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Gula AL, Walter JK, Morrison W, Kirschen MP. Exploring Ethical Dimensions in Neuropalliative Care. Semin Neurol 2024; 44:534-542. [PMID: 38914125 DOI: 10.1055/s-0044-1787775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Neurologic illnesses can be challenging to diagnose, involve changes in consciousness, and are often complicated by prognostic uncertainty. These disorders can affect how individuals interact with their environment, and as a result, many ethical concerns may arise related to their medical care. Key ethical issues in neuropalliative care include shared decision-making, evolving autonomy and capacity, best interest and harm principles, beneficence and nonmaleficence, futile and inappropriate care, justice and equity, and ableism. The four core principles of medical ethics, beneficence, nonmaleficence, justice, and autonomy, are foundational in considering approaches to these ethical challenges. Shared decision-making is rooted in the principle of autonomy. Evolving autonomy and capacity evoke autonomy, beneficence, and nonmaleficence. The best interest and harm principles are rooted in beneficence and nonmaleficence. Questions of futility and inappropriate care are founded in the principles of nonmaleficence, autonomy, and justice. Ableism invokes questions of nonmaleficence, autonomy, and justice. Practitioners of neurology will encounter ethical challenges in their practice. Framing decisions around the core ethical principles of beneficence, nonmaleficence, autonomy, and justice will help clinicians navigate challenging situations while acknowledging and respecting each patient's individual story.
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Affiliation(s)
- Annie L Gula
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer K Walter
- Department of Medical Ethics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wynne Morrison
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medical Ethics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew P Kirschen
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Sarkar S, Zaidi M, Raziani Y, Poghosyan H. Evaluating differences in receipt of survivorship care plan among cancer survivors with and without disabilities. Support Care Cancer 2024; 32:637. [PMID: 39235704 DOI: 10.1007/s00520-024-08796-6] [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: 03/12/2024] [Accepted: 08/08/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Despite the role of the Survivorship Care Plan (SCP) in facilitating treatment adherence, research on SCP receipt among cancer survivors with disabilities remains limited. Thus, our study investigated the association between SCP receipt and disability count among cancer survivors. METHODS We analyzed cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System, Cancer Survivorship: Course of Treatment module. The final sample included 2271 respondents with self-reported cancer history. The outcome was self-reported SCP receipt (0 = did not receive SCP, 1 = received written summary or follow-up care instructions, and 2 = received SCP-both). Independent variable was disability counts, comprised of six types: hearing, vision, cognition, mobility, self-care, and independent living difficulties. Disability count was categorized into 0 = none, 1 one disability, 2 = two disabilities, and 3 = ≥ 3 disabilities. We conducted weighted descriptive statistics and multinomial multivariable logistic regression. RESULTS The sample was mostly White (70.62%), female (59.42%), and aged ≥ 65 (54.88%). About 57% reported no disability, 20.89% reported 1-disability, 11.03% 2-disabilities, and 11.47% ≥ 3 disabilities. Mobility issues were the most common disability (26.86%), while self-care difficulties were the least common (6.40%). About 12.12% of cancer survivors did not receive SCP, 35.03% received either treatment summaries or follow-up care instructions, and 52.84% received SCP. Compared to those without disability, survivors with ≥ 3 disabilities had lower odds of receiving SCP (AOR 0.44, 95% CI 0.22-0.88, p = 0.022). CONCLUSIONS This study suggests disparities in SCP receipt by disability count. Addressing such disparities can promote treatment adherence and reduction of missed follow-up.
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Affiliation(s)
- Sayantani Sarkar
- Yale University, School of Nursing, New Haven, Connecticut, USA.
| | - Maryum Zaidi
- University of Massachusetts Lowell, Solomont School of Nursing, Lowell, MA, USA
| | - Yosra Raziani
- Yale University, School of Nursing, New Haven, Connecticut, USA
| | - Hermine Poghosyan
- Yale University, School of Nursing, New Haven, Connecticut, USA
- COPPER Center, Yale School of Medicine, New Haven, Connecticut, USA
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Ward LM, Cooper SA, Sosenko F, Morrison D, Fleming M, McCowan C, Robb K, Hanna CR, Hughes-McCormack L, Dunn K, Conway D, Henderson A, Smith G, Truesdale M, Cairns D. Population-based cancer incidence and mortality rates and ratios among adults with intellectual disabilities in Scotland: a retrospective cohort study with record linkage. BMJ Open 2024; 14:e084421. [PMID: 39142671 PMCID: PMC11331995 DOI: 10.1136/bmjopen-2024-084421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 07/19/2024] [Indexed: 08/16/2024] Open
Abstract
: Objective : To provide contemporary data on cancer mortality rates within the context of incidence in the population with intellectual disabilities. : Methods : Scotland's 2011 Census was used to identify adults with intellectual disabilities and controls with records linked to the Scottish Cancer Registry and death certificate data (March 2011-December 2019). The control cohort without intellectual disabilities and/or autism were used for indirect standardisation and calculation of crude incident rates/crude mortality rates, and age-sex standardised incident rate ratios/standardised mortality ratios (SIR/SMR), with 95% CIs. : Results : Adults with intellectual disabilities were most likely diagnosed cancers of digestive, specifically colorectal (14.2%), lung (9.3%), breast (female 22.9%), body of the uterus (female 9.3%) and male genital organs (male 17.6%). Higher incident cancers included metastatic cancer of unknown primary origin (female SIR=1.70, male SIR=2.08), body of uterus (female SIR=1.63), ovarian (female SIR=1.59), kidney (female SIR=1.85) and testicular (male SIR=2.49). SMRs were higher, regardless of a higher, similar or lower incidence (female SMR=1.34, male SMR=1.07). Excess mortality risk was found for colorectal (total SMR=1.54, male SMR=1.59), kidney (total SMR=2.01 u, female SMR=2.85 u), female genital organs (SMR=2.34 (ovarian SMR=2.86 u, body of uterus SMR=2.11), breast (female SMR=1.58) and metastatic cancer of unknown primary origin (female SMR=2.50 u, male SMR=2.84). : Conclusions : Adults with intellectual disabilities were more likely to die of cancer than the general population. Reasons for this may include later presentation/diagnosis (so poorer outcomes), poorer treatment/compliance or both. Accessible public health approaches are important for people with intellectual disabilities, and healthcare professionals need to be aware of the different cancer experiences faced by this population.
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Affiliation(s)
- Laura McKernan Ward
- Health Informatics Centre, University of Dundee School of Medicine, Dundee, UK
- Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - Sally-Ann Cooper
- Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - Filip Sosenko
- Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - David Morrison
- Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - Michael Fleming
- Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - Colin McCowan
- University of St Andrews Faculty of Medicine, St Andrews, UK
| | - Katie Robb
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Catherine R Hanna
- School of Cancer Sciences, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, Glasgow, UK
| | - Laura Hughes-McCormack
- Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - Kirsty Dunn
- Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - David Conway
- University of Glasgow Dental School, Glasgow, Glasgow, UK
| | - Angela Henderson
- Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - Gill Smith
- Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - Maria Truesdale
- Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - Deborah Cairns
- Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK
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Quon M. Addressing Ableism in Physician Well-Being Planning. JAMA 2024; 332:275-276. [PMID: 38913395 DOI: 10.1001/jama.2024.7736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
This Viewpoint discusses the importance of physician well-being for optimizing patient care and current efforts to improve physician well-being, describes how structural ableism affects the well-being of physicians with disabilities, and calls for further efforts to address ableism in the health care workforce.
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Affiliation(s)
- Michael Quon
- Department of Medicine (General Internal Medicine), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Inflammation and Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Fairman KA, Lira ST. Predictors of stool deoxyribonucleic acid test use in the United States: Implications for outreach to under-resourced populations. Prev Med 2024; 184:107981. [PMID: 38701951 DOI: 10.1016/j.ypmed.2024.107981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Although colorectal cancer screening (CRCS) is a public health priority, uptake is suboptimal in under-resourced groups. Noninvasive modalities, including stool deoxyribonucleic acid (sDNA) testing, may mitigate economic, geographic, cultural, or impairment-related barriers to CRCS. We assessed use of sDNA testing and other CRCS modalities in U.S. residents, comparing subgroups defined by several social determinants of health (SDOH). METHODS A nationally representative sample of community-dwelling respondents aged 50-75 years self-reported use of CRCS modalities in the 2020 Behavioral Risk Factor Surveillance System Survey. Statistical analyses assessed up-to-date screening status and choice of modality in the recommended screening interval. RESULTS Of 179,833 sampled respondents, 60.8% reported colonoscopy, 5.7% sDNA testing, 5.5% another modality. The rate of up-to-date screening was 72.0% overall and negatively associated with Hispanic ethnicity (63.6%), lower educational and annual income levels (e.g., CONCLUSIONS Under-resourced persons were more likely than better-resourced persons to access sDNA testing, possibly offsetting screening barriers in some groups. Findings suggest opportunities to increase CRCS with heightened communication about sDNA testing to those who may experience difficulty accessing other modalities.
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Affiliation(s)
- Kathleen A Fairman
- Midwestern University College of Pharmacy, Glendale Campus, 19555 North 59(th) Avenue, Glendale, AZ 85308, United States of America.
| | - Sarah T Lira
- Veterinary Pharmacy Resident, University of Illinois Urbana-Champaign, At the time the research was conducted, Dr. Lira was a PharmD student at the Midwestern University College of Pharmacy, Glendale Campus., 1008 West Hazelwood Drive, Urbana, IL 61802, United States of America.
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Bang G, Park M, Seon JY, Park SY. Comparative analysis of genetic testing utilization rates among people with and without disabilities in South Korea from 2016 to 2019, focusing on malignant neoplasms: A national population-based study. Cancer Med 2024; 13:e7102. [PMID: 38711356 DOI: 10.1002/cam4.7102] [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: 07/26/2023] [Revised: 02/13/2024] [Accepted: 03/02/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Oncogene testing is widely used to detect or direct cancer treatments. Compared to people without disabilities, people with disabilities in Korea have a lower cancer incidence rate but a fivefold higher cancer mortality rate, implying delayed detection. METHODS We used an administrative database combining disability status and care utilization to analyze every case of cancer-related genetic testing paid for by the National Health Insurance Services of Korea between 2016 and 2019. We first compared percentages of individuals who had taken a registered genetic test by their disability statuses. We then compared the most frequently utilized tests between individuals with and without disabilities. RESULTS Korean citizens, 175,000 in total, underwent at least one of the 192 registered cancer-related genetic tests between 2016 and 2019. People with disabilities utilized these genetic tests at higher rates than those without disabilities, regardless of sex or age. Among people aged ≥40 years, lung and colorectal cancer-related tests were most frequently utilized, regardless of disability status. CONCLUSION Although the cancer-related genetic test uptake rate is higher among people with disabilities than among those without disabilities, it is still possible that information on these tests is not as readily available to people with disabilities. Therefore, it is imperative for the government to actively devise strategies to enhance national cancer screening rates among people with disabilities.
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Affiliation(s)
- Gwanwook Bang
- Department of Medical Education and Humanities, College of Medicine, Kyunghee University, Seoul, South Korea
- Disability Health Research Center of Kyunghee University, Seoul, South Korea
| | - Minji Park
- Kyunghee University Hospital at Gangdong, Seoul, South Korea
| | - Jeong-Yeon Seon
- Health Insurance Research Institute, National Health Insurance Service, Wonju, South Korea
| | - So-Youn Park
- Department of Medical Education and Humanities, College of Medicine, Kyunghee University, Seoul, South Korea
- Disability Health Research Center of Kyunghee University, Seoul, South Korea
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Hansford RL, Ouellette-Kuntz H, Griffiths R, Hallet J, Decker K, Dawe DE, Kristjanson M, Cobigo V, Shooshtari S, Stirling M, Kelly C, Brownell M, Turner D, Mahar A. Breast (female), colorectal, and lung cancer survival in people with intellectual or developmental disabilities: A population-based retrospective cohort study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:332-342. [PMID: 38315327 PMCID: PMC11027730 DOI: 10.17269/s41997-023-00844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Cancer is a leading cause of death among people living with intellectual or developmental disabilities (IDD). There is little empirical evidence documenting survival or comparing outcomes to those without IDD. This study investigated the association between IDD and cancer survival among adults with breast (female), colorectal, or lung cancer. METHODS A population-based retrospective cohort study was conducted in Ontario, Canada, with routinely collected data. Patients with breast, colorectal, or lung cancer were included (2007‒2019). IDD status before cancer was determined using an established administrative data algorithm. The outcomes of interest included death from any cause and death from cancer. Cox proportional hazards models and competing events analyses using multivariable cause-specific hazards regression were completed. Analyses were stratified by cancer type. Interactions with age, sex, and stage at diagnosis, as well as sensitivity analyses, were completed. RESULTS The final cohorts included 123,695 breast, 98,809 colorectal, and 116,232 lung cancer patients. Individuals with IDD experienced significantly worse survival than those without IDD. The adjusted hazard ratios of all-cause death were 2.74 (95% CI 2.41‒3.12), 2.42 (95% CI 2.18‒2.68), and 1.49 (95% CI 1.34‒1.66) times higher for breast, colorectal, and lung cancer patients with IDD relative to those without. These findings were consistent for cancer-specific deaths. With few exceptions, worse survival for people with IDD persisted regardless of stage at diagnosis. CONCLUSION People with IDD experienced worse cancer survival than those without IDD. Identifying and intervening on the factors and structures responsible for survival disparities is imperative.
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Affiliation(s)
- Rebecca L Hansford
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Hélène Ouellette-Kuntz
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- ICES, Toronto, ON, Canada
| | | | - Julie Hallet
- ICES, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kathleen Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
| | - David E Dawe
- CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Mark Kristjanson
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
- St Amant Research Centre, Winnipeg, MB, Canada
| | - Virginie Cobigo
- ICES, Toronto, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Shahin Shooshtari
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- St Amant Research Centre, Winnipeg, MB, Canada
| | - Morgan Stirling
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Donna Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
| | - Alyson Mahar
- ICES, Toronto, ON, Canada.
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada.
- School of Nursing, Queen's University, Kingston, ON, Canada.
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Gil N, Cox A, Whitaker KL, Kerrison RS. Cancer risk-factor and symptom awareness among adults with intellectual disabilities, paid and unpaid carers, and healthcare practitioners: a scoping review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:193-211. [PMID: 38057951 DOI: 10.1111/jir.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The physical health of people with intellectual disabilities (ID) has been identified as an area of ongoing concern and priority. Research has increasingly focused on cancer, with studies indicating that people with ID are at an increased risk of cancer and of mortality, compared with the general population. This review aims to systematically identify and synthesise the published academic literature exploring cancer risk-factor and symptom awareness among people with IDs, carers and healthcare professionals. METHODS In line with Arksey and O'Malley's (2005) framework for scoping reviews, five incremental stages were followed: (1) identifying research question, (2) identifying relevant studies, (3) study selection, (4) extracting and charting of data, and (5) collating, summarising and reporting results. Findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews (PRISMA-Scr). RESULTS The search strategy identified 352 records, 16 records met all eligibility criteria and were included for review. The studies address a range of areas including knowledge and awareness of cancer risk-factors and symptoms and interventions to promote awareness of cancer. CONCLUSIONS Cancer risk-factor and symptom awareness is low among adults with ID, paid and unpaid carers and healthcare practitioners (HCPs). Theoretically underpinned, co-designed tools and interventions to improve awareness are lacking. There is uncertainty surrounding how to best support people with ID in raising cancer awareness, even within the professional healthcare environment. There is a predominance of research on breast cancer awareness. Future studies focusing on other cancers are needed to build a complete picture of awareness among adults with IDs, paid and unpaid carers, and HCPs.
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Affiliation(s)
- N Gil
- School of Health Sciences, University of Surrey, Guildford, UK
| | - A Cox
- School of Health Sciences, University of Surrey, Guildford, UK
| | - K L Whitaker
- School of Health Sciences, University of Surrey, Guildford, UK
| | - R S Kerrison
- School of Health Sciences, University of Surrey, Guildford, UK
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Chen P, Yu H, Lin CF, Guo J, Elliott J, Bleakney A, Jan YK. Effect of adaptive sports on quality of life in individuals with disabilities who use wheelchairs: a mixed-methods systematic review. Disabil Rehabil Assist Technol 2024:1-17. [PMID: 38330244 DOI: 10.1080/17483107.2024.2313110] [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: 11/07/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Adaptive sports participation has been shown to improve quality of life (QoL) in individual with disabilities. However, inconsistent results in various domains of QoL exist in the literature. The objective of this mixed-methods systematic review is to identify and synthesize evidence from quantitative and qualitative studies on the effect of adaptive sports on QoL in individuals with disabilities who use wheelchairs for mobility. METHODS A systematic literature review of quantitative, qualitative, and mixed-methods research on the effect of adaptive sports on QoL was conducted on five databases (Scopus, Web of Science, PsycINFO, Medline, and PubMed). Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool. RESULTS This review identified 4 key findings from 41 studies, including 31 quantitative and 10 qualitative studies. First, individuals with disabilities using wheelchairs for mobility who actively engaged in adaptive sports tend to report higher QoL scores compared with those who were inactive or did not participate. Second, the relationship between the duration of regular participation in adaptive sports and QoL scores exhibited inconsistent results. Third, a multi-component adaptive sports program demonstrates the potential to further improve QoL scores. Last, qualitative investigations reveal that participation in adaptive sports positively influences various domains of well-being in wheelchair users, including encompassing physical and emotional well-being, interpersonal relationships, material well-being, personal development, self-determination, and social inclusion. CONCLUSION This review provides a comprehensive relationship between adaptive sports participation and QoL of wheelchair users. This study identifies the value of multi-component interventions and demonstrates the diverse positive influences of adaptive sports on well-being.
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Affiliation(s)
- Panpan Chen
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Physical Education, Tsinghua University, Beijing, China
| | - Hongjun Yu
- Department of Physical Education, Tsinghua University, Beijing, China
| | - Cheng-Feng Lin
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan
| | - Jiaqi Guo
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jeannette Elliott
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Adam Bleakney
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Yih-Kuen Jan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Hansford R, Ouellette-Kuntz H, Bourque MA, Decker K, Derksen S, Hallet J, Dawe DE, Cobigo V, Shooshtari S, Stirling M, Kelly C, Brownell M, Turner D, Mahar AL. Investigating inequalities in cancer staging and survival for adults with intellectual or developmental disabilities and cancer: A population-based study in Manitoba, Canada. Cancer Epidemiol 2024; 88:102500. [PMID: 38035452 DOI: 10.1016/j.canep.2023.102500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/06/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Cancer is a leading cause of death among adults living with intellectual or developmental disabilities (IDD). However, few epidemiological studies exist worldwide quantifying inequalities in cancer stage at diagnosis and survival for people with IDD relative to those without IDD. METHODS A population-based, retrospective cohort study was conducted using provincial health and social administrative data in Manitoba, Canada. Adults (≥18 years) with a cancer diagnosis between 2004 and 2017 were included. Lifetime IDD was identified before the cancer diagnosis using an established algorithm. Modified Poisson regression with robust error variance was used to estimate the association between IDD status and metastatic cancer at diagnosis. Multivariable Cox proportional hazards analyses were used to the effect of IDD on overall survival following the cancer diagnosis. RESULTS The staging and prognosis cohorts included 62,886 (n = 473 with IDD) and 74,143 (n = 592 with IDD) cancer patients, respectively. People living with IDD were significantly more likely to be diagnosed with metastatic cancer and die following their cancer diagnosis compared to those without IDD (RR=1.20; 95 % CI 1.05-1.38; HR= 1.53; 95 % CI 1.38-1.71). Significant heterogeneity by sex was identified for cancer survival (p = 0.005). DISCUSSION People with IDD had more advanced cancer stage at diagnosis and worse survival relative to those without IDD. Identifying and developing strategies to address the factors responsible that contribute to these disparities is required for improving patient-centred cancer care for adults with IDD.
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Affiliation(s)
- Rebecca Hansford
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | | | | | - Kathleen Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada
| | - Shelley Derksen
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Julie Hallet
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - David E Dawe
- CancerCare Manitoba, Winnipeg, MB, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Virginie Cobigo
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Shahin Shooshtari
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; St Amant Research Centre, Winnipeg, MB, Canada
| | - Morgan Stirling
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Donna Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada
| | - Alyson L Mahar
- School of Nursing, Queen's University, Kingston, ON, Canada; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada.
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Lee WR, Son N, Yoo KB, Han KT. Disparities of health expenditure associated with the experience of admission in long-term care hospital among patients with colorectal cancer in South Korea: A generalized estimating equation. PLoS One 2023; 18:e0296170. [PMID: 38127950 PMCID: PMC10735009 DOI: 10.1371/journal.pone.0296170] [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: 08/22/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
With rising concerns about the functional role of long-term care hospitals in the Korean medical system, this study aimed to observe the experience of admission in the long-term care hospitals and their association with medical expenditures among patients with colorectal cancer, and to investigate disparities among vulnerable populations. Data were obtained from the National Health Insurance Senior Cohort Database in South Korea for the period 2008-2019. With 6,305 patients newly diagnosed with colorectal cancer between 2008 and 2015, we conducted a regression analysis using the Generalized Estimating Equation model with gamma distribution to investigate the association between health expenditure and the experience of long-term care hospitals. We also explored the interaction effect of disability or income, followed by subgroup analysis. Among patients who received care at long-term care hospitals, the health expenditure within one year and five years after the incidence of colorectal cancer was found to be higher than in those who did not receive such care. It was observed that the low-income and disabled groups experienced higher disparities in health expenditure. The rise in health expenditure highlights importance for functional improvement, aligning with these initial purpose of long-term care hospitals to address the growing healthcare needs of the elderly population and ensure efficient healthcare spending, of long-term care hospitals. To achieve this original intent, it is imperative for government initiatives to focus on reducing quality gaps in long-term care hospital services and addressing cost disparities among individuals with cancer, including those with disabilities or low-income.
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Affiliation(s)
- Woo-Ri Lee
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Noorhee Son
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea
| | - Ki-Bong Yoo
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Kyu-Tae Han
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea
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12
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Tosetti I, Kuper H. Do people with disabilities experience disparities in cancer care? A systematic review. PLoS One 2023; 18:e0285146. [PMID: 38091337 PMCID: PMC10718463 DOI: 10.1371/journal.pone.0285146] [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: 04/15/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Over 1.3 billion people, or 16% of the world's population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. METHODS A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of adult patients with disabilities and a sample without disabilities were included. Studies focused on cancer screening and not treatment were excluded, as well as editorials, commentaries, opinion papers, reviews, case reports, case series under 10 patients and conference abstracts. Studies were evaluated by one reviewer for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding. RESULTS Thirty-one studies were included in the systematic review. Compared to people without disabilities, PwD had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that PwD received poorer quality cancer care, including lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care. DISCUSSION Limitations of this work include the exclusion of qualitative research, no assessment of publication bias, selection performed by only one reviewer, results from high-income countries only, no meta-analysis and a high risk of bias in 15% of included studies. In spite of these limitations, our results show that PwD often experience severe disparities in cancer care with less guideline-consistent care and higher mortality than people without disabilities. These findings raise urgent questions about how to ensure equitable care for PwD; in order to prevent avoidable morbidity and mortality, cancer care programs need to be evaluated and urgently improved, with specific training of clinical staff, more disability inclusive research, better communication and shared decision-making with patients and elimination of physical, social and cultural barriers.
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Affiliation(s)
- Irene Tosetti
- M.Sc. Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Panunzio A, Gozzo A, Mazzucato G, Ornaghi PI, Filippo GD, Soldano A, De Maria N, Cianflone F, Orlando R, Boldini M, Pettenuzzo G, Montanaro F, Artibani W, Porcaro AB, Pagliarulo V, Cerruto MA, Antonelli A, Tafuri A. Impairment in Activities of Daily Living Assessed by the Barthel Index Predicts Adverse Oncological Outcomes After Radical Cystectomy for Bladder Cancer. Clin Genitourin Cancer 2023; 21:e495-e501.e2. [PMID: 37365053 DOI: 10.1016/j.clgc.2023.06.002] [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: 05/04/2023] [Revised: 05/30/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION We tested the association between functional impairment in activities of daily living (ADL) assessed through the Barthel Index (BI), and oncological outcomes following radical cystectomy (RC) for bladder cancer (BCa). PATIENTS AND METHODS We retrospectively analyzed data of 262 clinically nonmetastatic BCa patients, who underwent RC between 2015 and 2022, with available follow-up. According to preoperative BI, patients were divided in 2 groups: BI ≤90 (moderate/severe/total dependency in ADL) versus BI 95 to 100 (slight dependency/independency in ADL). Kaplan-Meier plots compared disease recurrence (DR)-, cancer-specific mortality (CSM)-, and overall mortality (OM)-free survival according to established categories. Multivariable Cox regression models tested the BI as an independent predictor of oncological outcomes. RESULTS According to the BI, the patient cohort was distributed as follows: 19% (n = 50) BI ≤90 versus 81% (n = 212) BI 95-100. Compared to patients with BI 95 to 100, patients with BI ≤90 were less likely to receive intravesical immuno- or chemotherapy (18% vs. 34%, p = .028), and more frequently underwent less complex urinary diversion as ureterocutaneostomy (36% vs. 9%, p < .001), or harbored muscle-invasive BCa at final pathology (72% vs. 56%, p = .043). In multivariable Cox regression models adjusted for age, ASA physical status score, pathological T and N stage, and surgical margins status, BI ≤90 independently predicted higher DR (HR [hazard ratio]:2.00, 95%CI [confidence interval]:1.21-3.30, p = .007), CSM (HR:2.70, 95%CI:1.48-4.90, p = .001), and OM (HR:2.09, 95%CI:1.28-3.43, p = .003). CONCLUSION Preoperative impairment in ADL was associated with adverse oncological outcomes following RC for BCa. The integration of the BI into clinical practice may improve the risk assessment of BCa patients candidates to RC.
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Affiliation(s)
- Andrea Panunzio
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; Department of Urology, "Vito Fazzi" Hospital, Lecce, Italy
| | - Alessandra Gozzo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Giovanni Mazzucato
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Paola Irene Ornaghi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Giacomo Di Filippo
- Department of General and Hepatobiliary Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Antonio Soldano
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Nicola De Maria
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesco Cianflone
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Rossella Orlando
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Michele Boldini
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Greta Pettenuzzo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesca Montanaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Walter Artibani
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Antonio Benito Porcaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | | | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; Department of Urology, "Vito Fazzi" Hospital, Lecce, Italy.
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Abstract
In this Viewpoint, the authors urge the USPSTF to undertake a comprehensive effort to ensure its recommendations systematically consider the effects of ableism and structural ableism on individuals with disability.
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Affiliation(s)
- Dimitri A Christakis
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
- Chief health officer, Special Olympics International, Washington, DC
| | - Lisa I Iezzoni
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Keegan G, Rizzo JR, Joseph KA. Disparities in breast cancer among patients with disabilities: care gaps, accessibility, and best practices. J Natl Cancer Inst 2023; 115:1139-1144. [PMID: 37421404 DOI: 10.1093/jnci/djad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
Pronounced disparities exist in detecting and treating breast cancer in women with disabilities, leading to cancer detection at advanced stages. This paper provides an overview of disparities for women with disabilities related to breast cancer screening and care, primarily focusing on clinically significant mobility disabilities. Current care gaps include screening barriers related to accessibility and inequitable treatment options, with race and ethnicity, socioeconomic status, geographic location, and disability severity factors mediating the disparities for this population. The reasons for these disparities are myriad and stem from both system-level deficiencies and individual-level clinician bias. Although structural changes are warranted, individual healthcare professionals must also be incorporated into the requisite change. Intersectionality is critical to disparities and inequities and should be central to any discussion of strategies for improving care for people with disabilities, many of whom have intersectional identities. Efforts to reduce screening rate disparities for breast cancer in women with mobility-related disabilities should start with improving accessibility through removing structural barriers, establishing comprehensive accessibility standards, and addressing healthcare professional bias. Future interventional studies are needed to implement and assess the value of programs to improve breast cancer screening rates in women with disabilities. Increasing the representation of women with disabilities in clinical trials may provide another avenue for reducing treatment disparities because these trials often provide breakthrough treatment to women with cancer diagnosed at later stages. Ultimately, attention to the specific needs of patients with disabilities should be improved across the United States to promote inclusive and effective cancer screening and treatment.
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Affiliation(s)
- Grace Keegan
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - John-Ross Rizzo
- Department of Physical Medicine and Rehabilitation and Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
- New York University Langone Health Institute of Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
| | - Kathie-Ann Joseph
- New York University Langone Health Institute of Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
- Departments of Surgery and Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Han X, Yang NN, Nogueira L, Jiang C, Wagle NS, Zhao J, Shi KS, Fan Q, Schafer E, Yabroff KR, Jemal A. Changes in cancer diagnoses and stage distribution during the first year of the COVID-19 pandemic in the USA: a cross-sectional nationwide assessment. Lancet Oncol 2023; 24:855-867. [PMID: 37541271 DOI: 10.1016/s1470-2045(23)00293-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The emergence of COVID-19 disrupted health care, with consequences for cancer diagnoses and outcomes, especially for early stage diagnoses, which generally have favourable prognoses. We aimed to examine nationwide changes in adult cancer diagnoses and stage distribution during the first year of the COVID-19 pandemic by cancer type and key sociodemographic factors in the USA. METHODS In this cross-sectional study, adults (aged ≥18 years) newly diagnosed with a first primary malignant cancer between Jan 1, 2018, and Dec 31, 2020, were identified from the US National Cancer Database. We included individuals across 50 US states and the District of Columbia who were treated in hospitals that were Commission on Cancer-accredited during the study period. Individuals whose cancer stage was 0 (except for bladder cancer), occult, or without an applicable American Joint Committee on Cancer staging scheme were excluded. Our primary outcomes were the change in the number and the change in the stage distribution of new cancer diagnoses between 2019 (Jan 1 to Dec 31) and 2020 (Jan 1 to Dec 31). Monthly counts and stage distributions were calculated for all cancers combined and for major cancer types. We also calculated annual change in stage distribution from 2019 to 2020 and adjusted odds ratios (aORs) using multivariable logistic regression, adjusted for age group, sex, race and ethnicity, health insurance status, comorbidity score, US state, zip code-level social deprivation index, and county-level age-adjusted COVID-19 mortality in 2020. Separate models were stratified by sociodemographic and clinical factors. FINDINGS We identified 2 404 050 adults who were newly diagnosed with cancer during the study period (830 528 in 2018, 849 290 in 2019, and 724 232 in 2020). Mean age was 63·5 years (SD 13·5) and 1 287 049 (53·5%) individuals were women, 1 117 001 (46·5%) were men, and 1 814 082 (75·5%) were non-Hispanic White. The monthly number of new cancer diagnoses (all stages) decreased substantially after the start of the COVID-19 pandemic in March, 2020, although monthly counts returned to near pre-pandemic levels by the end of 2020. The decrease in diagnoses was largest for stage I disease, leading to lower odds of being diagnosed with stage I disease in 2020 than in 2019 (aOR 0·946 [95% CI 0·939-0·952] for stage I vs stage II-IV); whereas, the odds of being diagnosed with stage IV disease were higher in 2020 than in 2019 (1·074 [1·066-1·083] for stage IV vs stage I-III). This pattern was observed in most cancer types and sociodemographic groups, although was most prominent among Hispanic individuals (0·922 [0·899-0·946] for stage I; 1·110 [1·077-1·144] for stage IV), Asian American and Pacific Islander individuals (0·924 [0·892-0·956] for stage I; 1·096 [1·052-1·142] for stage IV), uninsured individuals (0·917 [0·875-0·961] for stage I; 1·102 [1·055-1·152] for stage IV), Medicare-insured adults younger than 65 years (0·909 [0·882-0·937] for stage I; 1·105 [1·068-1·144] for stage IV), and individuals living in the most socioeconomically deprived areas (0·931 [0·917-0·946] for stage I; 1·106 [1·087-1·125] for stage IV). INTERPRETATION Substantial cancer underdiagnosis and decreases in the proportion of early stage diagnoses occurred during 2020 in the USA, particularly among medically underserved individuals. Monitoring the long-term effects of the pandemic on morbidity, survival, and mortality is warranted. FUNDING None.
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Affiliation(s)
- Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA.
| | - Nuo Nova Yang
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Changchuan Jiang
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nikita Sandeep Wagle
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Kewei Sylvia Shi
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Qinjin Fan
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Elizabeth Schafer
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
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Cancer Disparities Experienced by People with Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159187. [PMID: 35954534 PMCID: PMC9367955 DOI: 10.3390/ijerph19159187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
People with disabilities, who represent a rapidly growing and seriously disadvantaged segment of the U.S. population, face unremitting barriers to equal and accessible healthcare and a high prevalence of chronic health conditions. A slowly growing body of research suggests multiple cancer-related disparities between people with and without disabilities. This commentary identifies multiple aspects of the cancer experience and highlights ways cancer is impacted by disability. This includes vulnerabilities to risk factors, barriers to accessing healthcare, and disparities in screening, diagnosis, and treatment. The authors offer six essential pathways for reducing cancer disparities faced by people with disabilities. It is clear that reducing cancer health disparities experienced by people with disabilities will require the commitment and cooperation of a wide range of stakeholders.
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