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Shen X, Kane K, Katz AJ, Usinger D, Cao Y, Chen RC. Differences in Rural Versus Urban Patients With Prostate Cancer in Diagnosis and Treatment: An Analysis of a Population-Based Cohort. JCO Oncol Pract 2024; 20:1109-1114. [PMID: 38739876 DOI: 10.1200/op.23.00547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
PURPOSE Patients living in rural communities have greater barriers to cancer care and poorer outcomes. We hypothesized that rural patients with prostate cancer have less access and receive different treatments compared with urban patients. METHODS We used a population-based prospective cohort, the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study, to compare differences in prostate cancer diagnosis, access to care, and treatment in patients by geographic residence. The 2013 rural-urban continuum code (RUCC) was used to determine urban (RUCC 1-3) versus rural (RUCC 4-9) location of residence. RESULTS Patients with rural residence comprised 25% of the cohort (364 of 1,444); they were less likely to be White race and had lower income and educational attainment. Rural patients were more likely to have <12 cores on biopsy (47.1% v 35.7%; P < .001) and less likely (40.8% v 47.6%; P = .04) to receive multidisciplinary consultation. We observed significant differences in treatment between urban and rural patients, including rural patients receiving less active surveillance or observation (22.6% v 28.7%), especially in low-risk cancer (33.2% v 40.7%). On multivariable analysis that adjusted for patient and diagnostic factors, rural residence was associated with less use of active surveillance or observation over radical treatment (ie, surgery or radiation therapy; odds ratio, 0.49 v urban; P < .001) in patients with low-risk cancer. CONCLUSION Patients with prostate cancer who live in rural versus urban areas experience several differences in care that are likely clinically meaningful, including fewer cores in the diagnostic biopsy, less utilization of multidisciplinary consultation, less use of active surveillance, or observation for low-risk disease. Future studies are needed to assess the efficacy of interventions in mitigating these disparities.
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Affiliation(s)
- Xinglei Shen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | - Katelyn Kane
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | - Aaron J Katz
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | - Deborah Usinger
- Department of Urology, University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Ying Cao
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
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2
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Stout NL, Nikcevich D, Henderson TO, Steen P, Weiss M, Ades S, Mlodozyniec T, Koffarnus A, Barnick B, Paskett ED. Improving Rural Clinical Trial Enrollment: Recommendations From the Rural Health Working Group of the Alliance Clinical Trials Network. J Clin Oncol 2024; 42:1722-1725. [PMID: 38412385 PMCID: PMC11095896 DOI: 10.1200/jco.23.01667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 02/29/2024] Open
Affiliation(s)
- Nicole L. Stout
- West Virginia University School of Medicine, Department of Hematology Oncology, Morgantown, WV
- West Virginia University School of Public Health, Department of Health Policy, Management and Leadership, Morgantown, WV
| | - Daniel Nikcevich
- Department of Hematology Oncology, Essentia NCORP, Essentia Health, Duluth, MN
| | | | | | | | - Steven Ades
- University of Vermont Medical Center, Department of Hematology and Oncology, Burlington, VT
| | | | - Amy Koffarnus
- CROWN Consortium at St Vincent Hospital, Green Bay, WI
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3
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Paskett ED, Kruse-Diehr AJ, Oliveri JM, Vanderpool RC, Gray DM, Pennell ML, Huang B, Young GS, Fickle D, Cromo M, Katz ML, Reiter PL, Rogers M, Gross DA, Fairchild V, Xu W, Carman A, Walunis JM, McAlearney AS, Huerta TR, Rahurkar S, Biederman E, Dignan M. Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial. Transl Behav Med 2023; 13:748-756. [PMID: 37202831 PMCID: PMC10538475 DOI: 10.1093/tbm/ibad017] [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] [Indexed: 05/20/2023] Open
Abstract
Appalachian regions of Kentucky and Ohio are hotspots for colorectal cancer (CRC) mortality in the USA. Screening reduces CRC incidence and mortality; however, screening uptake is needed, especially in these underserved geographic areas. Implementation science offers strategies to address this challenge. The aim of the current study was to conduct multi-site, transdisciplinary research to evaluate and improve CRC screening processes using implementation science strategies. The study consists of two phases (Planning and Implementation). In the Planning Phase, a multilevel assessment of 12 health centers (HC) (one HC from each of the 12 Appalachian counties) was conducted by interviewing key informants, creating community profiles, identifying HC and community champions, and performing HC data inventories. Two designated pilot HCs chose CRC evidence-based interventions to adapt and implement at each level (i.e., patient, provider, HC, and community) with evaluation relative to two matched control HCs. During the Implementation Phase, study staff will repeat the rollout process in HC and community settings in a randomized, staggered fashion in the remaining eight counties/HCs. Evaluation will include analyses of electronic health record data and provider and county surveys. Rural HCs have been reluctant to participate in research because of concerns about capacity; however, this project should demonstrate that research does not need to be burdensome and can adapt to local needs and HC abilities. If effective, this approach could be disseminated to HC and community partners throughout Appalachia to encourage the uptake of effective interventions to reduce the burden of CRC.
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Affiliation(s)
- Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - Aaron J Kruse-Diehr
- University of Kentucky College of Medicine, Department of Family and Community Medicine, Lexington, KY, USA
- University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Robin C Vanderpool
- University of Kentucky College of Public Health, Department of Health, Behavior and Society, Lexington, KY, USA
| | - Darrell M Gray
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - Michael L Pennell
- The Ohio State University College of Public Health, Division of Biostatistics, Columbus, OH, USA
| | - Bin Huang
- University of Kentucky Markey Cancer Center, Division of Biostatistics, Biostatistics and Bioinformatics Shared Resource Facility, Lexington, KY, USA
| | | | - Darla Fickle
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Cromo
- University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA
| | - Mira L Katz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA
| | - Paul L Reiter
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA
| | - Melinda Rogers
- University of Kentucky Markey Cancer Center, Community Impact Office, Lexington, KY, USA
| | - David A Gross
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Vickie Fairchild
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Wendy Xu
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
| | - Angela Carman
- University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA
| | - Jean M Walunis
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ann Scheck McAlearney
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA
| | - Timothy R Huerta
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA
| | | | - Erika Biederman
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Dignan
- University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA
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4
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Rueter J, Anderson EC, Graham LC, Antov A, Helbig P, Gaitor L, Bourne J, Edelman E, Reed EK, Reddi HV, Mockus S, DiPalazzo J, Lu-Emerson C, Inhorn R, Sinclair SJ, Thomas CA, Brooks PL, Rasmussen K, Han P, Liu ET. The Maine Cancer Genomics Initiative: Implementing a Community Cancer Genomics Program Across an Entire Rural State. JCO Precis Oncol 2023; 7:e2200619. [PMID: 37163717 PMCID: PMC10309567 DOI: 10.1200/po.22.00619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 05/12/2023] Open
Abstract
PURPOSE The Maine Cancer Genomics Initiative (MCGI) aimed to overcome patient- and provider-level barriers to using genomic tumor testing (GTT) in rural practices by providing genomic tumor boards (GTBs), clinician education, and access to comprehensive large-panel next-generation sequencing to all patients with cancer in Maine. This paper describes the successful implementation of the initiative and three key services made operative between 2016 and 2020. METHODS A community-inclusive, hub-and-spoke approach was taken to implement the three program components: (1) a centralized GTB program; (2) a modular online education program, designed using an iterative approach with broad clinical stakeholders; and (3) GTT free of charge to clinicians and patients. Implementation timelines, participation metrics, and survey data were used to describe the rollout. RESULTS The MCGI was launched over an 18-month period at all 19 oncology practices in the State. Seventy-nine physicians (66 medical oncologists, 5 gynecologic oncologists, 1 neuro-oncologist, and 7 pediatric oncologists) enrolled on the study, representing 100% of all practicing oncologists in Maine. Between July 2017 and September 2020, 1610 patients were enrolled. A total of 515 cases were discussed by 47 (73%) clinicians in 196 GTBs. Clinicians who participated in the GTBs enrolled significantly more patients on the study, stayed in Maine, and reported less time spent in clinical patient care. CONCLUSION The MCGI was able to engage geographically and culturally disparate cancer care practices in a precision oncology program using a hub-and-spoke model. By facilitating access to GTT, structured education, and GTBs, we narrowed the gap in the implementation of precision oncology in one of the most rural states in the country.
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Affiliation(s)
| | - Eric C. Anderson
- Center for Interdisciplinary Population & Health Research (CIPHR), MaineHealth Institute for Research (MHIR), Portland, ME
- Tufts University School of Medicine, Boston, MA
| | | | | | | | | | | | - Emily Edelman
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - E. Kate Reed
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Honey V. Reddi
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Susan Mockus
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - John DiPalazzo
- Center for Interdisciplinary Population & Health Research (CIPHR), MaineHealth Institute for Research (MHIR), Portland, ME
| | | | | | | | | | | | | | - Paul Han
- Center for Interdisciplinary Population & Health Research (CIPHR), MaineHealth Institute for Research (MHIR), Portland, ME
| | - Edison T. Liu
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
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5
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Moss JL, Stoltzfus KC, Popalis ML, Calo WA, Kraschnewski JL. Assessing the use of constructs from the consolidated framework for implementation research in U.S. rural cancer screening promotion programs: a systematic search and scoping review. BMC Health Serv Res 2023; 23:48. [PMID: 36653800 PMCID: PMC9846667 DOI: 10.1186/s12913-022-08976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer screening is suboptimal in rural areas, and interventions are needed to improve uptake. The Consolidated Framework for Implementation Research (CFIR) is a widely-used implementation science framework to optimize planning and delivery of evidence-based interventions, which may be particularly useful for screening promotion in rural areas. We examined the discussion of CFIR-defined domains and constructs in programs to improve cancer screening in rural areas. METHODS We conducted a systematic search of research databases (e.g., Medline, CINAHL) to identify studies (published through November 2022) of cancer screening promotion programs delivered in rural areas in the United States. We identified 166 records, and 15 studies were included. Next, two reviewers used a standardized abstraction tool to conduct a critical scoping review of CFIR constructs in rural cancer screening promotion programs. RESULTS Each study reported at least some CFIR domains and constructs, but studies varied in how they were reported. Broadly, constructs from the domains of Process, Intervention, and Outer setting were commonly reported, but constructs from the domains of Inner setting and Individuals were less commonly reported. The most common constructs were planning (100% of studies reporting), followed by adaptability, cosmopolitanism, and reflecting and evaluating (86.7% for each). No studies reported tension for change, self-efficacy, or opinion leader. CONCLUSIONS Leveraging CFIR in the planning and delivery of cancer screening promotion programs in rural areas can improve program implementation. Additional studies are needed to evaluate the impact of underutilized CFIR domains, i.e., Inner setting and Individuals, on cancer screening programs.
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Affiliation(s)
- Jennifer L Moss
- Penn State College of Medicine, Hershey, PA, USA.
- Department of Family and Community Medicine, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, 90 Hope Drive, #2120E, MC A172, P.O. Box 855, Hershey, PA, 17033, USA.
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6
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Tatalovich Z, Stinchcomb DG, Ng D, Yu M, Lewis DR, Zhu L, Feuer EJR. Developing Geographic Areas for Cancer Reporting Using Automated Zone Design. Am J Epidemiol 2022; 191:2109-2119. [PMID: 36043397 DOI: 10.1093/aje/kwac155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 08/03/2022] [Accepted: 08/23/2022] [Indexed: 02/01/2023] Open
Abstract
The reporting and analysis of population-based cancer statistics in the United States has traditionally been done for counties. However, counties are not ideal for analysis of cancer rates, due to wide variation in population size, with larger counties having considerable sociodemographic variation within their borders and sparsely populated counties having less reliable estimates of cancer rates that are often suppressed due to confidentiality concerns. There is a need and an opportunity to utilize zone design procedures in the context of cancer surveillance to generate coherent, statistically stable geographic units that are more optimal for cancer reporting and analysis than counties. To achieve this goal, we sought to create areas within each US state that are: 1) similar in population size and large enough to minimize rate suppression; 2) sociodemographically homogeneous; 3) compact; and 4) custom crafted to represent areas that are meaningful to cancer registries and stakeholders. The resulting geographic units reveal the heterogeneity of rates that are hidden when reported at the county-level while substantially reducing the need to suppress data. We believe this effort will facilitate more meaningful comparative analysis of cancer rates for small geographic areas and will advance the understanding of cancer burden in the United States.
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7
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Hall JM, Szurek SM, Cho H, Guo Y, Gutter MS, Khalil GE, Licht JD, Shenkman EA. Cancer disparities related to poverty and rurality for 22 top cancers in Florida. Prev Med Rep 2022; 29:101922. [PMID: 35928594 PMCID: PMC9344025 DOI: 10.1016/j.pmedr.2022.101922] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
We aimed to examine poverty and rurality as potential predictors of cancer health disparities. This cross-sectional study used data from the Florida Cancer Data System on all cancer diagnoses in the years 2014-2018 to determine age-adjusted incidence and mortality (per 100,000 population) for the 22 most common cancer sites within rural and urban counties, and high poverty and low poverty communities. Rural/urban and high/low poverty related cancer disparities were tested for statistical significance using the Rate Ratio statistical test. Overall cancer incidence was significantly lower in rural areas than in urban, but significantly higher in high poverty communities. Rurality and poverty were both associated with disparity in cancer incidence risk for tobacco-related cancers. The overall mortality was 22% higher in high poverty areas compared to low poverty areas. Ten cancer sites had mortality disparity from 83% to 17% higher in high poverty areas. Only three cancer sites, all tobacco-related, had higher mortality in rural areas than urban areas, demonstrating the intersectional nature of inhaled and smokeless tobacco use in rural low-income communities. Cancer and mortality rates in rural and urban areas may be largely driven by poverty. The high disparities related to high poverty areas reflects poor access to preventative care and treatment. Low income communities, rural or urban, will require focused efforts to address challenges specific to each population.
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Affiliation(s)
- Jaclyn M. Hall
- Department of Health Outcomes and Biomedical Informatics, University of Florida, United States
| | - Sarah M. Szurek
- Department of Health Outcomes and Biomedical Informatics, University of Florida, United States
| | - Heedeok Cho
- Department of Health Outcomes and Biomedical Informatics, University of Florida, United States
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, United States
| | - Michael S. Gutter
- Department of Family, Youth and Community Sciences, University of Florida, United States
| | - Georges E. Khalil
- Department of Health Outcomes and Biomedical Informatics, University of Florida, United States
| | - Jonathan D. Licht
- Division of Hematology/Oncology, University of Florida Cancer Center, United States
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, University of Florida, United States
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Adsul P, Chambers D, Brandt HM, Fernandez ME, Ramanadhan S, Torres E, Leeman J, Baquero B, Fleischer L, Escoffery C, Emmons K, Soler M, Oh A, Korn AR, Wheeler S, Shelton RC. Grounding implementation science in health equity for cancer prevention and control. Implement Sci Commun 2022; 3:56. [PMID: 35659151 PMCID: PMC9164317 DOI: 10.1186/s43058-022-00311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute's Consortium for Cancer Implementation Science convened an action group focused on 'health equity and context' to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions. DISCUSSION In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity. To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.
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Affiliation(s)
- Prajakta Adsul
- Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - David Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD USA
| | - Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Essie Torres
- East Carolina University, 2309 Carol Belk Bldg, Greenville, NC 27858 USA
| | | | - Barbara Baquero
- University of Washington, 3980 15th Ave. NE, Seattle, WA 98195 USA
| | | | - Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Karen Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Montserrat Soler
- Ob/Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, OH USA
| | - April Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - Stephanie Wheeler
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7411, Chapel Hill, NC 27599 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, 722 W 168th Street, New York, NY 10032 USA
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Yousefi Nooraie R, Noyes K. Editorial: Challenges for the provision of guideline-recommended cancer care to rural and medically underserved communities. FRONTIERS IN HEALTH SERVICES 2022; 2:1113916. [PMID: 36925787 PMCID: PMC10012693 DOI: 10.3389/frhs.2022.1113916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Reza Yousefi Nooraie
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Katia Noyes
- Division of Health Services and Policy, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
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10
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Rimer BK. A tribute to Robert Croyle, PhD, Director, Division of Cancer Control and Population Sciences. Transl Behav Med 2021; 11:1967-1971. [PMID: 34850929 DOI: 10.1093/tbm/ibab024] [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] [Indexed: 01/18/2023] Open
Abstract
At the beginning of Dr. Robert Croyle's 18th and final year as director of the National Cancer Institute's (NCI) Division of Cancer Control and Population Sciences (DCCPS), before his retirement in December 2021, it is fitting to review some of his and the division's many accomplishments and pay tribute to him as one of the government's most effective leaders. The focus of this article is on Dr. Croyle's contributions in the behavioral and related domains and his and the division's impact on the landscape of cancer control and population sciences. Dr. Croyle joined DCCPS in 1998 as associate director for behavioral research. He became acting director of DCCPS in 2001 and then director in 2003. DCCPS is a formidable NCI division, with broad mandates and responsibilities and many partners from multiple sectors. The division conducts and supports an integrated program of the highest-quality genetic, epidemiological, behavioral, social, applied, survivorship, surveillance, and health care delivery cancer research. The division's notable successes in implementation science and the dissemination of evidence-based findings and products, use of cancer research consortia, and partnerships across National Institutes of Health and with external federal and nongovernmental organizations are among many that reflect Dr. Croyle's visionary leadership.
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Affiliation(s)
- Barbara K Rimer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7400, USA
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11
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Villanti AC, Klemperer EM, Sprague BL, Ahern TP. State-level rurality and cigarette smoking-associated cancer incidence and mortality: Do individual-level trends translate to population-level outcomes? Prev Med 2021; 152:106759. [PMID: 34358592 PMCID: PMC8545854 DOI: 10.1016/j.ypmed.2021.106759] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 01/27/2023]
Abstract
County-level analyses demonstrate that overall cancer incidence is generally lower in rural areas, though incidence and mortality from tobacco-associated cancers are higher than in non-rural areas and have experienced slower declines over time. The goal of our study was to examine state-level rurality and smoking-related cancer outcomes. We used publicly-available national data to quantify rurality, cigarette smoking prevalence, and smoking-attributable cancer incidence and mortality at the state level and to estimate the population-attributable fraction of cancer deaths attributable to smoking for each state, overall and by gender, for 12 smoking-associated cancers. Accounting for a 15-year lag between smoking exposure and cancer diagnosis, the median proportion of smoking-attributable cancer deaths was 28.2% in Virginia (24.6% rural) and ranged from 19.9% in Utah (9.4% rural) to 35.1% in Kentucky (41.6% rural). By gender, the highest proportion of smoking-attributable cancer deaths for women (29.5%) was in a largely urban state (Nevada, 5.8% rural) and for men (38.0%) in a largely rural state (Kentucky). Regression analyses categorizing state-level rurality into low (0-13.9%), moderate (15.3-29.9%) and high (33.6-61.3%) levels showed that high rurality was associated with 5.8% higher cigarette smoking prevalence, higher age-adjusted smoking-associated cancer incidence (44.3 more cases per 100,000 population), higher smoking-associated cancer mortality (29.8 more deaths per 100,000 population), and 3.4% higher proportion of smoking-attributable cancer deaths compared with low rurality. Our findings highlight the magnitude of the relationship between state-level rurality and smoking-attributable cancer outcomes and the importance of tobacco control in reducing cancer disparities in rural populations.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, USA; Cancer Control and Population Health Sciences Program, University of Vermont Cancer Center, USA.
| | - Elias M Klemperer
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, USA
| | - Brian L Sprague
- Cancer Control and Population Health Sciences Program, University of Vermont Cancer Center, USA; Division of Surgical Research, Department of Surgery, University of Vermont Larner College of Medicine, USA; Office of Health Promotion Research, University of Vermont Larner College of Medicine, USA
| | - Thomas P Ahern
- Cancer Control and Population Health Sciences Program, University of Vermont Cancer Center, USA; Division of Surgical Research, Department of Surgery, University of Vermont Larner College of Medicine, USA
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12
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Murphy C, Evans S, Askelson N, Eberth JM, Zahnd WE. Extent of Inclusion of "Rural" in Comprehensive Cancer Control Plans in the United States. Prev Chronic Dis 2021; 18:E86. [PMID: 34477549 PMCID: PMC8462285 DOI: 10.5888/pcd18.210091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction The National Comprehensive Cancer Control Program requires states, territories, and tribal organizations to develop comprehensive cancer control plans (CCCPs). In 2019, the National Advisory Committee on Rural Health and Human Services released a series of policy recommendations, including one recommending that CCCPs address rural cancer disparities. The objective of our study was to assess the extent to which jurisdictions considered “rural” in their CCCPs. Methods We reviewed the 66 CCCPs available on the Centers for Disease Control and Prevention’s website as of January 2020 to assess their inclusion of rural across 7 elements: 1) cancer burden data, 2) reduction of cancer disparities, 3) rural population description, 4) rural definition, 5) goals, 6) objectives, and 7) strategies. We summarized these elements by plan type (state or territory/tribal organization). For state CCCPs, we also compared the number of element types and the inclusion of rural-specific strategies by the percentage of the state’s population that was rural and the rural cancer mortality rate. Results Of 66 plans, 45 included a mention of rural in at least 1 element, including 38 of 50 state plans and 7 of 16 territory/tribal organization plans. Reduction of cancer disparities was the most common element noted. Less than one-third of all CCCPs included a rural-specific strategy. States with a high rural cancer mortality rate tended to have at least 1 rural-specific strategy. Conclusion Technical and financial support to improve rural data inclusion and implementation of rural-specific strategies in CCCPs may help improve the inclusion of rural data and strategy development.
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Affiliation(s)
- Cathryn Murphy
- College of Arts and Sciences, University of South Carolina, Columbia, South Carolina.,Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sydney Evans
- College of Liberal Arts & Sciences, University of Iowa, Iowa City, Iowa
| | - Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Jan M Eberth
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Whitney E Zahnd
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr, Ste 204, Columbia, SC 29210.
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Murphy CC, Lupo PJ, Roth ME, Winick NJ, Pruitt SL. Disparities in Cancer Survival Among Adolescents and Young Adults: A Population-Based Study of 88 000 Patients. J Natl Cancer Inst 2021; 113:1074-1083. [PMID: 33484568 DOI: 10.1093/jnci/djab006] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/23/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescents and young adults (AYA, aged 15-39 years) diagnosed with cancer comprise a growing, yet understudied, population. Few studies have examined disparities in cancer survival in underserved and diverse populations of AYA. METHODS Using population-based data from the Texas Cancer Registry, we estimated 5-year relative survival of common AYA cancers and examined disparities in survival by race and ethnicity, neighborhood poverty, urban or rural residence, and insurance type. We also used multivariable Cox proportional hazards regression models to examine associations of race or ethnicity, neighborhood poverty, urban or rural residence, and insurance type with all-cause mortality. RESULTS We identified 55 316 women and 32 740 men diagnosed with invasive cancer at age 15-39 years between January 1, 1995, and December 31, 2016. There were disparities in relative survival by race and ethnicity, poverty, and insurance for many cancer types. Racial and ethnic disparities in survival for men with non-Hodgkin lymphoma (74.5% [95% confidence interval (CI) = 72.1% to 76.7%] White vs 57.0% [95% CI = 51.9% to 61.8%] Black) and acute lymphocytic leukemia (66.5% [95% CI = 61.4% to 71.0%] White vs 44.4% [95% CI = 39.9% to 48.8%] Hispanic) were striking, and disparities remained even for cancers with excellent prognosis, such as testicular cancer (96.6% [95% CI = 95.9% to 97.2%] White vs 88.7% [95% CI = 82.4% to 92.8%] Black). In adjusted analysis, being Black or Hispanic, living in high-poverty neighborhoods, and having Medicaid, other government insurance, or no insurance at diagnosis were associated with all-cause mortality in both women and men (all 2-sided P < .01). CONCLUSIONS Our study adds urgency to well-documented disparities in cancer survival in older adults by demonstrating persistent differences in relative survival and all-cause mortality in AYAs. Findings point to several areas of future research to address disparities in this unique population of cancer patients.
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Affiliation(s)
- Caitlin C Murphy
- Department of Population and Data Sciences, Internal Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Michael E Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naomi J Winick
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sandi L Pruitt
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Zoellner JM, Porter KJ, Brock DJP, Mitchell EMK, Chapman H, Clarkston D, Cohn W, Hauser L, Morris DW, Ramey SY, Robinson B, Schriefer S, Voges N, Wiseman KP. Advancing engagement and capacity for rural cancer control: a mixed-methods case study of a Community-Academic Advisory Board in the Appalachia region of Southwest Virginia. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:44. [PMID: 34158127 PMCID: PMC8218281 DOI: 10.1186/s40900-021-00285-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The objectives are to: 1) describe engagement processes used to prioritize and address regional comprehensive cancer control needs among a Community-Academic Advisory Board (CAB) in the medically-underserved, rural Appalachian region, and 2) detail longitudinal CAB evaluation findings. METHODS This three-year case study (2017-2020) used a convergent parallel, mixed-methods design. The approach was guided by community-based participatory research (CBPR) principles, the Comprehensive Participatory Planning and Evaluation process, and Nine Habits of Successful Comprehensive Cancer Control Coalitions. Meeting artifacts were tracked and evaluated. CAB members completed quantitative surveys at three time points and semi-structured interviews at two time points. Quantitative data were analyzed using analysis of variance tests. Interviews were audio recorded, transcribed, and analyzed via an inductive-deductive process. RESULTS Through 13 meetings, Prevention and Early Detection Action Teams created causal models and prioritized four cancer control needs: human papillomavirus vaccination, tobacco control, colorectal cancer screening, and lung cancer screening. These sub-groups also began advancing into planning and intervention proposal development phases. As rated by 49 involved CAB members, all habits significantly improved from Time 1 to Time 2 (i.e., communication, priority work plans, roles/accountability, shared decision making, value-added collaboration, empowered leadership, diversified funding, trust, satisfaction; all p < .05), and most remained significantly higher at Time 3. CAB members also identified specific challenges (e.g., fully utilizing member expertise), strengths (e.g., diverse membership), and recommendations across habits. CONCLUSION This project's equity-based CBPR approach used a CPPE process in conjunction with internal evaluation of cancer coalition best practices to advance CAB efforts to address cancer disparities in rural Appalachia. This approach encouraged CAB buy-in and identified key strengths, weaknesses, and opportunities that will lay the foundation for continued involvement in cancer control projects. These engagement processes may serve as a template for similar coalitions in rural, underserved areas.
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Affiliation(s)
- Jamie M. Zoellner
- Department of Public Health Sciences, School of Medicine, University of Virginia, 16 E. Main St, Christiansburg, VA 24073 USA
| | - Kathleen J. Porter
- Department of Public Health Sciences, School of Medicine, University of Virginia, 16 E. Main St, Christiansburg, VA 24073 USA
| | - Donna-Jean P. Brock
- Department of Public Health Sciences, School of Medicine, University of Virginia, 16 E. Main St, Christiansburg, VA 24073 USA
| | - Emma Mc Kim Mitchell
- School of Nursing, University of Virginia, PO Box 800782, Charlottesville, VA 22908 USA
| | - Howard Chapman
- Tri-Area Community Health, P.O. Box 9, Laurel Fork, VA 24352 USA
| | - Deborah Clarkston
- Mountain Empire Community College Nursing Program, Phillips-Taylor Hall Rm 136, 3441 Mountain Empire Rd, Big Stone Gap, VA 24219 USA
| | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908 USA
| | - Lindsay Hauser
- Office of Outreach and Engagement, University of Virginia Cancer Center, Box 800334, Charlottesville, VA 22908 USA
| | - Dianne W. Morris
- Mountain Laurel Cancer Support and Resource Center, Mountain Empire Older Citizens, Inc., P.O. Box 888, Big Stone Gap, VA 24219 USA
| | - Sarah Y. Ramey
- Clinch Valley Medical Center, 6801 Gov. G. C. Peery Hwy., Richlands, Virginia, 24641 USA
| | - Brenna Robinson
- Office of Outreach and Engagement, University of Virginia Cancer Center, Box 800334, Charlottesville, VA 22908 USA
| | | | - Noelle Voges
- Office of Community Outreach & Engagement, University of Virginia Cancer Center, P.O. Box 800334, Charlottesville, VA 22903 USA
| | - Kara P. Wiseman
- Department of Public Health Sciences, University of Virginia, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908 USA
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Brandt HM, Vanderpool RC, Pilar M, Zubizarreta M, Stradtman LR. A narrative review of HPV vaccination interventions in rural U.S. communities. Prev Med 2021; 145:106407. [PMID: 33388323 PMCID: PMC10064483 DOI: 10.1016/j.ypmed.2020.106407] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/20/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Abstract
Uptake of human papillomavirus (HPV) vaccine in the United States (U.S.) is far below the Healthy People 2020 goal of 80% coverage among adolescents. In rural communities, HPV vaccination coverage is low, yet incidence and mortality rates of HPV-associated cancer are high. Much of the research focused on HPV vaccination in rural U.S. communities has involved qualitative investigations, observations, survey research, and secondary data analysis with limited implementation of interventional study designs. The purpose of this narrative review was to examine intervention studies to increase HPV vaccination in rural settings and to summarize study characteristics and associated outcomes. PubMed, PsycINFO, CINAHL, and Web of Science were searched utilizing systematic narrative review methodology for studies describing implementation of HPV vaccination interventions in rural U.S. settings from January 2006-December 2019. Using specific search criteria, 991 studies were identified. After abstract review, 30 full-text articles were assessed for eligibility, and 15 met the inclusion criteria. The 15 articles - published from 2011 to 2019 - described HPV vaccination interventions in rural settings of six states, including communities, health clinics, and schools. A range of primary and secondary outcomes were reported, including HPV vaccine receipt (series initiation, continuation, and/or completion); HPV vaccine knowledge; and/or cervical cancer knowledge. Across the studies, there was an absence of the description of rural context. As compared to the broader HPV vaccination intervention literature, interventions in rural settings were limited. More interventional research is needed in rural communities given the elevated rates of HPV-related cancer and low rates of HPV vaccine uptake.
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Affiliation(s)
- Heather M Brandt
- University of South Carolina Arnold School of Public Health, Department of Health Promotion, Education, Behavior, Rural and Minority Health Research Center, 915 Greene Street, Columbia, SC 29208, United States.
| | - Robin C Vanderpool
- National Cancer Institute, Division of Cancer Control and Population Sciences, Health Communication and Informatics Research Branch, 9609 Medical Center Drive, 3E610, Rockville, MD 20850, United States.
| | - Meagan Pilar
- Washington University in St. Louis, Brown School of Social Work, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, United States.
| | - Maria Zubizarreta
- University of South Carolina Arnold School of Public Health, Core for Applied Research and Evaluation, 915 Greene Street, Columbia, SC 29208, United States.
| | - Lindsay R Stradtman
- University of Kentucky College of Public Health, Department of Health, Behavior & Society, 113 Washington Avenue, Lexington, KY 40506, United States
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The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041384. [PMID: 33546168 PMCID: PMC7913122 DOI: 10.3390/ijerph18041384] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/15/2022]
Abstract
One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.
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Borders TF, Cecil JG. Rurality and Cancer Stage, Treatment, and Follow‐Up Care. J Rural Health 2020; 36:460-461. [DOI: 10.1111/jrh.12520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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