1
|
Cathcart-Rake E, Jatoi A. Educational Initiatives to Improve the Cancer-Related Disparities Facing Transgender and Gender Diverse (TGD) Individuals. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02469-y. [PMID: 38909333 DOI: 10.1007/s13187-024-02469-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 06/24/2024]
Abstract
Transgender and gender diverse (TGD) individuals face discrimination and experience disparate healthcare, and cancer care, in particular. Our team has developed four initiatives to start to mitigate the disparities facing TGD individuals, including (1) improving identification of TGD individuals with cancer in oncology clinics, (2) identifying rates and predictors of cancer screening among TGD individuals, (3) building a TGD patient-centric oncology clinic, and (4) developing prospective research that is dedicated to addressing the needs of TGD Individuals with cancer. Clinician-focused educational initiatives are integral aspects of this work to improve cancer care for TGD individuals.
Collapse
|
2
|
Coughlin SS, Stepleman L, Casanova T. Hematology and Oncology Fellow Education About Sexual and Reproductive Health. JCO Oncol Pract 2024; 20:869. [PMID: 38608207 DOI: 10.1200/op.24.00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/14/2024] Open
Affiliation(s)
- Steven S Coughlin
- Steven S. Coughlin, PhD, Department of Biostatistics, Data Science and Epidemiology, Augusta University, Augusta, GA; Lara Stepleman, PhD, Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA; and Tracy Casanova, PhD, Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, Georgia Cancer Center, Augusta University, Augusta, GA
| | - Lara Stepleman
- Steven S. Coughlin, PhD, Department of Biostatistics, Data Science and Epidemiology, Augusta University, Augusta, GA; Lara Stepleman, PhD, Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA; and Tracy Casanova, PhD, Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, Georgia Cancer Center, Augusta University, Augusta, GA
| | - Tracy Casanova
- Steven S. Coughlin, PhD, Department of Biostatistics, Data Science and Epidemiology, Augusta University, Augusta, GA; Lara Stepleman, PhD, Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA; and Tracy Casanova, PhD, Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, Georgia Cancer Center, Augusta University, Augusta, GA
| |
Collapse
|
3
|
Cathcart-Rake EJ, Jatoi A, Dressler EV, Kittel C, Weaver KE, Nightingale C, Neuman H, Loh KP, Kamen C. Sexual Orientation and Gender Identity Data Collection in Cancer Care: A Nationwide Landscape Assessment Update. JCO Oncol Pract 2024:OP2300724. [PMID: 38768413 DOI: 10.1200/op.23.00724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/08/2024] [Accepted: 04/08/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE Routine collection of sexual orientation (SO) and gender identity (GI; collectively SOGI) in cancer clinics advances cancer care equity. METHODS In 2022, NCI Community Oncology Research Program (NCORP) practice groups were asked about routine collection of SOGI data in the electronic health record. The proportions of practice groups reporting collection of SO and/or GI data were calculated, and practice group characteristics were assessed for associations. RESULTS Of 271 practice groups nationwide, 42% (n = 112) collect SO data, 58% (n = 157) collect GI data, and 35% (n = 96) collect both. In multivariate analyses, SO data collection was associated with practice groups having minority outreach staff (odds ratio [OR], 2.07 [95% CI, 1.12 to 3.81]; P = .02); GI data collection was associated with practice groups located in the Northeastern United States (OR, 2.08 [95% CI, 0.73 to 5.91]; P = .045), and those with a higher proportion of new patients who were White (OR, 1.02 [95% CI, 1.01 to 1.04]; P < .001). Practice groups in the South were least likely to collect SOGI data (OR, 0.49 [95% CI, 0.26 to 0.94]; P = .004). There were no statistically significant differences in SO and/or GI collection on the basis of the practice group's proportion of Medicaid/Medicare patients, number of new patients with cancer per year, or practice ownership. CONCLUSION Slightly over one third of NCORP practice groups report routinely collecting SOGI data. There are regional differences in data collection, underscoring the need to craft targeted, region-specific interventions focused on boosting the capture and recording of SOGI data in an affirming manner.
Collapse
Affiliation(s)
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Carol Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Chandylen Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Heather Neuman
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Kah Poh Loh
- Department of Surgery, University of Rochester, Rochester, NY
| | - Charles Kamen
- Department of Surgery, University of Rochester, Rochester, NY
| |
Collapse
|
4
|
Bybee SG, Wilson CM. Why Good Cancer Care Means Gender-Affirming Care for Transgender Individuals With Gendered Cancers: Implications for Research, Policy, and Practice. J Clin Oncol 2023; 41:3591-3594. [PMID: 37224435 PMCID: PMC10325736 DOI: 10.1200/jco.22.01857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 05/26/2023] Open
Affiliation(s)
- Sara G. Bybee
- University of Utah College of Nursing, Salt Lake City, UT
| | - Christina M. Wilson
- University of Alabama at Birmingham School of Nursing and Heersink School of Medicine, Division of Gynecologic Oncology, Birmingham, AL
| |
Collapse
|
5
|
Nelson NG, Lombardo JF, Shimada A, Ruggiero ML, Smith AP, Ko K, Leader AE, Mitchell EP, Simone NL. Physician Perceptions on Cancer Screening for LGBTQ+ Patients. Cancers (Basel) 2023; 15:cancers15113017. [PMID: 37296978 DOI: 10.3390/cancers15113017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
The LGBTQ+ community experiences cancer disparities due to increased risk factors and lower screening rates, attributable to health literacy gaps and systemic barriers. We sought to understand the experiences, perceptions, and knowledge base of healthcare providers regarding cancer screening for LGBTQ+ patients. A 20-item IRB-approved survey was distributed to physicians through professional organizations. The survey assessed experiences and education regarding the LGBTQ+ community and perceptions of patient concerns with different cancer screenings on a 5-point Likert scale. Complete responses were collected from 355 providers. Only 100 (28%) reported past LGBTQ+-related training and were more likely to be female (p = 0.020), have under ten years of practice (p = 0.014), or practice family/internal medicine (p < 0.001). Most (85%) recognized that LGBTQ+ subpopulations experience nuanced health issues, but only 46% confidently understood them, and 71% agreed their clinics would benefit from training. Family/internal medicine practitioners affirmed the clinical relevance of patients' sexual orientation (94%; 62% for medical/radiation oncology). Prior training affected belief in the importance of sexual orientation (p < 0.001), confidence in understanding LGBTQ+ health concerns (p < 0.001), and willingness to be listed as "LGBTQ+-friendly" (p = 0.005). Our study suggests that despite a paucity of formal training, most providers acknowledge that LGBTQ+ patients have unique health needs. Respondents had a lack of consensus regarding cancer screenings for lesbian and transgender patients, indicating the need for clearer screening standards for LGBTQ+ subpopulations and educational programs for providers.
Collapse
Affiliation(s)
- Nicolas G Nelson
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Joseph F Lombardo
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ayako Shimada
- Division of Biostatistics and Department of Experimental Pharmacology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Marissa L Ruggiero
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alexandria P Smith
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Kevin Ko
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Amy E Leader
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | - Edith P Mitchell
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | - Nicole L Simone
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| |
Collapse
|
6
|
Cathcart-Rake EJ, Kling JM, Carroll EF, Davidge-Pitts C, Le-Rademacher J, Ridgeway JL, Gonzalez CA, Jatoi A. Understanding Disparities: A Case Illustrative of the Struggles Facing Transgender and Gender Diverse Patients With Cancer. J Natl Compr Canc Netw 2023; 21:227-230. [PMID: 36791758 DOI: 10.6004/jnccn.2023.7005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
|
7
|
Chan ASW, Leung LM, Li JSF, Ho JMC, Tam HL, Hsu WL, Iu ANOS, Tang PMK, Yan E. Impacts of psychological wellbeing with HIV/AIDS and cancer among sexual and gender minorities: A systematic review and meta-analysis. Front Public Health 2022; 10:912980. [PMID: 36523575 PMCID: PMC9746694 DOI: 10.3389/fpubh.2022.912980] [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: 05/06/2022] [Accepted: 10/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background The agony and economic strain of cancer and HIV/AIDS therapies severely impact patients' psychological wellbeing. Meanwhile, sexual minorities experience discrimination and mental illness. LGBT individuals with cancer and HIV/AIDS play two roles. It is important to understand and examine this groups mental wellbeing. Objective The purpose of this study is to synthesize current studies on the impact of HIV/AIDS and cancer on LGBT patients' psychological wellbeing. Methods This research uses a systematic literature review at first and later stage a meta-analysis was run on the same review. In this study, data from Google academic and Web of Science has been used to filter literature. PRISMA 2020 Flow Diagram seeks research on LGBT cancer and HIV/AIDS patients. The above sites yielded 370 related papers, some of which were removed due to age or inaccuracy. Finally, meta-analyses was done on 27 HIV/AIDS and 33 cancer patients's analyse. Results The research included 9,898 LGBT cancer sufferers with AIDS and 14,465 cancer sufferers with HIV/AIDS. Using meta-analysis, we discovered the gap in psychological wellbeing scores between HIV/AIDS LGBT and non-LGBT groups ranged from -10.86 to 15.63. The overall score disparity between the HIV/AIDS LGBT and non-LGBT groups was 1.270 (95% CI = 0.990-1.560, Z = 86.58, P < 0.1). The disparity in psychological wellbeing scores between cancer LGBT group and general group varies from -8.77 to 20.94 in the 34 papers examined in this study. Overall, the psychological wellbeing score disparity between the cancer LGBT subset and the general group was 12.48 (95% CI was 10.05-14.92, Test Z-value was 268.40, P-value was <0.1). Conclusion Inflammation and fibrosis in HIV/AIDS and cancer sufferers adversely affect their psychological wellbeing.
Collapse
Affiliation(s)
- Alex Siu Wing Chan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China,*Correspondence: Alex Siu Wing Chan ;
| | - Lok Man Leung
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jane Siu Fan Li
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jacqueline Mei Chi Ho
- Faculty of Health and Social Sciences, School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Hon Lon Tam
- Faculty of Medicine, Nethersole School of Nursing, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Wing Leung Hsu
- Aceso Medical Centre, Hong Kong, Hong Kong SAR, China,Department of Pharmacy, Health and Well-being, University of Sunderland, Sunderland, United Kingdom
| | - April Nicole On Sang Iu
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Patrick Ming Kuen Tang
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,Elsie Yan
| | - Elsie Yan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China,Patrick Ming Kuen Tang
| |
Collapse
|
8
|
Pratt-Chapman ML, Goltz H, Latini D, Goeren W, Suarez R, Zhang Y, Harvey AC, Kamen C. Affirming Care for Sexual and Gender Minority Prostate Cancer Survivors: Results from an Online Training. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1137-1143. [PMID: 33242160 PMCID: PMC8149486 DOI: 10.1007/s13187-020-01930-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2020] [Indexed: 06/06/2023]
Abstract
Sexual and gender minority people have unique, unaddressed healthcare needs following prostate cancer. The research team along with a group of established subject matter experts developed a training and companion materials for healthcare professionals to address this need. Post-assessment evaluation was reported in frequencies and percentages by combining results from learners who attended an original, live web-based training and learners who completed the same training on-demand via a Learning Management System. Learners from both the live and archived training reported that the training increased their knowledge to effectively work with sexual and gender minority prostate cancer survivors. Learners also reported gaining new resources and strategies they could apply to their work. Results indicate the training fills an educational gap for healthcare professionals and supports the need for additional training of healthcare professionals focused on the healthcare needs of SGM cancer survivors.
Collapse
Affiliation(s)
- Mandi L Pratt-Chapman
- The George Washington University School of Medicine and Health Sciences, Washington, DC, 20052, USA.
- The George Washington University Cancer Center, 2600 Virginia Ave, #324, Washington, DC, 20037, USA.
| | - Heather Goltz
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, University of Houston-Downtown, Houston, TX, USA
| | - David Latini
- Scott Department of Urology, Baylor College of Medicine, Montrose Center and Montrose Research Institute, Houston, TX, USA
| | | | - Rhea Suarez
- The George Washington University School of Medicine and Health Sciences, Washington, DC, 20052, USA
- The George Washington University Cancer Center, 2600 Virginia Ave, #324, Washington, DC, 20037, USA
| | - Yuqing Zhang
- The George Washington University School of Medicine and Health Sciences, Washington, DC, 20052, USA
- The George Washington University Cancer Center, 2600 Virginia Ave, #324, Washington, DC, 20037, USA
| | - Allison C Harvey
- The George Washington University School of Medicine and Health Sciences, Washington, DC, 20052, USA
- The George Washington University Cancer Center, 2600 Virginia Ave, #324, Washington, DC, 20037, USA
| | - Charles Kamen
- Department of Surgery, University of Rochester, Rochester, NY, USA
| |
Collapse
|
9
|
Palliative and End-of-Life Care for Sexual and Gender Minority Cancer Survivors: a Review of Current Research and Recommendations. Curr Oncol Rep 2021; 23:39. [PMID: 33718997 DOI: 10.1007/s11912-021-01034-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Sexual and gender minority (SGM) cancer survivors (post-diagnosis to end-of-life) can face inadequate services along the cancer care continuum, including palliative and end-of-life (EOL) care. A growing literature base calls for more research on factors influencing palliative and EOL care access, outcomes, and distinct needs of SGM cancer survivors and caregivers. We analyzed peer-reviewed articles published 2015-present to identify trends. RECENT FINDINGS Ten articles were SGM-focused or inclusive, cancer-focused, and included substantive discussion of palliative and/or EOL care. Four were research studies (three case studies and one qualitative interview study) and six were literature reviews. Recurrent topics included disparities in cancer risk, access, and care; essential cultural and clinical competencies; and need for professional and organizational standards and policies addressing interpersonal and institutional discrimination and inclusion. Provision of equitable, competent palliative and EOL care depends on continued advancements in research, translated into person-centered approaches to care. We discuss implications of findings for improving palliative and EOL care for SGM cancer survivors.
Collapse
|
10
|
Pratt-Chapman ML. Efficacy of LGBTQI cultural competency training for oncology social workers. J Psychosoc Oncol 2020; 39:135-142. [PMID: 33030124 DOI: 10.1080/07347332.2020.1821862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Oncology social workers rarely receive training on the health care needs of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) cancer patients. This study examined the efficacy of an intensive workshop that aimed to increase the knowledge, confidence, and clinical preparedness of social workers supporting LGBTQI cancer patients. METHODS A workshop consisting of didactic and interactive content was provided to an opt-in sample of social workers (n = 26). Demographic questions, past exposure to LGBTQI patients and training, and self-reported behaviors were measured at baseline. Paired t-tests compared changes in confidence in learning objectives as well as self-reported knowledge, attitudinal awareness, and clinical preparedness based on the lesbian, gay, bisexual, transgender development of clinical skills scale. RESULTS Results showed statistically significant changes in two of three learning objectives (p = 0.001) and in two subscales of the LGBT-DOCSS (p < 0.001). CONCLUSIONS Oncology social workers can benefit from opportunities for learning specific to LGBTQI health.
Collapse
Affiliation(s)
- Mandi L Pratt-Chapman
- Patient-Centered Initiatives and Health Equity, The George Washington University, GW Cancer Center, Washington, DC, USA
| |
Collapse
|
11
|
Desai MJ, Gold RS, Jones CK, Din H, Dietz AC, Shliakhtsitsava K, Martinez ME, Vaida F, Su HCI. Mental Health Outcomes in Adolescent and Young Adult Female Cancer Survivors of a Sexual Minority. J Adolesc Young Adult Oncol 2020; 10:148-155. [PMID: 32730111 DOI: 10.1089/jayao.2020.0082] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Sexual minority (SM) individuals experience higher rates of anxiety and depression. Previous research on mental health disparities for SM cancer survivors has largely focused on adult survivors; however, studies are limited in the adolescent and young adult (AYA) population. This study's objective is to compare depression and anxiety symptoms between AYA, female cancer survivors who identify as an SM and those who identify as heterosexual. Methods: A cross-sectional analysis of 1025 AYA survivors aged 18-40 years (2015-2017) was performed. Patients self-reported SM identification and depression and anxiety symptoms, as measured by the Patient Health Questionnaire (PHQ8) and Generalized Anxiety Disorder Scale (GAD7), respectively. Multivariable logistic regression tested associations between SM identification and depression and anxiety. Results: Sixty-four participants (6%) identified as an SM. In adjusted analyses, SM participants had 1.88 higher odds of anxiety (odds ratio [OR] 1.88, confidence interval [95% CI] 1.05-3.35, p = 0.033) compared with heterosexual participants. SM participants did not have significantly higher odds of depression (OR 1.36, CI 0.75-2.47, p = 0.31). More social support was significantly associated with lower odds of depression (OR 0.91, CI 0.89-0.93, p < 0.001) and anxiety (OR 0.93, CI 0.91-0.94, p < 0.001). Conclusions: AYA cancer survivors identifying as an SM had nearly twice the odds of anxiety, with social support that is protective for both anxiety and depression. While mental health screening is recommended throughout the cancer care continuum, these data support the need for reliable screening, clinician awareness of increased vulnerability in the AYA, SM survivor population, and clinician training on culturally competent care and generation of evidence-based interventions.
Collapse
Affiliation(s)
- Milli J Desai
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Rebecca S Gold
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Chelsea K Jones
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Hena Din
- Department of Health Behavior, San Diego State University/University of California, San Diego, La Jolla, California, USA
| | - Andrew C Dietz
- Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Ksenya Shliakhtsitsava
- Department of Pediatric Hematology/Oncology, University of Texas Southwestern, Dallas, Texas, USA
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health and Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Florin Vaida
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
| | - Hui-Chun Irene Su
- Department of Obstetrics, Gynecology, & Reproductive Science and Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| |
Collapse
|