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Ko G, Naganathan G, Reel E, Cleland J, Covelli A, Wright FC, Cil TD. The Impact of COVID-19 on Breast Cancer Care: A Qualitative Analysis of Surgeons' Perspectives. Clin Breast Cancer 2024; 24:494-500.e1. [PMID: 38806320 DOI: 10.1016/j.clbc.2024.04.011] [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: 03/05/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION While studies have documented delays in breast cancer (BC) care during the COVID-19 pandemic due to healthcare restrictions, there have been no studies on the experiences, and, particularly, the challenges with providing care faced by breast surgeons during this unprecedented time. This paper aims to understand the perspectives of breast surgeons regarding the impact of the COVID-19 pandemic on BC care. METHODS We used purposeful and snowball sampling to identify breast surgeons in Ontario, Canada. One-on-one qualitative semi-structured interviews were conducted exploring the impact of the pandemic on BC treatment, psychosocial well-being of patients and providers, and the future state of BC care. Audio-recorded interviews were transcribed verbatim and analyzed using Thematic Analysis. RESULTS A total of 10 breast surgeons (5 community and 5 academic) were interviewed. Breast surgeons reported that the pandemic led to increased multidisciplinary collaboration and innovations in delivery of BC surgery (e.g., increased use of regional anesthesia). Multiple surgeons identified that the pandemic created disparities in BC care based geographic location and that existing disparities in care based on ethnicity or marginalization were exacerbated. Last, surgeons identified that virtual care improved, but also created some challenges to how BC care was delivered, with many hoping for this to be continued after the pandemic was over. CONCLUSIONS In this study, breast surgeons identified unique challenges and solutions to BC care delivery during the pandemic. Concerns regarding disparities in care based on geographic location and marginalized patients require further study to improve future BC care.
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Affiliation(s)
- Gary Ko
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gayathri Naganathan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Emma Reel
- Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jordan Cleland
- Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Andrea Covelli
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Frances C Wright
- Division of Surgical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Tulin D Cil
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.
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2
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Davis LE, Strumpf EC, Patel SV, Mahar AL. Income differences in time to colon cancer diagnosis. Cancer Med 2024; 13:e6999. [PMID: 39096087 DOI: 10.1002/cam4.6999] [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: 08/29/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval. METHODS This was a retrospective cohort study of colon cancer patients diagnosed 2007-2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis. RESULTS A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low-income neighborhoods was associated with longer 50th and 90th-percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6-23) longer in patients living in the lowest income neighborhoods compared to the highest. CONCLUSION These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.
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Affiliation(s)
- Laura E Davis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- ICES, Toronto, Canada
| | - Erin C Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Department of Economics, McGill University, Montreal, Canada
| | - Sunil V Patel
- Department of Surgery, Queen's University, Kingston, Canada
| | - Alyson L Mahar
- ICES, Toronto, Canada
- School of Nursing, Queen's University, Kingston, Canada
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Li V, Alibhai SMH, Noel K, Fazelzad R, Haase K, Mariano C, Durbano S, Sattar S, Newton L, Dawe D, Bell JA, Hsu T, Wong ST, Lofters A, Bender JL, Manthorne J, Puts MTE. Access to cancer clinical trials for racialised older adults: an equity-focused rapid scoping review protocol. BMJ Open 2024; 14:e074191. [PMID: 38245013 PMCID: PMC10807002 DOI: 10.1136/bmjopen-2023-074191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The intersection of race and older age compounds existing health disparities experienced by historically marginalised communities. Therefore, racialised older adults with cancer are more disadvantaged in their access to cancer clinical trials compared with age-matched counterparts. To determine what has already been published in this area, the rapid scoping review question are: what are the barriers, facilitators and potential solutions for enhancing access to cancer clinical trials among racialised older adults? METHODS We will use a rapid scoping review methodology in which we follow the six-step framework of Arksey and O'Malley, including a systematic search of the literature with abstract and full-text screening to be conducted by two independent reviewers, data abstraction by one reviewer and verification by a second reviewer using an Excel data abstraction sheet. Articles focusing on persons aged 18 and over who identify as a racialised person with cancer, that describe therapies/therapeutic interventions/prevention/outcomes related to barriers, facilitators and solutions to enhancing access to and equity in cancer clinical trials will be eligible for inclusion in this rapid scoping review. ETHICS AND DISSEMINATION All data will be extracted from published literature. Hence, ethical approval and patient informed consent are not required. The findings of the scoping review will be submitted for publication in a peer-reviewed journal and presentation at international conferences.
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Affiliation(s)
- Vivian Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine and Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Kristin Haase
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline Mariano
- BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lorelei Newton
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - David Dawe
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer A Bell
- Clinical and Organizational Ethics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tina Hsu
- Department of Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Sabrina T Wong
- Division of Intramural Research, National Institute of Nursing Research, Bethesda, Maryland, USA
| | - Aisha Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada
| | - Jacqueline L Bender
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Yap YS. Outcomes in breast cancer-does ethnicity matter? ESMO Open 2023; 8:101564. [PMID: 37290358 DOI: 10.1016/j.esmoop.2023.101564] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 06/10/2023] Open
Abstract
Ethnic or racial differences in breast cancer (BC) survival outcomes have been reported, but current data are largely restricted to comparisons between African Americans and non-Hispanic whites. Most analyses have traditionally been based on self-reported race which may not always be accurate, or are oversimplified in their classification. With increasing globalization, quantification of the genetic ancestry from genomic data may offer a solution to infer the complex makeup from admixture of races. Focusing on the larger and the latest studies, we will discuss recent findings on the differing host and tumor biology that may be driving these disparities, in addition to the extrinsic environmental or lifestyle factors. Socioeconomic disparities with lower cancer literacy may lead to late presentation, poorer adherence to treatment, and other lifestyle factors such as unhealthy diet, obesity, and inadequate physical activity. These hardships may also result in greater allostatic load, which is in turn associated with aggressive BC features in disadvantaged populations. Epigenetic reprogramming may mediate the effects of the environment or lifestyle factors on gene expression, with ensuing differences in BC characteristics and outcome. There is increasing evidence that germline genetics can influence somatic gene alterations or expression, as well as modulate the tumor or immune microenvironment. Although the precise mechanisms remain elusive, this may account for the varying distribution of different BC subtypes across ethnicities. These gaps in our knowledge highlight the need to interrogate the multiomics landscape of BC in diverse populations, ideally in large-scale collaborative settings with standardized methodology for the comparisons to be statistically robust. Together with improving BC awareness and access to good quality health care, a holistic approach with insights of the biological underpinnings is much needed to eradicate ethnic disparities in BC outcomes.
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Affiliation(s)
- Y-S Yap
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Clinical Programme, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore.
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Woods RR, Kliewer EV, McGrail KM, Spinelli JJ. Stage-Specific Risk of Breast Cancer among Canadian Immigrant and Non-Immigrant Women. J Immigr Minor Health 2023; 25:232-236. [PMID: 35767203 DOI: 10.1007/s10903-022-01378-w] [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: 06/01/2020] [Revised: 04/30/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Breast cancer screening utilization varies across immigrant and non-immigrant populations. Recent studies have also suggested that some immigrant populations in Canada present with a higher frequency of later-stage breast cancer compared to non-immigrants. Our study aimed to augment prior research by presenting breast cancer stage distributions and stage-specific breast cancer incidence rates for immigrant and non-immigrants in British Columbia, Canada. METHODS We utilized a population-based cohort of more than 1.3 million women built from linked administrative health and immigration data sets. Age-standardized incidence rate ratios were generated to compare immigrant and non-immigrant groups. Poisson regression was used to assess the relative frequency of later stage diagnosis among immigrant groups compared to non-immigrants. RESULTS Indian and Chinese immigrants both showed significantly lower stage I and stage II-IV incidence rates compared to non-immigrants. However, Indian immigrants showed a higher frequency of later stage tumours at diagnosis compared to non-immigrants, while in contrast Chinese immigrants showed a lower frequency of later stage tumours. Filipino immigrants showed similar stage-specific rates and stage at diagnosis compared to non-immigrants. CONCLUSIONS Our findings highlight a need for continued surveillance of cancer among immigrant and non-immigrant populations and inquiry into reasons for differences in stage at diagnosis across groups.
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Affiliation(s)
- Ryan R Woods
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
- Cancer Control Research, BC Cancer, 2nd Floor, 675 W 10th Ave, V5Z 1L3, Vancouver, BC, Canada.
| | - Erich V Kliewer
- Cancer Control Research, BC Cancer, 2nd Floor, 675 W 10th Ave, V5Z 1L3, Vancouver, BC, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kimberlyn M McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - John J Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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6
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Lofters AK, Gatov E, Lu H, Baxter NN, Corrado AM, Guilcher SJT, Kopp A, Vahabi M, Datta GD. Stage of colorectal cancer diagnosis for immigrants: a population-based retrospective cohort study in Ontario, Canada. Cancer Causes Control 2021; 32:1433-1446. [PMID: 34463874 PMCID: PMC8541965 DOI: 10.1007/s10552-021-01491-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/20/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most common cause of cancer death in Canada. Immigrants in Ontario, Canada's most populous province, are known to have lower rates of CRC screening, but differences in stage of CRC diagnosis are not known. METHODS We utilized linked administrative databases to compare early (stage I-II) versus late (stage III-IV) stage of CRC diagnosis for immigrants versus long-term residents among patients diagnosed in Ontario between 2012 and 2017 (n = 37,717) and examined the association of immigration-related, sociodemographic, and healthcare-related factors with stage. RESULTS Almost 45% of those with CRC were diagnosed at a late stage. Immigrants were slightly more likely to be diagnosed at a late stage than their long-term resident counterparts [Adjusted relative risks (ARRs) 1.06 (95% CI 1.02-1.10)], but after adjusting for age and sex, this difference was no longer significant. In fully adjusted models, we observed a higher likelihood of late-stage diagnosis for people with the fewest co-morbidities (ARR 0.86 [95% CI 0.83-0.89]) and those with no visits to primary care (versus a high level of continuity of care) [ARR 1.07 (95% CI 1.03-1.12)]. CONCLUSION Immigrants were not more likely to have a late-stage CRC diagnosis after adjusting for relevant factors, but access to primary care and healthcare contact was significantly associated with diagnostic stage. IMPACT Attachment to a primary care provider who provides regular preventive care may play a role in more favorable stage at diagnosis for CRC and thus should be a healthcare system priority.
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Affiliation(s)
- A K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Women's College Hospital Research Institute, Toronto, Canada.
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.
- ICES, Toronto, Canada.
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.
| | | | | | - N N Baxter
- ICES, Toronto, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - A M Corrado
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | - S J T Guilcher
- ICES, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - M Vahabi
- ICES, Toronto, Canada
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - G D Datta
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
- Research Center of the University of Montreal Hospital Center (CR-CHUM), Montreal, Canada
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7
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Walsh RL, Lofters A, Moineddin R, Krzyzanowska M, Grunfeld E. Primary Care Continuity and Wait Times to Receiving Breast Cancer Chemotherapy: A Population-Based Retrospective Cohort Study Using CanIMPACT Data. Curr Oncol 2021; 28:4786-4804. [PMID: 34898582 PMCID: PMC8628668 DOI: 10.3390/curroncol28060405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 12/18/2022] Open
Abstract
(1) Background: Wait times to chemotherapy are associated with morbidity and mortality in breast cancer patients; however, it is unclear how primary care physician (PCP) continuity impacts these wait times, or whether this association is different in immigrants, who experience cancer care inequities. We assessed the association between PCP continuity and the contact-to-chemotherapy interval (wait time from when a patient first presents to healthcare to the first day of receiving breast cancer chemotherapy), with a specific look at the immigrant population. (2) Methods: Population-based, retrospective cohort study of women who were diagnosed with stage I–III breast cancer in Ontario who received surgery and adjuvant chemotherapy. We used quantile regression at the median and 90th percentile to quantify the effect of PCP continuity on the contact-to-chemotherapy interval, performing a separate analysis on the immigrant population. (3) Results: Among 12,781 breast cancer patients, including 1706 immigrants, the median contact-to-chemotherapy interval (126 days) was 3.21 days shorter (95% confidence interval (CI) 0.47–5.96) in symptom-detected patients with low PCP continuity, 10.68 days shorter (95% CI 5.36–16.00) in symptom-detected patients with no baseline PCP visits and 17.43 days longer (95% CI 0.90–34.76) in screen-detected immigrants with low PCP continuity compared to the same groups with high PCP continuity. (4) Conclusions: Higher PCP continuity was not associated with a change in the contact-to-chemotherapy interval for most of our study population, but was associated with a marginally longer interval in our symptom-detected population and a shorter contact-to-chemotherapy interval in screen-detected immigrants. This highlights the importance of PCP continuity among immigrants with positive screening results. Additionally, having no PCP visits at baseline was associated with a shorter contact-to-chemotherapy interval in symptom-detected patients.
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Affiliation(s)
- Rachel Lin Walsh
- Department of Family & Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Correspondence:
| | - Aisha Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Department of Family & Community Medicine, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON M4N 3M5, Canada
| | - Rahim Moineddin
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON M4N 3M5, Canada
| | - Monika Krzyzanowska
- Princess Margaret Cancer Centre, Department of Medical Oncology & Hematology, University Health Network, Toronto, ON M5G 2C1, Canada;
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Eva Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
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8
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Walker MJ, Meggetto O, Gao J, Espino-Hernández G, Jembere N, Bravo CA, Rey M, Aslam U, Sheppard AJ, Lofters AK, Tammemägi MC, Tinmouth J, Kupets R, Chiarelli AM, Rabeneck L. Measuring the impact of the COVID-19 pandemic on organized cancer screening and diagnostic follow-up care in Ontario, Canada: A provincial, population-based study. Prev Med 2021; 151:106586. [PMID: 34217413 PMCID: PMC9755643 DOI: 10.1016/j.ypmed.2021.106586] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/16/2021] [Accepted: 04/25/2021] [Indexed: 12/14/2022]
Abstract
It is essential to quantify the impacts of the COVID-19 pandemic on cancer screening, including for vulnerable sub-populations, to inform the development of evidence-based, targeted pandemic recovery strategies. We undertook a population-based retrospective observational study in Ontario, Canada to assess the impact of the pandemic on organized cancer screening and diagnostic services, and assess whether patterns of cancer screening service use and diagnostic delay differ across population sub-groups during the pandemic. Provincial health databases were used to identify age-eligible individuals who participated in one or more of Ontario's breast, cervical, colorectal, and lung cancer screening programs from January 1, 2019-December 31, 2020. Ontario's screening programs delivered 951,000 (-41%) fewer screening tests in 2020 than in 2019 and volumes for most programs remained more than 20% below historical levels by the end of 2020. A smaller percentage of cervical screening participants were older (50-59 and 60-69 years) during the pandemic when compared with 2019. Individuals in the oldest age groups and in lower-income neighborhoods were significantly more likely to experience diagnostic delay following an abnormal breast, cervical, or colorectal cancer screening test during the pandemic, and individuals with a high probability of living on a First Nation reserve were significantly more likely to experience diagnostic delay following an abnormal fecal test. Ongoing monitoring and management of backlogs must continue. Further evaluation is required to identify populations for whom access to cancer screening and diagnostic care has been disproportionately impacted and quantify impacts of these service disruptions on cancer incidence, stage, and mortality. This information is critical to pandemic recovery efforts that are aimed at achieving equitable and timely access to cancer screening-related care.
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Affiliation(s)
- Meghan J Walker
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Olivia Meggetto
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Julia Gao
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | | | | | - Michelle Rey
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Usman Aslam
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Amanda J Sheppard
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aisha K Lofters
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontairo, Canada; IC/ES, Toronto, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Martin C Tammemägi
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Brock University, St. Catharines, Ontario, Canada
| | - Jill Tinmouth
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; IC/ES, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Kupets
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Anna M Chiarelli
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; IC/ES, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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9
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Samaroo K, Hosein A, Olivier LK, Ali J. Breast Cancer in the Caribbean. Cureus 2021; 13:e17042. [PMID: 34522520 PMCID: PMC8428164 DOI: 10.7759/cureus.17042] [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] [Accepted: 08/07/2021] [Indexed: 11/22/2022] Open
Abstract
Breast cancer (BC) is one of the leading causes of death among women globally. In the Caribbean, there is a higher mortality rate compared with North American and European countries which have higher incidence rates. We conducted a literature review to examine the BC dynamic in the Caribbean and determine the areas where further investigations are needed. The PubMed database was used for identifying relevant studies using a combination of specific keyword searches. All studies focusing on BC within the defined Caribbean population were selected for this review. A total of 117 papers were included. The data were organized and presented under the following headings and reported according to the country where available: BC incidence and mortality, patient demographics, clinicopathology, genetics, behavioral risks, diagnosis and treatment, and BC control. Our review uncovered major variability in the incidence, management, etiology, and mortality of BC among Caribbean countries. Low-resource countries are burdened by more advanced disease with expected poorer BC outcomes (i.e., shorter periods of disease-free survival). Countries with established national cancer registries seem to have a better approach to the management of BC. The introduction of cancer treatment programs in association with international nonprofit groups has shown tremendous improvement in quality, accessible cancer care for patients, particularly in low- and middle-income settings. BC research is relatively limited in the Caribbean, lacking in both scope and consistency. The unique Caribbean BC population of diverse ethnicities, environmental influence, immigrants, socioeconomic status, and sociocultural practices allows an optimal opportunity for epidemiological investigations that can provide deeper insights into the status of BC.
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Affiliation(s)
- Kristy Samaroo
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Amalia Hosein
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Lyronne K Olivier
- General Surgeon/Breast Surgical Oncologist, Sangre Grande General Hospital, Port of Spain, TTO
| | - Jameel Ali
- Surgery, University of Toronto, Toronto, CAN
- Breast Unit, St. James Medical Complex, Port of Spain, TTO
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10
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McClean AR, Kooij KW, Trigg J, Ye M, Sereda P, McLinden T, Bacani N, Aran N, Thomas R, Wong A, Klein MB, Hull M, Cooper C, Salters K, Hogg RS. Tobacco smoking and HIV-related immunologic and virologic response among individuals of the Canadian HIV Observational Cohort (CANOC). AIDS Care 2021; 34:982-991. [PMID: 34074181 DOI: 10.1080/09540121.2021.1929813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We assessed the relationship between tobacco smoking and immunologic and virologic response among people living with HIV (PLWH) initiating combination antiretroviral therapy (cART) in the Canadian HIV Observational Cohort (CANOC). Positive immunologic and virologic response, respectively, were defined as ≥50 cells/mm3 CD4 count increase (CD4+) and viral suppression ≤50 copies/mL (VL+) within 6 months of cART initiation. Using multinomial regression, we examined the relationship between smoking, immunologic, and virologic response category. Model A adjusted for birth sex, baseline age, enrolling province, and era of cohort entry; models B and C further adjusted for neighbourhood level material deprivation and history of injection drug use (IDU), respectively. Among 4267 individuals (32.7%) with smoking status data, concordant positive (CD4+/VL+) response was achieved by 64.2% never, 66.9% former, and 59.4% current smokers. In the unadjusted analysis, current smoking was significantly associated with concordant negative response (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.40-2.45). Similarly, models A and B showed an increased odds of concordant negative response in current smokers (adjusted OR [aOR] 1.78, 95% CI 1.32-2.39 and 1.74, 95% CI 1.29-2.34, respectively). The association between current smoking and concordant negative response was no longer significant in model C (aOR 1.18, 95%CI 0.85-1.65).
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Affiliation(s)
- Alison R McClean
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Katherine W Kooij
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Trigg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Monica Ye
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nicanor Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Niloufar Aran
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Canada
| | - Marina B Klein
- McGill University Health Centre, Montreal, Canada.,CIHR Canadian HIV Trials Network, Vancouver, Canada
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | | | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Simon Fraser University, Burnaby, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Simon Fraser University, Burnaby, Canada
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- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
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11
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Racine L, Andsoy I, Maposa S, Vatanparast H, Fowler-Kerry S. Examination of Breast Cancer Screening Knowledge, Attitudes, and Beliefs among Syrian Refugee Women in a Western Canadian Province. Can J Nurs Res 2021; 54:177-189. [PMID: 34038264 PMCID: PMC9109584 DOI: 10.1177/08445621211013200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Women living in the Arab world present low breast cancer screening rates,
delayed diagnosis, and higher mortality rates. Purpose To further explore the Muslim Syrian refugee women’s breast self-examination
(BSE), utilization of clinical breast examination (CBE) and mammography. Methods A cross-sectional descriptive exploratory study design was used. The sample
consisted of 75 refugee women. Data were collected using Champion’s Health
Belief Model Scale, the Cancer Stigma Scale, and the Arab Culture-Specific
Barriers to Breast Cancer Questionnaire. Descriptive, Pearson correlation
and logistic regression analyses were used to analyze the data. Results A minority of women had BSE (32%), CBE (12%) and mammograms (6.7%) anytime
during their lifetime. Women’s breast cancer screening (BCS) knowledge
ranked at a medium level (M = 10.57, SD = 0.40). Low knowledge score, BSE
information, policy opposition, responsibility, barriers to BSE, and
seriousness were found to be statistically significant in women’s BSE
practice. BSE benefits and religious beliefs significantly predict CBE Age,
education, knowledge, responsibility, susceptibility, social barriers, and
religious beliefs were statistically significant in women’s mammography use
(p < .01). Conclusions Participants’ breast cancer screening practices were low. Health beliefs,
Arab culture and stigma about cancer affected women’s BCS practices.
Faith-based interventions may improve knowledge and practices.
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Affiliation(s)
- Louise Racine
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Isil Andsoy
- Department of Nursing, Karabuk University, Karabuk, Turkey
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12
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Salters KA, Parent S, Nicholson V, Wang L, Sereda P, Pakhomova TE, Kibel M, Chau W, Closson K, Parashar S, Barrios R, Montaner JSG, Hogg RS. The opioid crisis is driving mortality among under-served people living with HIV in British Columbia, Canada. BMC Public Health 2021; 21:680. [PMID: 33832472 PMCID: PMC8028792 DOI: 10.1186/s12889-021-10714-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/19/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Universal provision of effective antiretroviral medication has been essential to reduce mortality, increase longevity, and reduce onward transmission of HIV. This study aims to illuminate persistent threats to the health and longevity of under-served PLWH in British Columbia (BC), Canada. Methods Between 2007 and 2010, 1000 PLWH across BC were enrolled in the Longitudinal Investigation into Supportive and Ancillary health services (LISA) study and completed a cross-sectional survey on their HIV-care experiences and healthcare engagement. The sample generally reflects an under-served population of PLWH. A linkage to the provincial Vital Statistics registry is used in this analysis in order to examine overall mortality and cause-specific mortality trends; probability of death was modeled using logistic regression for participants with ongoing clinical monitoring (n = 910). Results By June 2017, 208 (20.8%) participants had died. The majority of deaths 57 (27.4%) were attributed to drug-related complications or overdoses, 39 (18.8%) were attributed to HIV-related complications, and 36 (17.3%) to non-AIDS-defining malignancies. We observed elevated odds of death among PLWH who smoked tobacco (aOR: 2.11, 95% CI: 1.38, 3.23), were older (aOR: 1.06 per one-year increase, 95% CI: 1.04, 1.08), indicated heavy alcohol consumption (aOR: 1.57, 95% CI: 1.11, 2.22), and reported unstable housing (aOR: 1.96, 95% CI: 1.37, 2.80); while higher CD4 cell count was protective (aOR: 0.87 per 100-unit increase, 95% CI: 0.79, 0.94) as was male gender), though non-significant (aOR: 0.73, 95% CI: 0.49, 1.07). Conclusions Overdose is - the leading cause of mortality among a cohort of under-served PLWH in BC, Canada. Public health efforts to end the HIV epidemic and support the health and well-being of PLWH are being thwarted by persistent health inequities and the enormous and persistent risks facing people who use drugs. Integrated low-barrier primary care is essential for supporting under-served PLWH, and safe drug supply is needed to support PLWH who use drugs.
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Affiliation(s)
- Kate A Salters
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Stephanie Parent
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Valerie Nicholson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Tatiana E Pakhomova
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Mia Kibel
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - William Chau
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,School of Population and Public Health University of British Columbia, Vancouver, Canada
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,School of Population and Public Health University of British Columbia, Vancouver, Canada.,Vancouver Coastal Health, Vancouver, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada. .,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
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13
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Simkin J, Smith L, van Niekerk D, Caird H, Dearden T, van der Hoek K, Caron NR, Woods RR, Peacock S, Ogilvie G. Sociodemographic characteristics of women with invasive cervical cancer in British Columbia, 2004-2013: a descriptive study. CMAJ Open 2021; 9:E424-E432. [PMID: 33888548 PMCID: PMC8101640 DOI: 10.9778/cmajo.20200139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Although cancer screening has led to reductions in the incidence of invasive cervical cancer (ICC) across Canada, benefits of prevention efforts are not equitably distributed. This study investigated the sociodemographic characteristics of women with ICC in British Columbia compared with the general female population in the province. METHODS In this descriptive study, data of individuals 18 years and older diagnosed with ICC between 2004 and 2013 were obtained from the BC Cancer Registry. Self-reported sociodemographic characteristics were derived from standardized health assessment forms (HAFs) completed upon admission in the BC Cancer Registry. Standardized ratios (SRs) were derived by dividing observed and age-adjusted expected counts by ethnicity or race, language, and marital, smoking and urban-rural status. Differences between observed and expected counts were tested using χ2 goodness-of-fit tests. General population data were derived from the 2006 Census, 2011 National Household Survey and 2011/12 Canadian Community Health Survey. RESULTS Of 1705 total cases of ICC, 1315 were referred to BC Cancer (77.1%). Of those who were referred, 1215 (92.4%) completed HAFs. Among Indigenous women, more cases were observed (n = 85) than expected (n = 39; SR 2.16, 95% confidence interval [CI] 2.15-2.18). Among visible minorities, observed cases (n = 320) were higher than expected (n = 253; 95% CI 1.26-1.26). Elevated SRs were observed among women who self-identified as Korean (SR 1.78, 95% CI 1.76-1.80), Japanese (SR 1.77, 95% CI 1.74-1.79) and Filipino (SR 1.60, 95% CI 1.58-1.62); lower SRs were observed among South Asian women (SR 0.63, 95% CI 0.62-0.63). Elevated SRs were observed among current smokers (SR 1.34, 95% CI 1.33-1.34) and women living in rural-hub (SR 1.29, 95% CI 1.28-1.31) and rural or remote (SR 2.62, 95% CI 2.61-2.64) areas; the SR was lower among married women (SR 0.90, 95% CI 0.90-0.90). INTERPRETATION Women who self-identified as visible minorities, Indigenous, current smokers, nonmarried and from rural areas were overrepresented among women with ICC. Efforts are needed to address inequities to ensure all women benefit from cervical cancer prevention.
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Affiliation(s)
- Jonathan Simkin
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Laurie Smith
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Dirk van Niekerk
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Hannah Caird
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Tania Dearden
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Kimberly van der Hoek
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Nadine R Caron
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Ryan R Woods
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Stuart Peacock
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Gina Ogilvie
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
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14
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Walsh RL, Lofters AK, Moineddin R, Krzyzanowska MK, Grunfeld E. The effect of comorbidity on primary care use during breast cancer chemotherapy: a population-based retrospective cohort study using CanIMPACT data. CMAJ Open 2021; 9:E331-E341. [PMID: 33795223 PMCID: PMC8034254 DOI: 10.9778/cmajo.20200166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with breast cancer visit their primary care physicians (PCPs) more often during chemotherapy than before diagnosis, but the reasons are unclear. We assessed the association between physical comorbidities and mental health history (MHH) and the change in PCP use during adjuvant breast cancer chemotherapy. METHODS We conducted a population-based, retrospective cohort study using data from the Canadian Team to Improve Community-Based Cancer Care along the Continuum (CanIMPACT) project. Participants were women 18 years of age and older, who had received a diagnosis of stage I-III breast cancer in Ontario between 2007 and 2011 and had received surgery and adjuvant chemotherapy. We used difference-in-difference analysis using negative binomial modelling to quantify the differences in the 6-month rate of PCP visits at baseline (the 24-month period between 6 and 30 months before diagnosis) and during treatment (the 6 months from start of chemotherapy) between physical comorbidity and MHH groups. RESULTS Among 12 781 participants, the 6-month PCP visit rate increased during chemotherapy (mean 2.3 visits at baseline, 3.4 visits during chemotherapy). Patients with higher physical comorbidity levels or MHH visited their PCPs 4.2 or 1.7 more times, respectively, over 6 months compared to those with low physical comorbidity or no MHH at baseline and 2.5 or 1.1 more times, respectively, over 6 months during treatment. During treatment, the adjusted 6-month rate of PCP visits more than doubled in the group with the fewest physical comorbidities or no MHH compared with baseline (rate ratio 2.52, 95% confidence interval [CI] 2.43-2.61). This increase was lower in those with MHH (rate ratio 1.81, 95% CI 1.68-1.96) and in the highest physical comorbidity group (rate ratio 1.16, 95% CI 1.07-1.28). INTERPRETATION Patients with breast cancer who have more physical comorbidities and MHH have a higher frequency of PCP visits during adjuvant chemotherapy but lower absolute and relative increases in visits compared with baseline. Therefore, PCPs can expect to see their patients with fewer physical comorbidities and no MHH more often during chemotherapy. Primary care physicians can plan for their patients with high physical comorbidity levels and MHH to continue having frequent appointments while they undergo chemotherapy, and they can expect their patients with low physical comorbidity levels and no MHH to increase the frequency of their visits during chemotherapy, and should be prepared to provide breast cancer-related care to these patients.
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Affiliation(s)
- Rachel L Walsh
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont.
| | - Aisha K Lofters
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
| | - Rahim Moineddin
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
| | - Monika K Krzyzanowska
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
| | - Eva Grunfeld
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
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15
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Osei-Twum JA, Gedleh S, Lofters A, Nnorom O. Differences in Breast Cancer Presentation at Time of Diagnosis for Black and White Women in High Resource Settings. J Immigr Minor Health 2021; 23:1305-1342. [PMID: 33721146 PMCID: PMC8599379 DOI: 10.1007/s10903-021-01161-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 12/31/2022]
Abstract
This paper provides a narrative review of the existing literature on differences in demographic and biological features of breast cancer at time of diagnosis between Black and White women in Canada, the United Kingdom and the United States. Electronic database searches for published peer-reviewed articles on this topic were conducted, and 78 articles were included in the final narrative review. Differences between Black and White women were compared for eight categories including age, tumour stage, size, grade, lymph node involvement, and hormone status. Black women were significantly more likely to present with less favourable tumour features at the time of diagnosis than White women. Significant differences were reported in age at diagnosis, tumour stage, size, grade and hormone status, particularly triple negative breast cancer. Limitations on the generalizability of the review findings are discussed, as well as the implications of these findings on future research, especially within the Canadian context.
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Affiliation(s)
- Jo-Ann Osei-Twum
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Sahra Gedleh
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Women's College Research Institute, 76 Grenville St, Toronto, ON, M5G 1N8, Canada
| | - Onye Nnorom
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
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16
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Implementation of the Canadian National Standards in Breast Cancer Surgical Care: Gaps, Barriers, Enablers and Opportunities. ACTA ACUST UNITED AC 2021; 28:565-573. [PMID: 33477965 PMCID: PMC7903263 DOI: 10.3390/curroncol28010056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022]
Abstract
Background: Diagnosis and surgical treatment decision making for breast cancers has become increasingly complex. Recently, Canadian Partnership Against Cancer (CPAC) published pan-Canadian evidence-based surgical standards for the care of breast cancer patients. This study was undertaken to assess the degree to which these standards were currently met in practice and to further understand the determinants of their implementation nationally. Methods: This study was undertaken in two parts—(1) National survey of breast cancer surgeons to assess the perceived extent of implementation of these standards in their institution and province; (2) Formation of a focus group with a representative sample of breast surgeons across Canada to further understand the barriers and facilitators towards future breast standards implementation. Results: 35 surgeons participated in the survey: 66% were from community hospitals. There were four categories of standards that were the most significantly lacking across the country—(a) processes related to quality assurance, (b) turnaround time for pathology results (c) psychosocial and health-related support for the breast cancer patient and (d) breast reconstruction for patients undergoing mastectomy. The focus group included participants from all ten Canadian provinces. For each standard, the 134 determinants fell into three main categories—individual physician (n = 27, 20%); organizational (n = 46, 34%), and system (n = 61, 46%). While specific determinants were present for each category, surgical standards were more likely to be implemented in practice if (1) they aligned with organizational priorities standards; (2) the individual physicians or physician groups were accountable to the organization and/or cancer jurisdiction regarding compliance with the standard; and (3) if infrastructure or resources existed within the organization or system for the reliable collection of relevant, meaningful, practice changing data combined with the capability of benchmarking, peer–peer comparisons and timely feedback to the surgeons. Conclusion: The results of this study demonstrated variation, barriers and opportunities for the national implementation of CPAC’s breast cancer surgery standards and identified determinants of high-quality breast surgical care delivery.
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17
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Herbach EL, Weeks KS, O'Rorke M, Novak NL, Schweizer ML. Disparities in breast cancer stage at diagnosis between immigrant and native-born women: A meta-analysis. Ann Epidemiol 2020; 54:64-72.e7. [PMID: 32950654 DOI: 10.1016/j.annepidem.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/10/2020] [Accepted: 09/13/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To synthesize existing observational evidence to identify disparities in stage at breast cancer diagnosis between foreign- and native-born women. We hypothesized immigrant women would be less likely than natives to be diagnosed at a localized stage. METHODS Systematic searches for studies detailing stage at breast cancer diagnosis by birthplace in PubMed, Embase, and Web of Science yielded 11 relevant cohort studies from six countries. Odds ratios were pooled using random effects models. RESULTS Foreign-born women were 12% less likely to be diagnosed with breast cancer at a localized stage than natives (OR 0.88, 95% CI 0.82-0.95). A similar disadvantage was observed in immigrants from Asia, Eastern Europe, Latin America and the Caribbean, and developing or in transition nations; immigrants from developed countries experienced the least disparity. CONCLUSIONS This meta-analysis confirmed the presence of significant differences in breast cancer stage at diagnosis as per nativity. Across diverse immigrant groups and host countries, foreign-born women were significantly less likely to be diagnosed with localized breast cancer than native women; the magnitude of the disparity varied by region and economic condition of immigrants' birthplace.
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Affiliation(s)
- Emma L Herbach
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.
| | - Kristin S Weeks
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Michael O'Rorke
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Nicole L Novak
- Department of Community and Behavioral Health, University of Iowa, Iowa City
| | - Marin L Schweizer
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City; Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA
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18
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Koehn K, Burgess H, Lyndon S, Lu M, Ye M, Hogg RS, Parashar S, Barrios R, Salters KA. Characteristics of older adults living with HIV accessing home and community care services in British Columbia, Canada. AIDS Care 2020; 33:121-130. [PMID: 32476454 DOI: 10.1080/09540121.2020.1770673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Over half of people living with HIV (PLHIV) engaged in care in British Columbia (BC) are age ≥50. The public home and community care (HCC) system offers formal support that PLHIV may turn to as they age, but little is known about access specific to PLHIV. Using data from the STOP HIV/AIDS cohort, which includes linked treatment and demographic records for PLHIV accessing care in BC, we compared older PLHIV (defined as those age ≥50) who did and did not access HCC services. We estimated adjusted odds ratios (aORs) for factors associated with HCC service utilization using logistic regression. This study included 5,603 PLHIV age ≥50, 837 (14.94%) of whom accessed any HCC service between 2005 and 2015. Services most commonly used were community nursing (8.98%, n = 503) and rehabilitation (7.73%, n = 433). Those who received HCC were more likely to be female (aOR = 1.56, 95% CI = 1.24, 1.98), have a history of injection drug use (aOR = 1.88, 95% CI = 1.57, 2.25), have a higher Charlson comorbidity score (aOR = 1.11, 95% CI:1.07, 1.15) and to have visited a general practitioner in the past year (aOR = 2.17, 95% CI = 1.77, 2.67). Approximately 15% of older PLHIV have accessed HCC, but the extent of potential unmet need for these services requires further research.
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Affiliation(s)
- Katrina Koehn
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | | | - Michelle Lu
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Monica Ye
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Surita Parashar
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Vancouver Coastal Health Authority, Vancouver, Canada
| | - Kate A Salters
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Decker K, Moineddin R, Kendell C, Urquhart R, Biswanger N, Groome P, McBride ML, Winget M, Whitehead M, Grunfeld E. Changes in primary care provider utilization by phase of care for women diagnosed with breast cancer: a CanIMPACT longitudinal cohort study. BMC FAMILY PRACTICE 2019; 20:161. [PMID: 31752693 PMCID: PMC6873454 DOI: 10.1186/s12875-019-1052-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/15/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary care providers (PCPs) have always played an important role in cancer diagnosis. There is increasing awareness of the importance of their role during treatment and survivorship. We examined changes in PCP utilization from pre-diagnosis to survival for women diagnosed with breast cancer, factors associated with being a high user of primary care, and variation across four Canadian provinces. METHODS The cohorts included women 18+ years of age diagnosed with stage I-III invasive breast cancer in years 2007-2012 in British Columbia (BC), Manitoba (MB), Ontario (ON), and Nova Scotia (NS) who had surgery plus adjuvant chemotherapy and were alive 30+ months after diagnosis (N = 19,589). We compared the rate of PCP visits in each province across phases of care (pre-diagnosis, diagnosis, treatment, and survival years 1 to 4). RESULTS PCP use was greatest during treatment and decreased with each successive survival year in all provinces. The unadjusted difference in PCP use between treatment and pre-diagnosis was most pronounced in BC where PCP use was six times higher during treatment than pre-diagnosis. Factors associated with being a high user of primary care during treatment included comorbidity and being a high user of care pre-diagnosis in all provinces. These factors were also associated with being a higher user of care during diagnosis and survival. CONCLUSIONS Contrary to the traditional view that PCPs focus primarily on cancer prevention and early detection, we found that PCPs are involved in the care of women diagnosed with breast cancer across all phases of care.
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Affiliation(s)
- K. Decker
- CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R0E 0V9 Canada
- University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W2 Canada
| | - R. Moineddin
- University of Toronto, 500 University Avenue, Toronto, Ontario M5G 1V7 Canada
| | - C. Kendell
- Dalhousie University, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada
- Nova Scotia Health Authority, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada
| | - R. Urquhart
- Dalhousie University, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada
| | - N. Biswanger
- CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R0E 0V9 Canada
| | - P. Groome
- Queen’s University, 62 Fifth Field Company Lane, Kingston, Ontario K7L 3N6 Canada
| | - M. L. McBride
- BC Cancer Agency, 686 West Broadway, Suite 500, Vancouver, British Columbia V5Z 1G1 Canada
| | - M. Winget
- Stanford University, 1265 Welch Road, Stanford, California, 94305 USA
| | - M. Whitehead
- Queen’s University, 62 Fifth Field Company Lane, Kingston, Ontario K7L 3N6 Canada
| | - E. Grunfeld
- University of Toronto, 500 University Avenue, Toronto, Ontario M5G 1V7 Canada
- Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto, Ontario M5G 0A3 Canada
| | - for the Canadian Team to Improve Community-Based Cancer Care Along the Continuum (CanIMPACT)
- CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R0E 0V9 Canada
- University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W2 Canada
- University of Toronto, 500 University Avenue, Toronto, Ontario M5G 1V7 Canada
- Dalhousie University, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada
- Nova Scotia Health Authority, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada
- Queen’s University, 62 Fifth Field Company Lane, Kingston, Ontario K7L 3N6 Canada
- BC Cancer Agency, 686 West Broadway, Suite 500, Vancouver, British Columbia V5Z 1G1 Canada
- Stanford University, 1265 Welch Road, Stanford, California, 94305 USA
- Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto, Ontario M5G 0A3 Canada
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