1
|
Gilmore N, Grant SJ, Bethea TN, Schiaffino MK, Klepin HD, Dale W, Hardi A, Mandelblatt J, Mohile S. A scoping review of racial, ethnic, socioeconomic, and geographic disparities in the outcomes of older adults with cancer. J Am Geriatr Soc 2024; 72:1867-1900. [PMID: 38593225 DOI: 10.1111/jgs.18881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Cancer health disparities are widespread. Nevertheless, the disparities in outcomes among diverse survivors of cancer ages 65 years and older ("older") have not been systematically evaluated. METHODS We conducted a scoping review of original research articles published between January 2016 and September 2023 and indexed in Medline (Ovid), Embase, Scopus, and CINAHL databases. We included studies evaluating racial, ethnic, socioeconomic disadvantaged, geographic, sexual and gender, and/or persons with disabilities disparities in treatment, survivorship, and mortality among older survivors of cancer. We excluded studies with no a priori aims related to a health disparity, review articles, conference proceedings, meeting abstracts, studies with unclear methodologies, and articles in which the disparity group was examined only as an analytic covariate. Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines. RESULTS After searching and removing duplicates, 2573 unique citations remained and after screening 59 articles met the inclusion criteria. Many investigated more than one health disparity, and most focused on racial and ethnic (n = 44) or socioeconomic (n = 25) disparities; only 10 studies described geographic disparities, and none evaluated disparities in persons with disabilities or due to sexual and gender identity. Research investigating disparities in outcomes among diverse older survivors of cancer is increasing gradually-68% of eligible articles were published between 2020 and 2023. Most studies focused on the treatment phase of care (n = 28) and mortality (n = 26), with 16 examined disparities in survivorship, symptoms, or quality of life. Most research was descriptive and lacked analyses of potential underlying mechanisms contributing to the reported disparities. CONCLUSION Little research has evaluated the effect of strategies to reduce health disparities among older patients with cancer. This lack of evidence perpetuates cancer inequities and leaves the cancer care system ill equipped to address the unique needs of the rapidly growing and increasingly diverse older adult cancer population.
Collapse
Affiliation(s)
- Nikesha Gilmore
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, New York, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research and the Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Melody K Schiaffino
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, USA
| | - Heidi D Klepin
- Department of Hematology and Oncology, Comprehensive Cancer Center, Wake Forest University, Winston Salem, North Carolina, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeanne Mandelblatt
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Supriya Mohile
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|
2
|
Hastert TA. The Potential of Cancer Care Settings to Address Food Insecurity. J Clin Oncol 2022; 40:3569-3572. [PMID: 35776906 DOI: 10.1200/jco.22.01109] [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)
- Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| |
Collapse
|
3
|
Haier J, Schaefers J. Economic Perspective of Cancer Care and Its Consequences for Vulnerable Groups. Cancers (Basel) 2022; 14:cancers14133158. [PMID: 35804928 PMCID: PMC9265013 DOI: 10.3390/cancers14133158] [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: 02/08/2022] [Revised: 05/04/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary For cancer patients, many different reasons can cause financial burdens and economic threads. Sociodemographic factors, rural/remote location and income are known determinants for these vulnerable groups. This economic vulnerability is related to the reduced utilization of cancer care and the impact on outcome. Financial burden has been reported in many countries throughout the world and needs to be addressed as part of the sufficient quality of cancer care. Abstract Within healthcare systems in all countries, vulnerable groups of patients can be identified and are characterized by the reduced utilization of available healthcare. Many different reasons can be attributed to this observation, summarized as implementation barriers involving acceptance, accessibility, affordability, acceptability and quality of care. For many patients, cancer care is specifically associated with the occurrence of vulnerability due to the complex disease, very different target groups and delivery situations (from prevention to palliative care) as well as cost-intensive care. Sociodemographic factors, such as educational level, rural/remote location and income, are known determinants for these vulnerable groups. However, different forms of financial burdens likely influence this vulnerability in cancer care delivery in a distinct manner. In a narrative review, these socioeconomic challenges are summarized regarding their occurrence and consequences to current cancer care. Overall, besides direct costs such as for treatment, many facets of indirect costs including survivorship costs for the cancer patients and their social environment need to be considered regarding the impact on vulnerability, treatment compliance and abundance. In addition, individual cancer-related financial burden might also affect the society due to the loss of productivity and workforce availability. Healthcare providers are requested to address this vulnerability during the treatment of cancer patients.
Collapse
|
4
|
Martin JL, Azizoddin DR, Rynar LZ, Weber J, Oliver T, Weldon CB, Hauser JM. Comprehensive and Equitable Care for Vulnerable Veterans With Integrated Palliative, Psychology, and Oncology Care. Fed Pract 2021; 38:S28-S35. [PMID: 34733093 DOI: 10.12788/fp.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective Veterans who live with cancer need comprehensive care. The National Comprehensive Cancer Network and the American College of Surgeons Commission on Cancer guidelines recommend evaluating distress and providing appropriate follow-up to all patients with cancer. Methods We created patient-centered, collaborative clinics to screen for and address cancer-related distress. Medical oncologists received education about available supportive services and instructions on how to make referrals. Participants completed the Coleman Supportive Oncology Collaborative screening questions. Results Patients in this outpatient US Department of Veterans Affairs medical oncology clinic were primarily older, African American men. Most veterans screened positive for ≥ 1 type of cancer-related distress. Patients screened for high levels of distress received in-person clinical follow-up for further evaluation and to make immediate referrals to supportive care services. Conclusions We evaluated patients' needs, made referrals as needed, and helped bring care directly into the oncology clinic. Using a screening tool for cancer-related distress and managing distress with integrated psychosocial providers could improve care coordination and enhance patient-centered supportive oncology care, especially for high-risk patients. A full-time social worker was integrated into the medical oncology clinics based on our program's success.
Collapse
Affiliation(s)
- Joanna L Martin
- and are Palliative Care Physicians; is a Palliative Care Nurse Practitioner; and is a Palliative Care and Hematology Oncology Clinical Social Worker; all at Jesse Brown VA Medical Center in Chicago, Illinois. is Adjunct Faculty in Hematology and Oncology; Joanna Martin is a Health System Clinician; and Joshua Hauser is a Palliative Care Physician; all at Northwestern Feinberg School of Medicine in Illinois. Christine Weldon is Director at the Center for Business Models in Healthcare in Illinois. is a Research Scientist at Brigham and Women's Hospital and Affiliate Research Faculty, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, and Harvard Medical School, in Massachusetts. is an Assistant Professor, Supportive Oncology at Rush University Medical Center in Chicago
| | - Desiree R Azizoddin
- and are Palliative Care Physicians; is a Palliative Care Nurse Practitioner; and is a Palliative Care and Hematology Oncology Clinical Social Worker; all at Jesse Brown VA Medical Center in Chicago, Illinois. is Adjunct Faculty in Hematology and Oncology; Joanna Martin is a Health System Clinician; and Joshua Hauser is a Palliative Care Physician; all at Northwestern Feinberg School of Medicine in Illinois. Christine Weldon is Director at the Center for Business Models in Healthcare in Illinois. is a Research Scientist at Brigham and Women's Hospital and Affiliate Research Faculty, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, and Harvard Medical School, in Massachusetts. is an Assistant Professor, Supportive Oncology at Rush University Medical Center in Chicago
| | - Lauren Z Rynar
- and are Palliative Care Physicians; is a Palliative Care Nurse Practitioner; and is a Palliative Care and Hematology Oncology Clinical Social Worker; all at Jesse Brown VA Medical Center in Chicago, Illinois. is Adjunct Faculty in Hematology and Oncology; Joanna Martin is a Health System Clinician; and Joshua Hauser is a Palliative Care Physician; all at Northwestern Feinberg School of Medicine in Illinois. Christine Weldon is Director at the Center for Business Models in Healthcare in Illinois. is a Research Scientist at Brigham and Women's Hospital and Affiliate Research Faculty, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, and Harvard Medical School, in Massachusetts. is an Assistant Professor, Supportive Oncology at Rush University Medical Center in Chicago
| | - Jane Weber
- and are Palliative Care Physicians; is a Palliative Care Nurse Practitioner; and is a Palliative Care and Hematology Oncology Clinical Social Worker; all at Jesse Brown VA Medical Center in Chicago, Illinois. is Adjunct Faculty in Hematology and Oncology; Joanna Martin is a Health System Clinician; and Joshua Hauser is a Palliative Care Physician; all at Northwestern Feinberg School of Medicine in Illinois. Christine Weldon is Director at the Center for Business Models in Healthcare in Illinois. is a Research Scientist at Brigham and Women's Hospital and Affiliate Research Faculty, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, and Harvard Medical School, in Massachusetts. is an Assistant Professor, Supportive Oncology at Rush University Medical Center in Chicago
| | - Tyra Oliver
- and are Palliative Care Physicians; is a Palliative Care Nurse Practitioner; and is a Palliative Care and Hematology Oncology Clinical Social Worker; all at Jesse Brown VA Medical Center in Chicago, Illinois. is Adjunct Faculty in Hematology and Oncology; Joanna Martin is a Health System Clinician; and Joshua Hauser is a Palliative Care Physician; all at Northwestern Feinberg School of Medicine in Illinois. Christine Weldon is Director at the Center for Business Models in Healthcare in Illinois. is a Research Scientist at Brigham and Women's Hospital and Affiliate Research Faculty, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, and Harvard Medical School, in Massachusetts. is an Assistant Professor, Supportive Oncology at Rush University Medical Center in Chicago
| | - Christine B Weldon
- and are Palliative Care Physicians; is a Palliative Care Nurse Practitioner; and is a Palliative Care and Hematology Oncology Clinical Social Worker; all at Jesse Brown VA Medical Center in Chicago, Illinois. is Adjunct Faculty in Hematology and Oncology; Joanna Martin is a Health System Clinician; and Joshua Hauser is a Palliative Care Physician; all at Northwestern Feinberg School of Medicine in Illinois. Christine Weldon is Director at the Center for Business Models in Healthcare in Illinois. is a Research Scientist at Brigham and Women's Hospital and Affiliate Research Faculty, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, and Harvard Medical School, in Massachusetts. is an Assistant Professor, Supportive Oncology at Rush University Medical Center in Chicago
| | - Joshua M Hauser
- and are Palliative Care Physicians; is a Palliative Care Nurse Practitioner; and is a Palliative Care and Hematology Oncology Clinical Social Worker; all at Jesse Brown VA Medical Center in Chicago, Illinois. is Adjunct Faculty in Hematology and Oncology; Joanna Martin is a Health System Clinician; and Joshua Hauser is a Palliative Care Physician; all at Northwestern Feinberg School of Medicine in Illinois. Christine Weldon is Director at the Center for Business Models in Healthcare in Illinois. is a Research Scientist at Brigham and Women's Hospital and Affiliate Research Faculty, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, and Harvard Medical School, in Massachusetts. is an Assistant Professor, Supportive Oncology at Rush University Medical Center in Chicago
| |
Collapse
|
5
|
Hastert TA, Kirchhoff AC, Banegas MP, Morales JF, Nair M, Beebe-Dimmer JL, Pandolfi SS, Baird TE, Schwartz AG. Work changes and individual, cancer-related, and work-related predictors of decreased work participation among African American cancer survivors. Cancer Med 2020; 9:9168-9177. [PMID: 33159501 PMCID: PMC7724298 DOI: 10.1002/cam4.3512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/28/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
African American cancer survivors disproportionately experience financial difficulties after cancer. Decreased work participation (going from being employed full time to part time or from employed to not employed) can contribute to financial hardship after cancer but employment outcomes among African American cancer survivors have not been well described. This study estimates the prevalence of work changes and identifies factors associated with decreased work participation among African American cancer survivors. We analyzed data from 916 African American breast, colorectal, lung, and prostate cancer survivors who participated in the Detroit Research on Cancer Survivors (ROCS) cohort and were employed before their cancer diagnosis. Modified Poisson models estimated prevalence ratios of decreased work participation and work changes, including changes to hours, duties, or schedules, between diagnosis and ROCS enrollment controlling for sociodemographic and cancer‐related factors. Nearly half of employed survivors made changes to their schedules, duties, or hours worked due to cancer and 34.6% took at least one month off of work, including 18% who took at least one month of unpaid time off. More survivors employed full time (vs. part time) at diagnosis were on disability at ROCS enrollment (18.7% vs. 12.6%, P < 0.001), while fewer were unemployed (5.9% vs. 15.7%, P < 0.001). Nearly half (47.5%) of employed survivors decreased work participation. Taking paid time off was not associated with decreased work participation; however, taking unpaid time off and making work changes were associated with prevalence ratios of decreased work participation of 1.29 (95% CI: 1.03, 1.62) and 1.37 (95% CI: 1.07, 1.75), respectively. Employment disruptions are common after a cancer diagnosis. Survivors who take unpaid time off and make other work changes may be particularly vulnerable to experiencing decreased work participation.
Collapse
Affiliation(s)
- Theresa A Hastert
- Wayne State University School of Medicine, Detroit, MI, USA.,Karmanos Cancer Institute, Detroit, MI, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | - Mrudula Nair
- Wayne State University School of Medicine, Detroit, MI, USA.,Karmanos Cancer Institute, Detroit, MI, USA
| | - Jennifer L Beebe-Dimmer
- Wayne State University School of Medicine, Detroit, MI, USA.,Karmanos Cancer Institute, Detroit, MI, USA
| | - Stephanie S Pandolfi
- Wayne State University School of Medicine, Detroit, MI, USA.,Karmanos Cancer Institute, Detroit, MI, USA
| | - Tara E Baird
- Wayne State University School of Medicine, Detroit, MI, USA.,Karmanos Cancer Institute, Detroit, MI, USA
| | - Ann G Schwartz
- Wayne State University School of Medicine, Detroit, MI, USA.,Karmanos Cancer Institute, Detroit, MI, USA
| |
Collapse
|