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Ng W, Baik SH, Razavi M, Clark K, Lee J, Loscalzo M, Folbrecht J. Differences of biopsychosocial distress and requests for psychological assistance between Asian American and non-Hispanic White oncology patients. Psychooncology 2023; 32:1660-1666. [PMID: 37700725 DOI: 10.1002/pon.6214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE The purpose of this study was to compare Asian American (AA) to non-Hispanic White (NHW) cancer patients regarding biopsychosocial distress and requests for psychological assistance. METHODS This retrospective study included 5627 eligible patients, newly diagnosed with cancer, who completed the 30-item SupportScreen® survey of biopsychosocial distress. The top 10 sources of high distress were assessed. Distress domains (Emotional, Physical/Functional, and Practical) were examined by race/ethnicity. Requests for psychological assistance were also explored by ethnic groups. RESULTS Overall, the top 10 sources of high distress were similar between groups and approximately half consisted of concerns regarding physical symptoms. All patients preferred "talking" as their method of receiving assistance for these items. Ratings of emotional, practical, and physical/functional distress were similar between AA and NHW patients. However, AAs (vs. NHWs) requested more assistance regarding physical/functional and practical distress. No difference was observed between these two groups regarding requests for emotional support. CONCLUSIONS Overall, our study suggests that healthcare providers should be aware of the physical and practical needs of AA cancer patients and provide culturally sensitive care that addresses these needs.
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Affiliation(s)
- Winnie Ng
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Sharon H Baik
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Marianne Razavi
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Karen Clark
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Jonathan Lee
- Azusa Pacific University, Azusa, California, USA
| | - Matthew Loscalzo
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Jeanelle Folbrecht
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
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2
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Friedman AS, Thomas S, Suttiratana SC. Differences in Cancer Screening Responses to State Medicaid Expansions by Race and Ethnicity, 2011‒2019. Am J Public Health 2022; 112:1630-1639. [PMID: 36223588 PMCID: PMC9558180 DOI: 10.2105/ajph.2022.307027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate whether state Medicaid expansions' relationships to breast, cervical, and colorectal cancer screening differ by race/ethnicity. Methods. Analyses conducted in 2021 used 2011-2016 and 2018-2019 Behavioral Risk Factor Surveillance System data on adults aged 40 to 64 years with household incomes below 400% of the federal poverty guideline (FPG; n = 537 250). Triple-difference analyses compared cancer screening in Medicaid expansion versus nonexpansion states, before versus after expansion, among people with incomes above versus below the eligibility cutoff (138% FPG). Race/ethnicity and ethnicity-by-language interaction terms tested for effect modification. Results. Associations between Medicaid expansions and cancer screening were significant for past-2-year mammograms and past-5-year colorectal screening. Effect modification analyses showed elevated mammography among non-Hispanic Asian women (+9.0 percentage points; 95% confidence interval [CI] = 3.2, 14.8) and Hispanic women (+6.0 percentage points; 95% CI = 2.0, 10.1), and Papanicolaou tests among Hispanic women (+4.2 percentage points; 95% CI = 0.1, 8.2). Findings were not limited to English- or Spanish-speaking respondents and were robust to insurance status controls. Conclusions. Medicaid expansions yielded statistically significant increases in income-eligible Asian and Hispanic women's mammography and Hispanic women's Pap testing relative to non-Hispanic White women. Neither language proficiency nor insurance status explained these findings. (Am J Public Health. 2022;112(11):1630-1639. https://doi.org/10.2105/AJPH.2022.307027).
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Affiliation(s)
- Abigail S Friedman
- Abigail S. Friedman and Sakinah C. Suttiratana are with the Yale School of Public Health, New Haven, CT. Sasha Thomas is with Yale College, New Haven
| | - Sasha Thomas
- Abigail S. Friedman and Sakinah C. Suttiratana are with the Yale School of Public Health, New Haven, CT. Sasha Thomas is with Yale College, New Haven
| | - Sakinah C Suttiratana
- Abigail S. Friedman and Sakinah C. Suttiratana are with the Yale School of Public Health, New Haven, CT. Sasha Thomas is with Yale College, New Haven
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3
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Stenzel AE, Bustamante G, Sarkin CA, Harripersaud K, Jewett P, Teoh D, Vogel RI. The intersection of sexual orientation with race and ethnicity in cervical cancer screening. Cancer 2022; 128:2753-2759. [PMID: 35570647 DOI: 10.1002/cncr.34213] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cervical cancer screening is recommended for those with a cervix who are 21 to 65 years old, with specific timelines being dependent on individual risk. This study compared rates of ever undergoing Papanicolaou (Pap) testing at the intersection of self-reported sexual minority (SM) status and race/ethnicity. METHODS Data from the National Health Interview Survey (2015 and 2018) were used to examine cervical cancer screening disparities. Natal females without a history of hysterectomy who were 21 to 65 years old and had reported their sexual orientation and Pap testing history were included. Demographic and health characteristics were summarized with descriptive statistics. To adjust for differences in confounding variables between groups, propensity score-based inverse probability of treatment weighting (IPTW) was performed. IPTW-adjusted multivariable logistic regression models estimated odds of ever undergoing a Pap test by sexual orientation alone and with race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic). RESULTS SM persons (n = 877) had significantly reduced odds of ever undergoing Pap testing (odds ratio, 0.54; 95% confidence interval, 0.42-0.70) in comparison with heterosexual persons (n = 17,760). When the intersection of sexual orientation and race/ethnicity was considered, non-Hispanic White SM participants and Hispanic SM participants had reduced odds of ever undergoing Pap testing in comparison with non-Hispanic White heterosexual participants. No significant differences were observed between non-Hispanic White heterosexual participants and participants of non-Hispanic Black SM or Hispanic heterosexual identities. CONCLUSIONS SM participants were significantly less likely to have ever undergone a Pap test in comparison with heterosexual participants, with Hispanic SM participants having the lowest uptake. Future studies should further examine the roles of systemic discrimination and other key drivers of these disparities.
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Affiliation(s)
- Ashley E Stenzel
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota.,Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Gabriela Bustamante
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.,School of Public Health, Universidad San Francisco de Quito, Quito, Ecuador
| | - Courtney A Sarkin
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.,Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Katherine Harripersaud
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Patricia Jewett
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota.,Division of Hematology and Oncology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Deanna Teoh
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
| | - Rachel I Vogel
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
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4
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Santiago-Rodríguez EJ, Rivadeneira NA, Torres JM, Sarkar U, Hiatt RA. Socioeconomic status and colorectal cancer screening behaviors in a vulnerable multiethnic population. ETHNICITY & HEALTH 2022; 27:980-996. [PMID: 33121258 PMCID: PMC8081754 DOI: 10.1080/13557858.2020.1838454] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Despite some progress in recent years, colorectal cancer (CRC) screening adherence in the United States is still suboptimal, particularly among disadvantaged groups. In this study, we assessed the association between socioeconomic status (SES) and self-reported screening non-adherence (SNA) in a sample of racial/ethnic minorities living in San Francisco, California. DESIGN/METHODS A total of 376 participants of the San Francisco version of the Health Information National Trends Survey (SF-HINTS) with ages 50-75 years were included in this cross-sectional study. SNA was defined as not reporting blood stool test within the past year and not reporting sigmoidoscopy/colonoscopy within the past 10 years. Poisson regression models with robust variance estimators were used to evaluate the relation of SES with SNA, adjusting for measured confounders. Results are reported as prevalence ratios (PR) and 95% confidence intervals (95% CI). RESULTS Overall SNA was 40%. In multivariable models including all respondents, retired participants had significantly lower SNA prevalence than employed participants (PR = 0.46, 95% CI = 0.26 0.83). In stratified analyses by race/ethnicity, Black respondents with less than high school (PR = 1.93, 95% CI = 1.09, 3.43) and those with high school or equivalent (PR = 1.88, 95% CI = 1.16, 3.04) had significantly higher SNA prevalence than those with at least some college. Among non-Hispanic Asian/Pacific Islanders, those disabled had significantly higher prevalence of SNA as compared to employed people (PR = 4.26, 95% CI = 2.11, 8.60). None of the SES indicators were significantly associated to SNA among Hispanics. CONCLUSIONS Participants with lower SES characteristics were less likely to adhere to CRC screening guidelines and being retired was a predictor of compliance. There was evidence of heterogeneity in associations between SES and CRC screening by race/ethnicity. Life circumstances of retired people could provide insights for designing interventions aimed to improve CRC screening uptake in these priority groups. Future efforts should consider mechanisms underlying differences by race/ethnicity.
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Affiliation(s)
| | - Natalie A. Rivadeneira
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Urmimala Sarkar
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Robert A. Hiatt
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- UCSF Helen Diller Family Comprehensive Cancer Center
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5
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Racine L, Isik Andsoy I. Barriers and Facilitators Influencing Arab Muslim Immigrant and Refugee Women's Breast Cancer Screening: A Narrative Review. J Transcult Nurs 2022; 33:542-549. [PMID: 35473467 PMCID: PMC9240380 DOI: 10.1177/10436596221085301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: This narrative review identifies barriers and facilitators influencing breast cancer
screening among Arab Muslim immigrants and refugees. Low participation rates create
health inequities in breast cancer screening among this population. Method: A systematic search of peer-reviewed empirical articles was performed. PRISMA, CASP,
and MMAT checklists were used to appraise the studies. Results: Results include 3 themes: individual, health care system and health providers, and
cultural factors. Discussion: Lack of fluency in the new country’s language, lack of knowledge, and poor exposure to
breast cancer screening may contribute to the Arab Muslim women’s vulnerability to
undiagnosed or delayed breast cancer diagnosis.
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Schear RM, Hoyos JM, Davis AQ, Woods PL, Poblete S, Richardson RN, Finney Rutten LJ. Patient engagement and advocacy considerations in development and implementation of a multicancer early detection program. Cancer 2022; 128 Suppl 4:909-917. [PMID: 35133663 DOI: 10.1002/cncr.34047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/01/2021] [Accepted: 10/21/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Rebekkah M Schear
- Livestrong Cancer Institutes, Dell Medical School, University of Texas at Austin, Austin, Texas
| | | | - Anjee Q Davis
- American Cancer Society Cancer Action Network, Inc, Washington, District of Columbia
| | - Phylicia L Woods
- American Cancer Society Cancer Action Network, Inc, Washington, District of Columbia.,Fight Colorectal Cancer, Springfield, Missouri
| | | | - Robin N Richardson
- Livestrong Cancer Institutes at the Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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7
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Koehlmoos TP, Korona-Bailey J, Janvrin ML, Madsen C. Racial Disparities in the Military Health System: A Framework Synthesis. Mil Med 2021; 187:e1114-e1121. [PMID: 34910808 DOI: 10.1093/milmed/usab506] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/25/2021] [Accepted: 12/11/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Racial disparities in health care are a well-documented phenomenon in the USA. Universal insurance has been suggested as a solution to mitigate these disparities. We examined race-based disparities in the Military Health System (MHS) by constructing and analyzing a framework of existing studies that measured disparities between direct care (care provided by military treatment facilities) and private sector care (care provided by civilian health care facilities). MATERIALS AND METHODS We conducted a framework synthesis on 77 manuscripts published in partnership with the Comparative Effectiveness and Provider-Induced Demand Collaboration Project that use MHS electronic health record data to present an overview of racial disparities assessed for multiple treatment interventions in a nationally representative, universally insured population. RESULTS We identified 32 studies assessing racial disparities in areas of surgery, trauma, opioid prescription and usage, women's health, and others. Racial disparities were mitigated in postoperative complications, trauma care, and cancer screenings but persisted in diabetes readmissions, opioid usage, and minimally invasive women's health procedures. CONCLUSION Universal coverage mitigates many, but not all, racial disparities in health care. An examination of a broader range of interventions, a closer look at variation in care provided by civilian facilities, and a look at the quality of care by race provide further opportunities for research.
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Affiliation(s)
- Tracey Pérez Koehlmoos
- Center for Health Services Research, Uniformed Services University, Bethesda, MD 20814, USA
| | - Jessica Korona-Bailey
- Center for Health Services Research, Uniformed Services University, Bethesda, MD 20814, USA.,Henry M. Jackson Foundation, Bethesda, MD 20817, USA
| | - Miranda Lynn Janvrin
- Center for Health Services Research, Uniformed Services University, Bethesda, MD 20814, USA.,Henry M. Jackson Foundation, Bethesda, MD 20817, USA
| | - Cathaleen Madsen
- Center for Health Services Research, Uniformed Services University, Bethesda, MD 20814, USA.,Henry M. Jackson Foundation, Bethesda, MD 20817, USA
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8
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Qi M, Cahan O, Foreman MA, Gruen DM, Das AK, Bennett KP. Quantifying representativeness in randomized clinical trials using machine learning fairness metrics. JAMIA Open 2021; 4:ooab077. [PMID: 34568771 PMCID: PMC8460438 DOI: 10.1093/jamiaopen/ooab077] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/19/2021] [Accepted: 09/03/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE We help identify subpopulations underrepresented in randomized clinical trials (RCTs) cohorts with respect to national, community-based or health system target populations by formulating population representativeness of RCTs as a machine learning (ML) fairness problem, deriving new representation metrics, and deploying them in easy-to-understand interactive visualization tools. MATERIALS AND METHODS We represent RCT cohort enrollment as random binary classification fairness problems, and then show how ML fairness metrics based on enrollment fraction can be efficiently calculated using easily computed rates of subpopulations in RCT cohorts and target populations. We propose standardized versions of these metrics and deploy them in an interactive tool to analyze 3 RCTs with respect to type 2 diabetes and hypertension target populations in the National Health and Nutrition Examination Survey. RESULTS We demonstrate how the proposed metrics and associated statistics enable users to rapidly examine representativeness of all subpopulations in the RCT defined by a set of categorical traits (eg, gender, race, ethnicity, smoking status, and blood pressure) with respect to target populations. DISCUSSION The normalized metrics provide an intuitive standardized scale for evaluating representation across subgroups, which may have vastly different enrollment fractions and rates in RCT study cohorts. The metrics are beneficial complements to other approaches (eg, enrollment fractions) used to identify generalizability and health equity of RCTs. CONCLUSION By quantifying the gaps between RCT and target populations, the proposed methods can support generalizability evaluation of existing RCT cohorts. The interactive visualization tool can be readily applied to identified underrepresented subgroups with respect to any desired source or target populations.
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Affiliation(s)
- Miao Qi
- Department of Computer Science, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Owen Cahan
- Department of Mathematical Sciences, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Morgan A Foreman
- Center for Computational Health, IBM Research, Cambridge, Massachusetts, USA
| | - Daniel M Gruen
- Department of Mathematical Sciences, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Amar K Das
- Center for Computational Health, IBM Research, Cambridge, Massachusetts, USA
| | - Kristin P Bennett
- Department of Computer Science, Rensselaer Polytechnic Institute, Troy, New York, USA
- Department of Mathematical Sciences, Rensselaer Polytechnic Institute, Troy, New York, USA
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9
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Otto AK, Ketcher D, McCormick R, Davis JL, McIntyre MR, Liao Y, Reblin M, Vadaparampil ST. Using the health belief model to assess racial/ethnic disparities in cancer-related behaviors in an NCI-designated comprehensive cancer center catchment area. Cancer Causes Control 2021; 32:1085-1094. [PMID: 34132914 DOI: 10.1007/s10552-021-01457-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 06/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Racial and ethnic minorities experience well-documented disparities across the cancer trajectory. However, factors underlying these disparities may vary regionally. The Health Belief Model (HBM) was developed to explain and predict health-related prevention and early detection behaviors, particularly uptake of health services. Our goal was to use the HBM to guide an exploration of factors that contribute to racial/ethnic health disparities in the catchment area of a large National Cancer Institute-designated Comprehensive Cancer Center in the Southeastern United States. METHODS We conducted a secondary analysis of data collected by the cancer center for its triennial Community Health Needs Assessment, which sampled adults from the center's 15-county catchment area. White non-Hispanics (WNHs; n = 887), Black non-Hispanics (BNHs; n = 78), Hispanics/Latinxs (H/Ls; n = 185), and those identifying as another race/ethnicity ("Others"; n = 39) were compared across key HBM variables, including demographic/psychosocial information, perceived benefits and barriers to preventive health behaviors, risk perception, and health behavior outcomes. RESULTS Controlling for annual household income, relationship status, and age (for certain screening behaviors), significant differences were seen in information-seeking behaviors, risk perception, community attributes, discrimination, and distress. Non-WNH groups reported worse community attributes, higher everyday discrimination, lower health literacy, less confidence in their ability to get health information, and lower perceived risk of cancer. CONCLUSION This analysis presents a better understanding of how HBM factors may influence health disparities in the cancer center's catchment area. Results describe the needs of community members from racial and ethnic minority groups, which will inform future research, education, outreach, and service activities.
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Affiliation(s)
- Amy K Otto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Public Health Sciences, The University of Miami, Miami, FL, USA
| | - Dana Ketcher
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Rachael McCormick
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Jenna L Davis
- Moffitt Diversity, Moffitt Cancer Center, Tampa, FL, USA
| | - McKenzie R McIntyre
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Yunqi Liao
- Office of Community Outreach, Engagement, and Equity, Moffitt Cancer Center, Tampa, FL, USA
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
- Department of Family Medicine, University of Vermont, Burlington, VT, USA.
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Office of Community Outreach, Engagement, and Equity, Moffitt Cancer Center, Tampa, FL, USA
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10
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Vapiwala N, Miller D, Laventure B, Woodhouse K, Kelly S, Avelis J, Baffic C, Goldston R, Glanz K. Stigma, beliefs and perceptions regarding prostate cancer among Black and Latino men and women. BMC Public Health 2021; 21:758. [PMID: 33879107 PMCID: PMC8056613 DOI: 10.1186/s12889-021-10793-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health disparities in prostate cancer (PC) are thought to reflect the complex interplay of socioeconomics, environment and biology. The potential impact of beliefs and perceptions about PC among Black and Latino populations on clinical disparities are not well understood. This qualitative study was conducted to assess current prevalent and pervasive stigma, beliefs and perceptions regarding PC among Blacks and Latinos living in a large metropolitan area, thereby identifying potentially modifiable barriers to care. METHODS Qualitative data were collected through four separate focus groups of self-identified Black and Latino adult men and women living in Philadelphia to better understand their perceptions of PC diagnosis, screening and treatment. Each focus group was single-sex and conducted by racial/ethnic group in order to assess possible differences in beliefs about PC based on gender and racial/ethnic affiliation. Audio recordings were transcribed verbatim by trained research assistants and qualitative data analysis was conducted using modified grounded theory. RESULTS There were a total of 34 participants: 19 Hispanics/Latinos and 15 Blacks, with equal numbers of men and women (n=17). Median age was 57 years (range: 18 to 85 years). Dominant themes that emerged with respect to PC diagnosis included the stigma surrounding this condition and the perceived role of an "unhealthy lifestyle" and certain sexual behaviors as risk factors for PC development. While the majority of participants acknowledged the importance of PC screening and early detection, discussion centered around the barriers to both the interest in seeking medical care and the likelihood of securing it. These barriers included misunderstanding of PC etiology, distrust of the medical profession, and financial/access limitations. Men expressed substantial confusion about PC screening guidelines. In the Black female group, the role of faith and religion in the course of disease was a major theme. Both Black and Latina females discussed the role of fear and avoidance around PC screening and treatment, as well as the prevalence of misinformation about PC in their familial and social communities. CONCLUSION Black and Latino focus groups revealed the existence of cultural beliefs, misunderstandings and fears pertaining to PC which could influence health-related behaviors. Some themes were common across groups; others suggested racial and gender predilections. Future targeted efforts focused on directly addressing prevalent misperceptions among underserved communities in urban settings could help to improve health literacy and equity in PC outcomes in these populations.
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Affiliation(s)
- Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, TRC 4 West, Philadelphia, PA, 19104, USA.
| | - David Miller
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, TRC 4 West, Philadelphia, PA, 19104, USA
| | - Brenda Laventure
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, TRC 4 West, Philadelphia, PA, 19104, USA
| | - Kristina Woodhouse
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sheila Kelly
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, USA
| | - Jade Avelis
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, USA
| | - Cordelia Baffic
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, TRC 4 West, Philadelphia, PA, 19104, USA
| | | | - Karen Glanz
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, USA
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Hilverda F, Fissers K, van den Broek T. Turkish and Moroccan Dutch women’s views of using a self-sampling kit for human papillomavirus testing as a tool for cervical cancer screening: What are the barriers and the motivators? WOMEN'S HEALTH 2021; 17:17455065211065873. [PMID: 34903110 PMCID: PMC8679022 DOI: 10.1177/17455065211065873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: This study explores barriers and motivators to use self-sampling kits for
human papillomavirus testing for cervical cancer screening as perceived by
Dutch women of Turkish and Moroccan origin living in the Netherlands. Methods: A total of 11 in-depth semi-structured interviews were conducted and
structured according to the theory of planned behavior. Results: Findings suggest that self-sampling may lift important barriers hampering
traditional cervical cancer screening, such as those related to shame and
chastity. However, self-sampling raises its own barriers too. Most
importantly, some women fear that self-sampling may harm virginity. Some
women also do not feel confident about their ability to properly use the
self-sampling kit, but fears about the inability to properly use it often
fade away upon having seen the self-sampling kit. Moreover, results show
that knowledge about cervical cancer and its origin is limited, which may
undermine women’s willingness to participate in a screening program. Conclusions: These results suggest that communication strategies to encourage using
self-sampling kits among women of Turkish and Moroccan origin could benefit
from culturally sensitive approaches, for example, by placing emphasis on
issues such as virginity and chastity. Consistent with a recent advice of
the Health Council of the Netherlands, the kit could furthermore be sent to
eligible women as a standard procedure, rather than upon request. This could
reduce hassle and doubts about women’s ability to use the self-sampling kit.
Finally, educating women about the importance of screening to prevent
cervical cancer is needed to foster informed decision-making.
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Affiliation(s)
- Femke Hilverda
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Katleen Fissers
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Thijs van den Broek
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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12
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The association between patient experience and healthcare outcomes using SEER-CAHPS patient experience and outcomes among cancer survivors. J Geriatr Oncol 2020; 12:623-631. [PMID: 33277226 DOI: 10.1016/j.jgo.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To understand the relationship between patient experience, as measured by scores on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, and clinical and financial outcomes among older cancer survivors. MATERIALS AND METHODS We analyzed the records of all Fee-for-Service (FFS) Medicare beneficiaries 66 years and older who completed one CAHPS survey from 2001 to 2004 or 2007-2013 with one of the five following cancer types: breast, bladder, colorectal, lung, or prostate; and completed a CAHPS survey within 5 years of cancer diagnosis date. We conducted a multivariate analysis, controlling for clinical and demographic variables, to evaluate the association between excellent CAHPS scores and the following clinical and financial outcomes: mortality, emergency department visits, and total healthcare expenditures. RESULTS A total of 7395 individuals were present in our cohort, with 57% being male and 85.7% non-Hispanic White. Breakdown of the cohort by cancer site is as follows: prostate (40.4%), breast (28.6%), colorectal (14.0%), lung (9.4%), and bladder (7.6%). When looking at the relationship between CAHPS scores and clinical outcomes, there was no significant difference between excellent and non-excellent CAHPS score respondents in all three of the clinical outcomes studied. Furthermore, there was no association between ED utilization and patient experience scores when stratifying by cancer site and race/ethnicity among this cohort. CONCLUSION In this cohort, a highly rated patient experience, as measured by responses on the CAHPS survey, is not associated with improved clinical outcomes among older cancer survivors.
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Racial Disparities Vary by Patient Life Expectancy in Screening for Breast, Prostate, and Colorectal Cancers. J Gen Intern Med 2020; 35:3389-3391. [PMID: 31797159 PMCID: PMC7661603 DOI: 10.1007/s11606-019-05566-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 10/22/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
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Schoenborn NL, Massare J, Park R, Pollack CE, Choi Y, Boyd CM. Clinician Perspectives on Overscreening for Cancer in Older Adults With Limited Life Expectancy. J Am Geriatr Soc 2020; 68:1462-1468. [PMID: 32232838 DOI: 10.1111/jgs.16415] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES Guidelines recommend against routine screening for breast, colorectal, and prostate cancers in older adults with less than 10 years of life expectancy. However, clinicians often continue to recommend cancer screening for these patients. We examined primary care clinicians' perspectives regarding overscreening, as defined by limited life expectancy. DESIGN Semistructured, in-depth individual interviews. SETTING Twenty-one academic and nonacademic primary care clinics in Maryland. PARTICIPANTS Thirty primary care clinicians from internal medicine, family medicine, medicine/pediatrics, and geriatric medicine. MEASUREMENTS Interviews explored whether the clinicians believed that overscreening for breast, colorectal, or prostate cancers existed in older adults and their views on using life expectancy to decide on stopping routine screening. Audio recordings of the interviews were transcribed verbatim. Two investigators independently coded all transcripts using qualitative content analysis. RESULTS Most clinicians were physicians (24/30) and women (16/30). Content analysis generated three major themes. (1) Many, but not all, clinicians perceived overscreening in older adults as a problem. (2) There was controversy around using limited life expectancy to define overscreening due to concerns that the guidelines did not capture potential nonmortality benefits of screening; that population-based screening data could not be easily applied to individuals; that this approach failed to account for patient choice; and that life expectancy predictions were inaccurate. (3) Some clinicians worried that using life expectancy to define overscreening may inadvertently introduce bias and lead to unintended harms. CONCLUSIONS Several clinicians disagreed with guideline frameworks of using limited life expectancy to guide cancer screening cessation. Some disagreement stems from inadequate knowledge about the benefits and harms of cancer screening and indicates a need for education or decision support. Other reasons for disagreement highlight the need to refine the current recommended cancer screening approaches and identify strategies to avoid unintended consequences, such as introducing bias or exacerbating existing disparities. J Am Geriatr Soc 68:1462-1468, 2020.
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Affiliation(s)
- Nancy L Schoenborn
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jacqueline Massare
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Reuben Park
- The Johns Hopkins University, Baltimore, Maryland, USA
| | - Craig E Pollack
- Department of Healthy Policy and Management, The Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
| | - Youngjee Choi
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cynthia M Boyd
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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15
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Davis Lynn BC, Rosenberg PS, Anderson WF, Gierach GL. Black-White Breast Cancer Incidence Trends: Effects of Ethnicity. J Natl Cancer Inst 2019; 110:1270-1272. [PMID: 29982593 DOI: 10.1093/jnci/djy112] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/23/2018] [Indexed: 12/13/2022] Open
Abstract
Recent reports of converging black and white breast cancer incidence rates have gained much attention, potentially foreshadowing a worsening of the black-white breast cancer mortality disparity. However, these incidence rates also reflect the sum of non-Hispanics and Hispanics that may mask important ethnicity-specific trends. We therefore assessed race- and ethnicity-specific breast cancer trends using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 13 Registries Database (1992-2014). Age-period-cohort models projected rates for 2015-2030. Results confirmed merging of age-standardized incidence rates for blacks and whites circa 2012, but not for non-Hispanic black (NHB) and non-Hispanic white (NHW) women. Incidence rates were highest for NHW women (n = 382 290), followed by NHB women (n = 51 074), and then Hispanic white women (n = 48 651). The sample size for Hispanic blacks was too small for analysis (n = 693). Notably, future incidence rates are expected to slowly increase (2015 through 2030) among NHW women (0.24% per year, 95% confidence interval [CI] = 0.17 to 0.32) and slowly decrease for NHB women (-0.14% per year, 95% CI = -0.15 to -0.13). A putative worsening of the black-white mortality disparity, therefore, seems unlikely. Ethnicity matters when assessing race-specific breast cancer incidence rates.
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Affiliation(s)
- Brittny C Davis Lynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - William F Anderson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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16
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Jackson L, Jackson H, Mohammed M, Guthrie N, Kim S, Okolo R, Jackson F. Cancer in an Historic Washington DC African American Population and Its Geospatial Distribution. Front Oncol 2018; 8:383. [PMID: 30483472 PMCID: PMC6243064 DOI: 10.3389/fonc.2018.00383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/28/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Cancer continues to be a major cause of morbidity and mortality in the African American community but insights into the types and incidence of cancer 85 years ago have been virtually non-existent and little is known of its geospatial distribution. Historical information on cancer can shed light on current health disparities, particularly among African Americans. Objective: The aims of this study were to: (1) assess the frequencies of the cancer types present among Cobb Collection individuals; (2) compare these data with current research on cancer in African Americans; and (3) evaluate the pattern of cancer expression, including its geospatial distributions, as a cause of death between 1931 and 1969 in an historic African American subgroup and compare this pattern with the historic and contemporary patterns of cancer etiology and incidence. Methods: Systematic assessments of the existing clinical, demographic, and anatomical records in the Cobb Research Laboratory were made of individuals identified as dying from specific cancers from 1931 to 1969. These were compared with the national profiles of cancer during the historic time an individual died as well as the contemporary patterns of cancer deaths. Analysis of their residential addresses just prior to death were assessed using a commercial geographic information system. Each location was assigned a geospatial location and proximity between each site and clusters of sites were investigated. Results: Seventeen different cancer types were found within 28 individuals of the Cobb Collection between 1931 and 1969. The cancer types with the highest frequencies were carcinoma of stomach, lung, esophagus, larynx and bronchogenic carcinoma. Eighty-four percent of all cancer incidents occurred in males and 76% were among individuals identified as African American. Seventy-one percent of the highest incidence cancers were among African American males. Geospatial clustering was observed most noticeably in the redistribution of carcinoma of the esophagus. Conclusion: Our results provide historical depth to our knowledge of the common cancer causes of morbidity among African Americans of Washington DC from 1931 to 1969. We contrast these findings with national historical data on cancer etiology and ethnic disparities in incidence. Our study suggests that historic data can provide longitudinal depth to our understanding of the persistence of cancer susceptibilities in a vulnerable subgroup.
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Affiliation(s)
- Latifa Jackson
- W. Montague Cobb Research Laboratory, Howard University, Washington, DC, United States.,Department of Pediatrics, College of Medicine, Howard University, Washington, DC, United States
| | - Hasan Jackson
- W. Montague Cobb Research Laboratory, Howard University, Washington, DC, United States.,Global Research & Interdisciplinary Development, Washington, DC, United States.,Jackson Wellness Group, Bethesda, MD, United States
| | - Mariam Mohammed
- W. Montague Cobb Research Laboratory, Howard University, Washington, DC, United States
| | - Nicholas Guthrie
- W. Montague Cobb Research Laboratory, Howard University, Washington, DC, United States.,College of Medicine, Howard University, Washington, DC, United States
| | - Shihyun Kim
- W. Montague Cobb Research Laboratory, Howard University, Washington, DC, United States.,College of Medicine, Howard University, Washington, DC, United States
| | - Rita Okolo
- W. Montague Cobb Research Laboratory, Howard University, Washington, DC, United States
| | - Fatimah Jackson
- W. Montague Cobb Research Laboratory, Howard University, Washington, DC, United States.,Department of Biology, Howard University, Washington, DC, United States
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Castle PE. Charting the Future of Cancer Health Disparities Research-Letter. Cancer Res 2018; 78:1883-1885. [PMID: 29506973 DOI: 10.1158/0008-5472.can-17-2932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/21/2017] [Accepted: 01/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
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18
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Mahon S. Cancer Prevention and Detection: Application Across the Cancer Trajectory. Clin J Oncol Nurs 2018; 22:108-112. [DOI: 10.1188/18.cjon.108-112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ceres M, Quinn GP, Loscalzo M, Rice D. Cancer Screening Considerations and Cancer Screening Uptake for Lesbian, Gay, Bisexual, and Transgender Persons. Semin Oncol Nurs 2018; 34:37-51. [PMID: 29325817 DOI: 10.1016/j.soncn.2017.12.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To describe the current state of cancer screening and uptake for lesbian, gay, bisexual, and transgender (LGBT) persons and to propose cancer screening considerations for LGBT persons. DATA SOURCES Current and historic published literature on cancer screening and LGBT cancer screening; published national guidelines. CONCLUSION Despite known cancer risks for members of the LGBT community, cancer screening rates are often low, and there are gaps in screening recommendations for LGBT persons. We propose evidence-based cancer screening considerations derived from the current literature and extant cancer screening recommendations. IMPLICATIONS FOR NURSING PRACTICE The oncology nurse plays a key role in supporting patient preventive care and screening uptake through assessment, counseling, education, advocacy, and intervention. As oncology nurses become expert in the culturally competent care of LGBT persons, they can contribute to the improvement of quality of care and overall well-being of this health care disparity population.
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