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Baqri W, Rzadki K, Habbous S, Das S. Treatment, healthcare utilization and outcomes in patients with glioblastoma in Ontario: a 10-year cohort study. J Neurooncol 2024; 168:473-485. [PMID: 38702569 DOI: 10.1007/s11060-024-04690-7] [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: 03/08/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE Glioblastoma (GBM) is the most common malignant primary brain tumour in adults. Receipt of adjuvant therapies has been shown to exert a significant positive effect on patient survival. Little is known however about how changes in standards of care and healthcare system factors, such as access, affect real-world outcomes. In this study, we provide an overview of GBM in Ontario and examine elements of care, including treatment patterns, healthcare utilization, and overall survival, from 2010 to 2019, to interpret the impact of the changes in practice standards and expansion of the care network within this period. METHODS Using linked health-administrative databases from Ontario, Canada, we conducted a population-based cohort study to examine the clinical and biological characteristics, treatment, and healthcare utilization patterns of adult GBM patients diagnosed between 2010 and 2019. The primary outcomes were enrollment in adjuvant chemoradiation treatment and 1-, 2-, and 5-year survival. All analyses were performed using the Statistical Analysis Software (SAS). RESULTS 5392 patients were diagnosed with GBM in Ontario from 2010 to 2019 (58% male, 42% female). The median age at diagnosis was 64. Receipt of adjuvant chemoradiation within one year of diagnosis increased from 51% in 2010 to 63% in 2019. 1-year, 2-year, and 5-year overall survival for all patients remained stable, ranging between 40 and 43%, 15-19%, and 5-7%, respectively. For patients above the age of 65, however, 1-year survival increased from 19% in 2010 to 26% in 2019. INTERPRETATION Regionalization enabled access to treatment closer to home for many patients. Over the last decade, receipt of adjuvant chemoradiation increased among elderly patients, but the improvement in 1-year overall survival over time was accounted for by sociodemographic and clinical covariates. Our findings support the efforts for regionalization of services to improve accessibility. CONCLUSION This Ontario-based study provides insight into the effect of practice evolution and healthcare utilization on the overall survival of patients with GBM. Overall survival for most patients with glioblastoma has remained stagnant over the past decade. Changes in treatment standards and expansion of access to treating centres have been associated with prolonged survival in elderly glioblastoma patients.
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Affiliation(s)
- Wafa Baqri
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kathryn Rzadki
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
- Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Sunit Das
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada.
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada.
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2
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Howard EC, Murray Horwitz ME, Gunn CM, Bak S, Nelson KP, Morton S, Flacks-Dunning JG, Battaglia TA. Burden and trajectory of social needs after breast cancer diagnosis at a safety-net hospital. Breast Cancer Res Treat 2024:10.1007/s10549-024-07389-5. [PMID: 38851661 DOI: 10.1007/s10549-024-07389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Unmet social needs pose barriers to cancer care, contributing to adverse outcomes and health inequities. A better understanding of how social needs change after cancer diagnosis can inform more effective, equity-focused interventions. METHODS In this study, we examined self-reported social needs at 0, 3, and 6 months after a breast cancer diagnosis in a racially diverse, multilingual sample (n = 222) enrolled in patient navigation intervention at an urban safety-net hospital. At each timepoint, respondents completed surveys about social needs related to employment, disability benefits, housing and utilities, and personal and family stability. RESULTS Over three-quarters (78%, n = 175) reported ≥ 1 social need, and 46% (n = 102) reported ≥ 3 social needs. The most frequently reported need was housing and utilities (64%, n = 142), followed by employment (40%, n = 90). Individuals from minoritized groups more frequently reported an increased number of social needs over time, compared with their White counterparts (p = 0.02). CONCLUSION Our findings suggest that despite navigation, many cancer patients from historically underrepresented populations continue to experience social concerns over the first 6 months of treatment. Further research, conducted with historically underrepresented populations in research, is needed to better understand the social needs of breast cancer patients to inform effective and equitable interventions.
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Affiliation(s)
- Eileen C Howard
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA.
| | - Mara E Murray Horwitz
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Christine M Gunn
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, 02118, USA
- The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine, Lebanon, NH, 03755, USA
| | - Sharon Bak
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Kerrie P Nelson
- Department of Biostatistics, Boston University School of Public Health, Boston, 02118, USA
| | - Samantha Morton
- Samantha Morton Consulting, Boston, USA
- Formerly of MLPB (f/k/a Medical-Legal Partnership | Boston), Boston, USA
| | | | - Tracy A Battaglia
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
- Yale School of Medicine, Yale Cancer Center, New Haven, 06510, USA
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3
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Siegel RD, LeFebvre KB, Temin S, Evers A, Barbarotta L, Bowman RM, Chan A, Dougherty DW, Ganio M, Hunter B, Klein M, Miller TP, Mulvey TM, Ouzts A, Polovich M, Salazar-Abshire M, Stenstrup EZ, Sydenstricker CM, Tsai S, Oslen MM. Antineoplastic Therapy Administration Safety Standards for Adult and Pediatric Oncology: ASCO-ONS Standards. JCO Oncol Pract 2024:OP2400216. [PMID: 38776491 DOI: 10.1200/op.24.00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE To update the ASCO-Oncology Nursing Society (ONS) standards for antineoplastic therapy administration safety in adult and pediatric oncology and highlight current standards for antineoplastic therapy for adult and pediatric populations with various routes of administration and location. METHODS ASCO and ONS convened a multidisciplinary Expert Panel with representation of multiple organizations to conduct literature reviews and add to the standards as needed. The evidence base was combined with the opinion of the ASCO-ONS Expert Panel to develop antineoplastic safety standards and guidance. Public comments were solicited and considered in preparation of the final manuscript. RESULTS The standards presented here include clarification and expansion of existing standards to include home administration and other changes in processes of ordering, preparing, and administering antineoplastic therapy; the advent of immune effector cellular therapy; the importance of social determinants of health; fertility preservation; and pregnancy avoidance. In addition, the standards have added a fourth verification. STANDARDS Standards are provided for which health care organizations and those involved in all aspects of patient care can safely deliver antineoplastic therapy, increase the quality of care, and reduce medical errors.Additional information is available at www.asco.org/standards and www.ons.org/onf.
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Affiliation(s)
| | | | - Sarah Temin
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Amy Evers
- University of Pennsylvania Health System, Philadelphia, PA
| | - Lisa Barbarotta
- Smilow Cancer Hospital and Yale Cancer Center, New Haven, CT
| | - Ronda M Bowman
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Alexandre Chan
- University of California, Irvine, Chao Family Comprehensive Cancer Center, National Cancer Centre Singapore, Irvine, CA
| | | | - Michael Ganio
- ASHP (American Society of Health-System Pharmacists), Bethesda, MD
| | | | - Meredith Klein
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Tamara P Miller
- Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | | | | | | | - Maritza Salazar-Abshire
- Department of Nursing Education, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Susan Tsai
- Ohio State University Comprehensive Cancer Center, Columbus, OH
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4
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Al-Abdulla O, Sonsuz AA, Alaref M, Albakor B, Kauhanen J. The impact of humanitarian aid on financial toxicity among cancer patients in Northwest Syria. BMC Health Serv Res 2024; 24:641. [PMID: 38762456 PMCID: PMC11102167 DOI: 10.1186/s12913-024-11077-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024] Open
Abstract
INTRODUCTION The ongoing crisis in Syria has divided the country, leading to significant deterioration of the healthcare infrastructure and leaving millions of people struggling with poor socioeconomic conditions. Consequently, the affordability of healthcare services for the population has been compromised. Cancer patients in Northwest Syria have faced difficulties in accessing healthcare services, which increased their financial distress despite the existence of humanitarian health and aid programs. This study aimed to provide insights into how humanitarian assistance can alleviate the financial burdens associated with cancer treatment in conflict-affected regions. MATERIALS AND METHODS This research employed a quantitative, quasi-experimental design with a pre-test-post-test approach, focusing on evaluating the financial toxicity among cancer patients in Northwest Syria before and after receiving humanitarian aid. The study used purposeful sampling to select participants and included comprehensive demographic data collection. The primary tool for measuring financial toxicity was the Comprehensive Score for Financial Toxicity (FACIT-COST) tool, administered in Arabic. Data analysis was conducted using SPSS v25, employing various statistical tests to explore relationships and impacts. RESULTS A total of 99 cancer patients were recruited in the first round of data collection, out of whom 28 patients affirmed consistent receipt of humanitarian aid throughout the follow-up period. The results of the study revealed that humanitarian aid has no significant relationship with reducing the financial toxicity experienced by cancer patients in Northwest Syria. Despite the aid efforts, many patients continued to face significant financial distress. CONCLUSION The research findings indicate that current humanitarian assistance models might not sufficiently address the complex financial challenges faced by cancer patients in conflict zones. The research emphasizes the need for a more comprehensive and integrated approach in humanitarian aid programs. The study highlights the importance of addressing the economic burdens associated with cancer care in conflict settings and calls for a re-evaluation of aid delivery models to better serve the needs of chronic disease patients. The findings suggest a need for multi-sectoral collaboration and a systemic approach to improve the overall effectiveness of humanitarian assistance in such contexts.
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Affiliation(s)
- Orwa Al-Abdulla
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, P.O. Box 1627, Kuopio, 70211, Finland.
- Strategic Research Center (Öz SRC), Incili Pinar MAH, Gazi Muhtar Paşa BUL, Doktorlar Sitesi, 38E, 104. Sehitkamil, 27090, Gaziantep, Türkiye.
| | - Aliye Aslı Sonsuz
- Health Science Institute, Istanbul Medipol University, Beykoz, İstanbul, Türkiye
| | - Maher Alaref
- Strategic Research Center (Öz SRC), Incili Pinar MAH, Gazi Muhtar Paşa BUL, Doktorlar Sitesi, 38E, 104. Sehitkamil, 27090, Gaziantep, Türkiye
| | - Bakor Albakor
- Health Science Institute, Istanbul Medipol University, Beykoz, İstanbul, Türkiye
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, P.O. Box 1627, Kuopio, 70211, Finland
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Mohite P, Yadav V, Pandhare R, Maitra S, Saleh FM, Saleem RM, Al-malky HS, Kumarasamy V, Subramaniyan V, Abdel-Daim MM, Uti DE. Revolutionizing Cancer Treatment: Unleashing the Power of Viral Vaccines, Monoclonal Antibodies, and Proteolysis-Targeting Chimeras in the New Era of Immunotherapy. ACS OMEGA 2024; 9:7277-7295. [PMID: 38405458 PMCID: PMC10882662 DOI: 10.1021/acsomega.3c06501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 02/27/2024]
Abstract
In the realm of cancer immunotherapy, a profound evolution has ushered in sophisticated strategies that encompass both traditional cancer vaccines and emerging viral vaccines. This comprehensive Review offers an in-depth exploration of the methodologies, clinical applications, success stories, and future prospects of these approaches. Traditional cancer vaccines have undergone significant advancements utilizing diverse modalities such as proteins, peptides, and dendritic cells. More recent innovations have focused on the physiological mechanisms enabling the human body to recognize and combat precancerous and malignant cells, introducing specific markers like peptide-based anticancer vaccines targeting tumor-associated antigens. Moreover, cancer viral vaccines, leveraging engineered viruses to stimulate immune responses against specific antigens, exhibit substantial promise in inducing robust and enduring immunity. Integration with complementary therapeutic methods, including monoclonal antibodies, adjuvants, and radiation therapy, has not only improved survival rates but also deepened our understanding of viral virulence. Recent strides in vaccine design, encompassing oncolytic viruses, virus-like particles, and viral vectors, mark the frontier of innovation. While these advances hold immense potential, critical challenges must be addressed, such as strategies for immune evasion, potential off-target effects, and the optimization of viral genomes. In the landscape of immunotherapy, noteworthy innovations take the spotlight from the use of immunomodulatory agents for the enhancement of innate and adaptive immune collaboration. The emergence of proteolysis-targeting chimeras (PROTACs) as precision tools for cancer therapy is particularly exciting. With a focus on various cancers, from melanoma to formidable solid tumors, this Review critically assesses types of cancer vaccines, mechanisms, barriers in vaccine therapy, vaccine efficacy, safety profiles, and immune-related adverse events, providing a nuanced perspective on the underlying mechanisms involving cytotoxic T cells, natural killer cells, and dendritic cells. The Review also underscores the transformative potential of cutting-edge technologies such as clinical studies, molecular sequencing, and artificial intelligence in advancing the field of cancer vaccines. These tools not only expedite progress but also emphasize the multidimensional and rapidly evolving nature of this research, affirming its profound significance in the broader context of cancer therapy.
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Affiliation(s)
- Popat Mohite
- AETs
St. John Institute of Pharmacy and Research, Palghar, Maharashtra 401404, India
| | - Vaishnavi Yadav
- AETs
St. John Institute of Pharmacy and Research, Palghar, Maharashtra 401404, India
| | - Ramdas Pandhare
- MESs
College of Pharmacy, Sonai Tal-Newasa, Maharashtra 414105, India
| | - Swastika Maitra
- Center
for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai 600077, India
- Department
of Microbiology, Adamas University, Kolkata 700 126, West Bengal, India
| | - Fayez M. Saleh
- Department
of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Rasha Mohammed Saleem
- Department
of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65431, Saudi Arabia
| | - Hamdan S. Al-malky
- Regional
Drug Information Center, Ministry of Health, Jeddah 11176, Saudi Arabia
| | - Vinoth Kumarasamy
- Department
of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Vetriselvan Subramaniyan
- Pharmacology
Unit, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar
Sunway, 47500 Selangor
Darul Ehsan, Malaysia
- Center
for Transdisciplinary Research, Department of Pharmacology, Savetha
Dental College, Savetha Institute of Medical and Technical Sciences, Savetha University, Chennai, Tamil Nadu 600077, India
| | - Mohamed M. Abdel-Daim
- Department
of Pharmaceutical Sciences, Pharmacy Program, Batterjee Medical College, P.O. Box
6231, Jeddah 21442, Saudi Arabia
- Pharmacology
Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Daniel E. Uti
- Department
of Biochemistry, Faculty of Basic Medical Sciences, College of Medicine, Federal University of Health Sciences, Otukpo, Benue State 970001, Nigeria
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Navarro S, Tsui J, Barzi A, Stern MC, Pickering T, Farias AJ. Associations Between Patient Experience With Care, Race and Ethnicity, and Receipt of CRC Treatment Among SEER-CAHPS Patients With Multiple Comorbidities. J Natl Compr Canc Netw 2023; 22:e237074. [PMID: 38150827 PMCID: PMC10872498 DOI: 10.6004/jnccn.2023.7074] [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: 04/24/2023] [Accepted: 08/17/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Patients with colorectal cancer (CRC) and multiple comorbidities are less likely to receive guideline-concordant treatment (GCT), a disparity exacerbated by racial and ethnic disparities in GCT. Yet, positive patient experiences with care are associated with more appropriate care use. We investigated associations between patient experiences with care, race and ethnicity, and receipt of GCT for CRC among older adults with multiple comorbidities. METHODS We used SEER-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data to identify participants diagnosed with CRC from 2001 to 2017 at age ≥67 years with additional chronic conditions. Stage-specific GCT was identified following recommendations in the NCCN Guidelines for Colon and Rectal Cancer. Patient experiences with care were identified from CAHPS surveys. Multivariable log-binomial regression estimated associations between race and ethnicity and receipt of GCT by experiences with care. RESULTS A total of 2,612 patients were included. Those reporting excellent experience with getting care quickly were 5% more likely to receive GCT than those reporting less-than-excellent experience (relative risk [RR], 1.05; 95% CI, 1.04-1.05). When reporting less-than-excellent experience with getting care quickly, non-Hispanic Black (NHB) patients were less likely than non-Hispanic White (NHW) patients to receive GCT (RR, 0.80; 99.38% CI, 0.78-0.82), yet NHB patients were more likely to receive GCT than NHW patients when reporting excellent experience (RR, 1.05; 99.38% CI, 1.02-1.09). When reporting less-than-excellent experience with getting needed care, Hispanic patients were less likely than NHW patients to receive GCT (RR, 0.91; 99.38% CI, 0.88-0.94), yet Hispanic patients were more likely to receive GCT than NHW patients when reporting excellent experience (RR, 1.06; 99.38% CI, 1.03-1.08). CONCLUSIONS Although excellent patient experience among those with multiple comorbidities may not be strongly associated with receipt of GCT for CRC overall, improvements in experiences of accessing care among NHB and Hispanic patients with CRC and additional comorbidities may aid in mitigating racial and ethnic disparities in receipt of GCT.
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Affiliation(s)
- Stephanie Navarro
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California
| | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California
- USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Afsaneh Barzi
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Mariana C. Stern
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California
- USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Trevor Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California
| | - Albert J. Farias
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California
- USC Norris Comprehensive Cancer Center, Los Angeles, California
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Elshami M, Al-Madhoun S, Alser M, Al-Slaibi I, Yaseen A, Tuffaha A, Jabr H, Ubaiat S, Khader S, Khraishi R, Jaber I, Arafeh ZA, Alqattaa A, Hadi AAE, Barhoush O, Hijazy M, Eleyan T, Alser A, Hziema AA, Shatat A, Almakhtoob F, Mohamad B, Farhat W, Abuamra Y, Mousa H, Adawi R, Musallam A, Albarqi SI, Abu-El-Noor N, Bottcher B. Anticipated time to seek medical advice for possible ovarian cancer symptoms and perceived barriers to early presentation among Palestinian women: a national cross-sectional study. BMC Cancer 2023; 23:975. [PMID: 37833659 PMCID: PMC10571332 DOI: 10.1186/s12885-023-11484-z] [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: 06/05/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Several factors contribute to delayed presentation with ovarian cancer (OC) symptoms including poor symptom awareness and barriers to seeking help. This study explored the anticipated time to seek medical advice for possible OC symptoms and its association with OC symptom awareness. In addition, it examined perceived barriers that may delay help-seeking among Palestinian women. METHODS A cross-sectional study was conducted among adult women (≥ 18 years) recruited from hospitals, primary healthcare centers, and public spaces in 11 Palestinian governorates. A modified version of the OC awareness measure was used to collect data in face-to-face interviews. The questionnaire comprised three sections: sociodemographic details, awareness of 11 OC symptoms and time to seek medical advice, and barriers to early presentation. RESULTS Of 6095 participants approached, 5618 completed the OCAM (response rate = 92.1%). The proportion of participants who would immediately seek medical advice for a possible OC symptom varied based on the symptom's nature. For OC symptoms with pain, the proportion that reported immediate seeking of medical advice ranged from 7.9% for 'persistent low back pain' to 13.6% for 'persistent pain in the pelvis'. For non-specific potential OC symptoms, the proportion that reported immediate seeking of medical advice ranged from 2.3% for 'feeling full persistently' to 15.8% for 'increased abdominal size on most days'. Good OC symptom awareness was associated with higher likelihood of seeking medical advice within a week from recognizing 10 out of 11 OC symptoms. Emotional barriers were the most common barriers with 'feeling scared' as the most reported barrier (n = 1512, 52.4%). Displaying good OC symptom awareness was associated with a lower likelihood of reporting ≥ 4 emotional barriers (OR = 0.61, 95% CI: 0.38-0.98). CONCLUSION Participants with good OC symptom awareness were more likely to seek medical advice earlier and to display fewer emotional barriers. Establishing educational interventions to raise OC awareness may help in promoting earlier help-seeking and, thus, facilitate earlier diagnosis and improved prognosis.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7100, Cleveland, OH, 44106, USA.
- Ministry of Health, Gaza, Palestine.
| | | | - Mohammed Alser
- United Nations Relief and Works Agency for Palestine Refugees (UNRWA), Gaza, Palestine
| | | | - Areej Yaseen
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | - Sara Ubaiat
- Faculty of Medicine, Al-Quds University, Bethlehem, Palestine
| | - Salma Khader
- United Nations Relief and Works Agency for Palestine Refugees (UNRWA), Gaza, Palestine
| | - Reem Khraishi
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | - Inas Jaber
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Aya Alqattaa
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Ola Barhoush
- United Nations Relief and Works Agency for Palestine Refugees (UNRWA), Gaza, Palestine
| | - Maysun Hijazy
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Tamara Eleyan
- United Nations Relief and Works Agency for Palestine Refugees (UNRWA), Gaza, Palestine
| | - Amany Alser
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Amal Abu Hziema
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Amany Shatat
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Balqees Mohamad
- Doctors Without Borders (Medecins Sans Frontieres), Hebron, Palestine
| | - Walaa Farhat
- Faculty of Medicine, Al-Quds University, Jenin, Palestine
| | - Yasmeen Abuamra
- Faculty of Medicine, Al-Azhar University of Gaza, Gaza, Palestine
| | - Hanaa Mousa
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Reem Adawi
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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8
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Bacorn C, Serrano M, Lin LK. Review of sociodemographic risk factors for presentation with advanced non-melanoma skin cancer. Orbit 2023; 42:481-486. [PMID: 36120852 DOI: 10.1080/01676830.2022.2123930] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Non-melanoma skin cancers (NMSC) are often localized and associated with an excellent prognosis but a minority present with locally advanced or metastatic disease requiring extensive resection or systemic treatment. Medical factors that increase the risk of advanced skin cancers such as tobacco use, systemic immunosuppression or genetic syndromes have been described but the sociodemographic risk factors are relatively uninvestigated and under reported. In this review a cohort of patients presenting with periorbital NMSC is reviewed for social determinants of health correlated with presentation with advanced disease. METHODS Patients presenting with periorbital NMSC during a 10-year period are categorized as advanced (those tumors requiring extensive local resection, sacrifice of the globe or systemic therapy) or non-advanced and demographic features are compared between the two groups. RESULTS 274 cases of periorbital NMSC were classified as either non-advanced (177) or advanced (97). Patients with public safety net health insurance were twice as likely to present with advanced disease (25% vs 13%). Patients with advanced disease were significantly less likely to be under the care of a primary care physician, lived in economically depressed areas with lower mean household incomes, and lived further from tertiary medical care. CONCLUSION Financial and sociodemographic features are strongly associated with presentation with advanced NMSC. Further work is needed to determine which sociodemographic features are independent risk factors. A better understanding of the relevant barriers to care may reduce the burden of advanced disease at presentation in the future.
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Affiliation(s)
- Colin Bacorn
- Johns Hopkins Medicine, Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Melissa Serrano
- UC Davis School of Medicine, University of California Davis Health, Sacramento, California, USA
| | - Lily Koo Lin
- Department of Ophthalmology & Vision Science, University of California Davis Health, Sacramento, California, USA
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9
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Odai-Afotey A, Lederman RI, Ko NY, Gagnon H, Fikre T, Gundersen DA, Revette AC, Hershman DL, Crew KD, Keating NL, Freedman RA. Breast cancer treatment receipt and the role of financial stress, health literacy, and numeracy among diverse breast cancer survivors. Breast Cancer Res Treat 2023; 200:127-137. [PMID: 37178432 PMCID: PMC10182756 DOI: 10.1007/s10549-023-06960-w] [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: 10/17/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Disparities in breast cancer treatment for low-income and minority women are well documented. We examined economic hardship, health literacy, and numeracy and whether these factors were associated with differences in receipt of recommended treatment among breast cancer survivors. METHODS During 2018-2020, we surveyed adult women diagnosed with stage I-III breast cancer between 2013 and 2017 and received care at three centers in Boston and New York. We inquired about treatment receipt and treatment decision-making. We used Chi-squared and Fisher's exact tests to examine associations between financial strain, health literacy, numeracy (using validated measures), and treatment receipt by race and ethnicity. RESULTS The 296 participants studied were 60.1% Non-Hispanic (NH) White, 25.0% NH Black, and 14.9% Hispanic; NH Black and Hispanic women had lower health literacy and numeracy and reported more financial concerns. Overall, 21 (7.1%) women declined at least one component of recommended therapy, without differences by race and ethnicity. Those not initiating recommended treatment(s) reported more worry about paying large medical bills (52.4% vs. 27.1%), worse household finances since diagnosis (42.9% vs. 22.2%), and more uninsurance before diagnosis (9.5% vs. 1.5%); all P < .05. No differences in treatment receipt by health literacy or numeracy were observed. CONCLUSION In this diverse population of breast cancer survivors, rates of treatment initiation were high. Worry about paying medical bills and financial strain were frequent, especially among non-White participants. Although we observed associations of financial strain with treatment initiation, because few women declined treatments, understanding the scope of impact is limited. Our results highlight the importance of assessments of resource needs and allocation of support for breast cancer survivors. Novelty of this work includes the granular measures of financial strain and inclusion of health literacy and numeracy.
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Affiliation(s)
- Ashley Odai-Afotey
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ruth I Lederman
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Naomi Y Ko
- Section of Hematology and Medical Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Haley Gagnon
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Tsion Fikre
- Section of Hematology and Medical Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna C Revette
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dawn L Hershman
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
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10
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Ray EM, Teal RW, Carda-Auten J, Coffman E, Sanoff HK. Qualitative evaluation of barriers and facilitators to hepatocellular carcinoma care in North Carolina. PLoS One 2023; 18:e0287338. [PMID: 37347754 PMCID: PMC10287003 DOI: 10.1371/journal.pone.0287338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Many patients with hepatocellular carcinoma (HCC) never receive cancer-directed therapy. In order to tailor interventions to increase access to appropriate therapy, we sought to understand the barriers and facilitators to HCC care. METHODS Patients with recently diagnosed HCC were identified through the University of North Carolina (UNC) HCC clinic or local hospital cancer registrars (rapid case ascertainment, RCA). Two qualitative researchers conducted in-depth, semi-structured interviews. Interviews were audiotaped, transcribed, and coded. RESULTS Nineteen interviews were conducted (10 UNC, 9 RCA). Key facilitators of care were: physician knowledge; effective communication regarding test results, plan of care, and prognosis; social support; and financial support. Barriers included: lack of transportation; cost of care; provider lack of knowledge about HCC; delays in scheduling; or poor communication with the medical team. Participants suggested better coordination of appointments and having a primary contact within the healthcare team. LIMITATIONS We primarily captured the perspectives of those HCC patients who, despite the challenges they describe, were ultimately able to receive HCC care. CONCLUSIONS This study identifies key facilitators and barriers to accessing care for HCC in North Carolina. Use of the RCA system to identify patients from a variety of settings, treated and untreated, enabled us to capture a broad range of perspectives. Reducing barriers through improving communication and care coordination, assisting with out-of-pocket costs, and engaging caregivers and other medical providers may improve access. This study should serve as the basis for tailored interventions aimed at improving access to appropriate, life-prolonging care for patients with HCC.
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Affiliation(s)
- Emily M Ray
- Department of Medicine, Division of Oncology, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Randall W Teal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Connected Health Applications and Interventions Core, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jessica Carda-Auten
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Connected Health Applications and Interventions Core, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Erin Coffman
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Hanna K Sanoff
- Department of Medicine, Division of Oncology, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
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11
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Rodriguez GM, Leach M, Osorio J, Villicana G, Koontz Z, Wood EH, Duron Y, O'Brien D, Rosas LG, Patel MI. Exploring cancer care needs for Latinx adults: a qualitative evaluation. Support Care Cancer 2023; 31:76. [PMID: 36544063 PMCID: PMC9771768 DOI: 10.1007/s00520-022-07518-0] [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: 07/11/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Latinx adults with cancer, as compared with non-Latinx White adults, are diagnosed with more advanced stages and experience worse quality of life. Identifying barriers in cancer care among low-income Latinx adults is crucial to designing and implementing culturally appropriate interventions. The objective of this study was to explore the specific barriers encountered by Latinx adults after a cancer diagnosis and perspectives on the use of community health workers (CHWs) to address these barriers. METHODS We conducted semi-structured qualitative interviews with low-income Latinx adults with a past or current history of cancer and/or their caregivers in a community oncology clinic located in an agricultural community in California. Analysis was based in grounded theory and performed using the constant comparative method. RESULTS Sixteen interviews were conducted with patients alone (n = 11), a caregiver alone (n = 1), and patient-caregiver pairs (n = 4 patients; n = 4 caregivers). Four major themes emerged: (1) low cancer health literacy including cancer diagnosis and treatment, cancer fatalism, navigating next steps after diagnosis, advance directives, and precision medicine; (2) challenges in communicating and receiving supportive services due to language barriers; (3) stress and anxiety regarding financial hardships related to job loss, insurance barriers, and the COVID-19 pandemic; (4) the need for supportive, bilingual, and bicultural personnel to assist in overcoming these challenges. CONCLUSIONS Low-income Latinx adults with cancer and their caregivers experience health literacy, communication, and financial barriers that impede quality cancer care delivery. Embedding CHWs in the care team could be one way to address these barriers to culturally concordant, accessible care.
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Affiliation(s)
| | - Maria Leach
- Community Hospital, Montage Health, Monterey, CA, USA
| | | | | | | | - Emily H Wood
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Dale O'Brien
- Cancer Patients Alliance, Pacific Grove, CA, USA
| | - Lisa G Rosas
- Stanford University School of Medicine, Stanford, CA, USA
| | - Manali I Patel
- Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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12
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Kumar K, Mohammadnezhad M. "Once you get cancer you die. There is no way to get saved from cancer." A qualitative exploration of patients' perceptions towards cancer in Fiji. PLoS One 2022; 17:e0277970. [PMID: 36525441 PMCID: PMC9757585 DOI: 10.1371/journal.pone.0277970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Understanding patients' perspective to get an insight into cancer, and how best the public health systems can battle with this disease is the way forward in this current world. This study aimed to explore patients' knowledge about common cancers, barriers to assessing cancer information and cancer preventative approaches in Fiji. METHODS The study used a qualitative method approach that was conducted among patients who attended Special Outpatients (SOPD) at the four selected health centres in Lautoka Subdivision, Fiji from 1st March to 30th April 2021. A semi-structured open-ended questionnaire was used to guide in-depth interviews. These audio recordings were transcribed and analysed using thematic analysis. All interview transcripts were read and similar words and phrases were assigned numbers which were grouped together to identify themes and sub themes. RESULTS Twenty-eight patients took part in the in-depth interview and the responses were grouped into four themes including; cancer knowledge, diagnosis of cancer in a close friend/family, barriers of communication and optimizing cancer awareness. Patients' awareness about common cancers and cancer risk factors was low. Many barriers for cancer screening were highlighted including stigmatization, fear, worry, death, lack of information, herbal medicine use, lack of resources and delay in diagnosis. Awareness strategies highlighted by participants included community outreach programs, house to house visits, opportunistic screening, engagement of community health care workers and the concept of a cancer hub centre. CONCLUSION It is evident that there is a range of views from patients towards cancer and it is important to understand these perceptions to better guide public health interventions concerning cancer. This puts more focus on the need to invest more in information, education, and communication material for public campaigns that target a variety of people for a wider reach.
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Affiliation(s)
- Kaushal Kumar
- Fiji Ministry of Health and Medical Services, Lautoka Hospital, Lautoka, Fiji Islands
| | - Masoud Mohammadnezhad
- School of Nursing and Healthcare Leadership, University of Bradford, Bradford, United Kingdom
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Nakhon Pathom, Thailand
- * E-mail:
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13
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Fan Q, Nogueira L, Yabroff KR, Hussaini SMQ, Pollack CE. Housing and Cancer Care and Outcomes: A Systematic Review. J Natl Cancer Inst 2022; 114:1601-1618. [PMID: 36073953 PMCID: PMC9745435 DOI: 10.1093/jnci/djac173] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Access to stable and affordable housing is an important social determinant of health in the United States. However, research addressing housing and cancer care, diagnosis, and outcomes has not been synthesized. METHODS We conducted a systematic review of studies examining associations of housing and cancer care and outcomes using PubMed, Embase, Scopus, and CINAHL. Included studies were conducted in the United States and published in English between 1980 and 2021. Study characteristics and key findings were abstracted and qualitatively synthesized. RESULTS A total of 31 studies were identified. Housing-related measures were reported at the individual level in 20 studies (65%) and area level in 11 studies (35%). Study populations and housing measures were heterogeneous. The most common housing measures were area-level housing discrimination (8 studies, 26%), individual-level housing status (8 studies, 26%), and individual-level housing concerns (7 studies, 23%). The most common cancer outcomes were screening (12 studies, 39%) and mortality (9 studies, 29%). Few studies assessed multiple dimensions of housing. Most studies found that exposure to housing insecurity was statistically significantly associated with worse cancer care (11 studies) or outcomes (10 studies). CONCLUSIONS Housing insecurity is adversely associated with cancer care and outcomes, underscoring the importance of screening for housing needs and supporting systemic changes to advance equitable access to care. Additional research is needed to develop and test provider- and policy-level housing interventions that can effectively address the needs of individuals throughout the cancer care continuum.
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Affiliation(s)
- Qinjin Fan
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Leticia Nogueira
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - S M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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14
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Phillips S, Raskin SE, Harrington CB, Bishop D, Gany FM. "Like pouring salt in a wound": A qualitative exploration of the consequences of unmet housing needs for cancer patients and survivors in New York City. J Psychosoc Oncol 2022; 41:411-433. [PMID: 36271879 PMCID: PMC10322638 DOI: 10.1080/07347332.2022.2136025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify consequences of unmet housing needs in the period following cancer diagnosis. DESIGN Qualitative descriptive design. PARTICIPANTS New York City-based cancer patients and survivors (n = 21) who reported experience of unmet housing needs while receiving cancer treatment. Key informants (n = 9) with relevant expertise (e.g. oncology social workers). METHODS One-time semi-structured telephone or in-person interviews were conducted with all participants. Inductive thematic coding was conducted using a pragmatic paradigm. FINDINGS Four categories of consequences emerged: 1) cancer management and health (rest and recovery, illness/injury risk, medical care); 2) psychological (stress and anxiety, lack of control and independence, self-esteem/pride, sadness/depression, cancer coping); 3) social (relationships, consequences for others, isolation); and 4) standard of functional living. CONCLUSION The simultaneous experience of cancer and unmet housing needs is broadly burdensome. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Screening and resources for addressing unmet housing needs must be prioritized to holistically care for patients.
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Affiliation(s)
- Serena Phillips
- Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - Sarah E. Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Darla Bishop
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Francesca M. Gany
- Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Brown CM, Kanu C, Richards KM, Stevens L, Sasane R, McAneny B. Exploring access to care from the perspective of patients with breast cancer: A qualitative study. Cancer Med 2022; 11:2455-2466. [PMID: 35266321 PMCID: PMC9189472 DOI: 10.1002/cam4.4624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/18/2021] [Accepted: 12/30/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives Patients face a myriad of personal and system‐based challenges in accessing breast cancer care, but less is known about access as expressed and experienced by patients themselves. The objective of this qualitative study was to further explore the breadth of issues related to access from the perspective of patients with breast cancer across their care journey. Methods Twelve women participated in 1‐h semi‐structured interviews and 48 women participated in 2‐h focus groups at six oncology practices in 2018. Grounded theory was used to analyze the data. Results Six primary themes emerged concerning access to care: information, psychosocial support, health insurance, financial resources, timeliness, and emotions. Conclusions This study identified six core dimensions of access to care. Access encompassed not only gaining entrée to care services—in the traditional sense of access—but also the continuing support needed to effectively use those services throughout the cancer care journey. Future strategies aimed at improving access to breast cancer care should attend to these ongoing patient‐centric and system‐based issues which are mostly amenable to change.
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Affiliation(s)
- Carolyn M Brown
- TxCORE (Texas Center for Health Outcomes Research and Education), The University of Texas at Austin College of Pharmacy, Austin, Texas, USA
| | - Chisom Kanu
- Research Triangle Institute, Research Triangle Park, North Carolina, USA
| | - Kristin M Richards
- TxCORE (Texas Center for Health Outcomes Research and Education), The University of Texas at Austin College of Pharmacy, Austin, Texas, USA
| | - Laura Stevens
- Innovative Oncology Business Solutions, Albuquerque, New Mexico, USA
| | - Rahul Sasane
- Cerevel Therapeutics, Cambridge, Massachusetts, USA
| | - Barbara McAneny
- Innovative Oncology Business Solutions, Albuquerque, New Mexico, USA.,New Mexico Oncology Hematology Consultants, Albuquerque, New Mexico, USA
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Salabarría-Peña Y, Douglas C, Brantley M, Johnson AK. Informing the future of PrEP navigation: Findings from a five-site cluster evaluation. EVALUATION AND PROGRAM PLANNING 2022; 90:101999. [PMID: 34503854 DOI: 10.1016/j.evalprogplan.2021.101999] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
The PrEP (pre-exposure prophylaxis) Implementation, Data to Care and Evaluation (PrIDE) demonstration project funded 12 health departments (HD) (2016-2019) to scale up PrEP among sexual minorities at risk for HIV. Each health department (HD) conducted an evaluation of at least one local strategy, and, to maximize crossvalidation, an adapted cluster evaluation approach was employed. As a result, five HDs with similar evaluation questions regarding PrEP navigation were identified. Overall, PrEP navigation fit in well with HD clinics and community-based organizations. A hybrid model of patient, peer, and systems navigation linking clients to PrEP and social services was commonly used. Although there were no differences by setting regarding linking clients to PrEP providers, one HD demonstrated that having all PrEP services in the same location contributed the most to PrEP uptake. Navigator skill for case management and rapport building facilitated navigation, whereas staff turnover and lack of client health insurance were challenges. While one HD in a non-Medicaid expansion state was affected by health insurance issues the most, another HD demonstrated that providing payment assistance increased client PrEP use. The findings pinpoint PrEP navigation hybrid modality and having health insurance as promising strategies to increase PrEP uptake among priority groups.
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Affiliation(s)
- Yamir Salabarría-Peña
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA 30329, USA.
| | - Chelsea Douglas
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA 30329, USA.
| | - Meredith Brantley
- Tennessee Department of Health, Andrew Johnson Tower, 4th Floor, 710 James Robertson Pkwy, Nashville, TN 37243, USA.
| | - Amy K Johnson
- Ann & Robert H. Lurie Children's Hospital and Northwestern University, 225 East Chicago Avenue, Box 161, Chicago, IL 60611-2605, USA.
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17
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The cost of cancer care: how far would you go for a trial? Ir J Med Sci 2022; 191:2487-2491. [PMID: 35038110 PMCID: PMC8761872 DOI: 10.1007/s11845-021-02915-6] [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: 11/24/2021] [Accepted: 12/30/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Clinical trials are often considered the gold standard in cancer care. However, patients face barriers in trial participation including distances to cancer centres and personal costs including changing employment status, cost of medications, inpatient admissions, and parking tariffs. AIM Our aim was to compare the distances patients travelled for clinical trials compared to those receiving standard systemic anticancer therapy (SACT). We also investigated the additional costs associated with this. METHODS This was a retrospective review of electronic patient medical records. The distance from the patients' home address to Beaumont was calculated as a one-way journey in kilometres. Patients attending for clinical trials were compared to those receiving standard of care SACT. RESULTS A total of 271 patients receiving standard SACT over a 5-day period and 111 patients enrolled on 24 clinical trials were included. The median one-way distance travelled by patients enrolled in clinical trials was 41.4 km, compared to 14 km in those patients' receiving standard of care SACT. The median estimated cost was €13 vs €4.20 for those enrolled on clinical trials compared to those receiving standard of care treatment, respectively. CONCLUSION Patients enrolled on clinical trials often travel more than twice as far to receive their anti-cancer treatment compared to those receiving standard of care SACT and incur an increased cost of travel expenses.
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18
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Fügemann H, Goerling U, Gödde K, Desch AK, Müller-Nordhorn J, Mauckisch V, Siegerink B, Rieckmann N, Holmberg C. What do people with lung cancer and stroke expect from patient navigation? A qualitative study in Germany. BMJ Open 2021; 11:e050601. [PMID: 34949615 PMCID: PMC8710862 DOI: 10.1136/bmjopen-2021-050601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/03/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This qualitative study investigated patients' needs and wishes in relation to patient navigation. DESIGN A qualitative interview study was conducted. Participants were invited to take part in three in-depth interviews over a period of 6-12 months. Thematic analysis was used. SETTING Interviewees were sought in the Berlin metropolitan area of Germany in academic university hospitals, in rehabilitation clinics and through self-help organisations. PARTICIPANTS The sample consisted of individuals diagnosed with lung cancer (n=20) or stroke (n=20). RESULTS From the perspective of interviewees, patient navigators should function as consistent contact persons, present during the whole care trajectory. Their role would be to guide patients through an often confusing healthcare landscape, offering practical, advisory and emotional assistance corresponding to patients' needs. The study shows that-independent of the disease-participants had similar expectations and needs regarding support from navigators. CONCLUSION For chronic and complex diseases-as is the case with lung cancer and stroke-it appears less important for navigators to fulfil disease-specific tasks. Rather, they should ensure that patients' more general needs, in relation to social, practical and emotional support, are met in a way that suits their individual wishes. Following these results, patient navigation programmes might be designed to include generic elements, which should then be adapted to the infrastructure in a particular healthcare region and to the particularities of a specific healthcare system.
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Affiliation(s)
- Hella Fügemann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Ute Goerling
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kathrin Gödde
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anke Kristin Desch
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | | | - Verena Mauckisch
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bob Siegerink
- Dept clinical epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Rieckmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christine Holmberg
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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Gautier G, Lucas M, Vermeulin T, Di Fiore F, Merle V. Deprived social status is associated with decreased use of oral chemotherapy in patients with metastatic colorectal cancer: A retrospective cohort study on administrative databases in a French University Hospital. Pharmacol Res Perspect 2021; 9:e00888. [PMID: 34766736 PMCID: PMC8587174 DOI: 10.1002/prp2.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/02/2021] [Indexed: 11/15/2022] Open
Abstract
Factors associated with the choice of oral versus intravenous CT are not clearly established. Our purpose was to evaluate the influence of social status and home distance to hospital on the use of oral CT in patients with metastatic colorectal cancer (mCRC). This retrospective single-center study included mCRC patients between 2011 and 2017. Patient social status was assessed by European Deprivation Index (EDI) and home distance to the hospital was calculated. Univariable and multivariable logistic regression analyses were performed. One hundred and seventy-five mCRC patients were included, with 71 receiving oral CT. Most deprived patients received less oral CT (OR 0.5 [0.26, 0.96], p = .039). No association was found for road distance. Previous use of adjuvant oral CT was associated with oral CT in mCRC (OR 2.65 [1.06, 6.66], p = .038). Our results suggest that deprived social status is a factor associated with decreased use of oral CT in patients with mCRC. Clinical trial registration: no registration.
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Affiliation(s)
- Gwendoline Gautier
- Department of HepatogastroenterologyRouen University HospitalUNIROUENRouenFrance
| | - Mélodie Lucas
- Department of Medical InformationLe Havre HospitalLe HavreFrance
- Dynamiques et Evènements des Soins et des Parcours Research GroupRouen University HospitalUNIROUENRouenFrance
| | - Thomas Vermeulin
- Dynamiques et Evènements des Soins et des Parcours Research GroupRouen University HospitalUNIROUENRouenFrance
- CLCC H. BecquerelUnicancerRouenFrance
- LEDA‐LEGOSUniversité Paris‐DauphineParisFrance
| | - Frederic Di Fiore
- Department of HepatogastroenterologyRouen University HospitalUNIROUENRouenFrance
- CLCC H. BecquerelUnicancerRouenFrance
| | - Veronique Merle
- Dynamiques et Evènements des Soins et des Parcours Research GroupRouen University HospitalUNIROUENRouenFrance
- Inserm U1086 ANTICIPECaenFrance
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20
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Holden CE, Wheelwright S, Harle A, Wagland R. The role of health literacy in cancer care: A mixed studies systematic review. PLoS One 2021; 16:e0259815. [PMID: 34767562 PMCID: PMC8589210 DOI: 10.1371/journal.pone.0259815] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients diagnosed with cancer face many challenges and need a good understanding of their diagnosis and proposed treatments to make informed decisions about their care. Health literacy plays an important role in this and low health literacy has been associated with poorer outcomes. The aims of this review are to identify which outcomes relate to health literacy in patients with cancer, and to combine this through a mixed studies approach with the patient experience as described through qualitative studies. METHODS Four electronic databases were searched in January 2021 to identify records relating to health literacy and patients with cancer. Records were independently screened then assessed for inclusion by two reviewers according to the following criteria: patients aged ≥18 years with cancer, English language publication AND health literacy measured with validated tool and measured outcome associated with health literacy OR qualitative study exploring the role of health literacy as patients make decisions about health. Quality was independently assessed by two reviewers. A narrative synthesis was performed, and findings integrated through concept mapping. This systematic review was registered with PROSPERO, entry CRD42020166454. RESULTS 4441 records were retrieved. Following de-duplication, 2496 titles and abstracts were screened and full texts of 405 papers were reviewed for eligibility. 66 papers relating to 60 studies met the eligibility criteria. Lower health literacy was associated with greater difficulties understanding and processing cancer related information, poorer quality of life and poorer experience of care. Personal and situational influences contributed to how participants processed information and reached decisions about their care. CONCLUSION This review highlights the important role of health literacy for patients with cancer. Outcomes are poorer for those who experience difficulties with health literacy. Further efforts should be made to facilitate understanding, develop health literacy and support patients to become more involved in their care.
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Affiliation(s)
- Chloe E. Holden
- Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
- Dorset Cancer Centre, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, United Kingdom
| | - Sally Wheelwright
- Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - Amélie Harle
- Dorset Cancer Centre, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, United Kingdom
| | - Richard Wagland
- Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
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21
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Hong AS, Nguyen DQ, Lee SC, Courtney DM, Sweetenham JW, Sadeghi N, Cox JV, Fullington H, Halm EA. Prior Frequent Emergency Department Use as a Predictor of Emergency Department Visits After a New Cancer Diagnosis. JCO Oncol Pract 2021; 17:e1738-e1752. [PMID: 34038164 PMCID: PMC8600510 DOI: 10.1200/op.20.00889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To determine whether emergency department (ED) visit history prior to cancer diagnosis is associated with ED visit volume after cancer diagnosis. METHODS This was a retrospective cohort study of adults (≥ 18 years) with an incident cancer diagnosis (excluding nonmelanoma skin cancers or leukemia) at an academic medical center between 2008 and 2018 and a safety-net hospital between 2012 and 2016. Our primary outcome was the number of ED visits in the first 6 months after cancer diagnosis, modeled using a multivariable negative binomial regression accounting for ED visit history in the 6-12 months preceding cancer diagnosis, electronic health record proxy social determinants of health, and clinical cancer-related characteristics. RESULTS Among 35,090 patients with cancer (49% female and 50% non-White), 57% had ≥ 1 ED visit in the 6 months immediately following cancer diagnosis and 20% had ≥ 1 ED visit in the 6-12 months prior to cancer diagnosis. The strongest predictor of postdiagnosis ED visits was frequent (≥ 4) prediagnosis ED visits (adjusted incidence rate ratio [aIRR]: 3.68; 95% CI, 3.36 to 4.02). Other covariates associated with greater postdiagnosis ED use included having 1-3 prediagnosis ED visits (aIRR: 1.32; 95% CI, 1.28 to 1.36), Hispanic (aIRR: 1.12; 95% CI, 1.07 to 1.17) and Black (aIRR: 1.21; 95% CI, 1.17 to 1.25) race, homelessness (aIRR: 1.95; 95% CI, 1.73 to 2.20), advanced-stage cancer (aIRR: 1.30; 95% CI, 1.26 to 1.35), and treatment regimens including chemotherapy (aIRR: 1.44; 95% CI, 1.40 to 1.48). CONCLUSION The strongest independent predictor for ED use after a new cancer diagnosis was frequent ED visits before cancer diagnosis. Efforts to reduce potentially avoidable ED visits among patients with cancer should consider educational initiatives that target heavy prior ED users and offer them alternative ways to seek urgent medical care.
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Affiliation(s)
- Arthur S. Hong
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX,Arthur S. Hong, MD, MPH, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; e-mail:
| | - Danh Q. Nguyen
- University of Texas Southwestern Medical School, Dallas, TX
| | - Simon Craddock Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - D. Mark Courtney
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - John W. Sweetenham
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Navid Sadeghi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX,Parkland Health & Hospital System, Dallas, TX
| | - John V. Cox
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX,Parkland Health & Hospital System, Dallas, TX
| | - Hannah Fullington
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ethan A. Halm
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
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22
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Li HW, Scanlon ML, Kisilu N, Litzelman DK. The role of community health workers in the surgical cascade: a scoping review. HUMAN RESOURCES FOR HEALTH 2021; 19:122. [PMID: 34602064 PMCID: PMC8489043 DOI: 10.1186/s12960-021-00659-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Community health workers (CHWs) can increase access to various primary healthcare services; however, their potential for improving surgical care is under-explored. We sought to assess the role of CHWs in the surgical cascade, defined as disease screening, linkage to operative care, and post-operative care. Given the well-described literature on CHWs and screening, we focused on the latter two steps of the surgical cascade. METHODS We conducted a scoping review of the peer-reviewed literature. We searched for studies published in any language from January 1, 2000 to May 1, 2020 using electronic literature databases including Pubmed/MEDLINE, Web of Science, SCOPUS, and Google Scholar. We included articles on CHW involvement in linkage to operative care and/or post-operative surgical care. Narrative and descriptive methods were used to analyze the data. RESULTS The initial search identified 145 articles relevant to steps in the surgical cascade. Ten studies met our inclusion criteria and were included for review. In linkage to care, CHWs helped increase surgical enrollment, provide resources for vulnerable patients, and build trust in healthcare services. Post-operatively, CHWs acted as effective monitors for surgical-site infections and provided socially isolated patients with support and linkage to additional services. The complex and wide-ranging needs of surgical patients illustrated the need to view surgical care as a continuum rather than a singular operative event. CONCLUSION While the current literature is limited, CHWs were able to maneuver complex medical, cultural, and social barriers to surgical care by linking patients to counseling, education, and community resources, as well as post-operative infection prevention services. Future studies would benefit from more rigorous study designs and larger sample sizes to further elucidate the role CHWs can serve in the surgical cascade.
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Affiliation(s)
- Helen W. Li
- Department of Surgery, Washington University School of Medicine in St Louis, St. Louis, MO United States of America
| | - Michael L. Scanlon
- Indiana University Center for Global Health, 702 Rotary Circle, Suite RO 101, Indianapolis, IN 46202 United States of America
| | - Nicholas Kisilu
- Department of General Surgery and Anesthesiology, Moi University School of Medicine, Eldoret, Kenya
| | - Debra K. Litzelman
- William M. Tierney Center for Health Services Research, Regenstrief Institute, Inc. and Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 United States of America
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23
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Poteat T, Adams MA, Malone J, Geffen S, Greene N, Nodzenski M, Lockhart A, Su IH, Dean LT. Delays in breast cancer care by race and sexual orientation: Results from a national survey with diverse women in the United States. Cancer 2021; 127:3514-3522. [PMID: 34287838 PMCID: PMC8684596 DOI: 10.1002/cncr.33629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/19/2020] [Accepted: 01/19/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Despite known differences in breast cancer by both race and sexual orientation, data on the intersectional experiences of Black sexual minority women (BSMW) along the care continuum are scant. This study sought to understand delays in breast cancer care by examining the intersection of race and sexual orientation. METHODS This online, cross-sectional survey enrolled racially and sexually diverse women aged ≥ 35 years who had been diagnosed with breast cancer within the prior 10 years or had an abnormal screening in the prior 24 months. The authors calculated summary statistics by race/sexual orientation categories, and they conducted univariate and multivariable modeling by using multiple imputation for missing data. RESULTS BSMW (n = 101) had the highest prevalence of care delays with 5.17-fold increased odds of a care delay in comparison with White heterosexual women (n = 298) in multivariable models. BSMW reported higher intersectional stigma and lower social support than all other groups. In models adjusted for race, sexual orientation, and income, intersectional stigma was associated with a 2.43-fold increase in care delays, and social support was associated with a 32% decrease in the odds of a care delay. CONCLUSIONS Intersectional stigma may be an important driver of breast cancer inequities for BSMW. Reducing stigma and ensuring access to appropriate social support that addresses known barriers can be an important approach to reducing inequities in the breast cancer care continuum.
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Affiliation(s)
- Tonia Poteat
- University of North Carolina Chapel Hill, Department of Social Medicine, CB #7240, Chapel Hill, NC 27599
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
| | | | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
| | - Sophia Geffen
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
| | - Naomi Greene
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 North Broadway Street, Baltimore, MD 21205
| | - Michael Nodzenski
- University of North Carolina Chapel Hill, Department of Biostatistics, CB #7420, Chapel Hill, NC 27599
| | - Alex Lockhart
- University of North Carolina Chapel Hill, Department of Biostatistics, CB #7420, Chapel Hill, NC 27599
| | - I-Hsuan Su
- University of North Carolina Chapel Hill, Department of Biostatistics, CB #7420, Chapel Hill, NC 27599
| | - Lorraine T. Dean
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
- Johns Hopkins School of Medicine, Department of Oncology, 720 Rutland Ave, Baltimore, MD 21205
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24
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A Cross-Sectional Survey Exploring the Impact of the COVID-19 Pandemic on the Cancer Care of Adolescents and Young Adults. ACTA ACUST UNITED AC 2021; 28:3201-3213. [PMID: 34436044 PMCID: PMC8395398 DOI: 10.3390/curroncol28040278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 12/20/2022]
Abstract
We aimed to describe the negative and positive impacts of changes in cancer care delivery due to COVID-19 pandemic for adolescents and young adults (AYAs) in Canada, as well as the correlates of negative impact and their perspectives on optimization of cancer care. We conducted an online, self-administered survey of AYAs with cancer living in Canada between January and February 2021. Multiple logistic regression was used to identify factors associated with a negative impact on cancer care. Of the 805 participants, 173 (21.5%) experienced a negative impact on their cancer care including delays in diagnostic tests (11.9%), cancer treatment (11.4%), and appointments (11.1%). A prior diagnosis of mental or chronic physical health condition, an annual income of <20,000 CAD, ongoing cancer treatment, and province of residence were independently associated with a negative cancer care impact (p-value < 0.05). The majority (n = 767, 95.2%) stated a positive impact of the changes to cancer care delivery, including the implementation of virtual healthcare visits (n = 601, 74.6%). Pandemic-related changes in cancer care delivery have unfavorably and favorably influenced AYAs with cancer. Interventions to support AYAs who are more vulnerable to the adverse effects of the pandemic, and the thoughtful integration of virtual care into cancer care delivery models is essential.
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25
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Gunn AH, Sorenson C, Greenup RA. Navigating the high costs of cancer care: opportunities for patient engagement. Future Oncol 2021; 17:3729-3742. [PMID: 34296620 DOI: 10.2217/fon-2021-0341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Over the past decade, the financial burden of cancer care on patients and their families has garnered increased attention. Many of the potential solutions have focused on system-level interventions such as adopting value-based payment models and negotiating drug prices; less consideration has been given to actions at the patient level to address cancer care costs. We argue that it is imperative to develop and support patient-level strategies that engage patients and consider their preferences, values and individual circumstances. Opportunities to meet these aims and improve the economic experience of patients in oncology are discussed, including: shared decision-making and communication, financial navigation and treatment planning, digital technology and alternative care pathways, and value-based insurance design.
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Affiliation(s)
- Alexander H Gunn
- School of Medicine, Duke University, Durham, NC 27710, USA.,Duke-Margolis Center for Health Policy, Duke University, Durham, NC 27710, USA
| | - Corinna Sorenson
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC 27710, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC 27708, USA.,Sanford School of Public Policy, Duke University, Durham, NC 27710, USA
| | - Rachel A Greenup
- Department of Surgery, School of Medicine, Yale University, New Haven, CT 06510, USA.,Smilow Cancer Hospital, Yale University, New Haven, CT 06510, USA.,Yale Cancer Center, Yale University, New Haven, CT 06510, USA
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26
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Meghani SH, Levoy K, Magan KC, Starr LT, Yocavitch L, Barg FK. "I'm Dealing With That": Illness Concerns of African American and White Cancer Patients While Undergoing Active Cancer Treatments. Am J Hosp Palliat Care 2021; 38:830-841. [PMID: 33107324 PMCID: PMC8424597 DOI: 10.1177/1049909120969121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND National oncology guidelines recommend early integration of palliative care for patients with cancer. However, drivers for this integration remain understudied. Understanding illness concerns at the time of cancer treatment may help facilitate integration earlier in the cancer illness trajectory. OBJECTIVE To describe cancer patients' concerns while undergoing cancer treatment, and determine if concerns differ among African Americans and Whites. METHODS A 1-time, semi-structured qualitative interview was conducted with a purposive subsample of cancer patients participating in a larger study of illness concerns. Eligible patients were undergoing cancer treatments and had self-reported moderate-to-severe pain in the last week. Analysis encompassed a qualitative descriptive approach with inductive thematic analysis. RESULTS Participants (16 African American, 16 White) had a median age of 53 and were predominantly females (72%) with stage III/IV cancer (53%). Illness concerns were largely consistent across participants and converged on 3 themes: symptom experience (pain, options to manage pain), cancer care delivery (communication, care coordination and care transitions), and practical concerns (access to community and health system resources, financial toxicity). CONCLUSIONS The findings extend the scope of factors that could be utilized to integrate palliative care earlier in the cancer illness trajectory, moving beyond the symptoms- and prognosis-based triggers that typify current referrals to also consider diverse logistical concerns. Using this larger set of concerns aids anticipatory risk mitigation and planning (e.g. care transitions, financial toxicity), helps patients receive a larger complement of support services, and builds cancer patients' capacity toward a more patient-centered treatment and care experience.
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Affiliation(s)
- Salimah H. Meghani
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing; Philadelphia, Pennsylvania
| | - Kristin Levoy
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing; Philadelphia, Pennsylvania
| | | | - Lauren T. Starr
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing; Philadelphia, Pennsylvania
| | | | - Frances K. Barg
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania
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27
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Davis RE, Trickey AW, Abrahamse P, Kato I, Ward K, Morris AM. Association of Cumulative Social Risk and Social Support With Receipt of Chemotherapy Among Patients With Advanced Colorectal Cancer. JAMA Netw Open 2021; 4:e2113533. [PMID: 34106262 PMCID: PMC8190628 DOI: 10.1001/jamanetworkopen.2021.13533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Approximately 38% of patients with advanced colorectal cancer do not receive chemotherapy. OBJECTIVE To determine whether cumulative social risk (ie, multiple co-occurring sociodemographic risk factors) is associated with lower receipt of chemotherapy among patients with advanced colorectal cancer and whether social support would moderate this association. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, population-based, mailed survey study was conducted from 2012 to 2014. Participants were recruited between 2011 and 2014 from all adults within 1 year after diagnosis of stage III colorectal cancer in the Detroit, Michigan, and State of Georgia Surveillance, Epidemiology, End-Results cancer registries. Patients were eligible if they were aged 18 years or older, had undergone surgery 4 or more months ago, did not have stage IV cancer, and resided in the registry catchment areas. Data analyses were conducted from March 2017 to April 2021. MAIN OUTCOMES AND MEASURES The primary outcome was receipt of chemotherapy. Cumulative social risk represented a sum of 8 risk factors with the potential to drain resources from participants' cancer treatment (marital status, employment, annual income, health insurance, comorbidities, health literacy, adult caregiving, and perceived discrimination). Social support was operationalized as emotional support related to colorectal cancer diagnosis. RESULTS Surveys were mailed to 1909 eligible patients; 1301 completed the survey (response rate, 68%). A total of 1087 participants with complete data for key variables were included in the sample (503 women [46%]; mean [SD] age, 64 [13] years). Participants with 3 or more risk factors were less likely to receive chemotherapy than participants with 0 risk factors (3 factors, odds ratio [OR], 0.48 [95% CI, 0.26-0.87]; 4 factors, OR, 0.41 [95% CI, 0.21-0.78]; 5 factors, OR, 0.42 [95% CI, 0.20-0.87]; ≥6 factors, OR, 0.22 [95% CI, 0.09-0.55]). Participants with 2 or more support sources had higher odds of undergoing chemotherapy than those without social support (2 sources, OR, 3.05 [95% CI, 1.36-6.85]; 3 sources, OR, 3.24 [95% CI, 1.48-7.08]; 4 sources, OR, 3.69 [95% CI, 1.71-7.97]; 5 sources, OR, 4.40 [95% CI, 1.98-9.75]; ≥6 sources, OR 5.95 [95% CI, 2.58-13.74]). Within each social support level, participants were less likely to receive chemotherapy as cumulative social risk increased. CONCLUSIONS AND RELEVANCE Cumulative social risk was associated with reduced receipt of chemotherapy. These associations were mitigated by social support. Assessing cumulative social risk may identify patients with colorectal cancer who are at higher risk for omitting chemotherapy who can be targeted for support programs to address social disadvantage and increase social support.
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Affiliation(s)
- Rachel E. Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
| | - Amber W. Trickey
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Paul Abrahamse
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Ikuko Kato
- Department of Pathology, Karmanos Cancer Institute, Wayne State University, Michigan
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Arden M. Morris
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
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28
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Falcone M, Liu L, Farias A, Zhang J, Kang I, Li M, Stern MC, Lerman C. Evidence for racial/ethnic disparities in emergency department visits following breast cancer surgery among women in California: a population-based study. Breast Cancer Res Treat 2021; 187:831-841. [PMID: 33675489 PMCID: PMC10373425 DOI: 10.1007/s10549-021-06119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Racial/ethnic disparities in breast cancer outcomes may be related to quality of care and reflected in emergency department (ED) visits following primary treatment. We examined racial/ethnic variation in ED visits following breast cancer surgery. METHODS Using linked data from the California Cancer Registry and California Office of Statewide Health Planning and Development, we identified 151,229 women diagnosed with stage 0-III breast cancer between 2005 and 2013 who received surgical treatment. Differences in odds of having at least one breast cancer-related ED visit within 90 days post-surgery were estimated with logistic regression controlling for clinical and sociodemographic variables. Secondary analyses examined health care-related moderators of disparities. RESULTS Hispanics and non-Hispanic (NH) Blacks had an increased likelihood of having an ED visit within 90 days of surgery compared to NH Whites [OR = 1.11 (1.04-1.18), p = 0.0016; OR = 1.38 (1.27-1.50), p < 0.0001, respectively]; the likelihood was reduced in Asian/Pacific Islanders [aOR = 0.77 (0.71-0.84), p < 0.0001]. Medicaid and Medicare (vs. commercial insurance) increased the likelihood of ED visit for NH Whites, and to a lesser degree for Hispanics and NH Blacks (p < 0.0001 for interaction). Receipt of surgery at an NCI-designated Comprehensive Cancer Center or at a for-profit (vs. non-profit) hospital was associated with reduced likelihood of ED visits for all groups. CONCLUSION Racial/ethnic disparities in ED visits following breast cancer surgery persist after controlling for clinical and sociodemographic variables. Improving quality of care following breast cancer surgery could improve outcomes for all groups.
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Affiliation(s)
- Mary Falcone
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA
| | - Lihua Liu
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Albert Farias
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - JuanJuan Zhang
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Irene Kang
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA
| | - Ming Li
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mariana C Stern
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Caryn Lerman
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA.
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29
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Idos GE, Bonner JD, Haghighat S, Gainey C, Shen S, Mulgonkar A, Otero KJ, Geronimo C, Hurtado M, Myers C, Morales-Pichardo J, Kahana DD, Giboney P, Dea S. Bridging the Gap: Patient Navigation Increases Colonoscopy Follow-up After Abnormal FIT. Clin Transl Gastroenterol 2021; 12:e00307. [PMID: 33617188 PMCID: PMC7901799 DOI: 10.14309/ctg.0000000000000307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/11/2020] [Accepted: 12/18/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Recent studies indicate low rates of follow-up colonoscopy after abnormal fecal immunochemical testing (FIT) within safety net health systems. A patient navigation (PN) program is an evidence-based strategy that has been shown to improve colonoscopy completion in private and public healthcare settings. The aim of this study was to evaluate the effectiveness of a PN program to encourage follow-up colonoscopy after abnormal FIT within a large safety net hospital system. METHODS We established an enterprisewide PN program at 5 tertiary care hospitals within the Los Angeles County Department of Health Services system in 2018. The PN assisted adult patients aged 50-75 years with an abnormal FIT to a follow-up colonoscopy within 6 months. PN activities included initiating referral for and scheduling of colonoscopy, performing reminder phone calls to patient for their upcoming colonoscopy, and following up with patients who did not attend their colonoscopy. We assess the effectiveness of the PN intervention by comparing follow-up colonoscopy rates with a period before the intervention. RESULTS There were 2,531 patients with abnormal FIT results (n = 1,214 in 2017 and n = 1,317 in 2018). A majority were women (55% in 2017 vs 52% in 2018) with a mean age of 60 ± 6.2 years. From a previous mean of 163 days without PN in 2017, the mean time from abnormal FIT to colonoscopy with PN improved to 113 days in 2018. The frequency of colonoscopy completion with PN increased from 40.6% (n = 493) in 2017 to 46% (n = 600) in 2018. DISCUSSION After the introduction of the PN program, there was a significant increase in patients undergoing follow-up colonoscopy after abnormal FIT and patients were more likely to undergo colonoscopy within the recommended 6 months.
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Affiliation(s)
- Gregory E. Idos
- City of Hope National Medical Center, Duarte, California, USA
| | | | - Shida Haghighat
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Christina Gainey
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Stacy Shen
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ashwini Mulgonkar
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Karla Joyce Otero
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Christine Geronimo
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Maria Hurtado
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Caitlin Myers
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | | | - Doron D. Kahana
- Los Angeles County Department of Health Services, Los Angeles, California, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Paul Giboney
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Stanley Dea
- Los Angeles County Department of Health Services, Los Angeles, California, USA
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30
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Abstract
PROBLEM IDENTIFICATION Patients with cancer face high expectations for performing health literacy activities necessary for self-management and decision making, but only 12% of adults in the United States are proficient in health literacy. This review explores evidence regarding what is known about functional, interactive, and critical health literacy in adult oncology populations. LITERATURE SEARCH The review was conducted by searching extensively in the CINAHL® Plus database. DATA EVALUATION Of 614 articles retrieved from the literature search, 22 were included in the final sample. Most were cross-sectional, descriptive, correlational studies. SYNTHESIS Health literacy research in the United States focuses primarily on functional health literacy, but studies that include interactive and/or critical health literacy indicate their applicability in adult oncology populations. IMPLICATIONS FOR RESEARCH Additional research is needed to clarify the role of health literacy in cancer care to develop effective interventions that facilitate self-management and decision making.
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Rudenstine S, McNeal K, Schulder T, Ettman CK, Hernandez M, Gvozdieva K, Galea S. Depression and Anxiety During the COVID-19 Pandemic in an Urban, Low-Income Public University Sample. J Trauma Stress 2021; 34:12-22. [PMID: 33045107 PMCID: PMC7675401 DOI: 10.1002/jts.22600] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
Mental health disparities in the aftermath of national disasters and the protective role of socioeconomic status are both well documented. We assessed the prevalence of depression and anxiety symptoms among underresourced public university students during the COVID-19 pandemic in New York City. Between April 8, 2020, and May 2, 2020, adult students (N = 1,821) across the CUNY system completed an online survey examining COVID-19-related stressors and mental health and sociodemographic factors. Using multivariable logistical regression to assess the association between COVID-19-related stressors and depression and anxiety symptoms, we found a high prevalence and severity of depression and anxiety symptoms. We also observed that more exposure to COVID-19-related stressors was associated with increased depressive (27.0%, 41.4%, and 63.1% for low-, medium-, and high-level stressors, respectively) and anxiety symptoms (19.3%, 34.6%, 52.2%). In addition, the degree of exposure to COVID-19-related stressors served as an important predictor of depression and anxiety symptoms. Compared to high levels of stressors, the odds of depression were 0.2, 95% CI [0.2, 0.3] for low- and 0.4, 95% CI [0.3, 0.5] for medium-level stressors; for anxiety, the odds were 0.2, 95% CI [0.2, 0.3] for low and 0.05, 95% CI [0.4, 0.6] for medium stressors. Finally, household savings of less than $5,000 increased the risk of anxiety but not depression symptoms, OR = 1.3, 95% CI [1.0,1.6]. Together, these findings tell a devastating story of psychological distress among students from lower socioeconomic groups living in the COVID-19 epicenter of the U.S. pandemic.
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Affiliation(s)
- Sasha Rudenstine
- Department of PsychologyCity College of New YorkNew YorkNew YorkUSA
| | - Kat McNeal
- Department of PsychologyCity College of New YorkNew YorkNew YorkUSA
| | - Talia Schulder
- Department of PsychologyCity College of New YorkNew YorkNew YorkUSA
| | | | | | | | - Sandro Galea
- School of Public HealthBoston UniversityBostonMassachusettsUSA
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Brown CM, Richards KM, Vohra Y, Kanu C, Stevens L, Sasane R, Balu S, McAneny B. Evaluation of access to care issues in patients with breast cancer. J Med Econ 2021; 24:38-45. [PMID: 33317379 DOI: 10.1080/13696998.2020.1858580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS System-level efforts have been deployed to improve oncology care and access while reducing utilization and costs. Understanding the nature of access to care from the perspective of patients themselves is an unmet need. This study examined access to care in a population of women with breast cancer and its relationship to overall patient satisfaction. MATERIALS AND METHODS Patients with breast cancer from six oncology clinics in five states completed a survey during routine office visits. Access to care (higher scores indicated increasing access barriers), overall patient satisfaction, and patient demographic/clinical characteristics were measured. The relationships between access (composite and factor scores) and satisfaction were assessed using multivariable analyses controlling for age (the only significant characteristic from bivariate analyses). RESULTS A total of 180 patients completed the survey. Factor analysis of access to care items revealed an 8-factor measure - Insurance, Health System, Emotional, Holistic Treatment, Family Support, Knowledge/Understanding, Information Quality, and Financial Support - with high reliability (Composite: Cronbach alpha = 0.93; Factors: Cronbach alpha range = 0.85-0.91). Access composite score was moderately low (mean = 1.90), indicating an overall low level of access barriers, and overall patient satisfaction was high (mean = 4.59). The composite score (p < .001) and the Health System and Knowledge/Understanding factors (p < .01) were significant and negative predictors of overall satisfaction. LIMITATIONS Study sites were high functioning clinics and all, but one, are Oncology Care Model practices. Thus, the scope of access to care issues for patients of under-resourced clinics might not be well addressed. CONCLUSIONS Access to care overall and by factor was significantly predictive of patient satisfaction with care. In addition, access to care factors varied across several demographic and clinical characteristics. Future strategies that address access to care challenges should consider these modifiable, patient-centric, and system-based issues.
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Affiliation(s)
- Carolyn M Brown
- Texas Center for Health Outcomes Research and Education (TxCORE), College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Kristin M Richards
- Texas Center for Health Outcomes Research and Education (TxCORE), College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Yogesh Vohra
- Texas Center for Health Outcomes Research and Education (TxCORE), College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Chisom Kanu
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Laura Stevens
- Innovative Oncology Business Solutions, Albuquerque, NM, USA
| | | | | | - Barbara McAneny
- New Mexico Oncology Hematology Consultants, Albuquerque, NM, USA
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Graboyes EM, Halbert CH, Li H, Warren GW, Alberg AJ, Calhoun EA, Nussenbaum B, Marsh CH, McCay J, Day TA, Kaczmar JM, Sharma AK, Neskey DM, Sterba KR. Barriers to the Delivery of Timely, Guideline-Adherent Adjuvant Therapy Among Patients With Head and Neck Cancer. JCO Oncol Pract 2020; 16:e1417-e1432. [PMID: 32853120 PMCID: PMC7735037 DOI: 10.1200/op.20.00271] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Delays initiating guideline-adherent postoperative radiation therapy (PORT) in head and neck squamous cell carcinoma (HNSCC) are common, contribute to excess mortality, and are a modifiable target for improving survival. However, the barriers that prevent the delivery of timely, guideline-adherent PORT remain unknown. This study aims to identify the multilevel barriers to timely, guideline-adherent PORT and organize them into a conceptual model. MATERIALS AND METHODS Semi-structured interviews with key informants were conducted with a purposive sample of patients with HNSCC and oncology providers across diverse practice settings until thematic saturation (n = 45). Thematic analysis was performed to identify the themes that explain barriers to timely PORT and to develop a conceptual model. RESULTS In all, 27 patients with HNSCC undergoing surgery and PORT were included, of whom 41% were African American, and 37% had surgery and PORT at different facilities. Eighteen clinicians representing a diverse mix of provider types from 7 oncology practices participated in key informant interviews. Five key themes representing barriers to timely PORT were identified across 5 health care delivery levels: (1) inadequate education about timely PORT, (2) postsurgical sequelae that interrupt the tight treatment timeline (both intrapersonal level), (3) insufficient coordination and communication during care transitions (interpersonal and health care team levels), (4) fragmentation of care across health care organizations (organizational level), and (5) travel burden for socioeconomically disadvantaged patients (community level). CONCLUSION This study provides a novel description of the multilevel barriers that contribute to delayed PORT. Interventions targeting these multilevel barriers could improve the delivery of timely, guideline-adherent PORT and decrease mortality for patients with HNSCC.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Chanita Hughes Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Hong Li
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Graham W. Warren
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
- Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Elizabeth A. Calhoun
- Center for Population Science and Discovery, University of Arizona Health Sciences, Tucson, AZ
| | - Brian Nussenbaum
- American Board of Otolaryngology-Head and Neck Surgery, Houston, TX
| | - Courtney H. Marsh
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Terry A. Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - John M. Kaczmar
- Department of Medicine, Division of Medical Oncology, Medical University of South Carolina, Charleston, SC
| | - Anand K. Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - David M. Neskey
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Katherine R. Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Jetelina KK, Carr C, Murphy CC, Sadeghi N, S Lea J, Tiro JA. The impact of intimate partner violence on breast and cervical cancer survivors in an integrated, safety-net setting. J Cancer Surviv 2020; 14:906-914. [PMID: 32671556 DOI: 10.1007/s11764-020-00902-x] [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: 03/19/2020] [Accepted: 05/30/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Characterize prevalence of intimate partner violence (IPV) among breast and cervical survivors receiving care in an urban safety-net healthcare system; Examine the relationship between IPV and clinical characteristics, receipt of cancer treatment, and guideline-recommended survivorship care. METHODS From 2010 to 2017, breast and cervical cancer survivors were identified and recruited from a large, integrated, safety-net hospital system. Electronic health records (EHR; to measure survivorship care), cancer registry (to measure clinical characteristics), and patient telephone surveys (to measure IPV) were triangulated among 312 survivors. Bivariate and multivariable models assessed the relationship between victimization and clinical characteristics, cancer treatment, and guideline-recommended survivorship care. RESULTS Among the 312 participants, 54% identified as IPV+. Among breast cancer, IPV+ cancer participants were twice more likely to develop estrogen receptor negative ER- and/or progesterone receptor negative PR- tumor receptors compared with IPV- cancer participants (AOR = 2.31; 95% CI, 1.20, 4.44). IPV+ breast cancer participants were less likely to have surgery and less likely to have hormone therapy as a first course of treatment compared with IPV- participants. There was no relationship between IPV and adherence to guideline-recommended cancer survivorship care. CONCLUSIONS This study expands our current knowledge on how victimization, and specifically IPV, impact health among specialty care. Future research should determine the feasibility of implementing Trauma-Informed Care in oncology practices to better optimize care. IMPLICATIONS FOR CANCER SURVIVORS At integrated hospital systems, IPV+ cancer participants should utilize social workers, within their oncology clinics, to connect to victim services.
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Affiliation(s)
- Katelyn K Jetelina
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth Science Center at Houston, School of Public Health, 6011 Harry Hines Blvd, V8.106C, Dallas, TX, USA. .,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Christian Carr
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth Science Center at Houston, School of Public Health, 6011 Harry Hines Blvd, V8.106C, Dallas, TX, USA
| | - Caitlin C Murphy
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Navid Sadeghi
- Department of Internal Medicine, Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Parkland Health and Hospital System, Dallas, TX, USA
| | - Jayanthi S Lea
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jasmin A Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Communication in surgical decision-making while managing metastatic bone disease: matching patient expectations with surgical goals. Support Care Cancer 2020; 29:1111-1119. [PMID: 32607597 DOI: 10.1007/s00520-020-05595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is a paucity of research examining how surgical decision-making for metastatic bone disease (MBD) can be optimized to improve quality of life (QOL) and functional outcomes, while accurately aligning with patient goals and expectations. The objective of this study was to survey and interview patients with MBD and support persons (PS), physicians, and allied health care providers (HCP) with the goal of identifying (1) important surgical issues related to MBD management, (2) discordance in perioperative expectations, and (3) perceived measures of success in the surgical management of MBD. METHODS Utilizing a custom survey developed by HCP and patients with MBD, participants were asked to (1) identify important issues related to MBD management, (2) rank perceived measures of success, and (3) answer open-ended questions pertaining to the management of MBD. RESULTS From the survey, increased life expectancy, minimizing disease progression, removal of local tumour, timely surgery after diagnosis, increased length of hospitalization, and physiotherapy access were all identified as significant discordant goals between PS and physicians/HCP. Conversely, there was an agreement between physicians and HCP who considered improved QOL and functional outcomes as most important goals. Structured homogenous-group workshops identified the need for (1) improved discussions of prognosis, surgical options, expectations, timelines, and resources, (2) the use of a care team "quarterback", and (3) an increased use of multi-disciplinary treatment planning. CONCLUSIONS We feel this data highlights the importance of improved communication and coordination in treating patients with MBD. Further research evaluating how surgical techniques influence survival and disease progression in MBD is highly relevant and important to patients.
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Allen CG, Barbero C, Shantharam S, Moeti R. Is Theory Guiding Our Work? A Scoping Review on the Use of Implementation Theories, Frameworks, and Models to Bring Community Health Workers into Health Care Settings. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:571-580. [PMID: 30180116 PMCID: PMC6395551 DOI: 10.1097/phh.0000000000000846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Community health workers (CHWs) are becoming a well-recognized workforce to help reduce health disparities and improve health equity. Although evidence demonstrates the value of engaging CHWs in health care teams, there is a need to describe best practices for integrating CHWs into US health care settings. The use of existing health promotion and implementation theories could guide the research and implementation of health interventions conducted by CHWs. We conducted a standard 5-step scoping review plus stakeholder engagement to provide insight into this topic. Using PubMed, EMBASE, and Web of Science, we identified CHW intervention studies in health care settings published between 2000 and 2017. Studies were abstracted by 2 researchers for characteristics and reported use of theory. Our final review included 50 articles published between January 2000 and April 2017. Few studies used implementation theories to understand the facilitators and barriers to CHW integration. Those studies that incorporated implementation theories used RE-AIM, intervention mapping, cultural tailoring, PRECEDE-PROCEED, and the diffusion of innovation. Although most studies did not report using implementation theories, some constructs of implementation such as fidelity or perceived benefits were assessed. In addition, studies that reported intervention development often cited specific theories, such as the transtheoretical or health belief model, that helped facilitate the development of their program. Our results are consistent with other literature describing poor uptake and use of implementation theory. Further translation of implementation theories for CHW integration is recommended.
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Affiliation(s)
- Caitlin G Allen
- Emory University School of Public Health, Atlanta, Georgia (Ms Allen); Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Barbero and Ms Moeti; and IHRC, Inc, Atlanta, Georgia (Ms Shantharam)
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Yoder C, Holtzclaw A, Sarkar S. The Unique Role of Lung Cancer Nurse Navigators in Elderly Lung Cancer Patients. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00317-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gilbertson-White S, Perkhounkova Y, Saeidzadeh S, Hein M, Dahl R, Simons-Burnett A. Understanding Symptom Burden in Patients With Advanced Cancer Living in Rural Areas. Oncol Nurs Forum 2020; 46:428-441. [PMID: 31225835 DOI: 10.1188/19.onf.428-441] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the feasibility of using a biobehavioral approach to examine symptom burden in rural residents with advanced cancer. SAMPLE & SETTING 21 patients with advanced lung, colorectal, or pancreatic cancer were enrolled at the University of Iowa in Iowa City. METHODS & VARIABLES Using Cleeland's cytokine-immunologic model of symptom expression, symptom burden (i.e., severity, count, and interference) and inflammatory cytokines were measured for 24 weeks. Potential predictors included demographics, clinical characteristics, optimism, social support, and cancer-related stress. Descriptive statistics, Wilcoxon rank-sum, and Fisher's exact test were used for analysis. RESULTS Recruitment and retention rates were similar for rural and nonrural patients. Demographics, optimism, and social support were no different between groups. The cancer-related stress total score for rural patients was nearly half of the score of nonrural patients, with rural patients reporting significantly less avoidance. Symptom severity for the five worst symptoms remained moderate during the 24 weeks, whereas nonrural residents reported steady declines in severity of their five worst symptoms. Significant differences in inflammatory cytokines between groups were only found at one time point. IMPLICATIONS FOR NURSING Rural residents who seek care at a cancer center may be clinically and demographically more similar to their nonrural counterparts than to rural residents seeking local care.
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Golden SD, Kim K, Kong AY, Tao VQ, Carr D, Musburger P. Simulating the Impact of a Cigarette Minimum Floor Price Law on Adult Smoking Prevalence in California. Nicotine Tob Res 2020; 22:1842-1850. [DOI: 10.1093/ntr/ntaa046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/28/2020] [Indexed: 12/21/2022]
Abstract
Abstract
Introduction
Minimum floor price laws (MFPLs) are an emerging tobacco control policy that sets a minimum price below which a specific tobacco product cannot be sold. MFPLs target cheaper products and may disproportionately impact consumers choosing low price brands or using discounts to reduce prices. We developed a static microsimulation model for California, United States to project short-term effects of different MFPL options for a 20-stick pack of cigarettes on adult smoking behaviors.
Aims and Methods
We simulated 300 000 individuals defined by race and ethnicity, sex, age, and poverty status. Smoking behaviors and cigarette prices were assigned based on demographic distributions in the 2014–2016 California Behavioral Risk Factor Surveillance System. We drew 100 random samples (n = 30 000), weighted to state-level California demographic characteristics. We simulated six MFPL options and modeled impacts on smoking prevalence and cigarette consumption, in general, and separately for those in households below or above 250% of the federal poverty level, assuming a price elasticity of −0.4.
Results
Predicted changes in prices, prevalence, and consumption increased exponentially as the floor price increased from $7.00 to $9.50. Assuming 15% policy avoidance, projected increases in average cigarette prices ranged from $0.19 to $1.61. Decreases in smoking prevalence ranged from 0.05 to 0.43 percentage points, and decreases in average monthly cigarette consumption ranged from 1.4 to 12.3 cigarettes. Projected prices increased, and prevalence and consumption decreased, more among individuals in households below 250% federal poverty level.
Conclusions
MFPLs are a promising tobacco control strategy with the potential to reduce socioeconomic disparities in cigarette smoking prevalence and consumption.
Implications
Despite reductions in adult smoking prevalence, significant socioeconomic disparities remain, with lower-income groups smoking at substantially higher levels than higher-income groups. Policies that set a floor price below which a tobacco product cannot be sold could reduce socioeconomic disparities in smoking, depending on variation in prices paid by smokers prepolicy. By using a microsimulation model to predict changes in smoking for different population groups in California under several floor price scenarios, this study demonstrates that MFPLs have the potential to reduce adult smoking prevalence overall, and especially for lower-income tobacco users.
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Affiliation(s)
- Shelley D Golden
- 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
| | - KyungSu Kim
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Vivian Qingzi Tao
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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Patient barriers to cancer clinical trial participation and navigator activities to assist. Adv Cancer Res 2020; 146:139-166. [PMID: 32241387 DOI: 10.1016/bs.acr.2020.01.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical research is vital to the discovery of new cancer treatments that can enhance health and prolong life for cancer patients, but breakthroughs in cancer treatment are limited by challenges recruiting patients into cancer clinical trials (CT). Only 3-5% of cancer patients in the United States participate in a cancer CT and there are disparities in CT participation by age, race and gender. Strategies such as patient navigation, which is designed to provide patients with education and practical support, may help to overcome challenges of CT recruitment. The current study evaluated an intervention in which lay navigators were utilized to provide patient education and practical support for helping patients overcome barriers to CT participation and related clinical care. A patient barrier checklist was utilized to record patient barriers to CT participation and care, actions taken by navigators to assist patients with these barriers, and whether or not these barriers could be overcome. Forty patients received patient navigation services. The most common barriers faced by navigated patients were fear (n=9), issues communicating with medical personnel (n=9), insurance issues (n=8), transportation difficulties (n=6) and perceptions about providers and treatment (n=4). The most common activities undertaken by navigators were making referrals and contacts on behalf of patients (e.g., support services, family, clinicians; n=25). Navigators also made arrangement for transportation, financial, medication and equipment services for patients (n=11) and proactively navigated patients (n=8). Barriers that were not overcome for two or more patients included insurance issues, lack of temporary housing resources for patients in treatment and assistance with household bills. The wide array of patient barriers to CT participation and navigator assistance documented in this study supports the CT navigator role in facilitating quality care.
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Sabik LM, Vichare AM, Dahman B, Bradley CJ. Co-payment policies and breast and cervical cancer screening in Medicaid. AMERICAN JOURNAL OF MANAGED CARE 2020; 26:69-74. [PMID: 32059094 DOI: 10.37765/ajmc.2020.42395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study investigated the relationship between state Medicaid co-payment policies and cancer screening for Medicaid-enrolled women. STUDY DESIGN Cross-sectional analysis of administrative claims and enrollment data. METHODS Our data included Medicaid Analytic eXtract (MAX) outpatient claims files across 43 states in 2003, 2008, and 2010, the years for which both MAX data and state cost-sharing data were available. Data on enrollee demographics and screening services from enrollment and claims files were merged with state-year data on co-payment policies and county-level controls from the Area Health Resources File. Participants were nonelderly, nondisabled, nonpregnant women in the recommended age range for each screening service (50-64 years for mammograms; 21-64 years for Pap tests) enrolled in fee-for-service Medicaid. The main independent variable is whether an enrollee faced cost sharing for preventive services. We examined 3 categories of cost sharing: co-payments for all visits, including for preventive services; co-payments for outpatient visits but waived for preventive services; and no co-payments. The main outcome measure was receipt of mammogram or Pap test within a 12-month period. RESULTS Medicaid enrollees with co-payments for preventive services were less likely to receive both screening mammograms and Pap tests than enrollees in states not requiring cost sharing for preventive services. CONCLUSIONS Co-payments for preventive services discourage breast and cervical cancer screening among Medicaid enrollees. The effect is larger for breast cancer screening, which is costlier and requires an additional visit. Considering this evidence, cost sharing for preventive services may lead to adverse health consequences and greater long-term costs.
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Affiliation(s)
- Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh, 130 De Soto St, A613, Pittsburgh, PA 15261.
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Tashkandi E, BaAbdullah M, Zeeneldin A, AlAbdulwahab A, Elemam O, Elsamany S, Alfayez M, Dabash Y, Khayat E, Hassanin F, Abdulhameed R, Jazieh AR. Optimizing the Communication with Cancer Patients During the COVID-19 Pandemic: Patient Perspectives. Patient Prefer Adherence 2020; 14:1205-1212. [PMID: 32764893 PMCID: PMC7381793 DOI: 10.2147/ppa.s263022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND During curfew, patients are self-isolated at home and worried. Patient-doctor interactions may be disrupted and therefore need to be replaced by alternative effective communication methods. PURPOSE To describe the preferences of cancer patients with respect to communication methods and the use of patient-accessible electronic health records (PAEHRs). To record the impact on cancer patients during the COVID-19 pandemic and the knowledge and attitude of the patients towards it. PATIENTS AND METHODS We created a self-administered electronic survey that was piloted and evaluated for its clinical relevance. Using convenient sampling methods, we surveyed the cancer patients in our Oncology Center. RESULTS We received 385 responses between April 15 and April 30, 2020. The preferred method for communication was a phone call with a 92% response rate followed by the electronic patient portal, mobile application, telemedicine and text message in 75%, 76%, 73%, and 72%, respectively. The majority (97%) preferred the use of PAEHRs for appointments, 95% for drug delivery and to view laboratory tests, and 92% in requesting medical reports. In our survey, 22% of patients with cancer reported that their medical cancer care had not been affected by COVID-19. They reported that trusted sources of information during COVID-19 included the Ministry of Health with 98% and doctors with 94%. Sixty-one percent know that they are more susceptible to COVID-19 infection and 91% of respondents supported the notion of digital transformation in the caring of cancer patients. CONCLUSION Our study revealed a general acceptance of patients to telecommunication as substitute to in-person interaction with their physicians. Interaction between cancer patients and health care providers should not be disrupted but should be augmented with more effective platforms to improve health care outcomes.
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Affiliation(s)
- Emad Tashkandi
- Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia
- College of Medicine, Umm AlQura University, Makkah, Saudi Arabia
- Correspondence: Emad Tashkandi Oncology Center, King Abdullah Medical City, College of Medicine, Umm AlQura University, Makkah, Saudi ArabiaTel +966 555 29 0061 Email
| | - M BaAbdullah
- Information Technology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Ahmed Zeeneldin
- Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia
- Department of Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - A AlAbdulwahab
- Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Omima Elemam
- Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia
- Oncology Centre, Mansoura University, Mansoura, Egypt
| | - S Elsamany
- Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia
- Oncology Centre, Mansoura University, Mansoura, Egypt
| | - M Alfayez
- Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia
- College of Medicine, Umm AlQura University, Makkah, Saudi Arabia
| | - Y Dabash
- Patients Affairs, King Abdullah Medical City, Makkah, Saudi Arabia
| | - E Khayat
- Patients Experience, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Fayza Hassanin
- Nursing Administration, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Rasha Abdulhameed
- Nursing Administration, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Abdul Rahman Jazieh
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Penumarthy NL, Goldsby RE, Shiboski SC, Wustrack R, Murphy P, Winestone LE. Insurance impacts survival for children, adolescents, and young adults with bone and soft tissue sarcomas. Cancer Med 2019; 9:951-958. [PMID: 31838786 PMCID: PMC6997066 DOI: 10.1002/cam4.2739] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022] Open
Abstract
Background While racial/ethnic survival disparities have been described in pediatric oncology, the impact of income has not been extensively explored. We analyzed how public insurance influences 5‐year overall survival (OS) in young patients with sarcomas. Methods The University of California San Francisco Cancer Registry was used to identify patients aged 0‐39 diagnosed with bone or soft tissue sarcomas between 2000 and 2015. Low‐income patients were defined as those with no insurance or Medicaid, a means‐tested form of public insurance. Survival curves were computed using the Kaplan‐Meier method and compared using log‐rank tests and Cox models. Causal mediation was used to assess whether the association between public insurance and mortality is mediated by metastatic disease. Results Of 1106 patients, 39% patients were classified as low‐income. Low‐income patients were more likely to be racial/ethnic minorities and to present with metastatic disease (OR 1.96, 95% CI 1.35‐2.86). Low‐income patients had significantly worse OS (61% vs 71%). Age at diagnosis and extent of disease at diagnosis were also independent predictors of OS. When stratified by extent of disease, low‐income patients consistently had significantly worse OS (localized: 78% vs 84%, regional: 64% vs 73%, metastatic: 23% vs 30%, respectively). Mediation analysis indicated that metastatic disease at diagnosis mediated 15% of the effect of public insurance on OS. Conclusions Low‐income patients with bone and soft tissue sarcomas had decreased OS regardless of disease stage at presentation. The mechanism by which insurance status impacts survival requires additional investigation, but may be through reduced access to care.
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Affiliation(s)
- Neela L Penumarthy
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Robert E Goldsby
- Division of Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - Stephen C Shiboski
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | | | - Patricia Murphy
- Division of Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Lena E Winestone
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA.,Division of Allergy, Immunology, and BMT, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, USA
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Gilbertson-White S, Yeung C, Wickersham KE. "Just Living With Them": Symptom Management Experiences of Rural Residents With Advanced Cancer. Oncol Nurs Forum 2019; 46:531-542. [PMID: 31424451 DOI: 10.1188/19.onf.531-542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To understand how rural residents with advanced cancer experience and manage their symptoms. PARTICIPANTS & SETTING 16 adult patients with a diagnosis of advanced cancer, who were receiving antineoplastic treatment and living in rural areas of southeastern Iowa, participated in the study. METHODOLOGIC APPROACH Data were collected through semistructured, audio-recorded interviews using open-ended questions. Data were analyzed using content and dimensional analyses. FINDINGS Four themes were developed from the completed interviews, including (a) barriers and challenges associated with rural cancer care, (b) physical symptoms experienced from the time of diagnosis through the cancer trajectory, (c) symptom management strategies used to control physical symptoms, and (d) perceptions of having cancer and the use of technology in managing symptoms. IMPLICATIONS FOR NURSING Rural residents with advanced cancer experience a wide range of physical symptoms that may affect their quality of life. Although residents may develop self-management strategies to cope with symptoms, additional guidance on and interventions for how best to manage physical symptoms are needed.
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Phillips S, Raskin SE, Harrington CB, Brazinskaite R, Gany FM. "You Have to Keep a Roof Over Your Head": A Qualitative Study of Housing Needs Among Patients With Cancer in New York City. J Oncol Pract 2019; 15:e677-e689. [PMID: 31310572 DOI: 10.1200/jop.19.00077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Housing status can become compromised in the wake of financial hardship for some patients with cancer and become a source of disparity. This qualitative study describes the types of housing issues experienced by patients with cancer and survivors of cancer in New York City. METHODS Semistructured interviews were conducted with a volunteer sample of 21 patients with cancer or survivors of cancer treated in New York City who reported housing needs in the period after diagnosis through survivorship. Nine supplemental interviews were conducted with cancer and housing key informants. Conventional content analysis was conducted on transcripts to create a codebook describing types of housing needs. RESULTS Patients and survivors most commonly had breast (n = 9) and blood (n = 4) cancers and ranged from recently diagnosed to many years posttreatment. Twenty-nine distinct housing-related issues were identified, which were grouped into the following six major categories: housing costs (eg, rent, mortgage), home loss, doubled up or unstable housing, housing conditions, accessibility (eg, stairs, proximity to amenities), and safety. Issues were often interrelated. Housing needs sometimes predated cancer diagnosis. Other issues newly emerged in the wake of cancer-related physical limitations and disruption to finances. Needs ranged in severity and caused patients and survivors considerable burden during a difficult period of poor health and financial strain. CONCLUSION This study contributes depth to current understandings of housing needs among patients with cancer and survivors by providing detailed disaggregated descriptions. We recommend increasing availability of services responsive to these needs and exploring promising options such as patient navigation and legal services. Findings also highlight the importance of creative solutions addressing ecologic-level factors such as housing affordability.
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46
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Dimitropoulos G, Morgan-Maver E, Allemang B, Schraeder K, Scott SD, Pinzon J, Andrew G, Guilcher G, Hamiwka L, Lang E, McBrien K, Nettel-Aguirre A, Pacaud D, Zwaigenbaum L, Mackie A, Samuel S. Health care stakeholder perspectives regarding the role of a patient navigator during transition to adult care. BMC Health Serv Res 2019; 19:390. [PMID: 31208417 PMCID: PMC6580652 DOI: 10.1186/s12913-019-4227-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/06/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Transition to adult care represents a vulnerable period for young people with special health care needs as they navigate multiple life transitions and developmental issues. Patient navigators are a promising intervention designed to facilitate the transfer from pediatric to adult care. However, consistent definitions, key tasks, roles and responsibilities are lacking in guiding the scope of practice and the implementation of patient navigators. METHODS Fundamental qualitative description was utilized in this study to identify perceptions from health care providers about implementing a patient navigator service for young people with special health care needs in transition to adult care. A purposive sample of health care providers with a variety of backgrounds within pediatric and adult systems in Alberta, Canada were recruited. Semi-structured interviews with participants were analyzed using thematic analysis to inductively identify perceptions regarding the role of patient navigators. RESULTS A total of 43 health care providers highlighted the need for a patient navigator service to encompass 4 key stages for young people with special health care needs transitioning from pediatric to adult services: (1) identification of young people with special health care needs and families requiring support, (2) preparation for transfer, (3) health system navigation and, (4) post-transfer support. CONCLUSIONS The results of this qualitative study provide guidance for the development of patient navigator interventions for young people with special health care needs, as well as provide support for current transition services offered across Canada.
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Affiliation(s)
- Gina Dimitropoulos
- Faculty of Social Work, Professional Faculties 4212, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
| | | | - Brooke Allemang
- Faculty of Social Work, Professional Faculties 4212, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| | - Kyleigh Schraeder
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
| | - Shannon D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | - Jorge Pinzon
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
| | - Gregory Guilcher
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Pediatric Oncology and Blood and Marrow Transplant, Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Lorraine Hamiwka
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Nephrology, Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta Canada
| | - Kerry McBrien
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
| | - Alberto Nettel-Aguirre
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
| | - Daniele Pacaud
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Diabetes and Endocrinology, Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
| | - Andrew Mackie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
- Division of Cardiology, Stollery Children’s Hospital, Edmonton, Alberta Canada
| | - Susan Samuel
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Nephrology, Alberta Children’s Hospital, Calgary, Alberta Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
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Rice K, Sharma K, Li C, Butterly L, Gersten J, DeGroff A. Cost-effectiveness of a patient navigation intervention to increase colonoscopy screening among low-income adults in New Hampshire. Cancer 2018; 125:601-609. [PMID: 30548480 DOI: 10.1002/cncr.31864] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/19/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Colonoscopy is the most widely used colorectal cancer (CRC) screening test in the United States. Through the detection and removal of potentially precancerous polyps, it can prevent CRC. However, CRC screening remains low among adults who are recommended for screening. The New Hampshire Colorectal Cancer Screening Program implemented a patient navigation (PN) intervention to increase colonoscopy screening among low-income patients in health centers in New Hampshire. In the current study, the authors examined the cost-effectiveness of this intervention. METHODS A decision tree model was constructed using Markov state transitions to calculate the costs and effectiveness associated with PN. Costs were calculated for the implementation of PN in a statewide public health program and in endoscopy centers. The main study outcome was colonoscopy screening completion. The main decision variable was the incremental cost-effectiveness ratio associated with the PN intervention compared with usual care. RESULTS The average cost per screening with PN was $1089 (95% confidence interval, $1075-$1103) compared with $894 with usual care (95% confidence interval, $886-$908). Among patients who were navigated, approximately 96.2% completed colonoscopy screening compared with 69.3% of those receiving usual care (odds ratio, 11.2; P <. 001). The incremental cost-effectiveness ratio indicated that 1 additional screening completion cost approximately $725 in a public health program and $548 in an endoscopy center with PN compared with usual care, both of which are less than the average Medicare reimbursement of $737 for a colonoscopy procedure. CONCLUSIONS PN was found to be cost-effective in increasing colonoscopy screening among low-income adults in the New Hampshire Colorectal Cancer Screening Program, even at the threshold of current Medicare reimbursement rates for colonoscopy. The results of the current study support the implementation of PN in statewide public health programs and endoscopy centers.
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Affiliation(s)
- Ketra Rice
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krishna Sharma
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chunyu Li
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lynn Butterly
- New Hampshire Colorectal Cancer Screening Program, Mary Hitchcock Memorial Hospital, Lebanon, New Hampshire.,Department of Medicine, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, New Hampshire
| | - Joanne Gersten
- New Hampshire Colorectal Cancer Screening Program, Mary Hitchcock Memorial Hospital, Lebanon, New Hampshire
| | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kashima K, Phillips S, Harvey A, Van Kirk Villalobos A, Pratt-Chapman M. Efficacy of the Competency-Based Oncology Patient Navigator Training. JOURNAL OF ONCOLOGY NAVIGATION & SURVIVORSHIP 2018; 9:519-524. [PMID: 31772830 PMCID: PMC6879008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Patient navigators play a critical role in working across interdisciplinary cancer teams and guiding patient care throughout the cancer continuum. Training for cancer patient navigators is needed to increase navigator capacity to improve health outcomes, especially given the current climate of provider shortages and high healthcare costs. OBJECTIVE The objective of the study was to evaluate the efficacy of the competency-based online Oncology Patient Navigator Training: The Fundamentals, designed by The George Washington University Cancer Center to increase confidence among participants in training learning objectives, which align with patient navigator competencies. METHODS We analyzed pre- and postlesson data from 671 learners who completed the training from 2015 to 2017 to assess changes in confidence across learning objectives. Questions were asked on a 5-point Likert scale (strongly disagree to strongly agree). We calculated summary statistics and compared pre- and postlesson scores using paired t tests. RESULTS Learners reported statistically significant (P <.001) improvements in confidence across all objectives, increasing from an average mean of 3.6 to 4.3. Learners who completed this training also reported high intention to implement new strategies/skills/information into practice (87.7%). DISCUSSION The Oncology Patient Navigator Training: The Fundamentals was found to be efficacious in improving participant confidence, and learners intended to apply their training in practice. Further research on how effectively the training prepares participants for certification and for ability to perform navigation duties in practice is warranted. CONCLUSION This fundamental training for patient navigators increased learners' confidence on competency-based learning objectives.
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Affiliation(s)
- Kanako Kashima
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, Washington, DC
| | - Serena Phillips
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, Washington, DC
| | - Allison Harvey
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, Washington, DC
| | - Aubrey Van Kirk Villalobos
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, Washington, DC
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, Washington, DC
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50
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Wang TY, Chen VCH, Yang YH, Chen CY, Lee CP, Wu SI. The effects of anxiety on the receipt of treatments for esophageal cancer. Psychooncology 2018; 28:31-38. [PMID: 30264450 DOI: 10.1002/pon.4903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/30/2018] [Accepted: 09/14/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Ting-Yao Wang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital; Chiayi; Chang Gung University; Taoyuan Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Medical Foundation; Chang Gung Memorial Hospital; Chiayi Taiwan
- Health Information and Epidemiology Laboratory; Chang Gung Memorial Hospital; Chiayi Taiwan
- School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory; Chang Gung Memorial Hospital; Chiayi Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, and School of Traditional Chinese Medicine, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Institute of Occupational Medicine and Industrial Hygiene; National Taiwan University College of Public Health; Taipei Taiwan
| | - Chao-Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi and College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory; Chang Gung Memorial Hospital; Chiayi Taiwan
| | - Shu-I Wu
- Department of Medicine; Mackay Medical College; Taipei Taiwan
- Department of Psychiatry; Mackay Memorial Hospital; Taipei Taiwan
- Department of Audiology, Speech, and Language Pathology; Mackay Medical College; Taipei Taiwan
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