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Ochoa-Dominguez CY, Hamilton AS, Zhuang X, Mack WJ, Milam JE. Factors Associated With Agreement Between Parent and Childhood Cancer Survivor Reports on Child's Health Related Quality of Life. Eval Health Prof 2024; 47:328-335. [PMID: 37376980 PMCID: PMC11351002 DOI: 10.1177/01632787231185856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Pediatric Health Related Quality of Life (HRQoL) among childhood cancer survivors (CCS) measures the impact of illness and treatment from the patient's perspective. However, parents often serve as proxies when the child cannot provide information directly. Studies of agreement between parents' proxy assessment and child's self-report have shown discrepancies. Understanding the reasons for discrepancies is under studied. Thus, this study examined the agreement of 160 parent-CCS dyads on the child's domains of HRQoL by mean difference, intra-class correlation coefficients, and Bland-Altman plots. Differences in agreement were assessed by patients' age, ethnicity, and whether or not they lived with their parents. Overall, the Physical Function Score showed good agreement between parents and CCS (ICC = 0.62), while the Social Function Score had fair agreement (ICC = 0.39). CCS were more likely to rate their Social Function Score higher than their parent. The lowest agreement for the Social Function Score was found for 18-20 years old's (ICC = .254) versus younger or older CCS, and among non-Hispanic whites (ICC = 0.301) versus Hispanics. Differences in agreement varied by patient age and ethnicity, suggesting that other factors, including emotional, familial, and cultural factors, may influence parental awareness of CCS HRQoL.
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Affiliation(s)
- Carol Y. Ochoa-Dominguez
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Ann S. Hamilton
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Xueyan Zhuang
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Wendy J. Mack
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Joel E. Milam
- Department of Epidemiology and Biostatistics, University of California, Irvine
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Berkman AM, Choi E, Salsman JM, Peterson SK, Cheung CK, Andersen CR, Lu Q, Livingston JA, Hildebrandt MAT, Parsons SK, Roth ME. Excess risk of chronic health conditions in Hispanic survivors of adolescent and young adult cancers. J Cancer Surviv 2024; 18:907-916. [PMID: 36750493 DOI: 10.1007/s11764-023-01342-z] [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: 10/31/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE There is a growing population of survivors of adolescent and young adult (AYA) cancers (age 15-39 years at diagnosis). Studies in AYA cancer survivors have identified racial and ethnic disparities in long-term outcomes. To understand the extent to which a cancer diagnosis exacerbates pre-existent health disparities within a minoritized population, comparisons should be made to those of the same race or ethnicity without a cancer history. METHODS Self-reported data from the National Health Interview Survey (2009-2018) were used to identify Hispanic AYA cancer survivors and Hispanic age- and sex-matched controls. SES factors (marital status, income, education, insurance) and prevalence of chronic health conditions were compared between groups using chi-square tests. The log-odds of chronic conditions were modeled by survey-weighted logistic regression with relation to age at survey, sex, marital status, education, family income, and cancer group (control versus cancer), together with interactions between each variable and cancer group (survivors vs. controls). RESULTS Five hundred thirty-nine survivors and 5390 controls were included. Compared with controls, survivors were less likely to be married and have family income > 45 K/year, and more likely to be insured and have completed some college. Survivors had higher odds than controls of chronic health conditions (odds ratio (OR): 7.39, p < 0.001 for at least 1 and OR: 4.78, p < 0.001 for 3 or more) including cardiovascular disease, diabetes, and hypertension. Female sex, higher educational attainment, and public insurance were each associated with increased odds of chronic conditions in Hispanic AYA survivors. CONCLUSIONS An AYA cancer diagnosis is associated with poor SES outcomes and increased odds of comorbidities within the Hispanic population. IMPLICATIONS FOR CANCER SURVIVORS Cancer history can exacerbate underlying health disparities. Screening for chronic conditions is especially important in minoritized populations.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Eunju Choi
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Clark R Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qian Lu
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Institute, Houston, TX, USA
| | - J A Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle A T Hildebrandt
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Ochoa CY, Cho J, Miller KA, Baezconde-Garbanati L, Chan RY, Farias AJ, Milam JE. Hispanic/Latinos and non-Hispanic whites' childhood cancer survivors and parents: a dyadic analysis of coping resources and mental health. J Cancer Surviv 2024; 18:996-1005. [PMID: 36853581 PMCID: PMC10460832 DOI: 10.1007/s11764-023-01339-8] [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: 07/12/2022] [Accepted: 01/18/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE While limited, dyadic research demonstrates the interdependent relationship between the health and adjustment after treatment between cancer survivors and caregivers. We examined interrelationships between coping resources and mental health among childhood cancer survivors (CCS)-parent dyads. METHODS One hundred sixty CCS-parent dyads from the Project Forward pilot study completed validated questions assessing social support, religiosity, spirituality, depressive symptoms, and perceived stress. Bidirectional associations were identified with path analysis utilizing the actor-partner interdependence model (APIM). We used a multigroup approach to test for the moderating effects by Hispanic ethnicity on these relationships. RESULTS Mean age of CCS was 20 years old, 51% female, 30% diagnosed with leukemia, and mean of 7 years from diagnosis. The mean age of parents was 49 years old and 89% were mothers. For both CCS and parents, perceived social support was inversely associated with their depressive symptoms and perceived stress (e.g., actor effects). Parents' social support was not significantly associated with CCS's depressive symptoms and stress. However, higher perceived social support by the CCS was inversely associated with parents' depressive symptoms (β = - 0.202, p < 0.01) and perceived stress (β = - 0.164, p < 0.05) (e.g., partner effects). Additional actor effects were observed between spirituality, religiosity, and depressive systems when we explored the moderating effects of Hispanic ethnicity. CONCLUSION Partner effects of social support among CCS-parent dyads may influence psychological distress. IMPLICATION FOR CANCER SURVIVORS Our findings on parent-child associations between social support and psychosocial well-being imply that survivorship care can be enhanced when the social support needs of both survivors and their parents are addressed together.
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Affiliation(s)
- Carol Y Ochoa
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, N. Soto Street, 3rdFloor, Room 312-30, Los Angeles, CA, 90032, USA.
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA.
| | - Junhan Cho
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, N. Soto Street, 3rdFloor, Room 312-30, Los Angeles, CA, 90032, USA
| | - Kimberly A Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, N. Soto Street, 3rdFloor, Room 312-30, Los Angeles, CA, 90032, USA
| | - Lourdes Baezconde-Garbanati
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, N. Soto Street, 3rdFloor, Room 312-30, Los Angeles, CA, 90032, USA
| | - Randall Y Chan
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, N. Soto Street, 3rdFloor, Room 312-30, Los Angeles, CA, 90032, USA
| | - Joel E Milam
- Department of Epidemiology and Biostatistics, Department of Medicine, University of California, Irvine, Irvine, CA, USA
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Tinsley H, Gramatges M, Dreyer Z, Okcu MF, Shakeel O. Barriers to long-term follow-up in pediatric Hodgkin lymphoma survivors. Pediatr Blood Cancer 2024; 71:e30855. [PMID: 38200619 DOI: 10.1002/pbc.30855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND/PURPOSE Pediatric Hodgkin lymphoma (HL) survivors have an increased risk of late effects following treatment. Barriers at the patient, provider, and payor level adversely affect adherence to long-term follow-up. METHODS We conducted a retrospective chart review of HL survivors diagnosed from 1999 to 2014 at Texas Children's Hospital. HL survivors were considered lost to follow-up if there were no documented visits to Texas Children's Cancer Center Long-Term Survivor (LTS) clinic for 2 or more years after their last LTS clinic visit. Univariate and multivariable logistic regression analyses were conducted to explore factors contributing to loss to follow-up. Reasons for not attending subsequent LTS visits were assessed by phone interviews in a subset of lost to follow-up patients. RESULTS There were 120 HL survivors who had at least one LTS clinic visit in this timeframe; 64 (53%) were classified as lost to follow-up, and of these, 23 (36%) were interviewed. Eleven (47%) indicated that the reason for failure to follow-up was lack of or inadequate insurance, and seven (30%) stated they were unaware of the importance of continued follow-up. Loss to follow-up was associated with lack of insurance, earlier diagnosis, and lack of comorbidities in univariate analyses. Only earlier year of diagnosis (odds ratio [OR] 0.84, 95% confidence interval [CI]: 0.7-0.9, p = .01) and lack of insurance (OR 22.2, 95% CI: 4-123, p < .001) were associated with loss to follow-up in multivariable analyses. CONCLUSIONS Insurance status and awareness of the need for long-term follow-up care are key factors associated with loss to follow-up in survivors of HL. Targeted education and low-cost options for survivorship care are potential strategies for improving adherence to long-term follow-up care in HL survivors.
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Affiliation(s)
| | - Maria Gramatges
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - ZoAnn Dreyer
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - M Fatih Okcu
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Omar Shakeel
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Bailey K, Avolio J, Lo L, Gajaria A, Mooney S, Greer K, Martens H, Tami P, Pidduck J, Cunningham J, Munce S, Toulany A. Social and Structural Drivers of Health and Transition to Adult Care. Pediatrics 2024; 153:e2023062275. [PMID: 38084099 DOI: 10.1542/peds.2023-062275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 01/02/2024] Open
Abstract
CONTEXT Youth with chronic health conditions experience challenges during their transition to adult care. Those with marginalized identities likely experience further disparities in care as they navigate structural barriers throughout transition. OBJECTIVES This scoping review aims to identify the social and structural drivers of health (SSDOH) associated with outcomes for youth transitioning to adult care, particularly those who experience structural marginalization, including Black, Indigenous, and 2-spirit, lesbian, gay, bisexual, transgender, queer or questioning, and others youth. DATA SOURCES Medline, Embase, CINAHL, and PsycINFO were searched from earliest available date to May 2022. STUDY SELECTION Two reviewers screened titles and abstracts, followed by full-text. Disagreements were resolved by a third reviewer. Primary research studying the association between SSDOH and transition outcomes were included. DATA EXTRACTION SSDOH were subcategorized as social drivers, structural drivers, and demographic characteristics. Transition outcomes were classified into themes. Associations between SSDOH and outcomes were assessed according to their statistical significance and were categorized into significant (P < .05), nonsignificant (P > .05), and unclear significance. RESULTS 101 studies were included, identifying 12 social drivers (childhood environment, income, education, employment, health literacy, insurance, geographic location, language, immigration, food security, psychosocial stressors, and stigma) and 5 demographic characteristics (race and ethnicity, gender, illness type, illness severity, and comorbidity). No structural drivers were studied. Gender was significantly associated with communication, quality of life, transfer satisfaction, transfer completion, and transfer timing, and race and ethnicity with appointment keeping and transfer completion. LIMITATIONS Studies were heterogeneous and a meta-analysis was not possible. CONCLUSIONS Gender and race and ethnicity are associated with inequities in transition outcomes. Understanding these associations is crucial in informing transition interventions and mitigating health inequities.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Amy Gajaria
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Mooney
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Strategy for Patient Oriented Research Support Unit
- Faculty of Nursing, Grant MacEwan University, Edmonton, Alberta, Canada
| | - Katelyn Greer
- Alberta Strategy for Patient Oriented Research Support Unit
| | - Heather Martens
- Patient and Community Engagement Research (PaCER) Program, University of Calgary, Calgary, Alberta,Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- KickStand, Mental Health Foundation, Edmonton, Alberta, Canada
| | - Perrine Tami
- Public Health and Preventative Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sarah Munce
- Rehabilitation Sciences Institute
- Department of Occupational Science and Occupational Therapy
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
- Department of Pediatrics, Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Sickkids Research Institute, Toronto, Ontario, Canada
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Ochoa-Dominguez CY, Chan RY, Cervantes L, Banegas MP, Miller KA. Social support experiences of hispanic/latino parents of childhood cancer survivors in a safety-net hospital: a qualitative study. J Psychosoc Oncol 2023; 42:398-411. [PMID: 37787073 PMCID: PMC10987392 DOI: 10.1080/07347332.2023.2259365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE To describe the social support experiences of Hispanic/Latino parents while caregiving for childhood cancer survivors. RESEARCH APPROACH Semi-structured one-on-one interviews were conducted among 15 caregivers from a safety-net hospital in Los Angeles. A thematic analysis approach was used to analyze data. FINDINGS The positive influence of social support throughout their caregiving experience included (1) sharing information-enhanced knowledge, (2) receiving comfort and encouragement, (3) receiving tangible assistance reducing the caregiving burden, and (4) enhancing caregiving empowerment/self-efficacy. Sub-themes regarding the lack of social support included (1) being a single parent and (2) family and friends withdrawing after the child's cancer diagnosis. CONCLUSION We found Hispanic/Latino parents strongly value social support as it enables them to have essential resources that support caregiving for their child and themselves. Efforts should ensure that caregivers are routinely screened to identify their supportive needs so that support services for caregivers can be optimized and tailored, as those with a lack of social support may experience excessive caregiver burden.
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Affiliation(s)
- Carol Y. Ochoa-Dominguez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Randall Y. Chan
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lissette Cervantes
- Department of Medicine, Division of Hospital Medicine, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Matthew P. Banegas
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Kimberly A. Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Kim Y, Ritt-Olson A, Tobin J, Haydon M, Milam J. Beyond depression: correlates of well-being in young adult survivors of childhood cancers. J Cancer Surviv 2023; 17:1397-1404. [PMID: 35187609 DOI: 10.1007/s11764-022-01186-z] [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: 11/15/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study investigated the correlates of well-being with psychosocial and clinical factors in young adult childhood cancer survivors (YACCS) above and beyond depressive symptoms. METHODS Participants were from the Project Forward Cohort, a population-based study of young adult survivors of childhood cancers. Participants (n = 1166, Mage = 25.1 years) were recruited through the Los Angeles Cancer Surveillance Program (Cancer Registry covering Los Angeles County). A majority received a diagnosis of leukemia (36.1%) or lymphoma (21.7%). Participants completed self-reported questionnaires at one timepoint. Multiple regression analyses were performed with well-being as the outcome variable and psychosocial and clinical variables (social support, sense of adulthood, posttraumatic growth, treatment intensity, and self-rated health) as the independent variables. Covariates included demographics (age, gender, relationship status, race/ethnicity) and depressive symptoms. RESULTS In the multivariable model, posttraumatic growth, social support, sense of adulthood, and self-rated health were significantly associated with well-being (all ps < .05), when controlling for depressive symptoms. Treatment intensity and years since diagnosis were not significantly associated with well-being, when controlling for depressive symptoms. CONCLUSIONS There are unique correlates of well-being above and beyond depressive symptoms among YACCS. This finding illuminates individual differences that may be associated with well-being and provides targets for intervention. IMPLICATIONS FOR CANCER SURVIVORS Psychosocial interventions and survivorship care for YACCS should consider the broad aspects of well-being, independent of depressive symptoms.
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Affiliation(s)
- Yoonji Kim
- Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA.
| | | | - Jessica Tobin
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Marcie Haydon
- Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
- Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
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Mobley EM, Moke DJ, Milam J, Ochoa‐Dominguez CY, Stal J, Mitchell H, Aminzadeh N, Bolshakova M, Mailhot Vega RB, Dinalo J, Motala A, Hempel S. Disparities in pediatric cancer survivorship care: A systematic review. Cancer Med 2023; 12:18281-18305. [PMID: 37551113 PMCID: PMC10524017 DOI: 10.1002/cam4.6426] [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: 05/12/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Childhood cancer survivors (CCS) experience many long-term health problems that can be mitigated with recommended survivorship care. However, many CCS do not have access to survivorship care nor receive recommended survivorship care. We reviewed the empirical evidence of disparities in survivorship care for CCS. METHODS This systematic review searched PubMed, CINAHL, and PsycINFO for studies on survivorship care for CCS (PROSPERO: CRD42021227965) and abstracted the reported presence or absence of disparities in care. We screened 7945 citations, and of those, we reviewed 2760 publications at full text. RESULTS A total of 22 studies reported in 61 publications met inclusion criteria. Potential disparities by cancer treatment (N = 14), diagnosis (N = 13), sex (N = 13), and current age (N = 13) were frequently studied. There was high quality of evidence (QOE) of survivorship care disparities associated with non-White race, Hispanic ethnicity, and being uninsured. Moderate QOE demonstrated disparities among CCS who were unemployed and older. Lower QOE was found for disparities based on cancer diagnosis, cancer treatment, age at diagnosis, time since diagnosis, sex, insurance type, income, educational attainment, and geographic area. CONCLUSIONS We found strong empirical evidence of disparities in survivorship care for CCS associated with race, ethnicity, and insurance status. Multiple other disparate groups, such as those by employment, income, insurance type, education, cancer diagnosis, age at diagnosis, time since diagnosis, cancer treatment, geographic area, sex, and self-identified gender warrant further investigation. Prospective, multilevel research is needed to examine the role of other patient characteristics as potential disparities hindering adequate survivorship care in CCS.
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Affiliation(s)
- Erin M. Mobley
- Department of Surgery, College of MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | - Diana J. Moke
- Department of Hematology, Oncology, and Blood and Marrow TransplantationChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Department of Pediatrics, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Southern California Center for Young Adult Cancer Survivorship ResearchLos Angeles and IrvineCaliforniaUSA
| | - Joel Milam
- Southern California Center for Young Adult Cancer Survivorship ResearchLos Angeles and IrvineCaliforniaUSA
- Department of Epidemiology and Biostatistics, Program in Public HealthUniversity of California IrvineIrvineCaliforniaUSA
| | - Carol Y. Ochoa‐Dominguez
- Department of Radiation Medicine and Applied Sciences, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Julia Stal
- Southern California Center for Young Adult Cancer Survivorship ResearchLos Angeles and IrvineCaliforniaUSA
- Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Halle Mitchell
- Department of Surgery, College of MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | - Naghmeh Aminzadeh
- Southern California Evidence Review Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Maria Bolshakova
- Southern California Evidence Review Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Raymond B. Mailhot Vega
- Department of Radiation Oncology, College of MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | - Jennifer Dinalo
- Southern California Evidence Review Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Aneesa Motala
- Southern California Evidence Review Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Susanne Hempel
- Southern California Evidence Review Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Kaddas HK, Ramsay JM, Ou JY, Fair D, Kepka D, Kirchhoff AC. HPV Vaccination Initiation and Completion Among Pediatric, Adolescent, and Young Adult Cancer Survivors and a Comparison Population Sample Receiving Primary Care. J Pediatr Hematol Oncol 2023; 45:e236-e243. [PMID: 36219685 PMCID: PMC9974526 DOI: 10.1097/mph.0000000000002484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/11/2022] [Indexed: 11/07/2022]
Abstract
Human papillomavirus (HPV) vaccinations can reduce pediatric, adolescent, and young adult (PAYA) cancer survivors' susceptibility to HPV-related subsequent cancers. We examined differences in HPV vaccination initiation and completion among a Utah-based cohort of PAYA cancer survivors and a cancer-free population sample. Participants received primary care at 1 of 2 health care systems during study follow-up: 2006-2016. Vaccination records were identified from these health care systems, statewide vaccination records, and an all-payer claims database. HPV vaccination initiation (1 dose) and completion (3 doses) were compared between cancer survivors (N=1579) and age-matched and sex-matched cancer-free population sample (N=4513). Individuals were 9 to 21 years old at cohort entry. Mixed-effects Poisson regression estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Relative to the population sample, cancer survivors were less likely to initiate vaccination (IRR=0.8, 95% CI: 0.73-0.98). The most severe disparity compared with the population sample for vaccine initiation (IRR=0.5, 95% CI: 0.31-0.74) or completion (IRR=0.5, 95% CI: 0.28-0.89) was observed for Hispanic survivors. PAYA cancer survivors are less likely to initiate HPV vaccination series than noncancer counterparts. Targeted interventions should be directed at PAYA survivors to raise HPV vaccination with emphasis on high-risk groups such as Hispanic survivors.
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Affiliation(s)
- Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Joemy M Ramsay
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Douglas Fair
- Department of Pediatrics, University of Utah
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- College of Nursing
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Pediatrics, University of Utah
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10
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Bhambhvani HP, Peterson DJ, Sheth KR. Sociodemographic factors associated with Wilms tumor treatment and survival: a population-based study. Int Urol Nephrol 2022; 54:3055-3062. [PMID: 36069962 DOI: 10.1007/s11255-022-03343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Though Wilms tumor (WT) is one of the most common malignancies in children, there is a paucity of epidemiologic studies exploring sociodemographic disparities in treatment and survival. Here, we leveraged a national cancer registry to examine sociodemographic factors associated with receipt of adjuvant therapy, either chemotherapy or radiation, as well as overall survival among pediatric patients with WT. MATERIALS AND METHODS Within the Surveillance Epidemiology and End Results database (2000-2016), we identified 2043 patients (≤ 20 years of age) with unilateral WT. Multivariable logistic regression and Cox proportional hazard models were constructed to examine the association of sociodemographic factors with, respectively, adjuvant chemotherapy/radiotherapy and overall survival (OS). RESULTS Patients in the lowest SES quintile (OR 0.56, 95% CI 0.33-0.93, p = 0.03) were less likely to receive chemotherapy as compared to those in the highest SES quintile, though this association did not persist in sensitivity analyses including only patients at least 2 years of age and patients with regional/distant disease. In addition, female patients were more likely to receive chemotherapy (OR 1.46, 95% CI 1.08-1.97, p = 0.02) than male patients. Age, race, year of diagnosis, insurance status, and tumor laterality were not associated with receipt of chemotherapy. No sociodemographic variables were associated with receipt of radiotherapy. Lastly, as compared to Non-Hispanic-White patients, Hispanic patients had worse OS (HR 1.59, 95% CI 1.08-2.35, p = 0.02); no other sociodemographic variables were associated with OS. CONCLUSIONS This study suggests multilevel sociodemographic disparities involving ethnicity and SES in WT treatment and survival.
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Affiliation(s)
- Hriday P Bhambhvani
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA.
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Starr 9, New York, NY, 10065, USA.
| | - Dylan J Peterson
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Kunj R Sheth
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
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11
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Ochoa CY, Cho J, Miller KA, Baezconde-Garbanati L, Chan RY, Farias AJ, Milam JE. The Impact of Hispanic Ethnicity and Language on Communication Among Young Adult Childhood Cancer Survivors, Parents, and Medical Providers and Cancer-Related Follow-Up Care. JCO Oncol Pract 2022; 18:e786-e796. [PMID: 35544657 PMCID: PMC10166350 DOI: 10.1200/op.22.00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The triad of communication between young adult childhood cancer survivors (YACCSs), their parents, and their medical providers is an important process in managing health care engagement. This study sought to identify communication patterns among this triad, factors associated with communication, and engagement of survivorship care. METHODS We analyzed data from Project Forward, a population-based study that surveyed YACCSs and their parents. YACCSs were on average age 20 years, 7 years from diagnosis, 50% female, and 57% identified as Hispanic/Latino (N = 160 dyads). Latent class analysis of nine communication indicators from parent and YACCS surveys identified distinct classes of communication between YACCSs, parents, and medical providers. Associations between resulting classes and YACCS/parent characteristics were examined using multinomial logistic regression. Logistic regression was used to examine the association between communication classes and cancer-related follow-up care. RESULTS Latent class analysis identified three classes of triad communication: (1) high health care-focused communication (37.5%), (2) high comprehensive communication (15.6%), and (3) overall low communication (46.9%). After adjusting for covariates, greater time since diagnosis was associated with reduced odds of membership in class 2 while dyads with Spanish-speaking Hispanic parents were more likely to be in class 2 (v class 3). Additionally, YACCSs who were in either of the high communication groups were more likely to have received recent follow-up care. CONCLUSION Examining language preference provides an important contextual understanding as we found Spanish-speaking Hispanic parents engaged in high communication, which was associated with cancer-related follow-up care. Yet, our results also support the need to enhance communication between this triad to improve outcomes.
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Affiliation(s)
- Carol Y. Ochoa
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Junhan Cho
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kimberly A. Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lourdes Baezconde-Garbanati
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Randall Y. Chan
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Albert J. Farias
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joel E. Milam
- Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA
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12
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Stal J, Yi SY, Cohen-Cutler S, Gallagher P, Barzi A, Freyer DR, Milam JE, Lenz HJ, Miller KA. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist 2022; 27:579-586. [PMID: 35427410 PMCID: PMC9255970 DOI: 10.1093/oncolo/oyac052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/26/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Young adults (YA) diagnosed with rectal cancer are disproportionately impacted by the gonadotoxic effects of treatment and potential subsequent infertility. OBJECTIVE The purpose of this study was to characterize the prevalence of fertility preservation measures used, reasons why such measures were not used, and correlates of discussion between providers and YA rectal cancer survivors. DESIGN An online, cross-sectional survey was administered on the Facebook page of a national colorectal cancer (CRC) advocacy organization. Eligible participants were rectal cancer survivors diagnosed before age 50, between 6 and 36 months from diagnosis or relapse, and based in the US. RESULTS Participants were 148 rectal cancer survivors. Over half of the survivors reported that their doctor did not talk to them about potential therapy-related fertility complications. Only one-fifth of survivors banked sperm (males) or eggs/embryos (females) prior to their cancer therapy. Older age at diagnosis and greater quality of life were significantly associated with a higher likelihood of fertility discussions among males. Greater quality of life was significantly associated with a higher likelihood of fertility discussion among females. CONCLUSIONS These findings indicate that the majority of YA rectal cancer survivors do not receive, or cannot recall, comprehensive cancer care, and help to identify patients with rectal cancer who may be at risk for inadequate fertility counseling. Clinicians should provide proper counseling to mitigate this late effect and to ensure optimal quality of life for YA rectal cancer survivors.
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Affiliation(s)
- Julia Stal
- Corresponding author: Julia Stal, Department of Population and Public Health Sciences, Keck School of Medicine of USC, 2001 N. Soto Street, 3rd Floor, Los Angeles, CA 90032, USA. Tel: +1 858 997 4071;
| | - Serena Y Yi
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Sally Cohen-Cutler
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Afsaneh Barzi
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - David R Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA,Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA,Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA,University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Joel E Milam
- School of Medicine, Department of Epidemiology and Biostatistics, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Heinz-Josef Lenz
- Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Kimberly A Miller
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA,Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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13
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Mobley EM, Kim SE, Cousineau M, Tsui J, Miller KA, Tobin J, Freyer DR, Milam JE. Insurance coverage change and survivorship care among young adult survivors of childhood cancer. Health Serv Res 2022; 57:159-171. [PMID: 34378205 PMCID: PMC8763279 DOI: 10.1111/1475-6773.13868] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To (1) characterize change in type of insurance coverage among childhood cancer survivors from diagnosis to survivorship and (2) examine whether insurance change is associated with cancer-related follow-up care utilization. DATA SOURCES Participants in this study were derived from the Project Forward study, a population-based, observational study of childhood cancer survivors in Los Angeles County that used California Cancer Registry data to identify participants. STUDY DESIGN Multivariable logistic regression models incorporating survey nonresponse weights estimated the change in the marginal predicted probabilities of insurance change and survivorship care, adjusting for demographic, socioeconomic, and clinical covariates and clustering by treating hospital. DATA COLLECTION/EXTRACTION METHODS Study participants were diagnosed with cancer who were younger than age 20 years while living in Los Angeles County from 1996 to 2010 and were older than the age 18 years at the time of survey participation, from 2015 to 2017 (N = 1106). PRINCIPAL FINDINGS Most participants were 18-26 years of age, male, diagnosed before 2004, Hispanic/Latino race/ethnicity, single, without children, highly educated, not employed full time, and lived with their parents at survey. Almost half (N = 529) of participants experienced insurance change from diagnosis to survivorship. Insurance change was associated with insurance coverage at diagnosis, as those who were uninsured were most likely to experience change and gain coverage during survivorship (by 51 percentage points [ppt], standard error [SE] of 0.05). Survivors who experienced any change had decreased probability of reporting a recent cancer-related follow-up care visit, a disparity that was magnified for those who lost insurance coverage (-5 ppt, SE 0.02 for those who gained coverage; -15 ppt, SE 0.04 for those who lost coverage). CONCLUSIONS Insurance coverage change was associated with lower cancer-related follow-up care utilization. Indeed, survivors who experienced any insurance coverage change had decreased probability of having a cancer-related follow-up care visit, and this was magnified for those who lost their insurance coverage.
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Affiliation(s)
- Erin M. Mobley
- Department of Surgery, College of MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | - Sue E. Kim
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Michael Cousineau
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jennifer Tsui
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kimberly A. Miller
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA,Department of DermatologyKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jessica Tobin
- VA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - David R. Freyer
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA,Children's Hospital Los AngelesLos AngelesCaliforniaUSA,USC Norris Comprehensive Cancer CenterLos AngelesCaliforniaUSA
| | - Joel E. Milam
- Department of Epidemiology and Biostatistics, School of MedicineChao Family Comprehensive Cancer Center, University of CaliforniaIrvineCaliforniaUSA
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14
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Slaughter RI, Hamilton AS, Cederbaum JA, Unger JB, Baezconde-Garbanati L, Milam JE. Acculturation discrepancy and mental health associations among Hispanic childhood cancer survivors and their parents. Psychooncology 2021; 31:761-769. [PMID: 34825748 DOI: 10.1002/pon.5860] [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: 06/30/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Acculturation discrepancy occurs when the rate of host culture acquisition and/or heritage culture retention between non-native parents and their children diverges. The resulting conflict may exacerbate mental health conditions in already vulnerable populations. The present study examined discrepancies between Hispanic and Anglo-American acculturation, as two separate constructs, and mental health symptomology in Hispanic childhood cancer survivors (HCCS) and their parents. METHODS Participants were 68 matched parent-child dyads (HCCS (Mage = 19.4 (2.77) years., 50.0% female); and parent (Mage = 46.3 (6.07) years., 89.7% female)). Study variables were HCCS posttraumatic-growth (PTG) and quality-of-life (PedsQL); parent posttraumatic stress (PTSD); and parent/HCCS depressive symptoms (CESD) and acculturation orientations. Discrepancy was calculated as the dyadic difference between like acculturation measures. RESULTS After controlling for covariates, Hispanic acculturation discrepancy and HCCS psychosocial health (a subset of PedsQL) was negatively correlated (r = -0.26, p < 0.5); while Anglo-American acculturation discrepancy was positively associated with HCCS PTG (r = 0.34, p < 0.01) and overall PedsQL (r = 0.24, p < 0.05), and moderated the relationship between parent CESD and HCCS PedsQL. CONCLUSION The findings suggest that the two acculturation discrepancy constructs have opposite effects. HCCS losing their heritage culture while their parents simultaneously retain it appears to be a deleterious process; whereas, HCCS learning the US culture more rapidly than parents may have protective benefits. This study has important implications for mental health interventions among HCCS. Findings should be used to inform the survivorship clinical community of the value of acculturation timing and parent/child discrepancy.
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Affiliation(s)
- Rhona I Slaughter
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Julie A Cederbaum
- Department of Social Work, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Joel E Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
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15
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Reeves TJ, Mathis TJ, Bauer HE, Hudson MM, Robison LL, Wang Z, Baker JN, Huang IC. Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review. Front Public Health 2021; 9:741334. [PMID: 34778176 PMCID: PMC8586515 DOI: 10.3389/fpubh.2021.741334] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022] Open
Abstract
The five-year survival rate of childhood cancer has increased substantially over the past 50 yr; however, racial/ethnic disparities in health outcomes of survival have not been systematically reviewed. This scoping review summarized health disparities between racial/ethnic minorities (specifically non-Hispanic Black and Hispanic) and non-Hispanic White childhood cancer survivors, and elucidated factors that may explain disparities in health outcomes. We used the terms “race”, “ethnicity”, “childhood cancer”, “pediatric cancer”, and “survivor” to search the title and abstract for the articles published in PubMed and Scopus from inception to February 2021. After removing duplicates, 189 articles were screened, and 23 empirical articles were included in this review study. All study populations were from North America, and the mean distribution of race/ethnicity was 6.9% for non-Hispanic Black and 4.5% for Hispanic. Health outcomes were categorized as healthcare utilization, patient-reported outcomes, chronic health conditions, and survival status. We found robust evidence of racial/ethnic disparities over four domains of health outcomes. However, health disparities were explained by clinical factors (e.g., diagnosis, treatment), demographic (e.g., age, sex), individual-level socioeconomic status (SES; e.g., educational attainment, personal income, health insurance coverage), family-level SES (e.g., family income, parent educational attainment), neighborhood-level SES (e.g., geographic location), and lifestyle health risk (e.g., cardiovascular risk) in some but not all articles. We discuss the importance of collecting comprehensive social determinants of racial/ethnic disparities inclusive of individual-level, family-level, and neighborhood-level SES. We suggest integrating these variables into healthcare systems (e.g., electronic health records), and utilizing information technology and analytics to better understand the disparity gap for racial/ethnic minorities of childhood cancer survivors. Furthermore, we suggest national and local efforts to close the gap through improving health insurance access, education and transportation aid, racial-culture-specific social learning interventions, and diversity informed training.
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Affiliation(s)
- Tegan J Reeves
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Taylor J Mathis
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Hailey E Bauer
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States.,Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
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16
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Milam J, Freyer DR, Miller KA, Tobin J, Wojcik KY, Ramirez CN, Ritt-Olson A, Thomas SM, Baezconde-Garbanati L, Cousineau M, Modjeski D, Gupta S, Hamilton AS. Project Forward: A Population-Based Cohort Among Young Adult Survivors of Childhood Cancers. JNCI Cancer Spectr 2021; 5:pkab068. [PMID: 34585063 PMCID: PMC8462512 DOI: 10.1093/jncics/pkab068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/18/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Childhood cancer survivors (CCS) face increased risk of morbidity and are recommended to receive lifelong cancer-related follow-up care. Identifying factors associated with follow-up care can inform efforts to support the long-term health of CCS. Methods Eligible CCS (diagnosed between 1996 and 2010) identified through the Los Angeles County Cancer Surveillance Program responded to a self-report survey that assessed demographic, clinical, health-care engagement, and psychosocial risk and protective factors of recent (prior 2 years) cancer-related follow-up care. Weighted multivariable logistic regression was conducted to identify correlates of care. All statistical tests were 2-sided. Results The overall response rate was 44.9%, with an analytical sample of n = 1106 (54.2% Hispanic; mean [SD] ages at survey, diagnosis, and years since diagnosis were 26.2 [4.9], 11.6 [5.4], and 14.5 [4.4] years, respectively). Fifty-seven percent reported a recent cancer-related visit, with lower rates reported among older survivors. Having insurance, more late effects, receipt of a written treatment summary, discussing long-term care needs with treating physician, knowledge of the need for long-term care, having a regular source of care, and higher health-care self-efficacy were statistically significantly associated with greater odds of recent follow-up care, whereas older age, Hispanic or Other ethnicity (vs non-Hispanic White), and years since diagnosis were associated with lower odds of recent care (all Ps < .05). Conclusions Age and ethnic disparities are observed in receipt of follow-up care among young adult CCS. Potential intervention targets include comprehensive, ongoing patient education; provision of written treatment summaries; and culturally tailored support to ensure equitable access to and the utilization of care.
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Affiliation(s)
- Joel Milam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Departments of Medicine and Epidemiology and Biostatistics, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - David R Freyer
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jessica Tobin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Katherine Y Wojcik
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, WA, USA
| | - Cynthia N Ramirez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anamara Ritt-Olson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stefanie M Thomas
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Cousineau
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Denise Modjeski
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sapna Gupta
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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17
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Bradford N, Pitt E, Rumble S, Cashion C, Lockwood L, Alexander K. Persistent Symptoms, Quality of Life, and Correlates with Health Self-Efficacy in Adolescent and Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2021; 11:410-418. [PMID: 34582267 DOI: 10.1089/jayao.2021.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: The numbers of adolescent and young adult (AYA) survivors of childhood cancer are exponentially growing. To ensure suitable services are available to meet the needs of this growing population, understanding the experience of late effects, quality of life, and potentially modifiable factors, such as self-efficacy, is required. Methods: AYA survivors of childhood cancer recruited through an After Cancer Therapy Service at a Children's Hospital rated their symptoms experience, quality of life, and self-efficacy using the Patient Reported Outcome Common Terminology Criteria for Adverse Events, Functional Assessment of Cancer Therapy-General (FACT-G), and Patient-Reported Outcomes Measurement Information System (PROMIS®), respectively. Descriptive statistics were used to characterize the sample. Quality-of-life scores were compared with population norms. Regression analyses were used to explore the relationships between symptom experience, quality of life, and self-efficacy. Results: Thirty participants (mean age 22 ± 4.4 years) reported an average of nine symptoms as persistently experienced at moderate or higher rated intensity among participants (standard deviation ±8.7; range: 0-32; interquartile range: 2-16); over half (n = 17, 56.7%) had finished treatment 10 or more years ago. Participants scored lower on the FACT-G Physical Well-being and Emotional Well-being, and higher on Social Well-being subscales than the general population. Around two-thirds of participants were confident in their ability to self-manage their health based on their health self-efficacy score. Bivariate linear regression identified a statistically significant increase in the overall quality of life with increased self-efficacy, adjusted for age and sex (0.60, 95% confidence interval [CI] 0.30-0.90, p < 0.01). Higher symptom burden was associated with a lower overall quality of life after adjusting for age and sex (-0.95, 95% CI: -1.35 to -0.54, p < 0.001). Conclusion: Young cancer survivors experience a substantial number of persistent symptoms related to their cancer treatment that may negatively impact aspects of their quality of life. Health self-efficacy is a potential target for future interventions.
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Affiliation(s)
- Natalie Bradford
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Erin Pitt
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Shelley Rumble
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Christine Cashion
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Liane Lockwood
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Kimberly Alexander
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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18
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Tobin J, Cockburn M, Unger JB, Finch BK, Hamilton AS, Ritt-Olson A, Milam JE. Acculturation, Mental Health, and Wellbeing Among Hispanic/Latinx Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2021; 11:223-228. [PMID: 34283659 DOI: 10.1089/jayao.2021.0029] [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: 11/13/2022] Open
Abstract
Purpose: Ethnic disparities in childhood cancer survivor (CCS) mental health have been identified, although prior survivorship research has focused predominantly on non-Hispanic/Latinx (H/L) white survivors. Methods: This study examined the association of acculturation with depressive symptoms and wellbeing among 582 young adult H/L CCS recruited to a population-based study of CCS in Southern California. Results: In multivariable regression models adjusted for covariates, greater identification with both the Hispanic and Anglo cultures was positively associated with wellbeing (p = 0.007 and p < 0.0001, respectively), and Hispanic cultural identification was associated with fewer depressive symptoms (p = 0.04). Conclusions: Greater understanding of unique protective factors among minority CCS may inform tailored interventions promoting mental health.
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Affiliation(s)
- Jessica Tobin
- VA Greater Los Angeles Health Care System, Los Angeles, California, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Myles Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Brian K Finch
- Center for Economic and Social Research, Department of Sociology, Dornsife College of Letters, University of Southern California, Los Angeles, California, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anamara Ritt-Olson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joel E Milam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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19
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Ochoa CY, Miller KA, Baezconde-Garbanati L, Slaughter RI, Hamilton AS, Milam JE. Parental Cancer-related Information Seeking, Health Communication and Satisfaction with Medical Providers of Childhood Cancer Survivors: Differences by Race/Ethnicity and Language Preference. JOURNAL OF HEALTH COMMUNICATION 2021; 26:83-91. [PMID: 33688790 PMCID: PMC8547415 DOI: 10.1080/10810730.2021.1895919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
For childhood cancer survivors (CCS), parents play an important role in communicating with providers and conveying patient's needs. This exploratory study examined the prevalence of cancer-related information-seeking among parents of CCS and investigated the association between parents' race/ethnicity and language preference with health communication and satisfaction with child's medical providers. One hundred and sixty CCS and their parents from two hospitals in Los Angeles County were recruited from the SEER registry. Multivariable logistic regression analyses assessed associations between parents' race/ethnicity and language preference and their health communication with their child and with their child's medical care providers. Among the parents, 29% were Spanish-speaking Hispanics, 27% English-speaking Hispanics, and 43% English-speaking non-Hispanics. Regardless of language preference, Hispanic parents were more likely than non-Hispanic parents to receive health information about their CCS's cancer from hospital sources versus the internet. There was no difference by ethnicity/language in parent satisfaction with their CCS's medical provider. Spanish-speaking Hispanic parents were more likely to report talking to their CCS about the need for cancer-related follow-up care compared to non-Hispanic English-speaking parents. These findings point to the potential importance of parents' ethnicity and language for sources of health information and frequency of communication with their CCS about their cancer care.
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Affiliation(s)
- Carol Y. Ochoa
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kimberly A. Miller
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Rhona I. Slaughter
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ann S. Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joel E. Milam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Slaughter RI, Hamilton AS, Cederbaum JA, Unger JB, Baezconde-Garbanati L, Milam JE. Relationships between parent and adolescent/young adult mental health among Hispanic and non-Hispanic childhood cancer survivors. J Psychosoc Oncol 2020; 38:746-760. [PMID: 32895032 PMCID: PMC8284557 DOI: 10.1080/07347332.2020.1815924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To examine associations between parents and adolescent and young adult (AYA) childhood cancer survivors' (CCS) mental health, and differences by Hispanic ethnicity. SAMPLE Participants were 129 CCS (Mage = 19.5 yrs.; 49.9% female) and their parents (Mage = 49.0 yrs.; 87.6% female); 52.7% identified as Hispanic. METHODS CCS completed assessments of Depressive Symptoms (CES-D), Posttraumatic Growth (PTG) and Pediatric Quality of Life (PedsQL), while parents completed CES-D, Perceived Stress (PSS) and Posttraumatic Stress Disorder (PTSD) measures. RESULTS After controlling for covariates, all three negative parental mental health measures (Parent CES-D, PSS, and PTSD), were positively associated with CCS CES-D indicating that higher depressive symptoms and stress in parents was associated with higher depressive symptoms in CCS. Parent CES-D was negatively associated with CCS PedsQL and parent PSS was negatively associated with CCS PTG. Moderation analysis revealed parent PSS to be negatively associated with PedsQL and positively related to CES-D among Hispanic families only. CONCLUSION Higher parental negative mental health measures may adversely affect CCS levels of depression, while lower values for parental negative health measures were associated with positive CCS mental health outcomes in AYA. Hispanic parents experience more associations with stress than non-Hispanics. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Long-term survivorship follow-up care guidelines should address the mental health needs of both parents and CCS, paying particular attention to perceived stress in Hispanic families.
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Affiliation(s)
- Rhona I Slaughter
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Julie A Cederbaum
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Joel E Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
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21
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Tobin JL, Thomas SM, Freyer DR, Hamilton AS, Milam JE. Estimating cancer treatment intensity from SEER cancer registry data: methods and implications for population-based registry studies of pediatric cancers. Cancer Causes Control 2020; 31:881-890. [PMID: 32757117 PMCID: PMC7537342 DOI: 10.1007/s10552-020-01328-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 07/24/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The Intensity of Treatment Rating (ITR) Scale condenses treatment and clinical characteristics into a single measure to study treatment effects on downstream health outcomes across cancer types. This rating was originally developed for clinicians to determine from medical charts. However, large studies are often unable to access medical charts for all study participants. We developed and tested a method of estimating treatment intensity (TI) using cancer registry and patient self-reported data. METHODS We estimated two versions of TI for a cohort of pediatric cancer survivors-one utilized information solely available from cancer registry variables (TIR) and the other included registry and self-reported information (TIS) from survey participants. In a subset of cases (n = 135) for whom the gold standard TI (TIC) was known, both TIR and TIS were compared to TIC by calculating percent agreement and weighted Cohen's kappa, overall and within cancer subtypes. RESULTS In comparison to TIC, 71% of TI scores from both methods were in agreement (k = 0.61 TIR/0.54 TIS). Among subgroups, agreement ranged from lowest (46% TIR/39% TIS) for non-defined tumors (e.g., "Tumor-other"), to highest (94% TIR/94% TIS) for acute lymphoblastic leukemia (ALL). CONCLUSIONS We developed a methodology to estimate TI for pediatric cancer research when medical chart review is not possible. High reliability was observed for ALL, the most common pediatric cancer. Additional validation is needed among a larger sample of other cancer subgroups. The ability to estimate TI from cancer registry data would assist with monitoring effects of treatment during survivorship in registry-based epidemiological studies.
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Affiliation(s)
- Jessica L Tobin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Stefanie M Thomas
- Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, USA
| | - David R Freyer
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joel E Milam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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22
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Feng LR, Wolff BS, Liwang J, Regan JM, Alshawi S, Raheem S, Saligan LN. Cancer‑related fatigue during combined treatment of androgen deprivation therapy and radiotherapy is associated with mitochondrial dysfunction. Int J Mol Med 2019; 45:485-496. [PMID: 31894256 PMCID: PMC6984780 DOI: 10.3892/ijmm.2019.4435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/06/2019] [Indexed: 01/02/2023] Open
Abstract
Combined androgen deprivation therapy (ADT) and radiation therapy (RT) is the standard of care treatment for non-metastatic prostate cancer (NMPC). Despite the efficacy, treatment-related symptoms including fatigue greatly reduce the quality of life of cancer patients. The goal of the study is to examine the influence of combined ADT/RT on fatigue and understand its underlying mechanisms. A total of 64 participants with NMPC were enrolled. Fatigue was assessed using the Functional Assessment of Cancer Therapy-Fatigue. Mitochondrial function parameters were measured as oxygen consumption from peripheral blood mononuclear cells (PBMCs) extracted from participants' whole blood. An ADT/RT-induced fatigue mouse model was developed, with fatigue measured as a reduction in voluntary wheel-running activity (VWRA) in 54 mice. Mitochondrial function was assessed in the ADT/RT mouse brains using western blot analysis of glucose transporter 4 (GLUT4) and transcription factor A, mitochondrial (TFAM). The results demonstrated that fatigue in the ADT group was exacerbated during RT compared with the non-ADT group. This effect was specific to fatigue, as depressive symptoms were unaffected. PBMCs of fatigued subjects exhibited decreased ATP coupling efficiency compared to non-fatigued subjects, indicative of mitochondrial dysfunction. The ADT/RT mice demonstrated the synergistic effect of ADT and RT in decreasing VWRA. Brain tissues of ADT/RT mice exhibited decreased levels of GLUT4 and TFAM suggesting that impaired neuronal metabolic homeostasis may contribute to fatigue pathogenesis. In conclusion, these findings suggest that fatigue induced by ADT/RT may be attributable to mitochondrial dysfunction both peripherally and in the central nervous system (CNS). The synergistic effect of ADT/RT is behaviorally reproducible in a mouse model and its mechanism may be related to bioenergetics in the CNS.
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Affiliation(s)
- Li Rebekah Feng
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Brian S Wolff
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Josephine Liwang
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jeniece M Regan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sarah Alshawi
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sumiyya Raheem
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Leorey N Saligan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
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23
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Reynolds K, Spavor M, Brandelli Y, Kwok C, Li Y, Disciglio M, Carlson LE, Schulte F, Anderson R, Grundy P, Giese-Davis J. A comparison of two models of follow-up care for adult survivors of childhood cancer. J Cancer Surviv 2019; 13:547-557. [PMID: 31250352 DOI: 10.1007/s11764-019-00774-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 06/03/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Few studies have compared follow-up-care models for adult survivors of childhood cancer (ASCCs), though choice of model could impact medical test adherence, and health-related quality of life (QOL). This study compared two follow-up-care models, cancer-center-based versus community-based, for ASCCs in Alberta, Canada, to determine which model would demonstrate greater ASCC adherence to guideline-recommended medical screening tests for late effects, QOL, physical symptoms, and adherence to yearly follow-up. METHODS ASCC discharged to a community model (over 15 years) and those with comparable birth years (1973-1993) currently followed in a cancer center model were recruited via direct contact or multimedia campaign. Chart review identified chemotherapeutic and radiation exposures, and required medical late effect screening tests. ASCCs also completed questionnaires assessing QOL, physical symptoms, and follow-up behavior. RESULTS One hundred fifty-six survivors participated (community (n = 86); cancer center (n = 70)). Primary analysis indicated that cancer center ASCCs guideline-recommended total test adherence percentage (Mdn = 85.4%) was significantly higher than the community model (Mdn = 29.2%, U = 3996.50, p < 0.0001). There was no significant difference in QOL for cancer center ASCCs (M = 83.85, SD = 20.55 versus M = 77.50, SD = 23.94; t (154) = 1.77, p = 0.078) compared to community-based ASCCs. Cancer center-based ASCCs endorsed from 0.4-7.1% fewer physical symptom clusters, and higher adherence to follow-up behavior in comparisons using effect sizes without p values. CONCLUSION This study highlights the cancer center model's superiority for adherence to exposure-based medical late effect screening guidelines, cancer-specific follow-up behaviors, and the reporting of fewer physical complaints in ASCCs. IMPLICATIONS FOR CANCER SURVIVORS ASCCs followed in a cancer center model likely benefit from earlier late-effects detection and opportunities for early intervention.
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Affiliation(s)
- K Reynolds
- Long Term Survivor's Clinic, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Spavor
- Northern Alberta Childhood Cancer Survivor Program, 4E2, Stollery Children's Hospital, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada.
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alberta, Edmonton Clinic Health Academy, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Y Brandelli
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - C Kwok
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Y Li
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Psychosocial Resources, Alberta Health Services Cancer Care-Holy Cross Site, 2202 2nd Street SW, Calgary, Alberta, T2S 3C1, Canada
| | - M Disciglio
- Northern Alberta Childhood Cancer Survivor Program, 4E2, Stollery Children's Hospital, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada
| | - L E Carlson
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Psychosocial Resources, Alberta Health Services Cancer Care-Holy Cross Site, 2202 2nd Street SW, Calgary, Alberta, T2S 3C1, Canada
| | - F Schulte
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Division of Medical Science, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - R Anderson
- Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Oncology, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada
| | - P Grundy
- Northern Alberta Childhood Cancer Survivor Program, 4E2, Stollery Children's Hospital, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alberta, Edmonton Clinic Health Academy, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - J Giese-Davis
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Psychosocial Resources, Alberta Health Services Cancer Care-Holy Cross Site, 2202 2nd Street SW, Calgary, Alberta, T2S 3C1, Canada
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24
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Hamilton AS, Zhuang X, Modjeski D, Slaughter R, Ritt-Olson A, Milam J. Population-Based Survey Methods for Reaching Adolescent and Young Adult Survivors of Pediatric Cancer and Their Parents. J Adolesc Young Adult Oncol 2019; 8:40-48. [PMID: 30222486 PMCID: PMC6386077 DOI: 10.1089/jayao.2018.0033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Contacting childhood cancer survivors (CCS) to assess reasons for declining receipt of follow-up care after treatment is difficult and participation in surveys may be low, resulting in biased results. We sought to demonstrate effective recruitment and population-based sampling methods to improve response and minimize bias. METHODS Four hundred and seventy CCS diagnosed between 2000 and 2007 at two hospitals in Los Angeles County were selected from the California Cancer Registry and were 15-25 years of age at the time of interview. Surveys of survivors and their parents were completed by multiple methods including mail, online, and telephone. Effectiveness of "plain" versus "designer" formatting of study materials was tested. Variables associated with response were analyzed using univariate and multivariable methods. Effort required for recruitment was quantified. RESULTS Fifty percent of survivors (n = 235) and 36.5% of parents (n = 171) responded, and there were 160 parent-child dyads among them. Among located survivors, 61% participated. Response was higher for women, parents of younger survivors, and those from higher socioeconomic status areas. Among Hispanics, no variables were related to response. More effort was required to reach men and older survivors, but efforts beyond 15 calls and 7 remailings were unproductive. Formatting (i.e., plain vs. designer) did not affect response. CONCLUSION Efforts to reach survivors must include multiple methods to be successful. Use of an intensive recruitment strategy and population-based sample resulted in a largely representative sample of CCS, especially for Hispanics. Expensive design efforts had little effect on recruitment, suggesting that plainer materials are sufficient. This example may inform similar studies.
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Affiliation(s)
- Ann S. Hamilton
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Xueyan Zhuang
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Denise Modjeski
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Rhona Slaughter
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Anamara Ritt-Olson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Joel Milam
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
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25
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Feng LR, Fuss T, Dickinson K, Ross A, Saligan LN. Co-Occurring Symptoms Contribute to Persistent Fatigue in Prostate Cancer. Oncology 2019; 96:183-191. [PMID: 30625479 DOI: 10.1159/000494620] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/17/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Cancer-related fatigue is one of the most debilitating side effects of cancer and cancer therapy. We aimed to investigate co-occurring symptoms associated with persistent fatigue in men receiving external beam radiation therapy (EBRT) for nonmetastatic prostate cancer. METHODS A sample of 47 men with prostate cancer scheduled to receive radiotherapy (RT) were followed at baseline and 1 year after RT. Clinical and demographic data were obtained from chart review. Symptom measurements included urinary dysfunction (American Urological Association symptoms score), fatigue (Functional Assessment of Cancer Therapy - Fatigue questionnaire), sleep disturbance (Patient-Reported Outcomes Measurement Information System - Sleep Disturbance form), pain (physical well-being domain pain item of the Functional Assessment of Cancer Therapy - General), and depressive symptoms (Hamilton Depression Rating Scale). Paired t tests, correlations, general linear models, and logistic regressions were used to determine associations between fatigue and other symptom scores. RESULTS At 1 year after RT, 34% of subjects continued to experience fatigue. Urinary dysfunction was the best clinical predictor of persistent fatigue. Pain and depressive symptoms further improved the predictive power of the model. A multivariate linear regression model containing all these three clinical variables (urinary dysfunction, pain, and depressive symptoms) explained 74% of total variance associated with persistent fatigue after RT. CONCLUSIONS Persistent fatigue at 1 year after EBRT in prostate cancer survivors is likely related to a cluster of symptoms elicited by chronic inflammation. Therapies that target each of these symptoms will likely reduce fatigue in this patient population.
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Affiliation(s)
- Li Rebekah Feng
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Timothy Fuss
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Kristin Dickinson
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexander Ross
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA,
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26
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Cousineau MR, Kim SE, Hamilton AS, Miller KA, Milam J. Insurance Coverage, and Having a Regular Provider, and Utilization of Cancer Follow-up and Noncancer Health Care Among Childhood Cancer Survivors. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958018817996. [PMID: 30791853 PMCID: PMC6362514 DOI: 10.1177/0046958018817996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 11/08/2018] [Accepted: 11/16/2018] [Indexed: 01/07/2023]
Abstract
The objective of this study was to assess the role of health insurance coverage on patterns of health care utilization and access to cancer-related follow-up and non-cancer care among childhood cancer survivors (CCS). Cross-sectional survey design was used. Childhood cancer survivors were from 2 large hospitals in Los Angeles County. In all, 235 were identified through the Los Angeles Cancer Surveillance Program, diagnosed between the ages of 5 and 18 in 2000-2007 with any cancer type except Hodgkin lymphoma. At data collection in 2009-2010, participants were between 15 and 25 years old. Study exposure was health insurance coverage (private, public, and uninsured). Main outcomes and measures were respondents' regular source of care for cancer follow-up, noncancer care, and both; and having a cancer follow-up visit, primary care visit, and hospital emergency department visit in the past 2 years. Compared with those with private insurance, the uninsured were less likely to have a regular source for cancer follow-up (odds ratio [OR] = 4.3, 95% confidence interval [CI] = 1.9-9.4), less likely to have a source for noncancer care (OR = 3.3, 95% CI 1.6-6.9), and less likely to have a source of care for both (OR = 5.3, 95% CI = 2.1-13.5). Furthermore, uninsured CCS were less likely to have made visits to cancer specialists (OR = 4.5, 95% CI = 2.1-9.50) and were less likely to have seen a primary care physician in the past 2 years (OR = 3.9, 95% CI = 1.8-8.2). In addition, those with public (vs private) insurance were less likely to have a regular provider for primary care (OR = 2.5, 95% CI = 1.1-5.4) and less likely to have made a primary care visit in the past year (OR = 2.8, 95% CI = 2.1-13.5). Uninsured CCS are at risk of not obtaining cancer follow-up care, and those with public (vs. private) insurance have less access to primary care. Policies that ensure continuity of coverage for survivors as they age into adulthood may result in fewer barriers to needed care, which may lead to fewer health problems for CCS in the future.
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Affiliation(s)
| | - Sue E. Kim
- Keck School of Medicine of USC, Los
Angeles, USA
| | | | | | - Joel Milam
- Keck School of Medicine of USC, Los
Angeles, USA
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Sleight AG, Ramirez CN, Miller KA, Milam JE. Hispanic Orientation and Cancer-Related Knowledge in Childhood Cancer Survivors. J Adolesc Young Adult Oncol 2018; 8:363-367. [PMID: 30543480 DOI: 10.1089/jayao.2018.0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Cancer-related knowledge among childhood cancer survivors (CCSs) has been underexplored. In particular, little is known about factors impacting knowledge of the need for lifelong follow-up care in CCSs. This secondary analysis of data examined acculturation, cancer-related knowledge, demographics, and clinical factors in 193 ethnically and culturally diverse CCSs (age at study 19.9 ± 2.8 years). Cancer-related knowledge gaps were found across all participants. Univariate and multivariable logistic regression analyses indicated that Hispanic CCSs with greater Hispanic orientation were significantly more likely to be aware of a need for lifelong follow-up care. A greater focus on targeted risk communication with CCSs is warranted.
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Affiliation(s)
- Alix G Sleight
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.,2 National Cancer Institute, Rockville, Maryland
| | - Cynthia N Ramirez
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kimberly A Miller
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.,3 Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joel E Milam
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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28
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Kazak AE, Hwang WT, Chen FF, Askins MA, Carlson O, Argueta-Ortiz F, Vega G, Barakat LP. Validation of the Spanish Version of the Psychosocial Assessment Tool (PAT) in Pediatric Cancer. J Pediatr Psychol 2018; 43:1104-1113. [PMID: 29982606 DOI: 10.1093/jpepsy/jsy046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/07/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Family psychosocial risk screening is an important initial step in delivering evidence-based care and in addressing health disparities. There is currently no validated measure of family psychosocial risk in Spanish. The Psychosocial Assessment Tool (PAT) is a brief parent report screener based on the trilevel Pediatric Preventative Psychosocial Risk Model (PPPHM; Universal, Targeted, and Clinical). The current article validates a Spanish version of the PAT (Version 3.0) in pediatric oncology. Method Spanish-speaking Hispanic primary caregivers of 79 children newly diagnosed with cancer participated in this 4-institution multisite investigation, completing Spanish versions of the PAT and validation measures using REDCap. Results Over 60% of the sample had a high school or lower level of education and they primarily identified as Hispanic in terms of acculturation. Internal consistency for the total score (KR20 = 0.76) and the Social Support, Child Problems, Sibling Problems, and Family Problems subscales was strong (KR20 = 0.69-0.79). Stress Reactions, Family Structure, and Family Beliefs subscales were lower (KR20 = 0.43-0.55). Moderate to strong correlations with the criteria measures provided validation for the total and subscale scores. Nearly two-thirds of the sample scored in the Targeted or Clinical range of the PPPHM. The PAT was successful in identifying clinical cases. Conclusions The Spanish version of the PAT can be used with families of children newly diagnosed with cancer. Elevated psychosocial risks were found and warrant particular attention in providing psychosocial care attentive to the needs of Spanish-speaking families.
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Affiliation(s)
- Anne E Kazak
- Nemours Children's Health System.,Sidney Kimmel Medical School, Thomas Jefferson University
| | | | - Fang Fang Chen
- Nemours Children's Health System.,Sidney Kimmel Medical School, Thomas Jefferson University
| | | | | | | | | | - Lamia P Barakat
- Perelman School of Medicine, University of Pennsylvania.,The Children's Hospital of Philadelphia
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29
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Milam J, Slaughter R, Tobin JL, Unger JB, Ritt-Olson A, Freyer DR, Soto D, Hamilton AS. Childhood Cancer Survivorship and Substance Use Behaviors: A Matched Case-Control Study Among Hispanic Adolescents and Young Adults. J Adolesc Health 2018; 63:115-117. [PMID: 30060847 PMCID: PMC6070351 DOI: 10.1016/j.jadohealth.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/19/2018] [Accepted: 02/02/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This case-control study compared substance use behaviors between Hispanic adolescent and young adult survivors of childhood cancers (cases) and a community sample of participants without cancer (controls). METHODS A total of 100 cases were matched to controls (200 participants) one to one by ethnicity, age, and sex (mean age at survey 19.27, standard deviation = 1.92). Differences in self-reported previous 30-day use of tobacco, alcohol, binge drinking of alcohol, and marijuana were examined using conditional multivariable logistic regression. RESULTS The odds of tobacco, alcohol, binge drinking, and marijuana use were significantly lower for cases than for controls (all p's <.05). When stratified by age, cases (vs. controls) under 21 years of age reported lower levels of substance use (all p's <.05), whereas differences over the age of 21 were nonsignificant. CONCLUSIONS Lower levels of substance use among Hispanic adolescent and young adult survivors of childhood cancers (vs. controls) are most apparent at younger ages. Future work needs to examine a potential delay in initiation of use among survivors.
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Affiliation(s)
- Joel Milam
- Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Rhona Slaughter
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jessica L. Tobin
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B. Unger
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anamara Ritt-Olson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David R. Freyer
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Daniel Soto
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ann S. Hamilton
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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30
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Tobin J, Miller KA, Baezconde-Garbanati L, Unger JB, Hamilton AS, Milam JE. Acculturation, Mental Health, and Quality of Life among Hispanic Childhood Cancer Survivors: A Latent Class Analysis. Ethn Dis 2018; 28:55-60. [PMID: 29467567 DOI: 10.18865/ed.28.1.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Acculturation appears to be an important aspect of the association between ethnicity and disease, but it has not been explored in depth among childhood cancer survivors (CCS). The purpose of our study was to identify distinct acculturative profiles among Hispanic CCS and to assess differences in quality of life and depressive symptoms. Design Latent class analysis was used to identify distinct acculturative profiles using 9 indicator items reflecting Hispanic and Anglo cultural orientation. Multinomial logistic regression was performed to explore differences in depressive symptoms and quality of life between acculturation classes. Setting and Participants Participants were diagnosed in Los Angeles County, California, USA between 2000-2007 and were recruited for the study in 2009. Main Outcome Measures Center for Epidemiologic Studies depression scale and the PedsQL 4.0 quality of life scale. Results Three distinct acculturation classes emerged. All classes displayed a high probability of endorsing all Anglo orientation items. One class additionally demonstrated a high probability of endorsing all Hispanic orientation items and was labeled bicultural 40%); another demonstrated low probability of endorsing the Hispanic items so was labeled assimilated (32%); and the last demonstrated a high probability of endorsing only the Hispanic items related to language use and was labeled linguistically Hispanic/culturally Anglo (LH) (28%). Conclusions The assimilated group had significantly more depressive symptoms and lower quality of life than the other two groups. This may indicate that loss of the Hispanic culture may be associated with poorer psychosocial health among CCS.
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Affiliation(s)
- Jessica Tobin
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; Los Angeles, CA
| | - Kimberly A Miller
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; Los Angeles, CA
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; Los Angeles, CA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; Los Angeles, CA
| | - Joel E Milam
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; Los Angeles, CA
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31
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Turner JK, Hutchinson A, Wilson C. Correlates of post-traumatic growth following childhood and adolescent cancer: A systematic review and meta-analysis. Psychooncology 2017; 27:1100-1109. [DOI: 10.1002/pon.4577] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/21/2017] [Accepted: 10/23/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Jasmin K. Turner
- School of Psychology; University of Adelaide; Adelaide South Australia Australia
| | - Amanda Hutchinson
- School of Psychology, Social Work & Social Policy; University of South Australia; Adelaide South Australia Australia
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer; Flinders University; Bedford Park South Australia Australia
- Olivia Newton John Cancer Wellness and Research Centre; Heidelberg VIC Australia
- School of Psychology and Public Health; La Trobe University; Melbourne VIC Australia
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32
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Miller KA, Ramirez CN, Wojcik KY, Ritt-Olson A, Baezconde-Garbanati L, Thomas SM, Freyer DR, Hamilton AS, Milam JE. Prevalence and correlates of health information-seeking among Hispanic and non-Hispanic childhood cancer survivors. Support Care Cancer 2017; 26:1305-1313. [PMID: 29124416 DOI: 10.1007/s00520-017-3956-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Childhood cancer survivors (CCS) report high unmet information needs. This study examined the prevalence of cancer-related information-seeking among CCS and investigated associations between information-seeking behavior and positive health outcomes such as follow-up care. METHODS Participants (n = 193) were young adult CCS diagnosed with cancer in Los Angeles County, 54% of Hispanic ethnicity, with a mean age of 19.87, in remission, and at least 2 years from completion of treatment. CCS were asked where they accessed health information related to their cancer with response options categorized into four information domains: hospital resources, social media, other survivors, and family members. Multivariable logistic regression was used to assess variables associated with each information domain, including sociodemographics, post-traumatic growth (i.e., reporting positive changes since cancer diagnosis), health care engagement, level of education, and health insurance status. RESULTS Hospital resources were the most commonly accessed information domain (65.3%), and CCS of Hispanic ethnicity (vs. non-Hispanic) were more likely to access this source. Seeking information from other cancer survivors was positively associated with follow-up care and post-traumatic growth. Hispanic CCS were marginally less likely to seek information from other survivors and family than non-Hispanics. CONCLUSIONS While CCS obtain information from a variety of sources, hospital resources are an important site for access, particularly for individuals of Hispanic ethnicity. Information sharing between survivors may promote positive health care engagement; however, Hispanic CCS may be less likely to utilize this resource and may face barriers in information sharing with other cancer survivors.
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Affiliation(s)
- Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA. .,Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Cynthia N Ramirez
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
| | - Katherine Y Wojcik
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
| | - Anamara Ritt-Olson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
| | - Stefanie M Thomas
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - David R Freyer
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
| | - Joel E Milam
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
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Tobin J, Allem JP, Slaughter R, Unger JB, Hamilton AS, Milam JE. Posttraumatic growth among childhood cancer survivors: Associations with ethnicity, acculturation, and religious service attendance. J Psychosoc Oncol 2017; 36:175-188. [PMID: 28816639 DOI: 10.1080/07347332.2017.1365799] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study assessed the association between ethnicity, religious service attendance (RSA), and acculturation with posttraumatic growth (PTG) in a diverse sample of 235 childhood cancer survivors (CCS). PTG scores were estimated for each ethnicity, and by level of RSA and acculturation. There was a significant curvilinear relationship (inverted U) between RSA and PTG, such that moderate levels of RSA were associated with the highest PTG scores. Hispanics reported the highest PTG, and both Hispanic and Anglo cultural orientation were significantly positively associated with PTG. CCS with high or low frequency of RSA as well as Hispanic CCS who lack a strong sense of cultural identity may benefit from targeted efforts to promote psychosocial adaptation in the aftermath of cancer.
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Affiliation(s)
- Jessica Tobin
- a Department of Preventive Medicine, Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Jon-Patrick Allem
- a Department of Preventive Medicine, Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Rhona Slaughter
- a Department of Preventive Medicine, Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Jennifer B Unger
- a Department of Preventive Medicine, Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Ann S Hamilton
- a Department of Preventive Medicine, Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Joel E Milam
- a Department of Preventive Medicine, Keck School of Medicine , University of Southern California , Los Angeles , California , USA
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Feng LR, Suy S, Collins SP, Saligan LN. The role of TRAIL in fatigue induced by repeated stress from radiotherapy. J Psychiatr Res 2017; 91:130-138. [PMID: 28343068 PMCID: PMC5473507 DOI: 10.1016/j.jpsychires.2017.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/14/2017] [Accepted: 03/17/2017] [Indexed: 02/06/2023]
Abstract
Fatigue is one of the most common and debilitating side effects of cancer and cancer treatment, and yet its etiology remains elusive. The goal of this study is to understand the role of chronic inflammation in fatigue following repeated stress from radiotherapy. Fatigue and non-fatigue categories were assessed using ≥ 3-point change in Functional Assessment of Cancer Therapy-Fatigue questionnaire (FACT-F) administered to participants at baseline/before radiotherapy and one year post-radiotherapy. Whole genome microarray and cytokine multiplex panel were used to examine fatigue-related transcriptome and serum cytokine changes, respectively. The study included 86 subjects (discovery phase n = 40, validation phase n = 46). The sample in the discovery phase included men with prostate cancer scheduled to receive external-beam radiotherapy. A panel of 48 cytokines were measured and the significantly changed cytokine found in the discovery phase was validated using sera from a separate cohort of men two years after completing radiotherapy for prostate cancer at a different institution. Effects of the significantly changed cytokine on cell viability was quantified using the MTT assay. During the discovery phase, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and TRAIL decoy receptor, TNFRSF10C (TRAIL-R3), were significantly upregulated in fatigued (≥3-point decrease from baseline to 1yr-post radiotherapy) subjects (n = 15). In the validation phase, TRAIL correlated with fatigue scores 2yrs post-radiotherapy. TRAIL caused selective cytotoxicity in neuronal cells, but not in microglial and muscle cells, in vitro. Late-onset inflammation directed by TRAIL may play a role in fatigue pathogenesis post-repeated stress from irradiation.
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Affiliation(s)
- Li Rebekah Feng
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.
| | - Sean P. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Leorey N. Saligan
- Corresponding Author: Leorey N. Saligan, PhD, RN, CRNP, FAAN, National Institute of Nursing Research, National Institutes of Health, 9000 Rockville Pike, Building 3, Room 5E14, Bethesda, MD 20892, Phone: 301-451-1685 Fax: 301-480-0729,
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Abstract
Attendance to follow-up care after completion of cancer treatment is an understudied area. We examined demographic, clinical, and socioeconomic predictors of follow-up by pediatric cancer patients at a large center in 442 newly diagnosed patients using multivariable logistic regression analyses. Patients who did not return to clinic for at least 1000 days were considered lost to follow-up. Two hundred forty-two (54.8%) patients were lost. In multivariable analyses, the following variables were independent predictors of being lost to follow-up: treatment with surgery alone (odds ratio [OR]=6.7; 95% confidence interval [CI], 3.1-14.9), older age at diagnosis (reference, 0 to 4; ages, 5 to 9: OR=1.8, 95% CI, 1.1-3; ages, 10 to 14: OR=3.3; CI, 1.8-6.1; and ages, 15 and above: OR=4.8; CI, 2.1-11.7), lack of history of stem cell transplantation (OR=2, 95% CI, 1.04-3.7) and lack of insurance (OR=3.4; CI, 1.2-9.2). Hispanic patients had the best follow-up rates (53.7%) compared to whites and blacks (P=0.03). Attendance to long-term follow-up care is suboptimal in childhood cancer survivors. Predictors that were associated with nonattendance can be used to design targeted interventions to improve follow-up care for survivors of pediatric cancer.
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36
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Miller KA, Wojcik KY, Ramirez CN, Ritt-Olson A, Freyer DR, Hamilton AS, Milam JE. Supporting long-term follow-up of young adult survivors of childhood cancer: Correlates of healthcare self-efficacy. Pediatr Blood Cancer 2017; 64:358-363. [PMID: 27567026 PMCID: PMC5371425 DOI: 10.1002/pbc.26209] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/05/2016] [Accepted: 07/21/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Healthcare self-efficacy (HCSE), the perceived confidence to manage one's health care, has been identified as a critical component in the transition process from pediatric to adult-oriented care for childhood cancer survivors (CCSs). HCSE is amenable to intervention and associated with long-term follow-up care among CCSs. However, factors associated with HCSE have not been fully explored among CCSs. PROCEDURE We identified correlates of HCSE among a sample of CCSs (n = 193). Descriptive statistics and linear regression methods were used in this cross-sectional analysis. RESULTS In univariate analyses, higher physical and psychosocial quality of life, posttraumatic growth, and religious/spiritual importance were associated with higher HCSE. Attendance at a survivorship clinic, having a regular source of care (both noncancer and oncologist), and any type of health insurance were also associated with HCSE. Hispanic ethnicity was negatively associated with HCSE relative to non-Hispanics. In a multivariable model, psychosocial quality of life, religious/spiritual importance, survivorship clinic attendance, having a regular oncologist, and Hispanic ethnicity remained significantly associated with HCSE. CONCLUSIONS CCSs who reported greater well-being, who rated religion and spirituality of high importance, and who accessed specialized cancer services expressed greater HCSE. Hispanic CCSs, however, reported less HCSE than non-Hispanics. Interventions that attend to the quality of life and spiritual needs of CCSs have potential to build HCSE to support the healthcare transition process. Because Hispanic CCSs may be at risk of lower perceived confidence to navigate their health care, culturally competent, efficacy-enhancing interventions are needed for this population.
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Affiliation(s)
- Kimberly A. Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Katherine Y. Wojcik
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Cynthia N. Ramirez
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Anamara Ritt-Olson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - David R. Freyer
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California,Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California,Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California,USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Ann S. Hamilton
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Joel E. Milam
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
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37
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Feng L, Chen MK, Lukkahatai N, Hsiao CP, Kaushal A, Sechrest L, Saligan LN. Clinical Predictors of Fatigue in Men With Non-Metastatic Prostate Cancer Receiving External Beam Radiation Therapy. Clin J Oncol Nurs 2017; 19:744-50. [PMID: 26583638 DOI: 10.1188/15.cjon.744-750] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fatigue is one of the most distressing symptoms experienced by people with cancer receiving radiation therapy. OBJECTIVES The goal of this study is to evaluate clinical predictors of worsening fatigue during external beam radiation therapy (EBRT) in men with non-metastatic prostate cancer. METHODS Thirty-five men with non-metastatic prostate cancer scheduled for EBRT were followed at baseline, midpoint, and completion of EBRT. The Functional Assessment of Cancer Therapy-Fatigue scale was administered. Demographic and clinical data were obtained by chart review. Paired t-tests, correlations, general linear models, and logistic regressions were used to determine associations between fatigue scores and clinical data. FINDINGS Red blood cells, hemoglobin, and hematocrit levels were highly intercorrelated and, therefore, were grouped as one composite variable termed heme. Heme levels at baseline and androgen-deprivation therapy (ADT) were significantly correlated with worsening of fatigue symptoms from baseline to midpoint and endpoint. ADT alone did not have a significant correlation with fatigue, but it indirectly affected fatigue levels by influencing heme markers as treatment progressed. These findings provide evidence that hematologic markers and the use of ADT assist in predicting radiation therapy-related fatigue and guide symptom management.
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Affiliation(s)
- Li Feng
- National Institute of Nursing Research in the National Institutes of Health
| | | | | | | | | | | | - Leorey N Saligan
- National Institute of Nursing Research in the National Institutes of Health
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38
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Milam J, Slaughter R, Meeske K, Ritt-Olson A, Sherman-Bien S, Freyer DR, Kuperberg A, Hamilton AS. Substance use among adolescent and young adult cancer survivors. Psychooncology 2016; 25:1357-1362. [PMID: 26315824 PMCID: PMC4935633 DOI: 10.1002/pon.3958] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 06/10/2015] [Accepted: 08/05/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Health-promoting behaviors are recommended to childhood cancer survivors (CCS) to reduce late effects resulting from cancer treatment. Understanding factors associated with substance use is needed, especially among Hispanic CCS who are underrepresented in previous studies. The objective of this study is to examine substance use behaviors of recently treated Hispanic and non-Hispanic CCS. METHODS One hundred ninety-three Los Angeles County CCS who were diagnosed between 2000 and 2007 (54% Hispanic; mean age 19.9 years, SD = 2.8; mean age at diagnosis = 12.1, SD = 3.0; mean years since diagnosis = 7.8, SD = 2.0) provided self-reported information on substance use, demographics, clinical factors, religiosity, and depressive symptoms. Risk and protective factors for substance use were examined using multivariable logistic regression. RESULTS Prevalence of 30-day substance use was 11%, 25%, and 14% for tobacco, alcohol, and marijuana, respectively. In controlled regression models, age was positively associated with tobacco use, binge drinking, and polysubstance use (use of at least two of the three substances). Male gender, higher depressive symptoms, and higher socioeconomic status were associated with greater marijuana use. In addition, religiosity was negatively associated with the use of all substances. CONCLUSIONS The prevalence rates for substance use in this ethnically diverse representative sample of CCS are lower than those observed in the general population. Older CCS were at higher risk of substance use, and depression was associated with greater marijuana use. No differences by ethnicity were observed. Interventions for substance use prevention/cessation among CCS may be most effective if implemented before the age of 21 years and address mental health as part of survivorship care. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Joel Milam
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Rhona Slaughter
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kathleen Meeske
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Anamara Ritt-Olson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - David R Freyer
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Ann S Hamilton
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Bhatia S, Gibson TM, Ness KK, Liu Q, Oeffinger KC, Krull KR, Nathan PC, Neglia JP, Leisenring W, Yasui Y, Robison LL, Armstrong GT. Childhood cancer survivorship research in minority populations: A position paper from the Childhood Cancer Survivor Study. Cancer 2016; 122:2426-39. [PMID: 27253866 PMCID: PMC4956492 DOI: 10.1002/cncr.30072] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/10/2016] [Accepted: 03/25/2016] [Indexed: 01/05/2023]
Abstract
By the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the US population. This temporal shift in the racial/ethnic composition of the US population demands a close look at the race/ethnicity-specific burden of morbidity and premature mortality among survivors of childhood cancer. To optimize targeted long-term follow-up care, it is essential to understand whether the burden of morbidity borne by survivors of childhood cancer differs by race/ethnicity. This is challenging because the number of minority participants is often limited in current childhood cancer survivorship research, resulting in a paucity of race/ethnicity-specific recommendations and/or interventions. Although the overall childhood cancer incidence increased between 1973 and 2003, the mortality rate declined; however, these changes did not differ appreciably by race/ethnicity. The authors speculated that any racial/ethnic differences in outcome are likely to be multifactorial, and drew on data from the Childhood Cancer Survivor Study to illustrate the various contributors (socioeconomic characteristics, health behaviors, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, the authors outlined challenges in conducting race/ethnicity-specific childhood cancer survivorship research, demonstrating that there are limited absolute numbers of children who are diagnosed and survive cancer in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Cancer 2016;122:2426-2439. © 2016 American Cancer Society.
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Affiliation(s)
- Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Qi Liu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin C Oeffinger
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul C Nathan
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joseph P Neglia
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Wendy Leisenring
- Cancer Prevention and Clinical Statistics Programs, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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Lown EA, Phillips F, Schwartz LA, Rosenberg AR, Jones B. Psychosocial Follow-Up in Survivorship as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S514-84. [PMID: 26700918 PMCID: PMC5242467 DOI: 10.1002/pbc.25783] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 01/08/2023]
Abstract
Childhood cancer survivors (CCS) have a high risk of medical late effects following cancer therapy. Psychosocial late effects are less often recognized. Many CCS do not receive long-term follow-up (LTFU) care, and those who do are rarely screened for psychosocial late effects. An interdisciplinary team conducted a systematic review of qualitative and quantitative studies to assess social, educational, vocational, psychological, and behavioral outcomes along with factors related to receipt of LTFU care. We propose that psychosocial screening be considered a standard of care in long-term follow-up care and that education be provided to promote the use LTFU care starting early in the treatment trajectory.
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Affiliation(s)
- E. Anne Lown
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Farya Phillips
- School of Social Work, The University of Texas at Austin, Austin, Texas
| | - Lisa A. Schwartz
- The Children’s Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abby R. Rosenberg
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Barbara Jones
- School of Social Work, The University of Texas at Austin, Austin, Texas
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