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Kazmi AR, Hussaini SMQ, Chino F, Yabroff KR, Barnes JM. Associations of State Supplemental Nutrition Assistance Program Eligibility Policies With Mammography. J Am Coll Radiol 2024; 21:1406-1418. [PMID: 38935002 DOI: 10.1016/j.jacr.2024.04.028] [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: 11/29/2023] [Revised: 02/26/2024] [Accepted: 04/24/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The Supplemental Nutrition Assistance Program (SNAP) addresses food insecurity for low-income households, which is associated with access to care. Many US states expanded SNAP access through policies eliminating the asset test (ie, restrictions based on SNAP applicant assets) and/or broadening income eligibility. The objective of this study was to determine whether state SNAP policies were associated with the use of mammography among women eligible for breast cancer screening. METHODS Data for income-eligible women 40 to 79 years of age were obtained from the 2006 to 2019 Behavioral Risk Factor Surveillance System. Difference-in-differences analyses were conducted to compare changes in the percentage of mammography in the past year from pre- to post-SNAP policy adoption (asset test elimination or income eligibility increase) between states that and did not adopt policies expanding SNAP eligibility. RESULTS In total, 171,684 and 294,647 income-eligible female respondents were included for the asset test elimination policy and income eligibility increase policy analyses, respectively. Mammography within 1 year was reported by 58.4%. Twenty-eight and 22 states adopted SNAP asset test elimination and income increase policies, respectively. Adoption of asset test elimination policies was associated with a 2.11 (95% confidence interval [CI], 0.07-4.15; P = .043) percentage point increase in mammography received within 1 year, particularly for nonmetropolitan residents (4.14 percentage points; 95% CI, 1.07-7.21 percentage points; P = .008), those with household incomes <$25,000 (2.82 percentage points; 95% CI, 0.68-4.97 percentage points; P = .01), and those residing in states in the South (3.08 percentage points; 95% CI, 0.17-5.99 percentage points; P = .038) or that did not expand Medicaid under the Patient Protection and Affordable Care Act (3.35 percentage points; 95% CI, 0.36-6.34; P = .028). There was no significant association between mammography and state-level policies broadening of SNAP income eligibility. CONCLUSIONS State policies eliminating asset test requirements for SNAP eligibility were associated with increased mammography among low-income women eligible for breast cancer screening, particularly for those in the lowest income bracket or residing in nonmetropolitan areas or Medicaid nonexpansion states.
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Affiliation(s)
- Ali R Kazmi
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - S M Qasim Hussaini
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Fumiko Chino
- Department of Radiation Oncology, Lead, Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia; Scientific Vice President, Health Services Research
| | - Justin M Barnes
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
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2
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Britten O, Tosi S. The role of diet in cancer: the potential of shaping public policy and clinical outcomes in the UK. GENES & NUTRITION 2024; 19:15. [PMID: 39097687 PMCID: PMC11298086 DOI: 10.1186/s12263-024-00750-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024]
Abstract
Cancer universally represents one of the largest public health concerns, substantially contributing to global disease burden and mortality. The multifaceted interplay of environmental and genetic factors in the disease aetiology and progression has required comprehensive research to elucidate modifiable elements which can reduce the risk of incidence and improve prognosis. Among these factors, diet and nutrition have emerged as the most fundamental with a significant potential for influence and effect. Nutrition is not only an essential part of human survival, but also a vital determinant of overall health. Certain dietary requirements are necessary to support normal physiology. This includes individualised levels of macronutrients (proteins, carbohydrates and fats) and specific micronutrients (vitamins and minerals). Extensive research has demonstrated that diet plays a role in cancer pathogenesis at the genetic, epigenetic and cellular level. Therefore, its potential as a modifiable determinant of cancer pathogenesis for the purpose of prevention and improving management of disease must be further explored and implemented. The ability to influence cancer incidence and outcomes through dietary changes is underutilised in clinical practice and insufficiently recognised among the general public, healthcare professionals and policy-makers. Dietary changes offer the opportunity for autonomy and control over individuals health outcomes. Research has revealed that particular dietary components, as well as cultural behaviours and epidemiological patterns may act as causative or protective factors in cancer development. This review aims to comprehensively synthesise this research to further explore how to best utilise this knowledge within the community and clinical environment for more effective cancer prevention and therapeutic strategies. The identified key areas for improvement include the development of more specific, widely accepted guidelines, promoting increased involvement of dieticians within cancer multidisciplinary teams, enhancing nutritional education for healthcare professionals and exploring the potential implementation of personalised nutrition tools. A greater understanding of the complex interactions between diet and cancer will facilitate informed clinical interventions and public health policies to reduce global cancer burden and improve care for cancer patients and survivors.
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Affiliation(s)
- Oliver Britten
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner St, London, E1 2AD, UK
| | - Sabrina Tosi
- Leukaemia and Chromosome Laboratory, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK.
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3
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Loomba P, Raber MR, Aquino M, Rincon N, Rumfield L, Basen‐Engquist KM, Rechis R. Enhancing food access in a comprehensive cancer center area of influence through local partner capacity building. Cancer Med 2024; 13:e70070. [PMID: 39152705 PMCID: PMC11329840 DOI: 10.1002/cam4.70070] [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: 05/03/2024] [Revised: 06/28/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Food insecurity, an economic and social condition of limited food access, is associated with poor diet quality-a risk factor for several common cancers. The University of Texas MD Anderson Cancer Center supports healthy food access through community-led evidence translation by actively partnering with community-based organizations (CBOs). These partnerships aim to enhance the capacity of food assistance CBOs to effectively implement evidence-based food insecurity mitigation programs in the cancer center's area of influence. METHODS This case study aims to describe the cancer center's model for local food access capacity building and detail operationalization in the context of a whole-community cancer prevention effort (Be Well Baytown) in Baytown, Texas. RESULTS Elements central to the capacity building model include (i) assessment of baseline needs and capacity, (ii) empowering a community champion within a relevant CBO, (iii) mapping inter-sectoral community partnerships, collaborations, and linkages, and (iv) leveraging systems, connections, and resources to provide an enabling environment for overall food access systems growth. Through this process, Be Well Baytown enhanced the capacity of a local food pantry leading to increases in total reach, pounds of food distributed, and number of food distribution events in collaboration with intersectoral partners from 2018 to 2023. CONCLUSION This case study highlights the model's implementation as a co-benefit community partnership strategy to maximize the impact of food security programs integrated with comprehensive cancer center prevention efforts.
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Affiliation(s)
- Preena Loomba
- Department of Health Disparities ResearchUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Margaret R. Raber
- Department of Health Disparities ResearchUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Mayra Aquino
- Cancer Prevention and Control PlatformUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Lori Rumfield
- Goose Creek Consolidated Independent School DistrictBaytownTexasUSA
| | - Karen M. Basen‐Engquist
- Department of Health Disparities ResearchUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ruth Rechis
- Cancer Prevention and Control PlatformUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
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4
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Rosenberg SM, Zeng C, An A, Ssebyala SN, Stein T, Lombardo G, Walker D, Mercurio AM, Elreda L, Taiwo E, Hershman DL, Pinheiro LC. Characterizing "collateral damage" in men and women with metastatic breast cancer (mBC) from diverse racial and ethnic backgrounds in New York City. Breast Cancer Res Treat 2024; 207:129-141. [PMID: 38739311 DOI: 10.1007/s10549-024-07347-1] [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: 02/01/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Patients from diverse racial, ethnic, and socio-economic backgrounds may be particularly vulnerable to experiencing undue social and financial burdens ("collateral damage") from a metastatic breast cancer (mBC) diagnosis; however, these challenges have not been well explored in diverse populations. METHODS From May 2022 to May 2023, English- or Spanish-speaking adults with mBC treated at four New York-Presbyterian (NYP) sites were invited to complete a survey that assessed collateral damage, social determinants of health, physical and psychosocial well-being, and patient-provider communication. Fisher's exact and the Kruskal-Wallis rank-sum tests assessed differences by race and ethnicity. RESULTS Of 87 respondents, 14% identified as Hispanic, 28% non-Hispanic Black (NHB), 41% non-Hispanic White (NHW), 7% Asian American Pacific Islander (AAPI), and 10% other/multiracial. While 100% of Hispanic, NHW, and AAPI participants reported stable housing, 29% of NHB participants were worried about losing housing (p = 0.002). Forty-two percent of Hispanic and 46% of NHB participants (vs. 8%, NHW and 0%, AAPI, p = 0.005) were food insecure; 18% of Hispanic and 17% of NHB adults indicated lack of reliable transportation in the last year (vs. 0%, NHW/AAPI, p = 0.033). Participants were generally satisfied with the quality of communication that they had with their healthcare providers and overall physical and mental well-being were modestly poorer relative to healthy population norms. CONCLUSIONS In our study, NHB and Hispanic mBC patients reported higher levels of financial concern and were more likely to experience food and transportation insecurity compared to NHW patients. Systematically connecting patients with resources to address unmet needs should be prioritized to identify feasible approaches to support economically vulnerable patients following an mBC diagnosis.
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Affiliation(s)
- Shoshana M Rosenberg
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67st LA-0005, New York, NY, 10065, USA.
| | - Caroline Zeng
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Anjile An
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Shakirah N Ssebyala
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Taylor Stein
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67st LA-0005, New York, NY, 10065, USA
| | - Gina Lombardo
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Lauren Elreda
- Department of Medical Oncology, New York Presbyterian Hospital-Queens Hospital, Queens, NY, USA
| | - Evelyn Taiwo
- Department of Medical Oncology, Department of Medicine, New York Presbyterian Hospital-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Dawn L Hershman
- Division of Medical Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Laura C Pinheiro
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67st LA-0005, New York, NY, 10065, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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5
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Lemon SC, LeClair AM, Christenson E, Amburgey D, FitzGerald M, Cabral H, Lloyd-Travaglini C, Clark CR, Wang FQ, Ross J, Ohrenberger E, Haas JS, Freund KN, Battaglia TA. Implementation of social needs screening for minoritized patients newly diagnosed with breast cancer: a mixed methods evaluation in a pragmatic patient navigation trial. BMC Health Serv Res 2024; 24:783. [PMID: 38982469 PMCID: PMC11234663 DOI: 10.1186/s12913-024-11213-7] [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: 09/27/2023] [Accepted: 06/17/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Social needs inhibit receipt of timely medical care. Social needs screening is a vital part of comprehensive cancer care, and patient navigators are well-positioned to screen for and address social needs. This mixed methods project describes social needs screening implementation in a prospective pragmatic patient navigation intervention trial for minoritized women newly diagnosed with breast cancer. METHODS Translating Research Into Practice (TRIP) was conducted at five cancer care sites in Boston, MA from 2018 to 2022. The patient navigation intervention protocol included completion of a social needs screening survey covering 9 domains (e.g., food, transportation) within 90 days of intake. We estimated the proportion of patients who received a social needs screening within 90 days of navigation intake. A multivariable log binomial regression model estimated the adjusted rate ratios (aRR) and 95% confidence intervals (CI) of patient socio-demographic characteristics and screening delivery. Key informant interviews with navigators (n = 8) and patients (n = 21) assessed screening acceptability and factors that facilitate and impede implementation. Using a convergent, parallel mixed methods approach, findings from each data source were integrated to interpret study results. RESULTS Patients' (n = 588) mean age was 59 (SD = 13); 45% were non-Hispanic Black and 27% were Hispanic. Sixty-nine percent of patients in the navigators' caseloads received social needs screening. Patients of non-Hispanic Black race/ethnicity (aRR = 1.25; 95% CI = 1.06-1.48) and those with Medicare insurance (aRR = 1.13; 95% CI = 1.04-1.23) were more likely to be screened. Screening was universally acceptable to navigators and generally acceptable to patients. Systems-based supports for improving implementation were identified. CONCLUSIONS Social needs screening was acceptable, yet with modest implementation. Continued systems-based efforts to integrate social needs screening in medical care are needed.
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Affiliation(s)
- Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | | | | | | | | | - Howard Cabral
- Boston University School of Public Health, Boston, MA, USA
| | | | | | | | - Joellen Ross
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Ghazal LV, Doran J, Bryant M, Zebrack B, Liang MI. Evaluation of a Conference on Cancer-Related Financial and Legal Issues: A Potential Resource to Counter Financial Toxicity. Curr Oncol 2024; 31:2817-2835. [PMID: 38785495 PMCID: PMC11119701 DOI: 10.3390/curroncol31050214] [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: 04/08/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
This study describes the conception, development, and growth of the Triage Cancer Conference hosted by Triage Cancer, a national nonprofit organization providing free legal and financial education to the cancer community. We conducted a retrospective analysis of post-conference participant surveys. Descriptive statistics were calculated for participant demographics, and acceptability, feasibility, and appropriateness were evaluated. From 2016-2021, 1239 participants attended the conference and completed post-conference surveys. Participants included social workers (33%), nurses (30%), and cancer patients/survivors (21%), with representation from over 48 states. Among those who reported race, 16% were Black, and 7% were Hispanic. For acceptability, more than 90% of participants felt that the conference content, instructors, and format were suitable and useful. For feasibility, more than 90% of participants felt that the material was useful, with 93-96% reporting that they were likely to share the information and 98% reporting that they would attend another triage cancer event. Appropriateness was also high, with >80-90% reporting that the sessions met the pre-defined objectives. Triage Cancer fills an important gap in mitigating financial toxicity, and formal evaluation of these programs allows us to build evidence of the role and impact of these existing resources. Future research should focus on adding validated patient-reported outcomes, longer-term follow-up, and ensuring inclusion and evaluation of outcome metrics among vulnerable populations.
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Affiliation(s)
- Lauren V. Ghazal
- School of Nursing, University of Rochester, Rochester, NY 14642, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Joanna Doran
- Triage Cancer, Chicago, IL 60646, USA; (J.D.); (M.B.)
| | - Monica Bryant
- Triage Cancer, Chicago, IL 60646, USA; (J.D.); (M.B.)
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Margaret I. Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
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7
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Tucker-Seeley R, Abu-Khalaf M, Bona K, Shastri S, Johnson W, Phillips J, Masood A, Moushey A, Hinyard L. Social Determinants of Health and Cancer Care: An ASCO Policy Statement. JCO Oncol Pract 2024; 20:621-630. [PMID: 38386945 DOI: 10.1200/op.23.00810] [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: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024] Open
Abstract
ASCO's new policy statement on SDOH supports practices that sustain and advance cancer health equity.
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Affiliation(s)
| | | | | | | | | | | | - Azam Masood
- American Society of Clinical Oncology, Alexandria, VA
| | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, VA
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Haines E, Shelton RC, Foley K, Beidas RS, Dressler EV, Kittel CA, Chaiyachati KH, Fayanju OM, Birken SA, Blumenthal D, Rendle KA. Addressing social needs in oncology care: another research-to-practice gap. JNCI Cancer Spectr 2024; 8:pkae032. [PMID: 38676669 PMCID: PMC11104529 DOI: 10.1093/jncics/pkae032] [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: 04/05/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
Social determinants of health and unmet social needs are directly related to cancer outcomes, from diagnosis to survivorship. If identified, unmet social needs can be addressed in oncology care by changing care plans in collaboration with patients' preferences and accounting for clinical practice guidelines (eg, reducing the frequency of appointments, switching treatment modalities) and connecting patients to resources within healthcare organizations (eg, social work support, patient navigation) and with community organizations (eg, food banks, housing assistance programs). Screening for social needs is the first step to identifying those who need additional support and is increasingly recognized as a necessary component of high-quality cancer care delivery. Despite evidence about the relationship between social needs and cancer outcomes and the abundance of screening tools, the implementation of social needs screening remains a challenge, and little is known regarding the adoption, reach, and sustainability of social needs screening in routine clinical practice. We present data on the adoption and implementation of social needs screening at two large academic cancer centers and discuss three challenges associated with implementing evidence-based social needs screening in clinical practice: (1) identifying an optimal approach for administering social needs screening in oncology care, (2) adequately addressing identified unmet needs with resources and support, and (3) coordinating social needs screening between oncology and primary care.
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Affiliation(s)
- Emily Haines
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel C Shelton
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Kristie Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Carol A Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Krisda H Chaiyachati
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Oluwadamilola M Fayanju
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Daniel Blumenthal
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Katharine A Rendle
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA, USA
- Perelman School of Medicine, Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
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9
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Hong YR, Wang R, Case S, Jo A, Turner K, Ross KM. Association of food insecurity with overall and disease-specific mortality among cancer survivors in the US. Support Care Cancer 2024; 32:309. [PMID: 38664265 DOI: 10.1007/s00520-024-08495-2] [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: 10/30/2023] [Accepted: 04/10/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To investigate the association of food insecurity with overall and disease-specific mortality among US cancer survivors. METHODS Data from the National Health and Nutrition Examination Survey (NHANES 1999-2018) were used to examine the impact of food insecurity on mortality risks among cancer survivors in the US. Study participants aged ≥ 20 years who had a history of cancer and completed the Adult Food Security Survey Module were included. Mortality data [all-cause, cancer, and cardiovascular (CVD) specific] through December 31, 2019 were obtained through linkage to the National Death Index. Using multivariable Cox proportional hazard regression, hazard ratios of mortality based on food security status were estimated. RESULTS Among 5032 cancer survivors (mean age 62.5 years; 58.0% women; 86.2% non-Hispanic White), 596 (8.8%) reported food insecurity. Overall, 1913 deaths occurred (609 cancer deaths and 420 CVD deaths) during the median follow-up of 6.8 years. After adjusting for age, food insecurity was associated with a higher risk of overall (HR = 1.93; 95% CI = 1.56-2.39), CVD-specific (HR = 1.95; 95% CI = 1.24-3.05), and cancer-specific (HR = 1.70; 95% CI = 1.20-2.42) mortality (P < 0.001). However, after adjusting for socioeconomic characteristics and health-related factors (physical activity, diet quality measured by healthy eating index), the association between food insecurity and overall mortality was no longer statistically significant. CONCLUSIONS Food insecurity was associated with a greater risk of overall mortality among cancer survivors. Further studies are needed to confirm these findings and evaluate whether the observed association represents a causal phenomenon and, if so, whether the effect is modifiable with food assistance programs.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
| | - Ruixuan Wang
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Stuart Case
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Ara Jo
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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10
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Graboyes EM, Lee SC, Lindau ST, Adams AS, Adjei BA, Brown M, Sadigh G, Incudine A, Carlos RC, Ramsey SD, Bangs R. Interventions addressing health-related social needs among patients with cancer. J Natl Cancer Inst 2024; 116:497-505. [PMID: 38175791 DOI: 10.1093/jnci/djad269] [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: 11/10/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
Health-related social needs are prevalent among cancer patients; associated with substantial negative health consequences; and drive pervasive inequities in cancer incidence, severity, treatment choices and decisions, and outcomes. To address the lack of clinical trial evidence to guide health-related social needs interventions among cancer patients, the National Cancer Institute Cancer Care Delivery Research Steering Committee convened experts to participate in a clinical trials planning meeting with the goal of designing studies to screen for and address health-related social needs among cancer patients. In this commentary, we discuss the rationale for, and challenges of, designing and testing health-related social needs interventions in alignment with the National Academy of Sciences, Engineering, and Medicine 5As framework. Evidence for food, housing, utilities, interpersonal safety, and transportation health-related social needs interventions is analyzed. Evidence regarding health-related social needs and delivery of health-related social needs interventions differs in maturity and applicability to cancer context, with transportation problems having the most maturity and interpersonal safety the least. We offer practical recommendations for health-related social needs interventions among cancer patients and the caregivers, families, and friends who support their health-related social needs. Cross-cutting (ie, health-related social needs agnostic) recommendations include leveraging navigation (eg, people, technology) to identify, refer, and deliver health-related social needs interventions; addressing health-related social needs through multilevel interventions; and recognizing that health-related social needs are states, not traits, that fluctuate over time. Health-related social needs-specific interventions are recommended, and pros and cons of addressing more than one health-related social needs concurrently are characterized. Considerations for collaborating with community partners are highlighted. The need for careful planning, strong partners, and funding is stressed. Finally, we outline a future research agenda to address evidence gaps.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Simon C Lee
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- University of Kansas Cancer Center, University of Kansas, Kansas City, KS, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA
| | - Alyce S Adams
- Departments of Health Policy/Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Office of Cancer Health Equity and Community Engagement, Stanford Cancer Institute, Stanford Medicine, Stanford, CA, USA
| | - Brenda A Adjei
- Office of the Associate Director, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Mary Brown
- Adena Cancer Center, Hematology and Oncology, Chillicothe, OH, USA
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California-Irvine, Irvine, CA, USA
| | | | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Scott D Ramsey
- Department of Pharmacy, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - Rick Bangs
- SWOG Cancer Research Network, Portland, OR, USA
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11
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Barnes JM, Johnson KJ, Osazuwa-Peters N, Spraker MB. The impact of individual-level income predicted from the BRFSS on the association between insurance status and overall survival among adults with cancer from the SEER program. Cancer Epidemiol 2024; 89:102541. [PMID: 38325026 DOI: 10.1016/j.canep.2024.102541] [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: 11/01/2023] [Revised: 01/06/2024] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Among patients with cancer in the United States, Medicaid insurance is associated with worse outcomes than private insurance and with similar outcomes as being uninsured. However, prior studies have not addressed the impact of individual-level socioeconomic status, which determines Medicaid eligibility, on the associations of Medicaid status and cancer outcomes. Our objective was to determine whether differences in cancer outcomes by insurance status persist after accounting for individual-level income. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried for 18-64 year-old individuals with cancer from 2014-2016. Individual-level income was imputed using a model trained on Behavioral Risk Factors Surveillance Survey participants including covariates also present in SEER. The association of 1-year overall survival and insurance status was estimated with and without adjustment for estimated individual-level income and other covariates. RESULTS A total of 416,784 cases in SEER were analyzed. The 1-yr OS for patients with private insurance, Medicaid insurance, and no insurance was 88.7%, 76.1%, and 73.7%, respectively. After adjusting for all covariates except individual-level income, 1-year OS differences were worse with Medicaid (-6.0%, 95% CI = -6.3 to -5.6) and no insurance (-6.7%, 95% CI = -7.3 to -6.0) versus private insurance. After also adjusting for estimated individual-level income, the survival difference for Medicaid patients was similar to privately insured (-0.4%, 95% CI = -1.9 to 1.1) and better than uninsured individuals (2.1%, 95% CI = 0.7 to 3.4). CONCLUSIONS Income, rather than Medicaid status, may drive poor cancer outcomes in the low-income and Medicaid-insured population. Medicaid insurance coverage may improve cancer outcomes for low-income individuals.
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Affiliation(s)
- Justin M Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA.
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Johnson CM, Stubblefield E, Godinich BM, Walker M, Salcedo Price R, Allicock MA. A Scoping Review to Explore the Potential Benefits of Nutrition Interventions for Latino/a Adult Cancer Survivors in the US. Nutrients 2023; 15:4963. [PMID: 38068821 PMCID: PMC10708293 DOI: 10.3390/nu15234963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
Despite evidence for the role of healthy diets in preventing cancer, little is known about how nutrition can support positive health outcomes after a cancer diagnosis for Latino/a cancer survivors in the United States (U.S.). The purpose of this scoping review is to understand the potential benefits of nutrition interventions in supporting healthy survivorship among Latino/a cancer survivors in the U.S. A team compiled, evaluated, and summarized the available evidence. Potentially relevant studies were identified from a comprehensive search of peer-reviewed databases and the gray literature. Eligible studies included Latino/a adult cancer survivors with a nutrition education, dietary change, or behavioral intervention; and a nutrition-related health outcome. Data were extracted and summarized using tables. The review included 10 randomized controlled trials, with samples or subsamples of Latino/a cancer survivors. Interventions mostly focused on breast cancer survivors. The results showed some evidence that dietary behaviors, like fruit and vegetable intake, were related to positive outcomes, like a decreased risk of cancer (through changes in DNA methylation), decreased risk breast cancer recurrence (through changes in inflammatory biomarkers), or improved perception of health status. The findings highlight a need for community-engaged and culturally relevant nutrition interventions for Latino/a adults, especially for rural communities; and innovative intervention approaches, including m/ehealth approaches with long-term follow-up.
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Affiliation(s)
- Cassandra M. Johnson
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Emily Stubblefield
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Brandon M. Godinich
- Center for Health Promotion and Prevention Research and Center for Pediatric Population Health, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 2777 North Stemmons Freeway, Dallas, TX 75207, USA; (B.M.G.); (M.A.A.)
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Ave, El Paso, TX 79905, USA
| | - Miranda Walker
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Ramona Salcedo Price
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Marlyn A. Allicock
- Center for Health Promotion and Prevention Research and Center for Pediatric Population Health, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 2777 North Stemmons Freeway, Dallas, TX 75207, USA; (B.M.G.); (M.A.A.)
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Yabroff KR, Boehm AL, Nogueira LM, Sherman M, Bradley CJ, Shih YCT, Keating NL, Gomez SL, Banegas MP, Ambs S, Hershman DL, Yu JB, Riaz N, Stockler MR, Chen RC, Franco EL. An essential goal within reach: attaining diversity, equity, and inclusion for the Journal of the National Cancer Institute journals. J Natl Cancer Inst 2023; 115:1115-1120. [PMID: 37806780 DOI: 10.1093/jnci/djad177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | | | - Leticia M Nogueira
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Mark Sherman
- Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Cathy J Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, CO, USA
| | - Ya-Chen Tina Shih
- University of California Los Angeles Jonsson Comprehensive Cancer Center and Department of Radiation Oncology, School of Medicine, Los Angeles, CA, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, and Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scarlett L Gomez
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, CA, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dawn L Hershman
- Division of Hematology/Oncology, Columbia University, New York, NY, USA
| | - James B Yu
- Department of Radiation Oncology, St. Francis Hospital and Trinity Health of New England, Hartford, CT, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wells, Australia
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
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Barnes JM, Johnston KJ, Johnson KJ, Chino F, Osazuwa-Peters N. State Public Assistance Spending and Survival Among Adults With Cancer. JAMA Netw Open 2023; 6:e2332353. [PMID: 37669050 PMCID: PMC10481229 DOI: 10.1001/jamanetworkopen.2023.32353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/29/2023] [Indexed: 09/06/2023] Open
Abstract
Importance Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations. Objective To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity. Design, Setting, and Participants This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023. Exposure Differential state-level public assistance spending. Main Outcome and Measure The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage. Results A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P < .001), particularly for non-Hispanic Black individuals (0.29% [95% CI, 0.07%-0.52%] per $100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P < .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49% [95% CI, 0.26%-0.72%] per $100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects). Conclusions and Relevance This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation.
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Affiliation(s)
- Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Kenton J. Johnston
- General Medical Sciences Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | | | - Fumiko Chino
- Department of Radiation Oncology, Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
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Chinaemelum A, Munir MM, Pawlik TM. ASO Author Reflections: Impact of Food Insecurity on Outcomes After Resection of Hepatopancreaticobiliary Cancer. Ann Surg Oncol 2023; 30:5374-5375. [PMID: 37328573 DOI: 10.1245/s10434-023-13741-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Affiliation(s)
| | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Columbus, OH, USA.
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Chinaemelum A, Munir MM, Azap L, Woldesenbet S, Dillhoff M, Cloyd J, Ejaz A, Pawlik TM. Impact of Food Insecurity on Outcomes Following Resection of Hepatopancreaticobiliary Cancer. Ann Surg Oncol 2023; 30:5365-5373. [PMID: 37314542 DOI: 10.1245/s10434-023-13723-w] [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: 03/17/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Food insecurity (FI) may predispose individuals to suboptimal nutrition, leading to chronic disease and poor health outcomes. We sought to assess the impact of county-level FI on postoperative outcomes among patients undergoing resection of hepatopancreaticobiliary (HPB) cancer. METHODS Patients who were diagnosed with HPB cancer between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Data on annual county-level FI were obtained from the Feeding America: Mapping the Meal Gap report and were categorized into tertiles. Textbook outcome was defined as no extended length of stay, perioperative complications, 90-day readmission, and 90-day mortality. Multiple logistic regression and Cox regression models were used to assess outcomes and survival relative to FI. RESULTS Among 49,882 patients (hepatocellular: n = 11,937, 23.9%; intrahepatic cholangiocarcinoma: n = 2111, 4.2%; extrahepatic cholangiocarcinoma: n = 4047, 8.1%; gallbladder: n = 2853, 5.7%; pancreatic: n = 28,934, 58.0%), 6702 (13.4%) patients underwent a surgical resection. Median age was 75 years (interquartile range 69-82), and most patients were male (n = 25,767, 51.7%) and self-identified as White (n = 36,381, 72.9%). Overall, 5291 (10.6%) and 39,664 (79.5%) individuals resided in low or moderate FI counties, respectively, while 4927 (9.8%) patients resided in high FI counties. Achievement of textbook outcome (TO) was 56.3% (n = 6702). After adjusting for competing risk factors, patients residing in high FI counties had lower odds to achieve a TO versus individuals living in low FI counties (odds ratio 0.69, 95% confidence interval [CI] 0.54-0.88, p = 0.003). In addition, patients residing in moderate and high FI counties had a greater risk of mortality at 1- (referent, low, moderate: hazard ratio [HR] 1.09, 95% CI 1.05-1.14; high: HR 1.14, 95% CI 1.08-1.21), 3- (referent, low, moderate: HR 1.09, 95% CI 1.05-1.14; high: HR 1.14, 95% CI 1.08-1.21), and 5- (referent, low, moderate: HR 1.05, 95% CI 1.01-1.09; high: HR 1.07, 95% CI 1.02-1.13) years versus individuals from low FI counties. CONCLUSIONS FI was associated with adverse perioperative outcomes and long-term survival following resection of an HPB malignancy. Interventions directed towards mitigating nutritional inequities are needed to improve outcomes among vulnerable HPB populations.
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Affiliation(s)
- Akpunonu Chinaemelum
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lovette Azap
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Surgery, Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
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17
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Yabroff KR, Boehm AL, Nogueira LM, Sherman M, Bradley CJ, Shih YCT, Keating NL, Gomez SL, Banegas MP, Ambs S, Hershman DL, Yu JB, Riaz N, Stockler MR, Chen RC, Franco EL. An essential goal within reach: attaining diversity, equity, and inclusion for the Journal of the National Cancer Institute journals. JNCI Cancer Spectr 2023; 7:pkad063. [PMID: 37806772 PMCID: PMC10560610 DOI: 10.1093/jncics/pkad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | | | - Leticia M Nogueira
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Mark Sherman
- Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Cathy J Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, CO, USA
| | - Ya-Chen Tina Shih
- University of California Los Angeles Jonsson Comprehensive Cancer Center and Department of Radiation Oncology, School of Medicine, Los Angeles, CA, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, and Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Scarlett L Gomez
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, CA, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dawn L Hershman
- Division of Hematology/Oncology, Columbia University, New York, NY, USA
| | - James B Yu
- Department of Radiation Oncology, St. Francis Hospital and Trinity Health of New England, Hartford, CT, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wells, Australia
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
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Bona K, Keating NL. Addressing Social Determinants of Health: Now Is the Time. J Natl Cancer Inst 2022; 114:1561-1563. [PMID: 36130283 PMCID: PMC9745430 DOI: 10.1093/jnci/djac137] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medical Oncology, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pediatrics, Division of Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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