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Jadhav BN, Abdul Azeez EP, Mathew M, Senthil Kumar AP, Snegha MR, Yuvashree G, Mangalagowri SN. Knowledge, attitude, and practice of breast self-examination is associated with general self-care and cultural factors: a study from Tamil Nadu, India. BMC Womens Health 2024; 24:151. [PMID: 38431649 PMCID: PMC10909289 DOI: 10.1186/s12905-024-02981-9] [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: 11/22/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
AIM Breast cancer is the most prevalent type of cancer among women. One form of care related to early detection of breast cancer is breast self-examination (BSE). However, evidence on knowledge, attitude, and practice (KAP) of BSE and its determining factors are minuscule in an Indian context. Therefore, the present study primarily examined the prevalence of KAP of BSE. Further, its association with general self-care and cultural factors was determined. METHODS This cross-sectional study obtained data from 412 women (Mn age = 26.63) from two rural localities of Vellore district, Tamil Nadu, India. Self-reported questionnaires of KAP of BSE, self-care, and cultural factors were applied. Statistical analyses include independent sample t-test and binomial logistic regression. RESULTS The majority of the sample had inadequate knowledge (58%), unfavourable attitudes (73.8%), and poor practice (89.6%) of BSE. The general self-care among the sample was moderate. Self-care was found to be a significant predictor of knowledge (b = 0.07, p < .05) and attitude (b = 0.092, p < .05) toward BSE. Shyness was identified as a negative predictor of KAP. Discouraged breast health discussions predicted inadequate knowledge, and not being educated by family/friends had a negative impact on knowledge and practice. A preference for same-gender physicians led to an unfavourable attitude toward BSE. CONCLUSION The observed negative trends in KAP of BSE are concerning. The results imply that girls and women should be educated and encouraged to practice BSE and promote self-care behaviours. At the same time, efforts to reduce cultural barriers may be helpful to promote the KAP of BSE.
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Affiliation(s)
- Bhoomika N Jadhav
- School of Social Sciences and Languages, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, 632014, India
| | - E P Abdul Azeez
- School of Social Sciences and Languages, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, 632014, India.
| | - Manoj Mathew
- Department of Social Work, Kalinga University, Raipur, India
| | | | - M R Snegha
- School of Social Sciences and Languages, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, 632014, India
| | - G Yuvashree
- School of Social Sciences and Languages, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, 632014, India
| | - S N Mangalagowri
- School of Social Sciences and Languages, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, 632014, India
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Malmgren JA, Atwood MK, Kaplan HG. Persistence of patient-detected breast cancer over time: 1990-2019. Cancer 2023; 129:3862-3872. [PMID: 37552155 DOI: 10.1002/cncr.34973] [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: 04/07/2023] [Revised: 06/03/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The continued presentation of patient-detected breast cancer (BC) and associated characteristics over time is understudied. METHODS In a large institutional cohort of first primary stage 0-IV patients with BC in 1990-2019 (n = 15,827), diagnostic method (patient-detected [PtDBC] [n = 5844]; mammography-detected [MamDBC] [nondiagnostic] [n = 9248]; and physician-detected [PhysDBC] [n = 736]) and patient and tumor characteristics including age, race, TNM stage, and hormone-receptor status were reviewed. Pearson χ2 tests for bivariate comparisons and logistic regression for patient detection-associated factors were used. RESULTS In a cohort from 1990 to 2019, the proportion aged 50-74 years (55%-63%; p < .001) and non-White race (9%-37%; p < .001) increased over time. Percentage PtDBC decreased over time but case numbers increased (1990-1999: 44% [n = 1399]; 2010-2019: 34% [n = 2349]; p < .001). Excluding stage 0, PtDBC declined from 47% to 41% over time (p < .001). In 2010-2019, 21% of cases were stage 0, 91% of which were mammography detected (n = 1439). Seventy percent of patient-detected cases were stage II-IV (stage II, 44%; stage III, 20%; stage IV, 6%; p < .001). In adjusted logistic regression, the odds of PtDBC decreased over time (2000-2009: odds ratio [OR], .65 [95% CI, .58-.72]; 2010-2019: OR, .54 [95% CI, .49-.60]), with age <40 years OR, 15.81, and Black and non-White other at 50% increased risk. CONCLUSIONS The relative proportion of PtDBC decreased to a constant 34%-40% of total cases after 1990-1999. PtDBC case numbers increased in subsequent years (2000-2019), and were consistently higher stage. Interval cancers, mammography-screening uptake, breast health awareness of age groups outside screening guidelines, and underserved socioeconomic groups may be related to the continued significant PtDBC incidence. PLAIN LANGUAGE SUMMARY After decades of mammography-screening availability, symptomatic patient-detected breast cancer declined over time from 44% to a persistent rate of 34% in our institutional cohort. The persistence of patient-detected breast cancer over time presents a difficult situation for patients and care givers without clear diagnosis pathways for younger and older women outside recommended screening guidelines, who often present with higher stage and more lethal characteristics. More timely diagnosis and treatment including breast health awareness, prompt presentation of breast problems, outreach to younger age and minority groups, and provision of specialized training and care delivery for symptomatic patient-detected breast cancer are needed.
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Affiliation(s)
- Judith A Malmgren
- HealthStat Consulting, Inc., Seattle, Washington, USA
- School of Public Health, University of Washington, Seattle, Washington, USA
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3
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Kanwal F, Khaderi S, Singal AG, Marrero JA, Asrani SK, Amos CI, Thrift AP, Kramer JR, Yu X, Cao Y, Luster M, Al-Sarraj A, Ning J, El-Serag HB. Risk Stratification Model for Hepatocellular Cancer in Patients With Cirrhosis. Clin Gastroenterol Hepatol 2023; 21:3296-3304.e3. [PMID: 37390101 PMCID: PMC10661677 DOI: 10.1016/j.cgh.2023.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND & AIMS The available risk stratification indices for hepatocellular cancer (HCC) have limited applicability. We developed and externally validated an HCC risk stratification index in U.S. cohorts of patients with cirrhosis. METHODS We used data from 2 prospective U.S. cohorts to develop the risk index. Patients with cirrhosis were enrolled from 8 centers and followed until development of HCC, death, or December 31, 2021. We identified an optimal set of predictors with the highest discriminatory ability (C-index) for HCC. The predictors were refit using competing risk regression and its predictive performance was evaluated using the area under the receiver-operating characteristic curve (AUROC). External validation was performed in a cohort of 21,550 patients with cirrhosis seen in the U.S Veterans Affairs system between 2018 and 2019 with follow-up through 2021. RESULTS We developed the model in 2431 patients (mean age 60 years, 31% women, 24% cured hepatitis C, 16% alcoholic liver disease, and 29% nonalcoholic fatty liver disease). The selected model had a C-index of 0.77 (95% confidence interval [CI], 0.73-0.81), and the predictors were age, sex, smoking, alcohol use, body mass index, etiology, α-fetoprotein, albumin, alanine aminotransferase, and platelet levels. The AUROCs were 0.75 (95% CI, 0.65-0.85) at 1 year and 0.77 (95% CI, 0.71-0.83) at 2 years, and the model was well calibrated. In the external validation cohort, the AUROC at 2 years was 0.70 with excellent calibration. CONCLUSION The risk index, including objective and routinely available risk factors, can differentiate patients with cirrhosis who will develop HCC and help guide discussions regarding HCC surveillance and prevention. Future studies are needed for additional external validation and refinement of risk stratification.
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Affiliation(s)
- Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; VA HSR&D Center for Innovatio ns in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
| | - Saira Khaderi
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Amit G Singal
- Division of Digestive and Liver Diseases, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Jorge A Marrero
- Division of Digestive and Liver Diseases, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Sumeet K Asrani
- Division of Gastroenterology, Department of Medicine, Baylor University Medical Center, Dallas, Texas
| | - Christopher I Amos
- Section of Epidemiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Aaron P Thrift
- Section of Epidemiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jennifer R Kramer
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; VA HSR&D Center for Innovatio ns in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Xian Yu
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; VA HSR&D Center for Innovatio ns in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Yumei Cao
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; VA HSR&D Center for Innovatio ns in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Michelle Luster
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Abeer Al-Sarraj
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; VA HSR&D Center for Innovatio ns in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Jing Ning
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; VA HSR&D Center for Innovatio ns in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
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Hall JM, Mkuu RS, Cho HD, Woodard JN, Kaye FJ, Bian J, Shenkman EA, Guo Y. Disparities Contributing to Late-Stage Diagnosis of Lung, Colorectal, Breast, and Cervical Cancers: Rural and Urban Poverty in Florida. Cancers (Basel) 2023; 15:5226. [PMID: 37958400 PMCID: PMC10647213 DOI: 10.3390/cancers15215226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Despite advances in cancer screening, late-stage cancer diagnosis is still a major cause of morbidity and mortality in the United States. In this study, we aim to understand demographic and geographic factors associated with receiving a late-stage diagnosis (LSD) of lung, colorectal, breast, or cervical cancer. (1) Methods: We analyzed data of patients with a cancer diagnosis between 2016 and 2020 from the Florida Cancer Data System (FCDS), a statewide population-based registry. To investigate correlates of LSD, we estimated multi-variable logistic regression models for each cancer while controlling for age, sex, race, insurance, and census tract rurality and poverty. (2) Results: Patients from high-poverty rural areas had higher odds for LSD of lung (OR = 1.23, 95% CI (1.10, 1.37)) and breast cancer (OR = 1.31, 95% CI (1.17,1.47)) than patients from low-poverty urban areas. Patients in high-poverty urban areas saw higher odds of LSD for lung (OR = 1.05 95% CI (1.00, 1.09)), breast (OR = 1.10, 95% CI (1.06, 1.14)), and cervical cancer (OR = 1.19, 95% CI (1.03, 1.37)). (3) Conclusions: Financial barriers contributing to decreased access to care likely drive LSD for cancer in rural and urban communities of Florida.
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Affiliation(s)
- Jaclyn M. Hall
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA; (R.S.M.); (H.D.C.); (J.N.W.); (J.B.); (E.A.S.); (Y.G.)
- Cancer Informatics Shared Resource, University of Florida Health Cancer Center, 2033 Mowry Road, Gainesville, FL 32610, USA
| | - Rahma S. Mkuu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA; (R.S.M.); (H.D.C.); (J.N.W.); (J.B.); (E.A.S.); (Y.G.)
| | - Hee Deok Cho
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA; (R.S.M.); (H.D.C.); (J.N.W.); (J.B.); (E.A.S.); (Y.G.)
- Cancer Informatics Shared Resource, University of Florida Health Cancer Center, 2033 Mowry Road, Gainesville, FL 32610, USA
| | - Jennifer N. Woodard
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA; (R.S.M.); (H.D.C.); (J.N.W.); (J.B.); (E.A.S.); (Y.G.)
- Community Outreach and Engagement, University of Florida Health Cancer Center, 2033 Mowry Road, Gainesville, FL 32610, USA
| | - Frederic J. Kaye
- Division of Hematology and Oncology, Department of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, USA;
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA; (R.S.M.); (H.D.C.); (J.N.W.); (J.B.); (E.A.S.); (Y.G.)
- Cancer Informatics Shared Resource, University of Florida Health Cancer Center, 2033 Mowry Road, Gainesville, FL 32610, USA
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA; (R.S.M.); (H.D.C.); (J.N.W.); (J.B.); (E.A.S.); (Y.G.)
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA; (R.S.M.); (H.D.C.); (J.N.W.); (J.B.); (E.A.S.); (Y.G.)
- Cancer Informatics Shared Resource, University of Florida Health Cancer Center, 2033 Mowry Road, Gainesville, FL 32610, USA
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Tobin JN, Weiss ES, Cassells A, Lin TJ, Holder T, Carrozzi G, Barsanti F, Morales A, Mailing A, Espejo M, Gilbert E, Casiano L, O’Hara-Cicero E, Weed J, Dietrich AJ. A Randomized Controlled Trial to Increase Cancer Screening and Reduce Depression Among Low-Income Women. JOURNAL OF PREVENTION AND HEALTH PROMOTION 2022; 3:271-299. [PMID: 38566802 PMCID: PMC10986328 DOI: 10.1177/26320770221096098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Low-income women of color receive fewer cancer screenings and have higher rates of depression, which can interfere with cancer screening participation. This study assessed the comparative effectiveness of two interventions for improving colorectal, breast, and cervical cancer screening participation and reducing depression among underserved women in Bronx, NY, with depression. This comparative effectiveness randomized controlled trial (RCT) with assessments at study entry, 6, and 12 months utilized an intent-to-treat statistical approach. Eligible women were aged 50 to 64, screened positive for depression, and were overdue for ≥ 1 cancer screening (colorectal, breast, and/or cervical). Participants were randomized to a collaborative depression care plus cancer screening intervention (CCI + PCM) or cancer screening intervention alone (PCM). Interventions were telephone-based, available in English or Spanish, delivered over 12 months, and facilitated by a skilled care manager. Cancer screening data were extracted from electronic health records. Depression was measured with a validated self-report instrument (PHQ-9). Seven hundred fifty seven women consented and were randomized (CCI + PCM, n = 378; PCM, n = 379). Analyses revealed statistically significant increases in up-to-date status for all three cancer screenings; depression improved in both intervention groups. There were no statistically significant differences between the interventions in improving cancer screening rates or reducing depression. CCI and PCM both improved breast, cervical, and colorectal cancer screening and depression in clinical settings in underserved communities; however, neither intervention showed an advantage in outcomes. Decisions about which approach to implement may depend on the nature of the practice and alignment of the interventions with other ongoing priorities and resources.
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Affiliation(s)
| | | | | | - TJ Lin
- Clinical Directors Network (CDN), New York, NY, USA
| | | | - Gianni Carrozzi
- Montefiore Family Care Center, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | - Maria Espejo
- Lincoln Hospital Ambulatory Care Services, Bronx, NY, USA
| | - Erica Gilbert
- Segundo Ruiz Belvis Diagnostic &Treatment Center, Bronx, NY, USA
| | - Louann Casiano
- Morrisania Diagnostic & Treatment Center, Bronx, NY, USA
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Li H, Chen M, Yang Z, Xu C, Yu Q, Song J, Wang M, Gao X. Amorphophalli Rhizoma inhibits breast cancer growth, proliferation, migration, and invasion via the PI3K/AKT pathway. JOURNAL OF ETHNOPHARMACOLOGY 2022; 286:114926. [PMID: 34929308 DOI: 10.1016/j.jep.2021.114926] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Amorphophalli Rhizoma (APR) is widely used as an adjuvant treatment for advanced and metastatic triple-negative breast cancer (TNBC), but its effects, potential active ingredients, and mechanism of action on estrogen receptor-positive (ER+) and human epidermal growth factor receptor-positive (HER2+) breast cancer cells were not reported. AIM OF THE STUDY The present study investigated the effects and mechanism of APR on ER+ and HER2+ breast cancer cells. MATERIALS AND METHODS Rotary evaporation was used to prepare different extracts of APR. Cell activity was assessed using the cell counting kit-8 (CCK-8) method. Wound healing assays were used to assess cell migration, and a cell invasion assay was performed using a Transwell chamber with Matrigel matrix. A xenograft model was used to analyze the inhibitory effects of APR on tumor growth. Bioinformatics analyses were used to explore the potential mechanism of APR in breast cancer. RT-qPCR and Western blotting were performed to reveal the molecular mechanism. RESULTS The ethyl acetate extract of APR showed the strongest tumor inhibitory effect on ER+ and HER2+ breast cancer cells compared to petroleum ether or N-butanol extracts. APR inhibited ER+ and HER2+ breast cancer cell growth, proliferation, migration, and invasion via the phosphatidylinositol-3 kinase (PI3K)/AKT pathway. CONCLUSIONS APR had a significant inhibitory effect on ER+ and HER2+ breast cancer cells via the PI3K/AKT signaling pathway. Therefore, APR may be useful for preventing ER+ and HER2+ breast tumor growth, proliferation, migration, and invasion.
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Affiliation(s)
- Hailong Li
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, No. 18, Chaowang Road, 310014, Hangzhou, Zhejiang, China; Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Mingcang Chen
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, No. 18, Chaowang Road, 310014, Hangzhou, Zhejiang, China; Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Zimei Yang
- Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Chuchu Xu
- Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Qinghong Yu
- Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Jiaqing Song
- Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Mengqian Wang
- Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Xiufei Gao
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, Zhejiang, China.
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Fedewa SA, Yabroff KR, Bandi P, Smith RA, Nargis N, Zheng Z, Drope J, Jemal A. Unemployment and cancer screening: Baseline estimates to inform health care delivery in the context of COVID-19 economic distress. Cancer 2021; 128:737-745. [PMID: 34747008 PMCID: PMC8653134 DOI: 10.1002/cncr.33966] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/03/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022]
Abstract
Background During the coronavirus disease 2019 pandemic, US unemployment rates rose to historic highs, and they remain nearly double those of prepandemic levels. Employers are the most common source of health insurance among nonelderly adults. Thus, job loss may lead to a loss of health insurance and reduce access to cancer screening. This study examined associations between unemployment, health insurance, and cancer screening to inform the pandemic's potential impacts on early cancer detection. Methods Up‐to‐date and past‐year breast, cervical, colorectal, and prostate cancer screening prevalences were computed for nonelderly respondents (aged <65 years) with 2000‐2018 National Health Interview Survey data. Multivariable logistic regression models with marginal probabilities were used to estimate unemployed‐versus‐employed unadjusted and adjusted prevalence ratios. Results Unemployed adults (2000‐2018) were 4 times more likely to lack insurance than employed adults (41.4% vs 10.0%; P < .001). Unemployed adults had a significantly lower up‐to‐date prevalence of screening for cervical cancer (78.5% vs 86.2%; P < .001), breast cancer (67.8% vs 77.5%; P < .001), colorectal cancer (41.9 vs 48.5%; P < .001), and prostate cancer (25.4% vs 36.4%; P < .001). These differences were eliminated after accounting for health insurance coverage. Conclusions Unemployment was adversely associated with up‐to‐date cancer screening, and this was fully explained by a lack of health insurance. Ensuring the continuation of health insurance coverage after job loss may mitigate the pandemic's economic distress and future economic downturns' impact on cancer screening. Unemployment is adversely associated with up‐to‐date cancer screening, and this is fully explained by a lack of health insurance.
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Affiliation(s)
- Stacey A Fedewa
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Priti Bandi
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Early Detection and Screening, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Nigar Nargis
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Jeffrey Drope
- Healthy Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Ahmedin Jemal
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
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8
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Jamal J, MacMillan F, McBride KA. Barriers and Facilitators of Breast Cancer Screening amongst Culturally and Linguistically Diverse Women in South Western Sydney: A Qualitative Explorative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179129. [PMID: 34501723 PMCID: PMC8430955 DOI: 10.3390/ijerph18179129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/04/2022]
Abstract
Breast cancer is the most common cause of cancer amongst Australian women and the second most common cause of cancer mortality. Despite the proven effectiveness of early intervention, screening rates remain subpar across many regions in New South Wales (NSW). Screening rates are particularly low within the culturally and linguistically diverse (CALD) area of South Western Sydney (SWS). The objective of this study was to qualitatively explore barriers and facilitators to breast screening from the perspectives of CALD women from SWS. CALD women aged ≥40 who resided in SWS were invited to participate in a semi-structured interview to explore barriers and facilitators to breast cancer screening. Interviews were recorded, transcribed verbatim and analysed thematically to identify recurring patterns in the data. Sixteen women from CALD backgrounds participated. Women in this study reported absence of symptoms, fatalistic beliefs and embarrassment during the procedure to be the primary reasons for reluctance to screen. Lack of general practitioner (GP) endorsement, transport issues and pain associated with the procedure were also reported as additional barriers to screening. Common facilitators to screening included encouragement from family and friends, family history of cancer and media adverts. CALD women have distinctive barriers to mammography, which lead to poor breast screening participation rates. Opportunistic health promotion in this area is warranted and may lead to better health outcomes amongst this population.
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Affiliation(s)
- Javeria Jamal
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia;
| | - Freya MacMillan
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia;
- School of Health Science, Western Sydney University, Sydney, NSW 2560, Australia
| | - Kate A. McBride
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia;
- School of Health Science, Western Sydney University, Sydney, NSW 2560, Australia
- Correspondence:
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Lawson MB, Lee CI, Hippe DS, Chennupati S, Fedorenko CR, Malone KE, Ramsey SD, Lee JM. Receipt of Screening Mammography by Insured Women Diagnosed With Breast Cancer and Impact on Outcomes. J Natl Compr Canc Netw 2021; 19:1156-1164. [PMID: 34330103 DOI: 10.6004/jnccn.2020.7801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/21/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The purpose of this study was to determine factors associated with receipt of screening mammography by insured women before breast cancer diagnosis, and subsequent outcomes. PATIENTS AND METHODS Using claims data from commercial and federal payers linked to a regional SEER registry, we identified women diagnosed with breast cancer from 2007 to 2017 and determined receipt of screening mammography within 1 year before diagnosis. We obtained patient and tumor characteristics from the SEER registry and assigned each woman a socioeconomic deprivation score based on residential address. Multivariable logistic regression models were used to evaluate associations of patient and tumor characteristics with late-stage disease and nonreceipt of mammography. We used multivariable Cox proportional hazards models to identify predictors of subsequent mortality. RESULTS Among 7,047 women, 69% (n=4,853) received screening mammography before breast cancer diagnosis. Compared with women who received mammography, those with no mammography had a higher proportion of late-stage disease (34% vs 10%) and higher 5-year mortality (18% vs 6%). In multivariable modeling, late-stage disease was most associated with nonreceipt of mammography (odds ratio [OR], 4.35; 95% CI, 3.80-4.98). The Cox model indicated that nonreceipt of mammography predicted increased risk of mortality (hazard ratio [HR], 2.00; 95% CI, 1.64-2.43), independent of late-stage disease at diagnosis (HR, 5.00; 95% CI, 4.10-6.10), Charlson comorbidity index score ≥1 (HR, 2.75; 95% CI, 2.26-3.34), and negative estrogen receptor/progesterone receptor status (HR, 2.09; 95% CI, 1.67-2.61). Nonreceipt of mammography was associated with younger age (40-49 vs 50-59 years; OR, 1.69; 95% CI, 1.45-1.96) and increased socioeconomic deprivation (OR, 1.05 per decile increase; 95% CI, 1.03-1.07). CONCLUSIONS In a cohort of insured women diagnosed with breast cancer, nonreceipt of screening mammography was significantly associated with late-stage disease and mortality, suggesting that interventions to further increase uptake of screening mammography may improve breast cancer outcomes.
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Affiliation(s)
- Marissa B Lawson
- 1Department of Radiology, University of Washington School of Medicine; and
| | - Christoph I Lee
- 1Department of Radiology, University of Washington School of Medicine; and.,2Hutchinson Institute for Cancer Outcomes Research, and
| | - Daniel S Hippe
- 1Department of Radiology, University of Washington School of Medicine; and
| | | | | | - Kathleen E Malone
- 3Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Scott D Ramsey
- 2Hutchinson Institute for Cancer Outcomes Research, and.,3Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Janie M Lee
- 1Department of Radiology, University of Washington School of Medicine; and.,2Hutchinson Institute for Cancer Outcomes Research, and
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10
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Yuan R, Zhang C, Li Q, Ji M, He N. The impact of marital status on stage at diagnosis and survival of female patients with breast and gynecologic cancers: A meta-analysis. Gynecol Oncol 2021; 162:778-787. [PMID: 34140180 DOI: 10.1016/j.ygyno.2021.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022]
Abstract
The aim of this meta-analysis is to evaluate the effect of marital status on the stage at diagnosis and survival of female patients with breast and gynecologic cancers. A systematic literature search was conducted on electronic databases (PubMed, Cochrane and EMBASE) till December 31, 2020. Publications investigating the association of marital status with stage at diagnosis and/or cancer-specific mortality (CSM) and/or overall survival (OS) in female patients with breast or gynecologic cancers were retrieved. After studies were selected according to inclusion criteria, data extraction, quality assessment and data analysis were performed. 55 articles were eligible for inclusion, consisting of 1,195,773 female cancer patients with breast, vulvar, cervical, endometrial and ovarian cancers. Unmarried female cancer patients had higher odds of being diagnosed at later stage [odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.22-1.36)] and worse survival outcomes in CSM [hazard ratio (HR) = 1.22, 95% CI: 1.16-1.28] and OS (HR = 1.20, 95% CI: 1.14-1.25). This estimate did not vary by level of social support, number of adjustment factors, or between America and Europe. Being married is associated with timely diagnosis and favorable prognosis in most women's cancers. Unmarried female cancer patients have a higher risk of late-stage diagnosis and worse survival outcomes than the married. Greater concern shall be demonstrated towards unmarried female cancer patients. Furthermore, the impact of lacking economic and emotional support on survival outcomes in unmarried female cancer patients deserves particular attention.
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Affiliation(s)
- Ruixia Yuan
- Clinical Big Data Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qi Li
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mei Ji
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Nannan He
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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11
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Reece JC, Neal EFG, Nguyen P, McIntosh JG, Emery JD. Delayed or failure to follow-up abnormal breast cancer screening mammograms in primary care: a systematic review. BMC Cancer 2021; 21:373. [PMID: 33827476 PMCID: PMC8028768 DOI: 10.1186/s12885-021-08100-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/23/2021] [Indexed: 01/07/2023] Open
Abstract
Background Successful breast cancer screening relies on timely follow-up of abnormal mammograms. Delayed or failure to follow-up abnormal mammograms undermines the potential benefits of screening and is associated with poorer outcomes. However, a comprehensive review of inadequate follow-up of abnormal mammograms in primary care has not previously been reported in the literature. This review could identify modifiable factors that influence follow-up, which if addressed, may lead to improved follow-up and patient outcomes. Methods A systematic literature review to determine the extent of inadequate follow-up of abnormal screening mammograms in primary care and identify factors impacting on follow-up was conducted. Relevant studies published between 1 January, 1990 and 29 October, 2020 were identified by searching MEDLINE®, Embase, CINAHL® and Cochrane Library, including reference and citation checking. Joanna Briggs Institute Critical Appraisal Checklists were used to assess the risk of bias of included studies according to study design. Results Eighteen publications reporting on 17 studies met inclusion criteria; 16 quantitative and two qualitative studies. All studies were conducted in the United States, except one study from the Netherlands. Failure to follow-up abnormal screening mammograms within 3 and at 6 months ranged from 7.2–33% and 27.3–71.6%, respectively. Women of ethnic minority and lower education attainment were more likely to have inadequate follow-up. Factors influencing follow-up included physician-patient miscommunication, information overload created by automated alerts, the absence of adequate retrieval systems to access patient’s results and a lack of coordination of patient records. Logistical barriers to follow-up included inconvenient clinic hours and inconsistent primary care providers. Patient navigation and case management with increased patient education and counselling by physicians was demonstrated to improve follow-up. Conclusions Follow-up of abnormal mammograms in primary care is suboptimal. However, interventions addressing amendable factors that negatively impact on follow-up have the potential to improve follow-up, especially for populations of women at risk of inadequate follow-up. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08100-3.
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Affiliation(s)
- Jeanette C Reece
- Colorectal Cancer Unit, Centre for Epidemiology and Biostatistics and Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 207 Bouverie Street, Parkville, VIC, 3010, Australia. .,Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Eleanor F G Neal
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Peter Nguyen
- Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jennifer G McIntosh
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of Software Systems and Cybersecurity, Faculty of Information Technology, Monash University, VIC, Clayton, Australia
| | - Jon D Emery
- Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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12
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Friedman-Eldar O, Zippel D, Guy-Chen H, Eitan Gur S, Ben-Baruch N, Sharon E, Allweis TM. Advanced Breast Cancer at Diagnosis: Over One Third Adherent to Screening Recommendations. WOMEN'S HEALTH REPORTS 2020; 1:301-307. [PMID: 33786493 PMCID: PMC7784813 DOI: 10.1089/whr.2020.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 11/16/2022]
Abstract
Background: Advanced breast cancer (ABC) at diagnosis carries a worse prognosis, and can be attributed to delay in diagnosis, failure of screening tests, or aggressive biology. Better understanding of factors related with ABC at diagnosis could help decrease the proportion of such cases. Patients and Methods: This is a retrospective study of all patients diagnosed and treated for breast cancer (BC) at a single institution between 2012 and 2015. Data were collected from medical records and phone interviews, and included demographic, clinical, and tumor-related data, and adherence to screening recommendations. Results: Of 555 newly diagnosed BC patients, 390 (70.3%) were diagnosed early (stage 0–IIa), and 165 (29.7%) were diagnosed with ABC (stage IIb–IV). Of the165 patients diagnosed with ABC, 57 (34.5%) underwent screening mammography as recommended. More patients with ABC were <50 years (29.1% vs. 19%, p = 0.006). ABC was associated with higher grade, higher proliferation rate, Her2/neu overexpression, luminal B-like, and triple negative phenotypes. Mammography within 30 months of diagnosis was more prevalent among those diagnosed early (64.6% vs. 34.5%, p = 0.003). Only 31 (18.8%) of the screening eligible patients who were diagnosed at advanced stage did not adhere to screening recommendations. Conclusions: ABC at diagnosis is related to aggressive tumor biology and age <50 years. It is also associated with lower adherence to screening mammography; however, more than one third of patients diagnosed with ABC who were eligible for screening underwent screening mammography as recommended. Further research is needed to elucidate factors related with ABC at diagnosis, review screening guidelines, and develop more effective screening modalities.
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Affiliation(s)
- Orli Friedman-Eldar
- Department of Surgery and Sarah Markowitz Breast Health Center, Kaplan Medical Center, Rehovot, Israel.,Meirav Breast Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Douglas Zippel
- Meirav Breast Unit, Sheba Medical Center, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Helit Guy-Chen
- Department of Plastic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Shlomi Eitan Gur
- Department of Plastic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Noa Ben-Baruch
- Department of Oncology, Kaplan Medical Center, Rehovot, Israel
| | - Eran Sharon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Breast Surgery Unit, Rabin Medical Center, Petach-Tikva, Israel
| | - Tanir M Allweis
- Department of Surgery and Sarah Markowitz Breast Health Center, Kaplan Medical Center, Rehovot, Israel.,Hebrew University Medical School, Jerusalem, Israel
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13
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Marín-Romero S, Jara-Palomares L. Screening for occult cancer: where are we in 2020? Thromb Res 2020; 191 Suppl 1:S12-S16. [PMID: 32736769 DOI: 10.1016/s0049-3848(20)30390-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/27/2019] [Accepted: 01/12/2020] [Indexed: 10/23/2022]
Abstract
The relationship between venous thromboembolism (VTE) and cancer has become an area of intense debate due to the importance and the potential benefits of the identification of occult cancer following the diagnosis of unprovoked VTE. At present, extended screening is not recommended in patients with unprovoked VTE. However, if we were able to identify a group at greater risk of presenting cancer during follow-up, these patients would benefit from extended screening. The creation of a trans-organ screening model enables the unification of metrics of quality in the screening of cancer in different localizations. Likewise, it can incorporate cancer screening for other localizations or other specific situations of risk such as unprovoked VTE. This study summarizes the contribution of the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) initiative aimed at improving the cancer screening process. Likewise, we have carried out an updated review of unprovoked VTE and occult cancer. Finally, we discuss the studies currently ongoing aimed at identifying the population at greatest risk of presenting cancer during follow-up. The identification of this population at high risk could help to determine the following steps to undertake in order to implement screening in this population.
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Affiliation(s)
- Samira Marín-Romero
- Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain
| | - Luis Jara-Palomares
- Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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14
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Zhao J, Miller KD, Islami F, Zheng Z, Han X, Ma J, Jemal A, Yabroff KR. Racial/Ethnic Disparities in Lost Earnings From Cancer Deaths in the United States. JNCI Cancer Spectr 2020; 4:pkaa038. [PMID: 33134823 PMCID: PMC7583153 DOI: 10.1093/jncics/pkaa038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/30/2020] [Accepted: 04/29/2020] [Indexed: 11/14/2022] Open
Abstract
Background Little is known about disparities in economic burden due to premature cancer deaths by race or ethnicity in the United States. This study aimed to compare person-years of life lost (PYLLs) and lost earnings due to premature cancer deaths by race/ethnicity. Methods PYLLs were calculated using recent national cancer death and life expectancy data. PYLLs were combined with annual median earnings to generate lost earnings. We compared PYLLs and lost earnings among individuals who died at age 16-84 years due to cancer by racial/ethnic groups (non-Hispanic [NH] White, NH Black, NH Asian or Pacific Islander, and Hispanic). Results In 2015, PYLLs due to all premature cancer deaths were 6 512 810 for NH Whites, 1 196 709 for NH Blacks, 279 721 for NH Asian or Pacific Islanders, and 665 968 for Hispanics, translating to age-standardized lost earning rates (per 100 000 person-years) of $34.9 million, $43.5 million, $22.2 million, and $24.5 million, respectively. NH Blacks had higher age-standardized PYLL and lost earning rates than NH Whites for 13 of 19 selected cancer sites. If age-specific PYLL and lost earning rates for NH Blacks were the same as those of NH Whites, 241 334 PYLLs and $3.2 billion lost earnings (22.6% of the total lost earnings among NH Blacks) would have been avoided. Disparities were also observed for average PYLLs and lost earnings per cancer death for all cancers combined and 18 of 19 cancer sites. Conclusions Improving equal access to effective cancer prevention, screening, and treatment will be important in reducing the disproportional economic burden associated with racial/ethnic disparities.
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Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Kimberly D Miller
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Farhad Islami
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Jiemin Ma
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
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15
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Recondo G, Cosacow C, Cutuli HJ, Cermignani L, Straminsky S, Naveira M, Pitzzu M, De Ronato G, Nacuzzi G, Taetti G, Corsico S, Berrueta M, Colucci G, Gibbons L, Gutierrez L, García-Elorrio E. Access of patients with breast and lung cancer to chemotherapy treatment in public and private hospitals in the city of Buenos Aires. Int J Qual Health Care 2019; 31:682-690. [PMID: 31125084 DOI: 10.1093/intqhc/mzz047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 04/14/2019] [Accepted: 04/26/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Describe the time elapsed from the diagnosis to treatment with chemotherapy for patients with breast and lung cancer at public and private hospitals in Buenos Aires. DESIGN Retrospective cohort study. SETTING Three public and three private academic hospitals in Buenos Aires. PARTICIPANTS Patients with breast (n = 168) or lung cancer (n = 100) diagnosis treated with chemotherapy. MAIN OUTCOMES MEASURES Clinical and sociodemographic data were collected in a stratified sample. We used the Kaplan-Meier estimator to analyse the time elapsed and the log rank test to compare both groups. RESULTS For breast cancer patients, median time elapsed between diagnosis and treatment with chemotherapy was 76 days (95% CI: 64-86) in public and 60 days (95% CI: 52-65) in private hospitals (P = 0.0001). For adjuvant and neoadjuvant treatments, median time was 130 (95% CI: 109-159) versus 64 (95% CI: 56-73) days (P < 0.0001) and 57 days (95% CI: 49-75) versus 26 (95% CI: 16-41) days, respectively (P = 0.0002). There were no significant differences in the time from first consultation to diagnosis. In patients with lung cancer, median time from diagnosis to treatment was 71 days (95% CI: 60-83) in public hospitals and 31 days (95% CI: 24-39) in private hospitals (P = 0.0002). In the metastatic setting, median time to treatment was 63 days (95% CI: 45-83) in public and 33 (95% CI: 26-44) days in private hospitals (P = 0.005). CONCLUSIONS There are significant disparity in the access to treatment with chemotherapy for patients in Buenos Aires, Argentina.
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Affiliation(s)
- Gonzalo Recondo
- Medical Oncology, Centro de Educación Médica e Investigaciones Clínicas 'Norberto Quirno' (CEMIC), Buenos Aires, Argentina
| | - César Cosacow
- Instituto Universitario CEMIC, Buenos Aires, Argentina
| | - Hernán Javier Cutuli
- Medical Oncology, Instituto de Oncología Ángel H. Roffo, Buenos Aires, Argentina
| | - Luciano Cermignani
- Medical Oncology, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
| | - Samanta Straminsky
- Medical Oncology, Hospital General de Agudos 'Dr. Juan A. Fernández', Buenos Aires, Argentina
| | - Martin Naveira
- Medical Oncology, Hospital Británico de Buenos Aires. Buenos Aires, Argentina
| | - Martin Pitzzu
- Medical Oncology, Hospital General de Agudos 'Carlos G. Durand', Buenos Aires, Argentina
| | - Gabriela De Ronato
- Medical Oncology, Hospital General de Agudos 'Dr. Juan A. Fernández', Buenos Aires, Argentina
| | - Gabriela Nacuzzi
- Medical Oncology, Hospital General de Agudos 'Carlos G. Durand', Buenos Aires, Argentina
| | - Gonzalo Taetti
- Medical Oncology, Instituto de Oncología Ángel H. Roffo, Buenos Aires, Argentina
| | - Santiago Corsico
- Medical Oncology, Hospital Británico de Buenos Aires. Buenos Aires, Argentina
| | - Mabel Berrueta
- Data Unit, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Luz Gibbons
- Data Unit, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Laura Gutierrez
- Data Unit, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ezequiel García-Elorrio
- Quality of Care and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS)
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16
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Shon EJ, Townsend AL. Predictors of never having a mammogram among Chinese, Vietnamese, and Korean immigrant women in the U.S. PLoS One 2019; 14:e0224505. [PMID: 31693678 PMCID: PMC6834271 DOI: 10.1371/journal.pone.0224505] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/15/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer among Asian women in the U.S. The first objective was to investigate predictors (including ethnicity) of never having a mammogram in middle-aged and older Chinese, Vietnamese, and Korean immigrant women (main effects). The second objective was to explore whether relationships between predictors and never having a mammogram varied across the three groups (moderation effects of ethnicity). METHODS Merged (2005-2007-2009-2011) California Health Interview Survey data were utilized. Unweighted sample was 3,710 Asian women ages 40 years and older (Chinese = 1,389; Vietnamese = 1,094; Korean = 1,227). Replicate weighted total sample size was 1,710,233 (Chinese = 940,000; Vietnamese = 410,000; Korean = 360,000). Replicate-weighted multivariate logistic regression was applied. Interaction effects (moderator role of ethnicity) were also examined, using multivariate logistic regression, for the second objective. RESULTS For the first objective, odds of never having a mammogram were higher for women who were Korean (Ref = Vietnamese), unmarried, or a non-U.S. citizen. Odds were lower in women ages 50-59 or 60-69 (Ref = 70-85). Regarding the second objective, only for Chinese women, odds of never having a mammogram were lower as the number of physician visits got higher. CONCLUSION Culturally-sensitive outreach and services should be developed to target higher-risk groups. Patient-centered healthcare strategies tailored for the three groups could be effective. For Chinese women, in particular, regular information sessions or education programs could be provided for enhancing their physician visits.
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Affiliation(s)
- En-Jung Shon
- Department of Family Science and Social Work, Miami University, Oxford, OH, United States of America
| | - Aloen Louise Townsend
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States of America
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17
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Craddock Lee SJ, Reimer T, Garcia S, Williams EL, West M, Stuart T, Gerber DE. Definition and Coordination of Roles and Responsibilities Among Cancer Center Clinic and Research Personnel. JCO Oncol Pract 2019; 16:e64-e74. [PMID: 31589544 DOI: 10.1200/jop.19.00315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Effective enrollment and treatment of patients in cancer clinical trials require definition and coordination of roles and responsibilities among clinic and research personnel. MATERIALS AND METHODS We developed a survey that incorporated modified components of the Survey of Physician Attitudes Regarding the Care of Cancer Survivors. Surveys were administered to clinic nursing staff and research personnel at a National Cancer Institute-designated comprehensive cancer center. Results were analyzed using χ2-tests, t tests, and analyses of variance. RESULTS Surveys were completed by 105 staff members (n = 50 research staff, n = 55 clinic staff; 61% response rate). Research staff were more likely to feel that they had the skills to answer questions, convey information, and provide education for patients on trials (all P < .05). Both clinic and research staff reported receipt of communication about responsibilities in fewer than 30% of cases, although research staff reported provision of such information in more than 60% of cases. Among 20 tasks related to care of patients in trials, no single preferred model of responsibility assignment was selected by the majority of clinic staff for nine tasks (45%) or by research staff for three tasks (15%). Uncertainty about which team coordinates care was reported by three times as many clinic staff as research staff (P = .01). There was also substantial variation in the preferred model for delivery of care to patients in trials (P < .05). CONCLUSION Knowledge, attitudes, and perception of care and responsibilities for patients on clinical trials differ between and among clinic and research personnel. Additional research about how these findings affect efficiency and quality of care on clinical trials is needed.
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Affiliation(s)
| | | | - Sandra Garcia
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Mary West
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Tobi Stuart
- University of Texas Southwestern Medical Center, Dallas, TX
| | - David E Gerber
- University of Texas Southwestern Medical Center, Dallas, TX
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18
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Veron L, Gelot A, Gusto G, Arveux P, Delaloge S, Boutron‐Ruault M. Modifiable risk factors for advanced
vs
. early breast cancer in the French E3N cohort. Int J Cancer 2019; 146:850-860. [DOI: 10.1002/ijc.32354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Lucie Veron
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
- Paris‐South Saclay University Villejuif France
| | - Amandine Gelot
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
| | - Gaelle Gusto
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
| | - Patrick Arveux
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
| | | | - Marie‐Christine Boutron‐Ruault
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
- Paris‐South Saclay University Villejuif France
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19
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Heller DR, Chiu AS, Farrell K, Killelea BK, Lannin DR. Why Has Breast Cancer Screening Failed to Decrease the Incidence of de Novo Stage IV Disease? Cancers (Basel) 2019; 11:cancers11040500. [PMID: 30965658 PMCID: PMC6521320 DOI: 10.3390/cancers11040500] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/31/2019] [Accepted: 04/03/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Despite screening mammography, the incidence of Stage IV breast cancer (BC) at diagnosis has not decreased over the past four decades. We previously found that many BCs are small due to favorable biology rather than early detection. This study compared the biology of Stage IV cancers with that of small cancers typically found by screening. Methods: Trends in the incidence of localized, regional, and distant female BC were compared using SEER*Stat. The National Cancer Database (NCDB) was then queried for invasive cancers from 2010 to 2015, and patient/disease variables were compared across stages. Biological variables including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (Her2), grade, and lymphovascular invasion were sorted into 48 combinations, from which three biological subtypes emerged: indolent, intermediate, and aggressive. The distributions of the subtypes were compared across disease stages. Multivariable regression assessed the association between Stage IV disease and biology. Results: SEER*Stat confirmed that the incidence of distant BC increased between 1973 and 2015 (annual percent change [APC] = 0.46). NCDB data on roughly 993,000 individuals showed that Stage IV disease at presentation is more common in young, black, uninsured women with low income/education and large, biologically aggressive tumors. The distribution of tumor biology varied by stage, with Stage IV disease including 37.6% aggressive and 6.0% indolent tumors, versus sub-centimeter Stage I disease that included 5.1% aggressive and 40.6% indolent tumors (p < 0.001). The odds of Stage IV disease presentation more than tripled for patients with aggressive tumors (OR3.2, 95% CI 3.0–3.5). Conclusions: Stage I and Stage IV breast cancers represent very different populations of biologic tumor types. This may explain why the incidence of Stage IV cancer has not decreased with screening.
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Affiliation(s)
- Danielle R Heller
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA.
| | - Alexander S Chiu
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA.
| | - Kaitlin Farrell
- The Breast Center/Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA.
| | - Brigid K Killelea
- The Breast Center/Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA.
| | - Donald R Lannin
- The Breast Center/Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA.
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Doria-Rose VP, Greenlee RT, Buist DSM, Miglioretti DL, Corley DA, Brown JS, Clancy HA, Tuzzio L, Moy LM, Hornbrook MC, Brown ML, Ritzwoller DP, Kushi LH, Greene SM. Collaborating on Data, Science, and Infrastructure: The 20-Year Journey of the Cancer Research Network. EGEMS (WASHINGTON, DC) 2019; 7:7. [PMID: 30972356 PMCID: PMC6450242 DOI: 10.5334/egems.273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/16/2018] [Indexed: 12/13/2022]
Abstract
The Cancer Research Network (CRN) is a consortium of 12 research groups, each affiliated with a nonprofit integrated health care delivery system, that was first funded in 1998. The overall goal of the CRN is to support and facilitate collaborative cancer research within its component delivery systems. This paper describes the CRN's 20-year experience and evolution. The network combined its members' scientific capabilities and data resources to create an infrastructure that has ultimately supported over 275 projects. Insights about the strengths and limitations of electronic health data for research, approaches to optimizing multidisciplinary collaboration, and the role of a health services research infrastructure to complement traditional clinical trials and large observational datasets are described, along with recommendations for other research consortia.
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Affiliation(s)
- V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US
| | | | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
- University of California Davis School of Medicine, Davis, CA, US
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
| | - Jeffrey S. Brown
- Department of Population Medicine, Harvard Medical School, Boston, MA, US
- Harvard Pilgrim Health Care Institute, Boston, MA, US
| | - Heather A. Clancy
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
| | - Lisa M. Moy
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
| | - Mark C. Hornbrook
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, US
- Retired
| | - Martin L. Brown
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US
- Retired
| | | | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
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21
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Duggan C, Molina Y, Carosso E, Ibarra G, Thompson B. County of Residence and Screening Practices among Latinas and Non-Latina Whites in Two Rural Communities. Ethn Dis 2019; 29:31-38. [PMID: 30713414 DOI: 10.18865/ed.29.1.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objectives Latinas are less likely than non-Latina Whites (NLW) to utilize mammographic screening and are more likely to be diagnosed with late-stage breast cancer. Here, we examine the effects of county-level factors on guideline-concordant breast-cancer screening behaviors in Latinas and NLWs. Design Latinas (N=108) and NLW women (N=132) aged >40 years, residing in two adjacent rural, medically underserved counties in eastern Washington State, completed a baseline questionnaire on mammography utilization and demographics. Main Outcome Measures Differences in socioeconomic variables and knowledge of screening practices were examined by ethnicity and county of residence. Predictors of having had a mammogram within the past two years were analyzed using multivariate logistic regression. Results Ethnicity was not associated with having a guideline-concordant mammogram; however, age (odds ratio [OR]=1.04, 95%CI:1.01-1.08); having >12 years of education (OR=2.09, 95%CI:1.16-3.79); having a regular clinic for health care (OR=2.22, 95%CI:1.05-4.70); having had a prior clinical breast exam (OR=5.07, 95%CI:1.71-15.02), and county of residence (OR=2.27, 95%CI:1.18-4.37) were all associated with having had a guideline-concordant mammogram. Conclusions County of residence and having had a prior CBE were strong predictors of screening utilization. Community-level factors in medically underserved areas may influence screening patterns.
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Affiliation(s)
- Catherine Duggan
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yamile Molina
- Community Health Sciences Division, University of Illinois-Chicago, Chicago, IL
| | - Elizabeth Carosso
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Genoveva Ibarra
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Beti Thompson
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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22
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Doubeni CA, Fedewa SA, Levin TR, Jensen CD, Saia C, Zebrowski AM, Quinn VP, Rendle KA, Zauber AG, Becerra-Culqui TA, Mehta SJ, Fletcher RH, Schottinger J, Corley DA. Modifiable Failures in the Colorectal Cancer Screening Process and Their Association With Risk of Death. Gastroenterology 2019; 156:63-74.e6. [PMID: 30268788 PMCID: PMC6309478 DOI: 10.1053/j.gastro.2018.09.040] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Colorectal cancer (CRC) deaths occur when patients do not receive screening or have inadequate follow-up of abnormal results or when the screening test fails. We have few data on the contribution of each to CRC-associated deaths or factors associated with these events. METHODS We performed a retrospective cohort study of patients in the Kaiser Permanente Northern and Southern California systems (55-90 years old) who died of CRC from 2006 through 2012 and had ≥5 years of enrollment before diagnosis. We compared data from patients with those from a matched cohort of cancer-free patients in the same system. Receipt, results, indications, and follow-up of CRC tests in the 10-year period before diagnosis were obtained from electronic databases and chart audits. RESULTS Of 1750 CRC deaths, 75.9% (n = 1328) occurred in patients who were not up to date in screening and 24.1% (n = 422) occurred in patients who were up to date. Failure to screen was associated with fewer visits to primary care physicians. Of 3486 cancer-free patients, 44.6% were up to date in their screening. Patients who were up to date in their screening had a lower risk of CRC death (odds ratio, 0.38; 95% confidence interval, 0.33-0.44). Failure to screen, or failure to screen at appropriate intervals, occurred in a 67.8% of patients who died of CRC vs 53.2% of cancer-free patients; failure to follow-up on abnormal results occurred in 8.1% of patients who died of CRC vs 2.2% of cancer-free patients. CRC death was associated with higher odds of failure to screen or failure to screen at appropriate intervals (odds ratio, 2.40; 95% confidence interval, 2.07-2.77) and failure to follow-up on abnormal results (odds ratio, 7.26; 95% confidence interval, 5.26-10.03). CONCLUSIONS Being up to date on screening substantially decreases the risk of CRC death. In 2 health care systems with high rates of screening, most people who died of CRC had failures in the screening process that could be rectified, such as failure to follow-up on abnormal findings; these significantly increased the risk for CRC death.
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Affiliation(s)
- Chyke A. Doubeni
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stacey A. Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Theodore R. Levin
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Chelsea Saia
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alexis M. Zebrowski
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Virginia P. Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Shivan J. Mehta
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Joanne Schottinger
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Phased Implementation as a Strategy for Stepwise, Sustainable Improvement in Breast Healthcare in Low-Resource Settings. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ulbricht S, Beyer A, John U. [Utilization of Gynaecological Cancer Screening by Women 20 to 35 Years of Age Receiving Unemployment Benefits Under Social Security Code II]. DAS GESUNDHEITSWESEN 2018; 82:148-150. [PMID: 30273937 DOI: 10.1055/a-0667-9335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of the study was to analyze associations between utilization of gynaecological cancer screening (GCS) and the number of months during which state unemployment benefits (Social Security Code II) were drawn by women aged 20 to 35 years. The sample included 223 women with complete interview data (participation rate: 69%). The findings show that more women drawing unemployment benefits for a short-term (<12 months) utilized GCS compared to those receiving long-term benefits (>36 months).
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Affiliation(s)
- Sabina Ulbricht
- Institut für Sozialmedizin und Prävention, Greifswald, Universitätsmedizin Greifswald, Germany
| | - Angelika Beyer
- Abteilung Versorgungs-epidemiologie und Community Health, Universitätsmedizin Greifswald
| | - Ulrich John
- Institut für Sozialmedizin und Prävention, Greifswald, Universitätsmedizin Greifswald, Germany
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25
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Kim SJ, Glassgow AE, Watson KS, Molina Y, Calhoun EA. Gendered and racialized social expectations, barriers, and delayed breast cancer diagnosis. Cancer 2018; 124:4350-4357. [PMID: 30246241 DOI: 10.1002/cncr.31636] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/07/2018] [Accepted: 06/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Black women are more likely to be diagnosed at a later stage of breast cancer in part due to barriers to timely screening mammography, resulting in poorer mortality and survival outcomes. Patient navigation that helps to overcome barriers to the early detection of breast cancer is an effective intervention for reducing breast cancer disparity. However, the ability to recognize and seek help to overcome barriers may be affected by gendered and racialized social expectations of women. METHODS Data from a randomized controlled trial, the Patient Navigation in Medically Underserved Areas study, were used. The likelihood of obtaining a follow-up screening mammogram was compared between women who identified ≥1 barriers and those who did not. RESULTS Of the 3754 women who received the Patient Navigation in Medically Underserved Areas navigation intervention, approximately 14% identified ≥ 1 barriers, which led to additional navigator contacts. Consequently, those women who reported barriers were more likely to obtain a subsequent screening mammogram. Black women, women living in poverty, and women with a higher level of distrust were less likely to report barriers. CONCLUSIONS Minority women living in poverty have always been the source of social support for others. However, gendered and racialized social expectations may affect the ways in which women seek help for their own health needs. A way to improve the effectiveness of navigation would be to recognize how minority women's gender images and expectations could shape how they seek help and support. A report of no barriers does not always translate into no problems. Proactive approaches to identify potential barriers may be beneficial.
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Affiliation(s)
- Sage J Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Anne Elizabeth Glassgow
- College of Medicine, Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | | | - Yamile Molina
- Division of Community Health Science, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Elizabeth A Calhoun
- Center for Population Science and Discovery, University of Arizona Health Sciences, Tucson, Arizona
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26
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Molina Y, San Miguel LG, Tamayo L, Robledo C, Díaz CS, Lucio A, Coronado N, Ferrans CE. The "Empowering Latinas to Obtain Breast Cancer Screenings" study: Rationale and design. Contemp Clin Trials 2018; 71:1-8. [PMID: 29803815 DOI: 10.1016/j.cct.2018.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/08/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Latinas suffer disproportionately from breast cancer (BC) in part due to lower guideline-concordant screening. Multiple intervention approaches have been developed to promote screening through direct patient education and empowerment approaches (i.e., training community members to share BC information). This study compares the relative effects of these approaches on: 1) women's BC screening; and, 2) women's dissemination of BC information within their social networks. DESIGN/METHODS Our quasi-experimental trial is being implemented in community venues in two predominantly Latino neighborhoods in South and West Chicago. Eligible participants: 1) are female; 2) are 52-74 years old; 3) have not obtained a mammogram in the past 2 years; and, 4) have not previously participated in health-related volunteerism. Based on their geographic location, participants are assigned to one of two group-based interventions. Both interventions consist of three two-hour sessions, which includes BC early detection education. The education intervention sessions also covers BC prevention (diet, physical activity), whereas the empowerment intervention covers sharing information with family/friends, and health volunteerism. Navigation is provided for all women who wish to obtain mammograms. Primary outcomes include: 1) receipt of BC screening; and, 2) participants' dissemination of BC information. Secondary outcomes include positive changes in 1) participants' self-reported psychosocial facilitators; and, 2) social network members' BC behaviors. DISCUSSION The design of our program allows for a preliminary comparison of the effectiveness of these two approaches. This work will inform larger comparativeness trials and offers a new approach to intervention evaluation via social network analysis.
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27
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Estimating changes in the rate of synchronous and metachronous metastases over time: Analysis of SEER data. Adv Radiat Oncol 2017; 3:70-75. [PMID: 29556583 PMCID: PMC5856980 DOI: 10.1016/j.adro.2017.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 12/02/2022] Open
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Rapkin BD, Weiss E, Lounsbury D, Michel T, Gordon A, Erb-Downward J, Sabino-Laughlin E, Carpenter A, Schwartz CE, Bulone L, Kemeny M. Reducing Disparities in Cancer Screening and Prevention through Community-Based Participatory Research Partnerships with Local Libraries: A Comprehensive Dynamic Trial. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 60:145-159. [PMID: 28913882 PMCID: PMC5658033 DOI: 10.1002/ajcp.12161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Reduction of cancer-related disparities requires strategies that link medically underserved communities to preventive care. In this community-based participatory research project, a public library system brought together stakeholders to plan and undertake programs to address cancer screening and risk behavior. This study was implemented over 48 months in 20 large urban neighborhoods, selected to reach diverse communities disconnected from care. In each neighborhood, Cancer Action Councils were organized to conduct a comprehensive dynamic trial, an iterative process of program planning, implementation and evaluation. This process was phased into neighborhoods in random, stepped-wedge sequence. Population-level outcomes included self-reported screening adherence and smoking cessation, based on street intercept interviews. Event-history regressions (n = 9374) demonstrated that adherence outcomes were associated with program implementation, as were mediators such as awareness of screening programs and cancer information seeking. Findings varied by ethnicity, and were strongest among respondents born outside the U.S. or least engaged in care. This intervention impacted health behavior in diverse, underserved and vulnerable neighborhoods. It has been sustained as a routine library system program for several years after conclusion of grant support. In sum, participatory research with the public library system offers a flexible, scalable approach to reduce cancer health disparities.
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Affiliation(s)
- Bruce D. Rapkin
- Department of Epidemiology and Population Health, Division of Community Collaboration & Implementation Science, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, USA
| | - David Lounsbury
- Department of Epidemiology and Population Health, Division of Community Collaboration & Implementation Science, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Alexis Gordon
- Department of Epidemiology and Population Health, Division of Community Collaboration & Implementation Science, Albert Einstein College of Medicine, Bronx, NY, USA
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jennifer Erb-Downward
- Department of Epidemiology and Population Health, Division of Community Collaboration & Implementation Science, Albert Einstein College of Medicine, Bronx, NY, USA
- Institute for Children Poverty and Homelessness, New York, NY, USA
| | | | - Alison Carpenter
- Department of Epidemiology and Population Health, Division of Community Collaboration & Implementation Science, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carolyn E. Schwartz
- DeltaQuest Foundation, Inc., Concord, MA, USA
- Departments of Medicine & Orthopaedic Surgery, Tufts Univ. Medical School, Boston, MA, USA
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Brousselle A, Breton M, Benhadj L, Tremblay D, Provost S, Roberge D, Pineault R, Tousignant P. Explaining time elapsed prior to cancer diagnosis: patients' perspectives. BMC Health Serv Res 2017; 17:448. [PMID: 28659143 PMCID: PMC5490154 DOI: 10.1186/s12913-017-2390-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Cancer is the leading cause of death in Canada. Early cancer diagnosis could improve patients’ prognosis and quality of life. This study aimed to analyze the factors influencing elapsed time between the first help-seeking trigger and cancer diagnosis with respect to the three most common and deadliest cancer types: lung, breast, and colorectal. Methods This paper presents the qualitative component of a larger project based on a sequential explanatory design. Twenty-two patients diagnosed were interviewed, between 2011 to 2013, in oncology clinics of four hospitals in the two most populous regions in Quebec (Canada). Transcripts were analyzed using the Model of Pathways to Treatment. Results Pre-diagnosis elapsed time and phases are difficult to appraise precisely and vary according to cancer sites and symptoms specificity. This observation makes the Model of Pathways to Treatment challenging to use to analyze patients’ experiences. Analyses identified factors contributing to elapsed time that are linked to type of cancer, to patients, and to health system organization. Conclusions This research allowed us to identify avenues for reducing the intervals between first symptoms and cancer diagnosis. The existence of inequities in access to diagnostic services, even in a universal healthcare system, was highlighted.
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Affiliation(s)
- Astrid Brousselle
- Département des Sciences de la Santé Communautaire, Centre de recherche - Hôpital Charles-Le Moyne, Université de Sherbrooke, 150 Place Charles LeMoyne bureau 200, Longueuil, Quebec, Canada.
| | - Mylaine Breton
- Département des Sciences de la Santé Communautaire, Centre de recherche - Hôpital Charles-Le Moyne, Université de Sherbrooke, 150 Place Charles LeMoyne bureau 200, Longueuil, Quebec, Canada
| | | | - Dominique Tremblay
- École des Sciences Infirmières, Centre de recherche - Hôpital Charles-Le Moyne, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Sylvie Provost
- Direction de Santé Publique de Montréal, Institut de Recherche en Santé Publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Danièle Roberge
- Département des Sciences de la Santé Communautaire, Centre de recherche - Hôpital Charles-Le Moyne, Université de Sherbrooke, 150 Place Charles LeMoyne bureau 200, Longueuil, Quebec, Canada
| | - Raynald Pineault
- Direction de Santé Publique de Montréal, Institut de Recherche en Santé Publique de l'Université de Montréal, Montreal, Quebec, Canada.,Institut National de Santé Publique, Montreal, Canada
| | - Pierre Tousignant
- Direction de Santé Publique de Montréal, McGill University Health Centre, Montreal, Quebec, Canada.,Institut National de Santé Publique, Montreal, Canada
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30
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Lega IC, Fung K, Austin PC, Lipscombe LL. Metformin and breast cancer stage at diagnosis: a population-based study. ACTA ACUST UNITED AC 2017; 24:e85-e91. [PMID: 28490930 DOI: 10.3747/co.24.3380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The objective of the present study was to use a large, population-based cohort to examine the association between metformin and breast cancer stage at diagnosis while accounting for mammography differences. METHODS We used data from Ontario administrative health databases to identify women 68 years of age or older with diabetes and invasive breast cancer diagnosed from 1 January 2007 to 31 December 2012. Adjusted logistic regression models were used to compare breast cancer stage at diagnosis (stages i and ii vs. iii and iv) between the women exposed and not exposed to metformin. We also examined the association between metformin use and estrogen receptor status, tumour size, and lymph node status in the subset of women for whom those data were available. RESULTS We identified 3125 women with diabetes and breast cancer; 1519 (48.6%) had been exposed to metformin before their cancer diagnosis. Median age at breast cancer diagnosis was 76 years (interquartile range: 72-82 years), and mean duration of diabetes was 8.8 ± 5.9 years. In multivariable analyses, metformin exposure was not associated with an earlier stage of breast cancer (odds ratio: 0.98; 95% confidence interval: 0.81 to 1.19). In secondary analyses, metformin exposure was not associated with estrogen receptor-positive breast cancer, tumours larger than 2 cm, or positive lymph nodes. CONCLUSIONS This population-based study did not show an association between metformin use and breast cancer stage or tumour characteristics at diagnosis. Our study considered older women with long-standing diabetes, and therefore further studies in younger patients could be warranted.
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Affiliation(s)
- I C Lega
- Women's College Research Institute, Women's College Hospital.,Department of Medicine, University of Toronto
| | - K Fung
- Women's College Research Institute, Women's College Hospital.,Institute for Clinical Evaluative Sciences; and
| | - P C Austin
- Institute for Clinical Evaluative Sciences; and.,Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - L L Lipscombe
- Women's College Research Institute, Women's College Hospital.,Department of Medicine, University of Toronto.,Institute for Clinical Evaluative Sciences; and.,Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, ON
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31
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Mobley LR, Kuo TM. Demographic Disparities in Late-Stage Diagnosis of Breast and Colorectal Cancers Across the USA. J Racial Ethn Health Disparities 2017; 4:201-212. [PMID: 27072541 PMCID: PMC5182192 DOI: 10.1007/s40615-016-0219-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/22/2016] [Accepted: 03/09/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND We determined whether there were disparities in the likelihood of being diagnosed at a late stage for breast cancer (BC) or colorectal cancer (CRC) in each of 40 states, using the recently available US Cancer Statistics (USCS) database. METHODS We extracted 981,457 BC cases and 558,568 CRC cases diagnosed in 2004-2009. Separate multilevel regressions were run for each state and each cancer type. Models included person and area-level covariates and were identically specified across states. The disparities foci were race or ethnicity (white, African-American, Hispanic, Asian, all other), gender, and age (<40, 40-49, 50-64, 65-74, and 75+). Using whites, males, and the oldest age group as reference groups, we noted the statistically significant disparities coefficients (p value ≤0.05) and translated the findings via a set of maps of states in the USA. RESULTS National disparity estimates were not consistent with disparities identified in the states. Some states had estimates consistent with the national average, while others did not. Patterns of disparities across states were different for each covariate and mapped separately. CONCLUSION National disparity estimates may mask what is true at the more local, state level because national estimates can confound the effects of race with place. Cancer control efforts are local and require locally relevant information to assess needs. Findings from the period 2004-2009 establish valuable benchmarks against which to assess changes following national health reform implemented in 2010. The USCS database is a valuable new resource that will facilitate future disparities research.
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Affiliation(s)
- Lee R. Mobley
- School of Public Health and Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA USA
| | - Tzy-Mey Kuo
- Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Perrier MJ, Martin Ginis KA. Narrative interventions for health screening behaviours: A systematic review. J Health Psychol 2017; 22:375-393. [PMID: 26359288 DOI: 10.1177/1359105315603463] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Health information can be presented in different formats, such as a statistically-based or a story-based (e.g. narrative) format; however, there is no consensus on the ideal way to present screening information. This systematic review summarizes the literature pertaining to narrative interventions' efficacy at changing screening behaviour and its determinants. Five psychology and public health databases were searched; 19 studies, 18 focused on cancer and 1 on sexual health, met eligibility criteria. There is consistent evidence supporting the efficacy of narratives, but mixed evidence supporting an advantage for narratives over statistical interventions for screening behaviour and its determinants. Further investigation is warranted.
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Kumarasamy H, Veerakumar AM, Subhathra S, Suga Y, Murugaraj R. Determinants of Awareness and Practice of Breast Self Examination Among Rural Women in Trichy, Tamil Nadu. J Midlife Health 2017; 8:84-88. [PMID: 28706409 PMCID: PMC5496285 DOI: 10.4103/jmh.jmh_79_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Breast cancer is the most common cancer among women worldwide, and it can be detected at an early stage through self-examination which increases the chance of survival. This study aimed to assess knowledge and practice of breast self-examination (BSE) among females in a rural area of Trichy district. Methodology: This community-based, cross-sectional study was carried out among a total sample of 200 women in rural area of Trichy. The participants were interviewed using a structured interviewer-administered questionnaire to obtain information on their sociodemographic characteristics, awareness on breast cancer, and knowledge, attitude, practice of BSE. Data were entered into MS Excel and analyzed using SPSS version 20.0. Spearman correlation and Chi-square test were used to analyze the association between the variables. Results: The mean age of the study group was 36.9 ± 8.8 years. Eighty percent were literates. Most of the women 178 (89%) were aware of breast cancer. Only 26% of the women were aware of BSE. Only 18% of the females had ever checked their breast and 5% practiced it regularly. Awareness of BSE was found to be significantly associated with age and educational attainment. Conclusion: The level of knowledge and practice of BSE among females are unacceptably low. Efforts should be made to increase level of knowledge and practice of BSE through health education programs.
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Affiliation(s)
- Hemalatha Kumarasamy
- Department of Community Medicine, Chennai Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India
| | - A M Veerakumar
- Department of Community Medicine, Chennai Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India
| | - S Subhathra
- Department of Community Medicine, Chennai Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India
| | - Y Suga
- Department of Community Medicine, Chennai Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India
| | - R Murugaraj
- Department of Community Medicine, Chennai Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India
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Travel distance to screening facilities and completion of abnormal mammographic follow-up among disadvantaged women. Ann Epidemiol 2017; 27:35-41. [DOI: 10.1016/j.annepidem.2016.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/09/2016] [Accepted: 08/17/2016] [Indexed: 01/14/2023]
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Lee SJC, Clark MA, Cox JV, Needles BM, Seigel C, Balasubramanian BA. Achieving Coordinated Care for Patients With Complex Cases of Cancer: A Multiteam System Approach. J Oncol Pract 2016; 12:1029-1038. [PMID: 27577621 PMCID: PMC5356468 DOI: 10.1200/jop.2016.013664] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patients with cancer with multiple chronic conditions pose a unique challenge to how primary care and specialty care teams provide well-coordinated, patient-centered care. Effectiveness of these care teams in providing optimal health care depends on the extent to which they coordinate their goals and knowledge as components of a multiteam system (MTS). This article outlines challenges of care coordination in the context of an MTS, illustrated through the care experience of "Mr Fuentes," a patient in the Dallas County integrated safety-net system, Parkland. As a continuing patient with chronic illnesses, the patient being discussed is managed through one of the Parkland community-oriented primary care clinics. However, a cancer diagnosis triggered an additional need for augmented coordination between his different provider teams. Further research and practice should investigate the relationships of MTS coordination for shared care management, transfer to and from specialty care, treatment compliance, barriers to care, and health outcomes of chronic comorbid conditions, as well as cancer control and surveillance.
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Affiliation(s)
- Simon J. Craddock Lee
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Mark A. Clark
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - John V. Cox
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Burton M. Needles
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Carole Seigel
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Bijal A. Balasubramanian
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
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Laghzaoui O. [Medical history of a breast cancer: about a case!!! How to react]. Pan Afr Med J 2016; 24:56. [PMID: 27642397 PMCID: PMC5012778 DOI: 10.11604/pamj.2016.24.56.8721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 03/30/2016] [Indexed: 11/11/2022] Open
Abstract
Locally advanced breast cancer is a rare entity in developed countries while we continue to treat patients with advanced stage tumor in African countries. Our study reports the case of an intellectual patient referring the presence of a right breast nodule found during self-examination treated at the military hospital of Meknes, Morocco; she was examined only six months after discovery, in a historical state of locally advanced breast cancer. Our study aims to detect the contemporary anomalies leading to a delayed diagnosis of the breast cancer and to propose solutions to increase awareness among population.
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Affiliation(s)
- Omar Laghzaoui
- Laghzaoui, Service de Gynécologie Obstétrique de l'Hôpital Militaire Moulay Ismail, Université Sidi Mohammed Ben Abdellah, Faculté de Médecine et de Pharmacie, Fès, Maroc
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Drake BF, Tannan S, Anwuri VV, Jackson S, Sanford M, Tappenden J, Goodman MS, Colditz GA. A Community-Based Partnership to Successfully Implement and Maintain a Breast Health Navigation Program. J Community Health 2016; 40:1216-23. [PMID: 26077018 PMCID: PMC4626535 DOI: 10.1007/s10900-015-0051-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Breast cancer screening combined with follow-up and treatment reduces breast cancer mortality. However, in the study clinic, only 12 % of eligible women ≥40 years received a mammogram in the previous year. The objective of this project was to implement patient navigation, in our partner health clinic to (1) identify women overdue for a mammogram; and (2) increase mammography utilization in this population over a 2-year period. Women overdue for a mammogram were identified. One patient navigator made navigation attempts over a 2-year period (2009-2011). Navigation included working around systems- and individual-level barriers to receive a mammogram as well as the appropriate follow-up post screening. Women were contacted up to three times to initiate navigation. The proportion of women navigated and who received a mammogram during the study period were compared to women who did not receive a mammogram using Chi square tests for categorical variables and t tests for continuous variables with an α = 0.05. Barriers to previous mammography were also assessed. With 94.8 % of eligible women navigated and 94 % of these women completing mammography, the implementation project reached 89 % of the target population. This project was a successful implementation of an evidence-based patient navigation program that continues to provide significant impact in a high-need area. Cost was the most commonly cite barrier to mammography. Increasing awareness of resources in the community for mammography and follow-up care remains a necessary adjunct to removing structural and financial barriers to accessing preventive services.
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Affiliation(s)
- Bettina F Drake
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA. .,Alvin J. Siteman Cancer Center, St. Louis, MO, USA. .,Institute of Public Health, Washington University, St. Louis, MO, USA.
| | - Shivon Tannan
- Betty Jean Kerr People's Health Centers, St. Louis, MO, USA
| | - Victoria V Anwuri
- Institute of Public Health, Washington University, St. Louis, MO, USA
| | | | - Mark Sanford
- Betty Jean Kerr People's Health Centers, St. Louis, MO, USA
| | - Jennifer Tappenden
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA
| | - Melody S Goodman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, St. Louis, MO, USA.,Institute of Public Health, Washington University, St. Louis, MO, USA
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Lin Y, Wimberly MC. Geographic Variations of Colorectal and Breast Cancer Late-Stage Diagnosis and the Effects of Neighborhood-Level Factors. J Rural Health 2016; 33:146-157. [DOI: 10.1111/jrh.12179] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/11/2016] [Accepted: 02/06/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Yan Lin
- Department of Geography; South Dakota State University; Brookings South Dakota
| | - Michael C. Wimberly
- Geospatial Sciences Center of Excellence; South Dakota State University; Brookings South Dakota
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Fedewa SA, Sauer AG, Siegel RL, Jemal A. Prevalence of major risk factors and use of screening tests for cancer in the United States. Cancer Epidemiol Biomarkers Prev 2016; 24:637-52. [PMID: 25834147 DOI: 10.1158/1055-9965.epi-15-0134] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Much of the suffering and death from cancer could be prevented by more systematic efforts to reduce tobacco use, improve diet, increase physical activity, reduce obesity, and expand the use of established screening tests. Monitoring the prevalence of cancer risk factors and screening is important to measure progress and strengthen cancer prevention and early detection efforts. In this review article, we provide recent prevalence estimates for several cancer risk factors, including tobacco, obesity, physical activity, nutrition, ultraviolet radiation exposure as well as human papillomavirus and hepatitis B vaccination coverage and cancer screening prevalence in the United States. In 2013, cigarette smoking prevalence was 17.8% among adults nationally, but ranged from 10.3% in Utah to 27.3% in West Virginia. In addition, 15.7% of U.S. high school students were current smokers. In 2011-2012, obesity prevalence was high among both adults (34.9%) and adolescents (20.5%), but has leveled off since 2002. About 20.2% of high school girls were users of indoor tanning devices, compared with 5.3% of boys. In 2013, cancer screening prevalence ranged from 58.6% for colorectal cancer to 80.8% for cervical cancer and remains low among the uninsured, particularly for colorectal cancer screening where only 21.9% of eligible adults received recommended colorectal cancer screening.
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Affiliation(s)
- Stacey A Fedewa
- Department of Intramural Research, American Cancer Society, Atlanta, Georgia. Department of Epidemiology, Emory University, Atlanta, Georgia.
| | - Ann Goding Sauer
- Department of Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Department of Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Intramural Research, American Cancer Society, Atlanta, Georgia
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Chen YR, Chang-Halpenny C, Kumarasamy NA, Venegas A, Braddock Iii CH. Perspectives of Mobile Versus Fixed Mammography in Santa Clara County, California: A Focus Group Study. Cureus 2016; 8:e494. [PMID: 27014528 PMCID: PMC4792640 DOI: 10.7759/cureus.494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Our aim was to examine underserved women’s perceptions on mobile versus fixed mammography in Santa Clara, California through a focus group study. Background: Research has shown that medically underserved women have higher breast cancer mortality rates correlated with under-screening and a disproportional rate of late-stage diagnosis. The Community Health Partnership in Santa Clara County, California runs the Community Mammography Access Project (CMAP) that targets nearly 20,000 medically underserved women over the age of 40 in the county through the collaborative effort of an existing safety net of healthcare providers. However, little data exists on the advantages or disadvantages of mobile mammography units from the patient perspective. Methods: We assessed underserved women’s perspectives on mammography services in Santa Clara County through two focus groups from women screened at mobile or fixed site programs. Patients were recruited from both CMAP clinics and a county hospital, and focus group data were analyzed using content analysis. Results: We found that women from both the mobile and fixed sites shared similar motivating factors for getting a mammogram. Both groups recognized that screening was uncomfortable but necessary for good health and had positive feedback about their personal physicians. However, mobile participants, in particular, appreciated the atmosphere of mobile screening, reported shorter wait times, and remarked on the good communication from the clinic staff and empathetic treatment they received. However, mobile participants also expressed concern about the quality of films at mobile sites due to delayed initial reading of the films. Conclusions: Mobile mammography offers a unique opportunity for women of underserved populations to access high satisfaction screenings, and it encourages a model similar to CMAP in other underserved areas. However, emphasis should be placed on providing a warm and welcoming environment for patients and ensuring the quality of mammography images.
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Affiliation(s)
- Yi-Ren Chen
- Department of Neurosurgery, Stanford University School of Medicine
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Lipscomb J, Fleming ST, Trentham-Dietz A, Kimmick G, Wu XC, Morris CR, Zhang K, Smith RA, Anderson RT, Sabatino SA. What Predicts an Advanced-Stage Diagnosis of Breast Cancer? Sorting Out the Influence of Method of Detection, Access to Care, and Biologic Factors. Cancer Epidemiol Biomarkers Prev 2016; 25:613-23. [PMID: 26819266 DOI: 10.1158/1055-9965.epi-15-0225] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 12/11/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiple studies have yielded important findings regarding the determinants of an advanced-stage diagnosis of breast cancer. We seek to advance this line of inquiry through a broadened conceptual framework and accompanying statistical modeling strategy that recognize the dual importance of access-to-care and biologic factors on stage. METHODS The Centers for Disease Control and Prevention-sponsored Breast and Prostate Cancer Data Quality and Patterns of Care Study yielded a seven-state, cancer registry-derived population-based sample of 9,142 women diagnosed with a first primary in situ or invasive breast cancer in 2004. The likelihood of advanced-stage cancer (American Joint Committee on Cancer IIIB, IIIC, or IV) was investigated through multivariable regression modeling, with base-case analyses using the method of instrumental variables (IV) to detect and correct for possible selection bias. The robustness of base-case findings was examined through extensive sensitivity analyses. RESULTS Advanced-stage disease was negatively associated with detection by mammography (P < 0.001) and with age < 50 (P < 0.001), and positively related to black race (P = 0.07), not being privately insured [Medicaid (P = 0.01), Medicare (P = 0.04), uninsured (P = 0.07)], being single (P = 0.06), body mass index > 40 (P = 0.001), a HER2 type tumor (P < 0.001), and tumor grade not well differentiated (P < 0.001). This IV model detected and adjusted for significant selection effects associated with method of detection (P = 0.02). Sensitivity analyses generally supported these base-case results. CONCLUSIONS Through our comprehensive modeling strategy and sensitivity analyses, we provide new estimates of the magnitude and robustness of the determinants of advanced-stage breast cancer. IMPACT Statistical approaches frequently used to address observational data biases in treatment-outcome studies can be applied similarly in analyses of the determinants of stage at diagnosis. Cancer Epidemiol Biomarkers Prev; 25(4); 613-23. ©2016 AACR.
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Affiliation(s)
- Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, Georgia.
| | - Steven T Fleming
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky
| | | | - Gretchen Kimmick
- Department of Internal Medicine, Medical Oncology, Duke University Medical Center and Multidisciplinary Breast Cancer Program, Duke Cancer Institute, Durham, North Carolina
| | - Xiao-Cheng Wu
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Cyllene R Morris
- California Cancer Registry, Institute for Population Health Improvement, UC Davis Health System, Sacramento, California
| | - Kun Zhang
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia School of Medicine, and UVA Cancer Center, Charlottesville, Virginia
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Fahey KR. The Pioneering Role of the Vaccine Safety Datalink Project (VSD) to Advance Collaborative Research and Distributed Data Networks. EGEMS 2015; 3:1195. [PMID: 26793736 PMCID: PMC4708093 DOI: 10.13063/2327-9214.1195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Large-scale distributed data networks consisting of diverse stakeholders including providers, patients, and payers are changing health research in terms of methods, speed and efficiency. The Vaccine Safety Datalink (VSD) set the stage for expanded involvement of health plans in collaborative research. Expanding Surveillance Capacity and Progress Toward a Learning Health System: From an initial collaboration of four integrated health systems with fewer than 10 million covered lives to 16 diverse health plans with nearly 100 million lives now in the FDA Sentinel, the expanded engagement of health plan researchers has been essential to increase the value and impact of these efforts. The collaborative structure of the VSD established a pathway toward research efforts that successfully engage all stakeholders in a cohesive rather than competitive manner. The scientific expertise and methodology developed through the VSD such as rapid cycle analysis (RCA) to conduct near real-time safety surveillance allowed for the development of the expanded surveillance systems that now exist. Building on Success and Lessons Learned: These networks have learned from and built on the knowledge base and infrastructure created by the VSD investigators. This shared technical knowledge and experience expedited the development of systems like the FDA’s Mini-Sentinel and the Patient Centered Outcomes Research Institute (PCORI)’s PCORnet Conclusion: This narrative reviews the evolution of the VSD, its contribution to other collaborative research networks, longer-term sustainability of this type of distributed research, and how knowledge gained from the earlier efforts can contribute to a continually learning health system.
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Singal AG, El-Serag HB. Hepatocellular Carcinoma From Epidemiology to Prevention: Translating Knowledge into Practice. Clin Gastroenterol Hepatol 2015; 13:2140-51. [PMID: 26284591 PMCID: PMC4618036 DOI: 10.1016/j.cgh.2015.08.014] [Citation(s) in RCA: 383] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 02/07/2023]
Abstract
The epidemiology of hepatocellular carcinoma (HCC) is characterized by dynamic temporal trends, several major established (i.e., HCV, HBV, alcohol) and emerging (i.e., diabetes, obesity, NAFLD) risk factors. Epidemiologic studies and clinical trials have identified additional demographic, clinical, pharmacological, genetic and life style factors that further affect or modify the likelihood of HCC and can be used in clinical practice to identify at-risk patients (i.e., risk stratification or prognostic algorithms) that can be targeted for prevention and early detection programs. These studies have also paved the way toward several well established preventive measures including HBV vaccination, HBV treatment, HCV treatment and HCC surveillance, and potential chemoprevention using statins, metformin or coffee. However, the effectiveness of HCC prevention in clinical practice and at the population level has lagged behind due to patient, provider, system, and societal factors. The Quality in the Continuum of Cancer Care model provides a framework for evaluating the HCC prevention processes, including potential failures that create a gap between efficacy and effectiveness.
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Affiliation(s)
- Amit G Singal
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology and Center (Center for Innovations in Quality, Effectiveness and Safety), Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas.
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Molina Y, Ornelas IJ, Doty SL, Bishop S, Beresford SAA, Coronado GD. Family/friend recommendations and mammography intentions: the roles of perceived mammography norms and support. HEALTH EDUCATION RESEARCH 2015; 30:797-809. [PMID: 26324395 PMCID: PMC4654755 DOI: 10.1093/her/cyv040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 08/06/2015] [Indexed: 05/07/2023]
Abstract
Identifying factors that increase mammography use among Latinas is an important public health priority. Latinas are more likely to report mammography intentions and use, if a family member or friend recommends that they get a mammogram. Little is known about the mechanisms underlying the relationship between social interactions and mammography intentions. Theory suggests that family/friend recommendations increase perceived mammography norms (others believe a woman should obtain a mammogram) and support (others will help her obtain a mammogram), which in turn increase mammography intentions and use. We tested these hypotheses with data from the ¡Fortaleza Latina! study, a randomized controlled trial including 539 Latinas in Washington State. Women whose family/friend recommended they get a mammogram within the last year were more likely to report mammography intentions, norms and support. Perceived mammography norms mediated the relationship between family/friend recommendations and intentions, Mediated Effect = 0.38, 95%CI [0.20, 0.61], but not support, Mediated Effect = 0.002, 95%CI [-0.07, 0.07]. Our findings suggest perceived mammography norms are a potential mechanism underlying the effect of family/friend recommendations on mammography use among Latinas. Our findings make an important contribution to theory about the associations of social interactions, perceptions and health behaviors.
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Affiliation(s)
- Yamile Molina
- Community Health Sciences Division, University of Illinois-Chicago, Chicago, IL 60607, USA, Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA,
| | - India J Ornelas
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA, Department of Health Services, University of Washington, Seattle, WA 98122, USA
| | - Sarah L Doty
- Sea Mar community Health Centers, Seattle, WA 98108, USA
| | - Sonia Bishop
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Shirley A A Beresford
- Sea Mar community Health Centers, Seattle, WA 98108, USA, Department of Epidemiology, University of Washington, Seattle, WA 98122, USA and
| | - Gloria D Coronado
- Kaiser Permanente Research Center for Health Research, Portland, OR 97227, USA
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Beaber EF, Kim JJ, Schapira MM, Tosteson ANA, Zauber AG, Geiger AM, Kamineni A, Weaver DL, Tiro JA. Unifying screening processes within the PROSPR consortium: a conceptual model for breast, cervical, and colorectal cancer screening. J Natl Cancer Inst 2015; 107:djv120. [PMID: 25957378 PMCID: PMC4838064 DOI: 10.1093/jnci/djv120] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/18/2015] [Accepted: 04/03/2015] [Indexed: 12/13/2022] Open
Abstract
General frameworks of the cancer screening process are available, but none directly compare the process in detail across different organ sites. This limits the ability of medical and public health professionals to develop and evaluate coordinated screening programs that apply resources and population management strategies available for one cancer site to other sites. We present a trans-organ conceptual model that incorporates a single screening episode for breast, cervical, and colorectal cancers into a unified framework based on clinical guidelines and protocols; the model concepts could be expanded to other organ sites. The model covers four types of care in the screening process: risk assessment, detection, diagnosis, and treatment. Interfaces between different provider teams (eg, primary care and specialty care), including communication and transfer of responsibility, may occur when transitioning between types of care. Our model highlights across each organ site similarities and differences in steps, interfaces, and transitions in the screening process and documents the conclusion of a screening episode. This model was developed within the National Cancer Institute-funded consortium Population-based Research Optimizing Screening through Personalized Regimens (PROSPR). PROSPR aims to optimize the screening process for breast, cervical, and colorectal cancer and includes seven research centers and a statistical coordinating center. Given current health care reform initiatives in the United States, this conceptual model can facilitate the development of comprehensive quality metrics for cancer screening and promote trans-organ comparative cancer screening research. PROSPR findings will support the design of interventions that improve screening outcomes across multiple cancer sites.
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Affiliation(s)
- Elisabeth F Beaber
- : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT).
| | - Jane J Kim
- : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT)
| | - Marilyn M Schapira
- : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT)
| | - Anna N A Tosteson
- : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT)
| | - Ann G Zauber
- : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT)
| | - Ann M Geiger
- : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT)
| | - Aruna Kamineni
- : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT)
| | - Donald L Weaver
- : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT)
| | - Jasmin A Tiro
- : Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT)
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46
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Taplin SH, Weaver S, Chollette V, Marks LB, Jacobs A, Schiff G, Stricker CT, Bruinooge SS, Salas E. Teams and teamwork during a cancer diagnosis: interdependency within and between teams. J Oncol Pract 2015; 11:231-8. [PMID: 25873059 DOI: 10.1200/jop.2014.003376] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This article discusses the care process among three groups (primary care, radiology, and surgery) aiding a 57-year-old woman during her screening mammography and diagnosis of breast cancer. This is the first in a series of articles exploring principles and topics relevant to teams guiding clinicians involved in cancer care. The challenges demonstrated in this case illustrate how clinicians work within and between groups to deliver this first phase of cancer care. The case helps demonstrate the differences between groups and teams. Focusing on the patient and the overall process of care coordination can help move groups toward becoming teams who deliver better care by identifying and managing goals, roles, and interdependent care tasks. Care providers and researchers can use the case to consider their own work and essential aspects of teamwork needed to improve care, patient outcomes, and the evidence that supports each.
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Affiliation(s)
- Stephen H Taplin
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, MD; University of North Carolina, Chapel Hill, NC; Virginia Mason Hospital and Medical Center, Seattle, WA; Brigham and Women's Hospital, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; American Society of Clinical Oncology, Alexandria, VA; and University of Central Florida, Orlando, FL
| | - Sallie Weaver
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, MD; University of North Carolina, Chapel Hill, NC; Virginia Mason Hospital and Medical Center, Seattle, WA; Brigham and Women's Hospital, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; American Society of Clinical Oncology, Alexandria, VA; and University of Central Florida, Orlando, FL
| | - Veronica Chollette
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, MD; University of North Carolina, Chapel Hill, NC; Virginia Mason Hospital and Medical Center, Seattle, WA; Brigham and Women's Hospital, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; American Society of Clinical Oncology, Alexandria, VA; and University of Central Florida, Orlando, FL
| | - Lawrence B Marks
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, MD; University of North Carolina, Chapel Hill, NC; Virginia Mason Hospital and Medical Center, Seattle, WA; Brigham and Women's Hospital, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; American Society of Clinical Oncology, Alexandria, VA; and University of Central Florida, Orlando, FL
| | - Andrew Jacobs
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, MD; University of North Carolina, Chapel Hill, NC; Virginia Mason Hospital and Medical Center, Seattle, WA; Brigham and Women's Hospital, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; American Society of Clinical Oncology, Alexandria, VA; and University of Central Florida, Orlando, FL
| | - Gordon Schiff
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, MD; University of North Carolina, Chapel Hill, NC; Virginia Mason Hospital and Medical Center, Seattle, WA; Brigham and Women's Hospital, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; American Society of Clinical Oncology, Alexandria, VA; and University of Central Florida, Orlando, FL
| | - Carrie T Stricker
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, MD; University of North Carolina, Chapel Hill, NC; Virginia Mason Hospital and Medical Center, Seattle, WA; Brigham and Women's Hospital, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; American Society of Clinical Oncology, Alexandria, VA; and University of Central Florida, Orlando, FL
| | - Suanna S Bruinooge
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, MD; University of North Carolina, Chapel Hill, NC; Virginia Mason Hospital and Medical Center, Seattle, WA; Brigham and Women's Hospital, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; American Society of Clinical Oncology, Alexandria, VA; and University of Central Florida, Orlando, FL
| | - Eduardo Salas
- National Cancer Institute, Bethesda; Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, MD; University of North Carolina, Chapel Hill, NC; Virginia Mason Hospital and Medical Center, Seattle, WA; Brigham and Women's Hospital, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; American Society of Clinical Oncology, Alexandria, VA; and University of Central Florida, Orlando, FL
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47
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The association between diabetes and breast cancer stage at diagnosis: a population-based study. Breast Cancer Res Treat 2015; 150:613-20. [PMID: 25779100 DOI: 10.1007/s10549-015-3323-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/23/2015] [Indexed: 12/14/2022]
Abstract
Women with diabetes have higher breast cancer incidence and mortality. The purpose of this study was to examine the impact of diabetes on stage at breast cancer diagnosis, as a possible reason for their higher mortality. Using population-based health databases from Ontario, Canada, this retrospective cohort study examined stage at diagnosis (II, III, or IV vs I) among women aged 20-105 years who were newly diagnosed with invasive breast cancer between 2007 and 2012. We compared those with diabetes to those without diabetes. Diabetes was defined based on medical records using a validated algorithm. Among 38,407 women with breast cancer, 6115 (15.9 %) women had diabetes. Breast cancer patients with diabetes were significantly more likely to present with advanced-stage breast cancer than those without diabetes. After adjustment for mammograms and other covariates, diabetes was associated with a significantly increased risk of Stage II [adjusted odds ratio (aOR) 1.14, 95 % confidence interval (CI) 1.07, 1.22], Stage III (aOR 1.21, 95 % CI 1.11, 1.33), and Stage IV (aOR 1.16, 95 % CI 1.01, 1.33) versus Stage I breast cancer. Women with diabetes had a higher risk of lymph node metastases (aOR 1.16, 95 % CI 1.06, 1.27) and tumors with size over 2 cm (aOR 1.16, 95 % CI 1.06, 1.28). Diabetes was associated with more advanced-stage breast cancer, even after accounting for differences in screening mammogram use and other factors. Our findings suggest that diabetes may predispose to more aggressive breast cancer, which may be a contributor to their higher cancer mortality.
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48
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Miller JW, Plescia M, Ekwueme DU. Public health national approach to reducing breast and cervical cancer disparities. Cancer 2014; 120 Suppl 16:2537-9. [PMID: 25099895 DOI: 10.1002/cncr.28818] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 11/11/2022]
Abstract
Breast and cervical cancer have had disparate impact on the lives of women. The burden of breast and cervical cancer is more prominent among some racial and ethnic minority women. Providing comprehensive care to all medically underserved women is a critical element in continuing the battle to reduce cancer burden and eliminate disparities. The National Breast and Cervical Cancer Early Detection Program is the only nationally organized cancer screening program for underserved women in the United States. Its public health goal is to ensure access to high-quality screening, follow-up, and treatment services for diverse and vulnerable populations that, in turn, may reduce disparities.
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Affiliation(s)
- Jacqueline W Miller
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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49
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Mobley LR, Kuo TM, Traczynski J, Udalova V, Frech HE. Macro-level factors impacting geographic disparities in cancer screening. HEALTH ECONOMICS REVIEW 2014; 4:13. [PMID: 26054402 PMCID: PMC4883991 DOI: 10.1186/s13561-014-0013-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 06/26/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Examine how differences in state regulatory environments predict geographic disparities in the utilization of cancer screening. DATA SOURCES/SETTING 100% Medicare fee-for-service population data from 2001-2005 was developed as multi-year breast (BC) and colorectal cancer (CRC) screening utilization rates in each county in the US. STUDY DESIGN A comprehensive set of supply and demand predictors are used in a multilevel model of county-level cancer screening utilization in the context of state regulatory markets. States dictate insurance mandates/regulations and whether alternative providers (nurse practitioners) can provide preventive care services supplied by MDs. Controlling statistically for the supply of both types of providers, we study the joint effects of two private insurance regulations: one mandating that insureds with serious or chronic health conditions may receive continuity of care from their established physician(s) after changing health insurance plans, and another mandating that external grievance review is an option for all health plan coverage/denial decisions. These private insurance plan regulations are expected to affect the degree of beneficial spillovers from managed care practices, which may have increased area-wide cancer screening rates. PRINCIPAL FINDINGS The two private insurance regulations under study were significant predictors impacted by local market conditions. Managed care spillovers in local markets were significantly associated with higher BC screening rates, but only in states lacking the two forms of regulation under study. Spillovers were significantly associated with higher CRC cancer screening rates everywhere, but much higher in the unregulated states. Area poverty dampened screening rates, but less so for CRC screening in the states with these regulations. CONCLUSIONS Two state insurance regulations that empowered consumers with more autonomy to make informed utilization decisions varied across states, and exhibited significant associations with screening rates, which varied with the degree of managed care penetration or poverty in the state's counties. Beneficial spillover effects from managed care practices and negative influences from area poverty are not uniform across the United States. Both variables had stronger associations with CRC than BC screening utilization, as did state regulatory variables. CRC screening by endoscopy was more subject to market and regulatory factors than BC screening.
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Affiliation(s)
- Lee R Mobley
- />School of Public Health and Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA USA
| | - Tzy-Mey Kuo
- />Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Jeffrey Traczynski
- />Department of Economics, University of Hawaii at Manoa, Honolulu, HI 96822 USA
| | - Victoria Udalova
- />Department of Economics, University of Wisconsin-Madison, Madison, WI 53706 USA
| | - HE Frech
- />Department of Economics, University of California, Santa Barbara, CA USA
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50
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Tiro JA, Kamineni A, Levin TR, Zheng Y, Schottinger JS, Rutter CM, Corley DA, Skinner CS, Chubak J, Doubeni CA, Halm EA, Gupta S, Wernli KJ, Klabunde C. The colorectal cancer screening process in community settings: a conceptual model for the population-based research optimizing screening through personalized regimens consortium. Cancer Epidemiol Biomarkers Prev 2014; 23:1147-58. [PMID: 24917182 PMCID: PMC4148641 DOI: 10.1158/1055-9965.epi-13-1217] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Reducing colorectal cancer mortality by promoting screening has been a national goal for two decades. The NCI's Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium is the first federal initiative to foster coordinated, transdisciplinary research evaluating the entire cancer screening process in community settings. PROSPR is creating a central data repository to facilitate research evaluating the breast, cervical, and colorectal cancer screening process across different patient populations, provider types, and delivery systems. Data are being collected and organized at the multiple levels in which individuals are nested (e.g., healthcare systems, facilities, providers, and patients). Here, we describe a conceptual model of the colorectal cancer screening process guiding data collection and highlight critical research questions that will be addressed through pooled data. We also describe the three research centers focused on colorectal cancer screening with respect to study populations, practice settings, and screening policies. PROSPR comprehensively elucidates the complex screening process through observational study, and has potential to improve care delivery beyond the healthcare systems studied. Findings will inform intervention designs and policies to optimize colorectal cancer screening delivery and advance the Institute of Medicine's goals of effective, efficient, coordinated, timely, and safe health care with respect to evidence-based cancer screening.
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Affiliation(s)
- Jasmin A Tiro
- Authors' Affiliations: Department of Clinical Sciences, University of Texas Southwestern Medical Center and Harold C. Simmons Cancer Center, Dallas, Texas;
| | | | | | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | - Celette S Skinner
- Authors' Affiliations: Department of Clinical Sciences, University of Texas Southwestern Medical Center and Harold C. Simmons Cancer Center, Dallas, Texas
| | | | - Chyke A Doubeni
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ethan A Halm
- Authors' Affiliations: Department of Clinical Sciences, University of Texas Southwestern Medical Center and Harold C. Simmons Cancer Center, Dallas, Texas
| | - Samir Gupta
- Veterans Affairs San Diego Healthcare System, San Diego; Division of Gastroenterology, University of California San Diego, La Jolla, California
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