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Korn AR, Walsh-Bailey C, Correa-Mendez M, DelNero P, Pilar M, Sandler B, Brownson RC, Emmons KM, Oh AY. Social determinants of health and US cancer screening interventions: A systematic review. CA Cancer J Clin 2023; 73:461-479. [PMID: 37329257 PMCID: PMC10529377 DOI: 10.3322/caac.21801] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 06/19/2023] Open
Abstract
There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US-based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer-reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8-18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.
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Affiliation(s)
- Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
- Behavioral and Policy Sciences Department, RAND Corporation, Boston, MA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | - Margarita Correa-Mendez
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Peter DelNero
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Meagan Pilar
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Brittney Sandler
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - April Y. Oh
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Hébert JR. Reducing Racial Disparities in Surviving Gastrointestinal Cancer Will Require Looking Beyond the Fact That African-Americans Have Low Rates of Surgery. Cancer Epidemiol Biomarkers Prev 2021; 30:438-440. [PMID: 33857014 DOI: 10.1158/1055-9965.epi-20-1808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
This article by Bliton and colleagues in this issue of the journal concludes that disproportionately low surgery rates among Black patients contribute to the known survival disparity between Blacks and Whites. Using data from the National Cancer Database (NCDB), they were able to address the implicit hypothesis that the measured outcome disparities are partly attributable to failure to deliver surgical care equitably. As with most good research on difficult and complex topics, it also raises interesting and provocative questions about the role of race in poor survival among African-American patients with gastrointestinal cancer. The main limitation of the NCDB is its inability to account for individual-level factors. Those things related to health behaviors, such as diet, physical activity, and tobacco use, but that also include characteristics of the built environment, comprehensive access to care measures, clinical decision-making, racial discrimination and other forms of psychosocial stress, and environmental contamination, would influence both the likelihood of getting cancer and the probability of having aggressive disease with poor prognosis. These factors also may be related to clinical decision-making. Suggestions are made to design studies and collect data that would help to inform future investigations to deepen our understanding of racial disparities in cancer survival.See related article by Bliton et al., p. 529.
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Affiliation(s)
- James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
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Sahin MK, Aker S, Arslan HN. Barriers to Colorectal Cancer Screening in a Primary Care Setting in Turkey. J Community Health 2018; 42:101-108. [PMID: 27516067 DOI: 10.1007/s10900-016-0235-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Colorectal cancer (CRC) is the third most common form of cancer in men worldwide and the second most common in women. The purpose of this study was to determine both barriers established by primary health care providers (PHCPs) and barriers perceived by them and to produce solutions for achieving the desired results. A four-part questionnaire was administered to family physicians (FPs) and family health personnels (FHPs) in Samsun, Turkey on 01-15 May, 2016. Sixty-six percent of PHCPs were contacted. Data were evaluated as numbers and percentages, and statistical significance was analyzed using the Chi square and t tests. 478 PHCPs participated; 49.4 % were FPs and 50.6 % FHPs. Of the participants, 86.6 % stated that they performed CRC screening on patients. The level of participants knowing that screening should start at age 50 and conclude at age 70 was 49.7 %. The level of subjects requesting the fecal occult blood test (FOBT) at the correct intervals was 29.7 %, but only 6.9 % recommended colonoscopy at the correct intervals. Additionally, 18.2 % of subjects knew that the test used is immunochemical FOBT, and 60.5 % reported not using reminders. PHCPs' low levels of knowledge, awareness and advice compatible with guidelines concerning CRC screening may represent an obstacle to such screening. Barriers perceived by PHCPs include patients' inability to access definite medical information, deficiencies in the reminder system and patients' lack of interest in CRC screening. Additions to the screening program will be useful in overcoming barriers.
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Affiliation(s)
- Mustafa Kursat Sahin
- Department of Family Medicine, School of Medicine, Ondokuz Mayis University, 55138, Samsun, Turkey.
| | - Servet Aker
- Canik Community Health Center, Samsun Public Health Directorate, Samsun, Turkey
| | - Hatice Nilden Arslan
- Department of Non-Communicable Diseases, Samsun Public Health Directorate, Samsun, Turkey
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Holub JL, Morris C, Fagnan LJ, Logan JR, Michaels LC, Lieberman DA. Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network. J Rural Health 2017; 34 Suppl 1:s75-s83. [PMID: 28045200 DOI: 10.1111/jrh.12231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/03/2016] [Accepted: 11/30/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings. METHODS The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites. RESULTS No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P < .0001). Resected polyps were less likely to be retrieved (84.7% vs 91.6%; P < .0001) and sent to pathology (77.1% vs 91.3%; P < .0001) at ORPRN practices compared to nonrural sites. The overall polyp detection (39.0% vs 40.3%) was similar (P = .217) between ORPRN and nonrural practices. Of exams with polyps, the rate for largest polyp on exam 6-9 mm was 20.8% at ORPRN sites, compared to 26.8% at nonrural sites (P < .0001), and for polyps >9mm 16.6% vs 18.7% (P = .106). CONCLUSION ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings.
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Affiliation(s)
- Jennifer L Holub
- Department of Gastroenterology, Oregon Health & Science University, Portland, Oregon
| | - Cynthia Morris
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Lyle J Fagnan
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon
| | - Judith R Logan
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - LeAnn C Michaels
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon
| | - David A Lieberman
- Department of Gastroenterology, Oregon Health & Science University, Portland, Oregon
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Choi SK, Adams SA, Eberth JM, Brandt HM, Friedman DB, Tucker-Seeley RD, Yip MP, Hébert JR. Medicaid Coverage Expansion and Implications for Cancer Disparities. Am J Public Health 2015; 105 Suppl 5:S706-12. [PMID: 26447909 PMCID: PMC4627517 DOI: 10.2105/ajph.2015.302876] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We estimated the impact on cancer disparities in US states that have chosen or not chosen to expand Medicaid since passage of the Patient Protection and Affordable Care Act. METHODS Data came from the 2013 Uniform Data System for colorectal and cervical cancer screening rates among patients of federally qualified health centers (FQHCs); the 2012 Behavioral Risk Factor Surveillance System for colorectal, cervical, and breast cancer screening rates; and the US Cancer Statistics (2007-2011) for colorectal, cervical, and breast cancer mortality-to-incidence ratios (MIRs). Dyads of Medicaid expansion decisions with cancer screening rates and MIRs were mapped using ArcMap. RESULTS States that had not expanded Medicaid as of September 2014 had lower cancer screening rates, especially among FQHC patients. Overall, cancer MIRs were not significantly different by Medicaid expansion status. However, Southeastern states without Medicaid expansion tended to have higher cancer MIRs and lower screening rates. CONCLUSIONS Disparities in cancer screening that already disfavor states with high cancer rates may widen in states that have not chosen to expand Medicaid unless significant efforts are mounted to ensure their residents obtain preventive health care.
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Affiliation(s)
- Seul Ki Choi
- Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle
| | - Swann Arp Adams
- Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle
| | - Jan M Eberth
- Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle
| | - Heather M Brandt
- Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle
| | - Daniela B Friedman
- Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle
| | - Reginald D Tucker-Seeley
- Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle
| | - Mei Po Yip
- Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle
| | - James R Hébert
- Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle
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Lee DJ, Consedine NS, Gonzalez JR, Spencer BA. Association of healthcare barriers with prostate-specific antigen screening among African-American and Afro-Caribbean men. Urology 2012; 80:556-63. [PMID: 22789295 DOI: 10.1016/j.urology.2012.02.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 02/21/2012] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the association between the barriers to healthcare access and prostate-specific antigen (PSA) screening practices among African-American and Afro-Caribbean men. METHODS Stratified cluster sampling of census tracts in Brooklyn, New York yielded 533 men, aged 45-70 years. The men were classified into the following groups: U.S.-born white, U.S.-born African-American, Jamaican, and Trinidadian/Tobagonian. The subjects completed a written 6-item survey assessing the healthcare barriers. RESULTS Overall, 27% of men reported never having had a PSA test and 28% reported that they had received annual PSA screening. On multivariate analysis, those who viewed the healthcare system as convenient were more likely to report an initial PSA test (odds ratio 1.8, P < .05). Those who perceived difficulty in accessing reliable care were less likely to ever have had a PSA test (odds ratio 0.6, P < .05). Subjects who had not had a comprehensive discussion with their physician about prostate cancer were less likely to have had an initial PSA test and more likely to have maintained annual PSA screening (odds ratio 0.3 and 1.7, respectively, P < .05). CONCLUSION We identified 2 novel perceived barriers to prostate cancer screening: men who experience the healthcare system as inconvenient were less likely to initiate PSA testing, and those who found it difficult to obtain quality care were less likely to ever have had a PSA test. The perceived system barriers were more closely linked to PSA screening behavior than were the measures assessing perceptions of self-efficacy. Our results suggest that a broader discussion by physicians that addresses the perceptions regarding the healthcare system might enhance the understanding of, and increase the use of, prostate cancer screening among higher risk minority men.
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Affiliation(s)
- Daniel J Lee
- Department of Urology, Columbia University Medical Center, New York, NY 10032, USA.
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Hassan C, Rex DK, Zullo A, Cooper GS. Loss of efficacy and cost-effectiveness when screening colonoscopy is performed by nongastroenterologists. Cancer 2012; 118:4404-11. [PMID: 22707430 DOI: 10.1002/cncr.27664] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 04/18/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Specialty of the endoscopist has been related to the postcolonoscopy interval risk of colorectal cancer (CRC). However, the impact of such a difference on the long-term CRC prevention rate by screening colonoscopy is largely unknown. METHODS A Markov model was constructed to simulate the efficacy and cost of colonoscopy screening according to the specialty of the endoscopist in 100,000 individuals aged 50 years until death. The postcolonoscopy interval CRC risk (0.02%) and the relative risk (1.4) of interval CRC between gastroenterologist (GI) endoscopists and non-GI endoscopists were extracted from the literature. Both efficacy and costs were projected over a steady-state US population. Eventual increase in endoscopic capacity when assuming all procedures to be performed by GI endoscopists was simulated. RESULTS According to the simulation model, screening colonoscopy performed by non-GI endoscopists resulted in a 11% relative reduction in the long-term CRC incidence prevention rate compared with the same procedure performed by GI endoscopists. When projected on the US population, the reduced non-GI efficacy resulted in an additional 3043 CRC cases and the loss of $200 million per year. When increasing the relative risk from 1.4 to 2.0, the difference in the prevention rate between GI endoscopists and non-GI endoscopists increased to 19%. It increased further to 38% when also assuming a 3-fold increase in the risk of interval CRC. An additional 165 screening colonoscopies per endoscopist per year would be required to shift all non-GI procedures to GI endoscopists. CONCLUSIONS When screening colonoscopy is performed by non-GI endoscopists, a substantial reduction in the long-term CRC prevention rate may be expected. Such difference appeared to be greater when a suboptimal efficacy of colonoscopy in preventing CRC was assumed. A 10-year saving of $2 billion may be expected when shifting all screening colonoscopies from non-GI endoscopists to GI endoscopists.
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Affiliation(s)
- Cesare Hassan
- Division of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy.
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