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Tarver WL, Justice Z, Jonnalagadda P, Rahurkar S, Obeng-Gyasi S, Krok-Schoen JL, Petrecca A, Paskett ED. A scoping review of the evidence on survivorship care plans among minority, rural, and low-income populations. J Cancer Surviv 2024:10.1007/s11764-024-01609-z. [PMID: 38907799 DOI: 10.1007/s11764-024-01609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 04/19/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE Despite recent advances in cancer control and the number of cancer survivors increasing substantially over the past years, some cancer survivors continue to experience disparities due to barriers to recommended survivorship care. The use of survivorship care plans (SCPs) may be a way to help care for these individuals and their respective issues after they complete their primary treatment. The purpose of this scoping review is to understand the evidence on SCPs among minority, rural, and low-income populations: groups that experience disproportionately poorer cancer health outcomes. METHODS Computer-based searches were conducted in four academic databases. We included peer-reviewed studies published in the English language and conducted in the USA. We systematically extracted information from each paper meeting our inclusion criteria. RESULTS Our search identified 45 articles. The 4 major themes identified were (1) disparities in the receipt of SCPs where populations experience unmet needs; (2) benefits of SCPs, including improved care coordination and self-management of cancer; (3) needs and preferences for survivorship care; and (4) barriers and facilitators to using SCPs. CONCLUSIONS Despite the potential benefits, underserved cancer survivors experience disparities in the receipt of SCPs and continue to have unmet needs in their survivorship care. Survivorship care may benefit from a risk-stratified approach where SCPs are prioritized to survivors belonging to high-risk groups. IMPLICATIONS FOR CANCER SURVIVORS SCPs are a tool to deliver quality care for cancer survivors. While evidence is mixed on SCPs' benefits among the general population, SCPs show promise for underserved populations when it comes to proximal outcomes that contribute to disparities.
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Affiliation(s)
- Willi L Tarver
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | | | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Abigail Petrecca
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Miller MF, Olson JS, Doughtie K, Zaleta AK, Rogers KP. The interplay of financial toxicity, health care team communication, and psychosocial well-being among rural cancer patients and survivors. J Rural Health 2024; 40:128-137. [PMID: 37449966 DOI: 10.1111/jrh.12779] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/15/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Financial toxicity contributes to psychosocial distress among cancer patients and survivors. Yet, contextual factors unique to rural settings affect patient experiences, and a deeper understanding is needed of the interplay between financial toxicity and health care team communication and its association with psychosocial well-being among rural oncology patients. PURPOSE We examined associations between financial toxicity and psychosocial well-being among rural cancer patients, exploring variability in these linkages by health care team communication. METHODS Using data from 273 rural cancer patients who participated in Cancer Support Community's Cancer Experience Registry, we estimated multivariable regression models predicting depression, anxiety, and social function by financial toxicity, health care team communication, and the interplay between them. RESULTS We demonstrate robust associations between financial toxicity and psychosocial outcomes among our sample of rural cancer patients and survivors. As financial toxicity increased, symptoms of depression and anxiety increased. Further, financial toxicity was linked with decreasing social function. Having health care team conversations about treatment costs and distress-related care reduced the negative impact of financial toxicity on depressive symptoms and social function, respectively, in rural cancer patients at greatest risk for financial burden. CONCLUSIONS Financial toxicity and psychosocial well-being are strongly linked, and these associations were confirmed in a rural sample. A theorized buffer to the detrimental impacts of financial toxicity-health care team communication-played a role in moderating these associations. Our findings suggest that health care providers in rural oncology settings may benefit from tools and resources to bolster communication with patients about costs, financial distress, and coordination of care.
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Affiliation(s)
- Melissa F Miller
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Julie S Olson
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Kara Doughtie
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Alexandra K Zaleta
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Kimberly P Rogers
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
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Keimweiss S, Gurolnick A, Grant S, Burris J, Studts J, Lewis-Thames M. "Just give it to us straight!": a qualitative analysis of midwestern rural lung cancer survivors and caregivers about survivorship care experiences. J Cancer Surviv 2023:10.1007/s11764-023-01445-7. [PMID: 37632652 PMCID: PMC10895068 DOI: 10.1007/s11764-023-01445-7] [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: 06/26/2023] [Accepted: 08/02/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE We assessed the experiences of rural lung cancer survivors and caregivers to understand and identify barriers to posttreatment survivorship care management. METHODS From May 2021 to June 2022, we conducted semi-structured interviews with a purposively sampled cohort. Participants were either posttreatment lung cancer survivors (within 5 years of their last active treatment) or caregivers of a lung cancer survivor. Interviews probed participants regarding survivorship care knowledge, implementation, and navigation. Two analysts inductively coded verbatim transcripts and conducted a thematic analysis. RESULTS We interviewed N = 21 participants: lung cancer survivors (76%) and caregivers (24%). Participants self-identified as Non-Hispanic White (100%), were at least 65 years old (77%), identified as male (62%), and previously smoked ≥ 5 packs over the lifetime (71%). The perspectives of survivors and caregivers were similar; thus, we analyzed them together. Themes related to survivorship care included (1) frustrations and uncertainty regarding unexpected barriers, (2) strategies to improve the delivery of posttreatment information, (3) strategies to remain positive and respond to emotional concerns of survivorship care, and (4) the impact of engaging and patient-centered care teams. CONCLUSION Given the limited access to lung cancer care resources in rural communities, our findings reveal that following a survivorship care program or plan requires a high level of individual resilience and community/interpersonal networking. IMPLICATIONS FOR SURVIVORS This study's findings can be applied to improve practice-based care for rural posttreatment lung cancer survivors and provide an impetus for developing tools to assist patient navigation toward community-based supportive care and care management resources.
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Affiliation(s)
| | | | - Shakira Grant
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jamie Studts
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Bhatia S, Landier W, Paskett ED, Peters KB, Merrill JK, Phillips J, Osarogiagbon RU. Rural-Urban Disparities in Cancer Outcomes: Opportunities for Future Research. J Natl Cancer Inst 2022; 114:940-952. [PMID: 35148389 PMCID: PMC9275775 DOI: 10.1093/jnci/djac030] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/27/2021] [Accepted: 02/01/2022] [Indexed: 01/12/2023] Open
Abstract
Cancer care disparities among rural populations are increasingly documented and may be worsening, likely because of the impact of rurality on access to state-of-the-art cancer prevention, diagnosis, and treatment services, as well as higher rates of risk factors such as smoking and obesity. In 2018, the American Society of Clinical Oncology undertook an initiative to understand and address factors contributing to rural cancer care disparities. A key pillar of this initiative was to identify knowledge gaps and promote the research needed to understand the magnitude of difference in outcomes in rural vs nonrural settings, the drivers of those differences, and interventions to address them. The purpose of this review is to describe continued knowledge gaps and areas of priority research to address them. We conducted a comprehensive literature review by searching the PubMed (Medline), Embase, Web of Science, and Cochrane Library databases for studies published in English between 1971 and 2021 and restricted to primary reports from populations in the United States and abstracted data to synthesize current evidence and identify continued gaps in knowledge. Our review identified continuing gaps in the literature regarding the underlying causes of rural-urban disparities in cancer outcomes. Rapid advances in cancer care will worsen existing disparities in outcomes for rural patients without directed effort to understand and address barriers to high-quality care in these areas. Research should be prioritized to address ongoing knowledge gaps about the drivers of rurality-based disparities and preventative and corrective interventions.
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Affiliation(s)
- Smita Bhatia
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Wendy Landier
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Schroeder MC, Gao X, Lizarraga I, Kahl AR, Charlton ME. The Impact of Commission on Cancer Accreditation Status, Hospital Rurality and Hospital Size on Quality Measure Performance Rates. Ann Surg Oncol 2022; 29:2527-2536. [PMID: 35067792 DOI: 10.1245/s10434-021-11304-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/10/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Rural cancer patients receive lower-quality care and experience worse outcomes than urban patients. Commission on Cancer (CoC) accreditation requires hospitals to monitor performance on evidence-based quality measuresPlease confirm the list of authors is correc, but the impact of accreditation is not clear due to lack of data from non-accredited facilities and confounding between patient rurality and hospital accreditation, rurality, and size. METHODS This retrospective, observational study assessed associations between rurality, accreditation, size, and performance rates for four CoC quality measures (breast radiation, breast chemotherapy, colon chemotherapy, colon nodal yield). Iowa Cancer Registry data were queried to identify all eligible patients diagnosed between 2011 and 2017. Cases were assigned to the surgery hospital to calculate performance rates. Univariate and multivariate regression models were fitted to identify patient- and hospital-level predictors and assess trends. RESULTS The study cohort included 10,381 patients; 46% were rural. Compared with urban patients, rural patients more often received treatment at small, rural, and non-accredited facilities (p < 0.001 for all). Rural hospitals had fewer beds and were far less likely to be CoC-accredited than urban hospitals (p < 0.001 for all). On multivariate analysis, CoC accreditation was the strongest, independent predictor of higher hospital performance for all quality measures evaluated (p < 0.05 in each model). Performance rates significantly improved over time only for the colon nodal yield quality measure, and only in urban hospitals. CONCLUSIONS CoC accreditation requires monitoring and evaluating performance on quality measures, which likely contributes to better performance on these measures. Efforts to support rural hospital accreditation may improve existing disparities in rural cancer treatment and outcomes.
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Affiliation(s)
- Mary C Schroeder
- Division of Health Services Research, University of Iowa College of Pharmacy, Iowa City, IA, USA.
| | - Xiang Gao
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Ingrid Lizarraga
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Amanda R Kahl
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Mary E Charlton
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, IA, USA.,Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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Strayhorn SM, Lewis-Thames MW, Carnahan LR, Henderson VA, Watson KS, Ferrans CE, Molina Y. Assessing the relationship between patient-provider communication quality and quality of life among rural cancer survivors. Support Care Cancer 2021; 29:1913-1921. [PMID: 32803725 PMCID: PMC7882640 DOI: 10.1007/s00520-020-05674-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE We explored relationships between patient-provider communication quality (PPCQ) and three quality of life (QOL) domains among self-identified rural cancer survivors: social well-being, functional well-being, and physical well-being. We hypothesized that high PPCQ would be associated with greater social and functional well-being, but be less associated with physical well-being, due to different theoretical mechanisms. METHODS All data were derived from the 2017-2018 Illinois Rural Cancer Assessment (IRCA). To measure PPCQ and QOL domains, we respectively used a dichotomous measure from the Medical Expenditure Panel Survey's Experience Cancer care tool (high, low/medium) and continuous measures from the Functional Assessment of Cancer Therapy-General (FACT-G). RESULTS Our sample of 139 participants was largely female, non-Hispanic White, married, and economically advantaged. After adjusting for demographic and clinical variables, patients who reported high PPCQ exhibited greater social well-being (Std. β = 0.20, 95% CI: 0.03, 0.35, p = 0.02) and functional well-being (Std. β = 0.20, 95% CI: 0.05, 0.35, p = 0.03) than patients with low/medium PPCQ. No association was observed between PPCQ and physical well-being (Std. β = 0.06, 95% CI: - 2.51, 0.21, p = 0.41). Sensitivity analyses found similar, albeit attenuated, patterns. CONCLUSION Our findings aligned with our hypotheses. Future researchers should explore potential mechanisms underlying these differential associations. Specifically, PPCQ may be associated with social and functional well-being through interpersonal mechanisms, but may not be as associated with physical well-being due to multiple contextual factor rural survivors disproportionately face (e.g., limited healthcare access, economic hardship) and stronger associations with clinical factors.
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Affiliation(s)
- Shaila M Strayhorn
- University of Illinois at Chicago Institute for Health Research and Policy, 1747 W. Roosevelt Rd., Chicago, IL, 60608, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. St. Clair St., Chicago, IL, 60611, USA
- Center of Community Health, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., Chicago, IL, 60611, USA
| | - Leslie R Carnahan
- University of Illinois at Chicago Center for Research on Women and Gender, 1640 W. Roosevelt Rd., Chicago, IL, 60608, USA
- Division of Community Health Sciences, School of Public Health, 1603 W. Taylor St., MC 923, Chicago, IL, USA
| | - Vida A Henderson
- Division of Community Health Sciences, School of Public Health, 1603 W. Taylor St., MC 923, Chicago, IL, USA
- University of Illinois Cancer Center, 914 S. Wood St., Chicago, IL, 60612, USA
| | - Karriem S Watson
- Division of Community Health Sciences, School of Public Health, 1603 W. Taylor St., MC 923, Chicago, IL, USA
- University of Illinois Cancer Center, 914 S. Wood St., Chicago, IL, 60612, USA
| | - Carol E Ferrans
- University of Illinois at Chicago College of Nursing, 845 S. Damen Ave., Chicago, IL, 60612, USA
| | - Yamilé Molina
- University of Illinois at Chicago Center for Research on Women and Gender, 1640 W. Roosevelt Rd., Chicago, IL, 60608, USA.
- Division of Community Health Sciences, School of Public Health, 1603 W. Taylor St., MC 923, Chicago, IL, USA.
- University of Illinois Cancer Center, 914 S. Wood St., Chicago, IL, 60612, USA.
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