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Sheikh S, Bruno DS, Sun Y, Deng V, McClelland S, Obi E, Vinson V, Firstencel A, Lanese B, Lausin L, Dorth JA, Zaorsky NG, Hoy K, Krishnamurthi S. Impact of Clinical Trial Design on Recruitment of Racial and Ethnic Minorities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:567-572. [PMID: 38637443 DOI: 10.1007/s13187-024-02440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
Knowledge related to how oncology treatment trial design influences enrollment of racial and ethnic minorities is limited. Rigorous identification of clinical trial design parameters that associate favorably with minority accrual provides educational opportunities for individuals interested in designing more representative treatment trials. We identified oncology trials with a minimum of 10 patients at an NCI-Designated Comprehensive Cancer Center from 2010 to 2021. We defined a study endpoint of racial and ethnic minority accrual greater than zero. Multivariable logistic regression was used to determine whether co-variables predicted our study endpoint. P-values of less than 0.05 were considered significant. A total of 352 cancer trials met eligibility criteria. These studies enrolled a total of 7981 patients with a total of 926 racial and ethnic minorities leading to a median enrollment of 10%. Trials open in community sites (yes versus no) were more likely to have a minority patient (OR, 2.21; 95% CI, 1.02-4.96) as well as pilot/phase I studies compared to phase II/III (OR, 3.19; 95% CI, 1.34-8.26). Trials incorporating immunotherapy (yes versus no) were less likely to have a minority patient (OR, 0.47; 95% CI, 0.23-0.94). Trials open in community sites as well as early phase treatment studies were more likely to accrue minority patients. However, studies including immunotherapy were less likely to accrue racial and ethnic minorities. Knowledge gained from our analysis may help individuals design oncology treatment trials that are representative of more diverse populations.
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Affiliation(s)
- Saad Sheikh
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh PA, 15232, USA.
| | - Debora S Bruno
- Department of Hematology and Medical Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Yilun Sun
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Victoria Deng
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Shearwood McClelland
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Elizabeth Obi
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Valerie Vinson
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - April Firstencel
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Bob Lanese
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Loretta Lausin
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Jennifer A Dorth
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Kevin Hoy
- Clinical Research Office, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Smitha Krishnamurthi
- Department of Hematology and Medical Oncology, Case Comprehensive Cancer Center, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, 44195, USA
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Fairley R, Lillard JW, Berk A, Cornew S, Gaspero J, Gillespie J, Horne LL, Kidane S, Munro SB, Parsons M, Powers ER, Rizzo SE, Tishcler A, Wohl H, Weiss MC. Increasing Clinical Trial Participation of Black Women Diagnosed with Breast Cancer. J Racial Ethn Health Disparities 2024; 11:1701-1717. [PMID: 37314691 PMCID: PMC11101578 DOI: 10.1007/s40615-023-01644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/15/2023]
Abstract
Despite racial disparities in breast cancer mortality, Black women remain underrepresented in clinical trials. In this mixed methods research, 48 Black women were engaged via focus group discussions and in-depth interviews to better understand the lived experience of women with breast cancer. The results of this qualitative study informed the development of a subsequent online survey to identify barriers, motivators, and other factors that influence decision-making by Black women diagnosed with breast cancer when considering clinical trial participation. Among the 257 Black survey participants, most (95%) were aware of clinical trials; of those, most viewed them as lifesaving (81%) and/or benefiting others (90%). Negative perceptions such as serious side effects (58%), not receiving real treatment (52%), or risk of potential harm (62%) were indicated. Barriers included financial expenses (49%), concerns that their condition could be made worse (29%), that they would receive a placebo (28%), or that treatment was unapproved (28%). Participants were more likely than their health care providers (HCPs) to initiate discussions of clinical trials (53% versus 33%), and 29% of participants indicated a need for more information about risks and benefits, even after having those conversations. The most trustworthy sources of information on clinical trials were HCPs (66%) and breast cancer support groups (64%). These results suggest that trusted communities are key for providing education on clinical trials. However, there is also a need for HCPs to proactively discuss clinical trials with patients to ensure that they are adequately informed about all aspects of participation.
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Affiliation(s)
- Ricki Fairley
- TOUCH, The Black Breast Cancer Alliance, Annapolis, MD, USA
| | - James W Lillard
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Sophia Cornew
- Patient Network and Data, Invitae, San Francisco, CA, USA
| | | | | | - LaTrisha L Horne
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | | | | | | | - Emily R Powers
- TOUCH, The Black Breast Cancer Alliance, Annapolis, MD, USA.
| | | | | | | | - Marisa C Weiss
- Breastcancer.org, Ardmore, PA, USA
- Lankenau Medical Center, Wynnewood, PA, USA
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Brock DJP, Markwalter T, Li L, Venkatesh S, Helms C, Reid A, Zoellner JM. Exploring biorepository donation patterns, experiences, and recommendations: a mixed-methods study among Appalachian adults enrolled in a sugary drink reduction program. Front Public Health 2024; 12:1371768. [PMID: 38784591 PMCID: PMC11111869 DOI: 10.3389/fpubh.2024.1371768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Background Under-represented subgroups in biomarker research linked to behavioral health trials may impact the promise of precision health. This mixed methods study examines biorepository donations across an Appalachian sample enrolled in a sugary drink reduction intervention trial. Methods Participants enrolled in the behavioral trial were asked to join an optional biomarker study and were tracked for enrollment and biospecimen returns (stool and/or buccal sample). At 6 months, participants completed a summative interview on decision-making process, experiences collecting samples, and recommendations to encourage biospecimen donation. Return rates were analyzed across demographics (i.e., age, gender, race, education, income, health literacy status, and rurality status) using chi-squares. Qualitative data were content coded with differences compared by biomarker study enrollment and donation choices. Results Of the 249 invited participants, 171 (61%) enrolled, and 63% (n = 157) returned buccal samples and 49% (n = 122) returned stool samples. Metro residing participants were significantly more likely (56%) to return stool samples compared to non-metro (39%) counterparts [x2(1) = 6.61; p = 0.01]. Buccal sample return had a similar trend, 67 and 57%, respectively for metro vs. non-metro [x2(1) = 2.84; p = 0.09]. An additional trend indicated that older (≥40 years) participants were more likely (55%) to donate stool samples than younger (43%) participants [x2(1) = 3.39; p = 0.07]. No other demographics were significantly associated with biospecimen return. Qualitative data indicated that societal (66-81%) and personal (41-51%) benefits were the most reported reasons for deciding to donate one or both samples, whereas mistrust (3-11%) and negative perceptions of the collection process (44-71%) were cited the most by those who declined one or both samples. Clear instructions (60%) and simple collection kits (73%) were donation facilitators while challenges included difficult stool collection kits (16%) and inconveniently located FedEx centers (16%). Recommendations to encourage future biorepository donation were to clarify benefits to science and others (58%), provide commensurate incentives (25%), explain purpose (19%) and privacy protections (20%), and assure ease in sample collection (19%). Conclusion Study findings suggest the need for biomarker research awareness campaigns. Researchers planning for future biomarker studies in medically underserved regions, like Appalachia, may be able to apply findings to optimize enrollment.
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Affiliation(s)
- Donna-Jean P. Brock
- School of Medicine, Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Theresa Markwalter
- School of Medicine, Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Li Li
- School of Medicine, Family Medicine, University of Virginia, Charlottesville, VA, United States
| | - Samyukta Venkatesh
- School of Medicine, Family Medicine, University of Virginia, Charlottesville, VA, United States
| | - Cheyanne Helms
- School of Medicine, Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Annie Reid
- School of Medicine, Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Jamie M. Zoellner
- School of Medicine, Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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Pease M, Gupta K, Moshé SL, Correa DJ, Galanopoulou AS, Okonkwo DO, Gonzalez-Martinez J, Shutter L, Diaz-Arrastia R, Castellano JF. Insights into epileptogenesis from post-traumatic epilepsy. Nat Rev Neurol 2024; 20:298-312. [PMID: 38570704 DOI: 10.1038/s41582-024-00954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
Post-traumatic epilepsy (PTE) accounts for 5% of all epilepsies. The incidence of PTE after traumatic brain injury (TBI) depends on the severity of injury, approaching one in three in groups with the most severe injuries. The repeated seizures that characterize PTE impair neurological recovery and increase the risk of poor outcomes after TBI. Given this high risk of recurrent seizures and the relatively short latency period for their development after injury, PTE serves as a model disease to understand human epileptogenesis and trial novel anti-epileptogenic therapies. Epileptogenesis is the process whereby previously normal brain tissue becomes prone to recurrent abnormal electrical activity, ultimately resulting in seizures. In this Review, we describe the clinical course of PTE and highlight promising research into epileptogenesis and treatment using animal models of PTE. Clinical, imaging, EEG and fluid biomarkers are being developed to aid the identification of patients at high risk of PTE who might benefit from anti-epileptogenic therapies. Studies in preclinical models of PTE have identified tractable pathways and novel therapeutic strategies that can potentially prevent epilepsy, which remain to be validated in humans. In addition to improving outcomes after TBI, advances in PTE research are likely to provide therapeutic insights that are relevant to all epilepsies.
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Affiliation(s)
- Matthew Pease
- Department of Neurosurgery, Indiana University, Bloomington, IN, USA.
| | - Kunal Gupta
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Solomon L Moshé
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
- Department of Paediatrics, Albert Einstein College of Medicine, New York, NY, USA
| | - Daniel J Correa
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Aristea S Galanopoulou
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lori Shutter
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
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Morris HN, Winslow AT, Barreiro-Rosado JA, Torian S, Charlot M. Scoping Review of Barriers and Facilitators to Recruitment of Black People With Cancer in Biospecimen-Based Research. JCO Precis Oncol 2024; 8:e2300708. [PMID: 38748944 PMCID: PMC11371087 DOI: 10.1200/po.23.00708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 09/01/2024] Open
Abstract
The increasing focus on precision medicine to optimize cancer treatments and improve cancer outcomes is an opportunity to consider equitable engagement of people racialized as Black or African American (B/AA) in biospecimen-based cancer research. B/AA people have the highest cancer incidence and mortality rates compared with all other racial and ethnic groups in the United States, yet are under-represented in biospecimen-based research. A narrative scoping review was conducted to understand the current literature on barriers, facilitators, and evidence-based strategies associated with the engagement of B/AA people with cancer in biospecimen research. Three comprehensive searches of MEDLINE, CINAHL, Embase, and Scopus were conducted. Of 770 studies generated by the search, 10 met all inclusion criteria for this review. The most frequently reported barriers to engagement of B/AA people in biospecimen research were lack of biospecimen research awareness, fear of medical harm, and violation of personal health information privacy, resource constraints, and medical mistrust. Key facilitators included previous exposure to research, knowledge about underlying genetic causes of cancer, and altruism. Recommended strategies to increase participation of B/AA people in biospecimen-based research included community engagement, transparent communication, workforce diversity, education and training, and research participant incentives. Inclusion of B/AA people in biospecimen-based research has the potential to advance the promise of precision oncology for all patients and reduce racial disparities in cancer outcomes.
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Affiliation(s)
- Hayley N. Morris
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Stacy Torian
- Division of Libraries, New York University, New York, NY
| | - Marjory Charlot
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Graves JM, Beese SR, Abshire DA, Bennett KJ. How rural is All of Us? Comparing characteristics of rural participants in the National Institute of Health's All of Us Research Program to other national data sources. J Rural Health 2024. [PMID: 38683037 DOI: 10.1111/jrh.12840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/10/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE The National Institute of Health's All of Us Research Program represents a national effort to develop a database to advance health research, especially among individuals historically underrepresented in research, including rural populations. The purpose of this study was to describe the rural populations identified in the All of Us Research Program using the only proxy measure currently available in the dataset. METHODS Currently, the All of Us Research Program provides a proxy measure of rurality that identifies participants who self-reported delaying care due to far travel distances associated with living in rural areas. Using the All of Us Controlled Tier Dataset v6, we compared sociodemographic and health characteristics of All of Us rural participants identified via this proxy to rural US residents from nationally representative data sources using chi-squared tests. RESULTS 3.1% of 160,880 All of Us participants were rural, compared to 15%-20% of US residents based on commonly accepted rural definitions. Proportionally more rural All of Us participants reported fair or poor health status, history of cancer, and history of heart disease (P<.01). CONCLUSIONS The All of Us measure may capture a subset of underserved participants who live in rural areas and experience health care access barriers due to distance. Researchers who use this proxy measure to characterize rurality should interpret their findings with caution due to differences in population and health characteristics using this proxy measure rural compared to other commonly used rural definitions.
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Affiliation(s)
- Janessa M Graves
- WWAMI Rural Health Research Center, Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Shawna R Beese
- College of Nursing, Washington State University, Spokane, Washington, USA
- College of Agricultural, Human, and Natural Resource Sciences, Extension, Washington State University, Pullman, Washington, USA
| | - Demetrius A Abshire
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Kevin J Bennett
- University of South Carolina School of Medicine-Columbia, Columbia, South Carolina, USA
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Cheng TYD, Chaudhari PV, Bitsie KR, Striley CW, Varma DS, Cottler LB. The HealthStreet Cancer Survivor Cohort: a Community Registry for Cancer Research. J Cancer Surviv 2024; 18:366-374. [PMID: 35089522 PMCID: PMC9329490 DOI: 10.1007/s11764-022-01173-4] [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] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This report describes a cancer survivor cohort from a community engagement program and compares characteristics and willingness to participate in health research between the cancer survivors and non-cancer community members. METHODS Among 11,857 members enrolled in HealthStreet at the University of Florida (10/2011-03/2020), 991 cancer survivors were identified and 1:1 matched to control members without cancer on sex, age, and zip code. Demographics, body weight, height, social determinants of health, history of cancer, and willingness to participate in research were recorded by Community Health Workers as a part of the baseline Health Needs Assessment. RESULTS Among the cancer survivors, 71.6% were female and 19.2% lived in rural areas with a mean age of 56.7 years in females and 60.8 years in males. At baseline, 44.7% received a cancer diagnosis within 5 years, while 15.8%, more than 20 years. Cancer survivors (vs. matched non-cancer controls) were less likely to be Black (31.1% vs. 63.6%) but more likely to be divorced, separated, or widowed (49.5% vs. 41.2%), be normal/underweight (34.0% vs. 25.6%) and have health insurance (80.0% vs. 68.6%; all p < 0.05). Cancer survivors versus matched controls reported higher rates of ever being in a health research study (32.4% vs. 24.9%) and interest in participating in studies ranging from minimal risk to greater-than-minimal risk. CONCLUSIONS Cancer survivors from this community engagement program agnostic to cancer types and treatment are diverse in geography, race, and social determinants of health and can be a valuable resource for observational, interventional, and biospecimen research in cancer survivorship.
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Affiliation(s)
- Ting-Yuan David Cheng
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA.
| | - Piyush V Chaudhari
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA
| | - Kevin R Bitsie
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA
| | - Catherine W Striley
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA
| | - Deepthi S Varma
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA
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Issa TZ, Lambrechts MJ, Canseco JA, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Reporting demographics in randomized control trials in spine surgery - we must do better. Spine J 2023; 23:642-650. [PMID: 36400397 DOI: 10.1016/j.spinee.2022.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/07/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND CONTEXT Demographic factors contribute significantly to spine surgery outcomes. Although race and ethnicity are not proxies for disease states, the intersection between these patient characteristics and socioeconomic status significantly impact patient outcomes. PURPOSE The purpose of this study is to investigate the frequency of demographic reporting and analysis in randomized controlled clinical trials (RCTs) published in the three highest impact spine journals. STUDY DESIGN Systematic review. PATIENT SAMPLE We analyzed 278 randomized control trials published in The Spine Journal, Spine, and Journal of Neurosurgery: Spine between January 2012 - January 2022. OUTCOME MEASURES Extracted manuscript characteristics included the frequency of demographic reporting, sample size, and demographic composition of studies. METHODS We conducted a systematic review of RCTs published between January 2012 - January 2022 in the three highest impact factor spine journals in 2021: The Spine Journal, Spine, and Journal of Neurosurgery: Spine. We determined if age, gender, BMI, race, and ethnicity were reported and analyzed for each study. The overall frequency of demographic reporting was assessed, and the reporting trends were analyzed for each individual year and journal. Among studies that did report demographics, the populations were analyzed in comparison to the national population per United States (US) census reports. Studies were evaluated for bias using Cochrane risk-of-bias. RESULTS Our search identified 278 RCTs for inclusion. 166 were published in Spine, 65 in The Spine Journal, and 47 in Journal of Neurosurgery: Spine. Only 9.35% (N=26) and 3.9% (N=11) of studies reported race and ethnicity, respectively. Demographic reporting frequency did not vary based on the publishing journal. Reporting of age and BMI increased over time, but reporting of race and ethnicity did not. Among RCTs that reported race, 88% were conducted in the US, and 85.71% of the patients in these US studies were White. White subjects were overly represented compared to the US population (85.71% vs. 61.63%, p<.001), and non-White or Black patients were most underrepresented (2.89% vs. 25.96%, p<.001). CONCLUSIONS RCTs published in the three highest impact factor spine journals failed to frequently report patient race or ethnicity. Among studies published in the US, study populations are increasingly represented by non-Hispanic White patients. As we strive to care for an increasingly diverse population and reduce disparities to care, spine surgeons must do a better job reporting these variables to increase the external validity and generalizability of RCTs.
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Affiliation(s)
- Tariq Ziad Issa
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, 925 Chestnut St., Philadelphia, MO19107, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, 925 Chestnut St., Philadelphia, MO19107, USA.
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, 925 Chestnut St., Philadelphia, MO19107, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, 925 Chestnut St., Philadelphia, MO19107, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, 925 Chestnut St., Philadelphia, MO19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, 925 Chestnut St., Philadelphia, MO19107, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, 925 Chestnut St., Philadelphia, MO19107, USA
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Jones BL, Carter MC, Davis CM, Wang J. Diversity, Equity, and Inclusion: A Decade of Progress? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:116-125. [PMID: 36272720 DOI: 10.1016/j.jaip.2022.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
The concepts of diversity, equity, and inclusion are fundamental and more recently heavily discussed within medicine, research, and the larger society. There is increasing awareness that diversity of thoughts, perspectives, and backgrounds yields stronger teams and more effective results. There is also increasing awareness that stark inequities from systemic, institutional, and individual levels exist that limit the baseline opportunities for many populations. To close disparity gaps, broad aspects of diversity and promoting equity are required and efforts must be inclusive of those most marginalized. In this Clinical Commentary, we discuss, "How and If progress has been made in Diversity, Equity, Inclusion within the field of Allergy/Asthma/Immunology in the past decade?" We discuss the current state of clinical practice and what has been revealed over the past 10 years; describe our current workforce and what progress has or has not occurred there; and finally, review the state of scientific and medical research.
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Affiliation(s)
- Bridgette L Jones
- Department of Pediatrics, Section of Allergy, Asthma, Immunology and Division of Pediatric Clinical Pharmacology and Therapeutic Innovation, University of Missouri Kansas City School of Medicine, Children's Mercy Hospital Kansas City, Kansas City, Mo.
| | - Melody C Carter
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Carla M Davis
- Division of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Julie Wang
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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Hantel A, Kohlschmidt J, Eisfeld AK, Stock W, Jacobson S, Mandrekar S, Larson RA, Stone RM, Lathan CS, DeAngelo DJ, Byrd JC, Abel GA. Inequities in Alliance Acute Leukemia Clinical Trial and Biobank Participation: Defining Targets for Intervention. J Clin Oncol 2022; 40:3709-3718. [PMID: 35696629 PMCID: PMC9649272 DOI: 10.1200/jco.22.00307] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Representativeness in acute leukemia clinical research is essential for achieving health equity. The National Cancer Institute's mandate for Comprehensive Cancer Centers (CCCs) to define and assume responsibility for cancer control and treatment across a geographic catchment area provides an enforceable mechanism to target and potentially remediate participatory inequities. METHODS We examined enrollee characteristics across 15 Cancer and Leukemia Group B/Alliance cooperative group adult acute leukemia clinical trials (N = 3,734) from 1998 to 2013, including participation in optional companion biobanks. We determined enrollment odds by race-ethnicity for all participants adjusted for national incidence, and for those enrolled at CCCs adjusted for catchment area incidence. We modeled biobank participation by sociodemographics using logistic regression. RESULTS Non-Hispanic (NH)-White patients were more likely to be enrolled than NH-Black, NH-Asian, or Hispanic patients (odds ratio [OR], 0.75, 0.48, and 0.44, respectively; all P < .001), but less likely than NH-Native American patients (OR, 1.91; P < .001), adjusted for national incidence. Enrollment odds were lower for NH-Black, NH-Asian, and Hispanic patients at CCCs adjusted for catchment area incidence (OR, 0.57, 0.26, and 0.32, respectively; P < .001); differences were driven by overenrollment of NH-White patients from outside self-defined catchment areas (18.1% v 12.3%; χ2 P = .01) and by CCCs with less absolute enrollee diversity (rank sum P = .03). Among all enrollees, NH-White race-ethnicity and lower neighborhood deprivation correlated with biobank participation (OR, 1.81 and 1.45, respectively; P = .01 and .03). For CCC enrollees, the correlation of race-ethnicity with biobank participation was attenuated by a measure accounting for their site's degree of enrollment disparity but not neighborhood deprivation. CONCLUSION Acute leukemia clinical research disparities are substantial and driven by structural trial enrollment barriers at CCCs. Real-time CCC access and enrollment monitoring is needed to better align research participation with local populations.
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Affiliation(s)
| | - Jessica Kohlschmidt
- Alliance Statistics and Data Management Center, The Ohio State University, Columbus, OH
| | | | - Wendy Stock
- The University of Chicago, Comprehensive Cancer Center, Chicago, IL
| | - Sawyer Jacobson
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Sumithra Mandrekar
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | | | | | | | | | - John C. Byrd
- University of Cincinnati, Cancer Center-UC Medical Center, Cincinnati, OH
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11
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Coffin TB, Kenner BJ. Challenges in Recruitment and Retention: Leveraging Health-Related Antecedents and Information Carrier Factors to Improve Patient Participation in Pancreatic Cancer Research-A Review Article. Pancreas 2022; 51:1074-1082. [PMID: 37078928 PMCID: PMC10144271 DOI: 10.1097/mpa.0000000000002162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/18/2022] [Indexed: 04/21/2023]
Abstract
ABSTRACT Advancements in pancreatic ductal adenocarcinoma (PDAC) prevention, diagnosis, and treatment rely on representative and robust clinical trial participation. Given the severity of PDAC, along with the lack of effective early detection approaches, the need for accessible screening tools and new treatments is dire. Unfortunately, enrollment barriers often result in low participant accrual rates for PDAC studies and illustrate the challenging terrain researchers are facing. Research participation along with access to preventative care has been further impacted by the coronavirus disease 2019 pandemic. In this review, we use the Comprehensive Model for Information Seeking to discuss underexplored factors that influence patient participation in clinical studies. Adequate staffing, flexible scheduling, effective patient and physician communication, and culturally responsive messaging, along with the use of telehealth, can support enrollment objectives. Clinical research studies are a key component of health care, informing medical advancements, and improving outcomes. By leveraging health-related antecedents and information carrier factors, researchers can more effectively address barriers to participation and implement potential evidence-based mitigating strategies. While this work focuses on the PDAC research context, the lessons delineated here are applicable to the wider cancer research setting.
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12
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Affiliation(s)
- Dany Habr
- Pfizer OncologyPfizer Inc.New York CityNew YorkUSA
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13
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Rotsides JM, Moses LE, Malloy KM, Brenner C, Fayson SM, Brown DJ, Spector ME. Disparities in access to translational research. Curr Probl Cancer 2022; 46:100894. [DOI: 10.1016/j.currproblcancer.2022.100894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
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14
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McPhee NJ, Nightingale CE, Harris SJ, Segelov E, Ristevski E. Barriers and enablers to cancer clinical trial participation and initiatives to improve opportunities for rural cancer patients: A scoping review. Clin Trials 2022; 19:464-476. [PMID: 35586873 DOI: 10.1177/17407745221090733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Claire E Nightingale
- Monash Rural Health, Monash University, Bendigo, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Samuel J Harris
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
| | - Eva Segelov
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton, VIC, Australia.,Department of Oncology, Monash Health, Clayton, VIC, Australia
| | - Eli Ristevski
- Monash Rural Health, Monash University, Warragul, VIC, Australia
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15
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Fejerman L, Ramirez AG, Nápoles AM, Gomez SL, Stern MC. Cancer Epidemiology in Hispanic Populations: What Have We Learned and Where Do We Need to Make Progress? Cancer Epidemiol Biomarkers Prev 2022; 31:932-941. [PMID: 35247883 DOI: 10.1158/1055-9965.epi-21-1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/09/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
The Hispanic/Latino(x) population (H/L) in the United States of America is heterogeneous and fast growing. Cancer is the number one cause of death among H/Ls, accounting for 21% of deaths. Whereas for the most common cancers, incidence rates are lower in H/Ls compared with non-H/L White (NHW) individuals, H/Ls have a higher incidence of liver, stomach, cervical, penile, and gallbladder cancers. H/L patients tend to be diagnosed at more advanced stages for breast, colorectal, prostate, and lung cancers, and melanoma compared with NHW individuals. Etiologic and cancer outcomes research among H/Ls lags other populations. In this review, we provide a summary of challenges, opportunities, and research priorities related to cancer etiology, cancer outcomes, and survivorship to make progress in addressing scientific gaps. Briefly, we prioritize the need for more research on determinants of obesity, nonalcoholic fatty liver disease and its progression to liver cancer, stomach and gallbladder cancers, and pediatric acute lymphoblastic leukemia. We emphasize the need to improve cancer screening, early detection of cancer, and survivorship care. We highlight critical resources needed to make progress in cancer epidemiologic studies among H/L populations, including the importance of training the next generation of cancer epidemiologists conducting research in H/Ls.
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Affiliation(s)
- Laura Fejerman
- Department of Public Health Sciences, UC Davis Comprehensive Cancer Center, University of California Davis, Davis, California
| | - Amelie G Ramirez
- Department of Population Health Sciences, School of Medicine, Mays Cancer Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Mariana C Stern
- Department of Population and Public Health Sciences, Department of Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
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16
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Hiatt RA, Sibley A, Venkatesh B, Cheng J, Dixit N, Fox R, Ling P, Nguyen T, Oh D, Palmer NR, Pasick RJ, Potter MB, Somsouk M, Vargas RA, Vijayaraghavan M, Ashworth A. From Cancer Epidemiology to Policy and Practice: the Role of a Comprehensive Cancer Center. CURR EPIDEMIOL REP 2022; 9:10-21. [PMID: 35342686 PMCID: PMC8935108 DOI: 10.1007/s40471-021-00280-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/24/2022]
Abstract
Purpose of Review Cancer incidence and mortality are decreasing, but inequities in outcomes persist. This paper describes the San Francisco Cancer Initiative (SF CAN) as a model for the systematic application of epidemiological evidence to reduce the cancer burden and associated inequities. Recent Findings SF CAN is a multi-institutional implementation of existing evidence on the prevention and early detection of five common cancers (i.e., breast, prostate, colorectal, liver, and lung/tobacco-related cancers) accounting for 50% of cancer deaths in San Francisco. Five Task Forces follow individual logic models designating inputs, outputs, and outcomes. We describe the progress made and the challenges faced by each Task Force after 5 years of activity. Summary SF CAN is a model for how the nation’s Comprehensive Cancer Centers are ideally positioned to leverage cancer epidemiology for evidence-based initiatives that, along with genuine community engagement and multiple stakeholders, can reduce the population burden of cancer.
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Affiliation(s)
- Robert A Hiatt
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, USA.,Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA.,Mission Hall UCSF, 550 16th Street, 2nd Floor, San Francisco, CA 94158 USA
| | - Amanda Sibley
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA
| | - Brinda Venkatesh
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA
| | - Joyce Cheng
- Chinese Community Health Resource Center, San Francisco, USA
| | - Niharika Dixit
- Division of Hematology/Oncology, UCSF at Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Rena Fox
- Department of Medicine, UCSF, San Francisco, USA
| | - Pamela Ling
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA.,Department of Medicine, UCSF, San Francisco, USA.,Center for Tobacco Control Research and Education, UCSF, San Francisco, USA
| | - Tung Nguyen
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA.,Department of Medicine, UCSF, San Francisco, USA
| | - Debora Oh
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, USA
| | | | | | - Michael B Potter
- Department of Family and Community Medicine, UCSF, San Francisco, USA
| | - Ma Somsouk
- Division of Gastroenterology, UCSF, San Francisco, USA
| | - Roberto Ariel Vargas
- Center for Community Engagement, UCSF, San Francisco, USA.,Clinical and Translational Science Institute, UCSF, San Francisco, USA
| | | | - Alan Ashworth
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA
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17
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Gao H, Cao B, Dang N, Gu S, Xu M, Ji B, Shi Y, Liu S, Wang C. Comparison of factors influencing the willingness to donate biospecimens among guardians of children with cancer and adult cancer patients. Cancer Med 2022; 11:1524-1534. [PMID: 35112506 PMCID: PMC8921908 DOI: 10.1002/cam4.4544] [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: 08/16/2021] [Revised: 12/11/2021] [Accepted: 12/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background This study examined and compared the attitudes and willingness of guardians of children with cancer and adult cancer patients toward donating biospecimens and clinical data for cancer research. Methods We conducted a cross‐sectional study among guardians of children with cancer (Guardian group) from Shanghai Children's Medical Center and adult cancer patients (Adult group) from Shanghai Ninth People's Hospital between February 1, 2019, and January 31, 2020. Participants’ demographic data, willingness, and motivations for biospecimen donation were collected and analyzed. Results Of 670 participants, 90.8% (318/350) in the Guardian group and 88.1% (282/320) in the Adult group completed the questionnaire. Most participants were willing to donate residual tissue samples (92.8% in the Guardian group vs. 79.4% in the Adult group, pψ = 0.032) and clinical data (94.0% vs. 72.3%, pψ < 0.001) for medical research. Logistic regression analysis indicated that only child status (odds ratio [OR] = 0.140, p = 0.02), history of blood donation (OR = 4.467, p = 0.019) in the Guardian group, education (OR = 0.387, p = 0.037), and history of blood donation (OR = 2.556, p = 0.016) in the Adult group were significantly associated with participants’ willingness to donate biospecimens. The primary motivation for donation was helping other patients with cancer (65.4% vs. 24.5%, pψ < 0.001). The major barriers to donation were the potential to cause physical discomfort (61.0% vs. 64.9%, pψ = 0.032). Conclusions Guardians of children with cancer were more willing to donate biospecimens than adult cancer patients in China. It is essential to promote awareness of biospecimens donation, especially in adult cancer patients.
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Affiliation(s)
- Hongxiang Gao
- Department of Pediatric General Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Baige Cao
- Department of Endocrinology & Metabolism, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Nan Dang
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Gu
- Department of Pediatric General Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Min Xu
- Department of Pediatric General Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Ji
- Department of Operating Room, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiqi Shi
- Clinical Research Center for Cell Therapy, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Pediatric Health Advocacy Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Congrong Wang
- Department of Endocrinology & Metabolism, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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18
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Bodicoat DH, Routen AC, Willis A, Ekezie W, Gillies C, Lawson C, Yates T, Zaccardi F, Davies MJ, Khunti K. Promoting inclusion in clinical trials-a rapid review of the literature and recommendations for action. Trials 2021; 22:880. [PMID: 34863265 PMCID: PMC8643184 DOI: 10.1186/s13063-021-05849-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Without inclusion of diverse research participants, it is challenging to understand how study findings will translate into the real world. Despite this, a lack of inclusion of those from under-served groups in research is a prevailing problem due to multi-faceted barriers acting at multiple levels. Therefore, we rapidly reviewed international published literature, in relation to clinical trials, on barriers relating to inclusion, and evidence of approaches that are effective in overcoming these. Methods A rapid literature review was conducted searching PubMed for peer-reviewed articles that discussed barriers to inclusion or strategies to improve inclusion in clinical trial research published between 2010 and 2021. Grey literature articles were excluded. Results Seventy-two eligible articles were included. The main barriers identified were language and communication, lack of trust, access to trials, eligibility criteria, attitudes and beliefs, lack of knowledge around clinical trials, and logistical and practical issues. In relation to evidence-based strategies and enablers, two key themes arose: [1] a multi-faceted approach is essential [2]; no single strategy was universally effective either within or between trials. The key evidence-based strategies identified were cultural competency training, community partnerships, personalised approach, multilingual materials and staff, communication-specific strategies, increasing understanding and trust, and tackling logistical barriers. Conclusions Many of the barriers relating to inclusion are the same as those that impact trial design and healthcare delivery generally. However, the presentation of these barriers among different under-served groups may be unique to each population’s particular circumstances, background, and needs. Based on the literature, we make 15 recommendations that, if implemented, may help improve inclusion within clinical trials and clinical research more generally. The three main recommendations include improving cultural competency and sensitivity of all clinical trial staff through training and ongoing personal development, the need to establish a diverse community advisory panel for ongoing input into the research process, and increasing recruitment of staff from under-served groups. Implementation of these recommendations may help improve representation of under-served groups in clinical trials which would improve the external validity of associated findings. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05849-7.
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Affiliation(s)
| | - Ash C Routen
- Centre for Ethnic Health Research, University of Leicester, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Andrew Willis
- Centre for Ethnic Health Research, University of Leicester, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Winifred Ekezie
- Centre for Ethnic Health Research, University of Leicester, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Claire Lawson
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kamlesh Khunti
- Centre for Ethnic Health Research, University of Leicester, Leicester General Hospital, Leicester, UK. .,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK. .,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK. .,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
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19
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De Roos AJ, Schinasi LH, Miligi L, Cerhan JR, Bhatti P, ‘t Mannetje A, Baris D, Benavente Y, Benke G, Clavel J, Casabonne D, Fritschi L, Hofmann JN, Huynh T, Monnereau A, Piro S, Slager SL, Vajdic CM, Wang SS, Zhang Y, Bernstein L, Cocco P. Occupational insecticide exposure and risk of non-Hodgkin lymphoma: A pooled case-control study from the InterLymph Consortium. Int J Cancer 2021; 149:1768-1786. [PMID: 34270795 PMCID: PMC10560384 DOI: 10.1002/ijc.33740] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 11/07/2022]
Abstract
Evidence for the human health effects of pesticides is needed to inform risk assessment. We studied the relationship between occupational insecticide use and risk of non-Hodgkin lymphoma (NHL) by pooling data from nine case-control studies participating in the InterLymph Consortium, including 7909 cases and 8644 controls from North America, the European Union and Australia. Insecticide use was coded using self-report or expert assessment, for insecticide groups (eg, organophosphates, pyrethroids) and active ingredients (eg, malathion, permethrin). Associations with insecticides were estimated using logistic regression to produce odds ratios (ORs) and 95% confidence intervals (CI) for all NHL and NHL subtypes, with adjustment for study site, demographic factors and use of other pesticides. Occupational insecticide use, overall, was not associated with risk of NHL. Use of organophosphate insecticides was associated with increased risk of all NHL and the subtype follicular lymphoma, and an association was found with diazinon, in particular (ever use: OR = 2.05, 95%CI: 1.24-3.37). The carbamate insecticide, carbaryl, was associated with risk of all NHL, and the strongest associations were found with T-cell NHL for ever-use (OR = 2.44, 95%CI: 1.13-5.28) and longer duration (>8 years vs never: OR = 2.90, 95%CI: 1.02-8.25). There was no association of NHL with other broad groups of insecticides, including organochlorines and pyrethroids, and some inverse associations were estimated in relation to historical DDT use. Our findings contribute to the totality of evidence available to help inform risk decisions by public health and regulatory agencies of importance given continued, widespread use of organophosphate and carbamate insecticides.
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Affiliation(s)
- Anneclaire J. De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Leah H. Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lucia Miligi
- Environmental and Occupational Epidemiology Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - James R. Cerhan
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- Occupational and Environmental Health, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea ‘t Mannetje
- Center for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand
| | - Dalsu Baris
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yolanda Benavente
- Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO)/Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Geza Benke
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline Clavel
- Epidemiology of Childhood and Adolescent Cancers Group, Inserm, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
- Université Paris Descartes, Paris, France
| | - Delphine Casabonne
- Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO)/Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Jonathan N. Hofmann
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Betthesda, Maryland, USA
| | - Tran Huynh
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Alain Monnereau
- Epidemiology of Childhood and Adolescent Cancers Group, Inserm, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonié, University of Bordeaux, Inserm, Bordeaux, France
| | - Sara Piro
- Environmental and Occupational Epidemiology Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Susan L. Slager
- Division of Computational Biology and Hematology, Department of Quantitative Health Sciences and Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Claire M. Vajdic
- Centre for Big Data Research in Health, University of New South Wales, New South Wales, Australia
| | - Sophia S. Wang
- Division of Health Analytics, Department of Computational and Quantitative Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Yawei Zhang
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Beckman Research Institute of City of Hope, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Pierluigi Cocco
- Division of Population Health, Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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20
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DeWitt MA, Croghan IT, Vachon CM, Thacher TD, Venegas Pont MR, Neal L, Stan DL, Jenkins SM, Pruthi S. Assessing Biomarkers of Breast Cancer Risk in Underserved Women in a Midwestern County. J Prim Care Community Health 2021; 12:21501327211017792. [PMID: 34009069 PMCID: PMC8138283 DOI: 10.1177/21501327211017792] [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: 11/17/2022] Open
Abstract
Objective: The primary aim of this study was to evaluate the feasibility of collecting
risk factor information and accessing digitized mammographic data in a
medically marginalized population. A secondary aim was to examine the
association between vitamin D status and mammographic density. Methods: Breast-screening examinations were provided for age-appropriate patients, and
a referral for no-cost screening mammography was offered. Study participants
were asked to undergo 25-hydroxyvitamin D testing at mammography and 1-year
follow-up. Results: Of 62 women approached, 35 (56%) consented to participate. Of 32 participants
who had baseline mammography, the median mammographic density measured by
VolparaDensity (Volpara Solutions Limited) was 5.7%. After 1 year, 9 women
obtained follow-up mammograms, with a median density of 5.7%. Vitamin D
status was measured for 31 participants at baseline and 13 participants in
the following year. Insufficient vitamin D status (<30 ng/mL) was noted
in 77% at each time point. Mammographic density was not significantly
correlated with vitamin D status (P = .06). Conclusions: On the basis of this small pilot study, vitamin D insufficiency is common in
this study population. Owing to the small sample size, an association
between vitamin D insufficiency and breast density was not clear. Additional
unexpected findings included substantial barriers in initial access to care
and longitudinal follow-up in this population. Further study of these issues
is needed.
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21
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Otto AK, Ketcher D, McCormick R, Davis JL, McIntyre MR, Liao Y, Reblin M, Vadaparampil ST. Using the health belief model to assess racial/ethnic disparities in cancer-related behaviors in an NCI-designated comprehensive cancer center catchment area. Cancer Causes Control 2021; 32:1085-1094. [PMID: 34132914 DOI: 10.1007/s10552-021-01457-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 06/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Racial and ethnic minorities experience well-documented disparities across the cancer trajectory. However, factors underlying these disparities may vary regionally. The Health Belief Model (HBM) was developed to explain and predict health-related prevention and early detection behaviors, particularly uptake of health services. Our goal was to use the HBM to guide an exploration of factors that contribute to racial/ethnic health disparities in the catchment area of a large National Cancer Institute-designated Comprehensive Cancer Center in the Southeastern United States. METHODS We conducted a secondary analysis of data collected by the cancer center for its triennial Community Health Needs Assessment, which sampled adults from the center's 15-county catchment area. White non-Hispanics (WNHs; n = 887), Black non-Hispanics (BNHs; n = 78), Hispanics/Latinxs (H/Ls; n = 185), and those identifying as another race/ethnicity ("Others"; n = 39) were compared across key HBM variables, including demographic/psychosocial information, perceived benefits and barriers to preventive health behaviors, risk perception, and health behavior outcomes. RESULTS Controlling for annual household income, relationship status, and age (for certain screening behaviors), significant differences were seen in information-seeking behaviors, risk perception, community attributes, discrimination, and distress. Non-WNH groups reported worse community attributes, higher everyday discrimination, lower health literacy, less confidence in their ability to get health information, and lower perceived risk of cancer. CONCLUSION This analysis presents a better understanding of how HBM factors may influence health disparities in the cancer center's catchment area. Results describe the needs of community members from racial and ethnic minority groups, which will inform future research, education, outreach, and service activities.
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Affiliation(s)
- Amy K Otto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Public Health Sciences, The University of Miami, Miami, FL, USA
| | - Dana Ketcher
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Rachael McCormick
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Jenna L Davis
- Moffitt Diversity, Moffitt Cancer Center, Tampa, FL, USA
| | - McKenzie R McIntyre
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Yunqi Liao
- Office of Community Outreach, Engagement, and Equity, Moffitt Cancer Center, Tampa, FL, USA
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
- Department of Family Medicine, University of Vermont, Burlington, VT, USA.
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Office of Community Outreach, Engagement, and Equity, Moffitt Cancer Center, Tampa, FL, USA
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22
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Aristizabal P, Winestone LE, Umaretiya P, Bona K. Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer. Am Soc Clin Oncol Educ Book 2021; 41:e315-e326. [PMID: 34061564 PMCID: PMC9126642 DOI: 10.1200/edbk_320499] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Lena E. Winestone
- Department of Pediatrics, Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California San Francisco Benioff Children’s Hospitals, San Francisco, CA
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Puja Umaretiya
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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23
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Habr D, Ferdinand R. Addressing racial/ethnic disparities in cancer clinical trials: Everyone has a role to play. Cancer 2021; 127:3282-3289. [PMID: 33904590 DOI: 10.1002/cncr.33600] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022]
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24
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Partnering patients, caregivers, and basic scientists: an engagement model that fosters patient- and family-centered research culture. Transl Res 2021; 227:64-74. [PMID: 32739418 PMCID: PMC7719089 DOI: 10.1016/j.trsl.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/21/2022]
Abstract
Traditionally, basic scientists have not been as engaged in the translational continuum when it comes to engagement with patients, caregivers, and other community stakeholders. In order to address this discrepancy, a multi-disciplinary team at Moffitt Cancer Center conceived of and enacted the Patient-Researcher Forum (PRF) to promote a community-engaged research approach through communication, compassion, and bi-directional research insight for both patients/caregivers and researchers. We outline the structure and implementation of the PRF, its participants, and qualitative and quantitative results across 14 sessions. PRF sessions were conducted between July 2018 and October 2019 and included 29 patients/caregivers and close to 200 researcher/staff participants; post participation survey response rates assessing the PRF experience were 27.6% (patients/caregivers) and 60.3% (researchers) on average. Research staff overwhelmingly reported that the PRF was beneficial, citing that it helped them gain new patient-centered perspectives and helped them practice communicating research to lay audiences. Patients/caregivers also reported that the PRF was valuable, indicating that they gained a better understanding of research and that they developed a personal connection with researchers. Our PRF model may provide a strategy for improving basic scientist communication, ethics, and understanding of research impacts on the populations they wish to serve. This innovative model provides a much-needed direct connection between basic scientists and patients/caregivers which creates a 2-way learning platform that fosters understanding and research ideas in the spirit of community-engaged research.
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25
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Brown B, Taylor J, Dubé K, Kuzmanović D, Long Y, Marg L. Ethical Reflections on the Conduct of HIV Research with Community Members: A Case Study. J Empir Res Hum Res Ethics 2020; 16:65-77. [PMID: 33174498 DOI: 10.1177/1556264620970802] [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: 11/15/2022]
Abstract
Some researchers continue to engage in "helicopter" or "parachute" research and do not ethically engage or collaborate with communities from which data are collected. This paper uses a case study to discuss the ethical issues arising from these research practices and the importance of increasing meaningful community involvement in research. Set in the context of research among older people living with HIV, the case study is followed by the perspectives of four research stakeholders. Through these perspectives, this paper demonstrates the ethical perils and harms that stem from research practices exemplified in the case. We argue instead for researchers to practice participatory research methods in line with community-based participatory research approaches (CBPR), good participatory practices (GPP), the Denver Principles, and CIOMS guidelines. Towards this end, we describe tools developed in collaboration with stakeholders in the research process to help researchers incorporate community participation and reduce unethical research conduct.
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Affiliation(s)
| | - Jeff Taylor
- HIV & Aging Research Project-Palm Springs, Palm Springs, CA, USA
| | - Karine Dubé
- 2331University of North Carolina, Chapel Hill, NC, USA
| | - Dario Kuzmanović
- 8790University of California, Riverside, CA, USA.,The Joint Centre for Bioethics, University of Toronto, Canada
| | - Yasmeen Long
- FasterCures at the Milken Institute, Washington, DC, USA
| | - Logan Marg
- 8790University of California, Riverside, CA, USA
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26
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Aristizabal P. Diverse populations and enrollment in pediatric cancer clinical trials: Challenges and opportunities. Pediatr Blood Cancer 2020; 67:e28296. [PMID: 32343877 PMCID: PMC8203427 DOI: 10.1002/pbc.28296] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Paula Aristizabal
- Division of Pediatric Hematology/Oncology, Department of
Pediatrics, Rady Children's Hospital San Diego, University of California San
Diego/Peckham Center for Cancer and Blood Disorders, San Diego, California,Population Sciences, Disparities and Community Engagement,
University of California San Diego Moores Cancer Center, La Jolla, California
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27
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Olson J, Cawthra T, Beyer K, Frazer D, Ignace L, Maurana C, Millon-Underwood S, Pinsoneault L, Salazar J, Walker A, Williams C, Stolley M. Community and Research Perspectives on Cancer Disparities in Wisconsin. Prev Chronic Dis 2020; 17:E122. [PMID: 33034557 PMCID: PMC7553208 DOI: 10.5888/pcd17.200183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Significant disparities are apparent in geographic areas and among racial/ethnic minority groups in Wisconsin. Cancer disparities are complex and multifactorial and require collaborative, multilevel efforts to reduce their impact. Our objective was to understand cancer disparities and identify opportunities to collaborate across community and research sectors to address them. Methods From May 2017 through October 2018, we assembled groups of community members and researchers and conducted 10 listening sessions and 29 interviews with a total of 205 participants from diverse backgrounds. Listening sessions and interviews were scheduled on the basis of participant preference and consisted of a brief review of maps illustrating the breast and lung cancer burden across Wisconsin, and a semistructured set of questions regarding causes, solutions, and opportunities. Interviews followed the same structure as listening sessions, but were conducted between a facilitator and 1 or 2 individuals. Major themes were summarized from all sessions and coded. We used the Model for Analysis of Population Health and Health Disparities to identify areas for collaboration and to highlight differences in emphasis between community participants and researchers. Results Participants identified the need to address individual behavioral risks and medical mistrust and to build equitable multilevel partnerships. Communities provided insights on the impact of environment and location on cancer disparities. Researchers shared thoughts about societal poverty and policy issues, biologic responses, genetic predisposition, and the mechanistic influence of lifestyle factors on cancer incidence and mortality. Conclusion Listening sessions and interviews provided insight into contributors to cancer disparities, barriers to improving outcomes, and opportunities to improve health. The unique perspectives of each group underscored the need for multisector teams to tackle the complex issue of cancer disparities.
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Affiliation(s)
- Jessica Olson
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226.
| | - Tobi Cawthra
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - David Frazer
- University of Wisconsin-Madison, Madison, Wisconsin
| | - Lyle Ignace
- Gerald L. Ignace Indian Health Center, Milwaukee, Wisconsin
| | | | | | | | - Jose Salazar
- Sixteenth Street Community Health Centers, Milwaukee Wisconsin
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28
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Barrett NJ, Ingraham KL, Bethea K, Hwa-Lin P, Chirinos M, Fish LJ, Randolph S, Zhang P, Le P, Harvey D, Godbee RL, Patierno SR. Project PLACE: Enhancing community and academic partnerships to describe and address health disparities. Adv Cancer Res 2020; 146:167-188. [PMID: 32241388 DOI: 10.1016/bs.acr.2020.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Achieving cancer health equity is a national imperative. Cancer is the second leading cause of death in the United States and in North Carolina (NC), where the disease disproportionately impacts traditionally underrepresented race and ethnic groups, those who live in rural communities, the impoverished, and medically disenfranchised and/or health-disparate populations at high-risk for cancer. These populations have worse cancer outcomes and are less likely to be participants in clinical research and trials. It is critical for cancer centers and other academic health centers to understand the factors that contribute to poor cancer outcomes, the extent to which they impact the cancer burden, and develop effective interventions to address them. Key to this process is engaging diverse stakeholders in the development and execution of community and population health assessments, and the subsequent programs and interventions designed to address the need across the catchment area. This chapter describes the processes and lessons learned of the Duke Cancer Institute's (DCI) long standing community partnerships that led to Project PLACE (Population Level Approaches to Cancer Elimination), a National Cancer Institute (NCI)-funded community health assessment reaching 2315 respondents in 7 months, resulting in a community partnered research agenda to advance cancer equity within the DCI catchment area. We illustrate the application of a community partnered health assessment and offer examples of strategic opportunities, successes, lessons learned, and implications for practice.
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Affiliation(s)
- Nadine J Barrett
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States; Department of Family Medicine and Community Health, Duke School of Medicine, Durham, NC, United States; Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, United States.
| | - Kearston L Ingraham
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Kenisha Bethea
- Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, United States
| | - Pao Hwa-Lin
- Chinese Christian Church, Raleigh, NC, United States; Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | | | - Laura J Fish
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | | | - Ping Zhang
- Chinese American Friendly Association, Raleigh, NC, United States
| | - Peter Le
- St. Joseph's Primary Care, Raleigh, NC, United States
| | - Demetrius Harvey
- Black Men's Health Initiative, Wilson, NC, United States; Alumni Chapter of Kappa Alpha Psi Fraternity, Inc., Smithfield, NC, United States
| | | | - Steven R Patierno
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
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29
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Meade CD, Gwede CK. An invitation for optimal inclusivity: Investing in communities to advance equity in biomedical research and cancer care. Cancer 2020; 126:935-938. [PMID: 31909821 DOI: 10.1002/cncr.32683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/23/2019] [Accepted: 11/24/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Cathy D Meade
- Division of Population Science, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Clement K Gwede
- Division of Population Science, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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30
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Rivadeneira NA, Hoskote M, Le GM, Nguyen TT, Nápoles AM, Pasick RJ, Sarkar U, Hiatt RA. Advancing Cancer Control in San Francisco: Cancer Screening in Under-Represented Populations. Am J Prev Med 2020; 58:e1-e9. [PMID: 31862104 PMCID: PMC7173710 DOI: 10.1016/j.amepre.2019.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cancer risk and screening data are limited in their ability to inform local interventions to reduce the burden of cancer in vulnerable populations. The San Francisco Health Information National Trends Survey was developed and administered to assess the use of cancer-related information among under-represented populations in San Francisco to provide baseline data for the San Francisco Cancer Initiative. METHODS The survey instrument was developed through consultation with research and community partners and translated into 4 languages. Participants were recruited between May and September 2017 through community-based snowball sampling with quotas to ensure adequate numbers of under-represented populations. Chi-square tests and multivariate logistic regression were used between 2018 and 2019 to assess differences in screening rates across groups and factors associated with cancer screening. RESULTS One thousand twenty-seven participants were recruited. Asians had lower rates of lifetime mammogram (p=0.02), Pap test (p<0.01), and prostate-specific antigen test (p=0.04) compared with non-Asians. Hispanics had higher rates of lifetime mammogram (p=0.02), lifetime Pap test (p=0.01), recent Pap test (p=0.03), and lifetime prostate-specific antigen test (p=0.04) compared with non-Hispanics. Being a female at birth was the only factor that was independently associated with cancer screening participation (AOR=3.17, 95% CI=1.40, 7.19). CONCLUSIONS Screening adherence varied by race, ethnicity, and screening type. A collaborative, community-based approach led to a large, diverse sample and may serve as a model for recruiting diverse populations to add knowledge about cancer prevention preferences and behaviors. Results suggest targeted outreach efforts are needed to address disparate cancer screening behaviors within this diverse population.
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Affiliation(s)
- Natalie A Rivadeneira
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.
| | - Mekhala Hoskote
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Gem M Le
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Tung T Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland
| | - Rena J Pasick
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Urmimala Sarkar
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Robert A Hiatt
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California
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