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Althans AR, Meshkin D, Holder-Murray J, Cunningham K, Celebrezze J, Medich D, Tessler RA. Deprivation and Rurality Mediate Income Inequality's Association with Colorectal Cancer Outcomes. Am J Prev Med 2024:S0749-3797(24)00192-2. [PMID: 38866078 DOI: 10.1016/j.amepre.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 06/01/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Income inequality is associated with poor health outcomes, but its association with colorectal cancer is not well-studied. The authors aimed to determine the association between income inequality and colorectal cancer incidence/mortality in U.S. counties, and hypothesized that this association was mediated by deprivation. METHODS The authors performed a cross-sectional study of U.S. counties from 2015-2019 using statewide cancer registries and the Centers for Disease Control and Prevention WONDER database. Generalized linear negative binomial regression was performed in 2024 to estimate the association between Gini coefficient (income inequality) and colorectal cancer incidence/mortality using incidence rate ratios (IRRs) for the entire cohort and stratified by rurality. RESULTS A total of 697,981 colorectal cancer cases were diagnosed in the 5-year study period. On adjusted regression, for every 0.1 higher Gini coefficient, there was an 11% higher risk of both colorectal cancer incidence and mortality (IRR 1.11, 95%CI 1.03,1.19 and IRR 1.11, 95%CI 1.05, 1.18 respectively). The association between income inequality and incidence/mortality peaked in more rural counties, however there was not an overall dose-dependent relationship between rurality and these associations. Deprivation mediated the association between income inequality and colorectal cancer incidence (indirect effect B coefficient 0.088, p<0.001) and mortality (B coefficient 0.088, p<0.001). The magnitude and direction of the direct, indirect, and total effects differed in each rurality strata. CONCLUSIONS Much of income inequality's association with colorectal cancer outcomes operates through deprivation. Rural counties have a stronger association between higher income inequality and higher mortality, which works in tandem with deprivation.
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Affiliation(s)
- Alison R Althans
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213.
| | - Dana Meshkin
- University of Pittsburgh, School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213
| | - Jennifer Holder-Murray
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - Kellie Cunningham
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - James Celebrezze
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - David Medich
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - Robert A Tessler
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
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Liang PS, Dubner R, Xia Y, Glenn M, Lin K, Nagpal N, Ng S, Trinh-Shevrin C, Troxel AB, Kwon SC. Up-to-Date Colonoscopy Use in Asian and Hispanic Subgroups in New York City, 2003-2016. J Clin Gastroenterol 2024; 58:259-270. [PMID: 36753456 PMCID: PMC10397368 DOI: 10.1097/mcg.0000000000001835] [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: 10/19/2022] [Accepted: 01/03/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Colorectal cancer screening uptake in the United States overall has increased, but racial/ethnic disparities persist and data on colonoscopy uptake by racial/ethnic subgroups are lacking. We sought to better characterize these trends and to identify predictors of colonoscopy uptake, particularly among Asian and Hispanic subgroups. STUDY We used data from the New York City Community Health Survey to generate estimates of up-to-date colonoscopy use in Asian and Hispanic subgroups across 6 time periods spanning 2003-2016. For each subgroup, we calculated the percent change in colonoscopy uptake over the study period and the difference in uptake compared to non-Hispanic Whites in 2015-2016. We also used multivariable logistic regression to identify predictors of colonoscopy uptake. RESULTS All racial and ethnic subgroups with reliable estimates saw a net increase in colonoscopy uptake between 2003 and 2016. In 2015-2016, compared with non-Hispanic Whites, Puerto Ricans, Dominicans, and Central/South Americans had higher colonoscopy uptake, whereas Chinese, Asian Indians, and Mexicans had lower uptake. On multivariable analysis, age, marital status, insurance status, primary care provider, receipt of flu vaccine, frequency of exercise, and smoking status were the most consistent predictors of colonoscopy uptake (≥4 time periods). CONCLUSIONS We found significant variation in colonoscopy uptake among Asian and Hispanic subgroups. We also identified numerous demographic, socioeconomic, and health-related predictors of colonoscopy uptake. These findings highlight the importance of examining health disparities through the lens of disaggregated racial/ethnic subgroups and have the potential to inform future public health interventions.
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Affiliation(s)
- Peter S. Liang
- Department of Medicine, NYU Langone Health
- Department of Population Health, NYU Langone Health
- Department of Medicine, VA New York Harbor Health Care System
| | - Rachel Dubner
- Department of Medicine, McGaw Medical Center of Northwestern University
| | - Yuhe Xia
- Department of Population Health, NYU Langone Health
| | | | - Kevin Lin
- Department of Medicine, NYU Langone Health
| | | | - Sandy Ng
- Department of Medicine, Stony Brook University Hospital
| | - Chau Trinh-Shevrin
- Department of Medicine, NYU Langone Health
- Department of Population Health, NYU Langone Health
| | | | - Simona C. Kwon
- Department of Medicine, NYU Langone Health
- Department of Population Health, NYU Langone Health
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Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2024; 74:136-166. [PMID: 37962495 DOI: 10.3322/caac.21812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.
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Affiliation(s)
| | | | | | | | | | - Priti Bandi
- American Cancer Society, Atlanta, Georgia, USA
| | | | | | | | | | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Villamar DM, Polite BN. The Promise of Cancer Health Justice: How Stakeholders and the Community Can Build a Sustained and Equitable System of Cancer Care Through the Lens of Colorectal Cancer Interventions. Cancer J 2023; 29:338-342. [PMID: 37963368 DOI: 10.1097/ppo.0000000000000676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Disparities in outcomes and persistent barriers to adequate care in colorectal cancer are reflective of a system that has failed to achieve the ideals of health equity and health justice. In this review, we discuss that although much research has been done to improve upon gaps in screening, treatment, and supportive care in colorectal cancer, a concerted effort across multiple research, regulatory, and funding stakeholders with community-level organizations is essential in building a self-sustained system that effectively achieves health equity outcomes. We also highlight several examples of novel community-based interventions along the continuum of cancer care that demonstrate the potential of what can be accomplished when we invest in scaling up small-scale solutions to the state and national levels and offer ways in which stakeholders and the community may mutually benefit through a system of incentives, self-assessment tools, and attainable metrics.
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Affiliation(s)
- Dario M Villamar
- From the Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
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Liu JJ, DeCuir N, Kia L, Peterson J, Miller C, Issaka RB. Tools to Measure the Impact of Structural Racism and Discrimination on Gastrointestinal and Hepatology Disease Outcomes: A Scoping Review. Clin Gastroenterol Hepatol 2023; 21:2759-2788.e6. [PMID: 36549469 PMCID: PMC10279803 DOI: 10.1016/j.cgh.2022.12.002] [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: 08/08/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Structural racism and discrimination (SRD) are important upstream determinants of health perpetuated by discriminatory laws and policies. Therefore, measuring SRD and its impact on health is critical to developing interventions that address resultant health disparities. We aimed to identify gastrointestinal (GI) or liver studies that report measures of SRD or interventions to achieve health equity in these domains by addressing upstream determinants of health. METHODS We conducted a scoping review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping reviews guidelines. Studies that used an SRD measure or examined an upstream intervention in GI or liver disease were included. Studies that described health disparities in GI or liver conditions without mentioning SRD were excluded. Study characteristics, findings, and limitations were extracted. RESULTS Forty-six articles (19 studies using SRD measures and 27 studies of upstream interventions) were identified. Measures of residential racial segregation were reported most frequently. SRD was associated with poorer health outcomes for racial and ethnic minority populations. Although upstream intervention studies focused primarily on policies related to colon cancer screening and organ graft allocation, racial and ethnic disparities often persisted post-intervention. CONCLUSIONS To achieve health equity in GI and liver conditions, there is an urgent need for research that goes beyond describing health disparities to incorporating measures of SRD and implementing interventions that address this understudied determinant of health.
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Affiliation(s)
- Joy J Liu
- Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Nicole DeCuir
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Leila Kia
- Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Jonna Peterson
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Corinne Miller
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Rachel B Issaka
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, Washington.
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Wyatt LC, Patel S, Kranick JA, Raveis VH, Ravenell JE, Yi SS, Kwon SC, Islam NS. Disparities in colorectal cancer screening among South Asians in New York City: a cross-sectional study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1510-1518. [PMID: 33723796 PMCID: PMC8440659 DOI: 10.1007/s13187-021-01991-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
Despite improvements in colorectal cancer (CRC) screening in New York City (NYC) since the early 2000s, the degree to which disparities persist for specific Asian American subgroups has yet to be fully elucidated. The purpose of this study is to examine disparities in rates of timely colonoscopy screening among five racial/ethnic groups in NYC. We performed a retrospective cross-sectional analysis of combined 2014-2018 NYC Community Health Survey data. Prevalence estimates of timely colonoscopy screening (within the past 10 years) among individuals ≥ 50 years of age were calculated and presented overall (n = 24,288) and by socio-demographic variables. Racial/ethnic categories included White, Black, Hispanic, East Asian, and South Asian. Multivariable models examined socio-demographic and racial/ethnic predictors of timely colonoscopy screening. A trend analysis examined colonoscopy screening by race/ethnicity and year from 2012 to 2018 (n = 33,130). Age-adjusted prevalence of timely colonoscopy screening was lowest among Asian Americans (South Asian 61.1% and East Asian 65.9%) compared to Hispanics (71.3%), Blacks (70.2%), and Whites (68.6%). Adjustment by socio-demographics, including insurance status, further explained disparities for South Asians (adjusted risk ratio [RR] = 0.84, 95% CI = 0.73-0.97) compared to Hispanics; additionally, Whites (adjusted RR=0.88, 95% CI = 0.84-0.92) were less likely to have received a timely colonoscopy compared to Hispanics. Age, health insurance, poverty group, and education were significant predictors in adjusted regression. Results indicate that South Asians have not equally benefited from campaigns to increase colonoscopy screening in NYC. Our findings support the development of targeted, and linguistically and culturally adapted campaigns that facilitate access to health systems and leverage existing community assets and social support systems among South Asian populations.
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Affiliation(s)
- Laura C Wyatt
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 8th floor, New York, NY, 10016, USA.
| | - Shilpa Patel
- Center for Health Care Strategies, Inc., Hamilton, NJ, USA
| | - Julie A Kranick
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 8th floor, New York, NY, 10016, USA
| | - Victoria H Raveis
- Psychological Research Unit on Health, Aging, and the Community, New York University College of Dentistry, New York, NY, USA
| | - Joseph E Ravenell
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 8th floor, New York, NY, 10016, USA
| | - Stella S Yi
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 8th floor, New York, NY, 10016, USA
| | - Simona C Kwon
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 8th floor, New York, NY, 10016, USA
| | - Nadia S Islam
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 8th floor, New York, NY, 10016, USA
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Donegan C, Hughes AE, Lee SJC. Colorectal Cancer Incidence, Inequalities, and Prevention Priorities in Urban Texas: Surveillance Study With the "surveil" Software Package. JMIR Public Health Surveill 2022; 8:e34589. [PMID: 35972778 PMCID: PMC9428771 DOI: 10.2196/34589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Monitoring disease incidence rates over time with population surveillance data is fundamental to public health research and practice. Bayesian disease monitoring methods provide advantages over conventional methods including greater flexibility in model specification and the ability to conduct formal inference on model-derived quantities of interest. However, software platforms for Bayesian inference are often inaccessible to nonspecialists. OBJECTIVE To increase the accessibility of Bayesian methods among health surveillance researchers, we introduce a Bayesian methodology and open source software package, surveil, for time-series modeling of disease incidence and mortality. Given case count and population-at-risk data, the software enables health researchers to draw inferences about underlying risk and derivative quantities including age-standardized rates, annual and cumulative percent change, and measures of inequality. METHODS We specify a Poisson likelihood for case counts and model trends in log-risk using the first-difference (random-walk) prior. Models in the surveil R package were built using the Stan modeling language. We demonstrate the methodology and software by analyzing age-standardized colorectal cancer (CRC) incidence rates by race and ethnicity for non-Latino Black (Black), non-Latino White (White), and Hispanic/Latino (of any race) adults aged 50-79 years in Texas's 4 largest metropolitan statistical areas between 1999 and 2018. RESULTS Our analysis revealed a cumulative decline of 31% (95% CI -37% to -25%) in CRC risk among Black adults, 17% (95% CI -23% to -11%) for Latino adults, and 35% (95% CI -38% to -31%) for White adults from 1999 to 2018. None of the 3 observed groups experienced significant incidence reduction in the final 4 years of the study (2015-2018). The Black-White rate difference (per 100,000) was 44 (95% CI 30-57) in 1999 and 35 (95% CI 28-43) in 2018. Cumulatively, the Black-White gap accounts for 3983 CRC cases (95% CI 3746-4219) or 31% (95% CI 29%-32%) of total CRC incidence among Black adults in this period. CONCLUSIONS Stalled progress on CRC prevention and excess CRC risk among Black residents warrant special attention as cancer prevention and control priorities in urban Texas. Our methodology and software can help the public and health agencies monitor health inequalities and evaluate progress toward disease prevention goals. Advantages of the methodology over current common practice include the following: (1) the absence of piecewise linearity constraints on the model space, and (2) formal inference can be undertaken on any model-derived quantities of interest using Bayesian methods.
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Affiliation(s)
- Connor Donegan
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Geospatial Information Sciences, The University of Texas at Dallas, Dallas, TX, United States
| | - Amy E Hughes
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Simon J Craddock Lee
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
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Bissig S, Syrogiannouli L, Schneider R, Tal K, Selby K, Del Giovane C, Bulliard JL, Senn O, Ducros C, Schmid CP, Marbet U, Auer R. Change in colorectal cancer (CRC) testing rates associated with the introduction of the first organized screening program in canton Uri, Switzerland: Evidence from insurance claims data analyses from 2010 to 2018. Prev Med Rep 2022; 28:101851. [PMID: 35757577 PMCID: PMC9218582 DOI: 10.1016/j.pmedr.2022.101851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
First colorectal cancer (CRC) screening program in Switzerland launched in one canton in 2013. Launched in the context of high prevalent opportunistic CRC testing. Led to an increase in fecal occult blood testing and not colonoscopy. Claims data analyses enable estimating the net effect of programs in general population.
The first canton in Switzerland to implement an organized colorectal cancer screening program (OSP) was Uri. Starting in 2013, it offered 50–69-year-olds free testing with colonoscopy every 10 years or fecal occult blood test (FOBT) every 2 years. We tested the association between the OSP and testing rates over time. We analyzed claims data of 50–69-year-olds from Uri and neighboring cantons (NB) provided by a large health insurance and complemented it with data from the OSP. We fitted multivariate adjusted logistic regression models to compare overall testing rates and by method (colonoscopy or FOBT/both) We computed the 2018 rate of the population up-to-date with testing (colonoscopy within 9 years/FOBT within 2 years). Yearly overall testing rates in Uri increased from 8.7% in 2010 to 10.8% in 2018 and from 6.5% to 7.9% in NB. In Uri, the proportion tested with FOBT/both increased from 4.7% to 6.0% but decreased from 2.8% to 1.1% in NB. Testing by FOBT/both increased more between 2015 and 2018 than 2010–2012 in Uri than in NB (OR:2.1[95%CI:1.8–2.4]), it increased less for colonoscopy (OR:0.60[95%CI:0.51–0.70]), with no change in overall CRC testing (OR:0.91[95%CI:0.81–1.02]). In 2018 in Uri, 42.5% were up-to-date with testing (FOBT/both:9.2%, colonoscopy:35.7%); in NBs, 40.7% (FOBT/both:2.7%, colonoscopy:39%). Yearly FOBT rates in Uri were always higher than in NB. Though the OSP in Uri was not associated with a greater increase in overall testing rates, the OSP was associated with increased FOBT.
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Key Words
- AL, Swiss analysis list for laboratory measures
- CRC, colorectal cancer
- FOBT, gFOBT, iFOBT, fecal occult blood test, guaiac or immunochemical based (also called FIT)
- FSO, federal statistics office
- NB, neighboring cantons
- OSP, organized screening program
- PCG, pharmacy based cost groups
- SHS, swiss health survey
- TARMED, Swiss ambulant procedures codes
- Uri, the canton of Uri
- claims data
- colonoscopy
- colorectal cancer
- fecal occult blood test
- health insurance
- organized screening program
- screening
- testing rates
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Affiliation(s)
- Sarah Bissig
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Rémi Schneider
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University and University Hospital of Zurich, Zurich, Switzerland
| | - Cyril Ducros
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Christian P.R. Schmid
- CSS Institute for Empirical Health Economics, Tribschenstrasse 21, Lucerne, Switzerland
| | - Urs Marbet
- Division of Gastroenterology and Hepatology Cantonal Hospital of Uri, Altdorf, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Corresponding author at: Institute of primary health care (BIHAM), University of Bern, Mittelstrasse 43, CH - 3012 Bern, Switzerland.
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Syvyk S, Roberts SE, Finn CB, Wirtalla C, Kelz R. Colorectal cancer disparities across the continuum of cancer care: A systematic review and meta-analysis. Am J Surg 2022; 224:323-331. [PMID: 35210062 DOI: 10.1016/j.amjsurg.2022.02.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/27/2022] [Accepted: 02/16/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Disparate colorectal cancer outcomes persist in vulnerable populations. We aimed to examine the distribution of research across the colorectal cancer care continuum, and to determine disparities in the utilization of Surgery among Black patients. METHODS A systematic review and meta-analysis of colorectal cancer disparities studies was performed. The meta-analysis assessed three utilization measures in Surgery. RESULTS Of 1,199 publications, 60% focused on Prevention, Screening, or Diagnosis, 20% on Survivorship, 15% on Treatment, and 1% on End-of-Life Care. A total of 16 studies, including 1,110,674 patients, were applied to three meta-analyses regarding utilization of Surgery. Black patients were less likely to receive surgery, twice as likely to refuse surgery, and less likely to receive laparoscopic surgery, when compared to White patients. CONCLUSIONS Since 2011, the majority of research focused on prevention, screening, or diagnosis. Given the observed treatment disparities among Black patients, future efforts to reduce colorectal cancer disparities should include interventions within Surgery.
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Affiliation(s)
- Solomiya Syvyk
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia PA, USA
| | - Sanford E Roberts
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia PA, USA; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Caitlin B Finn
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia PA, USA; NewYork-Presbyterian Hospital/Weill Cornell Medicine, Department of Surgery, New York, NY, USA
| | - Chris Wirtalla
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia PA, USA; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia PA, USA; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Barthélemy EJ, Affana CK, Asfaw ZK, Dams-O'Connor K, Rahman J, Jones S, Ullman J, Margetis K, Hickman ZL, Dangayach NS, Giwa AO. Racial and Socioeconomic Disparities in Neurotrauma: Research Priorities in the New York Metropolitan Area through a Global Neurosurgery Paradigm. World Neurosurg 2022; 165:51-57. [PMID: 35700861 DOI: 10.1016/j.wneu.2022.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
The New York Neurotrauma Consortium (NYNC) is a nascent multidisciplinary research and advocacy organization based in the New York Metropolitan Area (NYMA). It aims to advance health equity and optimize outcomes for traumatic brain and spine injury patients. Given the extensive racial, ethnic, and socioeconomic diversity of the NYMA, global health frameworks aimed at eliminating disparities in neurotrauma may provide a relevant and useful model for the informing research agendas of consortia like the NYNC. In this review, we present a comparative analysis of key health disparities in traumatic brain injury (TBI) that persist in the NYMA as well as in low- and middle-income countries (LMIC). Examples include: (a) inequitable access to quality care due to fragmentation of healthcare systems, (b) barriers to effective prehospital care for TBI, and (c) socioeconomic challenges faced by patients and their families during the subacute and chronic post-injury phases of TBI care. This review presents strategies to address each area of health disparity based on previous studies conducted in both LMIC and high-income country (HIC) settings. Increased awareness of healthcare disparities, education of healthcare professionals, effective policy advocacy for systemic changes, and fostering racial diversity of the trauma care workforce can guide the development of trauma care systems in the NYMA that are free of racial and related healthcare disparities.
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Affiliation(s)
- Ernest J Barthélemy
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, California, USA.
| | | | - Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Kristen Dams-O'Connor
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jueria Rahman
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Salazar Jones
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Jamie Ullman
- New York Neurotrauma Consortium, Inc., New York, New York; Institute for Neurology and Neurosurgery at North Shore University Hospital
| | - Konstantinos Margetis
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Zachary L Hickman
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Neha S Dangayach
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Al O Giwa
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Islami F, Guerra CE, Minihan A, Yabroff KR, Fedewa SA, Sloan K, Wiedt TL, Thomson B, Siegel RL, Nargis N, Winn RA, Lacasse L, Makaroff L, Daniels EC, Patel AV, Cance WG, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2021. CA Cancer J Clin 2022; 72:112-143. [PMID: 34878180 DOI: 10.3322/caac.21703] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023] Open
Abstract
In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.
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Affiliation(s)
- Farhad Islami
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adair Minihan
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Health Services Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kirsten Sloan
- Public Policy, American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Tracy L Wiedt
- Health Equity, Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Blake Thomson
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Nigar Nargis
- Tobacco Control Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lisa Lacasse
- American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Laura Makaroff
- Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Elvan C Daniels
- Extramural Discovery Science, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - William G Cance
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Leder Macek AJ, Kirschenbaum JD, Ricklan SJ, Schreiber-Stainthorp W, Omene BC, Conderino S. Validation of rule-based algorithms to determine colorectal, breast, and cervical cancer screening status using electronic health record data from an urban healthcare system in New York City. Prev Med Rep 2021; 24:101599. [PMID: 34976656 PMCID: PMC8683885 DOI: 10.1016/j.pmedr.2021.101599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 11/07/2022] Open
Abstract
Cancer screening adherence can be estimated using electronic health record data. Screening algorithms had high sensitivity and specificity compared to manual review. Validation of screening algorithms can be performed using de-identified data.
Although cancer screening has greatly reduced colorectal cancer, breast cancer, and cervical cancer morbidity and mortality over the last few decades, adherence to cancer screening guidelines remains inconsistent, particularly among certain demographic groups. This study aims to validate a rule-based algorithm to determine adherence to cancer screening. A novel screening algorithm was applied to electronic health record (EHR) from an urban healthcare system in New York City to automatically determine adherence to national cancer screening guidelines for patients deemed eligible for screening. First, a subset of patients was randomly selected from the EHR and their data were exported in a de-identified manner for manual review of screening adherence by two teams of human reviewers. Interrater reliability for manual review was calculated using Cohen’s Kappa and found to be high in all instances. The sensitivity and specificity of the algorithm was calculated by comparing the algorithm to the final manual dataset. When assessing cancer screening adherence, the algorithm performed with a high sensitivity (79%, 70%, 80%) and specificity (92%, 99%, 97%) for colorectal cancer, breast cancer, and cervical cancer screenings, respectively. This study validates an algorithm that can effectively determine patient adherence to colorectal cancer, breast cancer, and cervical cancer screening guidelines. This design improves upon previous methods of algorithm validation by using computerized extraction of essential components of patients’ EHRs and by using de-identified data for manual review. Use of the described algorithm could allow for more precise and efficient allocation of public health resources to improve cancer screening rates.
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Barriers to Colorectal Cancer Screening Among Russian-speaking Immigrants: The Importance of Culture and Home Country Experiences. J Immigr Minor Health 2021; 24:1300-1308. [PMID: 34671898 DOI: 10.1007/s10903-021-01291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
There is potential to improve low colorectal cancer screening rates, reduce mortality, and narrow health disparities, if the distinctive screening barriers among Russian-speaking immigrants were better understood. However, there is little relevant research about the topic. To address this gap, this study aimed to identify barriers to timely colorectal cancer screening, especially colonoscopies, among Russian-speakers in New York City. Thirteen key informant interviews were performed with providers, community leaders, and academics. Eight focus groups were then conducted with 81 Russian-speaking individuals, age 50-75, who had not had a timely colonoscopy. Results were translated, transcribed, coded and analyzed. Barriers identified included individual, communal, and structural issues. Distinctive barriers, such as those related to culture and to the experiences of living under the Soviet system, were uncovered. Barriers identified can potentially be reduced through interventions suggested by the research, including more education and more effective provider recommendations.
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14
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Ng S, Xia Y, Glenn M, Nagpal N, Lin K, Trinh-Shevrin C, Troxel AB, Kwon SC, Liang PS. Factors Associated with Up-to-Date Colonoscopy Use Among Puerto Ricans in New York City, 2003-2016. Dig Dis Sci 2021; 66:2907-2915. [PMID: 33063189 PMCID: PMC8050125 DOI: 10.1007/s10620-020-06648-x] [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: 08/20/2020] [Accepted: 09/29/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Colorectal cancer is the second leading cause of cancer death among Hispanic Americans. Puerto Ricans are the second largest Hispanic subgroup in the USA and the largest in New York City, but little is known about predictors of colorectal cancer screening uptake in this population. AIMS We used the New York City Community Health Survey, a population-based telephone survey, to investigate predictors of up-to-date colonoscopy use over time among Puerto Ricans aged ≥ 50 years in NYC. METHODS We assessed the association between sociodemographic and medical factors and up-to-date colonoscopy use (defined as colonoscopy within the last 10 years) using univariable and multivariable logistic regression over six time periods: 2003-2005, 2006-2008, 2009-2010, 2011-2012, 2013-2014, and 2015-2016. RESULTS On multivariable analysis, age ≥ 65 years (OR 1.64-1.93 over three periods) and influenza vaccination (OR 1.86-2.17 over five periods) were the two factors most consistently associated with up-to-date colonoscopy use. Individuals without a primary care provider (OR 0.38-0.50 over three periods) and who did not exercise (OR 0.49-0.52 over two periods) were significantly less likely to have an up-to-date colonoscopy. CONCLUSIONS Older age, influenza vaccination, having a primary care provider, and exercise are independent predictors of up-to-date colonoscopy use among Puerto Ricans in NYC. Interventions to improve screening colonoscopy uptake among Puerto Ricans should be targeted to those aged 50-64 years and who do not have a primary care provider.
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Affiliation(s)
- Sandy Ng
- Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
| | - Yuhe Xia
- Department of Population Health, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
| | - Matthew Glenn
- NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Neha Nagpal
- Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
| | - Kevin Lin
- Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
| | - Chau Trinh-Shevrin
- Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
- Department of Population Health, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
| | - Andrea B Troxel
- Department of Population Health, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
| | - Simona C Kwon
- Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
- Department of Population Health, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
| | - Peter S Liang
- Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA.
- Department of Medicine, VA New York Harbor Health Care System, 423 E 23rd St 11N GI, New York, NY, 10010, USA.
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Patel S, Kranick J, Manne S, Shah K, Raveis V, Ravenell J, Yi S, Kwon S, Islam N. A Population Health Equity Approach Reveals Persisting Disparities in Colorectal Cancer Screening in New York City South Asian Communities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:804-810. [PMID: 32060860 PMCID: PMC8685893 DOI: 10.1007/s13187-020-01707-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To assess colorectal cancer (CRC) screening among South Asians (SAs) and explore the challenges and facilitators to CRC screening among SA subgroups in New York City (NYC). Fifty-one semi-structured in-depth interviews and surveys were conducted among SA immigrants in NYC. Qualitative results suggested challenges to CRC screening were related to socio-cultural factors, such as a lack of knowledge on CRC and CRC screening, and structural factors, such as cost and language. A physician referral was the most cited facilitator to CRC screening. Participants reported culturally and linguistically adapted education and information on CRC and CRC screening would help to overcome noted challenges. Our findings support the development of targeted, linguistically and culturally adapted campaigns for this population that facilitate access to health systems and leverage natural community assets and social support systems.
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Affiliation(s)
- Shilpa Patel
- Center for Health Care Strategies 200 American, Metro Blvd # 119, Hamilton, NJ, 08619, USA.
| | - Julie Kranick
- Department of Population Health, NYU Langone Medical Center, 180 Madison Avenue, New York, NY, 10016, USA
| | - Sharon Manne
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Krina Shah
- Institute of Environmental Medicine, 57 Old Forge Road, Tuxedo Park, NY, 10987, USA
| | | | - Joseph Ravenell
- Department of Population Health, NYU Langone Medical Center, 180 Madison Avenue, New York, NY, 10016, USA
| | - Stella Yi
- Department of Population Health, NYU Langone Medical Center, 180 Madison Avenue, New York, NY, 10016, USA
| | - Simona Kwon
- Department of Population Health, NYU Langone Medical Center, 180 Madison Avenue, New York, NY, 10016, USA
| | - Nadia Islam
- Department of Population Health, NYU Langone Medical Center, 180 Madison Avenue, New York, NY, 10016, USA
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Brown JJ, Asumeng CK, Greenwald D, Weissman M, Zauber A, Striplin J, Weng O, List JM, Farley SM, Winawer SJ. Decreased colorectal cancer incidence and mortality in a diverse urban population with increased colonoscopy screening. BMC Public Health 2021; 21:1280. [PMID: 34193094 PMCID: PMC8247120 DOI: 10.1186/s12889-021-11330-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background Although colorectal cancer screening has contributed to decreased incidence and mortality, disparities are present by race/ethnicity. The Citywide Colon Cancer Control Coalition (C5) and NYC Department of Health and Mental Hygiene (DOHMH) promoted screening colonoscopy from 2003 on, and hypothesized future reductions in CRC incidence, mortality and racial/ethnic disparities. Methods We assessed annual percent change (APC) in NYC CRC incidence, stage and mortality rates through 2016 in a longitudinal cross-sectional study of NY State Cancer Registry, NYC Vital Statistics, and NYC Community Health Survey (CHS) data. Linear regression tested associations between CRC mortality rates and risk factors. Results Overall CRC incidence rates from 2000 decreased 2.8% yearly from 54.1 to 37.3/100,000 population in 2016, and mortality rates from 2003 decreased 2.9% yearly from 21.0 to 13.9 in 2016 at similar rates for all racial/ethnic groups. Local stage disease decreased overall with a transient increase from 2002 to 2007. In 2016, CRC incidence was higher among Blacks (42.5 per 100,000) than Whites (38.0), Latinos (31.7) and Asians (30.0). In 2016, Blacks had higher mortality rates (17.9), than Whites (15.2), Latinos (10.4) and Asians (8.8). In 2016, colonoscopy rates among Blacks were 72.2%, Latinos 71.1%, Whites 67.2%, and Asians, 60.9%. CRC mortality rates varied by neighborhood and were independently associated with Black race, CRC risk factors and access to care. Conclusions In a diverse urban population, a citywide campaign to increase screening colonoscopy was associated with decreased incidence and mortality among all ethnic/racial groups. Higher CRC burden among the Black population demonstrate more interventions are needed to improve equity.
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Affiliation(s)
- Jennifer J Brown
- Bureau of Chronic Disease Prevention, NYC Department of Health and Mental Hygiene, New York, NY, USA.
| | - Charles K Asumeng
- Bureau of Chronic Disease Prevention, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - David Greenwald
- Mount Sinai Beth Israel/Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew Weissman
- Mount Sinai Beth Israel/Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann Zauber
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jared Striplin
- Bureau of Chronic Disease Prevention, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Olivia Weng
- Bureau of Chronic Disease Prevention, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | | | - Shannon M Farley
- Bureau of Chronic Disease Prevention, NYC Department of Health and Mental Hygiene, New York, NY, USA
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Kabiri N, Khodayari-zarnaq R, Khoshbaten M, Arab-Zozani M, Janati A. Gastrointestinal cancer prevention policies in Iran: A policy analysis of agenda-setting using Kingdon’s multiple streams. J Cancer Policy 2021; 27:100265. [DOI: 10.1016/j.jcpo.2020.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023]
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18
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Janati A, Khodayari-Zarnaq R, Khanijahani A, Khoshbaten M, Ghamkhar A, Kabiri N. Adherence to the new policy framework of the World Cancer Research Fund International in developing a policy package for the prevention of gastrointestinal cancers in Iran: a Delphi study. Glob Health Action 2021; 14:1978661. [PMID: 34586047 PMCID: PMC8491721 DOI: 10.1080/16549716.2021.1978661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Gastrointestinal cancers in Iran are among the major non-communicable diseases with a considerable burden on the health system. Changes in lifestyles as well as environmental factors have resulted in the emergence of these cancers. OBJECTIVE To elicit and quantitatively verify experts' opinions regarding the potential public health impact, feasibility, economic impact, and budgetary impact of gastrointestinal cancer prevention policies in Iran. METHODS Sixteen experts from Iran were recruited in an email-based, two-round Delphi study. In each round, a questionnaire of policy options for preventing gastrointestinal cancers, which adhered to the new policy framework of the World Cancer Research Fund International, was given to participants. In the first round, experts were asked to provide opinions for and against the policy options. The second round evaluated the policy options for their public health impact, feasibility, economic impact, and budgetary impact. RESULTS A total of 32 policy options were organized based on three domains: health-enhancing environments, system changes, and behavior change communications. Of the 32 policy options, there were consensus in 31 (96%) and 30 (93%) options for public health impact and feasibility, respectively. On study completion, experts reached a consensus in 29 of 32 (90%) policy options for economic impact; only on 26 (81%) of these policy options did participants reached consensus for budgetary impact. CONCLUSION Findings indicated that although nearly all policy options reached a consensus for their public health impact, some options are not feasible or do not appear to have an economic rationale for being implemented. Moreover, it is crucial to take into account the inter-sectoral collaboration between health and non-health sectors. Findings from this study can be helpful for health policymakers in identifying support for evidence-informed approaches regarding gastrointestinal cancer prevention.
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Affiliation(s)
- Ali Janati
- Iranian Center of Excellence in Health Management, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Khanijahani
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Manouchehr Khoshbaten
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ghamkhar
- School of Nursing and Allied Medical Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Neda Kabiri
- Research Center for Evidence based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Doubeni CA, Selby K, Gupta S. Framework and Strategies to Eliminate Disparities in Colorectal Cancer Screening Outcomes. Annu Rev Med 2020; 72:383-398. [PMID: 33208026 DOI: 10.1146/annurev-med-051619-035840] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Preventable differences in colorectal cancer (CRC) mortality across racial/ethnic, economic, geographic, and other groups can be eliminated by assuring equitable access and quality across the care continuum, but few interventions have been demonstrated to do so. Multicomponent strategies designed with a health equity framework may be effective. A health equity framework takes into account social determinants of health, multilevel influences (policy, community, delivery, and individual levels), screening processes, and community engagement. Effective strategies for increasing screening uptake include patient navigation and other interventions for structural barriers, reminders and clinical decision support, and data to continuously track metrics and guide targets for improvement. Community resource gaps should be addressed to assure high-quality services irrespective of racial/ethnic and socioeconomic status. One model combinespopulation-based proactive outreach screening with screening delivery at in-person or virtual points of contact, as well as community engagement. Patient- and provider-based behavioral interventions may be considered for increasing screening demand and delivery. Providing a choice of screening tests is recommended for CRC screening, and access to colonoscopy is required for completion of the CRC screening process.
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Affiliation(s)
- Chyke A Doubeni
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota 55905, USA; .,Department of Family Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), Lausanne 1011, Switzerland;
| | - Samir Gupta
- Section of Gastroenterology, Veterans Affairs San Diego Healthcare System, San Diego, California 92161, USA.,Department of Medicine, University of California at San Diego, La Jolla, California 92103, USA; .,Moores Cancer Center, University of California at San Diego, La Jolla, California 92103, USA
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20
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Carcinogenesis as Side Effects of Iron and Oxygen Utilization: From the Unveiled Truth toward Ultimate Bioengineering. Cancers (Basel) 2020; 12:cancers12113320. [PMID: 33182727 PMCID: PMC7698037 DOI: 10.3390/cancers12113320] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Cancer is a major cause of human mortality worldwide. No life on earth can live without iron. Persistent oxidative stress resulting from continuous use of iron and oxygen may be a fundamental cause of carcinogenesis. Many animal models demonstrated that excess iron may lead to carcinogenesis. This is supported by a variety of human epidemiological data on cancer risk and prognosis. Cancer is basically a disease of the genome with persistently activated oncogenes and inactivated tumor suppressor genes through which iron addiction with ferroptosis-resistance is established. We predict that fine use of nanomaterials and non-thermal plasma may be able to reverse this situation. Abstract Evolution from the first life on earth to humans took ~3.8 billion years. During the time there have been countless struggles among the species. Mycobacterium tuberculosis was the last major uncontrollable species against the human public health worldwide. After the victory with antibiotics, cancer has become the leading cause of death since 1981 in Japan. Considering that life inevitably depends on ceaseless electron transfers through iron and oxygen, we believe that carcinogenesis is intrinsically unavoidable side effects of using iron and oxygen. Many animal models unequivocally revealed that excess iron is a risk for carcinogenesis. This is supported by a variety of human epidemiological data on cancer risk and prognosis. Cancer is basically a disease of the genome with persistently activated oncogenes and inactivated tumor suppressor genes through which iron addiction with ferroptosis-resistance is maintained. Engineering has made a great advance in the past 50 years. In particular, nanotechnology is distinct in that the size of the engineered molecules is similar to that of our biomolecules. While some nano-molecules are found carcinogenic, there are principles to avoid such carcinogenicity with a smart possibility to use nano-molecules to specifically kill cancer cells. Non-thermal plasma is another modality to fight against cancer.
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Prochnow T, Patterson MS, Sharkey J, Umstattd Meyer MR. Health coalition collaboration network, perceived satisfaction and success. J Health Organ Manag 2020; 34:885-897. [PMID: 33063504 DOI: 10.1108/jhom-04-2020-0120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The health equity and prosperity of communities is closely linked to the effectiveness and success of local health coalitions. Social network analysis (SNA) is one mechanism to quantify and understand the factors leading to collaboration and effectiveness within these coalitions. This study aims to investigate network characteristics associated with perceived success and satisfaction in a health coalition and determine significant factors related to organizational collaborations. DESIGN/METHODOLOGY/APPROACH This study examined the Olympic Peninsula Healthy Community Coalition (OPHCC) which aims to prevent chronic disease in rural Clallam County, Washington. Representatives (n = 21) from member organizations (n = 18) were asked to report on organization characteristics, perceived satisfaction in coalition activities, perceived success toward coalition's mission, and collaborations with other organizations in the coalition. Multilevel modeling used to analyze whether an organization's position within the coalition network was associated with their perceived satisfaction and perceived success. Exponential random graph modeling was used to examine what factors may impact collaboration ties between coalition members. FINDINGS Organization representatives reported a total of 252 collaboration ties. In multilevel models, organization characteristics and network centrality scores accounted for between 61 and 68% of variance displayed in satisfaction scores and 45-61% of variance in perceived success scores. Exponential random graph modeling revealed activity level, for-profit status, and transitivity as significant factors in collaborative tie presence. ORIGINALITY/VALUE Encouraging consistent active participation, a balance of organizational type, and projects which require more than two collaborators may provide an environment for collaborative ties between organizations.
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22
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Impact of a Citywide Benchmarking Intervention on Colonoscopy Quality Performance. Dig Dis Sci 2020; 65:2534-2541. [PMID: 32036513 DOI: 10.1007/s10620-020-06067-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/09/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION There is marked variability in colonoscopy quality, limiting its effectiveness in colorectal cancer prevention. Multiple indicators have been established as markers for colonoscopy quality; however, there are conflicting data on the effects of quality reporting programs on endoscopist performance. In this study, we investigate the impact of a multicenter quarterly report card initiative on colonoscopy quality metric performance. METHODS Data were collected from 194 endoscopists at 10 participating sites throughout New York City using a Qualified Clinical Data Registry from January 2013 to December 2014. Adenoma detection rate (ADR), cecal intubation rate, withdrawal time, bowel preparation quality and appropriate interval recommendations were tracked. Report cards were distributed to each site on a quarterly basis and technical assistance was provided as needed. Performance trends were analyzed using the Cochran-Armitage trend and analysis of variance tests. RESULTS 37,258 screening colonoscopies were performed during the study period. There was a positive performance trend for ADR over time from the first quarter of 2013 to the last quarter of 2014 (15.6-25.7%; p < 0.001). There were also increases in cecal intubation rates (78.2-92.6%; p < 0.001), bowel preparation adequacy rates (77.5-92.8%; p < 0.001), and adherence to appropriate screening intervals (28.0-55.0%; p < 0.001). There was no clinically significant change in mean withdrawal time. CONCLUSIONS The implementation of a quarterly report card initiative resulted in statistically significant improvements in adenoma detection, cecal intubation, bowel preparation adequacy rates, and appropriate recommended screening intervals.
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23
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White PM, Itzkowitz SH. Barriers Driving Racial Disparities in Colorectal Cancer Screening in African Americans. Curr Gastroenterol Rep 2020; 22:41. [PMID: 32647903 DOI: 10.1007/s11894-020-00776-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Colorectal cancer screening has been shown to decrease mortality from colorectal cancer. Screening disparities continue to exist among ethnic minorities, particularly for African Americans. We herein review the barriers of colorectal cancer screening in this population. RECENT FINDINGS At its foundation are patient barriers, which are further compounded by physician-related barriers and the idiosyncrasies of the healthcare system. Interventions to address the barriers include patient outreach, provider education, and healthcare legislation addressing financial barriers. Recent research has focused on factors predicting intentions to undergo colorectal cancer screening. Underlying all of the barriers is the systemic racism that affects and influences the healthcare system as much as all other institutions and contributes to inequities in the delivery of effective cancer prevention efforts. Perpetual disparities in CRC screening within the African American community are due to multifactorial barriers from the individual patient to provider and healthcare system and societal influences. An awareness of the behavioral and systemic factors that affect African Americans must underpin efforts to reach full equity in delivering CRC screening to this often medically underserved segment of our society.
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Affiliation(s)
- Pascale M White
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box 1069, New York, NY, 10029, USA
| | - Steven H Itzkowitz
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box 1069, New York, NY, 10029, USA.
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24
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Costas-Muñiz R, Roberts N, Narang B, Mehmood R, Acharya S, Aragones A, Leng J, Gany F. Colorectal Cancer Screening and Access to Healthcare in New York City Taxi Drivers. J Immigr Minor Health 2020; 22:526-533. [PMID: 31263989 PMCID: PMC6938571 DOI: 10.1007/s10903-019-00911-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study examined differences in colorectal cancer screening across sociodemographic, migration, occupational, and health-related factors in a sample of male taxi drivers. Male drivers eligible for colorectal cancer screening (CRCS) (≥ 50 years old) were recruited in 55 community-based health fairs conducted during November 2015 to February 2017 in 16 taxi garages or community locations located in Queens, Brooklyn, Manhattan and Bronx. Participants completed a survey that included sociodemographic, migration, occupational, health-related, and cancer screening practices. For this study 33 questions were analyzed. The sample consisted of 137 male drivers, 27% of them had undergone CRCS. Occupation-related factors, including night shifts and driving high numbers of weekly hours, were associated with lower CRCS rates; having a family history of cancer, health insurance, a regular source of primary care, and a routine check-up in the last year, were associated with higher CRCS rates. The findings suggest that drivers with health insurance and better access to primary care are more likely to be up-to-date with CRCS. The results provide important information that can inform occupation-based public health interventions.
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Affiliation(s)
- Rosario Costas-Muñiz
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Immigrant Health & Cancer Disparities Service, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.
| | - Nicole Roberts
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Immigrant Health & Cancer Disparities Service, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Bharat Narang
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Immigrant Health & Cancer Disparities Service, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Rehan Mehmood
- South Asian Council for Social Services, 143-06, 45 Avenue, Flushing, NY, 11355, USA
| | - Sudha Acharya
- South Asian Council for Social Services, 143-06, 45 Avenue, Flushing, NY, 11355, USA
| | - Abraham Aragones
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Immigrant Health & Cancer Disparities Service, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Jennifer Leng
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Immigrant Health & Cancer Disparities Service, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Francesca Gany
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Immigrant Health & Cancer Disparities Service, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
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25
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DuHamel KN, Schofield EA, Villagra C, Sriphanlop P, Itzkowitz SH, Cotter G, Cohen N, Erwin DO, Winkel G, Thompson HS, Zauber AG, Jandorf LH. Promoting colonoscopy screening among low-income Latinos at average risk of colorectal cancer: A randomized clinical trial. Cancer 2020; 126:782-791. [PMID: 31742670 DOI: 10.1002/cncr.32541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 07/26/2019] [Accepted: 08/12/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Screening colonoscopy (SC) for colorectal cancer (CRC) is underused by Latino individuals. The current randomized clinical trial examined the impact of 3 interventions: 1) patient navigation; 2) patient navigation plus standard Centers for Disease Control and Prevention print materials; and 3) patient navigation plus culturally targeted print materials for Latinos referred for SC. Demographic, personal and health history, and psychometric factors associated with SC also were examined. METHODS A total of 344 urban Latino individuals aged 50 to 85 years with no personal and/or immediate family history of CRC diagnosed before age 60 years, no personal history of a gastrointestinal disorder, no colonoscopy within the past 5 years, with insurance coverage, and with a referral for SC were consented. Participants were randomized to patient navigation (20%), patient navigation plus standard Centers for Disease Control and Prevention print materials (40%), and patient navigation plus culturally targeted print materials (40%). The completion of SC was assessed at 12 months. RESULTS The interventions had an overall SC rate of 82%. Counterintuitively, patients with an average income of <$10,000 were found to have higher SC rates (87%) than those with a greater income (75%). CONCLUSIONS The addition of standard or culturally targeted print materials did not appear to increase SC rates above those for patient navigation. Indeed, after controlling for other variables, culturally targeted print materials were found to be associated with lower SC rates among Puerto Rican individuals.
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Affiliation(s)
- Katherine N DuHamel
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, Icahn Medical Institute, New York, New York.,Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth A Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cristina Villagra
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, Icahn Medical Institute, New York, New York
| | - Pathu Sriphanlop
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, Icahn Medical Institute, New York, New York
| | - Steven H Itzkowitz
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gina Cotter
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, Icahn Medical Institute, New York, New York.,Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noah Cohen
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, Icahn Medical Institute, New York, New York.,Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah O Erwin
- Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Gary Winkel
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, Icahn Medical Institute, New York, New York
| | - Hayley S Thompson
- Department of Community Outreach and Engagement, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lina H Jandorf
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, Icahn Medical Institute, New York, New York
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26
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Ni K, O'Connell K, Anand S, Yakoubovitch SC, Kwon SC, de Latour RA, Wallach AB, Sherman SE, Du M, Liang PS. Low Colorectal Cancer Screening Uptake and Persistent Disparities in an Underserved Urban Population. Cancer Prev Res (Phila) 2020; 13:395-402. [PMID: 32015094 DOI: 10.1158/1940-6207.capr-19-0440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/01/2020] [Accepted: 01/28/2020] [Indexed: 01/20/2023]
Abstract
Colorectal cancer screening has increased substantially in New York City in recent years. However, screening uptake measured by telephone surveys may not fully capture rates among underserved populations. We measured screening completion within 1 year of a primary care visit among previously unscreened patients in a large urban safety-net hospital and identified sociodemographic and health-related predictors of screening.We identified 21,256 patients ages 50 to 75 who were seen by primary care providers (PCP) in 2014, of whom 14,425 (67.9%) were not up-to-date with screening. Because PCPs facilitate the majority of screening, we compared patients who received screening within 1 year of an initial PCP visit to those who remained unscreened using multivariable logistic regression.Among patients not up-to-date with screening at study outset, 11.5% (1,658 patients) completed screening within 1 year of a PCP visit. Asian race, more PCP visits, and higher area-level income were associated with higher screening completion. Factors associated with remaining unscreened included morbid obesity, ever smoking, Elixhauser comorbidity index of 0, and having Medicaid/Medicare insurance. Age, sex, language, and travel time to the hospital were not associated with screening status. Overall, 39.9% of patients were up-to-date with screening by 2015.In an underserved urban population, colorectal cancer screening disparities remain, and overall screening uptake was low. Because more PCP visits were associated with modestly higher screening completion at 1 year, additional community-level education and outreach may be crucial to increase colorectal cancer screening in underserved populations.
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Affiliation(s)
- Katherine Ni
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kelli O'Connell
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sanya Anand
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York
| | | | - Simona C Kwon
- Department of Population Health, NYU Langone Health, New York, New York
| | - Rabia Ali de Latour
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York
| | | | - Scott E Sherman
- Department of Population Health, NYU Langone Health, New York, New York
| | - Mengmeng Du
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter S Liang
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York. .,Veterans Affairs New York Harbor Health Care System, New York, New York
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27
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Dey N, Kochman ML, Komanduri S, Melson JE, Muthusamy VR. Report from the AGA Center for GI Innovation and Technology's Consensus Conference: Envisioning Next-Generation Paradigms in Colorectal Cancer Screening and Surveillance. Gastroenterology 2020; 158:455-460. [PMID: 31525354 DOI: 10.1053/j.gastro.2019.05.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Neelendu Dey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington.
| | - Michael L Kochman
- Gastroenterology Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Srinadh Komanduri
- Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joshua E Melson
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush Medical College, Chicago, Illinois
| | - V Raman Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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28
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Carmeli A, Dranikoff L, Kundu A, Ladabaum U. The case for philanthropic investment to increase colorectal cancer screening rates: A novel paradigm to address a public health challenge. Cancer Med 2019; 9:1220-1229. [PMID: 31808317 PMCID: PMC6997057 DOI: 10.1002/cam4.2745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/26/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background Colorectal cancer (CRC) remains a leading cause of cancer‐related death despite being highly preventable. Efforts to increase participation in CRC screening have not met national goals. We developed a novel approach: building a business case for philanthropic investment in CRC screening. Methods A taskforce representing the public health community, professional societies, charitable foundations, academia, and industry was assembled to: (a) quantify the impact of improving CRC screening rates; (b) identify barriers to screening; (c) estimate the “activation cost” to overcome barriers and screen one additional person; (d) develop a holistic business case that is attractive to philanthropists; and (e) launch a demonstration project. Results We estimated that of 50 600 CRC deaths annually in the US, 55% occur in 50‐ to 85‐year‐olds and are potentially addressable by improvements in CRC screening. Barriers to screening were identified in all patient journey phases, including lack of awareness or insurance and logistical challenges in the pre‐physician phase. The cost to activate one person to undergo screening was $25‐175. This translated into a cost of $6000‐36 000 per CRC death averted by philanthropic investment. Based on this work, the Colorectal Cancer Alliance launched the effort “March Forth” to prevent 100 000 CRC deaths in the US over 10 years, with the first pilot in Philadelphia. Conclusions A holistic business plan can attract philanthropy to promote CRC screening. A simple message of “You can save a life from CRC with a $25 000 donation” can motivate demonstration projects in regions with high CRC rates and low screening participation.
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Affiliation(s)
| | - Lee Dranikoff
- Colorectal Cancer Alliance Board of Directors, Washington, DC, USA.,American Securities, New York, NY, USA
| | | | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
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29
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David Y, Ottaviano L, Park J, Iqbal S, Likhtshteyn M, Kumar S, Lyo H, Lewis AE, Lung BE, Frye JT, Huang L, Li E, Yang J, Martello L, Vignesh S, Miller JD, Follen M, Grossman EB. Confounders in Adenoma Detection at Initial Screening Colonoscopy: A Factor in the Assessment of Racial Disparities as a Risk for Colon Cancer. ACTA ACUST UNITED AC 2019; 10:269-289. [PMID: 31032142 DOI: 10.4236/jct.2019.104022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background and Aims The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there is increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients. Methods A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45-75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas. Results Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance were associated with adenoma detection. Conclusion In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.
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Affiliation(s)
- Yakira David
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America (USA) 11203.,Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, USA 10025
| | - Lorenzo Ottaviano
- Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Jihye Park
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York, USA
| | - Sadat Iqbal
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America (USA) 11203
| | - Michelle Likhtshteyn
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America (USA) 11203
| | - Samir Kumar
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America (USA) 11203
| | - Helen Lyo
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America (USA) 11203
| | - Ayanna E Lewis
- Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Brandon E Lung
- Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Jesse T Frye
- Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Li Huang
- Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Ellen Li
- Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Laura Martello
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America (USA) 11203
| | - Shivakumar Vignesh
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America (USA) 11203
| | - Joshua D Miller
- Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Michele Follen
- Department of Obstetrics and Gynecology, NYC HNC/Kings County, 451 Clarkson Ave, Brooklyn, New York, USA 11203
| | - Evan B Grossman
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America (USA) 11203.,Department of Medicine, Division of Gastroenterology, NYC Health and Hospitals/Kings County, 451 Clarkson Ave, Brooklyn, New York, USA 11203
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30
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Rastogi N, Xia Y, Inadomi JM, Kwon SC, Trinh-Shevrin C, Liang PS. Disparities in colorectal cancer screening in New York City: An analysis of the 2014 NYC Community Health Survey. Cancer Med 2019; 8:2572-2579. [PMID: 30843666 PMCID: PMC6536964 DOI: 10.1002/cam4.2084] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 12/17/2022] Open
Abstract
Background & Aims Disparities in colorectal cancer (CRC) screening uptake by race/ethnicity, socioeconomic status, and geography are well documented. We sought to further characterize the relationship between sociodemographic factors and up‐to‐date colonoscopy use in a diverse urban center using the 2014 New York City Community Health Survey (NYCCHS). Methods We examined overall colonoscopy uptake by race/ethnicity—with a particular interest in Asian and Hispanic subgroups—and used weighting to represent the entire 2014 NYC adult population. We also evaluated the association between 10 sociodemographic variables (age, sex, race/ethnicity, birthplace, home language, time living in the US, education, employment, income, and borough of residence) and colonoscopy use using univariable and multivariable logistic regression models. Results Up‐to‐date colonoscopy uptake was 69% overall with reported differences by racial/ethnic group, ranging from 44%‐45% for Mexicans and Asian Indians to 75% for Dominicans. In the multivariable regression model, colonoscopy use was associated with age greater than 65 years, Chinese language spoken at home, and not being in the labor force. Lower colonoscopy use was associated with living in the US for less than 5 years, Asian Indian language spoken at home, lower income, and residing outside of Manhattan. Conclusions Among New Yorkers older than age 50, up‐to‐date colonoscopy use varied significantly by race/ethnicity, especially in Asian and Hispanic subgroups. Recent immigrants, low‐income groups, and those living outside of Manhattan were significantly less likely to receive CRC screening. Targeted interventions to promote CRC screening in these underserved groups may improve overall screening uptake.
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Affiliation(s)
| | - Yuhe Xia
- NYU Langone Health, New York, New York
| | - John M Inadomi
- University of Washington School of Medicine, Seattle, Washington
| | | | | | - Peter S Liang
- NYU Langone Health, New York, New York.,VA New York Harbor Health Care System, New York, New York
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31
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Van Beck KC, Jasek J, Roods K, Brown JJ, Farley SM, List JM. Colorectal Cancer Incidence and Mortality Rates Among New York City Adults Ages 20-54 years during 1976-2015. JNCI Cancer Spectr 2018; 2:pky048. [PMID: 31360871 PMCID: PMC6649822 DOI: 10.1093/jncics/pky048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/30/2018] [Accepted: 08/10/2018] [Indexed: 12/17/2022] Open
Abstract
Colorectal cancer (CRC) incidence rates are rising in younger Americans and mortality rates are increasing among younger white Americans. We used New York State Cancer Registry data to examine New York City CRC incidence and mortality trends among adults ages 20–54 years by race from 1976 to 2015. Annual percent change (APC) was considered statistically significant at P less than .05 using a two-sided test. CRC incidence increased among those ages 20–49 years, yet blacks had the largest APC of 2.2% (1993–2015; 95% confidence interval [CI] = 1.4% to 3.1%) compared with 0.5% in whites (1976–2015; 95% CI = 0.2% to 0.7%). Among those aged 50–54 years, incidence increased among blacks by 0.8% annually (1976–2015; 95% CI = 0.4% to 1.1%), but not among whites. CRC mortality decreased among both age and race groups. These findings emphasize the value of local registry data to understand trends locally, the importance of timely screening, and the need for clinicians to consider CRC among all patients with compatible signs and symptoms.
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Affiliation(s)
- Kellie C Van Beck
- New York City Department of Health and Mental Hygiene, Queens, NY.,Data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.,Drafted the manuscript
| | - John Jasek
- Data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.,Drafted the manuscript.,The statistical analysis
| | - Kristi Roods
- Data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.,The statistical analysis
| | - Jennifer J Brown
- Provided supervision. All authors contributed to the concept and design; acquisition, analysis, or interpretation of data; and critical revision of the manuscript
| | - Shannon M Farley
- Provided supervision. All authors contributed to the concept and design; acquisition, analysis, or interpretation of data; and critical revision of the manuscript
| | - Justin M List
- Provided supervision. All authors contributed to the concept and design; acquisition, analysis, or interpretation of data; and critical revision of the manuscript
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32
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Communication and comprehensive cancer control coalitions: lessons from two decades of campaigns, outreach, and training. Cancer Causes Control 2018; 29:1239-1247. [PMID: 30535669 DOI: 10.1007/s10552-018-1122-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Comprehensive cancer control (CCC) coalitions and programs have delivered effective models and approaches to reducing cancer burden across the United States over the last two decades. Communication plays an essential role in diverse coalition activities from prevention to survivorship, including organizational and community capacity-building and as cancer control intervention strategies. METHODS Based upon a review of published CCC research as well as public health communication best practices, this article describes lessons learned to assist CCC coalitions and programs with systematic implementation of communication efforts as key strategies in cancer control. RESULTS Communication-oriented lessons include (1) effective communication work requires listening and ongoing engagement with key stakeholders, (2) communication interventions should target multiple levels from interpersonal to mediated channels, (3) educational outreach can be a valuable opportunity to bolster coalition effectiveness and cancer control outcomes, and (4) dedicated support is necessary to ensure consistent communication efforts. CONCLUSIONS External and internal communication strategies can optimize coalition efforts and resources to ultimately help produce meaningful improvement in cancer control outcomes.
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33
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Kwaan MR, Jones-Webb R. Colorectal Cancer Screening in Black Men: Recommendations for Best Practices. Am J Prev Med 2018; 55:S95-S102. [PMID: 30670207 DOI: 10.1016/j.amepre.2018.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/30/2018] [Accepted: 05/08/2018] [Indexed: 12/28/2022]
Abstract
Screening for colorectal cancer has been demonstrated to reduce colorectal cancer mortality. Blacks have a higher mortality from this malignancy, particularly men, yet screening rates in this population are often found to be lower than in whites. A modest literature demonstrates effective interventions that can increase screening rates in blacks; however, results are not consistent and ongoing work is required. Most work has not addressed specific barriers to screening in black men. Given the lack of studies on black men only, this study evaluated the state of research in the black population using a PubMed search. The authors provide commentary that proposes increased (1) state and local government support for collaborative programs with healthcare organizations, including patient navigation; (2) augmented community-organizing efforts to generate more attention to the need for colorectal cancer screening in the black community, with a focus on black men; and (3) federal research funding to promote investigation into new interventions and evaluation of existing ones. Specific recommendations for black men include lowering the screening age to 45years, increasing access to health care, the use of patient navigators, and improved reporting and monitoring of colorectal cancer screening rates. SUPPLEMENT INFORMATION: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
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Affiliation(s)
- Mary R Kwaan
- Department of Surgery, University California, Los Angeles, Los Angeles, California.
| | - Rhonda Jones-Webb
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
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34
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Neuwirth MG, Epstein AJ, Karakousis GC, Mamtani R, Paulson EC. Disparities in resection of hepatic metastases in colon cancer. J Gastrointest Oncol 2018; 9:126-134. [PMID: 29564178 DOI: 10.21037/jgo.2017.11.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Evidence suggests that resection of synchronous hepatic metastases (SHM) in stage IV colon cancer is safe and can improve survival in select patients. Little is known, however, about the use of hepatic resection in this setting on a population level. The aim of this study was to describe trends in resection rates of SHM in patients with stage IV colon cancer using a large national cohort database. Methods A retrospective cohort study was performed of stage IV colon cancer patients during 2000-2011 in Surveillance, Epidemiology and End Results (SEER) Medicare data who had diagnosis codes confirming SHM. Univariate and multivariate logistic regression were used to identify patient factors related to receipt of hepatic resection. Results There were 11,351 patients with colon cancer and SHM. Of these patients, 465 (4.1%) underwent surgical hepatic resection. The proportion increased steadily over time from 2000-2002 (3.5%) to 2009-2011 (5.1%) (P=0.03). Patients who were older with higher comorbidity burden were less likely to undergo hepatic resection. Additionally, the odds of hepatic resection were 30% lower for African-American patients than for white patients (OR 0.70, P=0.05). Odds of hepatic resection were 44% lower for patients from ZIP Codes with >20% poverty than for patients from areas with <5% poverty (OR 0.56, P<0.001). Interestingly, among patients who underwent no surgical treatment at all, only 25% saw a surgeon after diagnosis. This number increased over time from 21.6% in 2000 to 29.1% in 2011 (P<0.001). Similar disparities noted above were seen with surgical evaluation for hepatic resection. Conclusions Despite evidence supporting the safety and efficacy of hepatic resection in the setting of SHM, few patients are seen by surgeons and go onto receive hepatic surgery. Additionally, access to hepatic resection is notably lower for African Americans and patients from areas with higher poverty rates.
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Affiliation(s)
- Madalyn G Neuwirth
- Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew J Epstein
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ronac Mamtani
- Department of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - E Carter Paulson
- Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Ellis EM, Erwin DO, Jandorf L, Saad-Harfouche F, Sriphanlop P, Clark N, Dauphin C, Johnson D, Klasko-Foster LB, Martinez C, Sly J, White D, Winkel G, Kiviniemi MT. Designing a randomized controlled trial to evaluate a community-based narrative intervention for improving colorectal cancer screening for African Americans. Contemp Clin Trials 2018; 65:8-18. [PMID: 29198730 PMCID: PMC5803387 DOI: 10.1016/j.cct.2017.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe the methodology of a 2-arm randomized controlled trial that compared the effects of a narrative and didactic version of the Witness CARES (Community Awareness, Reach, & Empowerment for Screening) intervention on colorectal cancer screening behavior among African Americans, as well as the cognitive and affective determinants of screening. METHODS Witness CARES targeted cognitive and affective predictors of screening using a culturally competent, community-based, narrative or didactic communication approach. New and existing community partners were recruited in two New York sites. Group randomization allocated programs to the narrative or didactic arm. Five phases of data collection were conducted: baseline, post-intervention, three-month, six-month, and qualitative interviews. The primary outcome was screening behavior; secondary outcomes included cognitive and affective determinants of screening. RESULTS A total of 183 programs were conducted for 2655 attendees. Of these attendees, 19.4% (N=516) across 158 programs (50% narrative; 50% didactic) were study-eligible and consented to participate. Half (45.6%) of the programs were delivered to new community partners and 34.8% were delivered at faith-based organizations. Mean age of the total sample was 64.7years and 75.4% were female. CONCLUSION The planned number of programs was delivered, but the proportion of study-eligible attendees was lower than predicted. This community-based participatory research approach was largely successful in involving the community served in the development and implementation of the intervention and study.
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Affiliation(s)
- Erin M Ellis
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, SUNY, Buffalo, NY 14214, United States.
| | - Deborah O Erwin
- Office of Cancer Health Disparities Research, Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Lina Jandorf
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Frances Saad-Harfouche
- Office of Cancer Health Disparities Research, Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Pathu Sriphanlop
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Nikia Clark
- Office of Cancer Health Disparities Research, Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Cassandre Dauphin
- Office of Cancer Health Disparities Research, Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Detric Johnson
- Office of Cancer Health Disparities Research, Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States
| | - Lynne B Klasko-Foster
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, SUNY, Buffalo, NY 14214, United States
| | - Clarissa Martinez
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Jamilia Sly
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Drusilla White
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Gary Winkel
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Marc T Kiviniemi
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, SUNY, Buffalo, NY 14214, United States
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Abstract
UNLABELLED Despite an increase in colorectal cancer screening uptake, a substantial minority of individuals over 50 years of age remains unscreened. In the context of an RCT evaluating three educational interventions to increase CRC screening uptake, we examined the relationship of baseline colonoscopy knowledge and both intention to receive a colonoscopy and documented receipt of colonoscopy. Colonoscopy knowledge score, generally high, was positively associated with intention to receive colonoscopy but not with receipt of colonoscopy within 1 year post-randomization. Knowledge score was, however, positively associated with certain perceived barriers to colonoscopy: embarrassment and having to take a powerful laxative. CONCLUSION Knowledge is not sufficient to trigger colonoscopy uptake. If CRC screening promotion campaigns fail to acknowledge and address patients' emotional barriers to colonoscopy, CRC screening rates will not improve. CLINICAL TRIALS gov: Identifier: NCT02392143.
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Siba Y, Culpepper-Morgan J, Schechter M, Alatevi E, Jallow S, Onaghise J, Sey A, Ozick L, Sabbagh R. A decade of improved access to screening is associated with fewer colorectal cancer deaths in African Americans: a single-center retrospective study. Ann Gastroenterol 2017; 30:518-525. [PMID: 28845107 PMCID: PMC5566772 DOI: 10.20524/aog.2017.0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 03/27/2017] [Indexed: 12/22/2022] Open
Abstract
Background Controversy exists as to whether disparities in colorectal cancer (CRC) outcomes in African Americans (AAs) are best resolved by screening at age 45 or by proper use of existing guidelines. In 2004, an aggressive colonoscopy-based CRC screening program was implemented throughout New York City. Our goal was to determine the effect of that program on CRC outcomes in our mostly AA population. Methods CRC cases entered into Harlem Hospital’s tumor registry from January 1992 to December 2011 were divided into two cohorts: 1992-2003, the pre-intensive screening era (PSE), and 2004-2011, the intensive screening era (ISE). Each cohort was reviewed for demographics, indication for colonoscopy, tumor location, tumor stage, and mortality. Multivariate analysis was applied to the pooled cohorts to determine factors associated with survival. Results Inclusion criteria were met by 379 patients: 207 PSE and 172 ISE. Racial distribution, gender, age at presentation, and tumor location were not different during the two eras. Over 75% of patients were AA. During the ISE, 84% were insured compared to 34% in the PSE (P<0.0001). Fewer patients died during the ISE (21%) than during the PSE (67%) (P<0.0001). The ISE patients were diagnosed with earlier stages of CRC compared to the PSE. Increased survival was associated with being insured (hazard ratio [HR] 1.91, 95% confidence interval [CI] 1.30-2.81), distal tumors (HR 1.43, 95%CI 1.05-1.95), and being female (HR 1.36, 95%CI 1.01-1.850). Conclusions A multifaceted program reduced CRC outcome disparities in a poor AA community. Aggressive implementation of current colonoscopy screening guidelines still has unrealized potential to reduce CRC mortality disparities in AAs.
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Affiliation(s)
- Yahuza Siba
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Joan Culpepper-Morgan
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Menachem Schechter
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Eric Alatevi
- Department of Medicine, Harlem Hospital Center, Columbia University Medical Center, New York (Eric Alatevi, Sainabou Jallow, Jude Onaghise), USA
| | - Sainabou Jallow
- Department of Medicine, Harlem Hospital Center, Columbia University Medical Center, New York (Eric Alatevi, Sainabou Jallow, Jude Onaghise), USA
| | - Jude Onaghise
- Department of Medicine, Harlem Hospital Center, Columbia University Medical Center, New York (Eric Alatevi, Sainabou Jallow, Jude Onaghise), USA
| | - Albert Sey
- Department of Hospitalist Medicine, Ashtabula County Medical Center, Ohio (Albert Sey), USA
| | - Lisa Ozick
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Raja Sabbagh
- Department of Surgery, Harlem Hospital Center, Columbia University Medical Center, New York (Raja Sabbagh), USA
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Huang JL, Fang Y, Liang M, Li STS, Ng SKC, Hui ZSN, Ching J, Wang HH, Wong MCS. Approaching the Hard-to-Reach in Organized Colorectal Cancer Screening: an Overview of Individual, Provider and System Level Coping Strategies. AIMS Public Health 2017; 4:289-300. [PMID: 29546218 PMCID: PMC5690455 DOI: 10.3934/publichealth.2017.3.289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/19/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the proven effectiveness of colorectal cancer (CRC) screening on reduction of CRC mortality, the uptake of CRC screening remains low. Participation rate is one of determinants for the success of organized population-based screening program. This review aims to identify those who are hard-to-reach, and summarize the strategies to increase their screening rate from individual, provider and system levels. METHODS A systematic search of electronic English databases was conducted on the factors and strategies of uptake in CRC screening for the hard-to-reach population up to May 2017. DISCUSSION The coverage rate and participation rate are two indexes to identify the hard-to-reach population in organized CRC screening program. However, the homeless, new immigrants, people with severe mental illness, the jail intimates, and people with characteristics including lower education levels and/or low socioeconomic status, living in rural/remote areas, without insurance, and racial minorities are usually recognized as hard-to-reach populations. For them, organized screening programs offer a better coverage, while novel invitation approaches for eligible individuals and multiple strategies from primary care physicians are still needed to enhance screening rates among subjects who are hard-to-reach. Suggestions implied the effectiveness of interventions at the system level, including linkages to general practice; use of decision making tools; enlisting supports from coalition; and the continuum from screening to diagnosis and treatment. CONCLUSION Organized CRC screening offers a system access to approach the hard-to-reach populations. To increase their uptake, multiple and novel strategies from individual, provider and system levels should be applied. For policymakers, public healthcare providers and community stakeholders, it is a test to tailor their potential needs and increase their participation rates through continuous efforts to eliminate disparities and inequity in CRC screening service.
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Affiliation(s)
- Jason Liwen Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Miaoyin Liang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shannon TS Li
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Simpson KC Ng
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zero SN Hui
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jessica Ching
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Harry Haoxiang Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Martin Chi Sang Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong
- State Key Laboratory of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong
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Neugut AI, Lebwohl B. Commentary: Choosing how to screen for colorectal cancer. Semin Oncol 2017; 44:45-46. [DOI: 10.1053/j.seminoncol.2017.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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40
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Peterson EB, Ostroff JS, DuHamel KN, D'Agostino TA, Hernandez M, Canzona MR, Bylund CL. Impact of provider-patient communication on cancer screening adherence: A systematic review. Prev Med 2016; 93:96-105. [PMID: 27687535 PMCID: PMC5518612 DOI: 10.1016/j.ypmed.2016.09.034] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/17/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022]
Abstract
Cancer screening is critical for early detection and a lack of screening is associated with late-stage diagnosis and lower survival rates. The goal of this review was to analyze studies that focused on the role of provider-patient communication in screening behavior for cervical, breast, and colorectal cancer. A comprehensive search was conducted in four online databases between 1992 and 2016. Studies were included when the provider being studied was a primary care provider and the communication was face-to-face. The search resulted in 3252 records for review and 35 articles were included in the review. Studies were divided into three categories: studies comparing recommendation status to screening compliance; studies examining the relationship between communication quality and screening behavior; and intervention studies that used provider communication to improve screening behavior. There is overwhelming evidence that provider recommendation significantly improves screening rates. Studies examining quality of communication are heterogeneous in method, operationalization and results, but suggest giving information and shared decision making had a significant relationship with screening behavior. Intervention studies were similarly heterogeneous and showed positive results of communication interventions on screening behavior. Overall, results suggest that provider recommendation is necessary but not sufficient for optimal adherence to cancer screening guidelines. Quality studies suggest that provider-patient communication is more nuanced than just a simple recommendation. Discussions surrounding the recommendation may have an important bearing on a person's decision to get screened. Research needs to move beyond studies examining recommendations and adherence and focus more on the relationship between communication quality and screening adherence.
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Affiliation(s)
- Emily B Peterson
- George Mason University, 4400 University Drive, MSN 3D6, Fairfax, VA 22031, United States.
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Katherine N DuHamel
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Thomas A D'Agostino
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Marisol Hernandez
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Mollie R Canzona
- Wake Forest University, P.O. Box 7347, Winston-Salem, NC 27109, United States; Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
| | - Carma L Bylund
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States; Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar
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41
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Williams R, White P, Nieto J, Vieira D, Francois F, Hamilton F. Colorectal Cancer in African Americans: An Update. Clin Transl Gastroenterol 2016; 7:e185. [PMID: 27467183 PMCID: PMC4977418 DOI: 10.1038/ctg.2016.36] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 05/09/2016] [Indexed: 12/15/2022] Open
Abstract
This review is an update to the American College of Gastroenterology (ACG) Committee on Minority Affairs and Cultural Diversity's paper on colorectal cancer (CRC) in African Americans published in 2005. Over the past 10 years, the incidence and mortality rates of CRC in the United States has steadily declined. However, reductions have been strikingly much slower among African Americans who continue to have the highest rate of mortality and lowest survival when compared with all other racial groups. The reasons for the health disparities are multifactorial and encompass physician and patient barriers. Patient factors that contribute to disparities include poor knowledge of benefits of CRC screening, limited access to health care, insurance status along with fear and anxiety. Physician factors include lack of knowledge of screening guidelines along with disparate recommendations for screening. Earlier screening has been recommended as an effective strategy to decrease observed disparities; currently the ACG and American Society of Gastrointestinal Endoscopists recommend CRC screening in African Americans to begin at age 45. Despite the decline in CRC deaths in all racial and ethnic groups, there still exists a significant burden of CRC in African Americans, thus other strategies including educational outreach for health care providers and patients and the utilization of patient navigation systems emphasizing the importance of screening are necessary. These strategies have been piloted in both local communities and Statewide resulting in notable significant decreases in observed disparities.
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Affiliation(s)
- Renee Williams
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
| | - Pascale White
- Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida, USA
| | - Dorice Vieira
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
| | - Fritz Francois
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
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