Disparities in receipt of follow-up care instructions among female adult cancer survivors: Results from a national survey

A scoping review of the evidence on survivorship care plans among minority, rural, and low-income populations

PURPOSE

Despite recent advances in cancer control and the number of cancer survivors increasing substantially over the past years, some cancer survivors continue to experience disparities due to barriers to recommended survivorship care. The use of survivorship care plans (SCPs) may be a way to help care for these individuals and their respective issues after they complete their primary treatment. The purpose of this scoping review is to understand the evidence on SCPs among minority, rural, and low-income populations: groups that experience disproportionately poorer cancer health outcomes.

METHODS

Computer-based searches were conducted in four academic databases. We included peer-reviewed studies published in the English language and conducted in the USA. We systematically extracted information from each paper meeting our inclusion criteria.

RESULTS

Our search identified 45 articles. The 4 major themes identified were (1) disparities in the receipt of SCPs where populations experience unmet needs; (2) benefits of SCPs, including improved care coordination and self-management of cancer; (3) needs and preferences for survivorship care; and (4) barriers and facilitators to using SCPs.

CONCLUSIONS

Despite the potential benefits, underserved cancer survivors experience disparities in the receipt of SCPs and continue to have unmet needs in their survivorship care. Survivorship care may benefit from a risk-stratified approach where SCPs are prioritized to survivors belonging to high-risk groups.

IMPLICATIONS FOR CANCER SURVIVORS

SCPs are a tool to deliver quality care for cancer survivors. While evidence is mixed on SCPs' benefits among the general population, SCPs show promise for underserved populations when it comes to proximal outcomes that contribute to disparities.

Disparities in healthcare utilization and access by length of cancer survivorship among population-based female cancer survivors

PURPOSE

The current study examined disparities in the associations between medically vulnerable populations and healthcare-related outcomes among population-based female cancer survivors and determined if these associations differed by length of cancer survivorship.

METHODS

One thousand eight hundred ninety-seven women with a cancer history from the National Health and Nutrition Examination Survey from 1999 to 2016 contributed data. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated with multivariable logistic regression models to measure the associations between the predictors (race/ethnicity, poverty status, education, comorbidity status, US nativity) and outcomes (perceived health, healthcare utilization and access outcomes), overall and by length of survivorship.

RESULTS

There was an average of 14.3 years (SD = 11.7; range = 2-84) since initial cancer diagnosis, with 25.1% being short-term and 74.9% being long-term survivors. Overall, racial/ethnic minority women were more likely to report poor/fair health status (OR, 2.68; 95% CI 1.73-4.15) and utilizing routine care other than a doctor's office/HMO (OR, 1.61; 95% CI 1.12-2.29) in comparison with NHW survivors. Length of survivorship significantly modified the association between race/ethnicity and odds of seeing a mental health provider in the last year (p-interaction = 0.003), with short-term minority survivors being significantly more likely (OR, 2.63; 95% CI 1.29-5.35) and long-term minority survivors being less likely (OR, 0.68; 95% CI 0.37-1.23).

CONCLUSIONS

Racial/ethnic disparities exist among female cancer survivors for perceived health status and certain healthcare utilization outcomes, with some differences observed by length of cancer survivorship.

IMPLICATIONS FOR CANCER SURVIVORS

This study can begin to inform cancer survivorship care for medically vulnerable women along the cancer continuum.

Tailoring survivorship to diverse populations with genitourinary malignancies

Socioeconomic and racial/ethnic disparities in genitourinary malignancies remain a critical problem. Variations in initial and subsequent treatments, including survivorship care, likely contribute to these disparities. While the prevalence of genitourinary cancer survivors continues to grow, heterogeneity in survivorship care threatens to increase disparities. Several social factors, such as insurance status, language, and geography, drive heterogeneity observed in survivorship care. Linguistically tailored, culturally relevant survivorship is an essential component of a multidisciplinary effort to address racial/ethnic disparities among patients with genitourinary malignancies. Survivorship care is an essential component of cancer treatment, however if it is not developed and tested among a diverse patient population, it can lead to a widening of disparities observed among patients with genitourinary malignancies.