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Finster LJ, Shirazipour CH, Escobedo LA, Cockburn M, Surani Z, Haile RW. Addressing Health Disparities Across the Cancer Continuum—a Los Angeles Approach to Achieving Equity. Front Oncol 2022; 12:912832. [PMID: 35865462 PMCID: PMC9295745 DOI: 10.3389/fonc.2022.912832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Different models have been developed to address inequities across the cancer care continuum. However, there remains a scarcity of best practices on understanding and responding to the burden of cancer in a defined catchment area.As such, the National Cancer Institute (NCI) recently provided a framework to maximize the impact on cancer burden, including a greater focus on community outreach and engagement. In this paper, we describe how Cedars Sinai Cancer (CSC), a health system that serves one of the most diverse counties in the US, implemented the framework to define its catchment area, characterize its population, identify high risk priority groups, and make decisions to address health disparities. Methods We provide a review of the methods used to assess socio-ecological levels of influence. Data were reviewed from numerous national, statewide, and county sources and supplemented by locally administered questionnaires, heat maps, and community profile summaries to gain more localized snapshots of cancer disparities in Los Angeles County. Lastly, feedback was solicited from external peer groups, community stakeholders, and key decision-makers, and the proposed catchment area was aligned with the State’s Cancer Plan and the NCI Catchment Area and Community Outreach and Engagement Mandate. Results The selected CSC catchment area meets NCI criteria and has potential to demonstrate impact both at the population level and within specialty populations. As a result, strategies are being developed to organize community outreach and engagement, as well as research across basic, clinical, and population sciences to guide cancer control and prevention efforts. Discussion To maintain a high level of cultural inclusion and sensitivity, multiple layers of data are needed to understand localized pictures of cancer disparities and underlying causes. Community engagement remains essential to implementing policy, best practice, and translational science for broader impact. Impact The clinical and translation work conducted at any cancer center requires an understanding of the determinants of health that contribute to the differences in cancer incidence and mortality among different groups. The NCI-aligned approach that we highlight is critical to support the design of future cancer control strategies that address and possibly reduce local health inequities.
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Affiliation(s)
- Laurel J. Finster
- Cancer Research Center for Health Equity, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- *Correspondence: Laurel J. Finster,
| | - Celina H. Shirazipour
- Cancer Research Center for Health Equity, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Loraine A. Escobedo
- Cancer Research Center for Health Equity, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Myles Cockburn
- Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | - Zul Surani
- Cancer Research Center for Health Equity, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Robert W. Haile
- Cancer Research Center for Health Equity, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Maxwell AE, Lucas-Wright A, Gatson J, Vargas C, Santifer RE, Chang LC, Tran K. Community health advisors assessing adherence to national cancer screening guidelines among African Americans in South Los Angeles. Prev Med Rep 2020; 18:101096. [PMID: 32368438 PMCID: PMC7190749 DOI: 10.1016/j.pmedr.2020.101096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/13/2020] [Accepted: 04/12/2020] [Indexed: 11/29/2022] Open
Abstract
Community Health Advisors were able to assess cancer screening in South Los Angeles. About half of African American men and women were up to date with all screening tests. Screening rates in South LA regions are consistent with social determinants of health. Providers should recommend all screening tests to their patients. Our data confirm that South LA is a high priority area for promoting cancer screening.
We partnered with African American churches in South Los Angeles (LA) and trained Community Health Advisors (CHAs) to assess cancer screening. The purpose of this analysis is to report adherence to national cancer screening guidelines among African Americans in South LA, to assess relationships between adherence to colorectal cancer and other cancer screening guidelines, and to explore regional differences in screening rates. Between 2016 and 2018, 44 CHAs surveyed 777 African Americans between 50 and 75 years of age. Among 420 South LA residents, 64% of men and 70% of women were adherent to colorectal cancer screening guidelines. Adherence to mammography screening guidelines was 73%. Adherence to cervical cancer screening guidelines among women 50 to 65 years of age without hysterectomy was 80%. Fifty-nine percent of men had ever discussed the Prostate Specific Antigen (PSA) test with a physician. Adherence to colorectal cancer screening guidelines was significantly higher among respondents who were adherent to other cancer screening guidelines compared to their peers who were not adherent to other cancer screening guidelines (all p < 0.05). The fact that 22% of women who were adherent to breast cancer screening, 32% of women adherent to cervical cancer screening and 16% of men who had discussed the PSA test with a physician were not adherent to colorectal cancer screening guidelines suggests that providers should redouble their efforts to review all screening guidelines with their patients and to make appropriate recommendations. Regional differences in screening rates within South Los Angeles should inform future screening promotion efforts.
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Affiliation(s)
- Annette E Maxwell
- Center for Cancer Prevention and Control Research, University of California, Los Angeles Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095-6900, USA
| | - Aziza Lucas-Wright
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Juana Gatson
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Claudia Vargas
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Rhonda E Santifer
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - L Cindy Chang
- Center for Cancer Prevention and Control Research, University of California, Los Angeles Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095-6900, USA.,Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Khoa Tran
- Center for Cancer Prevention and Control Research, University of California, Los Angeles Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095-6900, USA
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Maxwell AE, Lucas-Wright A, Santifer RE, Vargas C, Gatson J, Chang LC. Promoting Cancer Screening in Partnership With Health Ministries in 9 African American Churches in South Los Angeles: An Implementation Pilot Study. Prev Chronic Dis 2019; 16:E128. [PMID: 31538568 PMCID: PMC6795066 DOI: 10.5888/pcd16.190135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose and Objectives We conducted a pilot study to assess the degree to which an intervention led by community health advisors (CHAs) to promote cancer screening was delivered as intended and to estimate the potential effect of the intervention on receipt of screening. In contrast to previous studies and to maximize its potential public health impact, the intervention targeted 4 screening tests and only participants who were not up to date with screening guidelines for at least 1 cancer. Because CHAs had to both determine baseline adherence and provide counseling on 4 screening tests, the protocol was complex. Complex protocols can reduce implementation fidelity. Intervention Approach In partnership with health ministries at 9 African American churches in South Los Angeles, we conducted a 1-group pretest–posttest pilot study to assess the feasibility of implementing the intervention. CHAs recruited and obtained consent from church members aged 50 to 75 years; assessed adherence to national screening guidelines for breast, cervical, colorectal, and prostate cancer; and provided evidence-based strategies (one-on-one counseling, print materials, reminder calls) to encourage screening for tests that were overdue. Evaluation Methods We assessed implementation fidelity by reviewing baseline screening assessments and counseling scripts completed by CHAs. We estimated potential effect of the intervention on receipt of screening by using data from 3-month follow-up surveys, conducted by the research team, of participants who were nonadherent at baseline. Results From June 2016 to June 2018, 44 CHAs conducted baseline assessments of 775 participants, of whom 338 (44%) were nonadherent to national guidelines for 1 or more cancer screening tests. CHAs provided counseling to most nonadherent participants. At follow-up, about one-third of participants reported that they had discussed cancer screening with their provider and a smaller proportion reported receipt of a screening test; 13% of men and 25% of women reported receipt of colorectal cancer screening. Implications for Public Health This study demonstrates that with training and ongoing technical assistance, CHAs at African American health ministries can implement complex research protocols with good fidelity.
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Affiliation(s)
- Annette E Maxwell
- Center for Cancer Prevention and Control Research, University of California, Los Angeles Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California.,UCLA Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900.
| | - Aziza Lucas-Wright
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Rhonda E Santifer
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Claudia Vargas
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Juana Gatson
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - L Cindy Chang
- Center for Cancer Prevention and Control Research, University of California, Los Angeles Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California.,Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, California
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Chen Y, Song W. Wnt/catenin β1/microRNA 183 predicts recurrence and prognosis of patients with colorectal cancer. Oncol Lett 2018. [PMID: 29541213 DOI: 10.3892/ol.2018.7886] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The present study assessed the association between the Wnt/catenin β1 (CTNNB1)/microRNA (miR)183 signaling pathway and the recurrence and prognosis of colorectal cancer. The expression of Wnt, CTNNB1 and miR183 in primary colorectal cancer tissue was increased compared with that in the paracarcinoma tissue. Disease-free survival and overall survival were decreased in patients with colorectal cancer and increased miR183 expression compared with those in patients with colorectal cancer and decreased miR183 expression. The human colorectal cancer cell line HCT-116 was treated with 5 µM inhibitor of Wnt response (IWR-2) for 24 h to inhibit Wnt protein expression. Downregulating Wnt and CTNNB1 expression inhibited the viability of, and induced cell death and caspase 3 protein expression in, HCT-116 cells. The expression of BCL2 associated X protein and miR183 was increased, and cyclin D1 protein expression was suppressed, by the downregulation of Wnt and CTNNB1 expression in HCT-116 cells. Collectively, the results of the present study suggested that the Wnt/CTNNB1/miR183 signaling pathway may represent a promising biomarker for the recurrence and prognosis of colorectal cancer.
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Affiliation(s)
- Yuzhuo Chen
- Department of Surgery, Tianjin Third Central Hospital, Tianjin 300170, P.R. China
| | - Weiliang Song
- Department of Surgery, Tianjin Third Central Hospital, Tianjin 300170, P.R. China
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Maxwell AE, Danao LL, Cayetano RT, Crespi CM, Bastani R. Implementation of an evidence-based intervention to promote colorectal cancer screening in community organizations: a cluster randomized trial. Transl Behav Med 2016; 6:295-305. [PMID: 27282431 PMCID: PMC4927441 DOI: 10.1007/s13142-015-0349-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED The implementation of evidence-based strategies to promote colorectal cancer (CRC) screening remains challenging. The aim of this study is to evaluate two strategies to implement an evidence-based intervention to promote CRC screening in Filipino American community organizations. Twenty-two community organizations were randomized to either a basic or enhanced implementation strategy. In both arms, community health advisors recruited participants non-adherent to CRC screening guidelines, conducted educational sessions, distributed print materials and free fecal occult blood test kits, reminded participants to get screened, and mailed letters to participants' providers. In the enhanced arm, leaders of the organizations participated in implementation efforts. While the effectiveness was similar in both arms of the study (screening rate at 6-month follow-up was 53 % in the enhanced arm, 49 % in the basic arm), 223 participants were screened in the enhanced arm versus 122 in the basic arm. The enhanced implementation strategy reached 83 % more participants and achieved a higher public health impact. TRIAL REGISTRATION NCT01351220 (ClinicalTrials.gov).
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Affiliation(s)
- Annette E Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA, USA.
- , 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Leda L Danao
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA, USA
| | - Reggie T Cayetano
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA, USA
| | - Catherine M Crespi
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA, USA
| | - Roshan Bastani
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA, USA
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Maxwell AE, Young S, Rabelo Vega R, Cayetano RT, Crespi CM, Bastani R. Building Capacity to Address Women's Health Issues in the Mixtec and Zapotec Community. Womens Health Issues 2015; 25:403-9. [PMID: 25986880 DOI: 10.1016/j.whi.2015.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 02/12/2015] [Accepted: 03/18/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Mixtecs and Zapotecs are indigenous populations from Mexico. Many are unable to read and write, and speak only their native nonwritten languages, Mixteco and Zapoteco. About one-half of California's indigenous farm worker population is estimated to be Mixteco-speaking (82,000-125,000), and about 20,000 Mixtecs and a smaller number of Zapotecs live in Ventura County. OBJECTIVES A community-academic partnership conducted mixed-methods research with the aims of 1) collecting preliminary data on women's health needs, 2) training promotoras to assist with this effort, and 3) engaging community members and obtaining their input through community dialogues. METHODS Promotoras who were bilingual in Spanish and either Mixteco or Zapoteco were trained to conduct surveys that included questions on breast feeding and receipt of breast and cervical cancer screening examinations. Barriers to and facilitators of women obtaining these cancer screening tests were discussed in small groups. RESULTS In 2013, 813 Mixtec and Zapotec women completed surveys. Although most women reported breast feeding (94%), and receipt of a pelvic examination (85%) and a breast examination (72%), only 44% of women 40 years and older had ever heard of and 33% had ever had a mammogram. Community members recommended offering free mammograms on the weekend by female providers, having women accompanied by promotoras who can translate, conducting door-to-door outreach, advertising cancer screening on the radio and providing small incentives to women. DISCUSSION Trained bilingual promotoras can assist in increasing the capacity of indigenous communities to conduct collaborative research by engaging community members and collecting local data.
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Affiliation(s)
- Annette E Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California.
| | - Sandra Young
- Mixteco/Indigena Community Organizing Project, Oxnard, California
| | - Roena Rabelo Vega
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California
| | - Reggie T Cayetano
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California
| | - Catherine M Crespi
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California
| | - Roshan Bastani
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California
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Maxwell AE, Danao LL, Cayetano RT, Crespi CM, Bastani R. Adoption of an evidence-based colorectal cancer screening promotion program by community organizations serving Filipino Americans. BMC Public Health 2014; 14:246. [PMID: 24618267 PMCID: PMC3995646 DOI: 10.1186/1471-2458-14-246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 03/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Filipino Americans have low rates of colorectal cancer (CRC) screening and high CRC mortality. To reduce this disparity, we conducted a dissemination trial in which we offered two levels of technical assistance to community organizations to disseminate an evidence-based CRC screening promotion program among their Filipino American members. This report describes the recruitment of organizations and adoption - the proportion and representativeness of organizations that decided to implement the program. METHODS During the recruitment phase, we completed organizational assessments with 44 community-based organizations (previous partners in research, organizations that were referred to us, or new organizations) to assess their eligibility to participate (having≥150 Filipino American members age 50+). We compared organizational characteristics of organizations that did and did not adopt our CRC screening promotion program. RESULTS Twenty two of the 44 community organizations that completed the assessment adopted the CRC screening promotion program (50%). Adoption was highest among organizations that had previously partnered with us (11/14=79%) and among organizations that were referred to us by community partners (5/10=50%) and lowest among new organizations (6/20=30%). Few organizational differences were found between adopters and non-adopters. CONCLUSIONS The high rate of adoption among organizations that were referred by community partners or had partnered with us in the past underscores the importance of community resources, community-academic relationships, and partnership in the dissemination process. However, the moderate rate of adoption among new organizations and the demands of completing documentation and assessments in our trial to advance dissemination research raise questions regarding the generalizability of study findings.
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Affiliation(s)
- Annette E Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles Young Dr, South A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900, USA.
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