1
|
Zhao MY, Lei YY, Aaronson MRM, De Silva SR, Badiee J, May FP. Colorectal Cancer Screening Rates at Federally Qualified Health Centers From 2014 to 2022: Incomplete Recovery From COVID-19 and Worsening Disparities. Am J Gastroenterol 2024; 119:1580-1589. [PMID: 38529856 DOI: 10.14309/ajg.0000000000002706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/15/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Federally Qualified Health Centers (FQHC) provide preventive health services such as colorectal cancer (CRC) screening to low-income and underinsured individuals. Overall CRC screening participation in the United States declined during the COVID-19 pandemic and recovered by 2021; however, trends in underresourced settings are unknown. METHODS Using Uniform Data System data from 2014 to 2022, we assessed trends in FQHC CRC screening rates nationally, in California, and in Los Angeles County and determined clinic-level factors associated with recent screening rate changes. For each FQHC, we calculated the screening rate change from 2019 to 2020, 2020 to 2021, and 2020 to 2022. We used mixed-effects linear regression to determine clinic-level characteristics associated with each screening rate change. RESULTS Across all FQHC (n = 1,281), 7,016,181 patients were eligible for CRC screening in 2022. Across the United States and in California, median screening rates increased from 2014 to 2019, severely declined in 2020, and failed to return to prepandemic levels by 2022. Both nationally and in California, CRC screening declined most dramatically from 2019 to 2020 in FQHC serving majority Hispanic/Latino patients or a high proportion of patients experiencing homelessness. From 2020 to 2022, screening rates did not recover completely in US FQHC, with disproportionate recovery among FQHC serving majority non-Hispanic Black patients. DISCUSSION CRC screening rates at FQHC did not return to prepandemic levels by 2022, and recovery varied by FQHC patient characteristics. Tailored interventions addressing low and decreasing CRC screening rates in FQHC are urgently needed to mitigate worsening CRC disparities.
Collapse
Affiliation(s)
- Matthew Y Zhao
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Yvonne Y Lei
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Megan R M Aaronson
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Sadie R De Silva
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Jayraan Badiee
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Folasade P May
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA
- UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California, USA
| |
Collapse
|
2
|
Higgins ST, Erath T, Chen FF. Examining U.S. disparities in smoking among rural versus urban women of reproductive age: 2002-2019. Prev Med 2024; 185:108054. [PMID: 38914268 PMCID: PMC11269002 DOI: 10.1016/j.ypmed.2024.108054] [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: 04/05/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVE This study is part of a programmatic investigation of rural disparities in cigarette smoking examining disparities in smoking prevalence and for the first-time quit ratios among adult women of reproductive age (18-44 years), a highly vulnerable population due to risk for multigenerational adverse effects. METHODS Data came from 18 years (2002-2019) of the U.S. National Survey on Drug Use and Health (NSDUH) among women (n = 280,626) categorized by rural-urban residence, pregnancy status, using weighted logistic regression models testing time trends and controlling for well-established sociodemographic predictors of smoking (race/ethnicity, education, income). Concerns regarding changes in survey methods used before 2002 and after 2019 precluded inclusion of earlier and more recent survey years in the present study. RESULTS Overall smoking prevalence across years was greater in rural than urban residents (adjusted odds ratio [AOR] = 1.11; 95%CI, 1.07-1.15; P < .001) including those not-pregnant (AOR = 1.10; 1.07-1.14; P < .001) and pregnant (AOR = 1.29; 1.09-1.52; P < .001). Overall quit ratios across years were lower in rural than urban residents (AOR = 0.93; 0.87-0.99; P < .001) including those not-pregnant (AOR = 0.93; 0.88-1.00, P = .035) and pregnant (AOR = 0.78; 0.62-0.99; P = .039). Interactions of rural versus urban residence with study years for prevalence and quit ratios overall and by pregnancy status are detailed in the main text. CONCLUSIONS These results support a longstanding and robust rural disparity in smoking prevalence among women of reproductive age including those currently pregnant and provides novel evidence that differences in smoking cessation contribute to this disparity further underscoring a need for greater access to evidence-based tobacco control and regulatory interventions in rural regions.
Collapse
Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States.
| | - Tyler Erath
- Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - Fang-Fang Chen
- Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| |
Collapse
|
3
|
Munhoz R, Sabesan S, Thota R, Merrill J, Hensold JO. Revolutionizing Rural Oncology: Innovative Models and Global Perspectives. Am Soc Clin Oncol Educ Book 2024; 44:e432078. [PMID: 38838274 DOI: 10.1200/edbk_432078] [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: 06/07/2024]
Abstract
For individuals living in rural areas, access to cancer care can be difficult. Barriers to access cross international boundaries and have a negative impact on treatment outcomes. Current models to increase rural access in the United States are reviewed, as is a system-wide approach to this problem in Australia. Ongoing efforts to increase access to clinical trials for patients in rural areas are also discussed.
Collapse
Affiliation(s)
- Rodrigo Munhoz
- Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil
| | - Sabe Sabesan
- Townsville Cancer Centre, Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | | | | | | |
Collapse
|
4
|
Kobritz M, Nofi CP, Egunsola A, Zimmern AS. Financial toxicity in early-onset colorectal cancer: A National Health Interview Survey study. Surgery 2024; 175:1278-1284. [PMID: 38378347 DOI: 10.1016/j.surg.2024.01.005] [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: 10/10/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Financial toxicity is increasingly recognized as a devastating outcome of cancer treatment but is poorly characterized in patients with early-onset colorectal cancer. Young patients are particularly vulnerable to financial toxicity as they are frequently underinsured and may suffer significant disruptions to professional and financial growth. We hypothesized that financial toxicity associated with colorectal cancer treatment confers long-lasting effects on patients' well-being and disproportionately impacts patients diagnosed at <50 years of age. METHODS A retrospective cross-sectional analysis of the National Health Interview Survey from years 2019 to 2021 was performed. Patients with a history of colorectal cancer were included and stratified by age at diagnosis. Randomly selected age-matched controls with no cancer history were used for comparison. The primary endpoint was financial toxicity, as assessed by a composite score formulated from 12 National Health Interview Survey items. The secondary endpoint was food security assessed by the United States Department of Agriculture's food security scale, embedded in the National Health Interview Survey. RESULTS When compared to age-matched controls, patients with colorectal cancer experienced significant financial toxicity, as reflected by a composite financial toxicity score (P = .027). Within patients with colorectal cancer, female sex (adjusted odds ratio = 1.46, P = .046) and early-onset disease (adjusted odds ratio = 2.11, P = .002) were found to significantly increase the risk of financial toxicity. Patients with early-onset colorectal cancer more frequently experienced food insecurity (P = .011), delayed necessary medical care (P = .053), mental health counseling (P = .043), and filling prescriptions (P = .007) due to cost when compared to patients with average-onset colorectal cancer. CONCLUSION Colorectal cancer is associated with significant long-term financial toxicity, which disproportionately impacts patients diagnosed at <50 years of age. Targeted interventions are warranted to reduce financial toxicity for patients with high-risk colorectal cancer.
Collapse
Affiliation(s)
- Molly Kobritz
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Surgery, Northwell-North Shore/Long Island Jewish, Manhasset, NY.
| | - Colleen P Nofi
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Surgery, Northwell-North Shore/Long Island Jewish, Manhasset, NY
| | - Adekemi Egunsola
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Surgery, Northwell-North Shore/Long Island Jewish, Manhasset, NY
| | - Andrea S Zimmern
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Surgery, Northwell-North Shore/Long Island Jewish, Manhasset, NY
| |
Collapse
|
5
|
Moss JL, Geyer NR, Lengerich EJ. Patterns of Cancer-Related Healthcare Access across Pennsylvania: Analysis of Novel Census Tract-Level Indicators of Persistent Poverty. Cancer Epidemiol Biomarkers Prev 2024; 33:616-623. [PMID: 38329390 DOI: 10.1158/1055-9965.epi-23-1255] [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] [Received: 10/11/2023] [Revised: 12/14/2023] [Accepted: 02/06/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Persistent poverty census tracts have had ≥20% of the population living below the federal poverty line for 30+ years. We assessed the relationship between persistent poverty and cancer-related healthcare access across census tracts in Pennsylvania. METHODS We gathered publicly available census tract-level data on persistent poverty, rurality, and sociodemographic variables, as well as potential access to healthcare (i.e., prevalence of health insurance, last-year check-up), realized access to healthcare (i.e., prevalence of screening for cervical, breast, and colorectal cancers), and self-reported cancer diagnosis. We used multivariable spatial regression models to assess the relationships between persistent poverty and each healthcare access indicator. RESULTS Among Pennsylvania's census tracts, 2,789 (89.8%) were classified as non-persistent poverty, and 316 (10.2%) were classified as persistent poverty (113 did not have valid data on persistent poverty). Persistent poverty tracts had lower prevalence of health insurance [estimate = -1.70, standard error (SE) = 0.10], screening for cervical cancer (estimate = -4.00, SE = 0.17) and colorectal cancer (estimate = -3.13, SE = 0.20), and cancer diagnosis (estimate = -0.34, SE = 0.05), compared with non-persistent poverty tracts (all P < 0.001). However, persistent poverty tracts had higher prevalence of last-year check-up (estimate = 0.22, SE = 0.08) and screening for breast cancer (estimate = 0.56, SE = 0.15; both P < 0.01). CONCLUSIONS Relationships between persistent poverty and cancer-related healthcare access outcomes differed in direction and magnitude. Health promotion interventions should leverage data at fine-grained geographic units (e.g., census tracts) to motivate focus on communities or outcomes. IMPACT Future studies should extend these analyses to other states and outcomes to inform public health research and interventions to reduce geographic disparities.
Collapse
Affiliation(s)
- Jennifer L Moss
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
- Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Eugene J Lengerich
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
- Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| |
Collapse
|
6
|
Atherton OE, Willroth EC, Graham EK, Luo J, Mroczek DK, Lewis-Thames MW. Rural-urban differences in personality traits and well-being in adulthood. J Pers 2024; 92:73-87. [PMID: 36725776 PMCID: PMC10390645 DOI: 10.1111/jopy.12818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE One large focus of personality psychology is to understand the biopsychosocial factors responsible for adult personality development and well-being change. However, little is known about how macro-level contextual factors, such as rurality-urbanicity, are related to personality development and well-being change. METHOD The present study uses data from two large longitudinal studies of U.S. Americans (MIDUS, HRS) to examine whether there are rural-urban differences in levels and changes in the Big Five personality traits and well-being (i.e., psychological well-being, and life satisfaction) in adulthood. RESULTS Multilevel models showed that Americans who lived in more rural areas tended to have lower levels of openness, conscientiousness, and psychological well-being, and higher levels of neuroticism. With the exception of psychological well-being (which replicated across MIDUS and HRS), rural-urban differences in personality traits were only evident in the HRS sample. The effect of neuroticism was fully robust to the inclusion of socio-demographic and social network covariates, but other effects were partially robust (i.e., conscientiousness and openness) or were not robust at all (i.e., psychological well-being). In both samples, there were no rural-urban differences in Big Five or well-being change. CONCLUSIONS We discuss the implications of these findings for personality and rural health research.
Collapse
Affiliation(s)
- Olivia E. Atherton
- University of Houston, Department of Psychology
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences
| | | | - Eileen K. Graham
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences
| | - Jing Luo
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences
| | - Daniel K. Mroczek
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences
- Northwestern University, Department of Psychology
| | | |
Collapse
|
7
|
Brenner AT, Waters AR, Wangen M, Rohweder C, Odebunmi O, Marciniak MW, Ferrari RM, Wheeler SB, Shah PD. Patient preferences for the design of a pharmacy-based colorectal cancer screening program. Cancer Causes Control 2023; 34:99-112. [PMID: 37072526 PMCID: PMC10113122 DOI: 10.1007/s10552-023-01687-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] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE To assess preferences for design of a pharmacy-based colorectal cancer (CRC) screening program (PharmFIT™) among screening-eligible adults in the United States (US) and explore the impact of rurality on pharmacy use patterns (e.g., pharmacy type, prescription pick-up preference, service quality rating). METHODS We conducted a national online survey of non-institutionalized US adults through panels managed by Qualtrics, a survey research company. A total of 1,045 adults (response rate 62%) completed the survey between March and April 2021. Sampling quotas matched respondents to the 2010 US Census and oversampled rural residents. We assessed pharmacy use patterns by rurality and design preferences for learning about PharmFIT™; receiving a FIT kit from a pharmacy; and completing and returning the FIT kit. RESULTS Pharmacy use patterns varied, with some notable differences across rurality. Rural respondents used local, independently owned pharmacies more than non-rural respondents (20.4%, 6.3%, p < 0.001) and rated pharmacy service quality higher than non-rural respondents. Non-rural respondents preferred digital communication to learn about PharmFIT™ (36% vs 47%; p < 0.001) as well as digital FIT counseling (41% vs 49%; p = 0.02) more frequently than rural participants. Preferences for receiving and returning FITs were associated with pharmacy use patterns: respondents who pick up prescriptions in-person preferred to get their FIT (OR 7.7; 5.3-11.2) and return it in-person at the pharmacy (OR 1.7; 1.1-2.4). CONCLUSION Pharmacies are highly accessible and could be useful for expanding access to CRC screening services. Local context and pharmacy use patterns should be considered in the design and implementation of PharmFIT™.
Collapse
Affiliation(s)
- Alison T Brenner
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Austin R Waters
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catherine Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Olufeyisayo Odebunmi
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Macary Weck Marciniak
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Parth D Shah
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| |
Collapse
|
8
|
Hirschey R, Rohweder C, Zahnd WE, Eberth JM, Adsul P, Guan Y, Yeager KA, Haines H, Farris PE, Bea JW, Dwyer A, Madhivanan P, Ranganathan R, Seaman AT, Vu T, Wickersham K, Vu M, Teal R, Giannone K, Hilton A, Cole A, Islam JY, Askelson N. Prioritizing rural populations in state comprehensive cancer control plans: a qualitative assessment. Cancer Causes Control 2023; 34:159-169. [PMID: 36840904 PMCID: PMC9959942 DOI: 10.1007/s10552-023-01673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program (NCCCP) requires that states develop comprehensive cancer control (CCC) plans and recommends that disparities related to rural residence are addressed in these plans. The objective of this study was to explore rural partner engagement and describe effective strategies for incorporating a rural focus in CCC plans. METHODS States were selected for inclusion using stratified sampling based on state rurality and region. State cancer control leaders were interviewed about facilitators and barriers to engaging rural partners and strategies for prioritizing rural populations. Content analysis was conducted to identify themes across states. RESULTS Interviews (n = 30) revealed themes in three domains related to rural inclusion in CCC plans. The first domain (barriers) included (1) designing CCC plans to be broad, (2) defining "rural populations," and (3) geographic distance. The second domain (successful strategies) included (1) collaborating with rural healthcare systems, (2) recruiting rural constituents, (3) leveraging rural community-academic partnerships, and (4) working jointly with Native nations. The third domain (strategies for future plan development) included (1) building relationships with rural communities, (2) engaging rural constituents in planning, (3) developing a better understanding of rural needs, and (4) considering resources for addressing rural disparities. CONCLUSION Significant relationship building with rural communities, resource provision, and successful strategies used by others may improve inclusion of rural needs in state comprehensive cancer control plans and ultimately help plan developers directly address rural cancer health disparities.
Collapse
Affiliation(s)
- Rachel Hirschey
- School of Nursing, UNC Chapel Hill, and Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
| | - Catherine Rohweder
- Center for Health Promotion & Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jan M Eberth
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico & University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Yue Guan
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Heidi Haines
- Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Paige E Farris
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Jennifer W Bea
- Department of Health Promotion Sciences, Mel & Enid Zuckerman, College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Andrea Dwyer
- Community and Behavioral Health, The Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Purnima Madhivanan
- University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Radhika Ranganathan
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Aaron T Seaman
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Thuy Vu
- MPH Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Karen Wickersham
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Maihan Vu
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Randall Teal
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Kara Giannone
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Alison Hilton
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Jessica Y Islam
- Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Natoshia Askelson
- Department of Community & Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
9
|
Feliu A, Finck C, Lemos M, Bahena Botello A, de Albuquerque Melo Nogueira F, Bonvecchio Arenas A, Garcés-Palacio IC, Jurberg C, Pesce K, Espina C. Latin America and the Caribbean Code Against Cancer 1st edition: Building capacity on cancer prevention to primary healthcare professionals. Cancer Epidemiol 2023; 86 Suppl 1:102400. [PMID: 37852724 DOI: 10.1016/j.canep.2023.102400] [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: 03/22/2023] [Revised: 05/11/2023] [Accepted: 06/15/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Every year 1.5 million new cancer cases are diagnosed in Latin America and the Caribbean (LAC). Of these, about 40 % could be prevented. Health illiteracy has been identified as a main barrier for cancer prevention. Primary healthcare professionals (HCP) are key in cancer prevention as they are the first entry point of the population into the healthcare system. The LAC Code Against Cancer 1st edition aims to improve health literacy and awareness of cancer prevention in the LAC population, through building capacity of primary HCP. METHODS The definition and development of the learning objectives, curriculum, structure, and evaluation of an online learning program for primary HCP was led by a dedicated group of experts from the LAC Code Against Cancer project. A pedagogical guideline and a template to ensure harmonization across topics were produced to guide the program development. Two rounds of internal revisions and an editorial process were performed. RESULTS An online competency-based microlearning program for primary HCP was produced, taking the LAC Code Against Cancer as a basis. The competences addressed in the curriculum are core knowledge, communication skills, decision-making and applying knowledge to real-world situations. A comprehensive evaluation to assess acquisition of these competences, based on the Miller's Pyramid, was designed with three data collection points: a) immediately before, to assess baseline knowledge and skills; b) immediately after, to determine acquired competences; and c) at 3-6 months follow-up, to assess performance in daily practice. The e-learning will be freely available in the Virtual Campus for Public Health of the Pan American Health Organization in Spanish, English, and Portuguese. CONCLUSION Primary HCP, perceived as trustworthy sources of information, are key actors to increase the population's awareness and literacy on cancer prevention. Building capacity of these professionals has the potential to increase dissemination and impact of the LAC Code Against Cancer by prompting communication with the public and offering personalized actionable preventive messages through counselling.
Collapse
Affiliation(s)
- Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, Lyon CEDEX 07 69366, France.
| | - Carolyn Finck
- Departamento de Psicología, Universidad de los Andes, Cra 1 Nr 18A-12, Bogotá, Colombia
| | - Mariantonia Lemos
- Universidad EAFIT, Escuela de Artes y Humanidades, Carrera 49 #7 sur 50, Medellín, Colombia
| | - Arlette Bahena Botello
- Escuela de Salud Pública, Instituto Nacional de Salud Pública, Universidad 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca, Morelos, Mexico
| | - Fernanda de Albuquerque Melo Nogueira
- Instituto Nacional do Câncer José Alencar Gomes da Silva, Coordenação de Prevenção e Controle do Câncer, Área Técnica Ambiente, Trabalho e Câncer, Rua Marqueês de Pombal, 125, 5o andar, Centro, Rio de Janeiro CEP: 20230-240, Brazil
| | - Anabelle Bonvecchio Arenas
- Centro de Investigación en Nutrición y Salud (CINyS), Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca, Morelos, Mexico
| | - Isabel C Garcés-Palacio
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Claudia Jurberg
- Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Av. Erasmo Braga 118 - 6º andar, Rio de Janeiro, Brazil
| | - Karina Pesce
- Diagnostico e Intervencionismo mamario del Hospital Italiano de Buenos Aires Argentina, Peron 4190. Capital Federal, Argentina
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, Lyon CEDEX 07 69366, France
| |
Collapse
|
10
|
Chen KY, Blackford AL, Sedhom R, Gupta A, Hussaini SMQ. Local Social Vulnerability as a Predictor for Cancer-Related Mortality Among US Counties. Oncologist 2023; 28:e835-e838. [PMID: 37335883 PMCID: PMC10485383 DOI: 10.1093/oncolo/oyad176] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023] Open
Abstract
Substantial gaps in national healthcare spending and disparities in cancer mortality rates are noted across counties in the US. In this cross-sectional analysis, we investigated whether differences in local county-level social vulnerability impacts cancer-related mortality. We linked county-level age-adjusted mortality rates (AAMR) from the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research database, to county-level Social Vulnerability Index (SVI) from the CDC Agency for Toxic Substances and Disease Registry. SVI is a metric comprising 15 social factors including socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. AAMRs were compared between least and most vulnerable counties using robust linear regression models. There were 4 107 273 deaths with an overall AAMR of 173 per 100 000 individuals. Highest AAMRs were noted in older adults, men, non-Hispanic Black individuals, and rural and Southern counties. Highest mortality risk increases between least and most vulnerable counties were noted in Southern and rural counties, individuals aged 45-65, and lung and colorectal cancers, suggesting that these groups may face highest risk for health inequity. These findings inform ongoing deliberations in public health policy at the state and federal level and encourage increased investment into socially disadvantaged counties.
Collapse
Affiliation(s)
- Krista Y Chen
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amanda L Blackford
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ramy Sedhom
- University of Pennsylvania, Philadelphia, PA, USA
| | - Arjun Gupta
- Masonic Cancer Center, University of Minnesota, Minneapolis, MI, USA
| | - S M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA
| |
Collapse
|
11
|
Keimweiss S, Gurolnick A, Grant S, Burris J, Studts J, Lewis-Thames M. "Just give it to us straight!": a qualitative analysis of midwestern rural lung cancer survivors and caregivers about survivorship care experiences. J Cancer Surviv 2023:10.1007/s11764-023-01445-7. [PMID: 37632652 PMCID: PMC10895068 DOI: 10.1007/s11764-023-01445-7] [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: 06/26/2023] [Accepted: 08/02/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE We assessed the experiences of rural lung cancer survivors and caregivers to understand and identify barriers to posttreatment survivorship care management. METHODS From May 2021 to June 2022, we conducted semi-structured interviews with a purposively sampled cohort. Participants were either posttreatment lung cancer survivors (within 5 years of their last active treatment) or caregivers of a lung cancer survivor. Interviews probed participants regarding survivorship care knowledge, implementation, and navigation. Two analysts inductively coded verbatim transcripts and conducted a thematic analysis. RESULTS We interviewed N = 21 participants: lung cancer survivors (76%) and caregivers (24%). Participants self-identified as Non-Hispanic White (100%), were at least 65 years old (77%), identified as male (62%), and previously smoked ≥ 5 packs over the lifetime (71%). The perspectives of survivors and caregivers were similar; thus, we analyzed them together. Themes related to survivorship care included (1) frustrations and uncertainty regarding unexpected barriers, (2) strategies to improve the delivery of posttreatment information, (3) strategies to remain positive and respond to emotional concerns of survivorship care, and (4) the impact of engaging and patient-centered care teams. CONCLUSION Given the limited access to lung cancer care resources in rural communities, our findings reveal that following a survivorship care program or plan requires a high level of individual resilience and community/interpersonal networking. IMPLICATIONS FOR SURVIVORS This study's findings can be applied to improve practice-based care for rural posttreatment lung cancer survivors and provide an impetus for developing tools to assist patient navigation toward community-based supportive care and care management resources.
Collapse
Affiliation(s)
| | | | - Shakira Grant
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jamie Studts
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | |
Collapse
|
12
|
Dasgupta P, Cameron JK, Goodwin B, Cramb SM, Mengersen K, Aitken JF, Baade PD. Geographical and spatial variations in bowel cancer screening participation, Australia, 2015-2020. PLoS One 2023; 18:e0288992. [PMID: 37471422 PMCID: PMC10358922 DOI: 10.1371/journal.pone.0288992] [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] [Received: 04/18/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Participation in bowel cancer screening programs remains poor in many countries. Knowledge of geographical variation in participation rates may help design targeted interventions to improve uptake. This study describes small-area and broad geographical patterns in bowel screening participation in Australia between 2015-2020. METHODS Publicly available population-level participation data for Australia's National Bowel Cancer Screening Program (NBCSP) were modelled using generalized linear models to quantify screening patterns by remoteness and area-level disadvantage. Bayesian spatial models were used to obtain smoothed estimates of participation across 2,247 small areas during 2019-2020 compared to the national average, and during 2015-2016 and 2017-2018 for comparison. Spatial heterogeneity was assessed using the maximized excess events test. RESULTS Overall, screening participation rates was around 44% over the three time-periods. Participation was consistently lower in remote or disadvantaged areas, although heterogeneity was evident within these broad categories. There was strong evidence of spatial differences in participation over all three periods, with little change in patterns between time periods. If the spatial variation was reduced (so low participation areas were increased to the 80th centile), an extra 250,000 screens (4% of total) would have been conducted during 2019-2020. CONCLUSIONS Despite having a well-structured evidence-based government funded national bowel cancer screening program, the substantial spatial variation in participation rates highlights the importance of accounting for the unique characteristics of specific geographical regions and their inhabitants. Identifying the reasons for geographical disparities could inform interventions to achieve more equitable access and a higher overall bowel screening uptake.
Collapse
Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Jessica K. Cameron
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Belinda Goodwin
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- Centre for Heath Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - Susanna M. Cramb
- Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kerrie Mengersen
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joanne F. Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Peter D. Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| |
Collapse
|
13
|
Nechuta S, Wallace H. Improving rural cancer prevention: targeted data and understanding rural-specific factors and lived experiences. J Natl Cancer Inst 2023; 115:345-348. [PMID: 36744916 PMCID: PMC10086619 DOI: 10.1093/jnci/djad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/07/2023] Open
Affiliation(s)
- Sarah Nechuta
- School of Interdisciplinary Health, Grand Valley State University, Grand Rapids, MI, USA
| | - Heather Wallace
- School of Interdisciplinary Health, Grand Valley State University, Grand Rapids, MI, USA
| |
Collapse
|
14
|
Rivera-Rivera JN, Borger T, Sizemore Y, Burris JL. Similarities and differences across the underlying dimensions of social functioning in rural and nonrural cancer survivors: A mixed-methods study. J Rural Health 2023; 39:434-443. [PMID: 36315053 PMCID: PMC10038817 DOI: 10.1111/jrh.12721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE For cancer survivors, social functioning greatly influences other quality of life dimensions. While there is potential for differences in social functioning to vary as a function of geographic residence, few studies examine the social functioning of rural cancer survivors specifically. This study aims to help fill this gap. METHODS This was an embedded mixed-methods study where all participants completed a questionnaire, and some were purposively selected to complete an interview to gather more information about social functioning (ie, social roles, activities, network, support, and constraint). Participants (n = 93; 63% rural) were recruited through a state cancer registry and cancer care facility. Participants were predominately White, non-Hispanic (92.47%), roughly half female (54.84%), and on average, diagnosed in the past two years (SD = 1.68), and 61.45 (SD = 10.87) years old. FINDINGS Few differences in the social functioning of rural and nonrural participants were found on questionnaires, though rural participants reported larger networks and more overall support. Across groups, common themes in the interview data were the experience of both social support (eg, instrumental support) and social constraint (eg, others minimizing participants' problems or sharing their own negative experiences). CONCLUSIONS This was the first cancer survivorship study to thoroughly examine social functioning by geographic residence. Rural cancer survivors described some unique strengths, but major group differences were not apparent. All participants highlighted situations when others, even with good intentions, were unhelpful to them. Future interventions to improve social functioning could work to dispel the belief that cancer survivors should handle their cancer on their own.
Collapse
Affiliation(s)
| | - Tia Borger
- University of Kentucky Department of Psychology, Lexington, KY
- University of Kentucky Markey Cancer Center, Lexington, KY
| | - Yancey Sizemore
- University of Kentucky Department of Psychology, Lexington, KY
| | - Jessica L. Burris
- University of Kentucky Department of Psychology, Lexington, KY
- University of Kentucky Markey Cancer Center, Lexington, KY
| |
Collapse
|
15
|
Wang P, Chapron J, Bennani S, Revel MP, Wislez M. [Lung cancer screening: Update, news and perspectives]. Bull Cancer 2023; 110:42-54. [PMID: 36496261 DOI: 10.1016/j.bulcan.2022.11.006] [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: 10/11/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
Lung cancer is the leading cause of cancer death in France and worldwide (20 % of cancer deaths). This mortality is partly linked to an overrepresentation of metastatic stages at diagnosis (approximately 55 % of lung cancers at diagnosis). Low-dose chest CT in a target population to detect early forms accessible to radical treatment has been evaluated through multiple randomized trials (NLST, NELSON, MILD, DANTE…). These trials demonstrated a reduction in lung cancer specific mortality. The current problem is to integrate a CT screening policy CT at a national level, which should be both efficient and cost-effective, while presenting the least harms for the eligible population. Finally, it is necessary to optimize the participation of the eligible population and particularly in the most deprived areas and ensure the proper implementation of smoking cessation measures.
Collapse
Affiliation(s)
- Pascal Wang
- AP-HP, hôpital Cochin, université Paris Cité, unité d'oncologie thoracique, service de pneumologie, 75014 Paris, France
| | - Jeanne Chapron
- AP-HP, hôpital Cochin, université Paris Cité, unité d'oncologie thoracique, service de pneumologie, 75014 Paris, France
| | - Souhail Bennani
- AP-HP, hôpital Cochin, Université Paris Cité, service de radiologie, 75014 Paris, France
| | - Marie-Pierre Revel
- AP-HP, hôpital Cochin, Université Paris Cité, service de radiologie, 75014 Paris, France
| | - Marie Wislez
- AP-HP, hôpital Cochin, université Paris Cité, unité d'oncologie thoracique, service de pneumologie, 75014 Paris, France; Université de Paris, centre de recherche des cordeliers, sorbonne université, Inserm, Team Inflammation, Complement, and Cancer, 75006 Paris, France.
| |
Collapse
|
16
|
Balata H, Quaife SL, Craig C, Ryan DJ, Bradley P, Crosbie PAJ, Murray RL, Evison M. Early Diagnosis and Lung Cancer Screening. Clin Oncol (R Coll Radiol) 2022; 34:708-715. [PMID: 36175244 DOI: 10.1016/j.clon.2022.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
Lung cancer remains the most significant cause of cancer death, accounting for about 20% of all cancer-related mortality. A significant reason for this is delayed diagnosis, either due to lack of symptoms in early-stage disease or presentation with non-specific symptoms common with a broad range of alternative diagnoses. More is needed in terms of increasing public awareness, providing adequate healthcare professional education and implementing clinical pathways that improve the earlier diagnosis of symptomatic lung cancer. Low-dose computed tomography screening of high-risk, asymptomatic populations has been shown to reduce lung cancer mortality, with focus now shifting towards how best to implement lung cancer screening on a wider scale in a safe, efficient and cost-effective manner. For maximum benefit, efforts must be made to optimise uptake, especially among high-risk populations with significant socioeconomic deprivation, as well as successfully incorporate tobacco-dependency treatment. Quality assured programme management will be critical to minimising screening-related harms and adequately managing incidental findings. By undertaking the above, there can be optimism that lung cancer outcomes can be improved significantly in the near future.
Collapse
Affiliation(s)
- H Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - S L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Craig
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - D J Ryan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - P Bradley
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - P A J Crosbie
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R L Murray
- Academic Unit of Lifespan and Population Health, Faculty of Medicine & Health Sciences, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, UK
| | - M Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|