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Altaf A, Munir MM, Khan MMM, Thammachack R, Rashid Z, Khalil M, Catalano G, Pawlik TM. Impact of patient, hospital, and operative characteristics relative to social determinants of health: Compliance with National Comprehensive Cancer Network guidelines for colon cancer. J Gastrointest Surg 2024:S1091-255X(24)00502-X. [PMID: 38878955 DOI: 10.1016/j.gassur.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 05/31/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Despite an established association with improved patient outcomes, compliance with National Comprehensive Cancer Network (NCCN) guidelines remains suboptimal. We sought to assess the effect of patient characteristics (PCs), operative characteristics (OCs), hospital characteristics (HCs), and social determinants of health (SDoH) on noncompliance with NCCN guidelines for colon cancer. METHODS Patients treated for stage I to III colon cancer from 2004 to 2017 were identified from the National Cancer Database. Multilevel multivariate regression analysis was performed to identify factors associated with receipt of NCCN-compliant care and quantify the proportion of variance explained by PCs, OCs, HCs, and SDoH. RESULTS Among 468,097 patients with colon cancer treated across 1319 hospitals, 1 in 4 patients did not receive NCCN-compliant care (122,170 [26.1%]). On regression analysis, older age (odds ratio [OR], 0.96; 95% CI, 0.96-0.96), female sex (OR, 0.97; 95% CI, 0.96-0.99), Black race (OR, 0.96; 95% CI, 0.94-0.98), higher Charlson-Deyo score (OR, 0.84; 95% CI, 0.82-0.86), tumor stage ≥II (OR, 0.42; 95% CI, 0.40-0.44), and tumor grade ≥ 3 (OR, 0.33; 95% CI, 0.32-0.34) were associated with lower odds of receiving NCCN-compliant care (all P values <.05). Higher hospital volume (OR, 1.02; 95% CI, 1.02-1.03), minimally invasive or robotic surgical approach (OR, 1.26; 95% CI, 1.23-1.29), adequate (≥12) lymph node assessment (OR, 3.46; 95% CI, 3.38-3.53), private insurance status (OR, 1.33; 95% CI, 1.26-1.40), Medicare insurance status (OR, 1.42; 95% CI, 1.35-1.49), and higher educational status (OR, 1.06; 95% CI, 1.02-1.09) were associated with higher odds of receiving NCCN-compliant care (all P values <.05). Overall, PCs contributed 36.5%, HCs contributed 1.3%, and OCs contributed 12.9% to the variation in guideline-compliant care, while SDoH contributed only 3.6% of the variation in receipt of NCCN-compliant care. CONCLUSION The variation in NCCN-compliant care among patients with colon cancer was largely attributable to patient- and surgeon-level factors, whereas SDoH were associated with a smaller proportion of the variation.
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Affiliation(s)
- Abdullah Altaf
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Muhammad Musaab Munir
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Muhammad Muntazir Mehdi Khan
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Razeen Thammachack
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Zayed Rashid
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Mujtaba Khalil
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Giovanni Catalano
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States.
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Shimels T, Gashawbeza B, Gedif Fenta T. Access to advanced healthcare services and its associated factors among patients with cervical cancer in Addis Ababa, Ethiopia. Front Oncol 2024; 14:1342236. [PMID: 38463222 PMCID: PMC10921226 DOI: 10.3389/fonc.2024.1342236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
Objective This study aimed to assess the extent of access to healthcare services, perception and associated factors among patients with cervical cancer in Addis Ababa, Ethiopia. Methods A facility-based cross-sectional study was conducted from 01 July through 30 August 2023 at two tertiary hospitals. Cases with histopathologic and clinical confirmation of cervical cancer were enrolled using a consecutive sampling technique. Data was collected through a validated questionnaire administered by interviewers using the KoboCollect application. Subsequently, the collected data underwent analysis using Statistical Sciences for Social Sciences (SPSS) version 26.0. Bivariable and multivariable regression models were performed at p ≤ 0.2 and p<0.05 statistical significance, respectively. Results A total of 391 patients were enrolled in the study. Health facilities were accessible for obtaining general medical services (56.5%), drugs (57.3%), laboratory diagnosis services (57.0%), imaging diagnosis services (56.8%), and radiotherapy services (55.8%) of the patients. Cost of services was affordable only in 11.5% of the cases. Essential anticancer medicines were out of stock for 229 (58.6%) of the patients during the past three months. About two-thirds of the patients have a good perception of access to healthcare services. In multivariable binary logistic regression, admission to the inpatient (AOR: 0.20, 95% CI: 0.06-0.67), joblessness (AOR: 0.19, 95% CI: 0.08-0.46), lower level of income to the extreme poverty line (3567ETB)(64.9 USD) (AOR: 0.19, 95% CI: 0.10-0.35), no CBHI coverage (AOR: 4.16, 95% CI: 1.76-9.85), having social support (AOR: 3.80; 95% CI: 1.96-7.41), and poor dietary practice (AOR: 2.36, 95% CI: 1.28-4.35) were found to have a statistically significant association with perceived good access to healthcare services. Conclusion Only close to a half of the patients with cervical cancer, in Addis Ababa, have adequate access to healthcare services. Nearly two-thirds of the patients reported perceived good access to the services. Many factors were found to show a statistically significant association with patients' perceived access to healthcare services.
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Affiliation(s)
- Tariku Shimels
- Research Directorate, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Pharmaceutics & Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Biruck Gashawbeza
- Department of Gynecology & Obstetrics, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Teferi Gedif Fenta
- Department of Pharmaceutics & Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Eaglehouse YL, Darmon S, Gage MM, Shriver CD, Zhu K. Characteristics Associated With Survival in Surgically Nonresected Pancreatic Adenocarcinoma in the Military Health System. Am J Clin Oncol 2024; 47:64-70. [PMID: 37851358 PMCID: PMC10805355 DOI: 10.1097/coc.0000000000001057] [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] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Pancreatic cancer is often diagnosed at advanced stages with high-case fatality. Many tumors are not surgically resectable. We aimed to identify features associated with survival in patients with surgically nonresected pancreatic cancer in the Military Health System. METHODS We used the Military Cancer Epidemiology database to identify the Department of Defense beneficiaries aged 18 and older diagnosed with a primary pancreatic adenocarcinoma between January 1998 and December 2014 who did not receive oncologic surgery as treatment. We used Cox Proportional Hazard regression with stepwise procedures to select the sociodemographic and clinical characteristics related to 2-year overall survival, expressed as adjusted hazard ratios (aHR) and 95% CIs. RESULTS Among 1148 patients with surgically nonresected pancreatic cancer, sex, race-ethnicity, marital status, and socioeconomic indicators were not selected in association with survival. A higher comorbidity count (aHR 1.30, 95% CI: 1.06-1.59 for 5 vs. 0), jaundice at diagnosis (aHR 1.57, 95% CI: 1.33-1.85 vs. no), tumor grade G3 or G4 (aHR 1.32, 95% CI: 1.05-1.67 vs. G1/G2), tumor location in pancreas tail (aHR 1.49, 95% CI: 1.22-1.83 vs. head) or body (aHR 1.30, 95% CI: 1.04-1.62 vs. head), and metastases were associated with survival. Patients receiving chemotherapy (aHR 0.66, 95% CI: 0.57-0.76) had better survival compared with no treatment. CONCLUSIONS In a comprehensive health system, sociodemographic characteristics were not related to survival in surgically nonresected pancreatic cancer. This implicates access to care in reducing survival disparities in advanced pancreatic cancer and emphasizes the importance of treating patients based on clinical features.
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Affiliation(s)
- Yvonne L. Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc
| | - Sarah Darmon
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc
| | - Michele M. Gage
- Departments of Surgery
- Division of Surgical Oncology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Craig D. Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- Departments of Surgery
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc
- Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences
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Volakakis N, Pylli M, Raftopoulos V, Kyrkou I, Xanthos T, Deltsidou A. Exploration of the factors that influence perceived quality of patient centered care among cancer survivors: A systematic review. Eur J Oncol Nurs 2024; 68:102503. [PMID: 38219476 DOI: 10.1016/j.ejon.2024.102503] [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: 08/14/2023] [Revised: 12/07/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE The purpose of this study was the estimation of the quality of patient centered care among cancer survivors. METHODS Following the PRISMA guidelines, MEDLINE and Google Scholar were systematically searched using the keywords "quality of patient centered care" and "cancer" from 2012 to 2022. RESULTS In this systematic review 7 articles were included, from which 5557 patients were derived, 3050 of them being females. The majority of them (2553 patients) suffered from haematological malignancies, while a considerable amount of them suffered from breast cancer. Three studies were conducted in Australia and four studies in Mexico. Factors, such as respect to patients' values and preferences, emotional support, management of psychological needs and integrated and coordinated care received a lower score. The characteristics that were statistically significantly related to the dimensions of person-centered care were numerous and were grouped into two major categories: a) socio-demographic such as gender, age, marital status, professional status, level of education, place of residence, type of insurance and b) clinical factors such as type of malignancy, psychiatric comorbidities, time interval of diagnosis, follow-up center, type of treatment. CONCLUSIONS The literature showed that there is a lack of comparative data regarding the perceived quality of patient centered care among cancer survivors. More psychometric tools of quality of patient centered care, or validation of the existed ones among all types of cancer survivors are needed, in order to identify and further improve the aspects of care that are not delivered successfully.
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Affiliation(s)
- N Volakakis
- General Hospital of Athens ''HIPPOCRATIO'', 114 Vas. Sofias Avenue, Athens, Greece; University of West Attica, Department of Midwifery, Saint Spiridonos Str, Athens, Greece.
| | - M Pylli
- National Public Health Organization of Greece, 3 Agrafon Str, Athens, Greece.
| | - V Raftopoulos
- National Public Health Organization of Greece, 3 Agrafon Str, Athens, Greece.
| | - I Kyrkou
- University of West Attica, Department of Midwifery, Saint Spiridonos Str, Athens, Greece.
| | - T Xanthos
- University of West Attica, Department of Midwifery, Saint Spiridonos Str, Athens, Greece.
| | - A Deltsidou
- University of West Attica, Department of Midwifery, Saint Spiridonos Str, Athens, Greece.
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Nichols HB, Wernli KJ, Chawla N, O’Meara ES, Gray MF, Green LE, Baggett CD, Casperson M, Chao C, Jones SMW, Kirchhoff AC, Kuo TM, Lee C, Malogolowkin M, Quesenberry CP, Ruddy KJ, Wun T, Zebrack B, Chubak J, Hahn EE, Keegan TH, Kushi LH. Challenges and Opportunities of Epidemiological Studies to Reduce the Burden of Cancers in Young Adults. CURR EPIDEMIOL REP 2023; 10:115-124. [PMID: 37700859 PMCID: PMC10495081 DOI: 10.1007/s40471-022-00286-9] [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] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
There are >1.9 million survivors of adolescent and young adult cancers (AYA, diagnosed at ages 15-39) living in the U.S. today. Epidemiologic studies to address the cancer burden in this group have been a relatively recent focus of the research community. In this article, we discuss approaches and data resources for cancer epidemiology and health services research in the AYA population. We consider research that uses data from cancer registries, vital records, healthcare utilization, and surveys, and the accompanying challenges and opportunities of each. To illustrate the strengths of each data source, we present example research questions or areas that are aligned with these data sources and salient to AYAs. Integrating the respective strengths of cancer registry, vital records, healthcare data, and survey-based studies sets the foundation for innovative and impactful research on AYA cancer treatment and survivorship to inform a comprehensive understanding of diverse AYA needs and experiences.
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Affiliation(s)
- Hazel B. Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Neetu Chawla
- Veterans Health Administration, Greater Los Angeles, CA
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Laura E. Green
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Christopher D. Baggett
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Chun Chao
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Anne C. Kirchhoff
- Huntsman Cancer Institute and Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Tzy-Mey Kuo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Marcio Malogolowkin
- Division of Pediatric Hematology-Oncology, University of California Comprehensive Cancer Center, Sacramento, CA
| | | | | | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Comprehensive Cancer Center, Sacramento, CA
| | - Brad Zebrack
- University of Michigan School of Social Work, Ann Arbor, MI
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Erin E. Hahn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Theresa H.M. Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Comprehensive Cancer Center, Sacramento, CA
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Pandit AA, Gressler LE, Halpern MT, Kamel M, Payakachat N, Li C. Differences in racial/ethnic disparities in patient care experiences between prostate cancer survivors and males without cancer: A SEER-CAHPS study. J Geriatr Oncol 2023; 14:101554. [PMID: 37320932 PMCID: PMC10335318 DOI: 10.1016/j.jgo.2023.101554] [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: 11/07/2022] [Revised: 04/14/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Our purpose was to evaluate whether racial/ethnic disparities in patient care experiences (PCEs) differ between males with prostate cancer ("PCa group") and males without cancer ("non-cancer group"). MATERIALS AND METHODS This retrospective study used 2007-2015 National Cancer Institute's Surveillance, Epidemiology and End Results registry data linked to Consumer Assessment of Healthcare Providers and Systems surveys. PCa and non-cancer groups were propensity score matched 1:5 on demographic and clinical characteristics. Differences in racial/ethnic disparities (DRD) (non-Hispanic Black [NHB], Hispanic, non-Hispanic Asian [NHA], and Other Races compared to non-Hispanic White [NHW]) in PCEs (getting needed care, getting care quickly, doctor communication, customer service, and getting needed prescription drugs) were compared between matched PCa and non-cancer groups. Per prior literature, DRD in PCE scores were categorized as small (<3), medium (≥3 but <5) or large (≥5). RESULTS There were 7312 males in the PCa group and 36,559 matched males in the non-cancer group. Within each group, all racial/ethnic minority categories reported worse scores compared to NHW individuals (p < 0.05) for ≥3 PCE composite measures. Compared to PCa group, a larger NHA-NHW difference was observed in non-cancer group for getting needed care (-4.65 in PCa vs. -7.77 in non-cancer; DRD = 3.11, p = 0.029) and doctor communication (-2.46 in PCa vs. -4.85 in non-cancer; DRD = 2.38, p = 0.023). DISCUSSION In both PCa and non-cancer groups, racial/ethnic minorities reported worse experiences compared to NHW individuals for several PCE measures. However, the difference in getting needed care and doctor communication between NHA and NHW individuals were more pronounced in non-cancer group than PCa group.
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Affiliation(s)
- Ambrish A Pandit
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
| | - Laura E Gressler
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
| | - Michael T Halpern
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America.
| | - Mohamed Kamel
- Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America; Department of Urology, Ain Shams University, Cairo 11566, Egypt.
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
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Afaya A, Ramazanu S, Bolarinwa OA, Yakong VN, Afaya RA, Aboagye RG, Daniels-Donkor SS, Yahaya AR, Shin J, Dzomeku VM, Ayanore MA, Alhassan RK. Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review. BMC Health Serv Res 2022; 22:1601. [PMID: 36587198 PMCID: PMC9805268 DOI: 10.1186/s12913-022-08927-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 12/05/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. METHODS We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. CONCLUSION This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities.
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Affiliation(s)
- Agani Afaya
- grid.15444.300000 0004 0470 5454Mo-Im Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea ,grid.449729.50000 0004 7707 5975Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Sheena Ramazanu
- grid.4280.e0000 0001 2180 6431Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Obasanjo Afolabi Bolarinwa
- grid.127050.10000 0001 0249 951XDepartment of Global Public Health, Canterbury Christ Church University, Canterbury, UK
| | - Vida Nyagre Yakong
- grid.442305.40000 0004 0441 5393Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Adongo Afaya
- grid.442305.40000 0004 0441 5393Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Gyan Aboagye
- grid.449729.50000 0004 7707 5975Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Silas Selorm Daniels-Donkor
- grid.8241.f0000 0004 0397 2876Department of Nursing, School of Health Sciences, University of Dundee, Scotland Dundee, UK
| | - Ahmed-Rufai Yahaya
- Hariri School of Nursing, American University of Beruit, Beirut, Lebanon ,grid.460777.50000 0004 0374 4427Department of Internal Medicine, Tamale Teaching Hospital, Tamale, Ghana
| | - Jinhee Shin
- grid.412965.d0000 0000 9153 9511Woosuk University, College of Nursing, Wanju, Republic of Korea
| | - Veronica Millicent Dzomeku
- grid.9829.a0000000109466120Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Martin Amogre Ayanore
- grid.449729.50000 0004 7707 5975Department of Health Policy Planning and Management, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Kaba Alhassan
- grid.449729.50000 0004 7707 5975Centre for Health Policy and Implementation Research. Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Types of usual sources of care and their association with healthcare outcomes among cancer survivors: a Medical Expenditure Panel Survey (MEPS) study. J Cancer Surviv 2022; 17:748-758. [PMID: 35687273 PMCID: PMC10016387 DOI: 10.1007/s11764-022-01221-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: 01/14/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess associations between usual source of care (USC) type and health status, healthcare access, utilization, and expenses among adult cancer survivors. METHODS This retrospective cross-sectional analysis using 2013-2018 Medical Expenditure Panel Survey included 2690 observations representing 31,953,477 adult cancer survivors who were currently experiencing cancer and reporting one of five USC types: solo practicing physician (SPP), a specific person in a non-hospital facility, a specific person in a hospital-based facility, a non-hospital facility, and a hospital-based facility. We used logistic regressions and generalized linear models to determine associations of USC type with health status, healthcare access, utilization, and expenses, adjusting for patient demographic and clinical characteristics. RESULTS All non-SPP USC types were associated with reporting more difficulties contacting USC by telephone during business hours (p < 0.05). Compared to SPP, non-hospital facility was associated with more difficulty getting needed prescriptions (OR: 1.81, p = 0.036) and higher annual expenses ($5225, p = 0.028), and hospital-based facility was associated with longer travel time (OR: 1.61, p = 048), more ED visits (0.13, p = 0.049), higher expenses ($6028, p = 0.014), and worse self-reported health status (OR: 1.93, p = 0.001), although both were more likely to open on nights/weekends (p < 0.05). Cancer survivors with a specific person in a hospital-based facility (vs. SPP) as USC were > twofold as likely (p < 0.05) to report difficulty getting needed prescriptions and contacting USC afterhours. CONCLUSIONS Among adult cancer survivors who were currently experiencing cancer, having a non-SPP type of UCS was associated with reporting more difficulties accessing care, worse health, more ED visits, and higher total expenses. IMPLICATIONS FOR CANCER SURVIVORS Transitioning to SPP type of USC may result in better healthcare outcomes.
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Coughlin SS, Chen J, Cortes JE. Health care access and utilization among adult cancer survivors: Results from the National Institutes of Health "All of Us" Research Program. Cancer Med 2021; 10:3646-3654. [PMID: 33942535 PMCID: PMC8178490 DOI: 10.1002/cam4.3924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 01/06/2023] Open
Abstract
Background Many cancer survivors face financial difficulties that prevent them from receiving appropriate health care. Racial/ethnic disparities in receipt of health care have been reported among cancer survivors, but recent data for important racial/ethnic subgroups of the US population are lacking. Methods To learn more about barriers to healthcare access faced by cancer survivors, we analyzed data from the NIH “All of Us” Research Program. Data were analyzed about demographic factors and other personal characteristics, personal medical history of cancer, healthcare utilization, and access to care. Results As of November 2020, a total of 5426 participants had a history of cancer (excluding skin cancer). About 88.2% were non‐Hispanic White; 3.9% were Black, African American, or African; 1.3% were Asian; 4.1% were Hispanic, Latino, or Spanish; and 1.2% reported more than one race. Just over one‐half had an annual income of $75,000 or greater. The majority of the participants (71.7%) were college graduates or had an advanced degree. About 47.0%% had private health insurance, 41.0% had Medicare, 6.0% had Medicaid, and the remainder had military, Veterans Affairs, other insurance, or no health insurance. Frequently cited reasons for delayed care in the past 12 months were “had to pay out of pocket for some or all of the procedures,” “deductible was too high/or could not afford the deductible,” “couldn't afford the copay,” “couldn't get time off work,” and “were nervous about seeing a health care provider.” Discussion A minority of cancer survivors who participated in the NIH “All of Us” Program had difficulty paying for health care in the past 12 months. Of particular concern are minorities such as African American and Hispanic cancer survivors along with those who are low income. Many cancer survivors face financial problems that prevent them from receiving timely and recommended health care. A minority of cancer survivors who participated in the NIH “All of Us” Research Program had difficulty paying for health care in the past 12 months. Of particular concern are minorities such as African American and Hispanic cancer survivors along with those who are low income.
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Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Jie Chen
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Jorge E Cortes
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Georgia Cancer Center, Augusta University, Augusta, GA, USA
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Cancer surveillance and preventive services in a diverse sample of breast and colorectal cancer survivors. J Cancer Surviv 2020; 15:213-223. [PMID: 32794009 DOI: 10.1007/s11764-020-00925-4] [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: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Cancer survivors diagnosed at an early age remain at risk for cancer recurrence and other chronic diseases. This study assessed engagement in surveillance for recurrence, cancer screening, and other recommended preventive health services among breast and colorectal cancer survivors with early-onset disease (≤ 50 years) who were diagnosed in California. METHODS Breast and colorectal cancer survivors diagnosed with early-onset cancer between 1999 and 2009 were identified through the California Cancer Registry, the state-based cancer registry, and surveyed. Multivariable regression analyses were used to assess correlates of receipt of cancer surveillance, cancer screening, and other preventive health services. RESULTS Of the 497 survivors that were invited to participate in the study, 156 completed the survey for a response rate of 31%. The sample was 50 years of age on average (range 32-69 years) with a mean time since diagnosis of 9 years. The majority of the sample (71%) was a racial/ethnic minority (24% Latino, 15% African American, 29% Asian). Overall, 80% received appropriate surveillance for recurrence, and 72% received recommended screening for early detection of other cancers (breast, cervical, colorectal). Increasing age was associated with lower likelihood of early detection screening (adjusted odds ratio (aOR) 0.28, 95% confidence interval (CI) 0.11-0.69), and higher income was associated with a greater likelihood (aOR 4.89, 95% CI 1.62-14.81). Screening rates were highest for blood pressure (96%), cholesterol (86%), and diabetes (81%), followed by dental visits (64%) and flu vaccination (35%). Greater use of recommended preventive health services was associated with increasing age, female sex, higher education level, and having health insurance. CONCLUSIONS Although the majority of survivors received appropriate surveillance for recurrence, engagement in other preventive health services varied substantially. IMPLICATIONS FOR CANCER SURVIVORS Efforts are needed to address gaps in the use of recommended cancer screening and preventive health services among cancer survivors, particularly survivors with early-onset disease who may be at increased risk for additional cancers and common chronic conditions over their lifetime.
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11
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Shared Care During Breast and Colorectal Cancer Treatment: Is It Associated With Patient-Reported Care Quality? J Healthc Qual 2020; 41:281-296. [PMID: 30829854 DOI: 10.1097/jhq.0000000000000192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
There is growing evidence that shared care, where the oncologist, primary care physician, and/or other specialty physicians jointly participate in care, can improve the quality of patients' cancer care. This cross-sectional study of breast and colorectal cancer patients (N = 534) recruited from the New Jersey State Cancer Registry examined patient and health system factors associated with receipt of shared care during cancer treatment into the early survivorship phase. We also assessed whether shared care was associated with quality indicators of cancer care: receipt of comprehensive care, follow-up care instructions, and written treatment summaries. Less than two-thirds of participants reported shared care during their cancer treatment. The odds of reporting shared care were 2.5 (95% CI: 1.46-4.17) times higher for colorectal than breast cancer patients and 52% (95% CI: 0.24-0.95) lower for uninsured compared with privately insured, after adjusting for other sociodemographic, clinical/tumor, and health system factors. No significant relationships were observed between shared care and quality indicators of cancer care. Given a substantial proportion of patients did not receive shared care, there may be missed opportunities for integrating primary care and nononcology specialists in cancer care, who can play critical roles in care coordination and managing comorbidities during cancer treatment.
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12
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13
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14
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Nipp RD, Sonet EM, Guy GP. Communicating the Financial Burden of Treatment With Patients. Am Soc Clin Oncol Educ Book 2018; 38:524-531. [PMID: 30231377 DOI: 10.1200/edbk_201051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years, high health care costs and the financial burden of cancer care have received increased attention. In response to the financial burden of cancer care, patients may jeopardize their health outcomes by not properly adhering to prescribed therapies or even forgoing and delaying care in an effort to defray costs. In addition, the financial burden experienced by patients with cancer may negatively impact clinical outcomes, such as quality of life, physical and psychological symptoms, and potentially, even survival. Notably, in the current era of targeted treatment and immunotherapies for patients with cancer, the rising costs of cancer continue to remain at the forefront of patient concerns. Therefore, a critical need exists to determine how best to assist patients with the cost burden of cancer diagnosis and treatment.
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Affiliation(s)
- Ryan D Nipp
- From the Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; CancerCare, New York, NY; Divisions of Unintentional Injury Prevention and Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ellen Miller Sonet
- From the Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; CancerCare, New York, NY; Divisions of Unintentional Injury Prevention and Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gery P Guy
- From the Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; CancerCare, New York, NY; Divisions of Unintentional Injury Prevention and Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
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Cohen SB, Unangst J. Data Integration Innovations to Enhance Analytic Utility of Clinical Trial Content to Inform Health Disparities Research. Front Oncol 2018; 8:365. [PMID: 30254982 PMCID: PMC6141801 DOI: 10.3389/fonc.2018.00365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/17/2018] [Indexed: 12/02/2022] Open
Abstract
Project Data Sphere (PDS) is a research platform that provides the research community with broad access to both de-identified patient-level data from oncology clinical trials and related analytic tools. While these data are rich in measures that characterize the clinical trials under study, data providers are required to de-identify patient-level data by removing key demographic data. To address these analytic constraints, the data profiles in selected PDS patient-level cancer phase III clinical datasets have been augmented by linking the social, economic, and health-related characteristics of like cancer survivors from nationally representative health and health care-related survey data. Using statistical linkage and model-based techniques, patient-level records in selected PDS datasets have been linked to those of comparable cancer survivors, and are thereby augmented with survey content on social, economic, and health-related characteristics. These new analytically enhanced PDS data resources enable more targeted analyses designed to examine questions such as how disparities in cancer patients' access to health care and income impact patient outcomes in specific phase III clinical trials, and what variations in patient outcomes are associated with specific demographic, socioeconomic, and health-related factors. This study provides an overview of the methodologies used to connect patient-level clinical trial data with nationally representative health-related data on cancer survivors from the national Medical Expenditure Panel Survey (MEPS). MEPS was designed to provide national population-based health care use, expenditure, and source of payment estimates in addition to measures of health status, demographic characteristics, employment, health insurance coverage, and access to health care. Study findings include probabilistic assessments of the representation of the patients in the respective clinical trials relative to the characteristics of cancer survivors in the general population. The study also demonstrates how the augmented datasets serve to enable researchers to assess the impact of socioeconomic factors added through data integration on cancer survival and related outcomes of interest.
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Affiliation(s)
- Steven B Cohen
- Division for Statistical and Data Sciences, RTI International, Washington, DC, United States
| | - Jennifer Unangst
- Division for Statistical and Data Sciences, RTI International, Washington, DC, United States
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Klügel S, Lücke C, Meta A, Schild-Suhren M, Malik E, Philipsen A, Müller HH. Concomitant psychiatric symptoms and impaired quality of life in women with cervical cancer: a critical review. Int J Womens Health 2017; 9:795-805. [PMID: 29133983 PMCID: PMC5669786 DOI: 10.2147/ijwh.s143368] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Our aim was to summarize the current relevant literature on concomitant psychiatric symptoms with a focus on anxiety/depression in a population with gynecologic cancer; to identify the predictors, associated factors, and prevention strategies of psychiatric disorders; to examine psychiatric disorders in a population with recurrent gynecologic cancer; and to describe the limitations of the literature and future research areas. Little is known about attending psychiatric disorders in patients with gynecologic and other malignant diseases like cervical or breast cancer. However, patients suffering from other types of gynecologic cancer (eg, genital/cervical cancer) may also have an increased risk of psychiatric symptoms. In this review, we identify the potential information deficits in this field. A two-rater independent literature search was conducted using the PubMed/Google Scholar search engines to systematically evaluate the literature on the research objectives, followed by a critical reflection on the results. Of the 77 screened studies, 15 met the criteria for inclusion in this review. Patients with gynecologic malignancies, especially cervical cancer, had a very high prevalence of psychiatric symptoms including depression (33%-52%). Additionally, the risk groups facing higher rates of concomitant reduced quality of life and increased psychiatric symptoms such as depression were identified. Specifically, low socioeconomic status, sexual inactivity, absence of a partner, and physical symptoms were correlated with an increased risk. Patients suffering from recurrent gynecologic cancer should receive particular attention because of their significantly increased risk of depressive symptoms. Screening programs are needed to detect psychiatric symptoms in cervical cancer patients and the associated high-risk groups. Regular screening should be implemented, and psychosocial care should be provided during follow-up.
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Affiliation(s)
- Stephanie Klügel
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky University Oldenburg, Bad Zwischenahn
| | - Caroline Lücke
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky University Oldenburg, Bad Zwischenahn
| | - Aurora Meta
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky University Oldenburg, Bad Zwischenahn
| | - Meike Schild-Suhren
- Department of Gynecology and Obstetrics, Carl von Ossietzky University Oldenburg, Oldenburg
| | - Eduard Malik
- Department of Gynecology and Obstetrics, Carl von Ossietzky University Oldenburg, Oldenburg
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky University Oldenburg, Bad Zwischenahn
| | - Helge Ho Müller
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky University Oldenburg, Bad Zwischenahn.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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