-Hartman AN, Hixon B, Kobrin SC, Li CI, Oliver M, Rendle KA, Skinner CS, Todd K, Zheng Y, Ziebell RA, Breslau ES, Chubak J, Corley DA, Greenlee RT, Haas JS, Halm EA, Honda S, Neslund-Dudas C, Ritzwoller DP, Schottinger JE, Tiro JA, Vachani A, Doria-Rose VP. Evaluating and Improving Cancer Screening Process Quality in a Multilevel Context: The PROSPR II Consortium Design and Research Agenda. Cancer Epidemiol Biomarkers Prev 2022; 31:1521-1531. [PMID: 35916603 PMCID: PMC9350927 DOI: 10.1158/1055-9965.epi-22-0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cancer screening is a complex process involving multiple steps and levels of influence (e.g., patient, provider, facility, health care system, community, or neighborhood). We describe the design, methods, and research agenda of the Population-based Research to Optimize the Screening Process (PROSPR II) consortium. PROSPR II Research Centers (PRC), and the Coordinating Center aim to identify opportunities to improve screening processes and reduce disparities through investigation of factors affecting cervical, colorectal, and lung cancer screening in U.S. community health care settings. METHODS We collected multilevel, longitudinal cervical, colorectal, and lung cancer screening process data from clinical and administrative sources on >9 million racially and ethnically diverse individuals across 10 heterogeneous health care systems with cohorts beginning January 1, 2010. To facilitate comparisons across organ types and highlight data breadth, we calculated frequencies of multilevel characteristics and volumes of screening and diagnostic tests/procedures and abnormalities. RESULTS Variations in patient, provider, and facility characteristics reflected the PROSPR II health care systems and differing target populations. PRCs identified incident diagnoses of invasive cancers, in situ cancers, and precancers (invasive: 372 cervical, 24,131 colorectal, 11,205 lung; in situ: 911 colorectal, 32 lung; precancers: 13,838 cervical, 554,499 colorectal). CONCLUSIONS PROSPR II's research agenda aims to advance: (i) conceptualization and measurement of the cancer screening process, its multilevel factors, and quality; (ii) knowledge of cancer disparities; and (iii) evaluation of the COVID-19 pandemic's initial impacts on cancer screening. We invite researchers to collaborate with PROSPR II investigators. IMPACT PROSPR II is a valuable data resource for cancer screening researchers.
Collapse
Affiliation(s)
- Elisabeth F. Beaber
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Brian Hixon
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Sarah C. Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Christopher I. Li
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Katharine A. Rendle
- Departments of Family Medicine and Community Health and of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Celette Sugg Skinner
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX,Simmons Comprehensive Cancer Center, Dallas, TX
| | - Kaitlin Todd
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Erica S. Breslau
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Robert T. Greenlee
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI
| | - Jennifer S. Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Ethan A. Halm
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Stacey Honda
- Hawaii Permanente Medical Group, Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI
| | | | | | | | - Jasmin A. Tiro
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX,Simmons Comprehensive Cancer Center, Dallas, TX
| | - Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| |
Collapse
|
285
|
Zavala VA, Casavilca-Zambrano S, Navarro-Vásquez J, Castañeda CA, Valencia G, Morante Z, Calderón M, Abugattas JE, Gómez H, Fuentes HA, Liendo-Picoaga R, Cotrina JM, Monge C, Neciosup SP, Huntsman S, Hu D, Sánchez SE, Williams MA, Núñez-Marrero A, Godoy L, Hechmer A, Olshen AB, Dutil J, Ziv E, Zabaleta J, Gelaye B, Vásquez J, Gálvez-Nino M, Enriquez-Vera D, Vidaurre T, Fejerman L. Association between Ancestry-Specific 6q25 Variants and Breast Cancer Subtypes in Peruvian Women. Cancer Epidemiol Biomarkers Prev 2022; 31:1602-1609. [PMID: 35654312 PMCID: PMC9662925 DOI: 10.1158/1055-9965.epi-22-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Breast cancer incidence in the United States is lower in Hispanic/Latina (H/L) compared with African American/Black or Non-Hispanic White women. An Indigenous American breast cancer-protective germline variant (rs140068132) has been reported near the estrogen receptor 1 gene. This study tests the association of rs140068132 and other polymorphisms in the 6q25 region with subtype-specific breast cancer risk in H/Ls of high Indigenous American ancestry. METHODS Genotypes were obtained for 5,094 Peruvian women with (1,755) and without (3,337) breast cancer. Associations between genotype and overall and subtype-specific risk for the protective variant were tested using logistic regression models and conditional analyses, including other risk-associated polymorphisms in the region. RESULTS We replicated the reported association between rs140068132 and breast cancer risk overall [odds ratio (OR), 0.53; 95% confidence interval (CI), 0.47-0.59], as well as the lower odds of developing hormone receptor negative (HR-) versus HR+ disease (OR, 0.77; 95% CI, 0.61-0.97). Models, including HER2, showed further heterogeneity with reduced odds for HR+HER2+ (OR, 0.68; 95% CI, 0.51-0.92), HR-HER2+ (OR, 0.63; 95% CI, 0.44-0.90) and HR-HER2- (OR, 0.77; 95% CI, 0.56-1.05) compared with HR+HER2-. Inclusion of other risk-associated variants did not change these observations. CONCLUSIONS The rs140068132 polymorphism is associated with decreased risk of breast cancer in Peruvians and is more protective against HR- and HER2+ diseases independently of other breast cancer-associated variants in the 6q25 region. IMPACT These results could inform functional analyses to understand the mechanism by which rs140068132-G reduces risk of breast cancer development in a subtype-specific manner. They also illustrate the importance of including diverse individuals in genetic studies.
Collapse
Affiliation(s)
- Valentina A. Zavala
- Department of Public Health Sciences, University of California Davis, Davis, California
| | | | | | | | | | - Zaida Morante
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | - Henry Gómez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | | | - Claudia Monge
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | - Scott Huntsman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Donglei Hu
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Sixto E. Sánchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru and Asociación Civil Proyectos en Salud (PROESA), Lima, Peru
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Angel Núñez-Marrero
- Department of Biochemistry, Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Lenin Godoy
- Department of Biochemistry, Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Aaron Hechmer
- Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Adam B. Olshen
- Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Julie Dutil
- Department of Biochemistry, Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Elad Ziv
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Jovanny Zabaleta
- Department of Pediatrics and Stanley S. Scott Cancer Center LSUHSC, New Orleans, Louisiana
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jule Vásquez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | | | - Laura Fejerman
- Department of Public Health Sciences, University of California Davis, Davis, California
- UC Davis Comprehensive Cancer Center, University of California Davis, Davis, California
- Corresponding Author: Laura Fejerman, UC Davis Comprehensive Cancer Center, 451 Health Sciences Drive, Davis, CA 95616. Phone: 530-754-1690; E-mail:
| |
Collapse
|
286
|
Kizub D, Manner CK, Graef K, Abubakar B, Orem J, Odedina F, Adeyeye MC, Nakigudde G, Ayalew K, Kalidas C, Lyerly HK, Norman T, Fashoyin-Aje L, Freedman J, Dent J, Cance B, Gralow J. Action for Increasing Diversity, Market Access, and Capacity in Oncology Registration Trials—Is Africa the Answer? Report From a Satellite Session of the Accelerating Anti-Cancer Agent Development and Validation Workshop. JCO Glob Oncol 2022; 8:e2200117. [PMID: 35714309 PMCID: PMC9232363 DOI: 10.1200/go.22.00117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients of African ancestry are not well-represented in cancer clinical trials despite bearing a disproportionate share of mortality both in United States and Africa. We describe key stakeholder perspectives and priorities related to bringing early-stage cancer clinical trials to Africa and outline essential action steps. Increasing Diversity, Market Access, and Capacity in Oncology Registration Trials—Is Africa the Answer? satellite session was organized at 2021 Accelerating Anti-Cancer Agent Development and Validation Workshop. Panelists included representatives of African Organization for Research and Training in Cancer, Uganda Cancer Institute, Uganda Women's Cancer Support Organization, BIO Ventures for Global Health, Bill & Melinda Gates Foundation, the US Food and Drug Administration, Nigeria's National Agency for Food and Drug Administration and Control, Bayer, and Genentech, with moderators from ASCO and American Cancer Society. Key discussion themes and resulting action steps were agreed upon by all participants. Panelists agreed that increasing diversity in cancer clinical trials by including African patients is key to ensuring novel drugs are safe and effective across populations. They underscored the importance of equity in clinical trial access for patients in Africa. Panelists discussed their values related to access and barriers to opening clinical trials in Africa and described innovative solutions from their work aimed at overcoming these obstacles. Multisectoral collaboration efforts that allow leveraging of limited resources and result in sustainable capacity building and mutually beneficial long-term partnerships were discussed as key to outlined action steps. The panel discussion resulted in valuable insights about key stakeholder values and priorities related to bringing early-stage clinical trials to Africa, as well as specific actions for each stakeholder group.
Collapse
Affiliation(s)
- Darya Kizub
- University of Texas MD Anderson Research Center, Houston, TX
| | | | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA
| | - Bello Abubakar
- National Hospital, Abuja, Nigeria
- African Organization for Research and Training in Cancer (AORTIC), Rondebosch, South Africa
| | | | - Folakemi Odedina
- African Organization for Research and Training in Cancer (AORTIC), Rondebosch, South Africa
- Mayo Clinic, Rochester, MN
| | | | | | - Kassa Ayalew
- United States Food and Drug Administration, Silver Spring, MD
| | | | | | - Thea Norman
- Bill & Melinda Gates Foundation, Seattle, WA
| | | | | | | | | | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA
| |
Collapse
|
287
|
Invited Commentary: Assessing Gastric and Gastroesophageal Junction Cancer Patient Prognosis in the Neoadjuvant Therapy Era. J Am Coll Surg 2022; 235:304-305. [PMID: 35839407 DOI: 10.1097/xcs.0000000000000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
288
|
Mekinda MA, Chaudhary S, Vanderford NL, White KB, Kennedy LS, Marriott LK. Approaches for Measuring Inclusive Demographics Across Youth Enjoy Science Cancer Research Training Programs. JOURNAL OF STEM OUTREACH 2022; 5:10.15695/jstem/v5i2.12. [PMID: 37840910 PMCID: PMC10575593 DOI: 10.15695/jstem/v5i2.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
The National Cancer Institute's (NCI) Youth Enjoy Science Program (YES) funds initiatives to support the cancer research training and career ambitions of middle school through undergraduate students from populations underrepresented in the biomedical sciences. The program has funded 16 institutions nationally as of January 2022. Given the program's focus on increasing diversity within the cancer research workforce, demographic characteristics of YES trainees provide essential information about the populations being served and program effectiveness. Six programs formed an interest group focused on trainee demographics and surveyed all YES grantees about their demographic data practices. Fifteen programs (94%) completed the survey. Survey data were analyzed through descriptive statistics and thematic coding. Findings revealed considerable variability in programs' approach to demographic data, including which demographics were measured, how they were operationalized, and when and how the data were collected. Half of YES programs (53%) could report underrepresented populations in biomedical research among trainees using consistent definitions. Most programs described efforts to improve their demographic data practices; however, challenges remained for the vast majority. In consideration of these findings, we offer recommendations for inclusive demographic data practices to better define and retain underrepresented populations in biomedical sciences.
Collapse
Affiliation(s)
- Megan A. Mekinda
- University of Chicago Medicine Comprehensive Cancer Center, Chicago, IL
| | - Sunita Chaudhary
- Rutgers Cancer Institute of New Jersey, Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nathan L. Vanderford
- Markey Cancer Center and the Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY
| | | | | | - Lisa K. Marriott
- OHSU-PSU School of Public Health; Oregon Health and Science University; Portland, OR
| |
Collapse
|
289
|
Lichter KE, Anderson J, Sim AJ, Baniel CC, Thiel CL, Chuter R, Collins A, Carollo E, Berg CD, Coleman CN, Abdel-Wahab M, Grover S, Singer L, Mohamad O. Transitioning to Environmentally Sustainable, Climate-Smart Radiation Oncology Care. Int J Radiat Oncol Biol Phys 2022; 113:915-924. [PMID: 35841919 PMCID: PMC10024638 DOI: 10.1016/j.ijrobp.2022.04.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/28/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Katie E Lichter
- Department of Radiation Oncology, University of California, San Francisco, California.
| | - Justin Anderson
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Austin J Sim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida; Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Claire C Baniel
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Cassandra L Thiel
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Robert Chuter
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Amy Collins
- Health Care Without Harm, Reston, Virginia; Department of Emergency Medicine, MetroWest Medical Center, Framingham, Massachusetts
| | - Erin Carollo
- Loyola University Chicago-Stritch School of Medicine, Chicago, Illinois
| | | | - C Norman Coleman
- Radiation Research Program, National Cancer Institute, Bethesda, Maryland
| | - May Abdel-Wahab
- Division of Human Health, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Botswana-UPenn Partnership, Philadelphia, Pennsylvania
| | - Lisa Singer
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Osama Mohamad
- Department of Radiation Oncology, University of California, San Francisco, California; Department of Urology, University of California, San Francisco, California
| |
Collapse
|
290
|
Offei-Dua V, Morris J, Mohammad A, Jones K, Ross W. Development of a cultural competency curriculum. J Natl Med Assoc 2022; 114:363-368. [PMID: 35931427 DOI: 10.1016/j.jnma.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/28/2022] [Indexed: 10/16/2022]
Abstract
There has been increased focus on health disparities and how to address them (Baciu et al., 2017; National Institutes of Health, 2021; Williams et al., 2021). Greater integration of social determinants of health (SDoH) education into undergraduate medical education has been identified as one possible intervention (Mangold et al., 2019; Doobay-Persaud et al., 2019; Lewis et al., 2020). The Liaison Committee on Medical Education places this education among its accreditation requirements (Mangold et al., 2019); however, no consensus exists on the most effective programming for training culturally competent physicians. This paper describes the development, implementation, and reception of one such program; a combined two-week Diversity Retreat and Washington University Medical Plunge at Washington University School of Medicine in St. Louis. This program exposed students to the historical, social, and cultural context of health disparities in the city and challenged them to recognize their own biases. Survey data showed that the program was well received and increased learners' subjective understandings of SDoH, the background of St. Louis, and patient-centered care. Learners also identified separation of SDoH material from other aspects of the curriculum and limited reinforcement of SDoH as areas for improvement. In 2020, the program was expanded and integrated into the broader curriculum. Here, we present WUMP, an example of one approach to SDoH training for medical students that was grounded in the local political and social context of St. Louis and prepared students to learn, train, and practice within that context.
Collapse
Affiliation(s)
- Victoria Offei-Dua
- Washington University in St. Louis School of Medicine, 660 S, 718 S. Euclid Avenue, CB 8121, CB 8023, Apt 128, St. Louis, MO 63110, United States.
| | - Jason Morris
- Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital and Brigham and Women's Hospital, 5 Emerson Place, Suite 101, Boston, MA 02114, United States.
| | - Arwa Mohammad
- Washington University in St. Louis School of Medicine, 660 S, 718 S. Euclid Avenue, CB 8121, CB 8023, Apt 128, St. Louis, MO 63110, United States.
| | - Kai Jones
- Washington University in St. Louis School of Medicine, 660 S, 718 S. Euclid Avenue, CB 8121, CB 8023, Apt 128, St. Louis, MO 63110, United States.
| | - Will Ross
- Division of Nephrology, Department of Medicine, Washington University in St. Louis School of Medicine, 660 South Euclid Ave. Campus Box 8023. St. Louis, MO 63110, United States.
| |
Collapse
|
291
|
Walsh KM, Neff C, Bondy ML, Kruchko C, Huse JT, Amos CI, Barnholtz-Sloan JS, Ostrom QT. Influence of county-level geographic/ancestral origin on glioma incidence and outcomes in US Hispanics. Neuro Oncol 2022; 25:398-406. [PMID: 35868246 PMCID: PMC9925707 DOI: 10.1093/neuonc/noac175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glioma incidence is 25% lower in Hispanics than White non-Hispanics. The US Hispanic population is diverse, and registry-based analyses may mask incidence differences associated with geographic/ancestral origins. METHODS County-level glioma incidence data in Hispanics were retrieved from the Central Brain Tumor Registry of the United States. American Community Survey data were used to determine the county-level proportion of the Hispanic population of Mexican/Central American and Caribbean origins. Age-adjusted incidence rate ratios and incidence rate ratios (IRRs) quantified the glioma incidence differences across groups. State-level estimates of admixture in Hispanics were obtained from published 23andMe data. RESULTS Compared to predominantly Caribbean-origin counties, predominantly Mexican/Central American-origin counties had lower age-adjusted risks of glioma (IRR = 0.83; P < 0.0001), glioblastoma (IRR = 0.86; P < 0.0001), diffuse/anaplastic astrocytoma (IRR = 0.78; P < 0.0001), oligodendroglioma (IRR = 0.82; P < 0.0001), ependymoma (IRR = 0.88; P = 0.012), and pilocytic astrocytoma (IRR = 0.76; P < 0.0001). Associations were consistent in children and adults and using more granular geographic regions. Despite having lower glioma incidence, Hispanic glioblastoma patients from predominantly Mexican/Central American-origin counties had poorer survival than Hispanics living in predominantly Caribbean-origin counties. Incidence and survival differences could be partially explained by state-level estimates of European admixture in Hispanics with European admixture associated with higher incidence and improved survival. CONCLUSIONS Glioma incidence and outcomes differ in association with the geographic origins of Hispanic communities, with counties of predominantly Mexican/Central American origin at significantly reduced risk and those of Caribbean origin at comparatively greater risk. Although typically classified as a single ethnic group, appreciating the cultural, socioeconomic, and genetic diversity of Hispanics can advance cancer disparities research.
Collapse
Affiliation(s)
- Kyle M Walsh
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA,The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC,Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA,Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Melissa L Bondy
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Jason T Huse
- Department of Translational Molecular Pathology and Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christopher I Amos
- Department of Medicine, Section of Epidemiology and Population Sciences, and Institute for Clinical and Translational Research, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA,Center for Biomedical Informatics & Information Technology and Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Quinn T Ostrom
- Corresponding Author: Quinn T. Ostrom, PhD, MPH, Department of Neurosurgery, Duke University School of Medicine, Box 3050, Durham, NC 27710 ()
| |
Collapse
|
292
|
Olakowski M, Bułdak Ł. Modifiable and Non-Modifiable Risk Factors for the Development of Non-Hereditary Pancreatic Cancer. Medicina (B Aires) 2022; 58:medicina58080978. [PMID: 35893093 PMCID: PMC9394367 DOI: 10.3390/medicina58080978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Pancreatic cancer is becoming an increasing healthcare concern. Though it is a 14th most common cancer worldwide, its incidence is steadily rising. Results of currently available therapies are still not satisfactory. Therefore, great attention should be put on the identification and reduction of risk factors for pancreatic cancer. A thorough up-to-date review of available data on the impact of well-established and novel risk factors of pancreatic cancer development have been performed. Several risk factors associated with lifestyle have significant impact on the risk of pancreatic cancer (i.e., smoking, obesity, alcohol consumption). Physicians should also be aware of the novel findings suggesting increasing role of microbiome, including viral and bacterial infections, in the development of pancreatic cancer. A growing body of evidence suggest also an increased risk during certain occupational exposures. In general, lifestyle seems to be a major contributor in the development of pancreatic cancer. Special attention should be given to individuals with a vicious cluster consisting of metabolic syndrome, tobacco smoking and alcohol consumption. Physicians should urge patients to comply to healthy diet, cessation of smoking and moderation of alcohol consumption, which may halve pancreatic cancer incidence. Further studies are warranted to explore the potential use of therapeutic approach on novel risk factors (e.g., microbiome).
Collapse
Affiliation(s)
- Marek Olakowski
- Department of Gastrointestinal Surgery, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland;
| | - Łukasz Bułdak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
- Correspondence:
| |
Collapse
|
293
|
Carethers JM. Commencing colorectal cancer screening at age 45 years in U.S. racial groups. Front Oncol 2022; 12:966998. [PMID: 35936740 PMCID: PMC9354692 DOI: 10.3389/fonc.2022.966998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/29/2022] [Indexed: 01/05/2023] Open
Abstract
Screening for colorectal cancer (CRC) is cost-effective for reducing its mortality among the average-risk population. In the US, CRC incidence and mortality differ among racial/ethnic groups, with non-Hispanic Blacks (NHB) and American Indian/Alaska Natives showing highest incidence and mortality and earlier presentation. Since 2005, some professional societies have recommended CRC screening for NHB to commence at 45 years or earlier; this was not implemented due to lack of recommendation from key groups that influence insurance payment coverage. In 2017 the highly influential U.S. Multi-Society Task Force for Colorectal Cancer recommended screening to commence at 45 years for NHB; this recommendation was supplanted by data showing an increase in early-onset CRCs in non-Hispanic Whites approaching the under-50-year rates observed for NHB. Subsequently the American Cancer Society and the USPSTF recommended that the entire average-risk population move to commence CRC screening at 45 years. Implementing screening in 45–49-year-olds has its challenges as younger groups compared with older groups participate less in preventive care. The US had made extensive progress pre-COVID-19 in closing the disparity gap for CRC screening in NHB above age 50 years; implementing screening at younger ages will take ingenuity, foresight, and creative strategy to reach a broader-aged population while preventing widening the screening disparity gap. Approaches such as navigation for non-invasive and minimally invasive CRC screening tests, removal of financial barriers such as co-pays, and complete follow up to abnormal non-invasive screening tests will need to become the norm for broad implementation and success across all racial/ethnic groups.
Collapse
|
294
|
Yu J, Sullivan BG, Senthil GN, Gonda A, Dehkordi-Vakil F, Campos B, Dayyani F, Senthil M. Prevalence of Primary Liver Cancer is Affected by Place of Birth in Hispanic People Residing in the United States: All of Us Research Program Report. Am Surg 2022; 88:2565-2571. [PMID: 35854430 DOI: 10.1177/00031348221109465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hispanic individuals have a disproportionately higher incidence and mortality for stomach, cervix, and liver cancers compared to Non-Hispanic White people. Since disparities in cancer incidence are influenced by multiple factors including immigration, elucidating the effect of birthplace and exposure to risk factors on the prevalence of these cancers is crucial for identifying high-risk populations and target risk reduction interventions. METHODS The National Institutes of Health All of Us Research Program is a prospective, multidimensional biomedical data resource of underrepresented, minoritized people. The Registered Tier Dataset v5 was utilized to evaluate the prevalence and risk of stomach, cervix, and liver cancers among United States (US) born and non-US born Hispanic participants. RESULTS Of over 434 000 current participants, 60 540 are Hispanic; 30 803 (50.9%) reported being US born and 29 294 (48.4%) non-US born. Non-US born Hispanic participants had significantly higher prevalence (.39% vs .21%, P < .001) and associated risk (OR 1.84, 95% CI 1.29-2.64, P < .001) of liver cancer, and trend towards higher prevalence of stomach (.14% vs .09%, P = .076) and cervix cancers (.27% vs .20%, P = .083) compared to US born counterparts. US born Hispanic patients with these 3 cancers were significantly younger than non-US born cohort (mean age 56.8 vs 61.7 years, P < .001). DISCUSSION This is the first report using All of Us data to show that non-US born Hispanic participants have a higher risk of liver cancer compared to US born participants. Further analyses, including genomic studies, are necessary to understand these differences and identify targets for risk reduction interventions.
Collapse
Affiliation(s)
- Jingjing Yu
- Department of Surgery, University of California, 21769Irvine Medical Center, Orange, CA, USA
| | - Brittany G Sullivan
- Department of Surgery, University of California, 21769Irvine Medical Center, Orange, CA, USA
| | | | - Amber Gonda
- Department of Surgery, University of California, 21769Irvine Medical Center, Orange, CA, USA
| | - Farideh Dehkordi-Vakil
- Department of Surgery, University of California, 21769Irvine Medical Center, Orange, CA, USA
| | - Belinda Campos
- Department of Chicano/Latino Studies, 8788University of California, Irvine, Irvine, CA, USA
| | - Farshid Dayyani
- Department of Medicine, University of California21769, Irvine Medical Center, Orange, CA, USA
| | - Maheswari Senthil
- Department of Surgery, University of California, 21769Irvine Medical Center, Orange, CA, USA
| |
Collapse
|
295
|
Ver Hoeve ES, Simon MA, Danner SM, Washington AJ, Coples SD, Percac-Lima S, Whited EC, Paskett ED, Naughton MJ, Gray DM, Wenzel JA, Zabora JR, Hassoon A, Tolbert EE, Calhoun E, Barton DL, Friese CR, Titler MG, Hamann HA. Implementing patient navigation programs: Considerations and lessons learned from the Alliance to Advance Patient-Centered Cancer Care. Cancer 2022; 128:2806-2816. [PMID: 35579501 PMCID: PMC9261966 DOI: 10.1002/cncr.34251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Six multidisciplinary cancer centers were selected and funded by the Merck Foundation (2017-2021) to collaborate in the Alliance to Advance Patient-Centered Cancer Care ("Alliance"), an initiative to improve patient access, minimize health disparities, and enhance the quality of patient-centered cancer care. These sites share their insights on implementation and expansion of their patient navigation efforts. METHODS Patient navigation represents an evidence-based health care intervention designed to enhance patient-centered care and care coordination. Investigators at 6 National Cancer Institute-designated cancer centers outline their approaches to reducing health care disparities and synthesize their efforts to ensure sustainability and successful transferability in the management of patients with cancer and their families in real-world health care settings. RESULTS Insights are outlined within the context of patient navigation program effectiveness and supported by examples from Alliance cancer center sites: 1) understand the patient populations, particularly underserved and high-risk patients; 2) capitalize on the existing infrastructure and institutional commitment to support and sustain patient navigation; and 3) build capacity by mobilizing community support outside of the cancer center. CONCLUSIONS This process-level article reflects the importance of collaboration and the usefulness of partnering with other cancer centers to share interdisciplinary insights while undergoing intervention development, implementation, and expansion. These collective insights may be useful to staff at other cancer centers that look to implement, enhance, or evaluate the effectiveness of their patient navigation interventions.
Collapse
Affiliation(s)
| | - Melissa A. Simon
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Sankirtana M. Danner
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | | | - Susan D. Coples
- Georgia Cancer Center for Excellence at Grady Health System, Atlanta, Georgia
| | | | | | | | | | - Darrell M. Gray
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Jennifer A. Wenzel
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - James R. Zabora
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Ahmed Hassoon
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Elliott E. Tolbert
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | | | - Debra L. Barton
- The University of Michigan School of Nursing, Ann Arbor, Michigan
| | | | - Marita G. Titler
- The University of Michigan School of Nursing, Ann Arbor, Michigan
| | | |
Collapse
|
296
|
Experience of a National Cancer Institute-Designated Community Outreach and Engagement Program in Supporting Communities During the COVID-19 Pandemic. J Community Health 2022; 47:862-870. [PMID: 35819548 DOI: 10.1007/s10900-022-01115-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Abstract
Coronavirus disease of 2019 (COVD-19) continues to disrupt cancer care delivery efforts and exacerbate existing health inequities. Here we describe the impact of COVID-19 on community outreach organizations partnering with a National Cancer Institute-designated Community Outreach and Engagement (COE) office in New York City (NYC) and lessons learned from these experiences. Between July and September of 2020, we conducted 16 semi-structured interviews with community key-informants to validate and inform efforts to support community organizations in response to COVID-19. Key-informants represented organizations performing a broad range of health and cancer care activities serving historically underserved, low-income, marginalized communities of color in NYC. All interviews were recorded, transcribed, and analyzed using rapid qualitative approaches. We summarize our response to challenges raised by partnering organizations. Themes included the impact of COVID-19 on communities served, challenges faced by organizations, and solutions to address COVID-19 related challenges. The COE and community organizations had to shift priorities and adapt engagement efforts to address the more urgent needs of the community (e.g., emotional distress, food insecurity). COVID-19 disrupted traditional community engagement activities for cancer outreach-calling for creativity and innovation in the community engagement process and shift in priorities. The COE responded by maintaining ongoing dialogue with community partners, by being flexible in scope/priorities beyond cancer prevention and control, and by providing education, outreach, fundraising and other resources, and developing new partnerships to meet needs of community organizations and the populations they serve.
Collapse
|
297
|
Cortés P, Ghoz HM, Stancampiano F, Omer M, Malviya B, Bowman AW, Palmer WC. Incidentalomas are associated with an increase in liver transplantation in patients with cirrhosis: a single-center retrospective study. BMC Gastroenterol 2022; 22:336. [PMID: 35818022 PMCID: PMC9275240 DOI: 10.1186/s12876-022-02379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Incidentalomas, defined as incidental findings on imaging, are a growing concern. Our aim was to determine the impact and outcomes of extrahepatic incidentalomas on liver transplantation.
Methods Patients at a large liver transplant center, who had an initial MRI for hepatocellular carcinoma screening between January 2004 and March 2020 were identified. Clinical data were collected retrospectively. Survival analysis, utilizing Kaplan Meier estimates and Cox proportional hazards regression analysis, was utilized to determine factors associated with liver transplantation. Results 720 patients were included. NASH (24.9%), HCV (22.1%) and alcohol (20.6%) were the most common causes of cirrhosis. 79.7% of patients had an extrahepatic incidentaloma. Older age and having received a liver transplant by the end of the study were associated with an incidentaloma. MELD was not associated with the presence of an incidentaloma. On univariate Cox proportional hazards regression, male sex, history of moderate alcohol use, smoking history, MELD, and incidentalomas were predictors of liver transplantation. On multivariate analysis, only MELD and the presence of an incidentaloma were found to be significant. Discovery of an incidentaloma was associated with a 30% increase in the risk of liver transplantation. Median time to transplantation did not differ based on the presence on an incidentaloma. Patients with cirrhosis from alcohol or HCV had a significantly shorter median time to transplantation than those with NASH. Renal and pancreatic lesions comprised 91% of all incidentalomas. Conclusions In this single-center retrospective study, extrahepatic incidentalomas were common in patients with cirrhosis. The finding of an incidentaloma was associated with a higher risk of liver transplantation despite a similar median time to transplantation if no incidentaloma was discovered.
Collapse
Affiliation(s)
- Pedro Cortés
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Hassan M Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Fernando Stancampiano
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Mohamed Omer
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Balkishan Malviya
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Andrew W Bowman
- Division of Hospital and Emergency Radiology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - William C Palmer
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| |
Collapse
|
298
|
Ahmad S, Ashktorab H, Brim H, Housseau F. Inflammation, microbiome and colorectal cancer disparity in African-Americans: Are there bugs in the genetics? World J Gastroenterol 2022; 28:2782-2801. [PMID: 35978869 PMCID: PMC9280725 DOI: 10.3748/wjg.v28.i25.2782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/27/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
Dysregulated interactions between host inflammation and gut microbiota over the course of life increase the risk of colorectal cancer (CRC). While environmental factors and socio-economic realities of race remain predominant contributors to CRC disparities in African-Americans (AAs), this review focuses on the biological mediators of CRC disparity, namely the under-appreciated influence of inherited ancestral genetic regulation on mucosal innate immunity and its interaction with the microbiome. There remains a poor understanding of mechanisms linking immune-related genetic polymorphisms and microbiome diversity that could influence chronic inflammation and exacerbate CRC disparities in AAs. A better understanding of the relationship between host genetics, bacteria, and CRC pathogenesis will improve the prediction of cancer risk across race/ethnicity groups overall.
Collapse
Affiliation(s)
- Sami Ahmad
- Department of Oncology, Johns Hopkins University, Baltimore, MD 21231, United States
| | - Hassan Ashktorab
- Department of Medicine, Howard University, Washington, DC 20060, United States
| | - Hassan Brim
- Department of Pathology, Howard University, Washington, DC 20060, United States
| | - Franck Housseau
- Department of Oncology, Johns Hopkins University, Baltimore, MD 21231, United States
| |
Collapse
|
299
|
Quino JE, Perez F, Perez A, Vang AP, Avendano L, Dang J, Chen MS, Arana AM, Rocha S, Nuno M, Lara PN, Fejerman L, Carvajal-Carmona LG. A Cancer Health Needs Assessment Reveals Important Differences Between US-Born and Foreign-Born Latinos in California. Front Oncol 2022; 12:883200. [PMID: 35875145 PMCID: PMC9300947 DOI: 10.3389/fonc.2022.883200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cancer is the leading cause of death among Latinos, the largest minority population in the United States (US). To address cancer challenges experienced by Latinos, we conducted a catchment area population assessment (CAPA) using validated questions from the National Cancer Institute (NCI) population health assessment supplement at our NCI-designated cancer center in California. Methods A mixed-methods CAPA was administered by bilingual-bicultural staff, with a focus on understanding the differences between foreign-born and US-born Latinos. Results 255 Latinos responded to the survey conducted between August 2019 and May 2020. Most respondents were foreign-born (63.9%), female (78.2%), and monolingual Spanish speakers (63.2%). Results showed that compared to US-born Latinos, foreign-born individuals were older, had lower educational attainment, were most likely to be monolingual Spanish speakers, were low-income, and were more likely to be uninsured. Foreign-born Latinos had lower levels of alcohol consumption and higher consumption of fruits and vegetables. The rate of preventive cancer screenings for breast, cervical and colorectal cancer did not differ by birthplace, although a low fraction (35.3%) of foreign-born Latinas who were up-to-date compared to US-born Latinas (83.3%) with colorectal cancer screening was observed. Time since the last routine check-up for all preventable cancers (cervical p=0.0002, breast p=0.0039, and colorectal p=0.0196) is significantly associated with being up to date with cancer screening. Individuals who had a check-up of two or more years ago are 84% less likely to be up to date with pap smears than those who had a check-up within the year (p=0.0060). Individuals without health insurance are 94% less likely to be up to date with mammograms and colonoscopy/FIT tests (p=0.0016 and p=0.0133, respectively) than those who are insured. There is no significant association between screening and nativity. Conclusions Considerable differences in socio-economic and environmental determinants of health and colorectal cancer screening rates were observed between US-born and foreign-born Latinos. The present study represents the foundation for future targeted intervention among immigrant populations at our cancer center’s catchment area.
Collapse
Affiliation(s)
- Juanita Elizabeth Quino
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
- Genome Center, University of California Davis, Davis, CA, United States
| | - Fabian Perez
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
- Genome Center, University of California Davis, Davis, CA, United States
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - Angelica Perez
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
| | - April Pangia Vang
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
- Genome Center, University of California Davis, Davis, CA, United States
| | - Leonie Avendano
- California Department of Public Health, Environmental Health Investigations Branch, Richmond, CA, United States
| | - Julie Dang
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
| | - Moon S. Chen
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
| | - Alexa Morales Arana
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
- Genome Center, University of California Davis, Davis, CA, United States
| | - Sienna Rocha
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
- Genome Center, University of California Davis, Davis, CA, United States
| | - Miriam Nuno
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
- Department of Surgery, University of California Davis Health, Sacramento, CA, United States
| | - Primo N. Lara
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
| | - Laura Fejerman
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - Luis G. Carvajal-Carmona
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA, United States
- Genome Center, University of California Davis, Davis, CA, United States
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Davis, CA, United States
- Center for Advancing Cancer Health Equity, School of Medicine, University of California Davis, Davis, CA, United States
- *Correspondence: Luis G. Carvajal-Carmona,
| |
Collapse
|
300
|
Finster LJ, Shirazipour CH, Escobedo LA, Cockburn M, Surani Z, Haile RW. Addressing Health Disparities Across the Cancer Continuum—a Los Angeles Approach to Achieving Equity. Front Oncol 2022; 12:912832. [PMID: 35865462 PMCID: PMC9295745 DOI: 10.3389/fonc.2022.912832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Different models have been developed to address inequities across the cancer care continuum. However, there remains a scarcity of best practices on understanding and responding to the burden of cancer in a defined catchment area.As such, the National Cancer Institute (NCI) recently provided a framework to maximize the impact on cancer burden, including a greater focus on community outreach and engagement. In this paper, we describe how Cedars Sinai Cancer (CSC), a health system that serves one of the most diverse counties in the US, implemented the framework to define its catchment area, characterize its population, identify high risk priority groups, and make decisions to address health disparities. Methods We provide a review of the methods used to assess socio-ecological levels of influence. Data were reviewed from numerous national, statewide, and county sources and supplemented by locally administered questionnaires, heat maps, and community profile summaries to gain more localized snapshots of cancer disparities in Los Angeles County. Lastly, feedback was solicited from external peer groups, community stakeholders, and key decision-makers, and the proposed catchment area was aligned with the State’s Cancer Plan and the NCI Catchment Area and Community Outreach and Engagement Mandate. Results The selected CSC catchment area meets NCI criteria and has potential to demonstrate impact both at the population level and within specialty populations. As a result, strategies are being developed to organize community outreach and engagement, as well as research across basic, clinical, and population sciences to guide cancer control and prevention efforts. Discussion To maintain a high level of cultural inclusion and sensitivity, multiple layers of data are needed to understand localized pictures of cancer disparities and underlying causes. Community engagement remains essential to implementing policy, best practice, and translational science for broader impact. Impact The clinical and translation work conducted at any cancer center requires an understanding of the determinants of health that contribute to the differences in cancer incidence and mortality among different groups. The NCI-aligned approach that we highlight is critical to support the design of future cancer control strategies that address and possibly reduce local health inequities.
Collapse
Affiliation(s)
- Laurel J. Finster
- Cancer Research Center for Health Equity, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- *Correspondence: Laurel J. Finster,
| | - Celina H. Shirazipour
- Cancer Research Center for Health Equity, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Loraine A. Escobedo
- Cancer Research Center for Health Equity, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Myles Cockburn
- Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | - Zul Surani
- Cancer Research Center for Health Equity, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Robert W. Haile
- Cancer Research Center for Health Equity, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| |
Collapse
|