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Qian Y, Wang X, Huang X, Li J, Jin C, Chen J, Sha M. Bounded rationality in healthcare: unraveling the psychological factors behind patient satisfaction in China. Front Psychol 2024; 15:1296032. [PMID: 38605837 PMCID: PMC11008602 DOI: 10.3389/fpsyg.2024.1296032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Patient satisfaction is a crucial metric to gauge the quality of medical services, but the psychological factors influencing patient satisfaction remain insufficiently explored. Methods This study examines these psychological factors by applying the theory of bounded rationality to 1,442 inpatients in Hangzhou, China, whose data were collected using a questionnaire. One-way ANOVA, correlation analysis, and hierarchical regression were used to analyze patient satisfaction and its associated factors. Additionally, the path analysis of the structural equation model revealed the mechanisms behind the key psychological factors that influenced patient satisfaction. Results Medical risk perception, the social cognition of the medical environment, and social desirability bias had significant positive impacts on patient satisfaction. By contrast, negative emotions had a significant negative impact on patient satisfaction. Notably, patients' negative emotions had both a suppressive effect and a positive moderating effect on the relationship between medical risk perception and patient satisfaction. Similarly, social desirability bias had a suppressive effect on the correlation between the social cognition of the medical environment and patient satisfaction, albeit with a negative moderating effect. Discussion These results suggest that when evaluating and improving patient satisfaction, accounting only for the factors that directly influence medical service quality is insufficient, as the indirect and moderating effects of patients' negative emotions and the social cognition of the medical environment must also be considered. Medical service providers should thus address patients' negative emotions, establish good doctor-patient relationships, optimize service environments, provide managers with medical risk education and training on negative emotions, and prioritize patient-centered care. Additionally, the government and relevant health departments should optimize medical policies, enhance fairness and accessibility, and create a positive social cognitive environment through public education and awareness campaigns.
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Affiliation(s)
- Yu Qian
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Xiaohe Wang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xianhong Huang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jinwen Li
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Chen Jin
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jie Chen
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - MengYi Sha
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
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Rong F, Shi R, Hu L, Wang D, Lv X, Zhao Y. Impact of risk perception and disease cognition on the willingness to participate in screening for lung cancer in a high-risk population. Eur J Cancer Prev 2024; 33:141-151. [PMID: 37751366 DOI: 10.1097/cej.0000000000000843] [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: 09/28/2023]
Abstract
OBJECTIVE Risk perception and disease cognition may influence the efficiency of lung cancer screening by affecting the participation rate. There is still some uncertainty regarding the association between risk perception and disease cognition and how they affect participation in lung cancer screening. Therefore, we explored the influence of risk perception and disease cognition on the willingness to participate in screening among people at high risk of lung cancer. METHODS Subjects with high-risk factors for lung cancer were recruited in Lu'an City, Anhui Province, China. Questionnaires were used to determine their demographic characteristics, risk perception, disease cognition, and willingness to engage in screening. RESULTS Of the 1955 subjects with high risk factors for lung cancer, 1136 (58.12%) were willing to participate in lung cancer screening. Univariable and multivariable analyses showed that disease cognition ( adj OR = 2.012, 95% CI: 1.528-2.649, P = 0.000), cognitive risk ( adj OR = 7.661, 95% CI: 6.049-9.704, P = 0.000), and affective risk ( adj OR = 5.964, 95% CI: 4.552-7.815, P = 0.000) were significant factors in promoting screening participation. For those with moderate risk perception, improving disease cognition was a key approach to increase screening participation. CONCLUSION This study elucidated the relationship between various factors and lung cancer screening participation and proposed a feasible route for the screening implementation, providing a theoretical basis to further improve the participation rate and efficiency of lung cancer screening.
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Affiliation(s)
- Feng Rong
- Cancer center, Lu'an Hospital of Anhui Medical University, Lu'an, Anhui, China
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Walsh JME, Karliner L, Smith A, Leykin Y, Gregorich SE, Livaudais-Toman J, Velazquez AI, Lowenstein M, Kaplan CP. LungCARE: Encouraging Shared Decision-Making in Lung Cancer Screening-a Randomized Trial. J Gen Intern Med 2023; 38:3115-3122. [PMID: 37653203 PMCID: PMC10651593 DOI: 10.1007/s11606-023-08189-1] [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: 12/01/2022] [Accepted: 03/23/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Lung cancer screening (LCS) is recommended for individuals at high risk due to age and smoking history after a shared decision-making conversation. However, little is known about best strategies for incorporating shared decision-making, especially in a busy primary care setting. OBJECTIVE To develop a novel tool, Lung Cancer Assessment of Risk and Education (LungCARE) to guide LCS decisions among eligible primary care patients. DESIGN Pilot cluster randomized controlled trial of LungCARE versus usual care. PARTICIPANTS Patients of providers in a university primary care clinic, who met criteria for LCS. INTERVENTION Providers were randomized to LungCARE intervention or control. LungCARE participants completed a computer tablet-based video assessment of lung cancer educational needs in the waiting room prior to a primary care visit. Patient and provider both received a summary handout of patient concerns and responses. MAIN MEASURES All eligible patients completed baseline interviews by telephone. One week after the index visit, participants completed a follow-up telephone survey that assessed patient-physician discussion of LCS, referral to and scheduling of LCS, as well as LCS knowledge and acceptability of LungCARE. Two months after index visit, we reviewed patients' electronic health records (EHRs) for evidence of a shared decision-making conversation and referral to and receipt of LCS. KEY RESULTS A total of 66 participants completed baseline and follow-up visits (34: LungCARE; 32: usual care). Mean age was 65.9 (± 6.0). Based on EHR review, compared to usual care, LungCARE participants were more likely to have discussed LCS with their physicians (56% vs 25%; p = 0.04) and to be referred to LCS (44% vs 13%; p < 0.02). Intervention participants were also more likely to complete LCS (32% vs 13%; p < 0.01) and had higher knowledge scores (mean score 6.5 (± 1.7) vs 5.5 (± 1.4; p < 0.01). CONCLUSIONS LungCARE increased discussion, referral, and completion of LCS and improved LCS knowledge. CLINICAL TRIAL REGISTRATION NCT03862001.
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Affiliation(s)
- Judith M E Walsh
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
- Multi-Ethnic Health Equity Research Center, UCSF, San Francisco, CA, USA.
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA.
| | - Leah Karliner
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Multi-Ethnic Health Equity Research Center, UCSF, San Francisco, CA, USA
| | - Ashley Smith
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Yan Leykin
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Steven E Gregorich
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Multi-Ethnic Health Equity Research Center, UCSF, San Francisco, CA, USA
| | - Jennifer Livaudais-Toman
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Ana I Velazquez
- Multi-Ethnic Health Equity Research Center, UCSF, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- Department of Medicine, Division of Hematology/Oncology, UCSF, San Francisco, CA, USA
| | - Margaret Lowenstein
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Celia P Kaplan
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Multi-Ethnic Health Equity Research Center, UCSF, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
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Fix BV, Wackowski OA, Sharma A, Diaz D, Bansal-Travers M, Cummings KM, Rees VW, Hatsukami DK, O'Connor RJ. Perceived Truthfulness of Reduced Lung Cancer Risk Advertising Claims Influences Consumers' Intention to try and to Purchase Snus. Tob Use Insights 2023; 16:1179173X231206042. [PMID: 37842177 PMCID: PMC10576425 DOI: 10.1177/1179173x231206042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
The objective of the current study was to evaluate the impact of a reduced risk claim about lung cancer, presented in various formats, on smokers' and non-smokers' interest in trying Camel Snus and intention to purchase Camel Snus. We varied claim formats by varying advertising messages for Camel Snus in 4 ways (1) text only; (2) bar chart; (3) text/testimonial; and (4) bar chart/testimonial. 3001 participants were recruited from a web-based consumer specialty panel via an email invitation. In 2015, a second study was conducted, using similar methods, where 3001 additional participants were recruited. Overall, controlling for other factors, the presence of an MRTP claim was not significantly related to interest in trying snus [X2 (4) = 8.567, P = .073], or purchase intentions [X2 (4) = 1.148, P = .887]. Relative to a control ad where no explicit health risk claim was made, the Graphic + testimonial [OR = 1.29] or Text only [OR = 1.41] claims did significantly increase interest in trying Camel Snus. However, the adverting format did not impact interest in purchasing Camel Snus. While current smokeless tobacco users (95%) and smokers (59%) expressed interest in trying Camel Snus, non-tobacco users (7%) showed low interest in trying or purchasing Camel Snus (P < .001). Interest in trying Camel Snus was stronger in younger smokers compared to older smokers. Among current smokers, worry about lung cancer (the key focus of the reduced risk claim) was not associated with interest in trying Camel Snus or with purchase intention [OR = .91, 95% CI: .72, 1.14] or intention to purchase snus [OR = 1.07, 95% CI: .86, 1.32]. Future research should evaluate how claim and messaging formats influence perceived truthfulness and whether this effect differs among sub-groups of consumers, such as adolescents, those with tobacco-related disease, and former smokers. It will also be helpful to understand whether perceptions of ad truthfulness result in changes in product use patterns over time. In sum, giving people truthful, credible information about relative product risks, such as through authorized MRTP claims, is important, but such information is likely insufficient to get smokers to switch.
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Affiliation(s)
- Brian V Fix
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Olivia A Wackowski
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Akshika Sharma
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Destiny Diaz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Vaughan W Rees
- Center for Global Tobacco Control, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Foley KL, Dressler EV, Weaver KE, Sutfin EL, Miller DP, Bellinger C, Kittel C, Stone RJ, Petty WJ, Land SR, Spangler JG, Lesser GJ, Chiles C. The Optimizing Lung Screening Trial (WF-20817CD): Multicenter Randomized Effectiveness Implementation Trial to Increase Tobacco Use Cessation for Individuals Undergoing Lung Screening. Chest 2023; 164:531-543. [PMID: 36931460 PMCID: PMC10410244 DOI: 10.1016/j.chest.2023.03.013] [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: 11/18/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND One-half of all people who undergo lung cancer screening (LCS) currently use tobacco. However, few published studies have explored how to implement effective tobacco use treatment optimally during the LCS encounter. RESEARCH QUESTION Was the Optimizing Lung Screening intervention (OaSiS) effective at reducing tobacco use among patients undergoing LCS in community-based radiology facilities? STUDY DESIGN AND METHODS The OaSiS study (National Cancer Institute [NCI] Protocol No.: WF-20817CD) is an effectiveness-implementation hybrid type II cluster randomized trial of radiology facilities conducted in partnership with the Wake Forest National Cancer Institute Community Oncology Research Program research base. We randomly assigned 26 radiology facilities in 20 states to the intervention or usual care group. Staff at intervention facilities implemented a variety of strategies targeting the clinic and care team. Eligible patient participants were aged 55 to 77 years undergoing LCS and currently using tobacco. Of 1,094 who completed a baseline survey (523 intervention group, 471 control group) immediately before the LCS appointment, 956 completed the 6-month follow-up (86% retention rate). Fifty-four percent of those who reported not using tobacco at 6 months completed biochemical verification via mailed cotinine assay. Generalized estimating equation marginal models were used in an intention-to-treat analysis to predict 7-day tobacco use abstinence. RESULTS The average self-reported abstinence among participants varied considerably across facilities (0%-27%). Despite a significant increase in average cessation rate over time (0% at baseline to approximately 13% at 6 months; P < .0001), tobacco use did not differ by trial group at 14 days (OR, 0.96; 95% CI, 0.46-1.99; P = .90), 3 months (OR, 1.17; 95% CI, 0.69-1.99; P = .56), or 6 months (OR, 0.97; 95% CI, 0.65-1.43; P = .87). INTERPRETATION The OaSiS trial participants showed a significant reduction in tobacco use over time, but no difference by trial arm was found. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03291587; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Kristie L Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kathryn E Weaver
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - David P Miller
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christina Bellinger
- Department of Pulmonology and Critical Care, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Carol Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Rebecca J Stone
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - W Jeffrey Petty
- Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Stephanie R Land
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - John G Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Glenn J Lesser
- Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Caroline Chiles
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC
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Bricker JB, Westmaas JL, Ostroff JS, Mull KE, Sullivan BM, Santiago-Torres M. Efficacy of smartphone applications to help cancer patients quit smoking: Protocol of the Quit2Heal randomized controlled trial. Contemp Clin Trials 2023; 129:107180. [PMID: 37040817 PMCID: PMC10283347 DOI: 10.1016/j.cct.2023.107180] [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: 02/09/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/13/2023]
Abstract
Cigarette smoking is highly prevalent among cancer patients in the United States (US), with up to half of cancer patients smoking at the time of their initial cancer diagnosis. However, evidence-based cessation programs are rarely implemented in oncology care, and smoking is not consistently treated in cancer treatment settings. Consequently, there is an urgent need for accessible and efficacious cessation treatments that are uniquely tailored to the needs of cancer patients. Here we describe the design and implementation of a randomized controlled trial (RCT) testing the efficacy of a smartphone app (Quit2Heal) versus a US Clinical Practice Guidelines-based app (QuitGuide) for smoking cessation among a planned sample of 422 cancer patients. Quit2Heal is designed to address cancer-related shame, stigma, depression, anxiety, and knowledge about the consequences of smoking/quitting. Quit2Heal is based on the principles of Acceptance and Commitment Therapy, a behavioral therapy that teaches skills for accepting cravings to smoke without smoking, values-driven motivation to quit, and preventing relapse. The primary aim of the RCT is to determine whether Quit2Heal has significantly higher self-reported 30-day point prevalence abstinence at 12 months relative to QuitGuide. The trial will also determine whether Quit2Heal's effect on cessation is (1) mediated by improvements in cancer-related shame, stigma, depression, anxiety, and knowledge about the consequences of smoking/quitting; and (2) moderated by baseline factors (e.g., cancer type, stage, time since diagnosis). If successful, Quit2Heal will offer a more efficacious, broadly scalable smoking cessation treatment that could be implemented alongside existing oncology care, thereby improving cancer outcomes.
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington, Department of Psychology, Seattle, WA, USA
| | | | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering, New York City, NY, USA
| | - Kristin E Mull
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Brianna M Sullivan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
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Lowenstein LM, Shih YCT, Minnix J, Lopez-Olivo MA, Maki KG, Kypriotakis G, Leal VB, Shete SS, Fox J, Nishi SP, Cinciripini PM, Volk RJ. A protocol for a cluster randomized trial of care delivery models to improve the quality of smoking cessation and shared decision making for lung cancer screening. Contemp Clin Trials 2023; 128:107141. [PMID: 36878389 PMCID: PMC10164095 DOI: 10.1016/j.cct.2023.107141] [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: 08/03/2022] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Patients eligible for lung cancer screening (LCS) are those at high risk of lung cancer due to their smoking histories and age. While screening for LCS is effective in lowering lung cancer mortality, primary care providers are challenged to meet beneficiary eligibility for LCS from the Centers for Medicare & Medicaid Services, including a patient counseling and shared decision-making (SDM) visit with the use of patient decision aid(s) prior to screening. METHODS We will use an effectiveness-implementation type I hybrid design to: 1) identify effective, scalable smoking cessation counseling and SDM interventions that are consistent with recommendations, can be delivered on the same platform, and are implemented in real-world clinical settings; 2) examine barriers and facilitators of implementing the two approaches to delivering smoking cessation and SDM for LCS; and 3) determine the economic implications of implementation by assessing the healthcare resources required to increase smoking cessation for the two approaches by delivering smoking cessation within the context of LCS. Providers from different healthcare organizations will be randomized to usual care (providers delivering smoking cessation and SDM on site) vs. centralized care (smoking cessation and SDM delivered remotely by trained counselors). The primary trial outcomes will include smoking abstinence at 12-weeks and knowledge about LCS measured at 1-week after baseline. CONCLUSION This study will provide important new evidence about the effectiveness and feasibility of a novel care delivery model for addressing the leading cause of lung cancer deaths and supporting high-quality decisions about LCS. CLINICALTRIALS GOV PROTOCOL REGISTRATION NCT04200534 TRIAL REGISTRATION: ClinicalTrials.govNCT04200534.
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Affiliation(s)
- Lisa M Lowenstein
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Ya-Chen Tina Shih
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jennifer Minnix
- Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Maria A Lopez-Olivo
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Kristin G Maki
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - George Kypriotakis
- Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Viola B Leal
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay S Shete
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - James Fox
- Pulmonary & Critical Care Medicine, The University of Texas Health East Texas, Tyler, TX, USA.
| | - Shawn P Nishi
- Pulmonary & Critical Care Medicine, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Paul M Cinciripini
- Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Robert J Volk
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Tu J, Uretsky E, Kang L, Yuan J, Zhong J. 'It's not within my control': local explanations for the development of lung cancer in China. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2022; 31:326-341. [PMID: 35731936 DOI: 10.1080/14461242.2022.2085056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
Rates of lung cancer in China are rising rapidly, creating an urgent need for prevention. Effective prevention measures require understanding local beliefs and perceptions about the risk for developing lung cancer. This article explores the explanations that Chinese lung cancer patients and their families give about the aetiology of their disease. Fifty-three interviews were conducted among lung cancer patients and their family members at a large tumour hospital in southern China. Participants presented a complex multifactorial explanation of lung cancer associating their disease with risks like tobacco use, occupational exposures, environmental pollution, lifestyle changes, and personal characters. While these are all standard risk factors commonly associated with lung cancer, participants presented them within a larger contextual frame of structural issues that impede their ability to change their behaviours. Using a social ecological model, we demonstrate how China's socio-cultural environment shapes assumptions about the risk of lung cancer with particular reference to work, home, social situations, and the natural environment.
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Affiliation(s)
- Jiong Tu
- School of Sociology and Anthropology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Elanah Uretsky
- East Asian Studies, Brandeis University, Waltham, MA, USA
| | - Lu Kang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Juan Yuan
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Jiudi Zhong
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
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Bonney A, Malouf R, Marchal C, Manners D, Fong KM, Marshall HM, Irving LB, Manser R. Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality. Cochrane Database Syst Rev 2022; 8:CD013829. [PMID: 35921047 PMCID: PMC9347663 DOI: 10.1002/14651858.cd013829.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lung cancer is the most common cause of cancer-related death in the world, however lung cancer screening has not been implemented in most countries at a population level. A previous Cochrane Review found limited evidence for the effectiveness of lung cancer screening with chest radiography (CXR) or sputum cytology in reducing lung cancer-related mortality, however there has been increasing evidence supporting screening with low-dose computed tomography (LDCT). OBJECTIVES: To determine whether screening for lung cancer using LDCT of the chest reduces lung cancer-related mortality and to evaluate the possible harms of LDCT screening. SEARCH METHODS We performed the search in collaboration with the Information Specialist of the Cochrane Lung Cancer Group and included the Cochrane Lung Cancer Group Trial Register, Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, current issue), MEDLINE (accessed via PubMed) and Embase in our search. We also searched the clinical trial registries to identify unpublished and ongoing trials. We did not impose any restriction on language of publication. The search was performed up to 31 July 2021. SELECTION CRITERIA: Randomised controlled trials (RCTs) of lung cancer screening using LDCT and reporting mortality or harm outcomes. DATA COLLECTION AND ANALYSIS: Two review authors were involved in independently assessing trials for eligibility, extraction of trial data and characteristics, and assessing risk of bias of the included trials using the Cochrane RoB 1 tool. We assessed the certainty of evidence using GRADE. Primary outcomes were lung cancer-related mortality and harms of screening. We performed a meta-analysis, where appropriate, for all outcomes using a random-effects model. We only included trials in the analysis of mortality outcomes if they had at least 5 years of follow-up. We reported risk ratios (RRs) and hazard ratios (HRs), with 95% confidence intervals (CIs) and used the I2 statistic to investigate heterogeneity. MAIN RESULTS: We included 11 trials in this review with a total of 94,445 participants. Trials were conducted in Europe and the USA in people aged 40 years or older, with most trials having an entry requirement of ≥ 20 pack-year smoking history (e.g. 1 pack of cigarettes/day for 20 years or 2 packs/day for 10 years etc.). One trial included male participants only. Eight trials were phase three RCTs, with two feasibility RCTs and one pilot RCT. Seven of the included trials had no screening as a comparison, and four trials had CXR screening as a comparator. Screening frequency included annual, biennial and incrementing intervals. The duration of screening ranged from 1 year to 10 years. Mortality follow-up was from 5 years to approximately 12 years. None of the included trials were at low risk of bias across all domains. The certainty of evidence was moderate to low across different outcomes, as assessed by GRADE. In the meta-analysis of trials assessing lung cancer-related mortality, we included eight trials (91,122 participants), and there was a reduction in mortality of 21% with LDCT screening compared to control groups of no screening or CXR screening (RR 0.79, 95% CI 0.72 to 0.87; 8 trials, 91,122 participants; moderate-certainty evidence). There were probably no differences in subgroups for analyses by control type, sex, geographical region, and nodule management algorithm. Females appeared to have a larger lung cancer-related mortality benefit compared to males with LDCT screening. There was also a reduction in all-cause mortality (including lung cancer-related) of 5% (RR 0.95, 95% CI 0.91 to 0.99; 8 trials, 91,107 participants; moderate-certainty evidence). Invasive tests occurred more frequently in the LDCT group (RR 2.60, 95% CI 2.41 to 2.80; 3 trials, 60,003 participants; moderate-certainty evidence). However, analysis of 60-day postoperative mortality was not significant between groups (RR 0.68, 95% CI 0.24 to 1.94; 2 trials, 409 participants; moderate-certainty evidence). False-positive results and recall rates were higher with LDCT screening compared to screening with CXR, however there was low-certainty evidence in the meta-analyses due to heterogeneity and risk of bias concerns. Estimated overdiagnosis with LDCT screening was 18%, however the 95% CI was 0 to 36% (risk difference (RD) 0.18, 95% CI -0.00 to 0.36; 5 trials, 28,656 participants; low-certainty evidence). Four trials compared different aspects of health-related quality of life (HRQoL) using various measures. Anxiety was pooled from three trials, with participants in LDCT screening reporting lower anxiety scores than in the control group (standardised mean difference (SMD) -0.43, 95% CI -0.59 to -0.27; 3 trials, 8153 participants; low-certainty evidence). There were insufficient data to comment on the impact of LDCT screening on smoking behaviour. AUTHORS' CONCLUSIONS: The current evidence supports a reduction in lung cancer-related mortality with the use of LDCT for lung cancer screening in high-risk populations (those over the age of 40 with a significant smoking exposure). However, there are limited data on harms and further trials are required to determine participant selection and optimal frequency and duration of screening, with potential for significant overdiagnosis of lung cancer. Trials are ongoing for lung cancer screening in non-smokers.
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Affiliation(s)
- Asha Bonney
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Reem Malouf
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | | | - David Manners
- Respiratory Medicine, Midland St John of God Public and Private Hospital, Midland, Australia
| | - Kwun M Fong
- Thoracic Medicine Program, The Prince Charles Hospital, Brisbane, Australia
- UQ Thoracic Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Henry M Marshall
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Louis B Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Renée Manser
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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10
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Goshe BM, Rasmussen AW, Wagner LI, Sicks JD, Gareen IF, Carlos RC, Herman BA, Walter AW, Regan S, Levy DE, Mahon I, Muzikansky A, Neil JM, Lui M, Dilip D, Malloy L, Gonzalez I, Finkelstein-Fox L, McCann C, Perez E, Ostroff JS, Park ER. Study protocol for a hybrid type 1 effectiveness-implementation trial testing virtual tobacco treatment in oncology practices [Smokefree Support Study 2.0]. BMC Public Health 2022; 22:1359. [PMID: 35841024 PMCID: PMC9284951 DOI: 10.1186/s12889-022-13631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Persistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet an evidence-based tobacco use intervention has not been well-integrated into cancer care in community oncology settings. This paper describes the protocol of a nation-wide clinical trial conducted by the ECOG-ACRIN National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base to assess the effectiveness of a virtual tobacco treatment intervention and the process of implementing tobacco treatment in NCORP community oncology settings. METHODS/DESIGN This two-arm, multisite (n: 49 NCORP sites) hybrid type 1 effectiveness-implementation randomized controlled trial compares the effectiveness of a Virtual Intervention Treatment (VIT) versus an Enhanced Usual Control (EUC) among English and Spanish speaking patients recently diagnosed with cancer, reporting current smoking and receiving care at a participating NCORP Community or Minority/Underserved Site. The VIT includes up to 11 virtual counseling sessions with a tobacco treatment specialist and up to 12 weeks of nicotine replacement therapy (NRT). The EUC arm receives a referral to the NCI Quitline. The primary study outcome is biochemically confirmed 7-day point prevalence smoking abstinence. Moderators of treatment effect will be assessed. The study evaluates implementation processes from participating NCORP site staff via survey, administrative, and focus group data, including reach, acceptability, appropriateness, fidelity, feasibility, adoption, cost and sustainability outcomes. DISCUSSION This trial will generate findings about the effectiveness of an evidence-based virtual tobacco treatment intervention targeting patients diagnosed with cancer and illuminate barriers and facilitators that influence implementing tobacco treatment into community oncology settings nationally. In the era of COVID-19, virtual care solutions are vital for maximizing access and utilization of tobacco treatment delivery. TRIAL REGISTRATION ClinicalTrials.gov (NCT03808818) on January 18th, 2019; Last update posted: May 21st, 2020.
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Affiliation(s)
- Brett M. Goshe
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Autumn W. Rasmussen
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Lynne I. Wagner
- grid.241167.70000 0001 2185 3318Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - JoRean D. Sicks
- grid.40263.330000 0004 1936 9094ECOG-ACRIN Biostatistics Center, Brown University, Providence, RI USA
| | - Ilana F. Gareen
- grid.40263.330000 0004 1936 9094Department of Epidemiology and the Center for Statistical Sciences, Brown University School of Public Health, Providence, RI USA
| | - Ruth C. Carlos
- grid.214458.e0000000086837370Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Benjamin A. Herman
- grid.40263.330000 0004 1936 9094ECOG-ACRIN Biostatistics Center, Brown University, Providence, RI USA
| | - Angela Wangari Walter
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.225262.30000 0000 9620 1122Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA USA
| | - Susan Regan
- grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Douglas E. Levy
- grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Irene Mahon
- grid.417949.60000 0004 0638 1385 ECOG-ACRIN Cancer Research Group, American College of Radiology, Philadelphia, PA USA
| | - Alona Muzikansky
- grid.32224.350000 0004 0386 9924Biostatistics Center, Massachusetts General Hospital, Boston, MA USA
| | - Jordan M. Neil
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.266902.90000 0001 2179 3618Department of Family and Preventative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Michelle Lui
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Deepika Dilip
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Laura Malloy
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Irina Gonzalez
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Lucy Finkelstein-Fox
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Caitlin McCann
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Elissa Perez
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Jamie S. Ostroff
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Elyse R. Park
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
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11
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Risk perception and disease knowledge in attendees of a community-based lung cancer screening programme. Lung Cancer 2022; 168:1-9. [DOI: 10.1016/j.lungcan.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/06/2022] [Accepted: 04/04/2022] [Indexed: 12/24/2022]
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12
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Bold KW, Cannon S, Ford BB, Neveu S, Sather P, Toll BA, Fucito LM. Examining Tobacco Treatment Perceptions and Barriers among Black versus Non-Black Adults Attending Lung Cancer Screening. Cancer Prev Res (Phila) 2022; 15:327-333. [PMID: 35063942 PMCID: PMC9064926 DOI: 10.1158/1940-6207.capr-21-0398] [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: 08/20/2021] [Revised: 12/05/2021] [Accepted: 01/18/2022] [Indexed: 11/16/2022]
Abstract
The US Preventive Services Task Force recommends annual lung cancer screening for patients at high risk based on age and smoking history. Understanding the characteristics of patients attending lung cancer screening, including potential barriers to quitting smoking, may inform ways to engage these high-risk patients in tobacco treatment and address health disparities. Patients attending lung cancer screening who currently smoke cigarettes completed a survey at Smilow Cancer Hospital at Yale-New Haven (N = 74) and the Medical University of South Carolina (N = 73) at the time of their appointment. The survey assessed demographics, smoking history, and perceptions and concerns about quitting smoking. Patients were 55 to 76 years old (mean = 63.3, SD = 5.3), N = 64 (43.5%) female, and N = 31 (21.1%) non-Hispanic Black. Patients smoked 16.3 cigarettes per day on average (SD = 9.2) and rated interest in quitting smoking in the next month as moderate (mean = 5.6, SD = 3.1, measured from 0 = "very definitely no" to 10 = "very definitely yes"). The most frequently endorsed concerns about quitting smoking were missing smoking (70.7%), worry about having strong urges to smoke (63.9%), and concerns about withdrawal symptoms (59.9%). In comparison with other races/ethnicities, Black patients were less likely to report concerns about withdrawal symptoms and more likely to report smoking less now and perceiving no need to quit. Findings identified specific barriers for tobacco treatment and differences by race/ethnicity among patients attending lung cancer screening, including concerns about withdrawal symptoms and perceived need to quit. Identifying ways to promote tobacco treatment is important for reducing morbidity and mortality among this high-risk population. PREVENTION RELEVANCE The current study examines patient characteristics and tobacco treatment perceptions and barriers among patients attending lung cancer screening who continue to smoke cigarettes that may help inform ways to increase treatment engagement and address tobacco-related health disparities to reduce morbidity and mortality from smoking.
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Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Sydney Cannon
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Bennie B Ford
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Susan Neveu
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Polly Sather
- Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin A Toll
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
- Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut
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13
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Dillard AJ, Lester J, Holyfield H. Associations between COVID-19 risk perceptions, behavior intentions and worry. HEALTH PSYCHOLOGY REPORT 2022; 10:139-148. [PMID: 38084329 PMCID: PMC10681832 DOI: 10.5114/hpr.2022.114477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/31/2022] [Accepted: 03/02/2022] [Indexed: 02/11/2024] Open
Abstract
BACKGROUND Risk perceptions are central to health behavior, but some types of risk perceptions may be more strongly connected to behavior than others. This research examined different risk perceptions of COVID-19 and their respective associations with behavior intentions and worry. PARTICIPANTS AND PROCEDURE U.S. college students (N = 248) and general adults (N = 300) reported their risk perceptions of COVID-19 - including absolute numerical, verbal, comparative, and feelings of risk - as well as their worry and intentions to do things such as get vaccinated. RESULTS Although most risk perceptions related to intentions and worry, feelings of risk were the most strongly and consistently related. The associations showed that the higher people's feelings of risk were, the greater were their intentions and worry. CONCLUSIONS Assessing feelings of risk of COVID-19 may provide the best insight into people's perceived threat of this virus.
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Affiliation(s)
- Amanda J. Dillard
- Department of Psychology, Grand Valley State University, Allendale, Michigan, United States
| | - Jenna Lester
- Department of Psychology, Grand Valley State University, Allendale, Michigan, United States
| | - Hope Holyfield
- Department of Psychology, Grand Valley State University, Allendale, Michigan, United States
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14
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Williams RM, Cordon M, Eyestone E, Smith L, Luta G, McKee BJ, Regis SM, Abrams DB, Niaura RS, Stanton CA, Parikh V, Taylor KL. Improved motivation and readiness to quit shortly after lung cancer screening: Evidence for a teachable moment. Cancer 2022; 128:1976-1986. [PMID: 35143041 PMCID: PMC9038674 DOI: 10.1002/cncr.34133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND For patients at high risk for lung cancer, screening using low-dose computed tomography (lung cancer screening [LCS]) is recommended. The purpose of this study was to examine whether screening may serve as a teachable moment for smoking-related outcomes. METHODS In a smoking-cessation trial, participants (N = 843) completed 2 phone interviews before randomization: before LCS (T0) and after LCS (T1). By using logistic and linear regression, the authors examined teachable moment variables (perceived risk, lung cancer worry) and outcomes (readiness, motivation, and cigarettes per day [CPD]). RESULTS Participants were a mean ± SD age of 63.7 ± 5.9 years, had 47.8 ± 7.1 pack-years of smoking, 35.2% had a high school diploma or General Educational Development (high school equivalency) degree or less, and 42.3% were undergoing their first scan. Between T0 and T1, 25.7% of participants increased readiness to quit, 9.6% decreased readiness, and 64.7% reported no change (P < .001). Motivation to quit increased (P < .05) and CPD decreased between assessments (P < .001), but only 1.3% self-reported quitting. Compared with individuals who reported no lung cancer worry/little worry, extreme worry was associated with readiness to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.1-3.0) and with higher motivation (b = 0.83; P < .001) at T1. Individuals undergoing a baseline (vs annual) scan were more ready to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.3-2.5). CONCLUSIONS During the brief window between registering for LCS and receiving the results, the authors observed that very few participants quit smoking, but a significant proportion improved on readiness and motivation to quit, particularly among individuals who were undergoing their first scan and those who were extremely worried about lung cancer. These results indicate that providing evidence-based tobacco treatment can build upon this teachable moment.
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Affiliation(s)
- Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Marisa Cordon
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Ellie Eyestone
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, District of Columbia
| | - Brady J McKee
- Division of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Shawn M Regis
- Division of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David B Abrams
- New York University School of Global Public Health, New York, New York
| | - Raymond S Niaura
- New York University School of Global Public Health, New York, New York
| | | | - Vicky Parikh
- Department of Population Health, MedStar Shah Medical Group, Hollywood, Maryland
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
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15
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Baggett TP, Barbosa Teixeira J, Rodriguez EC, Anandakugan N, Sporn N, Chang Y, Percac-Lima S, Park ER, Rigotti NA. Patient navigation to promote lung cancer screening in a community health center for people experiencing homelessness: Protocol for a pragmatic randomized controlled trial. Contemp Clin Trials 2022; 113:106666. [PMID: 34971796 DOI: 10.1016/j.cct.2021.106666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/13/2021] [Accepted: 12/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Lung cancer is a major cause of death among people experiencing homelessness, with mortality rates more than double those in the general population. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) could reduce lung cancer deaths in this population, although the circumstances of homelessness present multiple barriers to LCS LDCT completion. Patient navigation is a promising strategy for overcoming these barriers. METHODS The Investigating Navigation to Help Advance Lung Equity (INHALE) Study is a pragmatic randomized controlled trial of patient navigation for LCS among individuals receiving primary care at Boston Health Care for the Homeless Program (BHCHP). Three hundred BHCHP patients who meet Medicare/Medicaid criteria for LCS will be randomized 2:1 to usual care with (n = 200) or without (n = 100) LCS navigation. Following a structured, theory-based protocol, the patient navigator assists with each step in the LCS process, providing lung cancer education, facilitating shared decision-making visits with primary care providers (PCPs), assisting in making and attending LCS LDCT appointments, arranging follow-up when needed, and offering tobacco cessation support for smokers. The primary outcome is receipt of LCS LDCT at 6 months. Using a sequential explanatory mixed methods approach, qualitative interviews with participants and PCPs will aid in interpreting and contextualizing the trial results. DISCUSSION This trial will produce the first experimental evidence on patient navigation for cancer screening in a homeless health care setting. Results could inform cancer health equity efforts at the 299 Health Care for the Homeless programs that serve over 900,000 patients annually in the US.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Institute for Research, Quality & Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, United States of America.
| | - Joana Barbosa Teixeira
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Elijah C Rodriguez
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; New York University Grossman School of Medicine, New York, NY, United States of America
| | - Nillani Anandakugan
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Nora Sporn
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Elyse R Park
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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16
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Anderson SL, Livingston MD, Higgins KA, McBride CM. Predictors of Discussing Lung Cancer Screening with a Health Care Provider Among Current and Former Smokers in HINTS: A Secondary Data Analysis. Cancer Control 2022; 29:10732748221130567. [PMID: 36171178 PMCID: PMC9523846 DOI: 10.1177/10732748221130567] [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: 11/16/2022] Open
Abstract
Introduction Lung cancer screening is greatly underutilized among those who may benefit from early detection. Methods We analysed data from a subsample (n = 929) of the 2020 Health Information National Trends Survey. We tested multivariable logistic regression models of associations of cancer worry, information insufficiency, and perceived information gathering capacity with reports of having discussed lung cancer screening with a health care provider. Results Among former smokers, no factors were associated significantly with lung cancer screening information seeking. However, for current smokers, extreme cancer worry was positively and significantly associated with having discussed lung cancer screening with a health care provider (OR: 12.95; 95% CI: 2.11, 79.39). Conclusion To increase uptake of lung cancer screening, public health campaigns and healthcare providers will face the dual challenge of increasing perceived need for screening among former smokers while directing current smokers with high levels of worry to see the benefits of early detection.
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Affiliation(s)
- Shacoria L Anderson
- Department of Behavioral, Social and Health Education Sciences, 25798Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Melvin D Livingston
- Department of Behavioral, Social and Health Education Sciences, 25798Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristin A Higgins
- Department of Radiation Oncology, 189275Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Colleen M McBride
- Department of Behavioral, Social and Health Education Sciences, 25798Rollins School of Public Health, Emory University, Atlanta, GA, USA
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17
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Quaife SL, Waller J, Dickson JL, Brain KE, Kurtidu C, McCabe J, Hackshaw A, Duffy SW, Janes SM. Psychological Targets for Lung Cancer Screening Uptake: A Prospective Longitudinal Cohort Study. J Thorac Oncol 2021; 16:2016-2028. [PMID: 34403828 DOI: 10.1016/j.jtho.2021.07.025] [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: 06/23/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Low uptake of low-dose computed tomography lung cancer screening by high-risk groups compromises its effectiveness and equity as a population-level early detection strategy. Numerous psychological factors are implicated qualitatively or retrospectively, but prospective data are needed to validate their associations with uptake behavior and specify psychological targets for intervention. METHODS This is a prospective, longitudinal cohort study evaluating psychological correlates of lung cancer screening uptake. Ever-smokers (aged 55-77 y) were invited to a lung health check, at which low-dose computed tomography screening was offered through the SUMMIT Study-a multicenter screening implementation trial. One week after their screening invitation, 44,000 invitees were mailed the self-regulatory questionnaire for lung cancer screening. Regression analyses evaluated the constructs' associations with uptake (telephoning for an appointment) and sociodemographic characteristics. RESULTS Higher odds of uptake were associated with both positive and negative perceptions. Positive perceptions included lung cancer controllability, benefits of early diagnosis, improved survival when lung cancer is detected early, willingness to be treated, and believing smoking cessation is effective in reducing risk. Negative perceptions included a higher lung cancer risk perception, negative beliefs about the consequences of lung cancer, perceiving lung cancer as stigmatized, and a negative emotional response. Although current smokers held the highest risk perceptions, they also reported negative perceptions that could undermine how they behave in response to their risk. CONCLUSIONS Interventions to improve uptake should focus on changing perceptions that affect how an individual reacts when they believe their risk of lung cancer is high.
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Affiliation(s)
- Samantha L Quaife
- Wolfson Institute of Population Health, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, United Kingdom
| | - Kate E Brain
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Clara Kurtidu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John McCabe
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, United Kingdom
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, Cancer Institute, University College London, London, United Kingdom
| | - Stephen W Duffy
- Wolfson Institute of Population Health, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, United Kingdom
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18
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Warner ET, Park ER, Luberto CM, Rabin J, Perez GK, Ostroff JS. Internalized stigma among cancer patients enrolled in a smoking cessation trial: The role of cancer type and associations with psychological distress. Psychooncology 2021; 31:753-760. [PMID: 34797953 DOI: 10.1002/pon.5859] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Cancer patients who smoke may experience significant stigma due both to their disease, and negative attitudes and beliefs regarding smoking. We investigated whether internalized stigma differed between currently smoking cancer patients diagnosed with lung or head and neck cancers, other smoking related cancers, and non smoking-related cancers, and whether internalized stigma was associated with psychological distress. METHODS This cross-sectional analysis used baseline data on 293 participants enrolled in a multi-site randomized smoking cessation intervention trial of patients with recently diagnosed cancer. Internalized stigma was assessed using five Internalized Shame items from the Social Impact of Disease Scale. Smoking-related cancers included lung, head and neck, esophageal, bladder, kidney, liver, pancreatic, colorectal, anal, small intestinal, gastric, and cervical. We used multivariable linear regression to examine whether mean internalized stigma levels differed between individuals with lung and head and neck cancers, other smoking-related cancers, and non smoking-related cancers, adjusting for potential confounders. We further examined the association of internalized stigma with depression, anxiety, and perceived stress, overall and among cancer type groups. RESULTS Thirty-nine percent of participants were diagnosed with lung or head and neck cancer, 21% with another smoking-related cancer, and 40% with a non smoking-related cancer. In multivariable-adjusted models, participants with lung or head and neck cancers (11.6, 95% confidence intervals (CI) = 10.8-12.2; p < 0.0001) or other smoking-related cancers (10.7, 95% CI = 9.8-11.7; p = 0.03) had higher mean internalized stigma scores compared to those non-smoking-related cancers (9.3, 95% CI = 8.6-10.0). We observed similar positive associations between internalized stigma and depressive symptoms, anxiety, and perceived stress among participants with smoking-related and non smoking-related cancers. CONCLUSIONS Among smokers, those with smoking-related cancers experienced the highest levels of internalized stigma, and greater internalized stigma was associated with greater psychological distress across cancer types. Providers should assess patients for internalized and other forms of stigma, refer patients for appropriate psychosocial support services, and address stigma in smoking cessation programs.
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Affiliation(s)
- Erica T Warner
- Clinical Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Health Promotion and Resiliency Intervention Research Program, Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Christina M Luberto
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Health Promotion and Resiliency Intervention Research Program, Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julia Rabin
- Health Promotion and Resiliency Intervention Research Program, Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Giselle K Perez
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Health Promotion and Resiliency Intervention Research Program, Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Jamie S Ostroff
- Memorial Sloan-Kettering Cancer Center, Behavioral Sciences, New York, New York, USA
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19
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Neil JM, Chang Y, Goshe B, Rigotti N, Gonzalez I, Hawari S, Ballini L, Haas JS, Marotta C, Wint A, Harris K, Crute S, Flores E, Park ER. A Web-Based Intervention to Increase Smokers' Intentions to Participate in a Cessation Study Offered at the Point of Lung Screening: Factorial Randomized Trial. JMIR Form Res 2021; 5:e28952. [PMID: 34255651 PMCID: PMC8280830 DOI: 10.2196/28952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/25/2021] [Accepted: 05/16/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch. OBJECTIVE The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study. METHODS Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study. RESULTS A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (P=.12 and P=.61). In the multivariable model, quit importance (P<.001), perceived message relevance (P<.001), and affective risk response (ie, worry about developing lung cancer; P<.001) were significant predictors of intent to participate. The benefits of quitting frame significantly increased affective risk response (Meanbenefits 2.60 vs Meanrisk 2.40; P=.03), which mediated the relationship between message frame and intent to participate (b=0.24; 95% CI 0.01-0.47; P=.03). CONCLUSIONS This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study.
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Affiliation(s)
- Jordan M Neil
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Yuchiao Chang
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Brett Goshe
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Nancy Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Irina Gonzalez
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Saif Hawari
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lauren Ballini
- Department of Community Health, Tufts University, Medford, MA, United States
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Caylin Marotta
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Amy Wint
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kim Harris
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sydney Crute
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Efren Flores
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Elyse R Park
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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20
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Barta JA, Shusted CS, Ruane B, Pimpinelli M, McIntire RK, Zeigler-Johnson C, Myers RE, Evans NR, Kane GC, Juon HS. Racial Differences in Lung Cancer Screening Beliefs and Screening Adherence. Clin Lung Cancer 2021; 22:570-578. [PMID: 34257020 DOI: 10.1016/j.cllc.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND One challenge in high-quality lung cancer screening (LCS) is maintaining adherence with annual and short-interval follow-up screens among high-risk individuals who have undergone baseline low-dose CT (LDCT). This study aimed to characterize attitudes and beliefs toward lung cancer and LCS and to identify factors associated with LCS adherence. METHODS We administered a questionnaire to 269 LCS participants to assess attitudes and beliefs toward lung cancer and LCS. Clinical data including sociodemographics and screening adherence were obtained from the LCS Program Registry. RESULTS African-American individuals had significantly greater lung cancer worries compared with Whites (6.10 vs. 4.66, P < .001). In making the decision to undergo LCS, African-American participants described screening convenience and cost as very important factors significantly more frequently than Whites (60% vs. 26.8%, P< .001 and 58.4% vs. 37.8%, P = .001; respectively). African-American individuals with greater than high school education had significantly higher odds of LCS adherence (aOR 2.55; 95% CI, 1.14-5.60) than Whites with less than high school education. Participants who described screening convenience and cost as "very important" had significantly lower odds of completing screening follow-up after adjusting for demographic and other factors (aOR 0.56; 95% CI, 0.33-0.97 and aOR 0.54; 95% CI, 0.33-0.91, respectively). CONCLUSION Racial differences in beliefs about lung cancer and LCS exist among African-American and White individuals enrolled in an LCS program. Cost, convenience, and low educational attainment may be barriers to LCS adherence, specifically among African-American individuals. IMPACT More research is needed on how barriers can be overcome to improve LCS adherence.
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Affiliation(s)
- Julie A Barta
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Division of Pulmonary and Critical Care Medicine, Philadelphia, PA
| | - Christine S Shusted
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Department of Medicine, Philadelphia, PA
| | - Brooke Ruane
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Division of Pulmonary and Critical Care Medicine, Philadelphia, PA
| | - Marcella Pimpinelli
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Russell K McIntire
- Thomas Jefferson University, Jefferson College of Population Health, Philadelphia, PA
| | - Charnita Zeigler-Johnson
- Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, Philadelphia, PA
| | - Ronald E Myers
- Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, Philadelphia, PA
| | - Nathaniel R Evans
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Division of Thoracic Surgery, Philadelphia, PA
| | - Gregory C Kane
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Department of Medicine, Philadelphia, PA
| | - Hee-Soon Juon
- Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, Philadelphia, PA.
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21
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Hajek A, König HH. Fear of Dementia in the General Population: Findings from the German Socio-Economic Panel (GSOEP). J Alzheimers Dis 2021; 75:1135-1140. [PMID: 32390634 DOI: 10.3233/jad-200106] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim was to identify the determinants of fear of dementia in the general population. Data were taken from the innovation sample (n = 1,498; year 2012) of a nationally representative, longitudinal study. Summarizing, 28.8% reported no fear of dementia, 34.3% reported a little fear of dementia, 21.2% reported some fear of dementia, and 15.7% reported severe fear of dementia. Regressions showed that increased fear of dementia was associated with increased age, being female, an increased perceived own risk for developing dementia, an increased agreement that a diagnosis of dementia would ruin one's life, and a decreased perception that memory deterioration is preventable. Addressing modifiable factors may assist in reducing fear of dementia.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Researc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Researc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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Quaife SL, Janes SM, Brain KE. The person behind the nodule: a narrative review of the psychological impact of lung cancer screening. Transl Lung Cancer Res 2021; 10:2427-2440. [PMID: 34164290 PMCID: PMC8182717 DOI: 10.21037/tlcr-20-1179] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/12/2021] [Indexed: 12/28/2022]
Abstract
Lung cancer is the leading cause of cancer mortality globally, responsible for an estimated 1.76 million deaths worldwide in 2018 alone. Screening adults at high risk of lung cancer using low-dose computed tomography (LDCT) significantly reduces lung cancer mortality by finding the disease at an early, treatable stage. Many countries are actively considering whether to implement screening for their high-risk populations in light of the recently published Dutch-Belgian trial 'NELSON'. In deciding whether to implement a national screening programme, policymakers must weigh up the evidence for the relative risks posed to the entire screened population, including the potential psychological burden. This narrative review aimed to critically summarise the evidence for both negative and positive psychological responses experienced throughout the LDCT screening pathway, to describe their magnitude, duration and clinical relevance, and to draw out different aspects of measurement design crucial to their interpretation. A further aim was to discuss the available evidence for individual differences in psychological response, as well as interventions designed to promote psychological well-being. In summary, there was no evidence that the LDCT screening process caused adverse psychological outcomes overall, although those receiving indeterminate and suspicious LDCT results did report clinically raised anxiety and lung cancer-specific distress in the short-term. There was early evidence that demographic factors, smoking status and screening-ineligibility could be associated with individual differences in propensity to experience distress. Qualitative data suggested health beliefs could be modifiable mediators of these individual differences, but their aetiology requires quantitative and prospective research. There was also some evidence of positive psychological responses that could be capitalised on, and of the potential for person-centred communication interventions to achieve this. Further research needs to be embedded in real-world LDCT lung cancer screening services and use condition-specific measures to monitor outcomes and test evidence-based communication interventions in promoting psychological well-being.
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Affiliation(s)
- Samantha L. Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Kate E. Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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23
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Kaufman AR, Twesten JE, Suls J, McCaul KD, Ostroff JS, Ferrer RA, Brewer NT, Cameron LD, Halpern-Felsher B, Hay JL, Park ER, Peters E, Strong DR, Waters EA, Weinstein ND, Windschitl PD, Klein WMP. Measuring Cigarette Smoking Risk Perceptions. Nicotine Tob Res 2021; 22:1937-1945. [PMID: 31883013 DOI: 10.1093/ntr/ntz213] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
Risk perception is an important construct in many health behavior theories. Smoking risk perceptions are thoughts and feelings about the harms associated with cigarette smoking. Wide variation in the terminology, definition, and assessment of this construct makes it difficult to draw conclusions about the associations of risk perceptions with smoking behaviors. To understand optimal methods of assessing adults' cigarette smoking risk perceptions (among both smokers and nonsmokers), we reviewed best practices from the tobacco control literature, and where gaps were identified, we looked more broadly to the research on risk perceptions in other health domains. Based on this review, we suggest assessments of risk perceptions (1) about multiple smoking-related health harms, (2) about harms over a specific timeframe, and (3) for the person affected by the harm. For the measurement of perceived likelihood in particular (ie, the perceived chance of harm from smoking based largely on deliberative thought), we suggest including (4) unconditional and conditional items (stipulating smoking behavior) and (5) absolute and comparative items and including (6) comparisons to specific populations through (7) direct and indirect assessments. We also suggest including (8) experiential (ostensibly automatic, somatic perceptions of vulnerability to a harm) and affective (emotional reactions to a potential harm) risk perception items. We also offer suggestions for (9) response options and (10) the assessment of risk perception at multiple time points. Researchers can use this resource to inform the selection, use, and future development of smoking risk perception measures. IMPLICATIONS Incorporating the measurement suggestions for cigarette smoking risk perceptions that are presented will help researchers select items most appropriate for their research questions and will contribute to greater consistency in the assessment of smoking risk perceptions among adults.
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Affiliation(s)
- Annette R Kaufman
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | | | - Jerry Suls
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Kevin D McCaul
- Department of Psychology, North Dakota State University, Fargo, ND
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rebecca A Ferrer
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Linda D Cameron
- School of Social Sciences, Humanities, and the Arts, University of California, Merced, Merced, CA
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elyse R Park
- Department of Psychiatry and Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ellen Peters
- School of Journalism and Communication, University of Oregon, Eugene, OR
| | - David R Strong
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA.,Cancer Prevention and Control Program, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Erika A Waters
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, Saint Louis, MO
| | - Neil D Weinstein
- Department of Human Ecology, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Paul D Windschitl
- Department of Psychological and Brain Sciences, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA
| | - William M P Klein
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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24
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Asharani PV, Lau JH, Ai Ling Seet V, Devi F, Wang P, Roystonn K, Lee YY, Cetty L, Teh WL, Verma S, Mok YM, Chong SA, Subramaniam M. Smoking-Related Health Beliefs in a Sample of Psychiatric Patients: Factors Associated with the Health Beliefs and Validation of the Health Belief Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041571. [PMID: 33562257 PMCID: PMC7916053 DOI: 10.3390/ijerph18041571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 12/12/2022]
Abstract
This study examined the (a) health beliefs and emotions (perception of risk, benefits, severity, and worry) about smoking among current and former smokers, (b) their awareness of health warnings, (c) factors associated with smoking-related health beliefs, and (d) the factor structure of the health belief questionnaire. Participants (n = 184) were recruited from a tertiary psychiatric care hospital. Current smokers showed a significantly higher risk perception and lower perceived benefits compared to former smokers. Younger age (<40 years), nicotine dependence (ND), a history of smoking-related diseases (SRD), and intention to quit were significantly associated with a higher risk perception in current smokers. Younger age, a history of SRDs, and motivation to quit were positively associated with health beliefs, while the latter two were associated with worry. Motivation and younger age were associated with a better perception of benefits and severity. Information on the cigarette packets was the major source of awareness for the sample, and 69% reported that existing campaigns were not effective in discouraging their smoking. Personalized risk communication and educational initiatives must focus on improving the knowledge of risk, benefits, and increase motivation to promote health cognition and thus smoking cessation.
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Affiliation(s)
- P. V. Asharani
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
- Correspondence: ; Tel.: +65-63892961
| | - Jue Hua Lau
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Vanessa Ai Ling Seet
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Fiona Devi
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Kumarasan Roystonn
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Ying Ying Lee
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Laxman Cetty
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Swapna Verma
- Early Psychosis Intervention Programme, Institute of Mental Health, Singapore 539747, Singapore;
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Yee Ming Mok
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore;
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
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25
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Barni D, Danioni F, Canzi E, Ferrari L, Ranieri S, Lanz M, Iafrate R, Regalia C, Rosnati R. Facing the COVID-19 Pandemic: The Role of Sense of Coherence. Front Psychol 2020; 11:578440. [PMID: 33240166 PMCID: PMC7677188 DOI: 10.3389/fpsyg.2020.578440] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022] Open
Abstract
The worldwide outbreak of COVID-19, the ensuing pandemic, and the related containment measures pose considerable challenges to psychological resilience and well-being. Researchers are now forced to look for resources to cope with negative experiences linked to this health emergency. According to the salutogenic approach proposed by Antonovsky, the sense of coherence (SOC) is a major source of resilience. Thus, this study aimed at assessing the role of SOC in moderating the link between illness experiences (in terms of knowing persons diagnosed with COVID-19 and fear of contracting COVID-19) and psychological well-being. 2,784 participants, taken from a large sample of the Italian population (65.4% females) and aged between 18 and 85 years, filled in an anonymous online survey during the 3rd week of the lockdown. Findings supported the moderating role of SOC in shaping the link between illness experiences and psychological well-being. Specifically, participants who knew at least one person diagnosed with COVID-19 showed lower levels of psychological well-being at low levels of SOC. The negative relation between participants' fear of contracting COVID-19 and psychological well-being was stronger for those who showed higher levels of SOC. This study discusses the implications of these results for interventions aimed at reducing the pandemic's detrimental effects and promoting resilience.
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Affiliation(s)
- Daniela Barni
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Francesca Danioni
- Family Studies and Research University Centre, Catholic University of the Sacred Heart, Milano, Italy
| | - Elena Canzi
- Family Studies and Research University Centre, Catholic University of the Sacred Heart, Milano, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
| | - Laura Ferrari
- Family Studies and Research University Centre, Catholic University of the Sacred Heart, Milano, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
| | - Sonia Ranieri
- Family Studies and Research University Centre, Catholic University of the Sacred Heart, Milano, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
| | - Margherita Lanz
- Family Studies and Research University Centre, Catholic University of the Sacred Heart, Milano, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
| | - Raffaella Iafrate
- Family Studies and Research University Centre, Catholic University of the Sacred Heart, Milano, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
| | - Camillo Regalia
- Family Studies and Research University Centre, Catholic University of the Sacred Heart, Milano, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
| | - Rosa Rosnati
- Family Studies and Research University Centre, Catholic University of the Sacred Heart, Milano, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
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26
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Peiffer G, Underner M, Perriot J, Ruppert AM, Tiotiu A. [Smoking cessation and lung cancer screening]. Rev Mal Respir 2020; 37:722-734. [PMID: 33129612 DOI: 10.1016/j.rmr.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
Several studies have shown that lung cancer screening, using annual low-dose computed tomography (CT) scan in a targeted population of smokers and ex-smokers reduces overall and lung cancer specific mortality rates. This form of screening strategy is not currently established for use in France by the French High Authority for Health. Quitting smoking is the most important measure in reducing mortality from lung cancer. The maximum benefit in reducing mortality from lung cancer should be seen through an effective combination of smoking cessation intervention and chest CT screening to identify early, curable disease. However, current data to guide clinicians in the choice of smoking cessation interventions in this specific context are limited due to the small number of randomized studies that have been carried out. The optimal approach to smoking cessation during lung cancer screening needs to be clarified by new studies comparing different motivation strategies, establishing the ideal moment to propose stopping smoking and the most effective therapies to use.
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Affiliation(s)
- G Peiffer
- Service de pneumologie, CHR de Metz-Thionville, 1, allée du Château, 57085 Metz, France.
| | - M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France
| | - J Perriot
- CLAT 63, dispensaire Emile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - A-M Ruppert
- Unité de tabacologie, service de pneumologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - A Tiotiu
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Park ER, Perez GK, Regan S, Muzikansky A, Levy DE, Temel JS, Rigotti NA, Pirl WF, Irwin KE, Partridge AH, Cooley ME, Friedman ER, Rabin J, Ponzani C, Hyland KA, Holland S, Borderud S, Sprunck K, Kwon D, Peterson L, Miller-Sobel J, Gonzalez I, Whitlock CW, Malloy L, de León-Sanchez S, O’Brien M, Ostroff JS. Effect of Sustained Smoking Cessation Counseling and Provision of Medication vs Shorter-term Counseling and Medication Advice on Smoking Abstinence in Patients Recently Diagnosed With Cancer: A Randomized Clinical Trial. JAMA 2020; 324:1406-1418. [PMID: 33048154 PMCID: PMC8094414 DOI: 10.1001/jama.2020.14581] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Persistent smoking may cause adverse outcomes among patients with cancer. Many cancer centers have not fully implemented evidence-based tobacco treatment into routine care. OBJECTIVE To determine the effectiveness of sustained telephone counseling and medication (intensive treatment) compared with shorter-term telephone counseling and medication advice (standard treatment) to assist patients recently diagnosed with cancer to quit smoking. DESIGN, SETTING, AND PARTICIPANTS This unblinded randomized clinical trial was conducted at Massachusetts General Hospital/Dana-Farber/Harvard Cancer Center and Memorial Sloan Kettering Cancer Center. Adults who had smoked 1 cigarette or more within 30 days, spoke English or Spanish, and had recently diagnosed breast, gastrointestinal, genitourinary, gynecological, head and neck, lung, lymphoma, or melanoma cancers were eligible. Enrollment occurred between November 2013 and July 2017; assessments were completed by the end of February 2018. INTERVENTIONS Participants randomized to the intensive treatment (n = 153) and the standard treatment (n = 150) received 4 weekly telephone counseling sessions and medication advice. The intensive treatment group also received 4 biweekly and 3 monthly telephone counseling sessions and choice of Food and Drug Administration-approved cessation medication (nicotine replacement therapy, bupropion, or varenicline). MAIN OUTCOME AND MEASURES The primary outcome was biochemically confirmed 7-day point prevalence tobacco abstinence at 6-month follow-up. Secondary outcomes were treatment utilization rates. RESULTS Among 303 patients who were randomized (mean age, 58.3 years; 170 women [56.1%]), 221 (78.1%) completed the trial. Six-month biochemically confirmed quit rates were 34.5% (n = 51 in the intensive treatment group) vs 21.5% (n = 29 in the standard treatment group) (difference, 13.0% [95% CI, 3.0%-23.3%]; odds ratio, 1.92 [95% CI, 1.13-3.27]; P < .02). The median number of counseling sessions completed was 8 (interquartile range, 4-11) in the intensive treatment group. A total of 97 intensive treatment participants (77.0%) vs 68 standard treatment participants (59.1%) reported cessation medication use (difference, 17.9% [95% CI, 6.3%-29.5%]; odds ratio, 2.31 [95% CI, 1.32-4.04]; P = .003). The most common adverse events in the intensive treatment and standard treatment groups, respectively, were nausea (n = 13 and n = 6), rash (n = 4 and n = 1), hiccups (n = 4 and n = 1), mouth irritation (n = 4 and n = 0), difficulty sleeping (n = 3 and n = 2), and vivid dreams (n = 3 and n = 2). CONCLUSIONS AND RELEVANCE Among smokers recently diagnosed with cancer in 2 National Cancer Institute-designated Comprehensive Cancer Centers, sustained counseling and provision of free cessation medication compared with 4-week counseling and medication advice resulted in higher 6-month biochemically confirmed quit rates. However, the generalizability of the study findings is uncertain and requires further research. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01871506.
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Affiliation(s)
- Elyse R. Park
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Tobacco Treatment and Research Center, Massachusetts General Hospital, Boston
| | - Giselle K. Perez
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Susan Regan
- Harvard Medical School, Boston, Massachusetts
- Tobacco Treatment and Research Center, Massachusetts General Hospital, Boston
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - Alona Muzikansky
- MGH Biostatistics Center, Massachusetts General Hospital, Boston
| | - Douglas E. Levy
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Tobacco Treatment and Research Center, Massachusetts General Hospital, Boston
| | - Jennifer S. Temel
- Harvard Medical School, Boston, Massachusetts
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston
| | - Nancy A. Rigotti
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Tobacco Treatment and Research Center, Massachusetts General Hospital, Boston
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - William F. Pirl
- Harvard Medical School, Boston, Massachusetts
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kelly E. Irwin
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Ann H. Partridge
- Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mary E. Cooley
- Harvard Medical School, Boston, Massachusetts
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Emily R. Friedman
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston
| | - Julia Rabin
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston
| | - Colin Ponzani
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston
| | - Kelly A. Hyland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Susan Holland
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sarah Borderud
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kim Sprunck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Diana Kwon
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lisa Peterson
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jacob Miller-Sobel
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Irina Gonzalez
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston
| | - C. Will Whitlock
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Malloy
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston
| | - Suhana de León-Sanchez
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maureen O’Brien
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jamie S. Ostroff
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, New York
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See K, Manser R, Park ER, Steinfort D, King B, Piccolo F, Manners D. The impact of perceived risk, screening eligibility and worry on preference for lung cancer screening: a cross-sectional survey. ERJ Open Res 2020; 6:00158-2019. [PMID: 32201692 PMCID: PMC7073421 DOI: 10.1183/23120541.00158-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/23/2020] [Indexed: 11/05/2022] Open
Abstract
Lung cancer screening is effective at reducing lung cancer deaths when individuals at greatest risk are screened. Recruitment initiatives target all current and former smokers, of whom only some are eligible for screening, potentially leading to discordance between screening preference and eligibility in ineligible individuals. The objective of the present study was to identify factors associated with preference for screening among ever-smokers. Ever-smokers aged 55-80 years attending outpatient clinics at three Australian hospitals were invited. The survey recorded: 1) demographics; 2) objective lung cancer risk and screening eligibility using the Prostate Lung Colon Ovarian 2012 risk model; and 3) perceived lung cancer risk, worry about and seriousness of lung cancer using a validated questionnaire. Multivariable ordinal logistic regression identified predictors of screening preference. The survey was completed by 283 individuals (response rate 27%). Preference for screening was high (72%) with no significant difference between low-dose computed tomography screening-eligible and -ineligible individuals (77% versus 68%, p=0.11). Worry about lung cancer (adjusted-proportional odds ratio (adj-OR) 1.31, 95% CI 1.08-1.58; p=0.007) and perceived seriousness of lung cancer (adj-OR 1.31, 95% CI 1.05-1.64; p=0.02) were associated with higher preference for lung cancer screening while screening eligibility was not. The concept of "early detection" was the most important driver to have screening while practical obstacles like difficulty travelling to the scan or taking time off work were the least important barriers to screening. Most current or former smokers prefer to undergo screening. Worry about lung cancer and perceived seriousness of the diagnosis are more important drivers for screening preference than eligibility status.
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Affiliation(s)
- Katharine See
- Dept of Respiratory Medicine, Northern Hospital, Epping, Victoria, Australia
| | - Renee Manser
- Dept of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Dept of Medicine (Royal Melbourne Hospital), University of Melbourne, Victoria, Australia.,Dept of Medical Oncology and Haematology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Elyse R Park
- Harvard Medical School, Massachusetts General Hosptial, Boston, MA, USA
| | - Daniel Steinfort
- Dept of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Bridget King
- Dept of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Francesco Piccolo
- Midland Physician Service, St John of God Midland Private and Public Hospitals, Midland, Western Australia, Australia
| | - David Manners
- Midland Physician Service, St John of God Midland Private and Public Hospitals, Midland, Western Australia, Australia.,Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
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29
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Kok WH, Ban Yu-Lin A, Azhar Shah S, Abdul Hamid F. Determining the perception of a lung cancer screening programme among high-risk patients in a tertiary referral centre, Kuala Lumpur. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105819891743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Lung cancer is the second most common cause of cancer-related death and the third most common cancer in Malaysia. The rising prevalence of lung cancer suggests the need to consider disease screening for early detection, especially in the high-risk population, as it offers the best chance of cure. Objectives: The study aims to determine the willingness of high-risk respondents to participate in a lung cancer screening programme if made available to them, and to determine their attitude towards lung cancer screening and explore factors that might affect participation in a screening programme. Method: This is a cross-sectional, descriptive study over 6 months conducted in adult patients attending medical clinics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using face-to-face administered questionnaires. Results: In total 180 respondents were analysed. There were 177 (98.3%) males. Mean age was 59.8 ± 9.1 years. Of the respondents, 138 (76.7%) had poor knowledge about cancer screening. Former smokers comprised 119 (66.1%) of the participants, and 61 (33.9%) were current smokers. In total, 141 (78.3%) respondents indicated willingness to participate in a lung cancer screening programme. Out of this group, 68 (48.2%) respondents were unwilling to pay for the procedure. Only 18 (12.8%) were unwilling to undergo lung cancer treatment if detected early. Conclusions: Awareness about general cancer screening is low. Our study showed that when informed of their high-risk status, respondents were willing to participate in lung cancer screening. There should be more health programmes to promote and raise awareness about lung cancer.
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Affiliation(s)
- Wei Hao Kok
- Department of Medicine,Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Andrea Ban Yu-Lin
- Department of Medicine,Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shamsul Azhar Shah
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Faisal Abdul Hamid
- Department of Medicine,Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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30
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Nardi Agmon I, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Respir J 2020; 55:13993003.00506-2019. [PMID: 32051182 DOI: 10.1183/13993003.00506-2019] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Dept of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, CH Lyon Sud, Pierre Bénite, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Dept of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Dept of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Dept of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Dept of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital Sotiria, Athens, Greece
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31
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Agmon IN, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Radiol 2020; 30:3277-3294. [PMID: 32052170 DOI: 10.1007/s00330-020-06727-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany.
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Department of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, Sud, Pierre Bénite, Lyon, CH, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Department of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Department of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
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Park DW, Jang JY, Park TS, Lee H, Moon JY, Kim SH, Kim TH, Yoon HJ, Kang DR, Sohn JW. Burden of male hardcore smokers and its characteristics among those eligible for lung cancer screening. BMC Public Health 2020; 20:151. [PMID: 32005218 PMCID: PMC6995174 DOI: 10.1186/s12889-020-8266-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/22/2020] [Indexed: 12/18/2022] Open
Abstract
Background There are few data available about hardcore smokers and their behavioral characteristics among the lung cancer screening (LCS) population. The study investigated the burden of hardcore smokers within the LCS population, and determine the characteristics of hardcore smokers using nationally representative data in South Korea. Methods We used data from 2007 to 2012 from the Korean National Health and Nutrition Examination Survey. This study enrolled current male smokers aged 55–74 years. Among them, subjects eligible for LCS were defined as these populations with smoking histories of at least 30 PY. Hardcore smoking was defined as smoking >15 cigarettes per day, with no plan to quit, and having made no attempt to quit. Multivariate logistic regression analyses were used to estimate associations between hardcore smokers and various sociodemographic and other variables. Results The proportion of hardcore smokers among those who met LCS eligibility criteria decreased from 2007 to 2012 (from 39.07 to 29.47% of the population) but did not change significantly thereafter (P = 0.2770), and that proportion was consistently 10–15% higher than that of hardcore smokers among all male current smokers. The proportion without any plan to quit smoking decreased significantly from 54.35% in 2007 to 38.31% in 2012. However, the smokers who had made no intentional quit attempt in the prior year accounted for more than half of those eligible for LCS, and the proportion of such smokers did not change significantly during the study period (50.83% in 2007 and 51.03% in 2012). Multivariate logistic regression analyses showed that hardcore smokers were older (OR = 1.05, 95% confidence interval [CI] 1.01–1.09) than non-hardcore smokers. Hardcore smokers exhibited higher proportion of depression (OR = 6.55, 95% CI 1.75–24.61) and experienced extreme stress more frequently (OR = 1.93, 95% CI 1.13–3.29). Smokers who did not receive smoking cessation education within the past year were significantly more likely to be hardcore smokers (OR = 4.15, 95% CI 1.30–13.22). Conclusions It is important to identify a subset of smokers unwilling or minimally motivated to quit within the context of lung cancer screening. Anti-smoking education should be enhanced to influence hardcore smokers’ behavior.
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Affiliation(s)
- Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Ji-Yun Jang
- Department of Biostatistics, Yonsei University, Wonju College of Medicine, Wonju, Gangwon-do, South Korea
| | - Tai Sun Park
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Tae-Hyung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Dae Ryong Kang
- Department of Biostatistics, Yonsei University, Wonju College of Medicine, Wonju, Gangwon-do, South Korea.,Center of Biomedical Data Science, Institute of Genomic Cohort, Yonsei University, Wonju College of Medicine, Wonju, Gangwon-do, South Korea
| | - Jang Won Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.
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33
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Gagne SM, Fintelmann FJ, Flores EJ, McDermott S, Mendoza DP, Petranovic M, Price MC, Stowell JT, Little BP. Evaluation of the Informational Content and Readability of US Lung Cancer Screening Program Websites. JAMA Netw Open 2020; 3:e1920431. [PMID: 32003825 PMCID: PMC7042868 DOI: 10.1001/jamanetworkopen.2019.20431] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE The internet is an important source of medical information for many patients and may have a key role in the education of patients about lung cancer screening (LCS). Although most LCS programs in the United States have informational websites, the accuracy, completeness, and readability of these websites have not previously been studied. OBJECTIVE To evaluate the informational content and readability of US LCS program websites. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study assessed US LCS program websites identified on September 15, 2018. A standardized checklist was used to assess key informational content of each website, and text was analyzed for reading level, word count, and reading time. Links to US websites of national advocacy organizations with LCS program content were tabulated. All functional LCS program websites in Google internet search engine results using the search terms lung cancer screening, low-dose CT screening, and lung screening were included in the analysis. MAIN OUTCOMES AND MEASURES Radiologists used a standardized checklist to evaluate content, and readability was assessed with validated scales. Website word count, reading time, and number of links to outside LCS informational websites were assessed. RESULTS A total of 257 LCS websites were included in the analysis. The word count ranged from 73 to 4410 (median, 571; interquartile range, 328-909). The reading time ranged from 0.3 to 19.6 minutes (median, 2.5; interquartile range, 1.5-4.0). The median reading level of all websites was grade 10 (interquartile range, 9-11). Only 26% (n = 66) of websites had at least 1 web link to a national website with additional information on LCS. There was wide variability regarding reported eligibility age criteria, with ages 55 to 77 years most frequently cited (42% [n = 108]). Only 56% (n = 143) of websites mentioned smoking cessation. The subject of patient cost was mentioned on 75% (n = 192) of websites. Although major LCS benefits, such as detection of lung cancer, were discussed by most (93% [n = 239]) websites, less than half of the websites (45% [n = 115]) made any mention of possible risks associated with screening. CONCLUSIONS AND RELEVANCE There appears to be marked variability in the informational content of US LCS program websites, and the reading level of most websites is above that recommended by the American Medical Association and the National Institutes of Health. Efforts to improve website content and readability may be warranted.
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Affiliation(s)
- Staci M. Gagne
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Florian J. Fintelmann
- Thoracic Imaging and Intervention Division, Department of Radiology, Massachusetts General Hospital, Boston
| | - Efren J. Flores
- Thoracic Imaging and Intervention Division, Department of Radiology, Massachusetts General Hospital, Boston
| | - Shaunagh McDermott
- Thoracic Imaging and Intervention Division, Department of Radiology, Massachusetts General Hospital, Boston
| | - Dexter P. Mendoza
- Thoracic Imaging and Intervention Division, Department of Radiology, Massachusetts General Hospital, Boston
| | - Milena Petranovic
- Thoracic Imaging and Intervention Division, Department of Radiology, Massachusetts General Hospital, Boston
| | - Melissa C. Price
- Thoracic Imaging and Intervention Division, Department of Radiology, Massachusetts General Hospital, Boston
| | | | - Brent P. Little
- Thoracic Imaging and Intervention Division, Department of Radiology, Massachusetts General Hospital, Boston
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A qualitative study exploring cues and other motivators among a racially diverse sample of light and intermittent smokers. J Smok Cessat 2019. [DOI: 10.1017/jsc.2019.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AbstractIntroductionLight and intermittent smokers (LITS) represent almost 50% of all current smokers. Research is needed to understand smoking motives among adult light smokers.AimsTo explore smoking cues and motivators among a racially diverse sample of adult LITS (≤10 CPD). In addition, we explored differences between native (always smoked ≤10), and converted (former heavier) LITS.MethodsWe used purposive sampling to recruit participants who were native and converted LITS and to include equal numbers of African Americans, Whites and Latinos. We coded and analyzed transcripts using a stage approach to identify themes.ResultsFour main themes emerged that may be unique to light smokers and suggests potential strategies for intervention: (1) smoking in response to cues and control, (2) identifying as a smoker, (3) concern about health consequences, and (4) other priorities influencing smoking. There were some differences among smoking cues and motivators by race and ethnicity, and differences between native and converted LITS.ConclusionsOverall, LITS reported drivers of smoking that were unrelated to symptoms of nicotine withdrawal. Even when experiencing salient cues, our LITS cohort expressed the ability to assert control over smoking by abstaining when situational contexts made smoking inconvenient.
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Irwin KE, Steffens EB, Yoon Y, Flores EJ, Knight HP, Pirl WF, Freudenreich O, Henderson DC, Park ER. Lung Cancer Screening Eligibility, Risk Perceptions, and Clinician Delivery of Tobacco Cessation Among Patients With Schizophrenia. Psychiatr Serv 2019; 70:927-934. [PMID: 31357921 PMCID: PMC8386131 DOI: 10.1176/appi.ps.201900044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Individuals with schizophrenia experience increased lung cancer mortality and decreased access to cancer screening and tobacco cessation treatment. To promote screening among individuals with schizophrenia, it is necessary to investigate the proportion who meet screening criteria and examine smoking behaviors, cancer risk perception, and receipt of tobacco cessation interventions from psychiatry and primary care. METHODS The authors performed a cross-sectional survey and medical record review with 112 adults with schizophrenia treated with clozapine in a community mental health clinic (CMHC). RESULTS Among older participants (ages 55-77 years) with schizophrenia, 34% met the criteria for lung screening on the basis of smoking history (heavy current or former smokers), and more than half believed they had a low risk of developing lung cancer. Of all participants, 88% had visited their primary care provider (PCP) in the past year; PCPs represented 35 different practices. Only one in three current smokers reported that their PCP or psychiatrist assisted them in obtaining medications for tobacco cessation. CONCLUSIONS Given smoking history, many older adults with schizophrenia have potential to benefit from lung screening, yet most older participants underestimated their lung cancer risk. Although participants regularly accessed care, PCP and psychiatric visits may be missed opportunities to engage patients with schizophrenia in tobacco cessation and decrease preventable premature mortality. Embedding interventions in a CMHC, a centralized access point of care delivery for patients with schizophrenia, may have unique potential to increase uptake of cancer screening and tobacco cessation interventions.
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Affiliation(s)
- Kelly E Irwin
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Eleanor B Steffens
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - YooJin Yoon
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Efren J Flores
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Helen P Knight
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - William F Pirl
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Oliver Freudenreich
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - David C Henderson
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Elyse R Park
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
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Grebenshchikov IS, Studennikov AE, Ivanov VI, Ivanova NV, Titov VA, Vergbickaya NE, Ustinov VA. Idiotypic and anti-idiotypic antibodies against polycyclic aromatic hydrocarbon in human blood serum are new biomarkers of lung cancer. Oncotarget 2019; 10:5070-5081. [PMID: 31489116 PMCID: PMC6707943 DOI: 10.18632/oncotarget.27126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/29/2019] [Indexed: 11/25/2022] Open
Abstract
Evaluation of epidemiologic risk factor in relation to lung cancer invoked by polycyclic aromatic hydrocarbons has been inconsistent. To address this issue, we conducted a prospective evaluation of new biomarkers for lung cancer classified according levels of idiotypic and anti-idiotypic antibodies against polycyclic aromatic hydrocarbons in human blood serum. The blood serums of 557 lung cancer patients and 227 healthy donors were analysis of these antibodies by ELISA. Collected data were regrouped and analyzed by gender, smoking, and age as predictors of risk lung cancer factors. Also, the data of lung cancer patients were additionally analyzed by stages and types of lung cancer, surgery, and chemotherapy. It was suggested to use ratio of idiotypic and anti-idiotypic antibodies rather than distinguish level each of them separately. The ratio of levels in healthy people was 3.32 times higher than in lung cancer patients. This approach gave more precisely results and great prognostic value. The logistic regression model (AUC = 0.9) and neural networks (AUC = 0.95) were built to compare lung cancer patients and healthy donors by predictors. The ELISA data of 49 people random sampled from the originally ELISA data and ELISA data of 52 coal miners as a group of lung cancer risk were confirmed logistic regression model. So, suggested idiotypic and anti-idiotypic antibodies against polycyclic aromatic hydrocarbons were not only shown difference between healthy donors and lung cancer patients also elicited group of lung cancer risk among healthy people.
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Affiliation(s)
- Ivan S Grebenshchikov
- Federal State Scientific Institute, Federal Research Centre Coal and Coal Chemistry, Siberian Branch of the Russian Academy of Sciences, Institute of Human Ecology, Kemerovo, 650065, Russia
| | - Artem E Studennikov
- Federal State Scientific Institute, Federal Research Centre Coal and Coal Chemistry, Siberian Branch of the Russian Academy of Sciences, Institute of Human Ecology, Kemerovo, 650065, Russia
| | - Vadim I Ivanov
- Federal State Educational Institute of Higher Professional Education, Kemerovo State University, Kemerovo, 650043, Russia
| | - Natalia V Ivanova
- Federal State Educational Institute of Higher Professional Education, Kemerovo State University, Kemerovo, 650043, Russia
| | | | | | - Valentin A Ustinov
- Federal State Scientific Institute, Federal Research Centre Coal and Coal Chemistry, Siberian Branch of the Russian Academy of Sciences, Institute of Human Ecology, Kemerovo, 650065, Russia
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Warner ET, Lathan CS. Race and sex differences in patient provider communication and awareness of lung cancer screening in the health information National Trends Survey, 2013-2017. Prev Med 2019; 124:84-90. [PMID: 31054908 DOI: 10.1016/j.ypmed.2019.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/26/2019] [Accepted: 05/01/2019] [Indexed: 12/17/2022]
Abstract
Despite demonstrated reduction in lung cancer mortality, lung cancer screening uptake has been low. We investigated differences in discussions with physicians about lung cancer screening and awareness using repeated cross-sectional data from three cycles [4.2 (2013); 4.4(2014) and 5.1 (2017)] of the Health Information National Trends Survey. We included 4207 respondents age 55 to 80 who responded to this question: 'In the past year, have you talked with your doctor about having a test to check for lung cancer?'. We used logistic regression accounting for complex sample weighting to generate multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs). The proportion of participants reporting lung cancer screening discussions was low and did not increase over time. In the most recent cycle, 15.7% of current smokers and 9.9% of former smokers said they had discussed screening. Compared to males, females were 32% less likely to report a lung cancer screening discussion (OR: 0.68, 95% CI: 0.50-0.93) and the association was strongest among non-Hispanic White females. Estimates were similar among never (OR: 0.72, 95% CI: 0.43-1.20), current (OR: 0.73, 95% CI: 0.39-1.36), and former (OR: 0.66, 95% CI: 0.40-1.10) smokers. Females were 32% less likely than males to be aware of a lung cancer screening test (OR: 0.68, 95% CI: 0.47-0.99) and this association was strongest for non-Hispanic Black females (OR: 0.38, 95% CI: 0.19-0.77). Too few providers have discussed lung cancer screening with potentially eligible patients, particularly female patients. Further research is needed to evaluate possible causes for this finding.
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Affiliation(s)
- Erica T Warner
- Mongan Institute, Clinical and Translational Epidemiology Unit, Massachusetts General Hospital Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Christopher S Lathan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA, USA
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Sharma A, Kasza K, Hyland A, Cummings KM, Bansal-Travers M, Fong GT, O'Connor RJ. Awareness and interest in lung cancer screening among current and former smokers: findings from the ITC United States Survey. Cancer Causes Control 2019; 30:733-745. [PMID: 31123842 DOI: 10.1007/s10552-019-01186-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/16/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To examine the awareness of low-dose computed tomography (LDCT) lung cancer screening among a population of current and former smokers using a nationally representative sample from the United States. METHODS Data for this study come from Wave 9 of the International Tobacco Control (ITC) United States Survey, conducted between 2013 and 2015. Among respondents age ≥ 40 (n = 1145), a 50% random sample were asked a series of questions pertaining to lung cancer screening. This study examines awareness and screening behaviors in relationship to demographic characteristics of respondents, health beliefs, psychosocial behaviors, and smoking behaviors. Descriptive tables and χ2 tests were used to examine the association between those who were aware and unaware. Logistic regression analyses were conducted, stratified on respondents' smoking status. Data were weighed to be representative of the current smoking population in the US. RESULTS Overall, 52% of current and former smokers reported being aware of lung cancer screening. Among the group with no prior screening, 80.6% said they would take a lung cancer screening exam if recommended by their physician. In the multivariate models, former smokers had significantly greater awareness of lung cancer screening compared to current smokers [odds ratio 1.42 (95% confidence interval 1.03, 1.97)]. CONCLUSIONS Awareness of LDCT lung cancer screening was lower among current smokers compared to former smokers. Most smokers who had not ever been screened said they would have lung cancer screening if it were recommended by their physician, demonstrating the need for healthcare providers to encourage those eligible for screening to take the test.
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Affiliation(s)
- Anushree Sharma
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karin Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA. Richard.O'
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Hall DL, Neil JM, Ostroff JS, Hawari S, O'Cleirigh C, Park ER. Perceived cancer-related benefits of quitting smoking and associations with quit intentions among recently diagnosed cancer patients. J Health Psychol 2019; 26:831-842. [PMID: 31035808 DOI: 10.1177/1359105319845131] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
One third of smokers diagnosed with cancer continue smoking, perhaps due to low perceived cancer-related benefits of cessation. To examine perceived cancer-related benefits of quitting among newly diagnosed cancer patients who smoke and associations with quit intentions, baseline measures from patients (N = 303) enrolled in a randomized controlled trial were analyzed using hierarchical regression models and bootstrapping. Higher perceived cancer-related benefits of quitting were associated with having a smoking-related cancer and less education. Perceived cancer-related benefits of quitting and quit intentions were positively correlated, particularly among patients with smoking-related cancers. For smokers with smoking-related cancers, perceived cancer-related benefits of quitting are correlated with quit intentions.
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Affiliation(s)
- Daniel L Hall
- Massachusetts General Hospital, USA.,Harvard Medical School, USA
| | - Jordan M Neil
- Massachusetts General Hospital, USA.,Harvard Medical School, USA
| | | | - Saif Hawari
- Massachusetts General Hospital, USA.,Harvard Medical School, USA
| | | | - Elyse R Park
- Massachusetts General Hospital, USA.,Harvard Medical School, USA
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40
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Joseph AM, Rothman AJ, Almirall D, Begnaud A, Chiles C, Cinciripini PM, Fu SS, Graham AL, Lindgren BR, Melzer AC, Ostroff JS, Seaman EL, Taylor KL, Toll BA, Zeliadt SB, Vock DM. Lung Cancer Screening and Smoking Cessation Clinical Trials. SCALE (Smoking Cessation within the Context of Lung Cancer Screening) Collaboration. Am J Respir Crit Care Med 2019; 197:172-182. [PMID: 28977754 DOI: 10.1164/rccm.201705-0909ci] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
National recommendations for lung cancer screening for former and current smokers aged 55-80 years with a 30-pack-year smoking history create demand to implement efficient and effective systems to offer smoking cessation on a large scale. These older, high-risk smokers differ from participants in past clinical trials of behavioral and pharmacologic interventions for tobacco dependence. There is a gap in knowledge about how best to design systems to extend reach and treatments to maximize smoking cessation in the context of lung cancer screening. Eight clinical trials, seven funded by the National Cancer Institute and one by the Veterans Health Administration, address this gap and form the SCALE (Smoking Cessation within the Context of Lung Cancer Screening) collaboration. This paper describes methodological issues related to the design of these clinical trials: clinical workflow, participant eligibility criteria, screening indication (baseline or annual repeat screen), assessment content, interest in stopping smoking, and treatment delivery method and dose, all of which will affect tobacco treatment outcomes. Tobacco interventions consider the "teachable moment" offered by lung cancer screening, how to incorporate positive and negative screening results, and coordination of smoking cessation treatment with clinical events associated with lung cancer screening. Unique data elements, such as perceived risk of lung cancer and costs of tobacco treatment, are of interest. Lung cancer screening presents a new and promising opportunity to reduce morbidity and mortality resulting from lung cancer that can be amplified by effective smoking cessation treatment. SCALE teamwork and collaboration promise to maximize knowledge gained from the clinical trials.
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Affiliation(s)
| | | | - Daniel Almirall
- 3 Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | | | - Caroline Chiles
- 4 Department of Radiology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Paul M Cinciripini
- 5 Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Amanda L Graham
- 6 Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | | | | | - Jamie S Ostroff
- 8 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth L Seaman
- 9 Tobacco Control Research Branch, National Cancer Institute, Rockville, Maryland
| | - Kathryn L Taylor
- 10 Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Benjamin A Toll
- 11 Department of Public Health Sciences and Psychiatry, Medical University of South Carolina, Charleston, South Carolina; and
| | - Steven B Zeliadt
- 12 VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, Washington
| | - David M Vock
- 13 Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
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Chalian H, Khoshpouri P, Assari S. Patients' age and discussion with doctors about lung cancer screening; Diminished returns of Blacks. Aging Med (Milton) 2019; 2:35-41. [PMID: 31179418 PMCID: PMC6553649 DOI: 10.1002/agm2.12053] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND As age is one of the main risk factors for lung cancer, older adults are expected to receive more messages for lung cancer screening (LCS). It is, however, unclear whether age similarly increases patient's chance of discussing LCS across various racial groups. OBJECTIVE To determine racial differences in the effect of patients' age on patient-physician discussion about LCS. METHODS This cross-sectional study borrowed data from the Health Information National Trends Survey (HINTS 2017) which included 2,277 adults. Patients' demographic factors, socioeconomic characteristics, smoking status, possible LCS indication, and patient-physician discussion about LCS were measured. We ran logistic regression models for data analysis. RESULTS Independent of possible LCS indication, older patients were more likely to have patient-physician discussion about LCS. However, there is a significant interaction between race and age, suggesting a larger effect of age on the likelihood of discussing LCS with doctors for Whites than Blacks. In race-stratified models that controlled for possible LCS indication, higher age increased lung cancer discussion for Whites but not for Blacks. CONCLUSIONS Whether age increases the chance of discussing LCS or not depends on the patient's race, with Blacks receiving fewer messages regarding LCS as a result of their aging.
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Affiliation(s)
- Hamid Chalian
- Department of RadiologyDuke University Medical CenterDurhamNorth Carolina
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Shervin Assari
- Department of Family MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCalifornia
- Department of PsychiatryUniversity of MichiganAnn ArborMichigan
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Patten CA, Koller KR, Flanagan CA, Hiratsuka VY, Hughes CA, Wolfe AW, Decker PA, Fruth K, Brockman TA, Korpela M, Gamez D, Bronars C, Murphy NJ, Hatsukami D, Benowitz NL, Thomas TK. Biomarker feedback intervention for smoking cessation among Alaska Native pregnant women: Randomized pilot study. PATIENT EDUCATION AND COUNSELING 2019; 102:528-535. [PMID: 30391300 PMCID: PMC6421103 DOI: 10.1016/j.pec.2018.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 05/16/2023]
Abstract
OBJECTIVE There is some evidence for biomarker feedback when combined with cessation counseling for reducing smoking in pregnancy. This randomized controlled pilot study evaluated feasibility and potential efficacy of a social-cognitive theory (SCT)-based biomarker feedback intervention among pregnant Alaska Native (AN) smokers. METHODS Participants were randomly assigned to receive three study calls (10-20 min each): (1) biomarker feedback intervention (n = 30) including personalized cotinine results and feedback on their baby's likely exposure to carcinogen metabolite NNAL, or (2) contact control usual care condition based on the 5As (n = 30). Assessments were conducted at baseline, post-treatment, and delivery. RESULTS High rates of treatment compliance, study retention, and treatment acceptability were observed in both groups. 7-day point prevalence smoking abstinence rates at delivery verified with urinary cotinine were the same in both study groups (20% intent-to-treat analysis, 26% per-protocol). SCT-based measures did not change differentially from baseline by study group. CONCLUSION This trial supports the feasibility and acceptability of providing biomarker feedback within the clinical care delivery system, but the intervention did not promote increased smoking cessation during pregnancy compared to usual care. PRACTICE IMPLICATIONS Efforts are needed to promote the usual care and to develop alternative biomarker feedback messaging for pregnant AN women.
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Affiliation(s)
- Christi A Patten
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
| | - Kathryn R Koller
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK, 99508, USA
| | - Christie A Flanagan
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK, 99508, USA
| | - Vanessa Y Hiratsuka
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK, 99508, USA
| | - Christine A Hughes
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Abbie W Wolfe
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK, 99508, USA
| | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Kristin Fruth
- Department of Health Sciences Research, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Tabetha A Brockman
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Molly Korpela
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK, 99508, USA
| | - Diana Gamez
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK, 99508, USA
| | - Carrie Bronars
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Neil J Murphy
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK, 99508, USA
| | - Dorothy Hatsukami
- University of Minnesota, 717 Delaware St SE, Minneapolis, MN, 55414, USA
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California, San Francisco, 1001 Potrero Ave, SFGH 30, San Francisco, CA, 94110, USA
| | - Timothy K Thomas
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK, 99508, USA
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Perez GK, Gareen IF, Sicks J, Lathan C, Carr A, Kumar P, Ponzani C, Hyland K, Park ER. Racial Differences in Smoking-related Disease Risk Perceptions Among Adults Completing Lung Cancer Screening: Follow-up Results from the ACRIN/NLST Ancillary Study. J Racial Ethn Health Disparities 2019; 6:676-685. [PMID: 30737732 DOI: 10.1007/s40615-019-00566-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
Previous work suggests that, compared to white adults, black adults have lower perceived risk for smoking-related diseases (SRDs), which may influence cessation behavior and health outcomes; however, racial differences in SRD risk perceptions among high-risk patients (i.e., a group that exhibits elevated risk for SRDs) following lung screening remain unknown. This paper thus examined differences in risk perceptions for lung cancer and other SRDs among black and white National Lung Screening Trial (NLST) participants. We administered a 10-item measure of perceived lifetime risk of lung cancer and other SRD (Smoking Risk Perceptions Scale; SRPS) to NLST participants at 1 year following lung screening to (1) establish the internal consistency of the SRPS for both black and white participants, (2) compare smoking-related disease risk perceptions between black and white participants, and (3) identify predictors of risk perceptions for black and white participants using multivariable linear regression models. We determined the SRPS items loaded onto two factors (personal and comparative risks; Cronbach's alpha = 0.93 and 0.95 for 1743 white and 194 black participants, respectively), thus demonstrating high internal consistency for both black and white adults. Compared to white participants, black adults demonstrated lower SRD risk perceptions (SRPS range = 10-50, mean difference = 2.55, SE = 0.50, p < 0.001), even after adjusting for smoking status and sociodemographics. Younger age, female gender, higher education, white race, and current smoking status were independently associated with high risk perceptions. Sociodemographic factors associated with lower risk perceptions resemble factors related to continued smoking. Findings suggest current and former black smokers are at risk of having lower risk perceptions for lung cancer and SRDs than white adults following lung cancer screening; these differences may explain observed racial differences in cessation outcomes. Although similar factors influence black and white adults' beliefs, risk perceptions may differentially impact smoking behavior among these groups. Behavior change models that guide tobacco treatment approaches, particularly for high-risk black smokers, should consider the influence of cultural factors on risk perceptions and cessation efforts.
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Affiliation(s)
- Giselle K Perez
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Ilana F Gareen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - JoRean Sicks
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Christopher Lathan
- Harvard Medical School, Boston, MA, USA.,Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alaina Carr
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA
| | - Pallavi Kumar
- Abramsom Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kelly Hyland
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA.,University of South Florida and Moffitt Cancer Center, Tampa, FL, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
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Chalian H, Khoshpouri P, Assari S. Demographic, Social, and Behavioral Determinants of Lung Cancer Perceived Risk and Worries in a National Sample of American Adults; Does Lung Cancer Risk Matter? MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E97. [PMID: 30513895 PMCID: PMC6306727 DOI: 10.3390/medicina54060097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/20/2018] [Accepted: 11/29/2018] [Indexed: 12/19/2022]
Abstract
Background: Perceived risk and worries of developing cancer are important constructs for cancer prevention. Many studies have investigated the relationship between health behaviors and subjective risk perception. However, factors correlated with lung cancer risk perception and worries in individuals more susceptible to lung cancer have rarely been investigated. Objective: To determine demographic, social, and behavioral determinants of cancer perceived risk and worries and to explore heterogeneities in these associations by the level of lung cancer risk in a nationally representative sample of American adults. Methods: For this cross-sectional study, data came from the Health Information National Trends Survey (HINTS) 2017, which included a 2277 representative sample of American adults. Smoking status, cancer perceived risk, cancer worries, age, gender, race, education, income, and insurance status were measured. We ran structural equation models (SEMs) for data analysis. Results: "Ever smoker" status was associated with higher cancer perceived risk (b = 0.25; 95% CI = 0.05⁻0.44, p = 0.013) and worries (b = 0.34, 95% CI = 0.18⁻0.50, p < 0.001), suggesting that "ever smokers" experience higher levels of cancer perceived risk and worries regarding cancer, compared to "never smokers". Other factors that correlate with cancer perceived risk and worries were race, age, income, and insurance status. Blacks demonstrated less cancer perceived risk and worry (b = -0.98, 95% CI = -1.37⁻0.60, p < 0.001) in both low and high risk lung cancer groups. However, the effects of social determinants (income and insurance status) and age were observed in low but not high risk group. Conclusions: Determinants of cancer perceived risk and worries vary in individuals depending on the level of lung cancer risk. These differences should be considered in clinical practice and policy makings with the goal of improving participation rates in lung cancer screening programs.
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Affiliation(s)
- Hamid Chalian
- Department of Radiology, Duke University Medical Center, Durham, NC 27705, USA.
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA.
| | - Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA.
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
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45
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Cano S, Chrea C, Salzberger T, Alfieri T, Emilien G, Mainy N, Ramazzotti A, Lüdicke F, Weitkunat R. Development and validation of a new instrument to measure perceived risks associated with the use of tobacco and nicotine-containing products. Health Qual Life Outcomes 2018; 16:192. [PMID: 30241527 PMCID: PMC6151038 DOI: 10.1186/s12955-018-0997-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 08/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Making tobacco products associated with lower risks available to smokers who would otherwise continue smoking is recognized as an important strategy towards addressing smoking-related harm. Predicting use behavior is an important major component of product risk assessment. In this context, risk perception is a possible factor driving tobacco product uptake and use. As prior to market launch real-world actual product use cannot be observed, assessing risk perception can provide predictive information. Considering the lack of suitable validated self-report instruments, the development of a new instrument was undertaken to quantify perceived risks of tobacco and nicotine-containing products by adult smokers, former smokers and never-smokers. Methods Initial items were constructed based on a literature review, focus groups and expert opinion. Data for scale formation and assessment were obtained through two successive US-based web surveys (n = 2020 and 1640 completers, respectively). Psychometric evaluation was based on Rasch Measurement Theory and Classical Test Theory. Results Psychometric evaluation supported the formation of an 18-item Perceived Health Risk scale and a 7-item Perceived Addiction Risk scale: item response option thresholds were ordered correctly for all items; item locations in each scale were spread out (coverage range 75–87%); scale reliability was supported by high person separation indices > 0.93, Cronbach’s alpha > 0.98 and Corrected Item-Total Correlations > 0.88; and no differential item functioning was present. Construct validity evaluations met expectations through inter-scale correlations and findings from known-group comparisons. Conclusions The Perceived Risk Instrument is a psychometrically robust instrument applicable for general and personal risk perception measurement, for use in different types of products (including cigarettes, nicotine replacement therapy, potential Modified Risk Tobacco Products), and for different smoking status groups (i.e., current smokers with and without intention to quit, former smokers, never smokers).
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Affiliation(s)
- Stefan Cano
- Modus Outcomes, Spirella Building, Letchworth Garden City, SG6 4ET, UK
| | - Christelle Chrea
- Philip Morris Products S.A, Quai Jeanrenaud 3, 2000, Neuchâtel, Switzerland
| | - Thomas Salzberger
- Institute for Statistics and Mathematics, Institute for Marketing Management, University of Economics and Business (WU Wien), Welthandelsplatz 1, 1020, Vienna, Austria.
| | - Thomas Alfieri
- Covance Market Access Inc, 10300 Campus Point Drive, Suite 225, San Diego, CA, 92121-1511, USA
| | - Gerard Emilien
- Philip Morris Products S.A, Quai Jeanrenaud 3, 2000, Neuchâtel, Switzerland
| | - Nelly Mainy
- Philip Morris Products S.A, Quai Jeanrenaud 3, 2000, Neuchâtel, Switzerland
| | - Antonio Ramazzotti
- Philip Morris International Management S.A, Avenue de Rhodanie 50, 1007, Lausanne, Switzerland
| | - Frank Lüdicke
- Philip Morris Products S.A, Quai Jeanrenaud 3, 2000, Neuchâtel, Switzerland
| | - Rolf Weitkunat
- Philip Morris Products S.A, Quai Jeanrenaud 3, 2000, Neuchâtel, Switzerland
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46
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Kaufman AR, Dwyer LA, Land SR, Klein WMP, Park ER. Smoking-related health beliefs and smoking behavior in the National Lung Screening Trial. Addict Behav 2018; 84:27-32. [PMID: 29605757 PMCID: PMC6101245 DOI: 10.1016/j.addbeh.2018.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 12/20/2022]
Abstract
Understanding the association between smoking-related health beliefs and smoking cessation in the context of lung screening is important for effective cessation treatment. The purpose of the current study is to explore how current smokers' self-reported smoking-related health cognitions (e.g., self-efficacy) and emotions (e.g., worry) are related to cessation. This study utilized longitudinal data from current smokers (age 55-74) in a sub-study of the National Lung Screening Trial (NLST; 2002-2006; N = 2738). Logistic regression analyses examined associations of cessation at last assessment with smoking-related health cognitions and emotions, demographics, and two-way interactions among smoking-related health cognition and emotion variables, gender, and age. Over 37% (n = 1028) of smokers had quit at their last assessment of smoking status. Simple logistic regressions showed the likelihood of quitting was greater among participants reporting higher perceived severity of smoking-related diseases (OR = 1.17, p = .04), greater self-efficacy for quitting (OR = 1.32, p < .001), and fewer perceived barriers to quitting (OR = 0.82, p = .01). Likelihood of quitting was lower among non-Hispanic Black participants (versus non-Hispanic White participants) (OR = 0.68, p = .04) and higher among older participants (OR = 1.03, p = .002). Multiple logistic regression showed that participants reporting greater self-efficacy for quitting (B = 0.09, p = .05), fewer perceived barriers to quitting (B = -0.22, p = .01), and who were older (B = 0.03, p < .01) were more likely to quit smoking. These results suggest that, among heavy smokers undergoing lung screening, smoking-related health cognitions and emotions are associated with smoking cessation. These health beliefs must be considered an integral component of cessation in screening settings.
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Affiliation(s)
- Annette R Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States.
| | - Laura A Dwyer
- Cape Fox Facilities Services, 7050 Infantry Ridge Road, Manassas, VA 20109, United States
| | - Stephanie R Land
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States
| | - William M P Klein
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States
| | - Elyse R Park
- MGH/Harvard Medical School, 100 Cambridge Street, 16th Floor, Boston, MA 02114, United States
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47
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Roth JA, Carter-Harris L, Brandzel S, Buist DSM, Wernli KJ. A qualitative study exploring patient motivations for screening for lung cancer. PLoS One 2018; 13:e0196758. [PMID: 29975709 PMCID: PMC6033377 DOI: 10.1371/journal.pone.0196758] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 04/19/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Low-dose computed tomography (LDCT) of the chest for lung cancer screening of heavy smokers was given a 'B' rating by the U.S. Preventive Services Task Force (USPSTF) in 2013, and gained widespread insurance coverage in the U.S. in 2015. Lung cancer screening has since had low uptake. However, for those that do choose to screen, little is known about patient motivations for completing screening in real-world practice. OBJECTIVE To explore the motivations for screening-eligible patients to screen for lung cancer. METHODS Semi-structured qualitative interviews were conducted with 20 LDCT screen-completed men and women who were members of an integrated mixed-model healthcare system in Washington State. From June to September 2015, participants were recruited and individual interviews performed about motivations to screen for lung cancer. Audio-recorded interviews were transcribed and analyzed using inductive content analysis by three investigators. RESULTS Four primary themes emerged as motivations for completing LDCT lung cancer screening: 1) trust in the referring clinician; 2) early-detection benefit; 3) low or limited harm perception; and 4) friends or family with advanced cancer. CONCLUSION Participants in our study were primarily motivated to screen for lung cancer based on perceived benefit of early-detection, absence of safety concerns, and personal relationships. Our findings provide new insights about patient motivations to screen, and can potentially be used to improve lung cancer screening uptake and shared decision-making processes.
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Affiliation(s)
- Joshua A. Roth
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, Washington, United States of America
| | - Lisa Carter-Harris
- School of Nursing, Indiana University, Indianapolis, Indiana, United States of America
| | - Susan Brandzel
- Health Stories Project Insights, Seattle, Washington, United States of America
| | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
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48
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Hayashi H, Tan A, Kawachi I, Viswanath K. Does Segmentation Really Work? Effectiveness of Matched Graphic Health Warnings on Cigarette Packaging by Race, Gender and Chronic Disease Conditions on Cognitive Outcomes among Vulnerable Populations. JOURNAL OF HEALTH COMMUNICATION 2018; 23:523-533. [PMID: 29912655 PMCID: PMC6351315 DOI: 10.1080/10810730.2018.1474299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We examined the differential impact of exposure to smoking-related graphic health warnings (GHWs) on risk perceptions and intentions to quit among different audience segments characterized by gender, race/ethnic group, and presence of chronic disease condition. Specifically, we sought to test whether GHWs that portray specific groups (in terms of gender, race, and chronic disease conditions) are associated with differences in risk perception and intention to quit among smokers who match the portrayed group. We used data from Project CLEAR, which oversampled lower SES groups as well as race/ethnic minority groups living in the Greater Boston area (n = 565). We fitted multiple linear regression models to examine the impact of exposure to different GHWs on risk perceptions and quit intentions. After controlling for age, gender, education and household income, we found that women who viewed GHWs portraying females reported increased risk perception as compared to women who viewed GHWs portraying men. However, no other interactions were found between the groups depicted in GHWs and audience characteristics. The findings suggest that audience segmentation of GHWs may have limited impact on risk perceptions and intention to quit smoking among adult smokers.
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Affiliation(s)
- Hana Hayashi
- McCann Global Health, McCann Erickson, U.S.A., New York, United States of America
| | - Andy Tan
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Center for Community-Based Research, Dana-Farber Cancer Institute (DFCI), Boston, Massachusetts, United States of America
- Center for Translational Health Communication Science, HSPH/DFCI
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Center for Community-Based Research, Dana-Farber Cancer Institute (DFCI), Boston, Massachusetts, United States of America
- Center for Translational Health Communication Science, HSPH/DFCI
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Raz DJ, Nelson RA, Kim JY, Sun V. Pilot study of a video intervention to reduce anxiety and promote preparedness for lung cancer screening. Cancer Treat Res Commun 2018; 16:1-8. [PMID: 31298996 DOI: 10.1016/j.ctarc.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 03/22/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Lung cancer screening (LCS) with low dose computed tomography (LDCT) is associated with a 20% reduction in lung cancer mortality. Psychological burden is a potential harm associated with LCS, and is a major barrier to utilization. We aimed to examine the feasibility and acceptability of a video intervention designed to reduce anxiety and promote psychological preparedness of LCS. PATIENTS AND METHODS This is a two group, sequential enrollment pilot study of a video intervention that integrates information on screen criteria, procedures, benefits and harms, and follow-up plan. Participants were enrolled 1-2 weeks prior to baseline LDCT, and the intervention was administered in one in-person session on the day of LDCT. Outcomes were assessed at baseline (pre-screen), immediately after LDCT, and at 1 week, 3 months, and 7 months post-screen. Outcome measures included the SF-12 (HRQOL), STAI (anxiety), psychosocial consequences of LCS (COS-LC), risk perceptions for lung cancer, and a satisfaction tool. The student's t-test was used for exploratory evaluations on change from baseline scores both within and between groups. RESULTS Sixteen participants (8 intervention, 8 controls) enrolled and completed the study (61.5% retention). Participants in the control group reported a significantly increased sense of dejection at 1-month and 7-months post-screen as measured by the COS-LC (p = 0.01). Participants were highly satisfied with the intervention. CONCLUSION A video intervention that promoted psychological preparedness for LCS was feasible to implement as part of an LCS program and highly accepted by participants.
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Affiliation(s)
- Dan J Raz
- Division of Thoracic Surgery, Department of Surgery, USA.
| | | | - Jae Y Kim
- Division of Thoracic Surgery, Department of Surgery, USA.
| | - Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA, USA.
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50
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Alton D, Eng L, Lu L, Song Y, Su J, Farzanfar D, Mohan R, Krys O, Mattina K, Harper C, Liu S, Yoannidis T, Milne R, Brown MC, Vennettilli A, Hope AJ, Howell D, Jones JM, Selby P, Xu W, Goldstein DP, Liu G, Giuliani ME. Perceptions of Continued Smoking and Smoking Cessation Among Patients With Cancer. J Oncol Pract 2018; 14:e269-e279. [PMID: 29676948 DOI: 10.1200/jop.17.00029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Continued smoking after a cancer diagnosis leads to poorer treatment outcomes, survival, and quality of life. We evaluated the perceptions of the effects of continued smoking on quality of life, survival, and fatigue among patients with cancer after a cancer diagnosis and the effects of these perceptions on smoking cessation. PATIENTS AND METHODS Patients with cancer from all disease subsites from Princess Margaret Cancer Centre (Toronto, Ontario) were surveyed between April 2014 and May 2016 for sociodemographic variables, smoking history, and perceptions of continued smoking on quality of life, survival, and fatigue. Multivariable regression models evaluated the association between patients' perceptions and smoking cessation and the factors influencing patients' perceptions of smoking. RESULTS Among 1,121 patients, 277 (23%) were smoking cigarettes up to 1 year before diagnosis, and 54% subsequently quit; 23% had lung cancer, and 27% had head and neck cancers. The majority felt that continued smoking after a cancer diagnosis negatively affected quality of life (83%), survival (86%), and fatigue (82%). Current smokers during the peridiagnosis period were less likely to perceive that continued smoking was harmful when compared with ex-smokers and never-smokers ( P < .01). Among current smokers, perceiving that smoking negatively affected quality of life (adjusted odds ratio [aOR], 2.68 [95% CI, 1.26 to 5.72]; P = .011), survival (aOR, 5.00 [95% CI, 2.19 to 11.43]; P < .001), and fatigue (aOR, 3.57 [95% CI, 1.69 to 7.54]; P < .001) were each strongly associated with smoking cessation. Among all patients, those with a greater smoking history were less likely to believe that smoking was harmful in terms of quality of life (aOR, 0.98 [95% CI, 0.98 to 0.99]; P < .001), survival (aOR, 0.98 [95% CI, 0.98 to 0.99]; P < .001), and fatigue (aOR, 0.99 [95% CI, 0.98 to 0.99]; P < .001). CONCLUSION The perceptions of continued smoking after a cancer diagnosis among patients with cancer are strongly associated with smoking cessation. Counseling about the harms of continued smoking in patients with cancer, and in particular among those who have lower risk perceptions, should be considered when developing a smoking cessation program.
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Affiliation(s)
- Devon Alton
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Lawson Eng
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Lin Lu
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Yuyao Song
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Jie Su
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Delaram Farzanfar
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Rahul Mohan
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Olivia Krys
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Katie Mattina
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Christopher Harper
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Sophia Liu
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Tom Yoannidis
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Robin Milne
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - M Catherine Brown
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Ashlee Vennettilli
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Andrew J Hope
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Doris Howell
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Jennifer M Jones
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Peter Selby
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - David P Goldstein
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Geoffrey Liu
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Meredith E Giuliani
- University of Toronto; Ontario Cancer Institute; and Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
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