Association between health-related quality of life and colorectal cancer screening

Racial/Ethnic Disparity in the Relationship of Mental and Physical Health With Colorectal Cancer Screening Utilization Among Breast and Prostate Cancer Survivors

PURPOSE

We examined colorectal cancer (CRC) screening utilization among non-Hispanic White, non-Hispanic Black (NHB), non-Hispanic other (NHO)/Hispanic cancer survivors. We also determined whether experiencing poor physical and/or mental health affects CRC screening utilization in breast and prostate cancers across different racial/ethnic groups.

METHODS

Data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3,023 eligible treatment-utilizing cancer survivors with complete treatment were used. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association.

RESULTS

Among 3,023 eligible survivors, 67.7% of NHO/Hispanic survivors demonstrated lower CRC screening use compared with non-Hispanic White (82%) and NHB (89%) survivors (P < .001). In multivariable analysis, having frequent (14-30 days) poor mental health was associated with lower odds of receiving CRC screening among NHB (odds ratio [OR], 0.32; 95% CI, 0.11 to 0.95) and NHO/Hispanic (OR, 0.39; 95% CI, 0.18 to 0.81) survivors. Similar results in physical health were also found in NHB (OR, 0.34; 95% CI, 0.13 to 0.91) and NHO/Hispanic (OR, 0.22; 95% CI, 0.05 to 0.91) groups. Among those experienced both frequent poor mental and physical health, NHB/NHO/Hispanic were less likely to be screened for CRC (OR, 0.05; 95% CI, 0.02 to 0.10).

CONCLUSION

NHO/Hispanic survivors demonstrated lower CRC screening use. Frequent poor mental and/or physical health was strongly associated with lower CRC screening use among NHB and NHO/Hispanic survivors. Our study suggests that cancer survivorship care considering mental and physical health status may improve adherence to CRC screening recommendation (for secondary cancer prevention) for NHB, NHO, and Hispanic survivors.

Economic and Humanistic Burden of Cervical Cancer in the United States: Results from a Nationally Representative Survey

Objective: To measure the economic and humanistic burden of cervical cancer in the United States.

Materials and Methods: This was a retrospective analysis of Medical Expenditure Panel Survey data (2006–2015). Cervical cancer cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification code “180” or clinical classification software code “26”. The control group included women without any cancer diagnosis. Study outcomes included health care resource use (institutional inpatient and outpatient, emergency room, and physician office visits), costs, limitations in activities of daily living, and quality of life (general health status, 12-Item Short Form Health Survey [SF-12] physical and mental component summary [MCS], EuroQol-5D and Short-Form Six-Dimension health utility, and Patient Health Questionnaire-2 depression severity). Generalized linear models, controlling for sociodemographic and clinical covariates, were conducted to compare outcomes between cases and controls.

Results: The analytic cohort included 275,246 cervical cancer cases and 146,061,609 noncancer controls. Cases were significantly older (mean age [years]: 42.03 vs. 36.98) and had a higher Charlson comorbidity burden (mean score: 1.06 vs. 0.46) versus controls. Multivariate analyses suggested that compared to controls, cancer cases had significantly higher costs: institutional outpatient ($1,610 vs. $502), physician visit ($2,422 vs. $1,321), and total health care ($10,031 vs. $4,913). Cases were 1.99 (odds ratio [OR]: 1.991; 95% confidence interval [CI]: 1.23–3.22) and 2.56 (OR: 2.562; 95% CI: 1.78–3.68) times as likely to report activity limitations and poor general health versus controls. Cervical cancer patients had significantly lower SF-12 physical and MCS score, health utility, and higher depression severity.

Conclusions: Cervical cancer is associated with significant economic burden, activity limitations, and quality of life impairment among ambulatory women in the United States.

Impact of abdominal aortic aneurysm screening on quality of life

BACKGROUND

Screening for abdominal aortic aneurysm (AAA) is known to reduce AAA-related mortality; however, the psychological impact of population AAA screening is unclear. The aim was to assess the impact of AAA diagnosis on quality of life (QoL) using data from an established AAA screening programme.

METHODS

Mental and physical QoL scores for men diagnosed with AAA through participation in the English and Welsh AAA screening programmes were compared with no-AAA controls. Participants were identified through the United Kingdom Aneurysm Growth Study (UKAGS), a nationwide prospective cohort study of men with an AAA of less than 55 mm diagnosed through voluntary participation in screening. The UKAGS participants completed QoL questionnaires at the time of screening and annually thereafter.

RESULTS

A transient reduction in mental QoL scores was observed following the diagnosis of AAA, returning to baseline levels after 12 months. Physical QoL remained consistently lower in the AAA cohort. Participants thought about their AAA and the AAA growth progressively less 12 months after the initial screening diagnosis. AAA growth rate had no influence over QoL parameters.

DISCUSSION

This study suggests that screening for AAA does reduce mental QoL; however, this effect is transient (less than 12 months). Men diagnosed with AAA have a consistently worse physical QoL compared with controls.

Racial Disparities and Factors Affecting Michigan Colorectal Cancer Screening

INTRODUCTION

The objective of this study was to investigate the various factors that influence colorectal cancer screening in Michigan using 6091 participants in the Michigan Behavioral Risk Factor Surveillance System representing adults ≥ 50 years old.

METHODS

Screening for colorectal cancer was assessed as fecal occult blood testing or colonoscopy/sigmoidoscopy. Full models simultaneously adjusted for alcohol use, angina/coronary heart disease, stroke, heart attack, gender, income, marital status, race, age, diabetes, disability, exercise, health care coverage, health care access, smoking, and mental health. Data analysis included cross-tabulation and logistic regression modeling.

RESULTS

Minorities were 1.3 (unadjusted odds ratio; 95% confidence interval = 1.03-1.57) times more likely to never have a colonoscopy/sigmoidoscopy than non-Hispanic whites. Race/ethnicity was not significant in the full model, but adults with the following characteristics were significantly (p < 0.05) more likely to never have a colonoscopy/sigmoidoscopy: no personal doctor/health care provider, no health care coverage, light alcohol consumption ≤ 25% of days, no alcohol consumption, low income < $15,000, 50-64 years old, no diabetes, no activity limitation, no exercise, smoked daily, and smoked some days.

CONCLUSION

The racial disparity in colorectal cancer screening in Michigan was explained by other characteristics. The healthcare community can work to eliminate racial disparities in colorectal cancer screening by increasing screening efforts for individuals with these characteristics.

Association between serious psychological distress and nonparticipation in cancer screening and the modifying effect of socioeconomic status: Analysis of anonymized data from a national cross-sectional survey in Japan

BACKGROUND

It is unclear whether individuals who have serious psychological distress (SPD) are less likely to participate in screening tests for gastric cancer, lung cancer, and other types of cancer. Of the few studies that have examined the association between SPD and participation in cancer screening, none have reported modifying effects of educational, marital, or employment status.

METHODS

The authors analyzed a national representative data set from the 2010 Comprehensive Survey of Living Conditions of Japan., including individuals aged <69 years who met the national program criteria for each type of cancer screening (colorectal, gastric, and lung cancers, n = 29,926; breast cancer, n = 15,423; and cervical cancer, n = 24,735). SPD was defined as a score of 13 or greater on the Kessler 6 scale. Logistic regression analyses were conducted to examine the association between SPD and participation in cancer screening, and multivariate analyses stratified by socioeconomic status also were conducted.

RESULTS

SPD was significantly associated with a lower odds ratio (OR) for participation in screening for colorectal cancer (OR, 0.743; 95% confidence interval [CI], 0.638-0.866), gastric cancer (OR, 0.823; 95% CI, 0.717-0.946), and lung cancer (OR, 0.691; 95% CI, 0.592-0.807). Only educational status significantly modified the effect of SPD on participation in these 3 types of cancer screening (P < .05).

CONCLUSIONS

Individuals with SPD, especially those with lower education levels, were less likely to participate in screening for colorectal, gastric, and lung cancers. Individuals with SPD should be encouraged and supported to participate in cancer screening tests. Cancer 2018;124:555-62. © 2017 American Cancer Society.

Colonoscopy and sigmoidoscopy use among older adults in different countries: A systematic review

Screening for colorectal cancer (CRC) by colonoscopy and sigmoidoscopy has been demonstrated to be effective in reducing CRC incidence and mortality, and they are increasingly employed as screening tests and for diagnostic purposes in many countries. We conducted a systematic review to provide up-to-date estimates on the utilization of lower gastrointestinal endoscopy (colonoscopy and sigmoidoscopy) in the general average-risk population in different countries. PubMed and Web of Science were searched for relevant articles published between 1 September 2008 and 31 October 2016. A total of 23 studies from the US and 20 studies from other countries were included in this review. Estimates from the US were highest, continued to increase over the past decade and reached 62% for colonoscopy use within 10years in people aged 50-75years in 2012. Endoscopy use in other countries was substantially lower (12-44% for lifetime colonoscopy use and 13-30% for recent colonoscopy use), except for Germany, where 55% of the screening-eligible population reported colonoscopy utilization within the previous 10years in 2008-2011. Both lifetime and recent endoscopy use increased with age and peaked at approximately 70-75years. Although several European and Asian countries have started to collect endoscopy utilization data through periodic national health surveys, more data are still much needed from non-US countries. With the implementation of CRC screening programs in an increasing number of countries, especially European countries, an increase in endoscopy use and subsequent reduction in CRC incidence and mortality in the years to come might be expected in those countries.

Why Do Some People Choose Opportunistic Rather Than Organized Cancer Screening? The Korean National Health and Nutrition Examination Survey (KNHANES) 2010-2012

Purpose

Although the Korean government has implemented a universal screening program for common cancers, some individuals choose to participate in opportunistic screening programs. Therefore, this study was conducted to identify factors contributing to the selection of organized versus opportunistic screening by the Korean general population.

Materials and Methods

Data from 11,189 participants aged ≥ 40 yearswho participated in the fifth Korean National Health and Nutrition Examination Survey (2010-2012) were analyzed in this study.

Results

A total of 6,843 of the participants (58.6%) underwent cancer screening, of which 6,019 (51.1%) participated in organized and 824 (7.5%) participated in opportunistic screening programs. Being female, older, highly educated, in the upper quartile of income, an ex-smoker, and a light drinker as well as having supplementary private health insurance and more comorbid conditions and engaging in moderate physical activity 1-4 days per week were related to participation in both types of screening programs. Being at least a high school graduate, in the upper quartile for income, and a light drinker, as well as having more comorbid conditions and engaging in moderate physical activities 1-4 days per week had a stronger effect on those undergoing opportunistic than organized screening.

Conclusion

The results of this study suggest that socioeconomic factors such as education and income, as well as health status factors such as health-related quality of life and number of comorbid conditions and health behaviors such as drinking and engaging in moderate physical activity 1-4 days per week had a stronger influence on participation in an opportunistic than in an organized screening program for cancer.

Serum Unsaturated Free Fatty Acids: A Potential Biomarker Panel for Early-Stage Detection of Colorectal Cancer

Background: To screen biomarkers to differentiate early-stage colorectal cancer (CRC) from benign colorectal disease (BCD) and healthy controls.

Materials & Methods: Quantitative and qualitative analysis of C_16:1, C_18:3, C_18:2, C_18:1, C_20:4, and C_22:6 in 185 healthy controls, 55 patients with BCD, and 139 patients with CRC was performed. Comparisons of their levels in between CRC patients, BCD patients, and healthy controls were performed using Mann-Whitney U test.

Results: Serum levels of C_16:1, C_18:3, C_18:2, C_18:1, C_20:4, and C_22:6 in CRC patients were significantly decreased compared with healthy controls and BCD patients. A combination of C_16:1, C_18:2, C_20:4, and C_22:6 has excellent diagnostic performance to differentiate early-stage CRC patients from healthy controls plus BCD patients, with an AUC of 0.926, a sensitivity of 84.6%, and a specificity of 89.8%.

Conclusions: Serum levels of C_16:1, C_18:2, C_20:4, and C_22:6 could be diagnostic indicators of early-stage CRC patients.

Antitumor Activity of Total Flavonoids from Daphne genkwa in Colorectal Cancer

Daphne genkwa Sieb.et Zucc. is a well-known medicinal plant. This study was designed to investigate the anticancer effects of total flavonoids in D. genkwa (TFDG) in vitro and in vivo. HT-29 and SW-480 human colorectal cancer cells were cultured to investigate the anticancer activity of TFDG. In addition, the Apc(Min/+) mouse model was applied in the in vivo experiment. Results of the cell experiment revealed that TFDG possessed significant inhibitory effects on HT-29 and SW-480 human colorectal cancer cells (both p < 0.01). Furthermore, our in vivo data showed that after treatment with TFDG, there was a significant increase in life span (both p < 0.01) and tumor numbers were reduced in the colon (both p < 0.01), which was supported by the data of tumor distribution, body weight changes and organ index. Our results also indicated that expressions of interleukin (IL)-1α, IL-1β, IL-6, granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor in gut tissue were downregulated by treatments of TFDG, and immunity cytokine secretions in the serum were regulated after oral administration of TFDG. Taken together, these findings suggested that TFDG has a potential clinical utility in colorectal cancer therapeutics, and TFDG's action is likely linked to its ability to regulate immune function and inhibit the production of inflammatory cytokines.

The relationship between four health-related quality-of-life indicators and use of mammography and Pap test screening in US women

PURPOSE

Limited evidence is available to explain the role of four components of health-related quality of life (HRQoL) on breast and cervical cancer screening. The objective of this study was to determine the relationship between four HRQoL aspects and use of mammography and Pap test screening in US women.

METHODS

Data were obtained from the 2012 Behavioral Risk Factor Surveillance System (BRFSS). The outcome variables were receiving mammogram <2 versus ≥2 years in women aged 50-74 years, and receiving Pap test <3 versus ≥3 years in women aged 18-64 years. Eight logistic regression models were conducted to test the role of four HRQoL aspects (general health status, physical HRQoL, mental HRQoL, and activity limitation) on the two screening variables, after adjusting for covariates. Statistical analysis accounted for the complex sampling design of the BRFSS, and the a priori alpha error was set at p ≤ 0.05.

RESULTS

Among respondents, approximately 74 and 78 % of the women received mammography and Pap test, respectively. Three HRQoL aspects (general health status, physical HRQoL, and activity limitation) were significantly associated with mammography use (all p values < 0.05), whereas two HRQoL aspects (general health status and physical HRQoL) were significantly associated with Pap test (p values ≤ 0.05). All significant relationships demonstrated higher cancer screening rates among individuals with better HRQoL.

CONCLUSIONS

HRQoL is an important factor associated with use of mammography and Pap test. Future studies should explore the mechanisms associated with an individual's HRQoL and use HRQoL assessment as an avenue to influence adherence to use of mammography and Pap tests.